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Biomedical subjects

C S Hirsch

Publications and source records attributed to C S Hirsch.

At least 55 records · Page 3Linked to original sources
PubMed1994

Enhancement of intracellular growth of Mycobacterium tuberculosis in human monocytes by transforming growth factor-beta 1.

The production of transforming growth factor-beta (TGF beta 1) by human monocytes (MN) infected with Mycobacterium tuberculosis and its effects on the intracellular fate of the organism were studied. M. tuberculosis infection of MN induced both expression of mRNA and secretion of tumor necrosis factor-alpha (TNF alpha) and TGF beta 1 protein. Neutralizing antibody to TGF beta 1 reduced the intracellular growth of M. tuberculosis. The growth-enhancing effects of TGF beta 1 could not be explained by increased initial bacterial load. Preculture with TGF beta 1 decreased uptake of M. tuberculosis. Exposure of MN to increasing concentrations of TGF beta 1 before or after infection with M. tuberculosis accelerated intracellular bacterial replication. Both TNF alpha and interferon-gamma (IFN-gamma) limited mycobacterial replication. TGF beta 1 (10 ng/mL) abrogated the bacteriostatic effects of TNF alpha and IFN-gamma. Within the infected focus, TGF beta 1 produced by mononuclear phagocytes may play an important role in the pathogenesis of tuberculosis, in part by modulating the response to potentially protective cytokines such as TNF alpha and IFN-gamma.

Humans↗
PubMed1992

The epidemiology of murder-suicide.

OBJECTIVE: To review the epidemiology, patterns, and major determinants of murder-suicide and to discuss the clinical and research strategies for identifying the individuals at greatest risk for this type of violence. DATA SOURCES: Data were obtained from English-language articles based on searches using MEDLINE (from 1966), PsychINFO (from 1967), and EMBASE (from 1974) programs. In addition, relevant articles, books, and monographs identified from the reference list of retrieved articles were reviewed. STUDY SELECTION: Case-control studies, descriptive epidemiologic surveys, and case series were chosen for review. DATA EXTRACTION: Because of the limited scope of the pertinent research literature, all data relevant to the incidence, demographics, circumstances, and precipitants of murder-suicide were summarized by the authors. DATA SYNTHESIS: Murder-suicide occurs with an annual incidence of 0.2 to 0.3 per 100,000 person-years and accounts for approximately 1000 to 1500 deaths yearly in the United States. The annual incidence of these events is relatively constant across industrialized nations and has not significantly changed over several decades. The principal perpetrators are young males with intense sexual jealousy, depressed mothers, or despairing elderly men with ailing spouses. The principal victims are female sexual partners or consanguineous relatives, usually young children. Clinical depression, specific motivations such as male sexual proprietariness or maternal salvation fantasies, and a history of previous suicide attempts are important in explaining underlying psychopathological mechanisms. CONCLUSIONS: Murder-suicide occupies a distinct epidemiological domain that overlaps with suicide, domestic homicide, and mass murder. These events may be categorized into one of only several phenomenologic typologies that share similar demographics, motivations, and circumstances. Despite the disruption of families and communities caused by murder-suicide, there are no standardized operational definitions, validated taxonomic systems, or national surveillance networks for these events, all of which are needed to develop prevention strategies.

Case-Control Studies↗
PubMed1989

Venous air embolism from head and neck wounds.

Air emboli in the chambers of the right side of the heart and in the pulmonary artery were documented in 16 autopsies representing shotgun and gunshot wounds of the head, traffic fatalities with head trauma, and one neck incision. The pathology of venous air embolism and its interpretation in the context of death investigation are discussed.

Adolescent↗
PubMed1987

The physician assistant as forensic investigator.

Physician assistants are employed as forensic investigators at the Office of the Medical Examiner, Suffolk County, New York. We describe the educational qualifications of physician assistants and their valuable role in forensic medicine in Suffolk County.

Forensic Medicine↗
PubMed1986

Sudden, unexpected death due to "pineal apoplexy".

A 20-year-old woman had a minute vascular malformation in the wall of a glial cyst of the pineal body. Bleeding into the cyst lumen caused rapid expansion of the pineal body, resulting in compression of the midbrain and her sudden, unexpected death.

Adult↗
PubMed1986

The "empty heart" sign.

Approximately 15% of victims of instantly lethal central nervous system trauma have an empty or nearly empty heart at autopsy. This article defines and discusses the "empty heart" sign.

Brain Injuries↗
PubMed1984

Postmortem diagnosis of myocardial disease by enzyme analysis of pericardial fluid.

The authors measured the activities of CK, LDH, and their isoenzymes in pericardial fluid to determine their usefulness in evaluating acute myocardial injury. Their prospective study reveals that these enzymes significantly are elevated in cardiac deaths in contrast to fatalities from noncardiac causes. Also, a group of healthy individuals who were victims of violent deaths and died from extracardiac injuries had enzyme elevations greater than those found in acute cardiac deaths, suggesting catecholamine-mediated myocardial injury (stress cardiomyopathy) as part of the physiologic response to trauma. Measurements of cardiac enzymes in pericardial fluid may prove useful in establishing the postmortem diagnosis of acute myocardial injury in instances when such injury is suspected but cannot be established by ordinary histologic methods. Studies such as this may help in defining the participation of myocardial injury as one of the lethal mechanisms in various causes of death.

Autopsy↗
PubMed1984

Never say never. Negligible carboxyhemoglobin in the victim of a smoldering mattress fire.

For many years, a high blood carboxyhemoglobin concentration has been used as a criterion for determining that a victim of conflagration was alive in the fire. We report a case in which a man died from the combined effects of burns and hypertensive cardiovascular disease. He had a negligible blood carboxyhemoglobin concentration, but the environmental evidence and autopsy findings are indicative of life in the fire, which arose in a smoldering mattress. We conclude that uncritical, rigid adherence to the requirement that fire victims have high carboxyhemoglobin concentrations can be misleading.

Adult↗
PubMed1984

Forensic pathology and the autopsy.

Questionnaires sent to representative medicolegal jurisdictions in the United States showed that medicolegal necropsies comprise a substantial proportion of the total number of autopsies performed. Qualitative differences between customary hospital autopsies and their forensic counterparts include autopsy bias, the importance of trauma, biological variability, and medicolegal logic. Because of these differences, medicolegal autopsies have an important role to play in the education of undergraduate and graduate medical students and should be incorporated into the training programs of academic departments of pathology.

Autopsy↗
PubMed1984

Talking to the family after an autopsy.

Few physicians have opportunities that can match the pathologist's to bring compassion and understanding to the bereaved by means of the postautopsy consultation with families. The emotional responses of survivors are often dominated by guilt. Practical guidelines for talking to the bereaved consist of the honesty , compassion, and common sense of the pathologist.

Autopsy↗
PubMed1983

Acute responses to blunt head trauma. Experimental model and gross pathology.

This study of blunt craniocerebral trauma describes an experimental model that involves delivery of forceful blows to the resting movable skulls of anesthetized cats. Injuries inflicted by this method included skull fractures in 81% of cases, epidural hemorrhages in 50%, subdural hemorrhages in 80%, subarachnoid hemorrhages in 100%, and brain contusions in 84%. In the majority of instances the subdural and epidural hemorrhages were thin films of blood that did not compress or distort the subjacent brain. The distribution of cerebral contusions was restricted to the cerebral parenchyma beneath the locus of cranial impact except for contusions associated with skull fractures. This experimental model recapitulates clinically realistic human cranial trauma and produces pathological lesions suitable for investigation of the pathophysiology of blunt head trauma.

Animals↗
PubMed1981

Microcrystalline cellulose pulmonary embolism and granulomatosis. A complication of illicit intravenous injections of pentazocine tablets.

Four persons had extensive pulmonary granulomatosis from intravenous injections of cellulose derived from tablets intended for oral consumption. Three of these persons were known abusers of pentazocine (Talwin). The principal vascular lesion induced by cellulose is thrombosis. Destruction of arterial elastic laminae and pulmonary vascular dilation commonly ensue. Two of the victims had cor pulmonale. The cellulose crystals induced foreign body granulomas when extravasated subcutaneously at injection sites on the arms, as well as in the right ventricular endocardium. Cellulose crystals have highly characteristic morphology and histochemical staining reactions that facilitate their recognition and their distinction from talc and starch. The latter substances also are used as fillers in tablets and capsules, and lodge in the pulmonary vessels of persons who inject them intravenously.

Adult↗