Subcapsular hematoma in fatty liver of pregnancy

A case of fatty liver of pregnancy with subcapsular hematoma of the liver caused by intravenous heparin treatment is reported. The heparin was given for the thrombophlebitis of leg veins. The patient expired suddenly as a result of rupture of the subcapsular hematoma of the liver causing massive intraperitoneal hemorrhage. The pathophysiology and complications of the fatty liver of pregnancy are discussed.     

实验性脑死亡脑外器官变化

研究了原发性脑死亡垂体、肾上腺、胰腺、脾脏等脏器宏观、微观及超微结构的变化规律．结果如下：（1）胰腺腺泡酶原颗粒减少，胰岛细胞核固缩；（2）脾脏被膜下出血，脾窦扩张淤血；（3）肾上腺皮质及髓质细胞疏松，胞核浓缩；超微结构可见束状带细胞线粒体嵴消失，核质溶解；（4）腺垂体细胞核变小，胞质出现空泡，神经垂体胶质细胞增生，纤维组织排列紊乱，染色浅淡；（5）原发性脑死亡可以引起脑外器官包括垂体、肾上腺、胰腺、脾脏的形态结构变化，但远比脑组织本身的变化轻．     

Sudden death due to delayed rupture of hepatic subcapsular hematoma following blunt abdominal trauma

Blunt abdominal trauma can cause sudden, unexpected death due to injuries to internal organs. Rupture of a hepatic subcapsular hematoma is a relatively rare cause of sudden death following minor blunt abdominal trauma. Death may be delayed several days to weeks. The autopsy is an invaluable diagnostic tool that can be utilized to uncover sudden deaths due to abdominal trauma. The case of an alcoholic who died of a ruptured hepatic subcapsular hematoma is presented. The death investigation revealed that the victim had sustained blunt abdominal trauma during a fall a few days prior to death.     

Isolated peliosis of the spleen: report of 2 autopsy cases

Isolated peliosis of the spleen, characterized by the gross appearance of multiple cystlike, blood-filled cavities on cut surfaces of the organ, is a very rare pathologic entity that has been reported in 33 cases to date. We present 2 additional cases of isolated peliosis of the spleen observed at autopsy and confirmed by histology. In both cases investigated, cirrhosis of the liver was present. We hypothesize that local microcirculatory disturbances manifesting under altered local intravascular pressure conditions in the spleen may, at least to a certain degree, be responsible for the peliosis-associated vascular lesions. For the forensic pathologist, isolated peliosis of the spleen represents more than just another morphologic curiosity. The significance of peliosis lienalis lies in the potential of (1) overlooking the correct diagnosis as the cause of a spontaneous splenic rupture with intraabdominal hemorrhage, thus leading to the false conclusion of a violent death; and (2) misinterpreting the macromorphological appearance of this rare disease, also in the absence of splenic rupture, as a result of blunt force trauma.     

Pathology of peliosis

Peliosis is a pathological entity characterized by the gross appearance of multiple cyst-like, blood-filled cavities within parenchymatous organs. Peliosis has been related to several underlying debilitating illnesses such as tuberculosis, hematological malignancies, the acquired immunodeficiency syndrome (AIDS), and post-transplant immunodeficiency, as well as intravenous drug abuse, chronic alcoholism, and in conjunction with the intake of oral contraceptives or steroids. The classical pathoanatomical concept is based upon the opinion that peliosis exclusively develops in organs belonging to the mononuclear phagocytic system (liver, spleen, bone marrow, and lymph nodes). However, a paucity of studies indicates that other organs such as lungs, parathyroid glands, and kidneys may be affected too. Concerning the underlying pathogenetic mechanisms of onset and maintenance of peliosis, the morphological data obtained by different investigators suggest that there is more than one path of formal pathogenesis (e.g., congenital malformation of vessels manifesting under altered local intravascular pressure conditions, acquired vascular disorder triggered by toxic noxae, active proliferation of vessels corresponding to the benign end on the spectrum of neoplastic vascular lesions). In the liver, at gross inspection, the peliotic lesions give the cut sections a "swiss cheese" appearance. Microscopically, two different types of peliosis can be distinguished in the liver: (1) "parenchymal peliosis" consisting of irregular cavities that are neither lined by sinusoidal cells nor by fibrous tissue, and (2) "phlebectatic peliosis" characterized by regular, spherical cavities lined by endothelium and/or fibrosis. One of the differential diagnoses that most closely resembles peliosis hepatis is secondary hepatic congestion due to veno-occlusive disease or the Budd-Chiari syndrome. In the spleen, the peliotic lesions may be arranged sporadically, disseminated, or in clusters in an uneven distribution pattern. Histologically, the cavities show frequently well-demarcated margins that may appear focally lined by sinusoidal endothelium, or totally lack a clear cell lining. Differential diagnoses are hemangiomas and involvement of the spleen in hairy-cell leukaemia. Since the disease may culminate in spontaneous rupture of the affected organ and thus may mimic a violent death at autopsy, peliosis is far more than just another morphological curiosity. Awareness of peliosis at autopsy as well as an appreciation for the histopathological changes in less characteristic or advanced cases may become an important issue for both the forensic and clinical pathologist.     

Diving-related fatalities caused by underwater explosions: a report of two cases.

The authors report two cases of diving-related water blast with fatal outcome resulting from nearby underwater explosions. Water blast with fatal outcome almost exclusively occurs in wars at sea. Underwater explosions are extremely rare in diving because of the limited exposure. Forensic findings in both cases reported included expected injuries to gas-filled organs such as the middle ear, lungs, and intestine; some rarely described injuries such as rupture of the liver, spleen, and kidneys; and also some lesions that were not found in a search of the literature: rupture of the heart and contusion of the hypophysis. Injuries caused by fatal underwater explosions should be carefully evaluated in forensic medicine to provide data that may support a criminal investigation.     

Unusual skin lesions mimicking bruises caused by Pseudomonas septicemia secondary to undiagnosed peripheral T-cell lymphoma in a young woman

We present a case of a 30-year-old woman with learning difficulties who was found dead at home by her mother. Her body was partially naked and covered in a number of unusual skin lesions with a targetoid appearance with red erythematous centers and well-delineated halos of pallor. These lesions were initially thought to be bruises by the police and by a forensic postmortem instigated. Postmortem examination also identified hepatosplenomegaly, severe lymphadenopathy, and focal patchy colonic ulceration. Histologic examination of the skin and bowel ulcers showed the lesions to be areas of infarction caused by Pseudomonas aeruginosa vasculitis. Pseudomonas was also cultured from the swabs of the abdomen, the spleen, and the blood cultures. Histologic findings of the lymph nodes showed complete effacement of the normal architecture by a population of pleomorphic small lymphoid cells. Immunohistochemistry confirmed the predominant cell type to be T-cells. The diagnosis of peripheral T-cell lymphoma was made. The cause of death was given as Pseudomonas septicemia secondary to immunocompromise resulting from the undiagnosed peripheral T-cell lymphoma. The pathogenesis of Pseudomonas and its association with malignancy is discussed along with a brief review of peripheral T-cell lymphomas. This case report demonstrates the characteristic macroscopic appearance of cutaneous Pseudomonas-associated lesions and how they can be misinterpreted as bruises.     

Sudden death from tubercular myocarditis

Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.     

The forensic medical significance of morphometry of the spleen in drug addiction and chronic alcoholic intoxication

Data on histomorphologic damage to the spleen in chronic narcotic and alcoholic intoxication are described. The below features are recommended for the diagnosis of chronic exogenous intoxication: thickening and sclerosis of the spleen connective structures and a lower count of lymphocytes in the white pulp. The diagnosis criteria of chronic intoxication by intravenously administered opiates are: hyperplasia of the spleen follicles as well as a higher quantity of plasmocytes and of eosinophiles in the white pulp. Hypotrophy of the spleen lymphoid follicles and higher counts of monocytes and macrophages in the lymphoid follicles should be also regarded as a sign of chronic alcoholic intoxication. The obtained data can be used by forensic medical experts in the diagnosis of chronic narcotic intoxication and in its differential diagnosis versus alcoholic intoxication.     

人脾脏细胞核DNA含量与死亡时间关系的图像分析

目的研究人脾脏细胞DNA含量改变与死亡时间的关系。方法选取36例已知死亡时间的人体脾脏,在死后5～36h内逐时进行细胞学涂片、Feulgen Vans染色观察,并用图像分析系统,测定脾脏细胞核积分光密度、平均灰度等灰度参数,所得数据用SPSS软件分析。结果在5～36h内平均光密度、积分光密度、平均灰度均值均与死亡时间显著性相关,并得出对应的回归方程,其中平均光密度、积分光密度随死亡时间的延长而逐渐减小、平均灰度逐渐增大。结论人脾脏细胞核DNA含量改变呈现一定规律,与死亡时间明显相关。     

Potentialities of histological examinations of the spleen in the diagnosis of alcoholic and narcotic intoxication

Qualitative changes observed in the spleen in chronic narcotic and alcoholic intoxication are described. The below signs are recommended for use in the diagnosis of chronic exogenous intoxication: an increased thickness and sclerosis of the splenic connective structures and myelosis of the red pulp. The diagnostic criteria of chronic intoxication with intravenous opiates are the below changes in the spleen: hyperplasia of the splenic follicles, germinative foci in the follicles' stases and folds in vessels, edema of the vascular wall, hyperemia of follicular arteries and diapedetic hemorrhages. Hypoplasia of the follicles and venous hyperemia of the spleen should be regarded as signs of chronic alcoholic intoxication. The data obtained within the case study can be used by forensic medical experts in the diagnosis of narcotic and alcoholic intoxication.     

Spleen and portal lymphnode pathology in fatal drug addiction

Spleen and portal lymphnode sections from 86 drug addicts submitted for medico-legal autopsy at the Institute of Forensic Medicine in Copenhagen in the year 1979 were studied together with tissue sections from 24 "normal" persons. In 70% of the drug addicts the spleen weight was more than 200 g, and in 71% portal lymphnode hyperplasia was found. Birefringent foreign material was found in spleen tissue of drug addicts in 72% and in portal lymphnode tissue in 44%. Signs of antigen stimulation in both spleen and portal lymphnode tissue evaluated by the number of germinal centre and plasma cells were found in more than 80% of the drug addicts compared with about 20% of the "normal" persons. The results were related to anamnestic information of duration of drug abuse, to the spleen weight, to the occurrence of birefringent material and to the liver changes. Examination of lysozyme and immunoglobulin containing cells using the indirect preoxidase technique was performed in a total of 72 cases of spleen tissue, 59 cases of portal lymphnode tissue from drug addicts, 24 cases of spleen tissue and 18 of portal lymphnode tissue from "normal" persons. Lysozyme, IgM and IgG containing cells were found significantly more often among drug addicts than "normal" persons. The results indicate that the splenomegalia and the portal lymphnode hyperplasia often found in drug addicts are caused by continuous antigen stimulation due to repeated injections of various antigens.     

Liver and spleen ruptures in authentic car-to-car side collisions with main impact at front door or B-pillar.

Seventy-nine belt-protected front seat occupants sustained authentic car-to-car side collisions with impact at front door or B-pillar in which energy equivalent speed (EES) and delta V had a highly significant influence on the occurrence of liver and spleen ruptures. From an EES greater than or equal to 40 km/h the risk of suffering liver and spleen injuries proved to be much higher for occupants on the impact side. Drivers on the impact side often had combined liver and spleen ruptures, front seat passengers had only liver ruptures and combined liver and spleen ruptures. The number of rib fractures on the left or right had a highly significant influence on the occurrence of liver and spleen ruptures. Liver ruptures and combined liver and spleen ruptures were often combined with pelvic ruptures.     

Fatal renal hemorrhage after extracorporeal shock wave lithotripsy

Renal hematoma is one of the most severe complications of extracorporeal shock wave lithotripsy (ESWL). ESWL is used in the noninvasive treatment of urinary calculosis. The shock waves can lead to capillary damage, renal parenchymal or subcapsular hemorrhage. We present a case with fatal complication and the result of the medico-legal evaluation. A 71-year-old woman was treated by ESWL, renal hematoma was detected during the clinical observation, and the patient died. The death occurred despite close clinical observation as a consequence of a rare complication of ESWL. The mechanism of death was hemorrhagic hypovolemic shock due to renal hemorrhage complications due to ESWL for treatment of renal calculi. This therapeutic complication is a known complication of appropriate treatment.     

Fatal poisoning with blue vitriol

Cases of fatal poisoning with cupric compounds are relatively rare in everyday life and are not covered much in forensic literature. A case was encountered of fatal poisoning with a blue vitriol solution introduced into the uterine cavity in order to interrupt a pregnancy. A 39-year-old woman brought to the hospital by ambulance complained of pain in the lumbar region and profuse bloody genital discharge, which had appeared 3 days earlier. She believed she was 2 months pregnant and denied artificial interruption of the pregnancy. Upon examination, her condition was grave: a weak pulse of 80; blood pressure 100/60. The abdomen was soft, the liver and spleen not enlarged. Pasternak symptom was negative. The uterus was soft, painless and enlarged to 9 weeks of pregnancy. The uterine cervix was clean, the orifice closed. Discharge was profuse and bloody. The diagnosis was that she was 9 weeks pregnant and had a missed criminal abortion. Scraping out the uterus and corresponding therapy to control bleeding were ineffective. An operation was performed--extirpation of the uterus. However, despite the steps taken, the bleeding did not stop, and the patient's condition continued to worsen. 10 hours after being admitted to the hospital, she died. During forensic investigation, diffused, violet-colored cadaverous spots were discovered. Extensive subcutaneous hemorrhage was detected around the areas of injection. The skin covering was edematous; when pressed with a finger, areas of depression remained. There was about 250 ml of watery blood in the abdominal cavity. Internal organs were anemic. There were multiple subpleural, subepicardial, subcapsular, intraorgan and intramuscular micro- and macro-punctate hemorrhages; bleeding into the mucosa of the gastrointestinal tract and urinary tracts; and cerebral and pulmonary edema. Forensic histological examination showed acute circulatory disturbance with perivascular and peridiapedetic hemorrhage; concentrations of aggregated and hemolyzed erythrocytes in the small vessels and capillaries; cerebral, pulmonary and stromatic edema. In the kidneys there was coaugmentation of renal glomeruli; epithelial necrosis of part of the coiled ducts; lower epithelium in places had pigment grains; primarily in openings of straight ducts there were pigment cylinders; extreme plethora of the surrounding area, and infiltration from annular cells and polynuclears. Forensic chemical analysis showed 12.8 mg of copper; 6.6 mg in the uterus and 5.6 mg in the kidneys. From data obtained it can be concluded that the patient died from cupric compound poisoning, complicated by interruption of the pregnancy and uterine hemolytic hemorrhage. It was later established that during the month before being admitted to the hospital the patient introduced a solution of blue vitriol into the uterine cavity to interrupt the pregnancy.     

Tissue disposition of cocaine in man: a report of five fatal poisonings

The disposition of cocaine in five cases of fatal poisoning are presented. The highest concentrations of cocaine were found in urine, kidney, spleen, brain, lung and skeletal muscle. Cocaine concentrations in these organs far exceeded those in blood. Cocaine was detected in all other specimens tested including: bile, heart, liver, vitreous and adipose tissue. These results are in agreement with limited, previously reported, tissue data, and indicate that when urine is not available, kidney, spleen, brain and/or lung should be the specimen of choice for cocaine detection.     

Exogenous Lipoid Pneumonia as a Contributory Factor in a Drug‐related Death

Postmortem investigation often reveals various conditions, which may or may not have played a part in the death of the individual. The case of a 32‐year‐old woman is reported, with a long history of drug addiction. She was found dead in her bed. The autopsy revealed diffuse pulmonary edema with congestion of the lungs, brain, liver, and spleen. Microscopic examination of the lungs showed multiple intra‐alveolar and interstitial foamy macrophages and extracellular fat droplets surrounded by polynuclear giant cells. Death was attributed to acute polydrug intoxication. As microscopic examination had revealed severe pulmonary lesions, lipoid pneumonia was considered as a contributing factor to death. Lipoid pneumonia is an uncommon entity with the characteristic radiograph features and histologic findings of alveoli filled with vacuolated, lipid‐laden histiocytes. It can be either exogenous or endogenous in cause, based on the source of the lipid. Exogenous lipoid pneumonia usually results from aspiration or inhalation of fat‐like material, such as mineral oil or petroleum‐based lubricants and decongestants, resulting in pulmonary inflammatory reactions.     

The forensic medical characteristics of the injuries to the spleen in blunt trauma of the abdomen

Analysis of 220 sectional cases with blunt spleen trauma is given in this article. Trauma circumstances, morphologic features of spleen injuries depending on the kind of blunt trauma, mechanism of their formation were studied.     

盐酸曲马多在大鼠体内的分布特点

目的观察盐酸曲马多在大鼠体内的分布及其特点。方法大鼠以3倍和6倍LD50228mg/kg剂量盐酸曲马多灌胃染毒致死,取材,薄层色谱法检测其心、肺、肝、脾、肾、大脑和血内盐酸曲马多的浓度。结果3倍LD50剂量组大鼠肾、肺、血、肝、大脑、脾和心组织盐酸曲马多的浓度分别为112±15、59±17、53±31、32±19.7、22±11.5、20±20、16.7±8.3μg/g或μg/ml;6倍LD50剂量组大鼠血、肺、肝、心、肾、大脑和脾中盐酸曲马多的浓度分别为107.6±7.2、26.3±20、11.7±6.6、11.2±7.2、10.3±3.6、6.38±0.2、6.1±0.3μg/g或μg/ml。结论3倍LD50剂量组大鼠,肾、肺、血内盐酸曲马多浓度最高;6倍LD50剂量组大鼠血、肺、肝中盐酸曲马多的浓度最高。盐酸曲马多中毒时,血、肝、肺和肾可以作为法医毒物分析的检材。     

Organ weight effects of drowning and asphyxiation on the lungs,liver, brain,heart, kidneys,and spleen

An examination of the organ weights associated with victims of drowning, asphyxiation and trauma was undertaken to determine (a) the effects of asphyxiation compared to a trauma group, and in turn, (b) the effects of drowning compared to an asphyxiation group. Included in the study were 217 drowning deaths, 166 pure asphyxiation deaths and 381 trauma deaths. The effects of asphyxiation (compared to trauma) resulted in elevated mean organ weights for the lungs, liver, kidneys and spleen (with mean increases of 17.8, 10.5, 10.3 and 23.4%, respectively). Effects of drowning (compared to asphyxiation) resulted in elevated mean organ weights only with the lungs and kidneys (with mean increases of 30.0 and 4.4%, respectively). Only the mean heart and brain weight remained constant across all experimental groups. A picture of drowning is suggested in which elevated lung and kidney weights are the result of both asphyxiation and the aspiration of water that occurs with drowning, whereas elevated spleen and liver weights in drowning victims are associated with only the effects of asphyxiation. In addition, the common autopsy finding of a small, anemic spleen in drowning, rather than caused by some pathophysiological mechanism of death, is hypothesized to be a postmortem phenomenon.