Simultaneous sudden infant death syndrome: a case report.

The first reported case of simultaneous sudden infant death syndrome (SSIDS) in Allegheny County, Pennsylvania, occurred on February 27, 1998. Two-month-old black fraternal twin girls were both found dead in their crib at the same time. After an in-depth death scene investigation, police investigation, toxicologic analysis, and complete autopsies, a specific cause of death could not be identified. The deaths of the two girls were therefore ruled simultaneous sudden infant death syndrome.     

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.     

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…     

Morphofunctional changes of external male genitalia in alcoholism and substance abuse

The external male genitals (EMG) of male corpses, who abused alcohol and narcotics at lifetime, were examined. The objects were stained according to the common histological and histochemical methods. The study results are indicative of a high frequency rate of pathologic changes of the EMG in persons, who abused alcohol and narcotics at lifetime. The inflammatory, fibrosing and atrophic changes of the EMG as well as a reduced vascular permeability can be a cause for erection malfunction.     

Delayed sudden death in an infant following an accidental fall: a case report with review of the literature

Several controversies exist regarding ultimately lethal head injuries in small children. Death from short falls, timing of head injury, lucid intervals, presence of diffuse axonal injury (DAI), and subdural hematoma (SDH) as marker of DAI are the most recent controversial topics of debate in this evolving field of study. In this area of debate, we present a case of delayed death from a witnessed fall backwards off a bed in a 9-month-old black male child who struck his head on a concrete floor and was independently witnessed as "healthy" postfall for 72 hours until he was discovered dead in bed. Grandmother, babysitter, and mother all independently corroborated under police investigation that the child "acted and behaved normally" after the fall until death. Autopsy showed a linear nondisplaced parietal skull fracture, diastasis of adjacent occipital suture, subgaleal hemorrhage with evidence of aging, small posterior clotting SDH, marked cerebral edema, and a small tear of the midsuperior body of the corpus callosum consistent with focal axonal injury (FAI). No DAI was seen, and there were no retinal hemorrhages. All other causes of death were excluded upon thorough police and medical examiner investigation. Although this seems to be a rare phenomenon, a delayed, seemingly symptom-free interval can occur between a clinically apparent mild head injury and accidental death in a young child.     

Supravalvular aortic stenosis, Williams syndrome and sudden death. A case report

Supravalvular aortic stenosis (SVAS) is an uncommon but well characterized congenital narrowing of the ascending aorta above the level of the coronary arteries. It can be a familial disorder, can occur sporadically, or associated with Williams syndrome (WS) which is a neurodevelopmental disorder affecting connective tissue and the central nervous system. Sudden death is a well-known complication of non-syndromic SVAS but few cases have been reported associated with WS. We present a case of sudden death in a woman with the diagnosis of SVAS and WS since the age of 3 years who refused surgical correction and died at the age of 27 years. At autopsy, the aorta and pulmonary trunk were narrowed and the walls showed peculiar microscopical characteristics. In the cardiac conduction system the His bundle was small and intramyocardial. The incidence, pathology, pathogenesis and prognosis of both conditions (SVAS and WS) are reviewed.     

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.     

Non-diagnosed pheochromocytoma as a cause of sudden death in a 49-year-old man: a case report with medico-legal implications

Pheochromocytomas are known to be rare causes of sudden death. A 49-year-old man with a medical history of arterial hypertension and diabetes mellitus complained about nausea and malaise in the morning. During the day his condition deteriorated. He went to the emergency department, where he was given intravenous drugs against nausea and was sent home. On the way back, his condition deteriorated dramatically so that his wife drove back to the emergency room, where he collapsed and sustained cardiac arrest; resuscitation efforts were unsuccessful. Autopsy revealed a large tumour of the left adrenal gland. The strong suspicion of pheochromocytoma was confirmed by histology, immunohistochemistry and biochemical investigations. An acute hypertensive crisis, caused by the hitherto unknown pheochromocytoma was ascertained as the cause of death. The morphological findings are presented, the difficulty to diagnose pheochromocytoma and the medico-legal implications are discussed.     

Sellar fracture followed by sudden death: an autopsy case

The authors describe a case of sellar fracture followed by sudden death. The victim was involved in a wrangle. The autopsy revealed facial damage and sellar fracture and no evidence of cerebral damage, except for a mild subarachnoid hemorrhage in the left parietotemporal regions and undersurface of both frontal lobes. Sellar fracture is a rare and severe entity, associated with serious complications, which is frequently diagnosed postmortem. In any case, death is rarely a direct consequence of the sellar fracture itself and is usually considered to be the result of associated cerebral trauma. This case prompted us to screen the literature on sellar fracture to gain a better understanding of the mechanism of death.     

Morbus Fahr--considerations on a case of sudden death

This paper presents 21 cases related to cyanide intoxication by oral ingestion. Cyanide concentrations in biological specimens are especially different from the type of postmortem specimens, and very important in interpreting the cause of death in postmortem forensic toxicology. Besides the detection of cyanide in autopsy specimens, the autopsy findings were unremarkable. Biological samples (0.2mL or equal to less than 10μg of cyanide) were analyzed colorimetrically for cyanide. In a series of 21 cyanide fatalities, the concentration ranges (mean±SD) of cyanide in heart blood, peripheral blood and gastric contents were 0.1-248.6mg/L (38.1±56.6mg/L), 0.3-212.4mg/L (17.1±45.1mg/L) and 2.0-6398.0mg/kg (859.0±1486.2mg/kg), respectively. The ranges of the heart/peripheral blood concentration ratio and gastric contents/peripheral blood concentration ratio were 0.3-10.6 (mean 3.4) and 3.4-402.4 (mean 86.0), respectively. From the difference of cyanide concentration and the concentration ratio of cyanide in different types of postmortem specimens, the possibility of the postmortem redistribution of cyanide and death by oral ingestion of cyanide could be confirmed. We reported cyanide fatal cases along with a review of literature.     

Unexpected sudden death of a 12-year-old male with congenital single coronary artery

A rare autopsy case of a 12-year-old male with a single coronary artery is reported in which he suddenly and unexpectedly died after a brief period of physical and mental excitation. The single coronary artery originated from the left aortic sinus, then branched out the left circumflex artery and afterwards descended as the left anterior descending artery, while the right coronary artery originated almost at a right angle from the left anterior descending artery. The entire heart as well as the cardiac conduction system depended exclusively on the single coronary artery for oxygenated blood supply, and the unbalanced blood distribution on his exertion probably led to sudden cardiac death. Moreover, in this case, both the deceased's mother (at the age of 20 years) and grandmother on the mother's side died suddenly, thus suggesting a possibility of maternal transmission of this congenital anomaly in his family.     

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.     

Human herpesvirus-6 and sudden death in infancy: report of a case and review of the literature

Investigation of sudden death in infancy is a vital function of the medical examiner's office. Surveillance of these cases may lead to recognition of new diseases or new manifestations of previously described diseases. Human herpesvirus-6 (HHV-6) is a relatively newly described virus that has been recognized as a cause of acute febrile illness in early childhood. While most cases are apparently self-limited, seven fatal cases have been reported. We present a case of a seven-month-old Latin American male with recent otitis media and vomiting who was found dead in bed. Autopsy revealed interstitial pneumonitis with an atypical polymorphous lymphocytic infiltrate in the liver, kidney, heart, spleen, lymph nodes, and bone marrow, associated with erythrophagocytosis. Polymerase chain reaction (PCR) analysis of formalin-fixed paraffin-embedded tissue was positive for HHV-6 and negative for Epstein-Barr virus (EBV) and cytomegalovirus (CMV). HHV-6 was also detected in the atypical lymphoid infiltrate by in-situ hybridization.     

Pheochromocytoma and sudden death as a result of cerebral infarction in Turner's syndrome: report of a case

Various etiologies for hypertension in Turner's syndrome, a common feature of the disorder, are well recognized. Pheochromocytoma is not among them. A young woman with Turner's syndrome, recently diagnosed with hypertension, died suddenly and unexpectedly. A hemorrhagic cerebral infarct and an adrenal gland pheochromocytoma were found at necropsy. This is the first reported case of pheochromocytoma associated with Turner's syndrome.     

医疗纠纷中135例猝死分析

目的为探讨引起医疗纠纷案例中猝死发生的特点，特别是其年龄、性别、科室、疾病的分布和发生纠纷的原因，为有关单位调处医疗纠纷和制定有关法规提供科学依据。方法自本教研室1955～1996年42a间受理的法医病理学尸检资料中挑选各种医疗纠纷案例；制定统一表格，将其中猝死者逐一登记，并进行统计分析。结果42a中涉及医疗纠纷的淬死135例。其中男87例、女48例。年龄自新生儿～67岁。以新生儿和婴儿居多（67例），男明显多于女；其次为25～34岁的青壮年组（21例），女多于男。近12a发生的猝死（94例）是过去30a（41例）的2．3倍。猝死疾病以呼吸系统最常见（46％），次为心血管系统疾病（25％）；但54例成人猝死者心血管系统疾病占首位（26例），次为泌尿生殖系统疾病（12例）。发生的科室多见于产科和儿科（74例）。结论认为近10年来医疗纠纷中猝死案例明显增多；医疗纠纷中非医疗事故远多于医疗事故；法医病理尸检对正确、合理地调处医疗纠纷，并对探讨猝死的发生机制，反馈、丰富和发展相关临床学科的内容，以及提高诊治水平均具有重要意义。     

Schizophrenia and sudden death: a medical examiner case study.

This study reviews the causes of sudden death of 66 schizophrenic patients who presented to the Office of the Chief Medical Examiner (OCME) for the State of Maryland over a 3-year period from 1994 through 1996. We identified an increased incidence of suicide compared with the general population of OCME cases. This observation is consistent with reports by other investigators. The majority of the deaths were the result of natural diseases, mostly atherosclerotic cardiovascular disease. Accidents, suicides, and 1 homicide were also present in this group.     

A case of sudden cardiac death in connection with Salmonella typhimurium infection

A case of fatal myocarditis in a 24-year-old otherwise healthy man is described. It was possible to cultivate Salmonella typhimurium from the alimentary tract, the blood, the liver and skeletal muscles. The possibility of a solitary myocarditis with fatal outcome due to Salmonella typhimurium infection is discussed. Such a case seems not to have been mentioned previously in the literature.The problems concerning the statistical registration of such a death are briefly discussed.     

A case of sudden death by decidual cell embolism

A 35-year-old multipara died suddenly of a pulmonary embolism about 12 h after delivery. The morphological features and the entry site of the emboli into the circulation suggested that they were decidual cells. Intact decidual cells accounted for only a minority of the emboli: the great majority were cells that had lost their nuclei and/or had been fragmented. The presence of embolized areas, accompanied by fibroblasts and newly formed capillaries, suggested that the embolization process had started before the beginning of labor. However, no symptoms suggesting embolism had been recorded on the clinical chart.     

Coronary artery aneurysm and myocardial infarction resulting in sudden death of a 6 year-old child: a case report

This is a report of a 6-year-old child who died suddenly while at play and without any prior known illness. Autopsy revealed an extensive, fibrotic myocardial infarct involving the apex, diaphragmatic wall of the left ventricle and interventricular septum. The left anterior descending and the right coronary arteries presented with large, bulging calcified aneurysms. The aneurysms showed marked fibrous intimal thickening, atrophy of the media and extensive fragmentation of elastic elements. No evidence of active inflammation was present.