Atlas of Forensic Pathology

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CHAPTER 31 Special Dissections

A B Figure 31.11. Eversion of the esophagus. After creating a nick in the stomach near the gastroesophageal junction ( A ) through which forceps or a clamp is placed, pulling the proximal tip of the esophagus through the nick in the stomach, everting the esophagus ( B ).

QUICK REMOVAL OF THE ENTIRE SPINAL CORD WHEN PERFORMED While the spinal cord can be examined for a variety of reasons, including trauma and natural disease, obtaining the entire spinal cord is often only done with infant homicides. And, for trauma, the known or suspected region of the trauma can be directly inspected by opening up that segment of the vertebral column. While the entire spinal cord is best removed from a posterior approach, which, after excising the lamina allows for removal of the dura, the dorsal root ganglia, and the entire spinal cord, a more simple procedure can allow for examination of the spinal cord itself (eg, to assess for the presence of multiple sclerosis or a myelitis). HOW PERFORMED A small window to the spinal canal is made in the lower lumbar region of the vertebral column from an anterior approach. After the dura is cut and the spinal cord is exposed, the spinal cord is wrapped with a wet paper towel and with gentle traction, the entire spinal cord can be pulled from the vertebral column. Dolinak and Matshes neuropathology atlas has a good description of the procedure and demonstrative images. 2 UNDERWATER REMOVAL OF MACERATED INFANT BRAIN WHEN PERFORMED For the autopsy of a stillborn infant or an infant who has been in the hospital brain-dead for a period of time, the brain is often macerated and, during normal removal can be easily damaged. HOW PERFORMED The head or entire body of the infant is immersed in water. 5 The brain is removed while the head is immersed in water. Essentially, the water will allow the brain to float and maintain its shape. The brain can then be careful transferred from the water to formalin. To assist with the process, the scalp can be reflected prior to immersion in the water, and the area extensively flushed with water so that, when the cranium is opened, the water will stay relatively clear, best allowing for visualization of the brain for removal.

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