Sudden natural death at the wheel--a particular problem of the elderly?

Thirty-nine autopsy cases of sudden natural death at the wheel were analysed with special respect to the questions if this is a peculiar problem of the elderly and if there are particular pathological features in the elderly. The ages ranged from 33 through 83 years and the median age was 56.4 years. 97% of the deaths were attributable to cardiovascular diseases, about 90% to coronary heart disease. People older than 60 years of age tended to exhibit severe chronical arterio-sclerotic changes of the coronary arteries, especially multiple calcified stenoses and myocardial scars, but there was a low percentage of recent thrombotic occlusion of a coronary artery.     

Informed consent issues in the cardiac transplantation evaluation

As consultation-liaison psychiatrists to a cardiac transplantation team, we have observed various informed consent issues that are particularly associated with evaluation for cardiac transplantation. We discuss complicating factors that relate to each component of informed consent and present the defense mechanism of denial as a barrier to making the decision to accept or refuse transplantation. Changes in the evaluation protocol could preclude existing impediments to provision of information and patient autonomy; however, certain intrapsychic issues must be recognized as ongoing clinical realities to be addressed as the doctrine of informed consent continues to evolve.     

Comparative morphine determination in parts of the brain using combined gas chromatography/mass spectrometry. A possibility for assessing survival time

Comparison of the morphine concentrations in the medulla oblongata and the cerebellum provides information on the interval between morphine administration and death. If this period is short, the ratio of CMed:CCereb is below 1. The ratio is above 1 if a number of hours have passed at least. The balance of the morphine concentrations is achieved within a few hours. Results have been achieved by gas chromatography/mass spectrometry analysis in about 100 autopsy cases.