Biomedical subjects
Publications and source records attributed to J L Luke.
Fourier transform infrared (FT-IR) spectral mapping was used to study polymers in human tissue associated with silicone breast implants. Biomaterials such as polyesters, polyurethanes and silicone were identified by FT-IR spectroscopy, and their relative locations and distributions within tissue specimens were characterized by three-dimensional (3D) spectral maps.
Between 1 and 2 million women in the United States have silicone breast implants. Complications include capsular contracture and calcification and possibly connective tissue diseases such as scleroderma and rheumatoid arthritis, a subject of some controversy. In order to accurately assess the role of silicone in any histopathologic change, it is necessary to confirm its presence and to identify other foreign materials in the capsular tissue. Although light microscopy is used to visualize regions of tissue containing foreign inclusions, their chemical identity can only be determined using analytical techniques such as infrared or Raman microscopy. However, these conventional microprobe techniques record spectra only at single points and require an a priori knowledge of the locations of the inclusion to be probed. To significantly extend the capabilities of both infrared spectroscopy and optical microscopy, we have developed a new infrared imaging system that completely integrates these two methods. In this manuscript we highlight the ability of the technique to screen rapidly and to determine accurately the presence, size and chemical composition of silicone gel inclusions in human breast tissue.
The National Association of Medical Examiners Ad Hoc Committee on the Definition of Heat-Related Fatalities recommends the following definition of "heat-related death": a death in which exposure to high ambient temperature either caused the death or significantly contributed to it. The committee also recommends that the diagnosis of heat-related death be based on a history of exposure to high ambient temperature and the reasonable exclusion of other causes of hyperthermia. The diagnosis may be established from the circumstances surrounding the death, investigative reports concerning environmental temperature, and/or measured antemortem body temperature at the time of collapse. In cases where the measured antemortem body temperature at the time of collapse was > or = 105 degrees F (> or = 40.6 degrees C), the cause of death should be certified as heat stroke or hyperthermia. Deaths may also be certified as heat stroke or hyperthermia with lower body temperatures when cooling has been attempted prior to arrival at the hospital and/or when there is a clinical history of mental status changes and elevated liver and muscle enzymes. In cases where the antemortem body temperature cannot be established but the environmental temperature at the time of collapse was high, an appropriate heat-related diagnosis should be listed as the cause of death or as a significant contributing condition.
Breast implant capsular tissues from 86 cases were studied to characterize the relationship between capsular findings and the type of implant used. Tissues were examined by light microscopy, immunohistochemistry, scanning electron microscopy/energy dispersive x-ray analysis and Fourier transform infrared, and Raman microspectroscopy. Capsular pathology was influenced by the structure and composition of the implant. A pseudoepithelium at the inner capsular surface (synovial metaplasia) was noted with silicone gel-filled, saline-filled, and polyurethane-coated implants, and disproportionatelywith textured surface implants. Immunohistochemical studies of pseudoepithelium supported a macrophage/histiocyte cellular origin. Talc was identified intracellularly within macrophages in 42 cases. Capsular calcification was strongly associated with the presence of implant stabilization patch material. Infrared spectra were used to identify silicone, talc, Dacron, and two different types of polyurethane in capsular tissues. Micropapillary structures identified at the pseudoepithelial surface have, to the authors' knowledge, not been previously described.
High-definition Raman chemical imaging microscopy is applied to the histopathological characterization of biopsied human breast tissue containing foreign polymer inclusions. The polymer material is found in a patient with a history of silicone implant breast reconstructive surgery. Silicone implants are, on occasion, anchored to the soft tissues of the chest with polyester patches. In the case studied here, the polyester anchors were incorporated into the patient's fibrous tissue surrounding the implant. High-definition Raman chemical imaging provides molecular-specific image contrast in the complex breast tissue matrix without the use of stains or dyes. This is the first example in which Raman spectroscopic imaging microscopy has been applied to pathology. A goal of this and future studies is to complement traditional histopathologic diagnoses of disease states utilizing vibrational spectroscopic imaging techniques.
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Procedures leading to the proper investigation and certification of deaths occurring in police custody are discussed. The importance of training and experience, of interchange of information between investigator and forensic pathologist, and of common sense in the pursuit of fairness toward this end is emphasized.
A 21-year-old, previously healthy weight lifter collapsed during a bench press workout. He had taken anabolic androgenic steroids parenterally for the previous several months. Pertinent autopsy findings included marked cardiac and renal hypertrophy and hepatosplenomegaly, with regional myocardial fibrosis and focal myocardial necrosis. Nandrolone (19-nor-testosterone) metabolites were identified in postmortem urine. The possible etiologies of the cardiac findings are discussed.
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Correlation of the circumstances of death with the pathologic findings in this prospective study of deaths by hanging affords insight pertaining to certain of the pathophysiologic mechanisms involved in fatalities of this type. The presence of conjunctival and facial/periorbital petechial hemorrhages correlates with increasing levels of body support below the point of ligature suspension. Hyoid bone and/or thyroid cartilage fractures (found in 26% of cases) are most frequently identified in those persons found completely suspended and in victims in the older age ranges. No hyoid bone/thyroid cartilage fractures, internal soft tissue injury, or petechiae were present in 13 (21%) of the study cases.
Deaths associated with injected street preparations of heroin increased substantially in the District of Columbia between April 1979 and December 1982. The 1981 population-based mortality rate (17.4 per 100,000) is possibly the highest ever reported. A case-control study based on toxicologic analyses of postmortem blood samples indicates that concentrations of both heroin and ethanol are substantial risk factors for heroin-related deaths. Analyses of the composition of street-level preparations of heroin and quarterly mortality indicate that the quantity of heroin in packages sold on the street, the price of heroin in these packages, and the quinine weight per package each predict deaths equally as well. An increase in the causal use of heroin in combination with ethanol and quinine is the probable cause of this epidemic.
Vitreous humor chemistry studies were performed on 13 air crash victims who had remained immersed in near-freezing fresh water for seven to eight days. Glucose concentrations were observed to be higher than those in a comparison group of autopsied cases with prolonged postmortem intervals, suggesting that rapid chilling inhibited glycolysis. Evidence of dilution of vitreous humor electrolytes was also noted. After correction for the apparent degree of dilution, the potassium concentrations were found to fall within a narrow range.
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Two hundred eighty-seven deaths directly related to narcotic abuse occurred in the District of columbia between July 1971 and December 1979. Factors contributing to death in some cases included lack of opiate tolerance as well as the conjoint abuse of ethanol. Free morphine was identified more often in the blood of victims dying rapidly than in the blood of those with longer post-injection survival. A statistically significant correlation between the number of heroin-related fatalities and the purity of heroin available to the user was observed over the 8 1/2-year study period.
This report describes a man who died after a gunshot wound that entered the right atrium and exited from the right ventricle without entering the cardiac septa or the left side of the heart. At necropsy, the left atrial appendage was found to be inverted and invaginated into the mitral orifice. The invagination of the left atrial appendage is viewed as anatomic evidence that a negative left ventricular pressure was created as the left ventricular volume rapidly decreased as a result of right-sided cardiac exsanguination. Previously reported experiments in animals demonstrating the sucking (negative pressure) action of the left ventricle during ventricular diastole are summarized. The prerequisite for creation of a negative pressure in the ventricles during diastole is an extreme diminution in left ventricular volume, in this case as a result of right-sided cardiac bleeding. Only a vacuum effect of the left ventricle during diastole can explain the inversion and invagination of the left atrial appendage in this patient.
The recent decline in the incidence of the SIDS in the District of Columbia has permitted identification of what appears to be two separate groups of cases within the generic SIDS population. While deaths of bed-sharing victims remained relatively constant throughout the study period, a greater than fourfold decrease was seen in non-bed-sharing SIDS fatalities. The implications and preliminary nature of these findings are discussed in an attempt to stimulate further inquiry into the possible safety hazard of the practice of bed-sharing in the SIDS age group and its potential influence on the incidence of the SIDS.
Ethyl alcohol and its lethal effects were present either in the victim or in the environment, including persons responsible for a given death, in 53% of the cases autopsied during a six-month period at the Office of the Chief Medical Examiner in the District of Columbia. The results of this small, admittedly biased, sample indicate that the acute and chronic effects of alcohol are a major public health problem in this jurisdiction. Comparative figures from other medical examiner's systems suggest the national prevalence of the problem and confirm the gross inadequacy of data from death certificates for such research. Only when the combination of accurate pathological, toxicological, and historical information concerning all types of deaths is available can reliable statistics regarding the numbers and types of deaths related to alcohol be obtained.