Two anaphylactic deaths after chemonucleolysis.

Chemonucleolysis is a procedure for treatment of low back pain due to discogenic disease in which the drug chymopapain is injected into lumbar disks to produce chemical dissolution of the nucleus pulposus. More than 15,000 cases have been treated by chemonucleolysis world-wide. Anaphylaxis after the injection of chymopapain occurs in about 1% of such cases. The two cases described in this paper are the only known deaths due to anaphylaxis. Both patients suddenly became hypotensive after injection of chymopapain into a disk. One patient died shortly after this, whereas the second patient died of the complications of prolonged shock.     

急性钡中毒性脑病1例

急性钡中毒性脑病１例官鹏，刘世沧，李元福华西医科大学法医学系；成都６１００４１成都市公安局金牛区分局；成都６１００００ＡＣａｓｅＲｅｐｏｒｔｏｆＥｎｃｅｐｈａｌｏｐａｔｈｙＣａｕｓｅｄｂｙＡｃｕｔｅＢａｒｉｕｍｉｓｍ￥ＧｕａｎＰｅｎｇ；ＬｉｕＳｈｉｃ...     

Pulmonary thromboembolism following calf cellulitis: report of an unusual complication of dog bite.

We report a case of a 75-year-old woman who died of pulmonary thromboembolism following a dog bite to the calf. The bite caused laceration of the skin and gangrenous cellulitis of leg soft tissues. Six days after hospitalization, the patient died suddenly, despite early antibiotic and heparin administration. Postmortem examination revealed extensive thrombosis of the deep veins of the calf and massive thromboembolism of the main pulmonary arteries.     

Suicide with an unusual shotgun

The authors describe a special case of suicide, committed by a self-constructed nailgun. The inshot-wound, localized in the mouth, primarily remained undiagnosed. The patient survived two weeks and died of pulmonary embolism.     

Herniation of the heart. A death following intrapericardial pneumonectomy

A case is presented involving a patient who underwent an intrapericardial pneumonectomy for lung cancer and died of cerebral hypoxia due to herniation of the heart. The etiology and pathophysiology of cardiac herniation are reviewed.     

Sudden, unexpected death due to cardiac fibroma. Report of a case and review of the literature

A case of cardiac fibroma in a 58-year-old woman with a history of atrioventricular block is described. The patient died suddenly at home 6 days following the insertion of a pacemaker. Review of the pertinent literature is presented.     

Sudden death in mitral valve prolapse: Associated accessory atrioventricular pathways

Sudden death in patients with mitral valve prolapse is a rare complication with a possible arrhythmic mechanism. We made a detailed postmortem examination of the conduction system in three patients with MVP who died suddenly. One patient who died in cardiac failure had a normal conduction system. The two other patients with no cardiac symptoms prior to death had both accessory atrioventricular pathways.These findings suggest a higher incidence than hitherto known of accessory bypass tracts in patients with MVP who die suddenly, and support the presumption of an arrhythmic cause of death.     

Three unusual neuropathologic-related causes of sudden death

We discuss the autopsy findings of three medico-legal cases of sudden death associated with uncommon neuropathologic findings of which the general forensic pathologist may not be familiar. Case 1 was a 43-year-old man who died of a seizure due to malignant melanoma of the temporal lobe associated with neurocutaneous melanosis (NCM). Case 2 was a 57-year-old woman with a history of mental retardation and incoordination because of chronic lead poisoning, who died of a pulmonary thromboembolism due to deep venous thrombosis status post left leg fracture after a fall down a staircase. Autopsy revealed atrophy and gliosis of her cerebellum as a result of childhood lead poisoning. The third patient was a 75-year-old woman who died as a result of acute bacterial leptomeningitis at the cervico-medullary junction with acute inflammation of the connective tissue of her upper cervical spinal column associated with subluxation of her atlantoaxial (AA) joint, also known as Grisel's syndrome.     

Unexpected death as a result of infective endocarditis

Thirteen cases of infective endocarditis (IE) diagnosed for the first time at autopsy or, in those patients with a previous diagnosis of IE, not thought to be active at the time of death, are presented. Of the six patients who died within 24 h of the onset of symptoms, two died of obstruction of a valve orifice, two died of sepsis, one died of sepsis and alcoholic cardiomyopathy, and one died of a coronary artery embolus. Of the five patients with symptoms lasting more than 24 h, three died of sepsis and congestive heart failure. One died from sepsis alone and one died from congestive heart failure (CHF). In two patients whose duration of symptoms is unknown, one died of sepsis and CHF, and in the other the mechanism of death is unknown. Predisposing factors present in 11 of 13 patients included alcoholism (three), intravenous (IV) drug abuse (three), prosthetic valves (three), aortic stenosis (two), past rheumatic fever (one), and nonstenotic congenitally bicuspid valves (two). The reasons for no antemortem diagnosis were a missed or incorrect clinical diagnosis in three patients seen by a physician shortly before death, no signs or symptoms or found dead (four), non-specific signs and symptoms (three), refusal of medical treatment (one), and a solitary lifestyle (one); there was insufficient information about one patient. Individuals with needle tracks, generalized petechiae. Osler's nodes, splinter hemorrhages, intravenous catheters, pacemaker wires, and infected aortic-valve (A-V) shunts are at risk of IE. Blood and the vegetations should be cultured. The attending physician should be notified of the diagnosis in such cases.     

Sudden death in cerebral hemiatrophy

Hemiatrophia cerebri is a rare disease, and the etiology and pathogenesis remain unclear in most cases. In the present case, the marked hemiatrophy of the brain in a 19-year-old patient who died suddenly is attributed to encephalitis during early childhood and subsequent prolonged seizures.     

Detection of the calcium antagonist nicardipine and its metabolites by gas chromatography-mass spectrometry

An 89-year-old male patient, hospitalized with Parkinson's syndrome, suddenly died shortly after an intravenous drug injection. The conditions indicated that an overdose of nicardipine (1.3 mg/(mlkg)) may be given to the patient. At the autopsy, no pathological changes were noted. With a capillary gas chromatograph with mass spectrometer (GC-MS), nicardipine (4.97 microg/ml) and its pyridine metabolite (M-5, 5.0 microg/ml) were detected in the heart blood of the deceased. This result indicated that an overdose of intravenous nicardipine caused a sudden death of a patient in a poor condition.     

A fatality caused by heparin overdose

Because of suspected pulmonary embolism 550.000 I.U. of heparin were administered instead of 55.000 I.U. of heparin within 24 h to a 62 year old patient. The man died because of cerebral hemorrhage the following day. Autopsy findings are reported and difficulties in medical expertise are discussed.     

Suicide by self-removal of a pacemaker

A 70-year-old man extracted his own pacemaker and subclavian port used for delivery of chemotherapy, both implanted 2 weeks earlier. The patient died of septicemia within 6 days. This fatal outcome illustrates the risks of complications associated with severe psychiatric disorders after implantation of prosthetic devices.     

Hypersensitivity myocarditis and hepatitis associated with imipramine and its metabolite, desipramine

We present two cases of myocarditis and hepatitis with histologic characteristics of hypersensitivity-mediated drug reactions associated with imipramine and its metabolite, desipramine. In one case, death was directly attributed to myocarditis; in the second case, the patient died of an acute myocardial infarct, but myocarditis may have played a contributory role. One patient was taking imipramine, and therapeutic concentrations of imipramine and desipramine were documented in postmortem blood. The other patient was receiving desipramine documented by in-patient hospital medication records. Both cases had liver lesions associated in the medical literature with adverse drug reaction to imipramine. Although myocarditis has been previously associated with amitriptyline, these cases appear to be the first reported in association with imipramine/desipramine. The fact that one patient was taking only desipramine suggests that it may be the offending agent.     

A throttled hemophilic who died due to choking

It is the first reported case, in which death occurred due to asphyxia by choking in a victim of throttling. When an alcoholic hemophilic patient was throttled, he became unconscious. On regaining consciousness he died after approximately 16 h due to sub-mucosal collection of extravasated blood which blocked his upper respiratory tract. This paper stresses this unique danger of trauma to neck in hemophilic patients.     

Sudden death in a patient with Von Recklinghausen's neurofibromatosis

Sudden death caused by tumors is uncommon. Death attributable to an unsuspected primary intracranial neoplasm is especially rare. An undiagnosed brain tumor is particularly unusual in a patient with Von Recklinghausen's neurofibromatosis (NF). A young man with known NF, with no manifest central nervous system involvement, died less than 24 hours after plastic surgery. A glioblastoma multiforme was discovered at autopsy.     

Sudden Death After Myocardial Infarction in a High‐School Athlete

Abstract: This is an unusual case of ischemic heart disease occurring in a young female athlete, aged 14 years, in whom almost the entire posterior wall of the left ventricle was affected. The patient collapsed and died suddenly after a vigorous physical activity while resting at home. The ischemic lesion was apparently owing to right orifice stenosis in association with a small hypoplastic right coronary artery.     

Circumflex artery from the right coronary sinus: a not-so-benign anomaly

The origin of the circumflex coronary artery from the right sinus of Valsalva is generally considered a benign anomaly. Herein we report the sudden unexpected death of a 6-year-old boy who died after jumping into a swimming pool and whose only pathologic finding was this usually inconsequential coronary artery anomaly. A discussion of the pathophysiology of the disorder and a literature review are included. This is the youngest patient to die with this entity.     

Sudden infant death due to asplenia syndrome

An apparently healthy 80-day-old boy died suddenly for no apparent reason. The autopsy revealed that the patient had had congenital asplenia, extensive cardiovascular anomalies, and other organ malformations, including trisegmented lungs, hypoplasia of the corpus callosum and cranial bones, a symmetrical liver, accessory hepatic tissue in the adrenal glands, malrotation of the intestine, and hypoplasia of the greater omentum.