By Pekka Saukko, Bernard Knight
During this 3rd variation, Knight's Forensic Pathology remains to be the definitive overseas postgraduate textbook for forensic pathologists, masking all points of the medico-legal post-mortem, together with the reason and time of dying, interpretation of wounds and each different aspect of the research of a fatality. The emphasis is at the sensible software of information and study findings, and the hot variation keeps the usually praised traditions of readability and succinct presentation.
This publication could be a necessary textual content for all pathologists in education, and continues to be a customary textual content to these in perform.
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This is easier when there is some ventricular hypertrophy, but can be carried out in any heart. The heart is placed open on the cutting board, with the endocardium downwards. A long knife such as a brain knife is passed carefully into the cut edge of the left ventricle and sliced right through the muscle, keeping equidistant between endocardium and epicardium. The myocardium can then be opened out like a book, showing the interior • 26 • Examination of organs with any infarcts or fibrotic plaques.
Where neurological issues are involved, either traumatic or from natural disease, it is almost mandatory for the brain to be fixed before cutting. Even the impatience of the investigative authorities can usually be overcome if the advantages of a higher standard of opinion are explained. The technique of brain fixation is well known, but to summarize briefly, the brain is suspended in a container of 10 per cent buffered formalin, the volume being at least 5 litres and preferably 8. The brain is removed with the dura leaving the parasagittal bridging veins and falx intact and suspending the brain in an upright position by the falx.
The coronaries are therefore cut across at frequent intervals. Before the first cut, the ostia are examined for congenital variations (which are frequent) and for obstruction. The left coronary artery is then cut across from the epicardial surface, starting as close to the ostium as possible, as occlusion and severe stenosis can occur very near the origin. Serial cuts are then made at intervals of not more than 3 mm, first into the common trunk, then following the left circumflex laterally until the vessel becomes too small, usually when it dips down from the epicardium to become intramuscular.