Biomedical subjects
J A Perper
Publications and source records attributed to J A Perper.
Medicolegal problems in determining cause of death in motor vehicle accidents.
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Carbon monoxide and heart attacks.
A study of the relationship between carbon monoxide exposure and heart attacks was conducted in Baltimore. There was no evidence of clustering of either myocardial infarction or sudden ASHD on a specific day, nor was there correlation between the number of cases per day and ambient CO levels. Postmortem HbCO levels were slightly higher in ASHD sudden deaths than in sudden deaths due to other causes. Any differences were probably primarily due to cigarette smoking. Cigarette smokers who died suddenly due to ASHD had substantially higher postmortem HbCO levels than nonsmokers. Practically all of the elevated HbCO levels could be related to cigarette smoking or specific environmental exposure. There were no differences between HbCO levels in ASHD sudden death patients and in living controls. There was also no relationship between cardiac pathologic findings and postmortem HbCO levels among patients dying suddenly of ASH.
Unexpected, unexplained death in epileptic patients.
Thirty-seven cases of unexpected, unexplained death in epileptic patients were recorded by the Allegheny County Coroner's Office during the years 1969 through 1973. In no case was there anatomic or chemical evidence at autopsy sufficient to explain death. All patients had a duration of epilepsy greater than a year. All but two had less than one seizure per month. Blood levels of anticonvulsants at autopsy revealed only three patients with therapeutic levels of the drugs. Almost 50 percent of the cases studied had no demonstrable anticonvulsant. It is suggested that inadequate levels of anticonvulsant drugs are a significant factor associated with unexpected, unexplained death in epileptic patients.
Trends in mortality due to cirrhosis of the liver in Allegheny County -- comparison with Baltimore, Maryland.
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Arteriosclerosis of coronary arteries in sudden, unexpected deaths.
The authors graphically studied the topographic pattern and severity of coronary arteriosclerosis in arteriosclerotic heart disease (ASHD) sudden deaths using an improved technique involving in toto removal and decalcification of the main coronary tree. The study involved 171 cases of ASHD sudden death and 154 deaths from other causes. White males were the most severely affected group. The majority of the ASHD deaths had three or four major coronary vessels showing greater than 75% luminal stenosis; single-artery disease was a rare occurence. The intra- and interarterial pattern of coronary stenosis was equally severe and diffuse, with the exception of the arteries to SA and AV nodes. No small intramyocardial blood vessel disease was evident. Severe chronic coronary stenosis was associated with a high incidence of old myocardial infarction. The anatomical and pathological pattern of coronary stenosis in ASHD deaths appears to have ominous therapeutic implications.
Medicolegal problems in determining cause of death in motor vehicle accidents.
The major problems of medical and legal causation in traffic-associated fatalities have been reviewed, and the possible pitfalls in relating causation emphasized. In conclusion, the determination and evaluation of causality in vehicular traffic deaths may be a very complex process, requiring special skills and thorough understanding of medicolegal issues. Proper determination of medicolegal causality is crucial to the financial, legal, and medical interests of many individuals and social groups.
An epidemic of deaths attributed to fatty liver in Baltimore.
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Sudden, unexpected death in alcoholics.
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Medical experimentation on captive populations in the United States.
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Granulomatous peritonitis induced by rice-starch glove powder. A clinical and experimental study.
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Ethical, religious, and legal considerations to the transplantation of human organs.
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Epidemiology of homicide in Allegheny County, Pennsylvania, between 1966-1974 and 1984-1993.
BACKGROUND: We compared homicide death rates and characteristics of homicide victims and perpetrators in 1966-1974, 1984-1990, 1992-1993, and 1996 in Allegheny County, Pennsylvania, in an attempt to detect possible differences in the pattern of homicides. METHODS: Data were obtained from death certificates, coroner's records, police reports and newspapers. RESULTS: In the 1990s the homicide death rate increased for 15- to 24-year-old black men. The rate was 69 per 100,000/year for black men ages 15-24 years from 1966 to 1974 and rose to 275 per 100,000 from 1992 to 1993. Currently, the rates appear to be declining again. Preliminary data from 1996 showed the number of homicide deaths excluding vehicular homicides between 1993 and 1996 to decline from 19 to 8 for white men, from 70 to 42 for black men, from 9 to 3 for white women, and from 13 to 6 for black women with little change in the population (denominator). The dramatic drop from 111 to 61 deaths over a short time is similar to changes across the United State and is characteristic of epidemic rise and fall of homicides in the community. CONCLUSIONS: Between 1966 and 1993 Allegheny County experienced two separate homicide epidemics, one between 1966 and 1976 and the other between 1990 and 1993. Epidemics of homicide occur frequently and have different characteristics. New characteristics of the most recent epidemic of homicide include more homicides out of home, among strangers; less association with alcohol; and multiple perpetrators. Drug-use-associated homicides have also increased. Guns are the primary agents of homicide epidemics.
Matching the lost skin of a homicide suspect.
A case of matching a fragment of lost skin to a homicidal assailant's thumb is reported. The methods used included physical and photographic matching of corresponding configuration and skin ridges, serological blood grouping and enzymes typing. The conclusiveness of such a matching approach is self-evident.
Massive perinatal hepatic necrosis from maternal oxytocin overdose.
Review of clinical records regarding administration of oxytocin may provide clues to the etiology of hepatic infarction in the neonate. The authors present a case in which a large and rapid maternal overdose of oxytocin (17,300 mU over 20 min) during end-stage labor was associated with neonatal death and extensive hepatic infarction. These findings represent novel complications of oxytocin administration.