摘要:

Acute coronary thrombosis does not play a major role in the causation of sudden unexpected death due to coronary artery disease. In a study of 500 consecutive autopsies of individuals aged 20–99 years, dying suddenly and unexpectedly of coronary artery disease, only 67 (13.4%) showed an acute thrombosis. In contrast, studies of hospitalized patients with acute transmural infarction of the myocardium showed a rate of coronary artery occlusion > 80%.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The etiology of sudden unexpected death in young and middle age adults is frequently listed as undetermined, thereby causing much grief and fear among family members. When careful, methodical autopsies were performed, a significant number of cases of hypoplastic coronary artery disease (HCAD) were found where no other etiological factor could account for the deaths or where there was a solo coronary occlusion proximal to the hypoplastic coronary artery. This is in marked contrast to the small number of cases that have been reported, indicating that HCAD is more common than is generally realized. A representative series of seven cases of sudden death due to HCAD is presented, possible mechanisms of death in HCAD are fully discussed, and recommendations for an autopsy checklist for investigating sudden cardiac death at autopsy are presented.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In a review of 1,034 consecutive forensic autopsies, there were 43 cases that had a distinct zone of subendocardial hemorrhage in the septal wall of the left ventricle. Cases in which there was direct injury to the heart or cardiac resuscitation were not counted. Of the 43 cases, 26 (60%) died of head injuries. Other causes of death were drug or chemical intoxication (14%) and abdominal injuries (12%); miscellaneous causes accounted for 14%. The time between injury and death varied considerably; in 13 cases (30%), the interval was < 1 h. Drugs and/or alcohol were not factors in the appearance of subendocardial hemorrhage, unless the drug itself caused death. Among the drug- or chemical-related fatalities, there were four cases of cocaine overdose with subendocardial hemorrhages. The results of this study are consistent with the hypothesis that cardiac lesions secondary to noncardiac injuries, particularly head injuries, are mediated by hypersecretion of catecholamines. Previous studies have shown significant cardiac decompensation due to non-cardiac injuries, and it is likely that the cardiac lesions are part of the mechanism of death. The secondary cardiac lesions are also important for heart transplantation; catecholamine-mediated cardiac damage following head injury or shock may adversely affect performance of the transplant in the recipient.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Eleven cases of sudden death of men restrained in a prone position by police officers are reported. Nine of the men were hogtied, one was tied to a hospital gurney, and one was manually held prone. All subjects were in an excited delirious state when restrained. Three were psychotic, whereas the others were acutely delirious from drugs (six from cocaine, one from methamphetamine, and one from LSD). Two were shocked with stun guns shortly before death. The literature is reviewed and mechanisms of death are discussed.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Records of the Adelaide Children's Hospital Histopathology Department were reviewed for cases of deaths resulting from hanging or wedging occurring in early childhood and infancy. The 14 cases identified were analyzed with respect to age, sex, circumstances of death, and postmortem findings. The mean age at death was 14 months (range, 6–36 months) and the male to female ratio was 9:5. In one case, death occurred in a baby car seat, another in a pram/stroller, and in another a curtain cord was responsible. In the remaining 11 cases, death occurred in the baby's crib. In eight cases the mechanism of death was hanging with partial suspension, including six cases in which part of the infant's clothing became caught on the crib. Petechial hemorrhages on the face were found in all of the hanging deaths whereas intrathoracic petechiae were identified in only two cases. Only one of the wedging deaths showed facial petechiae whereas intrathoracic petechiae were identified in four of the six cases. Conjunctival hemorrhages were only recorded in only two of the 14 cases.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The relationship between the blood to vitreous humor ethanol ratios (B/V) and the corresponding urine to blood ethanol ratios (U/B) of 200 postmortem cases were found to be bimodal in nature. Using the U/B ratio of 1.20 as a demarcation below which early absorption prevails, the results in the early absorption phase gave an average B/V ratio of 1.29, a range from 0.71 to 3.71, and a relatively large standard deviation of 0.57, whereas the results in the other phases (late absorption and elimination) gave an average B/V ratio of 0.89, a spread from 0.32 to 1.28, and a standard deviation of 0.19. It would appear that the blood ethanol levels can be estimated using B = 1.29 V for early absorption phase cases and B = 0.89 V for cases in subsequent phases. The former relationship would underestimate the blood ethanol levels in cases of very early absorption phase and the later overestimate the levels of late elimination cases. The ethanol distribution results in cases of fatal road traffic accidents and suicides by falling, in which 69% of the deceased sustained some form of head injury, were found to be similar to those of other postmortem cases. The observations reflect that vitreous humor, being reasonably protected, is likely to survive certain traumatic deaths and be available for postmortem ethanol investigation. The U/B ethanol ratios recorded in this work had an average of 1.29, a range from 0.19 to 5.19, and a standard deviation of 0.48.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A fatality due to ingestion of zolpidem, a recently developed nonbenzodiazepine hypnotic, and acepromazine, a phenothiazine sedative used in veterinary practice, is reported. Both drugs were identified and quantified using high-performance liquid chromatography with diodearray detection. Zolpidem and acepromazine blood concentrations were 3.29 and 2.40 μg/ml, respectively. It is the first report of a death involving either of these two drugs. The results are discussed in the light of the existing literature and may suggest a reciprocal potentiation of the toxic effects of zolpidem and phenothiazines.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The medium-chain acylcoenzyme-A dehydrogenase enzyme (MCAD) is involved in the initial stages of breakdown of medium-chain-length fatty acids in mitochondria. A deficiency of this enzyme can become symptomatic during a catabolic state and may resemble Reye syndrome. We report the case of a 17-month-old white girl whose 1-day history of vomiting and agitation followed by generalized unresponsiveness caused her to be brought to a local emergency department. She died after resuscitative efforts failed, and an autopsy revealed severe cerebral edema, marked hepatic steatosis, and steatosis of the renal tubule epithelia. Electron microscopy of the liver showed cytoplasmic lipid spherules and mitochondria with dense matrices, changes similar to Reye syndrome; however, postmortem examination of the decedent's blood revealed elevated medium-chain-length acylcarnitines diagnostic of an MCAD deficiency. Although uncommon, a deficiency of this enzyme should be considered in apparent Reye syndrome victims.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Autopsy examination performed on a 75-year-old woman who had been in a minor road traffic accident revealed an occipital lobar hematoma with subdural extension. Histological examination of brain tissue showed the presence of severe cerebral amyloid angiopathy. Diagnostic techniques and correlation and interpretation of these findings are discussed.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Foreign bodies being forced into the esophagus as a form of fatal child abuse is rare. A 4.5-month-old female infant presented to clinicians with respiratory distress. Several coins were recovered from the esophagus. One month later, she was found dead in her crib. At autopsy, there were three coins in the esophagus. In addition, there were cutaneous contusions of various ages, acute and partially healed fractures of the extremities, old aspirated foreign material in the lungs, and pulmonary fat emboli. Although the fat emboli may have contributed to the death, several potentially fatal mechanisms from the esophageal foreign bodies deserve consideration. These include vagal stimulation from esophageal distention, aspiration of swallowed fluids after esophageal obstruction, compression of the trachea or the heart by the coins, and cardiac compression or airway occlusion by the introducing finger.

ISSN:0195-7910    

出版商:OVID    

年代:1993

数据来源: OVID