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Biomedical subjects

C S Hirsch

Publications and source records attributed to C S Hirsch.

At least 73 records · Page 4Linked to original sources
PubMed1980

Human stress cardiomyopathy. Myocardial lesions in victims of homicidal assaults without internal injuries.

In order to clarify the relationship between stress and sudden death, we reviewed homicidal assaults that occurred in Cuyahoga County, Ohio (metropolitan Cleveland), over the preceding 30 years. Specifically, attention was focused on the autopsy and investigative findings relating to victims who died as a direct result of physical assault without sustaining internal injuries. Fifteen such victims were identified, and 11 of them showed cardiac changes (myofibrillar degeneration) consistent with "stress cardiomyopathy," comparable to lesions described in stressed animal experiments. Age matched and cardiac disease matched control subjects showed little or no evidence of such changes. Two victims survived for a time in the hospital, suffered arrhythmias throughout the hospital course, and had the described cardiac lesions at autopsy. We interpret our data as being strongly supportive of the theory of catecholamine mediation of these myocardial changes in man and of the lethal potential of stress through its effect on the heart.

Adult↗
PubMed1980

The contrecoup phenomenon. Reappraisal of a classic problem.

We describe briefly and comment upon the salient strengths and limitations of the major published theories that purport to explain the mechanism of contrecoup cerebrocortical contusions. Through the application of mechanical principles, we then present a modification, clarification, and expansion of selected aspects of several theories. Our final formulation emphasizes the injurious potential of nonuniform compressive stress and the relationship between brain lag and rotationally induced injury. The resulting theory remains faithful to the laws of physics while explaining the location and distribution of cerebrocortical contusions opposite the site of a moving head impact.

Biomechanical Phenomena↗
PubMed1980

Subtle fatal child abuse.

The majority of homicide victims in infancy and childhood have been either beaten or starved to death. However, the pathologist must recognize a much broader range of fatalities in early life for which an adult appropriately bears criminal responsibility. To emphasize the diversity and potential subtlety of homicide in infancy and childhood, we present six instances of fatal child abuse that illustrate the types of unusual physical and chemical assault and the covert negligence that kill children. Unfamiliarity with the law, lack of suspicion in approaching cases, and failure to utilize necessary techniques to establish the mechanism of death can obscure recognition of the homicidal nature of such fatalities.

Anemia, Sickle Cell↗
PubMed1979

Violent death in a metropolitan county: II. Changing patterns in suicides (1959-1974).

Suicide rates in Cuyahoga County (metropolitan Cleveland) rose from 10.2 in 1958 to 12.5 per 100,000 populations in 1974 (23 per cent increase) with the greatest rise among nonwhite males (from 5.9 to 13.1, or 122 per cent). Increased rates were observed in both the city (19 per cent increase) and suburbs (35 per cent increase). Rates increased among young non-white and white adults of both sexes aged 15--34 years, but decreased slightly among adults aged 65 years and older. These findings are consistent with national trends. Alcohol was present in the blood of one-fourth of the individuals who were "dead on arrival," and at intoxicating levels in 20 per cent. There were increasing percentages of victims with positive blood alcohol and with intoxicating levels during the study period. White male victims in the city had significantly higher frequencies of such findings than their counterparts in the suburbs. The rates of suicide committed by firearms rose among all race-sex groups, with the greatest increase among city nonwhite males (2.1 to 7.7, or 267 per cent). Suicide by chemical agents (roughly one-half being barbiturates) increased in all groups except city nonwhite males, with the greatest increase among white males and suburban white females. Firearms among males and poisoning among females displaced asphyxia as the leading modes of suicide.

Adolescent↗
PubMed1977

Violent death in a metropolitan county. Changing patterns in homicide (1958-74).

Analysis of homicide patterns in Cuyahoga County, Ohio (metropolitan Cleveland), for 1958-1974 discloses the following major trends: a dramatic rise in overall homicide rates in the city (320 per cent) and suburbs (200 per cent); an increase in justifiable homicide; a doubling of the percentage of homicides incident to other felonies; a markedly increased incidence of homicide among younger persons; a conspicuous rise in firearm killings (now 81 per cent of all homicides); and a continued preponderance of intraracial homicide, with the highest rates among nonwhite males in the city. The trends in Cuyahoga County are consistent with those in other United States metropolitan counties. Homicide is responsible for a major part of the decreased life expectancy among young, urban, non-white men. The factor most consistently associated with these trends is the increased use of handguns.

Adolescent↗
PubMed1977

Carboxyhemoglobin concentrations in flash fire victims: report of six simultaneous fire fatalities without elevated carboxyhemoglobin.

Eight people died in a traffic accident involving a tractor-trailer and ten autos. The accident caused a series of flash fires from ruptured gas tanks. Complete autopsies established that six of the victims died exclusively from thermal trauma; none showed an elevated blood carboxyhemoglobin concentration. Flash fire victims are exceptions to the axiom that elevation of blood carboxyhemoglobin is a sine qua non for concluding that a decedent recovered from the scene of a conflagration was alive in the fire.

Accidents, Traffic↗
PubMed1976

A suicidal gunshot wound of the back.

An 18-year-old woman committed suicide by shooting herself in the right temple, presternal region, and lower thoracic back. The anatomic and other investigative data on this case are reported and discussed in the perspective of our experience with suicides by firearms.

Adolescent↗
PubMed1975

Arterial dysplasia with ruptured basilar artery aneurysm: report of a case.

An 11 year old girl died unexpectedly as a result of spontaneous subarachnoid hemorrhage originating from a ruptured giant fusiform aneurysm of the basilar artery. The aneurysm had developed as a long standing complication of arterial fibromuscular dysplasia. This discussion describes the light and electron microscopic findings in the aneurysm and the histologic examination of abnormalities in the muscular arteries of the viscera.

Aneurysm↗
PubMed1975

Contrecoup skull fractures.

The authors describe the frequency, pathological features, and significance of contrecoup fractures of the anterior cranial fossae, which occur commonly when falls with occipital or temporal impacts cause fatal head injuries.

Accidents↗
PubMed1974

Accidental firearm fatalities in a metropolitan county (1958-1973).

A study of accidental firearm fatalities in Cuyahoga Count, Ohio, (Metropolitan Cleveland) from 1958-1973, inclusive, has shown a threefold increase in the rate of such deaths since1967. They are more frequent in the central city than in the suburbs, show a male preponderance, are more common in nonwhites, have a peak prevalence in the 25-34-year age range and usually happen in the home. Approximately half of the adult victims had been drinking alcoholic beverages when shot. It is hypothesized that the frequency of accidental firearm fatalities is primarily related to the number of guns, particulary handguns, in civilian possession. The data indicate that a loaded firearm in the home is more likely to cause an accidental death than to be used as a lethal weapon against and intruder.

Accidents, Home↗