Cerebral tissue pulmonary embolization due to head trauma: a case report with immunohistochemical confirmation

Pulmonary embolization of cerebral tissue as the result of severe head trauma is an uncommon, if not rare, phenomenon, and few cases have been reported in the literature. The authors discuss the case of a 51-year-old male who died six days after suffering extensive head trauma in a motor vehicle collision. At autopsy, white-gray emboli were found in several subsegmental pulmonary arteries. The results of histologic examination with the hematoxylineosin stain gave the impression that the emboli were necrotic cerebral tissue; however, routine special stains for neural tissue produced inconclusive results. Immunohistochemical staining of the emboli with monoclonal mouse anti-human neurofilament protein (Dako Corp., Carpinteria, California) confirmed the cerebral nature of the emboli. To the authors' knowledge, this is the first reported case of pulmonary embolization of cerebral tissue confirmed by immunohistochemistry.     

头颈外伤致椎动脉破裂伴颅底蛛网膜下腔出血1例尸检分析

头颈外伤致椎动脉破裂伴颅底蛛网膜下腔出血１例尸检分析易旭夫，刘敏，吴家Ｓｕｂａｒａｃｈｎｏｉｄｈａｅｍｏｒｒｈａｇｅｄｕｅｔｏｒｕｐｔｕｒｅｏｆｔｈｅｖｅｒｔｅｂｒａｌａｒｔｅｒｙａｓｓｏｃｉａｔｅｄｗｉｔｈｈｅａｄｔｒａｕｍａ：ｒｅｐｏｒｔｏｆｏｎ...     

Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature

The fetus is subjected to mechanical forces during labor and delivery, which may result in traumatic injuries. Such injuries include intracranial hemorrhage, spinal cord lesions, cephalhematoma, cranial or peripheral nerve palsies, intraabdominal organ rupture, or bony fractures. Risk for perinatal trauma and mortality is increased in primigravidas, multiple gestations, abnormal presentations, maternal-fetal disproportion, oligohydramnios, forceps or vacuum extractions, and internal version maneuvers. Very-low-birth-weight neonates (<1500 g) are at high risk due to ease of deformity of the cranium. Infants with certain congenital anomalies or pathologic processes that distort normal anatomy are also at increased risk, especially when a prenatal diagnosis is lacking. The authors present a case of a term gestation neonate who sustained a cervical spine dislocation fracture of C5-7, with subtotal transection of the spinal cord and resultant paralysis. The fetus was in vertex presentation, and a manual vaginal delivery was attempted. When the infant lodged in the birth canal following a difficult delivery of the head and arms, its enlarged abdomen was palpated, and the delivery was converted to an emergent cesarean section. The infant lived for 3 days and then expired due to neurologic complications of trauma sustained during the attempted vaginal delivery. Autopsy revealed a previously undiagnosed intraabdominal immature teratoma. The pathology of teratomas, the most common neonatal tumor and occasionally implicated in cases of birth trauma, will be addressed, followed by a review of the literature concerning birth trauma.     

An unusual fatal injury due to tyre burst: a case report

A 20 year-old male driver of a heavy duty crane, employed in an industry located in an industrial area on the outskirts of Delhi was fatally injured while repositioning an ill-fitted locking rim of a crane tyre (Fig. 1). The inner tube of the crane tyre had accidentally burst, dislodging the loose iron-locking rim, which hit the individual with a great force resulting in multiple injuries. He died on his way to the hospital.     

地塞米松致过敏性休克猝死1例

不少药物都有致过敏的不良反应，严重的可导致过敏性休克。地塞米松米是常用的抗过敏性休克药物，导致过敏性休克者较为少见，笔者在进行医疗事故鉴定工作中遇有1例，现报导如下。     

地塞米松致过敏性休克猝死1例

不少药物都有致过敏的不良反应,严重的可导致过敏性休克。地塞米松米是常用的抗过敏性休克药物,导致过敏性休克者较为少见,笔者在进行医疗事故鉴定工作中遇有1例,现报导如下。案例钟某,女,54岁,教师。因乏力、盗汗、低热、食欲减退二十余天、皮肤淤斑7天,于1998年6月2日在某医院门诊以“慢性粒细胞白血病”收入血液科。6月3日行骨髓穿刺术,6月4日骨髓细胞学报告:慢性粒细胞白血病(慢性期)。确诊后按常规治疗方案进行治疗。患者在注射干扰能后出现了常见的发热反应和皮疹、瘙痒症等,口服抗过敏药后皮疹瘙痒治疗无效。6月19日上午临时加用1次…     

Suicide due to oral ingestion of lidocaine: a case report and review of the literature

The Authors describe a rare case of suicide in a 31-year-old woman, due to oral ingestion of lidocaine; the histological and toxicological findings are discussed to provide useful information to the present experience with this particular modality of death. Histological examination revealed generalized stasis. In the myocardium we observed segmentation of the myocardial cells and/or widening of intercalated discs and associated group of hypercontracted myocardial cells with "square" nuclei in line with hyperdistended ones. Non-eosinophilic bands of hypercontracted sarcomeres alternating with stretched, often apparently separated sarcomeres, small foci of paradiscal contraction band necrosis, and perivascular fibrosis were observed too. Lidocaine was detected in the subject's urine through immunoenzymatic screening. Toxicological analysis by solid-liquid extraction and gas chromatography-mass spectrometry (GC-MS) analysis, was carried out to identify and quantify the individual substances present in the biological fluids and organs. Lidocaine concentrations were as follows: blood 31 microg/mL, gastric content 2.5 g, liver 10 microg/g, kidney 12 microg/g, brain 9 microg/g, spleen 24 microg/g, lung 84 microg/g, heart 9 microg/g, urine 9 microg/mL, and bile 6 microg/mL. No other drugs or alcohol were detected. When blood lidocaine reaches toxic levels, serious toxic symptoms associated with the central nervous system and cardiac system are noted. The overdose of lidocaine produces death from ventricular fibrillation or cardiac arrest. In this case, according to macroscopic and microscopic findings, the cause of death was most likely cardiac and possibly related to ventricular fibrillation.     

Correlation of trauma and cause of death to accident reconstruction: a case of a flight accident report.

This paper reports on the disaster that occurred after a flight was hijacked at Baiyuen International Airport in Guangzhou, China, on Tuesday, 2 Oct. 1990. The authors show the results of analyses for the causes of death and trauma and compare the disaster with several previous flight accidents that have occurred in China. The authors show, with the analysis on this accident, the possibility and reliability of reconstructing a disaster by medicolegal investigation.     

Fatal trauma to the neck: immunohistochemical study of local injuries

As fatal trauma to the neck is often associated with short survival times, proof of vitality may often be difficult using standard histochemical techniques. Soft tissue neck injuries resulting from strangulation by ligature or manual strangulation were examined immunohistochemically using antibodies to myoglobin, fibronectin, C5b-9 and MRP14, and compared to controls consisting of accidental soft tissue neck injuries as well as undamaged neck soft tissue. Although survival times in the study and control groups were unknown and certainly some individual variation may be expected in the time course of normal wound development, both the study and control groups demonstrated similar time courses in the immunohistochemical detection of antigen. Myoglobin was always found in those samples in which only one antigen was shown to be involved in an injury-specific pattern; myoglobin and fibronectin were found in samples with dual antigen involvement. Samples involving three antigens always included C5b-9 in addition to myoglobin and fibronectin. The single positive MRP14 sample in the study and control groups was simultaneously positive for the other markers used. Myoglobin, fibronectin, C5b-9 and MRP14 are therefore suitable for immunohistochemical detection of vital reactions and estimation of temporal relationships in the early posttraumatic period after neck trauma.     

广泛性软组织挫伤后肺脂肪栓塞1例

广泛性软组织挫伤后一般是由于继发休克、弥漫性血管内凝血 (ＤＩＣ)或者挤压综合征而导致死亡[1～ 3 ] ,引起肺脂肪栓塞则少见。广泛性软组织挫伤后因血液中脂肪释放引起肺脂肪栓塞致死则更为罕见 ,笔者曾遇一例 ,现予以报道如下 :案　例孙某 ,男 ,2 4岁 ,农民。某日夜 11:30伙同杨某 (男 ,18岁 )到某菜场里偷窃蔬菜时 ,被守护菜农抓获后被数人分别用木棒、铁棒、铁锨、拳脚殴打约 1小时。次日凌晨 2 :2 0送医院。急诊病历记载 :全身多处疼痛 ,左小腿畸形、疼痛、出血。体检 :Ｔ37.0℃ ,ＢＰ13/ 9ｋＰａ ,Ｐ80次 /分 ,Ｒ2 0次 /分 ,神清 ,…     

广泛性软组织挫伤后肺脂肪栓塞1例

广泛性软组织挫伤后一般是由于继发休克、弥漫性血管内凝血（DIC）或者挤压综合征而导致死亡［1～3］,引起肺脂肪栓塞则少见。广泛性软组织挫伤后因血液中脂肪释放引起肺脂肪栓塞致死则更为罕见,笔者曾遇一例,现予以报道如下:     

Multiple self-inflicted gunshot wounds to the head: report of a case and review of the literature

Multiple self-inflicted gunshot wounds to the head are rare and usually present a challenge to the pathologist and to the police in determining the manner of death. We report a case of two suicidal gunshot wounds to the head. The literature is reviewed, and the pertinent findings, including location of the wounds, location of the brain injuries, types of weapons used, and criteria important to determine the manner of death, are discussed.     

Sudden death due to dissecting pulmonary artery aneurysm: a case report and review of the literature

Pulmonary artery aneurysm and pulmonary artery dissection are rare antemortem diagnoses, most often associated with sudden death. These pathologic entities are strongly associated with chronic pulmonary hypertension due to structural cardiac defects, either congenital or acquired. We report the case of a 49-year-old woman who died suddenly due to dissection and rupture of a large pulmonary trunk aneurysm, with subsequent cardiac tamponade. Key historical and physical findings are described. Additionally, we present a discussion of the incidence, clinical presentation, pathogenesis, and pathologic diagnostic features of pulmonary artery dissection.     

Fatal intoxication due to tramadol alone: case report and review of the literature

Poisoning may also lead to both coma and multiple organ failure, also in youngsters without a known major medical history. As not all toxic agents are routinely screened when a poisoning is suspected, it is useful to consider less frequently encountered poisons in certain cases. We describe the occurrence of asystole and multiple organ failure which occurred in a young man after a suspected tramadol overdose. The tramadol concentration on admission in the ICU was indeed 8 microg/ml (mg/l), far above the therapeutic range. Subsequently, the patient developed severe acute liver failure, finally leading to death. Post-mortem toxicology did not reveal any other poison responsible for this unfavourable course as only very high serum and tissue tramadol and desmethyltramadol concentrations were found. Only a few fatal poisonings attributable to tramadol alone, as observed in our case, have been reported. An overview of these cases is presented.     

Vascular lesions in intestinal ischemia induced by cocaine-alcohol abuse: report of a fatal case due to overdose

Intestinal ischemia induced by cocaine abuse is a rare condition. To this date, only three cases have been described. The diagnosis of bowel ischemia should be suspected whenever a cocaine addict has severe abdominal pain. A pathological examination of the resected bowel segment was performed in one case, and the diagnosis was confirmed microscopically. However, the existence of pathologic alterations of the intestinal vessels was not confirmed. Why the intestinal injury is segmental and whether it is related to the dose ingested, the administration route, or the combination of cocaine with alcohol, caffeine, or marijuana remain unclear. The authors report one fatal case associated with cocaine-alcohol overdose. The postmortem examination demonstrated the existence of segmental intestinal ischemia. Microscopic study failed to demonstrate thrombosis in the mesenteric vessels; however, we found an unusual lesion affecting the arterioles located in the intestinal submucosa of the hemorrhagic areas.