Floppy aortic valve presenting as sudden death

A previously healthy 34-year-old Dutch immigrant to Australia died unexpectedly in his sleep. At autopsy the only significant finding was a floppy aortic valve (FAV). Histologic, histochemical and electron microscopic studies corroborated the macroscopic diagnosis. Previously described associations of the FAV include the floppy mitral valve, Marfan's syndrome, aortic root dilatation and aortic cystic medial necrosis. None of these features were found in the present case which is the first recorded example of isolated FAV presenting as sudden death. The mechanism of death is obscure, and while it is presumed to be dysrhythmic, a detailed histological examination of the cardiac conducting system revealed no anatomic abnormality.     

Strut fracture in a Bjork-Shiley aortic valve prosthesis

Strut fracture can be a life-threatening adverse effect of mechanical prosthetic heart valves. This complication has occurred in the DeBakey, the Beall, the Cooley-Cutter and, most recently, the Bjork-Shiley valves. We report the case of a 35-year-old man who died suddenly 16 months after a 60 degree Bjork-Shiley Convexo-Concave heart valve prosthesis was inserted in the aortic position. At autopsy, the two welded attachments of the valve's outlet strut had fractured. The valve's tilting disc was found in his abdominal aorta.     

Sudden death in infancy due to bicuspid aortic valve

Symptoms of bicuspid aortic valve usually occur in the age group of 50-70 years, but rarely, it can also lead to sudden unexpected death in infancy and early childhood. The autopsy of a 2-month-old baby boy, found dead in his cot, revealed the heart weight as 25 g, and the macroscopic examination showed the circumference of the aortic valve consisting of two leaflets as 8 mm. The thickness of the left ventricle, right ventricle, and septum was measured as 8, 7, and 10 mm, respectively. Microscopically, the heart revealed hypertrophic changes of myocytes. Subendocardial areas displayed necrosis of myocytes, and severe and diffuse ischemic changes characterized by loss of myofibers and vacuolization. Interstitial pneumonia was identified in the lungs. Death occurred as a result of a congenital bicuspid aortic valve obstructing the left ventricular outflow tract complicated by lung infection. As there are only a few reported cases in infancy, and congenital bicuspid aortic valve can lead to sudden unexpected death, this case is presented to the forensic community.     

Death by lightning

Deaths from lightning injuries are infrequent, amounting to 0.2-0.8 per million people per year, and are associated with climatologic conditions. The victims are mostly young, active people who are struck during various outdoor activities during the summer months. Even though many people can be struck by the same bolt of lightning, multiple casualties are uncommon. Among the fatalities, various types of skin burns are regularly present, often at an entry site on or near the head, and at an inferiorly located exit site. These skin injuries often consist of superficial burns and singed hair; deep burns and charring are uncommon. Arborescent skin marks seem to occur less frequently. Internal findings at autopsy are nonspecific.     

Death related to aortic coarctation in a young female during sexual intercourse

Coarctation of the aorta (CA) is diagnosed mainly in pediatric patients, and therapy is conservative if asymptomatic, but surgical treatment is required if advanced arterial hypertension is present. Moderate to severe forms contraindicate any type of physical activity requiring cardiac effort. Here, we describe the first documented death of an apparently healthy 35-year-old woman because of cardiac tamponade by rupture of an aortic aneurysm, possibly related to congenital CA, prolonged use of oxymetazoline hydrochloride, and physical and/or emotional stress during sexual activity. Our patient was asymptomatic for classical CA symptoms. The patient's breathing difficulties likely in hindsight were due not so much to nasal congestion, but rather to an ineffective oxygenation of the blood from the abnormal heart. In an attempt to treat the "nasal disease," the patient ingested chronic and excessive doses of decongestants, aggravating her fatal disease. The danger of inhaling large doses of nasal decongestants without an appropriate medical indication is highlighted here.     

Death by greyhound.

We present the case of a man who was last seen leaving to feed his greyhound dogs. He was found dead lying in a yard just outside the gate to one of the dog pens. Holes were present in the fence on both sides of the gate. The holes were of sufficient size to allow the passage of the head and neck of a greyhound to the shoulders. To open the gate one had to bend down to unfasten a latch 45 cm above ground level. Leaning down to unfasten the latch brought one into close proximity to the holes on either side of the gate. The scene and clothing appeared undisturbed. Autopsy (K.A.L.) revealed the cause of death to be blunt throat trauma. The throat trauma was of marked degree and consistent with at least a single heavy crushing injury directed from the front and somewhat below. In addition there were a series of almost vertical light abrasions on one side of the neck. There were minimal injuries to the rest of the body. There were no injuries specific for assault. In an attempt to explain the almost vertical abrasions on the side of the neck, the scene was re-examined by the pathologist. This revealed loose wire strands on the gate post. It is consistent that a fall against this area could account for the almost vertical abrasions on one side of the neck.(ABSTRACT TRUNCATED AT 250 WORDS)     

Morphometric Investigation of Death by Asphyxia

Abstract:  The aim of this study was to investigate the possibility of distinguishing deaths by asphyxia from those due to natural causes by comparing morphometric measurements in lungs. The study population comprised 27 subjects: 14 cases of death by asphyxia (hanging or drowning) and 13 cases of sudden natural death. Eighty parenchyma sections were used for each subject. Data were collected by computerized image analysis. Measurements aimed at quantifying, as percentages, pulmonary parenchyma (mean values of positive-fraction areas [PFA] and their standard deviations). Subjects who died of natural causes and of drowning showed a relative internal homogeneity compared to those who hanged. Results show significant discrimination between drowned subjects and those dying of natural causes (mean of PFA p  = 0.01) and between hanged and drowned subjects (SD of PFA p  = 0.04). Attention must be paid to the possible role played by senile emphysema. The method is proposed as a complementary tool in forensic cases.     

Death caused by ingestion of endosulfan

This paper reports the autopsy and toxicological findings of a death caused by ingestion of endosulfan dispersed in a colorless liquid containing about 55% of xylene (w/v). For isolation of endosulfan, the biological material was homogenized and the drug was isolated by extraction with ether. Quantitative determinations were carried out by gas chromatography. The following concentrations of endosulfan were found: Blood 30 mg/L Gastric contents 0.5 g in the total 50 mL Liver 20 mg/kg Kidney 2.0 mg/kg Brain 0.3 mg/kg Xylene (solvent) was detected only in stomach contents (0.4 g in the total 50 mL).     

Death caused by orphenadine poisoning

The number of deaths as a consequence of orphenadine poisoning seems to increase, mostly among severely psychotic males. The lethal dose corresponds to the weekly average dose used in the treatment of neuroleptic extrapyramidal side effects. Based on the literature, the serious, rapidly incipient, cardiac, and neurologic symptoms of poisoning are emphasized. The handing out of orphenadine to suicidal persons must be restricted, and even small overdoses (1-2 g) ought to result in the immediate initiation of observation at an intensive care unit.     

产后出血死亡原因分析

目的 分析产后出血死亡案例法医病理学鉴定的特点,探究产后出血致死的常见原因,为法医工     

Sudden Death by Occult Metastatic Carcinoma

A 33-year-old female collapsed and died suddenly after presenting with acute dyspnea and increasing cough over the preceding several months. Autopsy revealed poorly differentiated linitis plastica adenocarcinoma of the stomach. Microscopic examination of the lungs showed features consistent with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a well-described complication in patients with adenocarcinoma. The typical presentation involves acute pulmonary hypertension, right-sided heart failure, and sudden death, often before the adenocarcinoma is discovered. The pathophysiology of PTTM remains elusive; it has been suggested that carcinoma cells may produce substances that influence pulmonary vasculature. Our patient had classic clinical and histologic features of PTTM in addition to prominent extravascular compression by intralymphatic tumor cells. These features undoubtedly caused her precipitous decline and lethal pulmonary hypertension, induced by underlying adenocarcinoma. This case demonstrates that sudden death can occur from pulmonary hypertension induced by metastatic carcinoma with remarkably little prior symptomatology.     

Death following acute poisoning by moclobemide

A fatality due to ingestion of a reversible inhibitor of monoamine-oxidase A (MAO-A) is reported. Moclobemide is generally considered as a safe drug far less toxic than tricyclic anti-depressants. However, severe intoxications may result from interactions with other drugs and food such as selective serotonin reuptake inhibitors (SSRIs), anti-Parkinsonians of the MAOI-type (e.g. selegiline) or tyramine from ripe cheese or other sources. In the present case, high levels of moclobemide were measured in peripheral blood exceeding toxic values reported so far in the scientific literature. The body fluid concentrations of moclobemide were of 498 mg/l in peripheral whole blood, 96.3 mg/l in urine while an amount of approximately 33 g could be recovered from gastric contents. The other xenobiotics were considered of little toxicological relevance. The victim (male, 48-year-old) had a past history of depression and committed one suicide attempt 2 years before death. Autopsy revealed no evidence of significant natural disease or injury. It was concluded that the manner of death was suicide and that the unique cause of death was massive ingestion of moclobemide.     

通过程序控制死刑

如何控制死刑问题已经成为中国亟待解决的重大现实课题。从各国的实践来看,控制死刑主要包括实体控制与程序控制两种路径。尽管通过宪法或者刑法可以对死刑控制起到立竿见影的效果,但是,通过实体控制死刑,存在难以克服的局限性。相比较而言,通过程序控制死刑,则具有明显的优势。在中国目前无法全面废除死刑而实体控制又存在较大难度的情况下,通过程序控制死刑应是明智之举。