Kinking of a coronary artery as a rare complication in mitral valve replacement

We present the case of a 70-year old woman who had elective mitral and aortic valve surgery. She underwent surgery without complications for about 4h until 4 pm. Approx. 3h after surgery her condition deteriorated. 1500ml of blood were collected in the chest drainage until 11 pm. An emergency thoracotomy in the patient's bed showed a ventricular rupture. Death occurred around 11:30 pm. At autopsy, the implants of the biological mitral and aortic valves were found to be sewn tightly. There was no vascular injury and no unusual bleedings to the mediastinum. In the left ventricular wall, a rupture of 1cm and a surrounding fresh myocardial infarction area of 10cm×6cm was noted. Preparation of the coronary arteries showed moderate coronary atherossclerosis without stenosis or clots. The left circumflex coronary artery (LCX) showed a sharp, obviously stenosing kink which had been caused by the mitral valve surgery. Exsanguination due to ventricular rupture following myocardial infarction caused by implant-related "kinking" of a coronary artery, was found to be the cause of death.     

Embolism of heart tissue to the middle cerebral artery as a complication of heart surgery.

After suture closure of an intraarterial septal defect an atrioventricular block occurred in a 6 years old child. Therefore, the suture was removed and the defect closed by a Dacron patch. The sinus rhythm returned. After the operation convulsions occurred, the patient died after 16h which was considered to be due to cerebral air embolism. Autopsy confirmed a correct operation, but the right middle cerebral artery has been found to be completely occluded by heart muscle and pericardial fat tissue.     

The concept of forensic emergency medicine as illustrated by an unusual complication of pulmonary artery catheterization

Forensic pathologists are regularly confronted with emergency and invasive medical procedures performed on critically ill or traumatized patients. Basic knowledge of such procedures and their possible complications is therefore mandatory in medico-legal practice. In this article, we describe a very unusual complication of pulmonary artery catheterization: through-and-through perforation of the carotid artery, initially without hemodynamic consequence. Death resulted from an aggravation of the preexisting cerebral edema (secondary to a craniocerebral trauma). The misplacement of the pulmonary artery catheter was clinically missed because the guidewire was initially deflected on the cervical spine towards the subclavian vein where the catheter--by chance--entered the circulatory system and followed its normal route further. The forensic importance of leaving all invasive medical devices in situ on a deceased person when a medico-legal autopsy is to be expected and the mutual interaction between emergency and forensic medicine (forensic emergency medicine) are discussed.     

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.     

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.     

Acute myoglobinuria as a fatal complication of heroin addiction

A fatal case of myoglobinuria complicating heroin addiction is described. Clinically the patient had no overt symptoms of rhabdomyolysis. Pathologists should be alerted to this rare complication in heroin addicts who die of no apparent cause. The antimyoglobin immunoperoxidase technique is useful in confirming the diagnosis.     

Sudden death caused by coronary artery aneurysms: a late complication of Kawasaki disease

The authors describe three cases (two blacks and one Latin American) of sudden death caused by late complications of Kawasaki disease (mucocutaneous lymph node syndrome). At autopsy each heart contained multiple coronary artery aneurysms with luminal stenosis caused by intimal hyperplasia and thrombi. Although virtually all fatal cases of Kawasaki disease occur within six months of the onset of symptoms, there have been other reported deaths up to 14 years after the acute illness. The coronary artery aneurysms of Kawasaki disease may persist and cause death years after the acute illness.     

Use of "therapeutic complication" as a manner of death

Analyses of deaths due to therapeutic complications (TCs) provide important quality of care information for medical providers. In New York City, 463 deaths were investigated by the Office of Chief Medical Examiner and certified with TC as the manner of death in 2003. The TC manner of death is used for fatalities due to predictable complications of appropriate medical therapy. All death certificates and select autopsy, hospital, and investigation reports were reviewed. Data concerning cause of death, contributing conditions, age, race, and sex were extracted. The types of complications and the causes of death were classified into various types of surgical and nonsurgical categories of complications. These included: postoperative infections, pulmonary emboli, and technical and medication complications. The use of TC as a manner of death has benefits and limitations. Without the TC option, one is forced to certify certain deaths (e.g., penicillin anaphylaxis) either as natural or accident. The TC option allows easy identification and tracking of medical complications for public health purposes and also allows more consistent reporting of natural and medical-accidental deaths. In general, complications that occur during emergency surgeries/procedures for natural disease, tend to be certified with a natural manner. The "but for" test may be used to distinguish natural from TC deaths. There are criteria for distinguishing TC from accidents and homicides. TCs that occur during treatment of a potentially life-threatening injury, are superseded by the manner dictated by the circumstances of the initiating injury. The certification of TC usually does not address errors of omission, clinical judgement/management, or missed diagnoses.     

The use of the subculture of violence as mitigation in a capital murder case

This paper examines the role a sociologist in a capital murder case involving a defendant who was black and a victim who was a white on-duty police officer. The author of this paper testified in this specific case and has worked as a sociologist in over 60 capital murder cases. The use of the subculture of violence as mitigation is presented.     

物尽其用与矿业权出资入股

判断资源是否得到了合理的配置，需考虑供给与需求的关系。在供给有限的前提下，合理的资源配置决定着人们的需求能够在多大程度上得到满足。不合理的资源配置决策含浪费稀缺资源，降低需要被满足的程度。就矿业权来讲，它在取得时已经发生了大量的成本消耗，再加之资源存在的有限，若将之用于出资，既是封矿藏价值的尊重，又可实现价值利用的最大化。本文试从矿业权物权理论出发，阐述矿业权出资入股符合物尽其用原则的要求。     

我国体育协会章程与体育纠纷解决方式的研究--以足球协会章程研究为中心

体育纠纷呈爆炸式地增加,研究体育纠纷的解决方式成为必要.体育协会章程在纠纷解决中起着重要的作用,研究我国足球协会章程中体育纠纷解决机制具有代表性.通过研究发现协会章程中有关纠纷解决机制存在的问题,建议统一体育协会章程对纠纷解决机制的规定 ,明晰、简化内部纠纷解决机构的设置,强调作出的处罚具有独立性和权威性,并在章程中规定在内部纠纷解决方式使用穷尽时,可以选择仲裁和诉讼.     

The use of hair as a toxicological tool in DFC casework

When drugging related offences are cited, most people think of sexual assault. However, the law covers any crime committed whilst the complainant is under the influence of alcohol or drugs i.e. the use of a drug to modify a person's behaviour for criminal gain. The case types encountered include robbery, blackmail and of course sexual offences.Hair analysis for drugs is now well established in Forensic Toxicology. Its use as an analytical tool in workplace testing, post-mortem toxicology and criminal cases is expanding both in the UK and worldwide, and it is now widely accepted as an alternative or complimentary matrix for these cases. This paper will provide a brief overview of hair testing in cases of Drug Facilitated Crime stressing the importance of timely sample collection. Its usefulness in cases of this type will be highlighted through case examples.     

Small bowel perforation as a complication of microsurgical lumbar diskectomy. A case report and brief review of the literature

Ventral perforation is a rare complication of lumbar diskectomy. Injury to retroperitoneal vessels is the most common serious complication to such perforation. Ventral perforation with damage to the bowel is rarely reported. The authors present the first case report of injury to the small bowel during a microsurgical lumbar diskectomy. The case illustrates the importance of awareness of bowel injury as a possible complication of diskectomy. Possible pre- and postoperative considerations are also discussed. A brief review of the literature on bowel injuries after this common surgical procedure is also given.     

Expert evaluation of aftereffects of migration of catheters in the vessels during subclavian vein catheterization

Eleven cases with migration (escape) of catheters, inserted into subclavian veins, into the vascular bed, are analyzed by the results of forensic medical evaluations. Expert evaluation of aftereffects of the complications caused by flaws in medical care is made. Suggestions are made on evaluation of the severity of harm inflicted to health in such cases and the criteria of such evaluations are offered.     

Psychologists as consultants for changes of venue the use of public opinion surveys

This study reports the use of public opinion surveys to support motions to change venue. Step-bystep procedures of venue surveys are outlined, and results of their use in five capital murder trials are presented. Employing a quasi-experimental approach to the surveys allows inferences, about the likelihood of obtaining between-county differences of certain magnitudes. In addition, the use of a survey instrument with standardized subparts permits a second, novel type of contrast: comparisons previous cases. The responsiveness of this approach to the typical criticisms of venue surveys is discussed.