Biomedical subjects

G Lau

Publications and source records attributed to G Lau.

At least 37 records · Page 2Linked to original sources

PubMed1996

Accidental intraventricular vincristine administration: an avoidable iatrogenic death.

A patient with acute lymphoblastic leukaemia was mistakenly given vincristine intraventricularly, as part of an intensified course of chemotherapy. Despite a CNS washout and supportive treatment, the patient developed progressive ascending paralysis, gradually lapsed into coma and died some 10 days later. Autopsy and post-mortem histological examination showed evidence of brain death caused by florid encephalomyelitis, apparently induced by the intraventricular administration of vincristine.

Adult↗

PubMed1996

Perioperative deaths: a comparative study of coroner's autopsies between the periods of 1989-1991 and 1992-1994.

An earlier retrospective, clinicopathological review of 132 perioperative Coroner's autopsies (excluding cases of preoperative major trauma), conducted by the Department of Forensic Medicine during the period from January 1989 to December 1991, showed that such cases accounted for an average of 2% of all Coroner's autopsies performed during that time. Of these, 15.2% were iatrogenic deaths which were unrelated to anaesthetic complications. Over the subsequent 3-year period (January 1992 to December 1994), there were 170 similar cases, arising from a total of 6468 Coroner's autopsies, representing a composite necropsy incidence of 2.6% (annual incidence: 2.5% to 2.8%) and an absolute increase of 38 cases over the previous period (P < 0.05). Also, the proportion of non-anaesthetic, iatrogenic deaths almost doubled to 28.8% (P < 0.02). Although these observations do not, considered alone, denote a rise in perioperative mortality during the second period (1992 to 1994), as compared to the first, since both studies were limited to deaths reported to the Coroner, they do seem to emphasize the need for a comprehensive ongoing clinical and medico-legal audit of perioperative deaths locally. At present, the proportion of perioperative deaths which are not reported to the Coroner and, thereby, escape medico-legal review, remains undertermined. In addition, as at the end of June 1995, only 23 of 51 pathologically unnatural deaths received a Coroner's verdict of misadventure, with an additional 11 such cases pending inquiry. This rather wide divergence between medical opinion and legal judgement could be a subject of further research.

Aged↗

PubMed1996

Natural disease and alcohol intoxication amongst drivers of motor vehicles in Singapore from 1989 to 1993: a study of 140 necropsies.

A 5-year retrospective study of 140 necropsies conducted on drivers of vehicles (excluding motorcyclists) involved in fatal motoring events, drawn from 1285 traffic deaths, showed a marked preponderance of males (95%) and of Chinese subjects (87.1%), with over half (53.6%) aged between 20 and 39 years. Approximately a third was free of morphological evidence of natural disease, while the remainder showed evidence of various combinations of ischaemic heart disease (64.3%), hypertensive heart disease (38.6%), chronic obstructive airways disease (25.7%), benign hypertensive nephrosclerosis (15%), cerebral atheroma (15%) and other conditions. While the majority succumbed to the effects or complications of severe trauma, 35 subjects (25%) died from natural (that is, non-traumatic) causes, with 17 or almost half of these having occurred as sudden deaths "at the wheel", not associated with any form of collision. The mean age of the former (traumatic deaths) was 35.3 years while that of the latter (natural deaths) was 55.2 years (P < 0.001). Notably, ischaemic heart disease was the predominant natural cause, accounting for 31 of all such cases, none of which resulted in death or injury to any passenger, pedestrian or another motorist. It was also the cause of death in 12 vocational drivers, corresponding to 0.9% of all traffic deaths during this period. Although 34 drivers (24.3%) had detectable blood ethanol levels at autopsy, of which 28 (20%) exceeded the current legal limit of 80 mg/100 ml, all of the cases where death was attributed to natural causes were free of ethanol. However, 15 subjects (10.7%) who had died from trauma but had significant underlying pathology, comprising 13 cases of ischaemic heart disease, had blood ethanol concentrations well above the legal limit. It is possible that, in at least some of the latter, alcohol consumption might have acutely aggravated the underlying pathology and combined to contribute to the occurrence of these fatal accidents.

Accidents, Traffic↗

PubMed1995

A fatal case of drug-induced multi-organ damage in a patient with Hansen's disease: dapsone syndrome or rifampicin toxicity?

An elderly patient with borderline tuberculoid Hansen's disease (leprosy) developed the diaminodiphenylsulphone syndrome after approximately 8 weeks of multi-drug therapy comprising dapsone and rifampicin. Postmortem histological examination, following autopsy, demonstrated features consistent with drug-induced hepatitis, tubulo-interstitial nephritis and myocarditis. Although these could have been engendered by dapsone toxicity, it was thought that a concommitant adverse reaction to rifampicin, which is known to be hepatotoxic, nephrotoxic and possibly capable of predisposing to the dapsone syndrome, could not be excluded.

Acute Kidney Injury↗

PubMed1995

Iatrogenically-related, fatal haemorrhage occurring in end-stage renal failure: a series of three cases.

Three patients with end-stage renal failure died from acute haemorrhage which, in the first two cases, was related to the use of internal jugular catheters for haemodialysis. In the third instance, severe haemorrhage was caused by the apparent self-insertion of a 16-gauge butterfly needle, connected to a siliconised cannula (also designed for haemodialysis) into the superficial median cubital vein of the left forearm. The hazards associated with the use of internal jugular catheters and the medicolegal implications of these cases are briefly discussed.

Acute Disease↗

PubMed1995

Sudden death arising from a congenital coronary artery fistula.

A medico-legal autopsy conducted on a young Chinese man, a victim of sudden unexpected death, with a vague and unconfirmed history of congenital cardiovascular disease, revealed the presence of a congenital right coronary artery (arteriosystemic) fistula communicating with the markedly hypertrophied left ventricle, which showed microscopic evidence of myocardial ischaemia. The pathology of this rare condition is described and briefly reviewed.

Adult↗

PubMed1995

An unusual case of pneumatically-induced facial and cervical injuries.

An army mechanic sustained a penetrating mandibular injury, associated with right atlantooccipital dislocation, when the inner tube of a military truck tyre burst. It is thought that he had used a sledgehammer, having wielded it lengthwise with the free end of its hollow cylindrical handle held uppermost, to reposition the locking ring of the fully inflated tyre. In all probability, the sudden release of highly pressurised air disloged the locking ring and forced the circular end of the handle into his right lower jaw, thereby fracturing the mandible and causing an acute hyperextension injury of the cervical spine, with resultant profound spinal shock and instantaneous death.

Adult↗

PubMed1995

Button-pexy fixation for repair of ileostomy and colostomy prolapse.

Intestinal stomas are used in the surgical management of a number of congenital and acquired gastrointestinal conditions. Minor stomal complications are relatively common and are often well managed with nonoperative measures. Stomal prolapse may not represent a serious problem, but occasionally it requires surgical correction because of severe skin excoriation, bleeding, or incarceration of the bowel. The authors describe the treatment of stomal prolapse with the technique of button-pexy fixation, as originally described by C.W. Mayo.

Colostomy↗

PubMed1995

Pulmonary cartilage embolism: fact or artefact?

Microscopic examination of the lungs of a victim of traumatic asphyxia showed the presence of isolated foci of pulmonary bone marrow and cartilage embolism, although no macroscopic fractures were found. This condition could have resulted from a microfracture at a costochondral junction caused by the severe chest compression that led to the victim's death, or it might have been a resuscitation artefact. The possible role of pulmonary cartilage embolism as a marker of antemortem injury is considered.

Adult↗

PubMed1995

Pulmonary thromboembolism is not uncommon--results and implications of a five-year study of 116 necropsies.

A retrospective study of 116 cases of fatal pulmonary thromboembolism, drawn from a total of 11,044 Coroner's autopsies, conducted over a 5-year period, yielded a necropsy prevalence of 1.05%, with an annual incidence varying between 0.78%-1.32%. There was a statistically significant peak monthly incidence of 1.89% in September (P < 0.03), as well as significantly higher rates between April to September as a whole, compared to the rest of the year (P < 0.03). There was a marked preponderance of females (male:female ratio = 0.59) and 48.3% of the subjects were > or = 60 years of age, with a distinct peak (23.3%) in the 8th decade. The prevalence of the common predisposing factors were as follows: surgery 41.4%, trauma 30.2%, sepsis 22.4%, obesity 18.1%, malignancy 10.3% and pregnancy 4.3%. The peak time of death following trauma and/or immobilization was one week. Apparently, a total of 54 subjects (46.6%) were ambulant prior to death, while 29 (25%) did not have any of the common risk factors studied. The prevalence of cigarette smoking and oral contraception could not be ascertained due to inadequate clinical documentation, even among medical inpatients. The majority of deaths (85.3%) occurred in hospitals, of which 44.8% were surgical patients. Pulmonary thromboembolism was apparently not suspected in 77.1% of the 105 patients who died whilst under the care of qualified medical practitioners, there being no significant difference between medical and surgical inpatients. In these cases, death was most often attributed to acute myocardial infarction or ischaemic heart disease. The study also showed a high prevalence of underlying chronic obstructive airways disease (37.1%) and of moderate to severe coronary atheroma (37.9%). The clinico-pathological and medico-legal implications of these findings are discussed.

Aged↗

PubMed1994

A case of sudden maternal death associated with resuscitative liver injury.

A pregnant lady suffered massive pulmonary thromboembolism whilst undergoing pelvic ultrasonography at an obstetric unit. She was vigorously resuscitated for approximately 2 h and later transferred to a cardiovascular surgical department where an emergency pulmonary embolectomy was performed, at which time, some 21 of blood, emanating from lacerations of the right hepatic lobe, were found in the peritoneal cavity. Despite heroic measures, she died intraoperatively, having developed clinical features of disseminated intravascular coagulation. Autopsy demonstrated the presence of multiple liver lacerations which are believed to have been caused by protracted external cardiac massage and would have contributed to her death.

Adult↗

PubMed1994

Massive chylothorax associated with lymphangiomatosis of the bone.

Chylothorax in the absence of tumor or trauma is uncommon. Lymphangiomatosis of the bone, although extremely rare, has been associated with chylothorax. The authors describe the case of a 12-year-old boy who presented with a symptomatic left chylothorax associated with lymphangiomatosis of the ribs, scapula, and clavicle. Despite tube thoracostomies and the initiation of total parenteral nutrition, massive losses of chyle persisted, resulting in hypoproteinemia and severe lymphopenia. Control of the chylothorax was achieved by a parietal pleurectomy and application of fibrin glue (Tisseel). In the literature there are 16 cases of chylothorax associated with lymphangiomatosis of the bone. Their presentation, treatment, and outcome are reviewed. Conservative treatments such as dietary manipulations or thoracenteses were rarely successful. Thoracotomy with parietal pleurectomy on the side of the effusion is usually effective in controlling the chylothorax. Lymphangiomatosis should be considered a diagnostic possibility for any child who presents with a chylothorax.

Biopsy↗

PubMed1994

Cecal volvulus in the Cornelia de Lange syndrome.

Cornelia de Lange syndrome is a congenital malformation characterized by severe growth failure, mental retardation, and multiple physical anomalies. A variety of gastrointestinal anomalies have been described, including malrotation, colonic duplication, and nonfixation of the colon. Two patients with Cornelia de Lange syndrome presented to our institution with acute distal bowel obstruction. In both cases, emergency laparotomy showed cecal volvulus with necrosis of the terminal ileum, cecum, and ascending colon, secondary to nonfixation of the colon. Resection and an end-ileostomy were performed and later successfully reversed in both patients. Intestinal obstruction is a known cause of death in these children, and nonfixation of the colon has been identified during autopsy. Parents of children with Cornelia de Lange syndrome should be counseled as to the possibility of bowel obstruction resulting from cecal volvulus. This awareness may lead to earlier identification and treatment of this potentially lethal gastrointestinal tract anomaly.

Cecal Diseases↗

PubMed1994

Fatal haemorrhage following intra-aortic balloon counterpulsation: a case report and a brief review of its clinico-pathological and medico-legal aspects.

Intra-aortic balloon counterpulsation may result in serious and possibly fatal vascular complications, such as arterial dissection, in as many as 20 per cent of cases. A significant proportion of these complications may go unrecognized clinically. The following is an account of such a case from Singapore in which an elderly patient with a history of severe ischaemic heart disease died within 25 hours of coronary bypass surgery (resulting from massive intraperitoneal haemorrhage), as a consequence of post-operative intra-aortic balloon counterpulsation. The clinico-pathological and medico-legal aspects of the case are also discussed, together with a brief mention of the role of post-mortem coronary angiography in assessing venous graft patency and integrity.

Aged↗

PubMed1994

Amniotic fluid embolism as a cause of sudden maternal death.

The aetiology of amniotic fluid embolism has remained very much an enigma, although recent evidence points towards a combination of a severe haemodynamic disturbance, consisting of transient pulmonary hypertension, profound hypoxia and left ventricular failure, followed by secondary coagulopathy in about 40 per cent of patients who survive the initial event. Leucotrienes, prostaglandins and other vasoactive substances contained in amniotic fluid are postulated to play a fundamental role in its pathogenesis. In addition, amniotic fluid is also thought to possess thromboplastin-like properties. In common with all other causes of maternal death, it warrants a thorough and careful medico-legal investigation.

Adult↗

PubMed1994

Ischaemic heart disease as a natural cause of death in motorists.

A study of 2,709 fatalities among road users, arising from a total of 59,164 accidents resulting in injury or death, between 1983-1992 in Singapore, showed that 1,134 and 904 deaths involved drivers of motor vehicles and motorcyclists (excluding pillion riders) respectively. In 13 cases of the former and 2 of the latter, death was deemed to have occurred naturally as a consequence of ischaemic heart disease. Two taxi drivers and both motorcyclists had apparently either collapsed "at the wheel" or whilst mounted on their motorcycles without their vehicles having been involved in actual accidents. In the remaining 11 cases, the vehicles had collided with other vehicles, fixed roadside structures or had veered off the road. However, none of these resulted in injury or death to passengers, occupants or other vehicles or to passing pedestrians. Thus, the prevalence of fatal ischaemic heart disease, as a natural cause of death, among motorists during this time was 0.7% (SD +/- 0.5), corresponding to 0.25 per 1000 (SD +/- 0.18) accidents resulting in injury or death; with less than 0.5% (SD +/- 0.4), corresponding to 0.19 per 1,000 accidents (SD +/- 0.17) resulting in injury or death, being associated with actual collisions. Although significant and dramatic metabolic derangements may occur during driving, thereby predisposing motorists to ischaemic heart disease, or aggravating pre-existing disease, these results and those of earlier studies would appear to suggest that serious road accidents are rarely caused by, or contributed to, coronary atherosclerosis and its attendant complications.

Accidents, Traffic↗

PubMed1994

Sudden postoperative death from ruptured intracranial vascular malformations in a patient receiving total parenteral nutrition.

A 30-year-old female patient underwent oesophagectomy and colonic transposition for multiple oesophageal strictures associated with epidermolysis bullosa dystrophica. On the 9th postoperative day, she had convulsions and died, whilst in a state of severe hyperglycaemia, which was presumably iatrogenically induced by total parenteral nutrition. Autopsy and subsequent histological examination revealed that the cause of death was acute subarachnoid haemorrhage from ruptured, intracranial cryptic arteriovenous malformations. Postmortem vitreous biochemistry confirmed that death had occurred in a state of hyperglycaemia. The pathology of intracranial vascular malformations and the medico-legal implications of this case are discussed.

Adult↗

PubMed1994

Acute fulminant, fatal coxsackie B virus infection: a report of two cases.

Within a space of four months, between March to June 1993, medico-legal autopsies on 9 sudden infant deaths from natural causes were conducted at the Department of Forensic Medicine. Of these, 6 were due to unspecified interstitial pneumonitis or myocarditis (consistent with viral aetiologies), while 1 was attributed to adenovirus infection. The remaining 2 were due to fulminant Coxsackie virus (type B1) infection, where the post-mortem findings included leptomeningitis, myocarditis, florid interstitial pneumonitis, pancreatitis and focal hepatic necrosis. Coxsackie B viruses are often implicated in perinatal disease and, together with other viral infections, should be considered in the investigation of all sudden infant deaths.

Coxsackievirus Infections↗