Traumatic rupture of an abdominal aortic aneurysm associated with the use of a seatbelt

Injury to the abdominal aorta after blunt trauma continues to be a relatively infrequent occurrence. In this report, we describe a case of traumatic rupture of an abdominal aortic aneurysm associated with inappropriate seatbelt use.     

Two cases of death associated with the use of lithium carbonate

Two cases of death associated with the use of lithium carbonate are described. The first one concerns a 39-year-old man who was found suddenly dead on his hospital bed. Toxicologic analysis revealed "therapeutic" levels of lithium, nitrazepam, flurazepam, and phenobarbital. The second case involves a 54-year-old woman initially treated for acute cardiac failure and hypertension, who was finally recognized as a case of lithium intoxication; she died of cardiac arrest without evident cardiac lesions and without lithium ions in serum and urine. The medicolegal aspects of both cases are discussed, with reference to the problems of diagnosis, clinical and toxicological correlations, and the medical responsibility.     

Sudden death associated with a cardiac diverticulum.

We describe the unusual case of a 20-year-old Aboriginal man who was admitted to hospital with chest pain. He died 1 day later. Necropsy showed extensive anterior myocardial infarction in the left ventricle. An isolated diverticulum arising from the subaortic valve region of the left ventricle had compressed the left main coronary artery.     

Sudden death associated with food and exercise

Exercised-induced anaphylaxis occurs in conjunction with significant physical exertion. Anaphylaxis occurring when an individual exercise within a few hours of ingesting a particular food is an unusual variant. Cardiovascular symptoms can be the sole manifestation of exercise-induced food allergies, in which case death may mimic sudden cardiac death during physical exertion due to other pathologic causes. We report the sudden and unexpected death of an individual following the ingestion of hazelnuts and almonds, to which the individual was not previously known to be allergic. The decedent collapsed during vigorous dancing. The death was not associated with cutaneous or laryngeal manifestations of anaphylaxis. Awareness of the variable manifestations of food-precipitated anaphylaxis is necessary to correctly establish the diagnosis. An elevated serum tryptase level may be indicative of an allergic reaction, and allergen-specific IgE levels may be used to confirm the particular antigen.     

Sudden unexpected death associated with atlanto-occipital fusion

A case of sudden, unexplained death in a 24-year-old male is presented. There were two previous spells of loss of consciousness. There was remarkable narrowing of the foramen magnum with indentation of the medulla. The atlas was partly fused with the occipital bone and a portion of abnormal bone compromised the foramen magnum from anterior reducing its anteroposterior dimensions to 16 mm (n 25-35 mm). Close clinical examination of this area in patients with acute intermittent symptomatology, or at the time of autopsy in cases of sudden unexpected death is stressed.     

星状神经节麻醉诱发急性心衰猝死1例

案例某男,57岁.主因颈部及左肩部疼痛到某门诊部就治.查体:P80次/分,BP120/80mmHg,颈部活动受限,第6、7颈椎有压痛;左肩关节压痛明显,活动受限.问无心脏病史.     

Sudden cardiac death in a 5-year-old girl associated with parvovirus B19 infection

We report on a 5-year-old girl who suddenly collapsed and died while dancing at a family party. Histological examination of the heart including the cardiac conduction system revealed lymphocytic infiltrations of the sinu-atrial node and perivascular infiltration in the atrio-ventricular region. Additionally, foci of mononuclear infiltrates were observed in the myocardium. Consequently, myocarditis was diagnosed as cause of death. The child also had lymphocytic conjunctivis, parotitis and tracheitis. Evaluation of infections by means of nested polymerase chain reaction revealed parvovirus B19 DNA (PVB19) in tissue samples of the trachea.     

Sudden death associated with a multifocal type II hemangioendothelioma of the liver in a 3-month-old infant

Sudden unexpected death in an infant caused by or associated with neoplasm is rare. We describe a case of a sudden death in an apparently healthy 3-month-old female, in which the autopsy revealed a multiple type II infantile hepatic hemangioendothelioma (IHE). This uncommon tumor has, untreated, a relatively high mortality rate, mainly due cardiac failure resulting from massive arteriovenous shunts, but the association with sudden infant death is very rare.     

Fetal death following maternal trauma: two case reports and a survey of the literature.

When a fetus dies after its mother has suffered trauma, questions often arise about whether the fetal death was linked to the maternal injury. Many state statutes make it a criminal act to cause the death of a fetus by injuring the mother. The authors present two cases in which fetal death resulted from maternal trauma. In addition, we review the pertinent literature on this subject and offer guidelines that may help forensic pathologists evaluate these difficult and often emotionally charged cases.     

The spectrum of intramyocardial small vessel disease associated with sudden death

Intramyocardial small vessel abnormalities are not commonly recognized. The best known abnormality is fibromuscular dysplasia involving the sinoatrial or atrioventricular nodal arteries. Small vessel disease has been reported as an isolated cardiac anomaly in individuals with sudden death, and may also be associated with other cardiac conditions including hypertrophic cardiomyopathy and mitral valve prolapse. The nature of the association is unknown, and the mechanism causing sudden death is sometimes obscure. We describe pathological changes of the intramyocardial small vessels of three individuals with sudden death. Abnormalities involved small vessels at different levels. In all the cases, the abnormalities were thought to have caused or contributed to the individual's death. The possible mechanisms of this are discussed.     

成人非典型急性流脑猝死1例

随着抗生素的广泛使用 ,流行性脑膜炎的发病死亡率已经很低 ,而成人患此病死亡则更罕见 ,[1] 现报道一例 :某男 ,2 6岁。某日被人发现死亡 ,死亡前一天因头痛、头昏、发烧、咽痛到某医院门诊就诊。家属怀疑死亡与临床用药有关 ,要求尸检确定死亡原因。尸检发现 :死者发育正常 ,营养中等 ,颜面部及躯干、四肢皮肤点状或片状出血 ,大小为针头大至 1.5ｃｍ× 1.5ｃｍ ,双眼睑结膜下出血点。左肺 5 5 0 ｇ ,右肺 6 2 0 ｇ ,双肺表面可见出血斑 ,切面未见结节及空洞。心包腔见少量液体 ,心 330ｇ ,心包膜可见出血点 ,冠状动脉及心瓣膜未见明显异…     

成人非典型急性流脑猝死1例

随着抗生素的广泛使用,流行性脑膜炎的发病死亡率已经很低,而成人患此病死亡则更罕见 ,[1]现报道一例: 某男,26岁.某日被人发现死亡,死亡前一天因头痛、头昏、发烧、咽痛到某医院门诊就诊 .家属怀疑死亡与临床用药有关,要求尸检确定死亡原因.     

Common mitochondrial DNA deletion associated with sudden natural death in adults

One of the most frequent causes of death in developed countries is sudden natural death (SND), which is the most common indication for medico-legal autopsies. Cardiac diseases are frequently detected among SND. Mitochondrial DNA (mtDNA) is easily damaged by reactive oxygen species, and it may cause dysfunction in tissues, leading to early events in cardiovascular disease. A specific mtDNA deletion of 4977 bp is associated to aging, myocardial dysfunction, and bioenergetic deficit. The potential link between mtDNA damage and SND has not been investigated before. Our aim was to evaluate the accumulation of the common mtDNA4977-deletion in cardiac muscle samples from autopsies of SND in adults (n = 14) in comparison to control samples from unnatural deaths (n = 12). Serial dilution-polymerase chain reaction method was performed to estimate the proportion of the total mtDNA harboring the mtDNA4977-deletion. Coefficient variation intra-assay was 8%, and inter-assay was 12%. MtDNA4977-deletion percentage was higher in samples obtained from victims of SND than in those from subjects who died of unnatural causes (p < 0.05). No differences in mtDNA4977-deletion were found between SND victims 39-51 years old, and no correlation was found between these samples and age, r = 0.30, p = 0.29 while it was significant among control samples, r = 0.68, p < 0.05. The association between mtDNA4977 deletion with SND victims might offer a tool to provide additional information to clarify complex SND investigations.     

抗生素救治感染性休克死亡2例分析

笔者在检案实践中,遇到两例在应用抗生素输液救治晚期感染性休克患者过程中,突发病情加重死亡。因死于输液过程中,怀疑用药问题,引发纠纷。但经系统病理尸检证实系常规救治的病情转归结果,现予以报道。案情资料【案例1】某男,58岁。反复咳嗽、咯血、胸痛1年余,加重伴发热、呼吸困难2周入院,诊断为“肺癌晚期,肺部感染,支气管扩张”。回家后,由个体医生继续予氨苄青霉素静滴治疗2周。本次予10%GS250ml+氨苄青霉素6.0g(与前同批号)静滴40分钟时,突然病情加重,抢救无效死亡。死后49h尸检所见:尸斑暗红色,恶病质;脑血管淤血,脑回宽沟窄。双扁桃…     

抗生素救治感染性休克死亡2例分析

笔者在检案实践中，遇到两例在应用抗生素输液救治晚期感染性休克患者过程中，突发病情加重死亡。因死于输液过程中，怀疑用药问题，引发纠纷。但经系统病理尸检证实系常规救治的病情转归结果，现予以报道。     

Fatal childhood vascular injuries associated with seat belt use

The deaths of two children who were passengers in motor vehicles involved in accidents were directly attributable to vascular injuries derived from seat belts. In the first case, a 10-year-old boy died as a result of abdominal aortic transection by a lap seat belt, and in the second case a 15-year-old boy died as a result of transection of his common carotid artery by a lap-shoulder seat belt. Although these cases demonstrate rare fatalities associated with seat belt use, there is no doubt that seat belts have significantly reduced mortality and morbidity from traffic accidents. Although it is possible that a fatal outcome might have occurred in each of these cases from other injuries that might have been sustained had seat belts not been worn, appropriate positioning and size of seat belt harnesses might have avoided the lethal injuries.     

Sudden death associated with solitary intracavitary right atrial metastatic tumour deposit.

We report a case of cardiac metastasis of primary adrenal cortical carcinoma to the endocardium of the right atrium resulting in an intracavitary mass which we believe caused sudden death by blocking the tricuspid valve orifice. We have been unable to find a similar case previously reported although primary atrial myxoma is well known to be a rare cause of sudden cardiac death by the same mechanism. Modern non-invasive imaging techniques have facilitated recognition of intracavitary cardiac metastases, and with surgical intervention, when feasible, the risk of sudden cardiac death can be reduced.