Injury of the vertebral artery in suicidal hanging

The vertebral artery was investigated in suicidal hanging for specific forensic, but also general traumatological reasons. The objective was to establish the extent to which the vertebral artery in its relatively protected position is injured at all and if so, in what form. For this purpose, cervical spine preparations with the posterior space of the skull were fixed in formalin and detached in the sagittal plane in 36 unselected cases of suicidal hanging after angiographic visualization of the vertebral artery. Afterwards, both vertebral arteries were visualized, and vascular injuries were compared with injuries of the soft tissues of the neck, of the cervical spine, and of the external types of hanging. The vertebral artery was shown to be injured quite frequently (rupture, intimal tear, sub-intimal hemorrhage), namely in one quarter of all cases, and indeed in more than half taking into account the perivascular bleeding. In this way, frequencies were found which were far in excess of those of the common carotid artery. The different mechanical behavior of these two paired neck arteries in traction are dealt with and the form of injury explained.     

阴茎动脉Doppler超声分析

目的研究健康成年男性阴茎背动脉(DA)、海绵体动脉(CA)PI、RI及S/D的正常值。方法将257名健康成年男性按年龄分为5组,分别为<30岁组65名,30～39岁组83名,40～49岁组61名,50～59岁组38名,60岁以上组10名。用Logidop!2型数字式Doppler超声血流仪检查双侧阴茎背动脉、双侧海绵体动脉PI、RI及S/D值。结果阴茎疲软状态下,阴茎背动脉、海绵体动脉PI、RI和S/D值个体左右比较无差异,各年龄组也无差异。建议正常参考值分别为:(1)LDA:PI1.43～3.43,RI0.72～0.92,S/D2.68～10.56。(2)RDA:PI1.47～3.47,RI0.73～0.93,S/D3.27～10.09。(3)LCA:PI1.49～3.21,RI0.74～0.90,S/D3.17～9.55。(4)RCA:PI1.93～3.27,RI0.72～0.90,S/D3.22～9.42。结论作为一种筛选手段,Doppler超声血流检测手段,有一定的应用价值。     

Morphometric studies of the vertebral artery in infants and small children

The internal circumference of the vertebral artery and the cross-sectional area of its tunica media were measured planimetrically at three different topographical sites in 48 cases of sudden infant death syndrome (SIDS) and 18 reference cases. Based on preliminary determination of the error of measurement, both groups studied showed significant differences between sides. As the degree of differences is often marked, impressive haemodynamic consequences can be expected. The findings are discussed with regard to SIDS.     

Periadventitial extracranial vertebral artery hemorrhage in a case of shaken baby syndrome

We report a case of a two-month-old boy who became unresponsive in the sole custody of his father. Resuscitation efforts on route to the hospital were able to restore the infant's heart beat. However, neurologic function never recovered. Autopsy revealed massive cerebral edema, recent subdural, and subarachnoid hemorrhages, bilateral retinal hemorrhages, and cervical spine ligament hemorrhages. Separation of individual cervical vertebrae showed extensive, bilateral, periadventitial vertebral artery hemorrhages between C1 and C4, with corresponding luminal compression of the vertebral arteries. The importance of this previously unreported phenomena of periadventitial vertebral artery hemorrhage in the setting of shaken baby syndrome is discussed.     

Traumatic dissection of the vertebral artery in a toddler following a short fall

Spontaneous subarachnoid haemorrhage (SAH) in children is uncommon, but is sometimes seen after rupture of aneurysms, and in different disorders. Traumatic SAH is common after serious accidental head injury, but is also reported after child abuse with vigorous shaking. To avoid unnecessary accusations of innocent care givers, it is important not to misinterpret the findings as abusive head trauma in small children with SAH. In the presented case, a nearly two-year-old girl was brought to the hospital after a fall witnessed by her father. The girl was unconscious, with elevated intracranial pressure, SAH and bilateral retinal haemorrhage (RH). She was pronounced dead after 9h. Premortem angiography revealed a dissection of the right vertebral artery, and postmortem examination revealed a traumatic lesion deep in the neck, at the base of the skull. Cerebral edema, in combination with SAH and RH, is highly suggestive of abusive head trauma. However, no external lesions, no skeletal lesions, especially no long bone metaphyseal lesions, or subdural haematomas occurring at the same time as SAH, were found. There was no report of previous child abuse in the family. Based on the radiological and postmortem findings, we believe that an accidental fall caused a blunt force trauma with a subsequent dissection of the right vertebral artery. To our knowledge, accidental tear of one of the vertebral arteries, leading to SAH in a toddler, has previously not been described. Child abuse is an important exclusion diagnosis with serious legal implications.     

Traumatic subarachnoid hemorrhage and extracranial vertebral artery injury: a case report and review of the literature

The case is presented of a 19-year-old man who was assaulted and died shortly afterward from a large traumatic basal subarachnoid hemorrhage (TBSAH) that arose from rupture of the left vertebral artery, proximal to the point at which the artery penetrated the dura. The literature regarding TBSAH and vertebral artery rupture is reviewed, and a number of points are highlighted: patients with TBSAH may remain conscious for a period of hours after injury, subcutaneous or muscular bruising may be contralateral to the ruptured vessel, fractures of the transverse processes of the cervical vertebrae and significant pathology of the vertebral artery are not typically associated with TBSAH, and rupture of the vertebral artery may be intracranial, junctional, or extracranial.     

Lipitor battle in the Netherlands--District Court invalidates Warner-Lambert's EP '281 and holds EP '633 infringed

In the continuing Lipitor (atorvastatin) battle between theIndian company Ranbaxy and Pfizer/Warner-Lambert, the DistrictCourt of The Hague held that Ranbaxy's generic atorvastatinfalls within the scope of protection of EP '633, the main patentcovering atorvastatin, and invalidated another atorvastatinpatent, EP '281.     

The course of respiration and circulation in 'toluene-sniffing'

To investigate the course of respiration and circulation in death by toluene inhalation, 25 dogs were allowed to rebreathe toluene vapor in a 1-1 plastic bag expanded with air, and electrocardiogram (ECG), electroencephalogram (EEG), blood pressure (BP) in the femoral artery and intrathoracic pressure (ITP) were registered. The respiratory movement continued two times longer than that of death by suffocation using a plastic bag of the same size. In the ECG, low voltage of R waves precipitously appeared several minutes after the beginning of the experiment and continued. The BP gradually reduced by half and kept the level for several minutes. The stage was considered toluene narcosis. Toward the end of the respiratory movement, the BP increased gradually. The analysis of the ECG complexes during the toluene inhalation revealed the direct effect of toluene to the septal and ventricular muscle of the heart. But in the end of the respiratory movement, it revealed ST segment elevation and upright T. In a few experimental animals, some of the transient arrhythmia with fluctuation of the BP appeared during the course, and in one of these dogs, fatal ventricular fibrillation occurred suddenly. These findings suggested that in most cases of sudden death in 'toluene-sniffing', the cause of death is severe hypoxia during toluene narcosis, but in a few cases, it is fatal arrhythmia due to the direct effect of toluene to the heart muscle.     

The course of respiration and circulation in death by carbon dioxide poisoning

To investigate the effects of very high concentrations of carbon dioxide (CO2) upon the course of respiration and circulation, dogs were allowed to breathe high concentrations of CO2 while intrathoracic pressure, blood pressure (BP) in the femoral artery, electrocardiogram and electroencephalogram readings were registered. The respiratory movements either increased just after inhalation of high concentrations of CO2 and then ceased in 1 min, or decreased and continued for a while according to the concentrations of CO2. The BP showed an initial depression, then returned to the original level, then fell again rapidly or maintained an appreciable level for a while until circulatory breakdown. In the dogs allowed to breathe the gas mixture of 80% CO2 with 20% O2, the respiratory movement ceased in 1 min, and the terminal respirations were seen with the circulatory breakdown after apnoea of several minutes. These findings showed that the cause of death in breathing high concentrations of CO2 is not hypoxia, but the CO2 poisoning.     

胸腰椎压缩性骨折压缩程度评估方法比较

目的探讨胸腰椎压缩性骨折压缩程度不同评估方法间的差异。方法 1.选取211例胸腰椎压缩性骨折X线片资料,用4种方法以压缩椎体前缘高度分别与其后缘、上一椎体前缘、下一椎体前缘、上下椎体前缘高度均值比较,评估相应压缩程度并比较各方法间的差异。2.选取其中146例,测量压缩椎体相邻上方三个正常椎体高度,比较中位椎体前缘高度分别与其后缘、上一椎体前缘、下一椎体前缘、上下椎体前缘高度均值的差异。结果 1.压缩椎体前缘分别与后缘、上一椎体前缘、上下椎体前缘高度均值评估的压缩程度,两两组间P0.05;但压缩椎体前缘与后缘、下一椎体前缘评估组间P0.05。2.正常中位椎体前缘与后缘、上一椎体前缘、下一椎体前缘高度组间均P0.05,而与上下椎体前缘高度均值组间P0.05,且一致性较好。结论本文不同方法对胸腰椎骨折压缩程度评估存在差异,压缩椎体前缘与上下椎体前缘高度均值比较评估其压缩程度更准确。     

Significance of functional and nutritive pulmonary circulation for vital reactions in the form of embolisms

The functional and nutritive circulation in the lungs is connected by anastomoses between the pulmonary and bronchial arteries. The anastomoses have the structure of blocked arteries from which arteriovenous anastomoses proceed to the peribronchial plexus. The pulmonary artery is provided with a flow impulse by the anastomoses, and oxygen-containing blood is admixed with the venous blood, thus forming an "aortalization" in the lungs. By diverting the bloodstream, venous blood can reach the bronchial artery. The peculiarities of the lung circulation are important for vital reactions in the form of macro- and microembolisms. Macroembolisms prove the functionality of the system if branches of the pulmonary artery are closed before the arteries are blocked. A hemorrhagic infarction either arises or does not arise, and the hemorrhagic infarction cannot exceed a certain limit. A microembolism is over and above the anastomoses. If the microembolism is greater, pressure in the arteria pulmonaris can cause blood from the pulmonary artery to overflow into the bronchial artery. Because arteriovenous anastomoses arise from the blocked arteries, microemboli can now reach the systemic circulation. Thus, the system described can explain the passage of microemboli into the systemic circulation, avoiding the capillaries of the lungs; on the other hand, larger microembolisms can prove the functionality of the system.     

Endothelial cell membrane perforation of aorta and pulmonary artery in the electrocution victims

Some electrocution deaths occur without detectable current marks on the skin, making forensic examination to determine the true cause of death more difficult. Because arterial thrombosis was a frequent finding in victims of electrocution, we investigated injury to the endothelium of the aorta and pulmonary artery with a scanning electron microscope in five cases of death known to be caused by electrocution. We found large pores on the surface of endothelial cells of the aorta and pulmonary artery in those who died of electrocution, but no endothelial membrane perforation was found in those who died of cardiac diseases. These findings were present within 12h after death. Therefore, scanning electron microscopic evidence of endothelial perforation in the aorta and pulmonary artery could be a useful marker to identify electrocution for those victims without detectable current marks on the skin.     

Ruptured cerebral artery aneurysm and bacterial meningitis in a man with osteogenesis imperfecta

This report describes a 38-year-old man with osteogenesis imperfecta who died of a ruptured cerebral artery aneurysm and bacterial meningitis. He had multiple long bone fractures in the past, and approximately 4 months before death, he had surgery to relieve symptoms of basilar impression. The surgery was complicated by a postoperative wound infection. For the next 4 months, he had intermittent headaches and vomiting. He was found dead in his bed at home. At autopsy, he had a ruptured anterior communicating artery aneurysm and bacterial meningitis. Cerebrospinal fluid and blood cultures had growth of Staphylococcus aureus. Osteogenesis imperfecta is a disorder of type I collagen. Type I collagen is present in many tissues, including blood vessels. The etiology of cerebral artery aneurysm formation is multifactorial. Some patients with cerebral artery aneurysms have been shown to have abnormalities in type III collagen. There has not been a reported relationship made between abnormalities in type I collagen and aneurysms. Meningitis can also result in cerebral artery aneurysms, but they are usually due to Aspergillus or Mycobacterium species. The case we report is unique; cerebral artery aneurysm formation may have been due to osteogenesis imperfecta and/or bacterial meningitis.     

A gastric artery aneurysm complicated by a dissection of gastric and hepatic arteries: possible role of adventitial inflammation and disruption of internal elastic lamina in splanchnic artery dissection

A 77-year-old woman was found deceased at home. An autopsy examination revealed a hemoperitoneum due to a ruptured false aneurysm of a branch of the left gastric artery. A long dissection extending from the aneurysm involved splanchnic arteries including the left gastric, common hepatic, right and left branches of proper hepatic, and intrahepatic arteries. An intimal tear was identified in the common hepatic artery. Neutrophils infiltrating in the adventitia may have been reactive and may have triggered the adventitial rupture of aneurysm or development of the dissection. Disruption of the internal elastic lamina, which has been proposed to cause dissection of intracranial arteries, was seen in the dissected arteries. Little is currently known about aneurysms or dissections of splanchnic arteries; however, observation of adventitial inflammation and internal elastic lamina may help disclose the etiology and pathogenesis.     

房室结纤维和脂肪增多与房室结动脉狭窄的关系

目的探讨房室结纤维、脂肪含量与房室结动脉狭窄之间的关系,分析房室结内病理性纤维化和病理性脂肪浸润的原因。方法选取119例心源性猝死案例,用Image-pro plus图像分析软件检测组织切片,计算房室结面积,房室结动脉内径、房室结动脉管腔面积(lumen area,LA)、外周横截面积(perimeterarea,PA),纤维组织面积和脂肪组织面积。将所有案例分为动脉狭窄组和正常对照组组,观察房室结动脉PA/LA值及房室结纤维及脂肪含量的改变。结果狭窄组房室结动脉PA/LA值在21～40岁最大,40岁以下两组房室结脂肪含量和总间质含量差异有统计学意义。结论房室结动脉狭窄与房室结间质含量增多有一定关系。     

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.