forensic pathology

 

 

Colour Atlas of Forensic Medicine and Pathology. Catonese CA (Ed). CRC Press 2010

Having read many forensic pathology atlases over the years, of variable quality and usefulness, I was looking forward to seeing what an up-to-date atlas would bring, particularly from practitioners coming out of the 'Charles Hirsch' school of forensic pathology in New York City. In fact that New York City connection is used, by the authors, as a 'selling point':

Our collective experiences as trainees and staff at the Office of the Chief Medical Examiner in New York City under the tutelage of Dr Charles S Hirsch has made us the forensic pathologists we are today. Our mentor's emphasis on precision and accuracy in description of findings, translation of these descriptions into language easily understood by a broad range of end users, and the public health importance of our work has left an indelible imprint that we desire to pass on to others.

The authors in the Preface.

Having read works by Dr Hirsch, and having - albeit briefly - watched the manner in which his Office works (during the 9/11 disaster period), I was excited to see a modern text coming from those 'under his wing'. I was a little underwhelmed on completion of this book but, on reflection, this probably relates to an inherent dissatisfaction with atlases, rather than a criticism of Catanese and his co-contributors per se.

An atlas must, I think, stand or fall on the strength of its images, and the 'cataloguing' or indexing of those images. The major strength of this book is undoubtedly the variety of photographs depicting different examples of the same sort of lesion. Multiple images of torn and injured frenula, for example, or gunshot entrance wounds are selected in order to give the reader a sense of similarity without giving the impression that all such injuries are identical in appearance.

Sadly, some of the images do not come up to the standard required of an atlas. Several are underexposed, shadowed or frankly out of focus. It is often disappointing when reviewing photographs following an autopsy to discover that the very images one really wanted to be of excellent quality were, in fact, out of focus, or the focal plane was just slightly at the wrong level. When it comes to selecting photographs for an atlas, however, it is not appropriate to include such images simply because they are 'the only ones available' to illustrate that particular feature.

An additional strength of this atlas is the inclusion of several photographs 'per case', for example in a homicidal strangulation staged to look like a suicidal hanging; such a series helped to put the whole of the case into perspective and was consequently much more useful than looking at a single image, say of injuries to the neck in isolation. Other notable examples of distinctive wounds/ injuries not well illustrated in other textbooks include those caused by a baseball bat and a bicycle chain.

As a reader used to using metric measurements, the continued reference to inches is somewhat distracting, as is the use of a flexible/ sticky scale that results in injury measurement distortion. In forensic practice, substandard injury documentation could result in subsequent difficulties when attempting to 'match' suspected injury-causing implements/ weapons with 'patterned injuries' on the surface of a body, and such photographic wound documentation practices should not be illustrated in textbooks, unless shown as an example of 'what not to do'.

Atlases tend not to have too much in the way of accompanying text, save for brief descriptions of the features being illustrated in the photographs, and this book is no exception to that trend. Some introductory text is presented for each chapter, but such text is no replacement for that contained in a non-atlas textbook, particularly as it is not referenced to the literature.

On the whole, this atlas has much to commend it to those in training in forensic pathology, and probably also surgical histopathology. More experienced practitioners may still find enough to justify purchasing this text, although the rather scanty index may prevent such practitioners accessing the images of interest rapidly enough.

If I were a forensic pathology trainee, I would definitely find this book to be of immense interest and, with this in mind, I would recommend this atlas to junior pathologists wholeheartedly.

The Hospital Autopsy

The Hospital Autopsy - A manual of fundamental autopsy practice. 3rd edition. Burton JL, Rutty GN (Editors), Hodder Arnold 2010

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Since the publication of the second edition, the hospital autopsy rate has continued to decline to such an extent that in many centres autopsies that are not performed on the instruction of a medicolegal authority have become a rarity. This has necessitated the addition of a subtitle to the title of this edition of the book to denote that this book now aims to provide information to a wider range of pathologists engaged in autopsy practice. This includes those examinations undertaken at the request of a medicolegal authority but who do not need the expertise of a forensic pathologist, and those performed with the consent of the relatives of the deceased.

The editors in the Preface.

 

As the editors of this new edition of 'The Hospital Autopsy' make clear in their preface, hospital (or 'consent') post mortem examinations remain in decline in the UK as well as in many other countries; medicolegal autopsies, however, continue to be made (by pathologists trained in histopathology but not necessarily forensic pathology) and this book is therefore particularly valuable to those individuals making such medicolegal examinations. If one accepts the need to retain the 'brand' from previous editions - rather than conceding that the 'subtitle' would perhaps represent a more appropriate 'lead title' of this book - this offering from Burton and Rutty is to be welcomed; guidance on the practicalities of making a post mortem examination remains a very worthwhile endeavour.

The first thing that strikes this reviewer about the third edition is the considerable improvement in layout and style from previous editions; the use of colour boxes and tables within the text enhances readability and gives this edition a 'fresh' and modern feel. The clarity of the colour photographs used to illustrate the text is excellent, and makes a welcome change from seeing pixellated, grainy and out-of-focus images used in some other texts aimed at the same market.

New additions to this edition include chapters on:

  • the role of the autopsy in medical education (written by Burton, a 'medical educationalist' with experience in curriculum design and implementation);
  • religious attitudes to the autopsy;
  • autopsies of patients with high-risk infections (written by Professor Sebastian Lucas, a histopathologist with experience in HIV/ AIDS autopsy pathology);
  • peri-operative and post-operative deaths;
  • the radiological autopsy (highlighting the potential use for CT/ MRI post mortem examinations in death investigation); and
  • the decomposed body and 'unascertained' autopsy.

The layout of the book follows a logical sequence, from generalities regarding the origin/ history of the autopsy, through the law relating to the autopsy, the 'mechanics' of making the examination, and to the additional investigations common to most examinations (including toxicology, biochemistry and microbiology). The inclusion of chapters on wounds and injuries attempts to provide the non-forensic reader with some instruction on matters likely to arise in non-suspicious coronial death investigations, but cannot hope to cover other aspects of pathology that have traditionally been within the domain of forensic pathology, but which may present themselves in cases 'routinely' dealt with by non-forensically trained autopsy pathologists.

Newcomers to autopsy pathology will find this text a compact, but comprehensive, source of practical guidance, and will undoubtedly become the 'must-read' autopsy pathology book for post-graduate histopathology trainees.

The chapter on the law relating to autopsies will also, no doubt, be of particular interest to them, in view of the way in which tissue retention following post mortem examination is perceived in England and Wales. The participation of the Head of Regulation of the Human Tissue Authority (soon to disappear from the political landscape following the 'comprehensive spending review' by the UK Coalition government) is to be broadly welcomed, although it is a shame that the editors have provided no discussion as to the merits or otherwise of the Human Tissue Act 2004 - and its impact on the practice of autopsy pathology in England and Wales - the marginalisation of pathologists from the decision-making processes of the Human Tissue Authority, or more general concerns regarding the functions (and enforcement activities) of the Authority.

Tissue retention at post mortem examinations has become a topic of considerable importance to autopsy pathologists in the UK, and a criticism of this book is that the topic has not been addressed in any meaningful manner, save for sections written by a coroner and the representative of the Human Tissue Authority.

Many histopathologists making post mortem examinations for coroners apparently perceive that they 'can not take histology'; some claim that they have been instructed by the coroner not to retain tissue for microscopy, whilst others blame their reluctance to do so on the perception that they will be 'acting illegally under the terms of the Human Tissue Act', and do not wish to risk being 'branded a criminal' and potentially being sent to prison. Whatever the truth of the matter, this book does little to encourage the practice of post mortem microscopy (which the Royal College of Pathologists believes is best practice in all autopsies - see Guidelines on Autopsy Practice 2002 Section 9), although it does concede that 'Whilst it is generally recognised that some histology is a normal part of an autopsy conducted under section 19 of the Coroners Act 1988, the power to retain significant amounts of tissue, or whole organs, for 'special examination' only arises under section 20 of that Act'.

As far as this reviewer is aware, rule 9 of the Coroners Rules 1984 (preservation of material) has not been 'repealed', and its ommision from the section dealing with those rules is somewhat mystifying, given that it places a strict duty on autopsy pathologists to 'make provision, so far as is possible, for the preservation of material which in his opinion bears upon the cause of death', and will therefore be of some importance to those making post mortem examinations on behalf of the coroner. Whether 'making provision' for the preservation of material equates to examining that material under the microscope is perhaps a moot point, but the argument can certainly be made that if the material 'bears upon the cause of death' it is of sufficient pathological significance to warrant the microscopic confirmation of that significance determined at 'naked eye' examination.

At a time when the quality of coronial post mortem examinations is under scrutiny (one in four coroner's autopsy reports was deemed 'poor' or 'unacceptable' following an investigation by the National Confidential Enquiry into Patient Outcome and Death) one would also have liked to have seen a chapter devoted to 'maintaining the quality of the post mortem examination', and a reminder that microscopy is an essential part of such a quality examination. There is, however, a chapter on the autopsy and clinical audit, which is to be welcomed.

This reviewer would have liked to have seen a chapter addressing the approach to the post mortem examination, and an analysis of the 'issues' raised by the case, prior to physically making the examination. Such an approach focuses the pathologist's mind on the matters to be addressed by the examination, and the order in which the examination must be made in order to maximise the ability to obtain the 'best evidence' possible from that examination. Having completed the examination, the information gained must be integrated with the medical history (or other circumstances communicated to the pathologist) and a 'clinico-pathological correlation' formulated. Having worked through the issues raised by the case, and the 'naked eye' evidence gained from the examination, one might be in a position to give an opinion as to the medical cause of death, which can be communicated to the coroner. The need for additional information - from toxicological analysis etc - can also be communicated to the coroner. The planning of the examination and the considered review of the examination findings in this manner is, in this reviewer's opinion, an essential component of the making of a quality examination, that furnishes reliable information required by society and the death investigation process, and as such deserves detailed attention in any textbook aimed at providing trainee autopsy pathologists with the knowledge with which to succeed in their endeavours.

These criticisms aside, this third edition of 'The Hospital Autopsy' is a welcome addition to the literature aimed at trainee pathologists, and can be recommeded to junior post graduate trainees as an excellent introductory text.

 

 

Forensic autopsy. A handbook and atlas

 

Forensic autopsy. A handbook and atlas. Pomara C, Karch SB, Fineshi V. CRC Press (Taylor and Francis Group) 2010

 

The medicolegal autopsy must consist of more than just a final diagnosis. We are obliged to supply reasons for the diagnoses we provide, and we must be able to defend those reasons. We must be prepared to explain not only what we have done, but how we did it, and do so in sufficient detail so that someone else who reviews the same data will reach the same conclusions. Simply put: Personal experience is good, science is better.

The authors in the Preface.

The forensic autopsy requires a different approach to the 'hospital', or 'consent' autopsy; whilst all autopsies should be made following an analysis of the issues pertinent to the case, the hospital autopsy is less concerned with the external examination, and is usually focused on answering clinically relevant questions such as 'did the chemo-radiotherapy that this individual received for the treatment of their colon cancer have any effect on the size of the primary tumour?'.

Textbooks addressing the 'mechanics' of the post mortem examination have been available in the recent past, but none has focused specifically on the requirements of the forensic examination, and the specific techniques that often accompany such examinations, such as soft tissue dissection of the face, and examination of the vertebral arteries. This slim volume from a predominantly European team addresses deficiencies in the material currently available to those individuals training to make forensic post mortem examinations, and do so in a highly accessible and nicely illustrated text.

Dissection techniques follow a 'layered' approach, vital in forensic examinations in order to follow lesions/ injuries 'through the body', from the skin surface to the 'target organs or tissues'. One is able to follow the author's description of the dissection process with ease, providing the novice with a clear 'pathway' with which to successfully make the relevant examination in the confident knowledge that the 'end product' will be a professional dissection.

Documentation of findings - positive and negative - is a key requirement of the modern forensic autopsy, enabling others to review the examination findings after the first examination. If one records photographically the stages of the 'layered dissections', as illustrated in this book, one will go some way to satisfying the need to provide robust and reliable records of forensic examinations.

Dissection of the soft tissues of the limbs is infrequently mentioned in other post mortem examination handbooks - a deficiency rectified in this book - exposing the novice to techniques required in some cases, and which may not be encountered with a frequency with which they are able to achieve confidence. A review of the guidance, and illustrations, in this book will go some way to address this lack of exposure.

Having addressed the technical aspects of the soft tissue and organ dissections, the authors include chapters on histological laboratory techniques, and confocal laser scanning microscopy. These chapters are out of place, and do not add anything to the 'value' of this book. If one wishes to read about such matters, one would seek to gain knowledge from a specialist book on histological techniques, rather than this atlas. Such chapters could have been replaced with expanded chapters on the physical dissection techniques, perhaps illustrated with case studies of cases involving injury, and demonstrating the sequence of findings associated with, for example a stab wound, with the appearances at each 'level' in the body. Multiple examples of a technique in different cases would reinforce the nature of the technique, and the range of appearances, in different individuals, revealed by that same technique.

The chapter on post mortem radiology is brief and, whilst of interest, does nothing to assist the practitioner in the practicalities of post mortem radiography.

Overall, I found the dissection guidance to be of immense assistance in teaching forensic examination techniques to trainees, and would certainly recommend this book to them in their early stages of training. However, it falls short of being as useful as it might have been due to a relative lack of illustrated example cases, and I look forward to seeing a much expanded 2nd edition that might start each chapter with the techniques to be used, and then provide more abundant illustrations of those techniques 'in practice'.

 

forensic pathology

Forensic pathology for forensic scientists, police, and death investigators. Prahlow J. Humana Press 2010

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Sample pages (on forensic science) here ...

 

Forensic pathology is a highly specialised area of medicine. In order to understand and appreciate the principles and practice of this subject, one must consider that forensic pathologists must learn the scientific principles that underpin medicine, be well-versed in the theory and practice of clinical medicine, and have a command of the principles and practice of histopathology. Such a path takes many years, following which forensic pathologists continue to 'learn on-the-job'.

One can undertake a 'lifetime of learning', and still come across 'something new' in (almost) every case. It is against this background that other professionals coming into contact with forensic pathologists, and forensic pathological principles, must attempt to decipher the language used by such pathologists, and to interpret the significance of forensic pathological findings relevant to the case in hand. This is an extremely 'tall-order' for anyone who lacks the same grounding as the pathologist, and provides the opportunity for inadvertent mistakes to occur in the death investigation process.

Prahlow is therefore to be congratulated in his remarkably all-encompassing book, which is well-written for his target audience of the non-medically trained professional involved in the death investigation process. The breadth of this text is wide, and the language used is perfectly pitched for the 'lay' individual.

The reader is taken through anatomy, physiology, clinical medicine, pathology and finally forensic pathology in a logical order, and at each stage he/ she is reminded of underpinning principles when necessary. Topics are cross-referenced without unnecessary repetition of large chunks of knowledge previously described in other parts of the book.

Anyone involved even at the periphery of a death investigation will find much of interest in the title, and I have no hesitation whatsoever in recommending it to them. The firm US-centric slant limits its usefulness to those involved in suspicious death investigation in the UK, but the majority of content will still be of use, particularly to those coroner's officers in England and Wales that do not have a 'health-care' background.

Forensic pathology trainees are always asking 'what book(s) can I read' for a particular topic, and this question was in this reviewer's mind when reading Prahlow's book. As an introductory text on the whole of forensic pathology, it can be highly recommended; once the basics are covered, the trainee can 'graduate' to a more in-depth text (such as the excellent Knight's Forensic Pathology, for example). What shines through Prahlow's book though is a firm grasp of the language necessary to impart complex forensic pathological knowledge to a 'lay audience', and this approach is necessary for all those forensic pathology professionals required to interact with a 'lay-audience', including in the coroner's court, where it is necessary to explain pathological findings to the family of the deceased.

Prahlow is a 'seasoned professional', who offers many wise statements regarding the limitations of forensic pathology, and it is the personal 'guidance' of such pathologists that is often lacking in modern forensic pathology textbooks. A novice often turns to his senior colleagues to gain valuable insight and advice on a particularly intriguing case, only to discover that such a case has been seen by them on numerous previous occasions, and that if one was to do x, y, or z, one would be able to address the issues posed by that case in consideration by the 'junior' pathologist. Reading Prahlow's book brought to mind many such conversations that this reviewer has had with senior colleagues in the past, and it is to be recommended to trainees as a source of 'paternal advice'.

The quality of photographs in this book is poor, but it is accompanied by an accompanying CD Rom of higher quality colour photographs, the legends to which can be found in the text for each chapter. The inclusion of such a disc of images does make up for the poorer quality black and white photographs accompanying the text, but it is a shame that such colour illustrations did not appear within the text itself.

Overall, Prahlow is to be congratulated on producing such an accessible overview of forensic pathology 'for the lay person', and has created a 'classic in the making' for that audience. Whilst not intended for a pathological audience, he has nevertheless also provided a valuable resource for forensic pathology trainees starting out in their careers, and I suspect that this will start to appear on the bookshelves of many such trainees, despite the book's title.

 

autopsy pathology

The operated heart at autopsy. Hauser SL (Humana Press 2010)

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The performance of a post mortem examination on a body in which there is a known history of remote cardiac surgery, let alone a case apparently involving a death during or shortly after such surgery, can be daunting to the inexperienced autopsy pathologist. Textbooks usually consulted on such technical matters are usually brief in their advice, and one is frequently in need of the 'words of wisdom' from more experienced colleagues.

Written by a cardiac surgeon who changed specialties and is now a cardiac pathologist, this relatively slim volume is lavishly illustrated, and contains excellent practical advice for the autopsy pathologist on how to approach a post cardiac surgery case.

The book covers a general approach to the examination and then delves in to the heart of the matter (pun intended!) and provides detailed descriptions of cases involving coronary artery bypass grafting, valve replacements, other surgical prostheses and the correction of congenital defects.

One read of this book is not enough to grasp the intricacies of the content, and it is a volume that I will definitely be going back to time and again as the case mix requires.

This book should certainly be on the reading list of anyone involved in post-operative death autopsies, trainee histopathologists, cardiac and forensic pathologists alike. The only downside is the price - £100 is a bit much for such a slender monograph, but I suppose that such specialist books, with a relatively limited readership must command a higher price to recover the publishing costs. Nonetheless, I would thoroughly recommend this book for purchase, particularly by those pathology departments fortunate enough to be able to continue purchasing textbooks in the current times of austerity!

 

For excellent online cardiovascular pathology resources, follow this link ..

 

Forensic Medicine in Western Society - a History

Forensic Medicine in Western Society - a History, Watson KD, Routledge (Taylor and Francis Group) 2011

 

From a forensic pathologist's perspective, 'Forensic Medicine in Western Society – a History' misses the mark. AJP Taylor allegedly said, “History is not a catalogue but a convincing version of events” - Dr Watson's version of the very recent history is inaccurate and poorly researched.

In chapter 3, 'Experts and expertise', which aims to survey the development of forensic medicine/ pathology and 'medico-legal experts' in the United Kingdom, Dr Watson states that England 'consequently has the highest autopsy rate in the West', and cites at that point a textbook from 1984! This is followed by a 'throwaway comment', 'the current standard of post-mortems is nationally inconsistent', which raises some interesting questions.

(a) What is meant by 'nationally'? Does she mean England (which is how it logically should be interpreted given her preceding reference to England), or the United Kingdom (which is the sub-heading for this part of the chapter) or Wales (given the citation at that point)?.

(b) What does she mean by 'the current standard of post-mortems', what sort of post mortem examination is she referring to, and what sort of expert is she referring to?

The majority of post mortem examinations in England and Wales are currently made by hospital-based surgical pathologists/ histopathologists – who usually have no 'expertise' in forensic pathology – on behalf of coroners. Surgical histopathologists would not consider themselves to be 'medico-legal experts' and the post mortem examinations made by them are quite different to forensic post mortem examinations made by forensic pathologists, who have special expertise in autopsy pathology/ forensic pathology, and who would describe themselves as 'medico-legal experts'.  Forensic pathologists in England and Wales are therefore the 'experts' in medico-legal post mortem examinations, rather than those surgical pathologists who make post mortem examinations for coroners.

This is an important distinction to make because, as Dr Watson correctly alludes to, there have been concerns expressed about the quality of coroner's post mortem examination reports (and by implication, the quality of the examinations leading to those sub-standard reports, although this may not necessarily be true). Those concerns were raised by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), in their report 'The Coroner's Autopsy: do we deserve better?', published in 2006 (and which can be accessed online at http://www.ncepod.org.uk/2006.htm). Dr Watson does not, however, cite this report itself – the 'primary source' - preferring to cite a BBC News article available online. Why cite such a 'secondary source' when the authoritative document is easily available for all? Did she know of its existence?

Dr Watson states that the 'current standard' of post mortem examination is inconsistent, but does not elaborate on what she means by the 'current standard'. Is this the 'quality standard' envisaged by the Royal College of Pathologists (RCPath) in their 2002 'Guidelines on autopsy practice' (available online at www.rcpath.org/resources/pdf/main_document.pdf) – who, incidentally, recommend histological sampling of all major organs in all autopsies as 'best practice' – or perhaps the 'Code of Practice and Performance Standards' (produced by the RCPath and Home Office in 2004, and also available online at www.rcpath.org/resources/pdf/CodeOfPracForensicPath1104.pdf)? Most 'coronial pathologists', not being forensic pathologists, will be working to the RCPath 2002 'standard', save for limitations imposed on them by the coroner authorising the examination.

Having alluded to a 'problem' with the 'current standard of post-mortems', which she says is inconsistent 'nationally', she then cites another BBC news online report referring to action taken by the Human Tissue Authority (HTA) at the University Hospital of Wales in Cardiff. This news item, based on a press release from the HTA , and a quote from the hospital's new Chief Executive, identified alleged 'problems in procedures, facilities and equipment' and 'poor compliance with regulatory standards'. The quality of post mortem examinations (or the 'standard' of those examinations) was not at issue, and a reference to this HTA action is irrelevant to her point. By citing this HTA action, however, she gives the reader the misleading impression that the HTA action was, in fact, related to quality standards, and that post mortem examinations in the University Hospital of Wales fell below those standards. This, in my view, is a very serious error that must be corrected in further reprints of this book.

The reasons for the way in which the HTA went about their business in Cardiff may never be known, given that the organisation is due to be axed shortly, but perhaps that might be an interesting line of 'historical' research. One only needs to review the minutes of meetings of the HTA following its regulatory action in Cardiff, however, to see that their (disproportionate) action had profound (adverse) implications for their senior staff, their perception by the pathology community and their subsequent approach to minor 'regulatory matters'. A similar review of the RCPath Bulletin would also reveal the thoughts of the President of the RCPath on the whole debacle.

In the space of a few lines Dr Watson displays such a complete lack of insight into the intricacies of how post mortem examinations are made in England and Wales, let alone the rest of the United Kingdom, that one cannot help but wonder what else she has got wrong.

Historians have a responsibility to be accurate, particularly in matters that are within the very recent past, and which are very amenable to accurate research. I can not recommend this book to anyone who wishes to read an authoritative account, and I hope that future print runs of this book are revised/ corrected. Perhaps academics writing about the history of forensic medicine/ pathology should involve those who actually know about that specialist field – the forensic pathologists themselves.

Review coming soon ...

Atlas of Forensic Histopathology. Cummings et al 2011

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Color Atlas of Fetal and Neonatal Histology

 

Color Atlas of Fetal and Neonatal Histology. Ernst LM, Ruchelli ED, Huff DS. Springer 2011

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As a junior pathologist starting out in paediatric pathology, I was in the same position as other trainees in having to ‘get to grips’ with normal fetal and perinatal histology, before attempting to interpret changes thought to be a consequence of disease, trauma, or post mortem artefact. Sadly, this excellent textbook was not available then, and I struggled to find suitable illustrations and descriptions of the normal - developmentally appropriate - organs and tissues retained from post mortem examinations.

The authors provide an overview of the normal histological appearance of all major organs and tissues in their concise text, some of which will be only rarely of interest, whilst chapters on the heart, lungs, kidneys, and brain for example, will be of use on many more occasions.

The most significant contribution of this text is the detail provided on the normal appearance of organs and tissues through the developmental stages leading up to early neonatal life, and those stages are represented in clear, and occasionally annotated photomicrographs.

Whilst this book will undoubtedly be of most use to trainee paediatric pathologists, there is much of relevance for forensic pathologists too; when attempting to determine the viability of fetal remains, for example, one must have an idea of the likely gestational age, and a histological assessment of the developmental stage of organs such as the lungs and kidneys, can sometimes be a useful adjunct to other techniques, including radiology. This book should not only find its place on the shelves of paediatric pathology departments, but on those of forensic pathologists too.

It would be nice to see this excellent resource expanded with more examples of the normal compared to the abnormal – a hybrid histology/ histopathology text – and perhaps made available online, with case studies and self-assessment questions for trainees to gauge their understanding of the normal appearance of fetal and neonatal histology. Such a resource might also include selected ‘virtual slides’ that can be navigated online, such that the features described at each developmental stage can be seen in the context of the surrounding tissue.

Overall, the authors have produced a unique educational resource that will be invaluable to trainee pathologists and others, and they are to be highly commended.

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