[1S] UNIT 2 The Post-Mortem Examination (Autopsy) Flashcards
Considered the ultimate medical audit, an _______ can be categorized by five different rulings for manner of death: natural (sickness, disease), accident, homicide (death due to another person), suicide (putting oseself to death), or undetermined
Autopsy / Post-Mortem Examination
T/F: In a case where suspicious circumstances surround the death, a medical examiner or coroner can order an autopsy without consent from next of kin
T
T/F: Not everyone receives an autopsy upon death
T
HISTORY OF POSTMORTEM EXAMINATIONS
The first recorded autopsy occurs when Antistius examines _______ _______’s body after his assassination, determining which of the 23 stab wounds proved fatal.
Julius Caesar
HISTORY OF POSTMORTEM EXAMINATIONS
T/F: It was one wound to the chest that ruptured Caesar’s aorta
T
HISTORY OF POSTMORTEM EXAMINATIONS
The assassination of Julius Caesar was the result of a conspiracy by approximately 60 Roman senators who called themselves ________.
Liberators
HISTORY OF POSTMORTEM EXAMINATIONS
They led the Liberators and stabbed Julius Caesar to death in a location adjacent to the Theatre of Pompey on the Ides of March (March 15), 44 BC.
Gaius Cassius Longinus and Marcus Junius Brutus
HISTORY OF POSTMORTEM EXAMINATIONS
He was the dictator of the Roman Republic at the time, having recently been declared dictator perpetuo by the Senate.
Julius Caesar
HISTORY OF POSTMORTEM EXAMINATIONS
An 1806 painting by Vincenzo Camuccini, originally commissioned in 1793 by Frederick Hervey, 4th Earl of Bristol, for
whom he had already produced a copy of Raphael’s Deposition
La mort de Cèsar or The Death of Julius Caesar
HISTORY OF POSTMORTEM EXAMINATIONS
In 1247, he wrote “Hsi Yüan Lu, or The Washing Away of Wrongs,” an instruction manual on how to conduct medico-legal investigations, examine corpses, and determine the time and cause of death. Other forward-thinking forensic issues were illustrated, such as poisoning, decomposition, wounds from various weapons, strangulation, and fake wounds.
Song Ci
HISTORY OF POSTMORTEM EXAMINATIONS
The manual contained details on how a human cadaver looks like
Hsi Yüan Lu, or The Washing Away of Wrongs
HISTORY OF POSTMORTEM EXAMINATIONS (1302)
The investigation was requested by a magistrate in _______. Before the advent of the microscope, his observations were limited by the power of the human eye and his tools.
Bologna
HISTORY OF POSTMORTEM EXAMINATIONS (1302)
Influenced by The Washing Away of Wrongs, ____________ ___ _________conducted the first-known legal autopsy where the death was investigated explicitly to determine if there was fault (what is referred to as a medico-legal autopsy)
Bartolomeo da Varignana
HISTORY OF POSTMORTEM EXAMINATIONS
T/F: Throughout the Renaissance, anatomy teachers and students in medical schools performed dissections themselves. They would congregate in an operating theater and watch as a cadaver was opened by a “lay dissector.”
F; did not perform
HISTORY OF POSTMORTEM EXAMINATIONS
Performed a number of “autopsies,”
dissecting corpses and observing the anatomy unseen by the naked eye.
Leonardo da Vinci and Michelangelo
HISTORY OF POSTMORTEM EXAMINATIONS
The father of modern pathology, he realized the importance of the microscope when conducting pathological research to uncover minute details.
Rudolf Virchow
WHY POSTMORTEM EXAMINATION? (PME)
T/F: Wherever Scientific medicine of high quality is practiced, postmortem examinations are performed.
T
HISTORY OF POSTMORTEM EXAMINATIONS
Through his examinations, he characterized a case of leukemia, and his resulting report is one of the earliest
formal reports on this cancer.
Rudolf Virchow
WHY POSTMORTEM EXAMINATION? (PME)
T/F: Whenever a conscientious physician knows why he “lost” his patient, a post mortem examination has been performed
T
WHY POSTMORTEM EXAMINATION? (PME)
A physician who wants answers
Conscientious Physician
WHY POSTMORTEM EXAMINATION? (PME)
T/F: Whenever criminal law is enforced
T
WHY POSTMORTEM EXAMINATION? (PME)
T/F: Whenever a death certificate shows accurately the causes of death and confirmed medical diagnosis for the assembling of vital statistics a postmortem has been performed
T
WHY POSTMORTEM EXAMINATION? (PME)
T/F: Whenever there is medical research on the causes and nature of diseases such as cancer, heart disease, and stroke, infectious diseases, neurodegenerative diseases, and transplantation medicine, the investigative method is the postmortem examination
T
WHY POSTMORTEM EXAMINATION? (PME)
T/F: There is no need to perform an autopsy when criminal law is enforced
F; need to perform
WHY POSTMORTEM EXAMINATION? (PME)
T/F: An informed society requires a postmortem examination in human
death for the good of medical science,
for the public’s health and for the future care of the living patient.
T
PREPARATIONS BEFORE THE POSTMORTEM EXAMINATION
● This is the most important step in the autopsy procedure
● Identifiers on the body must be confirmed and matched with the autopsy consent form
● Also confirm any limitations or restrictions to the autopsy at this time
Step 3: Confirmation of Decedent Identity
PREPARATIONS BEFORE THE POSTMORTEM EXAMINATION
● Obtain and confirm consent for autopsy
● Obtain and review clinical records
● Contact clinical team and staff pathologist
Step 1: Administrative Preparations
PREPARATIONS BEFORE THE POSTMORTEM EXAMINATION
● Set up of dissection instruments and tools
● Lay out swabs, media, etc. for any ancillary studies to be performed
● Prepare photographic equipment
● Assemble personal protective equipment
Step 2: Preparation of the Autopsy Room
4 Preliminaries for Post-Mortem Exam
- Written consent from the next of kin-abide by the extent or restrictions allowed
- Death certificate (blue /pink white forms)
- Medical abstract / Clinical data
- Medicolegal clearance
Consent for Autopsy (in order)
- Spouse
- Adult Children
- Adult grandchildren
- Parent
- Brother/Sister
- Nephew
- Grandparent Uncle/Aunt
- Cousin
- Stepchildren
PREPARING FOR THE AUTOPSY
T/F: If autopsy is not required by law, it can be done without permission
F; If autopsy is not required by law, it cannot be done until the next of kin gives permission
THREE LEVELS OF PME
In which all body cavities are examined (including the head / brain)
Complete
PREPARING FOR THE AUTOPSY
T/F: Consent form must be signed in the presence of a witness or a third party
T
THREE LEVELS OF PME
Which may exclude the head / brain
Limited (Partial)
THREE LEVELS OF PME
Where specific organs only are examined usually (focused on 1 part only)
Selective
PME is permitted without consent in the following circumstance
T/F: When it is ordered by the police or coroner
T
PME is permitted without consent in the following circumstance
T/F: When it is necessary to complete the death certificate
T
PME is permitted without consent in the following circumstance
T/F: When the deceased himself has given consent before he died (advanced directive)
T
Autopsy that is ordered by the state coroner
Coronial autopsies
T/F: An autopsy can be hospital-based (non-coronial) or coronial
T
PME is permitted without consent in the following circumstance
T/F: Deceased military personnel who dies in active duty/training in the military service
T
An autopsy is usually carried out within ___ hrs after the death of a person
48 hrs
Autopsy that may be performed at the request of the family of the deceased
Hospital-based autopsy
AUTOPSY: Selective, partial, complete
Extent
AUTOPSY: Gross findings (provisional anatomic diagnosis)
Death certificate
AUTOPSY: Forensic
Medico legal
AUTOPSY: Gross and microscopic findings (Final Anatomic diagnosis)
Final diagnosis
CRITERIA FOR AUTOPSIES
T/F: Deaths in which autopsy may help to explain unknown and unanticipated medical complications to the attending physician.
T
CRITERIA FOR AUTOPSIES
T/F: All deaths in which the cause of death or a major diagnosis is known with reasonable certainty on clinical grounds.
F; not known
CRITERIA FOR AUTOPSIES
T/F: Cases in which autopsy may help to allay concerns of the family and/or the public regarding the death, and to provide
reassurance to them regarding the same.
T
CRITERIA FOR AUTOPSIES
T/F: Unexpected or unexplained deaths occurring during or following any dental, medical or surgical diagnostic procedures and/or therapies.
T
CRITERIA FOR AUTOPSIES
T/F: Deaths of patients who have participated in clinical trials (protocols) without approval from the institutional review boards.
F; approved by institutional review boards.
CRITERIA FOR AUTOPSIES
T/F: Unexpected or unexplained deaths which are apparently natural and not subject to a forensic medical jurisdiction.
T
CRITERIA FOR AUTOPSIES
T/F: Natural deaths which are subject to, but waived by, a forensic medical jurisdiction such as (a) persons dead on arrival at hospitals (b) deaths occurring in hospitals within 24 hours of admission, and (c) deaths in which the patient sustained or apparently sustained an injury while hospitalized.
T
CRITERIA FOR AUTOPSIES
T/F: Deaths resulting from low-risk infectious and contagious diseases.
F; high-risk
CRITERIA FOR AUTOPSIES
T/F: Deaths known or suspected to have resulted from environmental or occupational hazards.
T
CRITERIA FOR AUTOPSIES
T/F: All obstetric, perinatal and pediatric deaths.
T
CRITERIA FOR AUTOPSIES
T/F: Deaths at any age in which it is believed that autopsy would disclose a known or suspected illness which also
may have a bearing on survivors or recipients of transplant organs.
T
Has jurisdiction in medicolegal cases, and may authorize the pathologist to proceed with an autopsy.
medicolegal examiner or the coroner
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All natural deaths occurring in the hospital within 48 hrs of admission, unless the case was attended by a private physician within 36 hours of death
F; within 24 hrs of admission
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: Newborns in the first 24 hrs of life
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All deaths due to known cases
F; unknown
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All injury cases, old or recent
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All deaths due to suspicious cases
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All abortion cases, whether self induced or otherwise
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All cases without medical attendance within 72 hours prior to the hour of death
F; 36 hrs
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All violent, accidental, and sudden deaths
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All deaths due to drowning, hanging or
strangulation
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All deaths due to shooting, stab wounds, burns, electricity, lightning, tetanus, etc.
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All homicides & suicides
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: All cases in which there is suspicion of
poisoning
T
JURISDICTION OF THE MEDICO-LEGAL AUTOPSY
T/F: Stillborns & Prematures
T
Criteria for the pronouncement of death
Somatic Death
- Death of an organism
- Cessation of circulation and respiration (1960s)
Somatic Death
CRITERIA FOR PRONOUNCEMENT DEATH
T/F: Redefinition from cessation to reversible cessation of cardiorespiratory functions after resuscitation attempts
F; irreversible
CRITERIA FOR PRONOUNCEMENT DEATH
T/F: Advances in resuscitation techniques that are capable of reviving effectively cases of clinical death
CRITERIA FOR PRONOUNCEMENT DEATH
T/F: Advanced life-sustaining equipment capable of maintaining cardiovascular and respiratory functions despite severe brain injury
T
CRITERIA FOR BRAIN DEATH
T/F: Present cephalic (brainstem) reflexes
F; absent
CRITERIA FOR PRONOUNCEMENT DEATH
T/F: Brain Death - National Institute of Neurological Diseases and Stroke in the United States (1977)
T
CRITERIA FOR BRAIN DEATH
T/F: Coma and Cerebral unresponsiveness
T
CRITERIA FOR BRAIN DEATH
T/F: Dyspnea
F; Apnea
CRITERIA FOR BRAIN DEATH
T/F: Electrocerebral silence
T
T/F: Criteria for brain death should be present for 30 minutes at least 6 hour after onset of coma and apnea
T
AMERICAN BAR ASSOCIATION AND THE NATIONAL CONFERENCE OF COMMISSIONERS OF UNIFORM STATE LAWS LEGISLATIVE DEFINITION OF DEATH: (1980)
T/F: Irreversible cessation of all functions of the entire brain, including the brainstem is dead
T
AMERICAN BAR ASSOCIATION AND THE NATIONAL CONFERENCE OF COMMISSIONERS OF UNIFORM STATE LAWS LEGISLATIVE DEFINITION OF DEATH: (1980)
T/F: Reversible cessation of circulatory and respiratory functions
F; irreversible
Somatic Death by the American Academy of Neurology
- Coma
- Absence of motor response, pupillary response to light and pupils at mid-position, corneal reflexes, gag reflex, coughing in response to tracheal suctioning, sucking & rooting reflexes
Medical Certification of Death
- Immediate cause of Death
- Antecedent cause of Death
- Underlying cause of Death
As amended by Republic Act No. 7885, organ and tissue donations from donors who have been declared brain dead have been allowed.
Republic Act 7170 or Organ Donation Act of 1991
MEDICAL CERTIFICATION OF DEATH
Is the final disease, injury, or complication directly causing death
Immediate Cause of Death
MEDICAL CERTIFICATION OF DEATH
In the case of sudden or traumatic death, the violent act or accident is the antecedent to an injury entered, although these two events are often almost simultaneous.
Immediate Cause of Death
MEDICAL CERTIFICATION OF DEATH
It precedes death as a consequence of an underlying cause or causes.
Immediate Cause of Death
MEDICAL CERTIFICATION OF DEATH
Other intervening cause (or causes) of death occurring between the underlying
and immediate causes is called the antecedent cause.
Antecedent Cause of Death
MEDICAL CERTIFICATION OF DEATH
The condition(s) that led to or precipitated the immediate cause of death, as
recorded on a death certificate.
Antecedent Cause of Death
MEDICAL CERTIFICATION OF DEATH
Defined for public health and legal purposes as “the disease or injury that initiated the train of events leading to death.”
Underlying (proximate) cause of death
MEDICAL CERTIFICATION OF DEATH
Or the circumstances of the accident or violence which produced the fatal injury
Underlying (proximate) cause of death
MEDICAL CERTIFICATION OF DEATH
Without an underlying cause, the death would not have happened
Underlying (proximate) cause of death
MEDICAL CERTIFICATION OF DEATH
coronary arterial atherosclerosis
Underlying COD
MEDICAL CERTIFICATION OF DEATH
It is the most important entry in the certificate since mortality statistics is based on this underlying cause. All certification of death must include an underlying cause.
Underlying (proximate) cause of death
MEDICAL CERTIFICATION OF DEATH EXAMPLE
Congestive heart failure
Immediate COD
MEDICAL CERTIFICATION OF DEATH EXAMPLE
Myocardial Ischaemia caused by coronary
artery disease
Antecedent COD
DESCRIPTIONS OF VARIOUS MANNERS OF DEATH
Death resulting from disease
Natural
DESCRIPTIONS OF VARIOUS MANNERS OF DEATH
Death as a result of environmental influence
Accidental
DESCRIPTIONS OF VARIOUS MANNERS OF DEATH
Death intentionally self-inflicted
Suicide
DESCRIPTIONS OF VARIOUS MANNERS OF DEATH
Death resulting from the deliberate action of another person
Homicide
DESCRIPTIONS OF VARIOUS MANNERS OF DEATH
Unknown cause
Indeterminate or Undetermined
Can be used to determine the approximate time of death of the patient
Post-Mortem Changes
These changes include livor mortis, rigor mortis, decomposition and taphonomy (processes that would occur on a deceased body until it fossilizes).
Post-Mortem Changes
Refers to a continuum of changes that occur in a dead body following death
Post-Mortem Changes
Decomposition of the body
Post-Mortem Changes
POSTMORTEM CHANGES
● First demonstrate change after death is cooling of the body
● No drastic change
● Decrease in temperature per hour
Algor Mortis
POSTMORTEM CHANGES
Means temperature
Algor
ALGOR MORTIS
T/F: As a rule the body cools at 1.5°F/hr (50% of cases)
T
POSTMORTEM CHANGES
At room temp, the body cools down at 2°F/hr to 2.5°F/hr for the 1st hour
Algor Mortis
POSTMORTEM CHANGES
T/F: Algor mortis is a reliable indicator as to the time of death
F; not reliable
POSTMORTEM CHANGES
At room temp, the body cools down at 1.5°F/hr to 2°F/hr in the next 12 hours
Algor Mortis
POSTMORTEM CHANGES
At room temp, the body cools down at 1°F/hr in the next 12 to18 hours
Algor Mortis
POSTMORTEM CHANGES
Rigidity of the body due to hardening of the skeletal muscles caused by a series of physiochemical events after death
Rigor Mortis
POSTMORTEM CHANGES
Lack of ATP regeneration and increased acidity result in the formation of locking-chemical bridges between actin & myosin
Rigor Mortis
POSTMORTEM CHANGES
Due to depletion of ATP and accumulation of lactic acid (lactic acidosis); in a dead body, the glycogen stores are rapidly depleted, preventing the energy dependent breakage of sarcomere contraction
Rigor Mortis
POSTMORTEM CHANGES
This interlocking is fixed and produces rigor mortis without shortening of the muscle
Rigor Mortis
POSTMORTEM CHANGES
Sets within 2 hrs after death (head & neck) initially notable in the small muscles (i.e. head region – jaw) followed by larger muscle groups (i.e. legs) (Forensic Sci Int 1978; 12:97)
Rigor Mortis
POSTMORTEM CHANGES
Blood supply gravitates to the skin vessels which becomes toneless and dilate
after circulation ceases. Evident as deep purple-red discoloration in the skin
and internal organs
Livor Mortis or Postmortem (Lividity) Hypostasis
POSTMORTEM CHANGES
Fixed rigor mortis of the upper extremities wherein the arms are suspended against gravity indicating they were previously held in that position while rigor was fixing.
Antigravitational rigor mortis
POSTMORTEM CHANGES: LIVOR MORTIS
Occurs in gravity dependent areas of the body that come into contact with firm surfaces (i.e. floor, tight clothing); livor mortis is spared in these areas due to localized pressure preventing blood from entering the skin
Blanching
POSTMORTEM CHANGES: RIGOR MORTIS
● Complete and fully fixed after approx. _____ hours
● Dissipates after approximately ____ hours
6-12
36-48
POSTMORTEM CHANGES
Becomes evident as early as 20 min after death
Livor Mortis or Postmortem (Lividity) Hypostasis
POSTMORTEM CHANGES: LIVOR MORTIS
Fully evident within 4 hrs and fixed in approx. _____ hrs
8 - 12
POSTMORTEM CHANGES
Tardien spots aka Tardieu petechiae, Tardieu spots
Livor Mortis or Postmortem (Lividity) Hypostasis
Tardieu’s ecchymoses, subpleural spots of ecchymosis that follow the death
of a newborn child by strangulation or suffocation, were first described by
______ in 1859, and were so named in his honor.
Tardieu
Is pink to purple discoloration of the skin from blood pooling in dependent areas of the body
Lividity
Are purple to black spots on the
skin that can develop along with lividity, from the rupture of capillaries
Tardieu spots
Other postmortem changes
- Postmortem clotting of blood
- Discoloration of tissues
- Autolysis and Putrefaction
- Dessication (Tache Noir)
POST-MORTEM CHANGES
After death, the skin and mucosal membranes may desiccate resulting in a change in color and character of these tissues
Post-Mortem Drying / Dessication
POST-MORTEM CHANGES
Horizontal linear scleral blackening along the equator of the globe of the eye; the sclera is exposed to drying when the eyelids are incompletely shut; tache noir is often initially red in appearance and over time becomes black
Tache noir de la sclérotique
POST-MORTEM CHANGES
Lips, tip of tongue and scrotum darken
Post-Mortem Drying / Dessication
TECHNIQUES OF AUTOPSY
Refers to a cut or dissection on the skin
Primary autopsy incision
TECHNIQUES OF AUTOPSY
Primary autopsy incision for scalp
Mastoid-to-Mastoid incision
TECHNIQUES OF AUTOPSY
Primary autopsy incision for trunk
I-shaped, Y-shaped or Modified Y-shaped
TECHNIQUES OF AUTOPSY
2 Secondary Autopsy Incisions
- Sawing of the skull
- Cutting of the sternal plate
TECHNIQUES OF AUTOPSY
Cutting of bones to expose the cavities
○ Cranial cavity
○ Thoracic cavity
○ Abdominal cavity
○ Pelvic cavity
Secondary Autopsy Incisions
T/F: For a woman, the Y-incision is curved around the bottom of the breasts before meeting at the breast bone.
T
SKIN INCISIONS
It is a straight line incision extending from the chin to the symphysis pubis
I-shaped
SKIN INCISIONS
This type of incision starts near the acromian process and progresses downwards towards the xiphoid process
Y-shaped
SKIN INCISIONS
○ ‘Y’ shaped incision is made from the suprasternal notch to symphysis pubis
○ It extends from the suprasternal notch over the clavicle to its center on both sides and passes upwards over the neck, behind the ear
Modified Y-shaped
● To expose the chambers of the Heart
● To expose the inner lungs
Quaternary Autopsy Incisions
CONVENTIONAL TECHNIQUES OF AUTOPSY
● Organs removed and dissected individually
● Order of Examination
Techniques of Virchow
● To expose the inner liver
● To open the urinary bladder cavity
● To expose the GIT lumen
Quaternary Autopsy Incisions
CONVENTIONAL TECHNIQUES OF AUTOPSY
In-situ dissection in part combined with en-bloc technique
Technique of Rokitansky
CONVENTIONAL TECHNIQUES OF AUTOPSY
Technique of Virchow
- Head
- Thoracic
- Abdominal Organs
CONVENTIONAL TECHNIQUES OF AUTOPSY
En bloc technique
Technique of Ghon
CONVENTIONAL TECHNIQUES OF AUTOPSY
En masse technique
Technique of Letulle
CONVENTIONAL TECHNIQUES OF AUTOPSY
The simplified minimally invasive autopsy, which consists of histological and microbiological analyses of blood samples, cerebrospinal fluid samples, and tissue samples from solid organs using biopsy needles or core needles biopsy techniques, could be an alternative method to the complete autopsy
MINIMALLY INVASIVE: Needle Autopsy
CONVENTIONAL TECHNIQUES OF AUTOPSY
A generic term for a postmortem examination in which there is minimal to no disruption of major body cavities. (e.g., by using CT scan, MRI, laparoscopy, and needle biopsies)
MINIMALLY INVASIVE: Needle Autopsy
CONVENTIONAL TECHNIQUES OF AUTOPSY
Aspiration of blood, urine, cytology, etc., for analysis
Minimally Invasive
CONVENTIONAL TECHNIQUES OF AUTOPSY
Multiple percutaneous needle biopsies after death (“blind biopsies”)
Minimally Invasive
CONVENTIONAL TECHNIQUES OF AUTOPSY
Laparoscopic and thorascopic investigation with tissue sampling
Minimally Invasive
NON-FORENSIC AUTOPSY RECORDS
Wet tissue retention
3 months after final report
CONVENTIONAL TECHNIQUES OF AUTOPSY
Extensive organ sampling or removal via a limited incision (e.g., a 15-cm upper abdominal wall incision)
MINIMALLY INVASIVE: “Mini-autopsy”
NON-FORENSIC AUTOPSY RECORDS
Gross tissues retention
3 months or up to 6 months after the final report has been released
CONVENTIONAL TECHNIQUES OF AUTOPSY
This is like taking a picture of the internal structures without opening the system.
Imaging Autopsies
FORENSIC AUTOPSY RECORDS
Paraffin blocks, slides, reports, gross photographs / negatives, dried blood stain / frozen tissue for DNA retention
Indefinitely
NON-FORENSIC AUTOPSY RECORDS
Reports retention
10 yrs (archival material)
NON-FORENSIC AUTOPSY RECORDS
Slides retention
10 yrs
FORENSIC AUTOPSY RECORDS
Wet tissue retention
3 yrs
NON-FORENSIC AUTOPSY RECORDS
Paraffin blocks retention
10 yrs
FORENSIC AUTOPSY RECORDS
Body Fluids and Tissues for Toxicology retention
1 yr
