SCUBA tank corrosion as a cause of death.

Corrosion of compressed air breathing tanks may result in dangerous oxygen depletion. In every SCUBA mishap the residual air should have, as one of the tests, a measurement of oxygen content. The tank should also have a visual inspection. All compressed air breathing tanks should have a routine visual inspection on a regular basis, even if the tank is made or lined with corrosion resistant material.     

Sudden death due to a central neurocytoma.

The central neurocytoma is a common, usually intraventricular tumor with bland histologic features. We report a case of a 51-year-old man who died suddenly. At autopsy, a neurocytoma with acute hemorrhage filled the anterior left lateral ventricle. The tumor matrix and surrounding brain tissue contained accumulations of hemosiderin. Previously, 2 cases of central neurocytoma with associated hemorrhage have been reported. Hemorrhage appears to be a serious complication associated with these neoplasms.     

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.     

监禁中猝死综合征

监禁中猝死综合征是由于高度紧张或躁动状态下,以及其他因素诸如酒精或其他药物的使用、犯人自身的生理情况、特定的强制性体位等因素共同作用下,发生被监禁人员死亡。由于其发生意外,缺乏特征性的尸检结果和毒物分析结果,而成为法医病理学工作者在法医鉴定实践工作中遇到的一个难题。本文总结了相关的危险因素,如犯人的精神状况、药物的使用、被擒拿时所处的体位以及肥胖等,为有效地预防此类事件的发生和法医鉴定工作提供参考。     

Sudden death due to intravascular hemolysis after bladder irrigation with distilled water.

A 45-year-old white man was hospitalized with gross hematuria, one month after cystoscopy and biopsy for the same complaint. The biopsy revealed cystitis glandularis. One day after admission, he developed seizures and died within hours. Autopsy, laboratory tests, and further questioning of the hospital staff showed that he died of acute hyponatremia and massive intravascular hemolysis after irrigating the bladder with sterile water. Two deep bladder ulcers with exposed veins served as the portals of entry. Until now, this fatal complication had been described only during transurethral surgery. Both a careful autopsy and hospital investigation is necessary to differentiate in-hospital natural death from iatrogenic fatality.     

Sudden death in angiodysplasia of the gastroesophageal junction.

A 22-year-old Korean soldier, who had received blows to the neck and epigastrium from an officer 10 h earlier, suddenly died after massive hematemesis. He had been in relatively good health except for episodes of blood-tinged vomiting approximately 5 and 7 months prior to this event. Postmortem examination revealed angiodysplasia involving the gastroesophageal junction, and the stomach was distended with blood. No abnormal findings were present around the whole viscera, and the duodenum was free of blood. The pathologic significance of upper gastrointestinal angiodysplasia as a potential source of bleeding and a chronologic correlation between the trauma and bleeding are discussed.     

Sudden death due to lymphoplasmacytic hypophysitis.

We report the case of a 37-year-old mentally retarded woman who died suddenly with premortem clinical signs of diabetes insipidus. At autopsy, her pituitary was infiltrated and destroyed by a lymphoplasmacytic infiltrate, affecting the posterior pituitary more severely than the anterior pituitary. Vitreous electrolytes showed a pattern of hypertonic dehydration, compatible with diabetes insipidus.     

Sudden death in the alcoholic

A study of victims of alcohol abuse was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida. During the year 1983, all cases in which alcoholism, either acute or chronic, was the cause of death primarily or contributory in a natural or accidental manner of death were collected. These 118 cases were then analyzed as to the age, race, sex, and cause of death of the victim along with the blood alcohol content, the drugs detected at autopsy, the scene circumstances, the geographic location of the terminal incident, noting whether or not there was a history of drinking prior to the terminal incident, the average weights of key target organs, and the histopathology of the liver. The most common victim is an older (greater than 50 years) white male who dies from "chronic alcoholism" with a terminal negative blood alcohol. This victim is usually "found dead" at home with a past history of drinking, and histopathologically the liver depicts fatty metamorphosis rather than cirrhosis.     

Sudden death in cardiac myxoma

Nonmalignant tumour (heart myxoma) is often a cause of sudden death. Morphological investigation of 11 heart myxomas (8 in the left atrium, 1 in the right atrium) was performed. These myxomas were generally attached to endocardium in the area of the oval foramen. Sudden death occurred due to infarction of the brain, heart and other vitally important organs as a result of embolism of greater circulation vessels by disintegrated tumour located at the left side of the heart, then due to lung failure caused by embolism of lesser circulation vessels by tumour located at the right half of the heart, and due to heart failure as a result of occlusion of atrioventricular foramen by big myxoma.     

Sudden death in hemodialysis patients

Hemodialysis patients may die suddenly and unexpectedly from a number of causes. These may be divided into those deaths due directly to and occurring during hemodialysis, those deaths occurring while the patient is not undergoing dialysis, and those deaths that may occur at any time. The first group includes brain herniation, air embolism, acute hemorrhage as a result of machine malfunction or fistula rupture, electrocution, cardiac arrhythmia caused by hypokalemia, complications of subclavian intravenous catheter insertion, third-degree heart block as a result of triglyceride emulsion, and disseminated intravascular coagulation (DIC) or hyperkalemia caused by overheated dialysate. The second group includes deaths due to pericardial tamponade because of effusion and suicidal causes of death (exsanguination, electrolyte imbalance as a result of excessive intake of salt, fluid, or potassium) as well as more conventional methods of suicide. The last category includes people dying of arteriosclerotic cardiovascular disease, hypertensive cardiovascular disease, and internal hemorrhage. Investigation of these deaths, including pertinent historical, laboratory, and autopsy data and investigation of dialysis equipment, is discussed.     

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.     

Sudden death in urticaria pigmentosa

A case of sudden death of a 25-year-old man, with a six years history of Urticaria pigmentosa, is reported. On a cold morning in November he was found lying dead on the lawn. Histology revealed no signs of systemic mastocytosis. The biochemical investigations (high free histamine level in urine) in addition to a BAC of 0,72 mg/g and the scene conditions (cold irritation) explained the mechanism of death, a systemic anaphylactoid reaction.     

Sudden death as a complication of bacterial endocarditis

Three cases are reported to demonstrate the range of possible lesions and wide variation in lethal mechanisms that may be found in cases of unexpected death subsequently shown to be due to bacterial endocarditis. Case 1: A 36-year-old man was found dead on his bedroom floor surrounded by drug paraphernalia. At autopsy, acute myocardial ischemia was present caused by coronary artery ostial occlusion complicating acute bacterial endocarditis of the aortic valve. Case 2: A 54-year-old man with chronic renal failure was found dead in bed at home. At autopsy, a left middle cerebral artery territory cerebral infarct was present due to septic embolization from bacterial endocarditis involving the aortic valve. Case 3: A 23-year-old man was found collapsed in a pool of blood. At autopsy, upper airway hemorrhage from an arteriobronchial fistula was present caused by septic pulmonary infarction from previous endocarditis of a congenital ventricular septal defect. This report demonstrates that bacterial endocarditis may still be a cause of sudden and unexpected death presenting to forensic mortuaries and that the underlying mechanisms may involve complex sequences of pathological changes that compromise vascular function.     

Sudden unexpected death in epilepsy: a retrospective study

Patients with epilepsy have a mortality rate higher than that of the general population; sudden unexpected death represents a significant category of mortality in these patients. The precise frequency of occurrence of sudden unexpected death in epilepsy (SUDEP) is not well defined, with a range of 1 in 370 to 1100 in the general epileptic population. A major difficulty with incidence studies is the continued reluctance in using the term SUDEP as a cause of death, making reliance solely on death certificates inconsistent and incomplete. Knowledge about SUDEP remains limited, as no single common risk factor has yet been identified, although predisposing conditions have been suggested. The purpose of this study is to review the association between several clinical variables and SUDEP to elucidate risk factors. The characteristics of the 67 cases in this series correlate with published findings in previous studies. Attributes that may be used to define an at-risk group of epileptics include age less than 40 years, male gender, long history of seizure disorder, undermedication or poorly controlled seizure activity, and mental or physical stress. Education of physicians as to the existence of SUDEP and risk factors is imperative in improving patient education and reduction in mortality.     

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 due to unsuspected coronary vasculitis.

Coronary artery vasculitis is a well-recognized complication of polyarteritis nodosa and is occasionally seen in other forms of systemic vasculitis. However, involvement of the major epicardial coronary arteries leading to myocardial infarction and death is uncommon. Isolated coronary arteritis is even more rare. We report three cases of sudden death due to myocardial ischemia associated with arteritis of the major coronary arteries. All three decedents were previously healthy young to middle-aged men who had died suddenly after complaints of chest pain and shortness of breath. The autopsy findings and differential diagnoses are presented. Such cases are of particular interest to the medical examiner because of the sudden, unexpected nature of the deaths. An approach to the correct diagnosis is discussed.     

Sudden death from hyponatremia and hypokalemia in a woman with Gardner syndrome.

The authors present the case of a 39-year-old woman with Gardner syndrome who died from marked hyponatremia and hypokalemia. Gardner syndrome is a rare variant of the familial adenomatous polyposis syndrome in which the affected individual develops thousands of polyps within the gastrointestinal tract, with a 100% risk of eventual malignant change. Individuals with Gardner syndrome also develop a variety of extra gastrointestinal abnormalities. In the case presented, a woman with a clinical history of Gardner syndrome who had previously undergone a total colectomy with ileorectal anastomosis presented to the hospital with a recent history of sore throat, fever, diarrhea, and abdominal pain. The symptoms were considered clinically to be due to a viral gastroenteritis. She was admitted to the hospital, where she had episodes of collapse believed to be vasovagal in origin. She suffered a cardiorespiratory arrest and died 24 hours after admission. After her death, electrolyte estimation performed on blood taken shortly before death revealed severe hyponatremia and hypokalemia. Postmortem examination showed the gastric mucosa to be virtually covered by innumerable adenomatous and hyperplastic polyps. Fewer polyps were seen within the small bowel. There was no evidence of malignancy. The features were consistent with Gardner syndrome. Hyponatremia and hypokalemia have been described in patients with villous adenomas and in familial adenomatous polyposis syndromes associated with numerous colonic polyps. The cause of death in this case was considered to be hyponatremia and hypokalemia associated with florid gastric polyps in a woman with Gardner syndrome. Viral gastroenteritis contributed to the death by causing further electrolyte depletion. To the best of the authors' knowledge, death in Gardner syndrome has not been described as attributable to such metabolic disturbance, in particular in those who have only gastric, small bowel, and rectal polyps remaining after total colectomy.     

Sudden cardiac death and right ventricular dysplasia.

Right ventricular cardiomyopathy dysplasia, now a well-established clinical and morphologic entity, was first reported in the medical literature in 1982. The cases of sudden death of two young men are here reported, with macroscopic and histologic findings. The anatomical explanation of such death was a fibrotic, lipomatous, or fibrolipomatous replacement and infiltration of the myocardium of the right ventricle. It is suggested that death due to right ventricular cardiomyopathy seems to be the result of electrical instability of right ventricular myocardium. There were no congenital malformations such as septal defect or valvular deformity. The subjects' heart weights were normal. Signs of myocardial degeneration and necrosis with or without inflammatory infiltrates were not identified.     

Sudden coronary death in Copenhagen city

In 1968 and 1972 – 1973 investigations in Copenhagen city were performed in order to acquire data concerning the occurrence of acute ischaemic heart disease (AIHD), including sudden coronary death (SCD).The incidence of AIHD was 0.4 % with a total mortality of 56 %. Of all patients with AIHD 40 – 45 % terminated in SCD, being responsible for about a quarter of all deaths in Copenhagen city at that time. Patients suffering CSD had more seldom a previous history of ischaemic heart disease (IHD) than patients with AIHD not complicated by cardiac arrest/SCD.Patients with a previous history of IHD and/or prodromal symptoms had a longer decision time before calling a doctor or an ambulance than patients without such symptoms, especially the elderly. The decision time was neither affected by the day of the week nor the month of the year with regard to the occurrence of cardiac symptoms. On the other hand, the mean decision time was significantly longer if symptoms began between 12 midnight and 8 a.m. compared with the other times of the day.The study showed finally that younger people are more liable to die from SCD outside hospital than the elderly.