Biomedical subjects

J A Prahlow

Publications and source records attributed to J A Prahlow.

33 records · Page 2Linked to original sources

PubMed1998

Familial thoracic aortic aneurysms and dissections.

Rupture of thoracic aortic aneurysms and/or dissections is not rare, occurring in approximately 0.6% of all medicolegal autopsies. Most forensic pathologists are aware of the association between thoracic aortic aneurysms/dissections and trauma, atherosclerosis, inflammation and Marfan syndrome. In this report, we discuss a familial form of thoracic aortic dilatation and/or dissection that is distinct from Marfan syndrome. In addition, we review the topic of thoracic aortic aneurysm and dissection and encourage family notification by forensic pathologists when familial forms of aortic disease are suspected at autopsy.

Accidents↗

PubMed1997

Lesions that simulate gunshot wounds.

A variety of postmortem and antemortem defects can be misinterpreted as true antemortem injuries. In this paper, we present a collection of six cases with defects which simulate gunshot wounds. We briefly discuss each case and emphasize the importance of scene investigation, clinical correlation and careful examination in such cases.

Journal Article↗

PubMed1997

Cardiac perforation due to Wallstent embolization: a fatal complication of the transjugular intrahepatic portosystemic shunt procedure.

The transjugular intrahepatic portosystemic shunt procedure is an effective intervention for patients with bleeding esophageal varices. Potential complications are numerous but rarely serious. A case of hemopericardium, cardiac tamponade, and death caused by perforation of the right atrium and aorta by a stent after embolization from the liver during stent placement is reported.

Adult↗

PubMed1997

The implantable cardioverter-defibrillator. A potential hazard for autopsy pathologists.

The implantable cardioverter-defibrillator (ICD) is an implantable electronic device that has been proven to be safe and effective in treating various malignant tachyarrhythmias in susceptible individuals. As the use of ICDs becomes more widespread, more individuals with the implanted devices will be encountered at autopsy. Manipulation of an activated ICD can result in electrical shock. To avoid injury, pathologists must be properly prepared to deal with bodies containing activated ICDs. These devices can also provide valuable information that may be helpful in determining the cause and mechanism of death. Herein, we present information regarding the appropriate guidelines and safeguards for pathologists confronted with an activated ICD.

Accidents, Occupational↗

PubMed1996

Postmortem coronary subtraction angiography.

Thorough examination of the coronary arteries is essential when performing medicolegal autopsies. In some cases, evaluation is optimized by using postmortem angiography before dissection. Unfortunately, most techniques are far too time-consuming to be readily employed by forensic pathologists. We describe a simple technique of "subtraction angiography" that provides valuable information in a timely manner in cases that can benefit from postmortem angiographic analyses. We find the technique particularly helpful in cases that have had invasive coronary artery procedures contemporaneous with death.

Angiography, Digital Subtraction↗

PubMed1996

Uterine pyomyoma as a complication of pregnancy in an intravenous drug user.

Pyomyoma (suppurative leiomyoma) is a rare entity characterized by infarction and infection of a uterine leiomyoma. Pyomyomas may pose both diagnostic and therapeutic difficulties, leading to potential complications such as bacteremia, uterine rupture, and even death. In the case we describe, uterine pyomyoma occurred as a complication of pregnancy in a 31-year-old woman with a history of intravenous drug abuse. We postulate that the patient's illicit drug use caused transient bacteremia resulting in bacterial seeding of a uterine leiomyoma that had infarcted due to pregnancy. Therapy consisted of total abdominal hysterectomy and intravenous antibiotic administration. We believe this is the first reported case of a pyomyoma developing in association with intravenous drug abuse.

Adult↗

PubMed1996

Neoplasms of the pineal region.

Tumors of the pineal region are rare but pose interesting diagnostic and therapeutic challenges. A diverse group of neoplasms may occur in the pineal region, and correct histologic diagnosis is critical to proper management of the disease. To emphasize the need for tissue diagnosis, we present five cases of pineal region tumors, including germinoma, pinealoblastoma, pinealoma, astrocytoma, and meningioma. In addition, we discuss the differential diagnosis of pineal region tumors, emphasizing the histologic, prognostic, and therapeutic differences between various tumor types.

Adult↗

PubMed1996

Gender identification of human hair using fluorescence in situ hybridization.

Identification of the gender of hair represents relevant medicolegal evidence in criminal cases. The efficacy of Fluorescence In Situ Hybridization (FISH) using chromosome X and Y centromeric probes was tested to determine its ability to identify correctly the gender of hair. In this preliminary study, FISH correctly identified the gender of cells from hair as old as 26 days. The technique is accurate, rapid, sensitive, easily performed, and readily available. As a forensic laboratory technique, FISH shows great promise.

Female↗

PubMed1995

Sudden death in epilepsy due to an isolated subependymal giant cell astrocytoma of the septum pellucidum.

We report a case of sudden unexpected death in an individual with epilepsy. Autopsy revealed a subependymal giant cell astrocytoma of the septum pellucidum, but there were no other lesions of tuberous sclerosis. We discuss sudden death in epilepsy, deaths related to primary brain tumors, the pathology of subependymal giant cell astrocytoma, and whether or not such a tumor can exist outside the setting of tuberous sclerosis. We also discuss the implications such findings may have on surviving family members, as well as the important role of the forensic pathologist in such cases.

Adult↗

PubMed1995

Extra-adrenal myelolipoma: report of two cases.

Myelolipomas are benign tumors composed of an admixture of mature adipose tissue and normal hematopoietic cells. The vast majority occur within the adrenal glands, but several extra-adrenal myelolipomas (EAMLs) have been reported. The typical EAML is a solitary, well-defined mass within the abdomen, most commonly in the retroperitoneal presacral area. EAMLs may produce symptoms related to their mass effect, but they are occasionally incidental findings. Most commonly, the patient is older than 40 years and has no hematologic abnormalities. It is important to distinguish EAMLs from other soft tissue tumors, in particular liposarcomas, myxoid malignant fibrous histiocytomas, and extramedullary hematopoietic tumors. We discuss two cases of EAML. The first was in the retroperitoneum of a 76-year-old woman. It is the largest EAML ever reported, measuring 26 cm x 15 cm x 11 cm. The second, a presacral mass in a 68-year-old man, was diagnosed preoperatively by percutaneous computed tomography-guided fine needle aspiration biopsy. Preoperative diagnosis facilitated surgical management in this case. We discuss the clinical, radiologic, and pathologic characteristics and the differential diagnosis of this rare entity.

Aged↗

PubMed1995

Medical examiner/death investigator training requirements in state medical examiner systems.

Comprehensive and properly performed investigation of suspicious, unusual, unnatural, and various natural deaths is necessary to maintain the health, safety, and well-being of society as a whole. Adequate investigation requires the combined efforts and cooperation of law-enforcement and other public-service agencies, medical professionals, and those within the forensic community. As such, the "death investigator" plays a crucial role in the investigation process. These front-line investigators, whether they be coroners, medical examiners, physicians, other medical professionals, or lay-people, are required to make important decisions which have far-reaching consequences on how death investigation cases proceed. Death investigation practices vary greatly among medico-legal jurisdictions. A recent publication has categorized state death investigation systems by type of system. In an attempt to better delineate death investigation practices with specific regard to investigators' training and continuing education requirements, we surveyed the 20 systems categorized as state medical examiner systems and the five states with combined state medical examiner and county coroner/medical examiner systems. We present our findings and make recommendations which address the attributes and deficiencies of current death investigation practices.

Autopsy↗

PubMed1994

Death due to cocaine intoxication initially thought to be a homicide.

We present a case of accidental death due to cocaine ingestion in which the victim's bizarre behavioral manifestations initially led law enforcement officials to consider the death a homicide. By virtue of the medical examiner's thorough investigation, the true accidental nature of the death was brought to light.

Adult↗

PubMed1993

Lipid-laden foamy macrophages in renal cell carcinoma. Potential frozen section diagnostic pitfall.

Lipid-laden foamy macrophages are characteristic of xanthogranulomatous pyelonephritis (XGP). We have encountered a case of renal cell carcinoma (RCC), with extensive necrosis, in which confluent sheets of foamy macrophages were a dominant feature. We describe the case and discuss the potential frozen section diagnostic problem in attempting to distinguish between confluent sheets of xanthoma cells a "reactive" change in RCC and xanthoma cells as a fundamental component of XGP. We propose that awareness of that problem should prompt the pathologist to request additional samples.

Aged↗

PubMed1993

Histiocytoid cardiomyopathy: case report and literature review.

The sudden death of an infant may be due to a variety of causes. In such cases, complete autopsy with radiologic, gross, microscopic, and toxicologic examination is warranted. We present a case of a previously healthy 15-month-old girl with no known disease, who experienced witnessed cardiac arrest, ventricular fibrillation, and death. Complete postmortem examination revealed histiocytoid cardiomyopathy as the cause of death. Histiocytoid cardiomyopathy is a rare infantile cardiac-muscle disorder characterized by the presence of enlarged, polygonal subendocardial myocytes which, by light microscopy, lack normal striations, and instead have granular, faintly eosinophilic cytoplasm. Ultrastructurally, the myocytes contain numerous mitochondria and markedly reduced numbers of myofibrils. Clinically, the disorder is characterized by cardiac arrhythmias and/or sudden death occurring in children under the age of two years. We discuss the differential diagnosis, proposed theories of etiology, and the pathology of this rare entity.

Cardiomyopathies↗

PubMed1993

Cyanoacrylate adhesive technique in wound edge approximation.

Cyanoacrylate, the adhesive component of many commercially available strong-binding glues, has been used by the medical profession for various purposes, including tissue adhesion and repair, embolization, sclerotherapy, and hemostasis. Mortuary science professionals rely on cyanoacrylate's adhesive property to aid in body restoration techniques following embalming. Forensic applications include the use of cyanoacrylate fumes for latent fingerprint detection. An additional application for this sticky chemical is currently unrecognized by many within the forensic community. Specifically, cyanoacrylate's adhesive property makes possible the relatively simple, efficient, and rapid approximation of disrupted skin and tissue when warranted during a forensic autopsy. The final result is aesthetically pleasing and lends itself to subsequent photographic documentation especially when patterned injuries are encountered. We discuss the technique, benefits, and limitations of the cyanoacrylate adhesive method in this setting and present several cases wherein the technique has produced satisfying results.

Cyanoacrylates↗