[HIV-related deaths outside health facilities in Stockholm].
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Adult↗
Biomedical subjects
J Rajs
Publications and source records attributed to J Rajs.
Sudden infant death in Stockholm. A forensic pathology study covering ten years.
During a ten year period, March 1976-February 1986, 83 non-selected consecutive cases of sudden unexpected death in infants, between one week and one year of age, were examined at the Department of Forensic Medicine in Stockholm. Forty-three deaths (52%) were classified as typical or possible cases of Sudden Infant Death Syndrome (SIDS), 35 (42%) as non-violent non-SIDS cases and 5 (6%) as non-natural deaths. Cardiovascular disease, including myocarditis, was found in 21 (25%) instances, infections with inflammatory manifestations in various organs outside the heart in 12 (14%) and miscellaneous, non-violent causes of death in 2 (2%) cases. The male:female ratio was 1.15:1 for SIDS and 1.30:1 for non-SIDS cases. A peak of incidence was found for SIDS cases in infants between two and four months of age, while non-SIDS victims tended to be somewhat older. Ninety-five percent of the SIDS fatalities occurred during the winter months (October-April) as compared to 71% of the non-SIDS cases. Outdoor temperature below the annual mean of 5.9 degrees C in combination with a sudden decrease in temperature was associated with sudden deaths, particularly SIDS. Thirty-three percent of the SIDS victims died in their cribs compared to 51% of the non-SIDS cases. Corresponding figures for deaths outdoors in a pram were 33% and 11%, respectively. Fourteen percent of the infants in both groups died while in bed with one of the parents. Ninety-five percent of the SIDS victims were previously healthy, but in 9% one or more periods of abnormal breathing had been noted. The corresponding figures for non-SIDS were 70% and 3%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Female↗
Patterns in sharp force fatalities--a comprehensive forensic medical study: Part 2. Suicidal sharp force injury in the Stockholm area 1972-1984.
A total of 89 cases of sharp force suicide that had been committed in the Stockholm area in Sweden from 1972 through 1984 were investigated. The series showed a male preponderance, sex ratio 3.3, and among males a shift towards the age group 40 to 49 years of age. An impact of cultural/ethnic factors was indicated by the overrepresentation of Finnish and Hungarian immigrants. A psychiatric diagnosis had been ascribed in 22 cases, and addiction to drugs or alcohol in 23. Previous attempts at self-destruction were recorded in 11 cases, only 1 of which was by sharp force. Classical indicators of suicidal intent, for example, suicide notes and the presence of hesitation injuries, were found in 28 and 80%, respectively. A preference for certain anatomical locations (throat, precordium, epigastrium, wrists) was confirmed as was the tendency to expose the skin before inflicting suicidal wounds. As compared to homicidal precordial stabs whose entrance wounds usually run vertically, horizontal or upwards/left-slanting stabs are strongly suggestive of suicide. Although cases were encountered where several "rules of thumb" concerning homicidal versus suicidal patterns were violated, our series contained no case of injuries to the backside of the trunk and no case of more than one wound piercing the left ventricle of the heart. Multiple chest wounds transecting costal or sternal bone were however not uncommon, and, along with the use of bizarre tools and objects like wood chisels or pieces of glass, illustrated the determination of suicidal intent. Toxicological analysis was positive for drugs in 22 and for alcohol in 27 cases. Blood alcohol levels were roughly similar to those found in victims of homicidal sharp force, whereas drug levels tended to be lower or higher in suicides.
Adult↗
[Heroin administered via a cotton wad as a possible cause of death of a 1-year-old child].
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Child Abuse↗
A statistical model examining repetitive criminal behavior in acts of violence.
A simple statistical model for examining repetitive criminal behavior in acts of violence is described. The units, called "parameters," are nonquestionable data concerning environment of the crime, personal properties, and postmortem findings of the victim, obtained by double-blind investigation performed by two forensic pathologists. Parameters shared by two or more criminal acts allegedly committed by the same assailant were compared with the same parameters recorded from 50 or 100 other mutually independent criminal acts committed by other known assailants. This allowed an evaluation of the probability (p) of a crime pattern expressed as a parameter score to recur in mutually independent cases. The distribution of the score, when plotted on a logarithmic scale in all examples, showed an approximately normal distribution. The relation between probability (p), the estimated mean (means), and standard deviation (SD) yielded a normal curve. Different patterns of action by different perpetrators and patterns indicating repetitive behavior could be obtained. The method is applicable during investigation of crimes in which the perpetrator acts in a repetitive manner, as in serial murders.
Crime↗
Unexpected death in patients suffering from eating disorders. A medico-legal study.
Medico-legal investigation into causes of unexpected death of five persons who suffered from eating disorders did not give distinct pathoanatomical explanations. The analysis disclosed a number of risk factors whose interplay may have resulted in a circulatory catastrophy. These factors were of organisational and ideological character: simultaneous treatment at different departments, lack of contact with psychiatrists, or unclear criteria for admission to hospital; or somatic: circulatory and electrocardiographic S-T and T wave abnormalities, hypopotassemia and hypoglycemia, as well as anergy of the emaciated patient which may have led to symptoms of bronchopneumonia being overlooked. Morphological investigation revealed heart atrophy as well as recent lesions such as haemorrhages, fragmentation and contraction bands of the myofibres. In two extremely emaciated patients there was a disproportion between the size of the mitral valves and the atrophic ventricular wall, an appearance similar to "floppy valves". In one instance an erroneously inserted gastric tube contributed to vomiting, hypopotassemia and sudden death.
Adolescent↗
Patterns in sharp force fatalities--a comprehensive forensic medical study.
A ten-year series of 142 homicidal fatalities caused by sharp force injury was studied with the aim to systematize information inherent in the characteristics of the victim and the pattern of injuries. The population of victims consisted of 112 males (79%) and 30 females (21%); among perpetrators, 125 (88%) were males. Among victims as well as among perpetrators, persons of non-Swedish origin were overrepresented in relation to their share of the nonselected population. In 82 cases (58%), one or two wounds had been inflicted; in 23 cases (16%), ten or more wounds. In the latter group, eleven victims but no perpetrators were female. In the majority of cases victim and perpetrator were known to each other, and in instances of multiple wounding, a close relationship between the two was clearly more common than in the group of one- to two-wound fatalities. Tests for blood alcohol were positive in 86 of 116 victims (74%), the majority being in elimination phase. Furthermore, 96 of 120 perpetrators (80%) had positive tests or were known to be drunk at the time of the killing. In multiple wound fatalities, alcohol inebriation was less common both among victims and perpetrators. In these cases, the two persons involved were usually closely related or intimately known to each other, and in the absence of psychiatric disorder in the assailant, the motive was of a passionate type.
Accidents↗
Sudden unexpected death as a complication of eating disorders.
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Adolescent↗
Discussion of "procedures and responsibilities in forensic toxicology--to what extent are they the results of laboratory facilities?".
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Child↗
Cardiovascular abnormalities in children: a ten-year forensic pathologic study.
In order to obtain information on types, incidence, and significance of cardiovascular abnormalities in children, a total of 104 consecutive medicolegal autopsies of children aged 8 days to 16 years during a 10-year period from May 1974 to April 1984 were studied. Extensive histological examination of the hearts was performed in 92 out of 104 cases and complemented with chemical and microbiological analyses. In the natural death group consisting of 53 children, 26 (49%) showed abnormalities: 7 (13%) malformations, 11 (21%) cardiomyopathies, 5 (9%) idiopathic subaortic hypertrophy, and 3 (7%) a heart weight only 50% of the expected weight. In the violent death ("control") group, abnormalities were found in 8 of 39 cases (21%), all of which were cardiomyopathy. Only 5 of 34 cardiovascular abnormalities (every 7th case), all complex malformations, were clinically recognized. In 14 (15%) of the total 92 examined cases the cardiovascular abnormality was the only apparent cause of death, and in 12 (13%) a contributing cause of sudden unexpected natural death, while in 3 (3%) it was related to a fatal accidental injury. In 5 (13%) of the 39 cases of violent death, cardiomyopathy was an incidental finding without any connection to the circumstances or cause of death. The causes of cardiovascular abnormalities were associated with bacterial and viral infections, respiratory disorders, phenytoin sensitivity, or were unknown. Because of the differences in diagnostic criteria employed by previous investigators, it cannot be determined whether the incidence of the cardiovascular abnormalities and sudden cardiac death in children found in this material was higher than in other studies.
Adolescent↗
Postmortem findings of pulmonary lesions of older datum in intravenous drug addicts. A forensic-pathologic study.
At post-mortem examination the lungs of 30 intravenous narcotic addicts were compared to two groups of 30 age- and sex-matched controls with no history of narcotic abuse. A distinctly uneven distribution of pulmonary pathology among the two groups was found, with various non-acute, non-granulomatous lesions dominating in the addict group. Microscopically, the typical pattern consisted of focally thickened, fibrotic and hypercellular alveolar septa, accumulation of haemosiderin-laden macrophages in alveolar walls as well as in the lumina of alveoli and respiratory passages, and vascular lesions with full-thickness fibrosis of arterial walls. An attempt at quantitative scoring of the changes indicated that the extent of pulmonary pathology increases with the addict's age or duration of narcotic abuse and with the degree of social deterioration. The same changes could also be demonstrated in some control cases with a history of salicylate or alcohol abuse, or with known heart/lung disease. The addict group also exhibited myocardial alterations in 28 of 30 cases. Typical findings were myofibrillar degeneration and fatty infiltration. In 15 of 30 addicts morphological and toxicological examination did not yield a definitive cause of death. However, the present demonstration of cardiopulmonary pathology suggests that narcotic addicts may be prone to acute circulatory and/or respiratory derangement even if no overdose of drugs is taken.
Adult↗
HLA-B27-associated heart disease. Clinicopathologic study of three cases.
The histologic features of the cardiac lesions in HLA-B27-associated heart disease were examined in three cases that illustrate different nuances of the clinical spectrum of this disorder. One of these cases constitutes an important link between the previously established concept of cardiac manifestations in ankylosing spondylitis and Reiter's disease and the recently introduced, wider concept of HLA-B27-associated cardiac manifestations. A correlation between the invasive electrophysiologic results and the autopsy findings is demonstrated in another case.
Aged↗
Difference between in vivo and postmortem distances between anterior chest and heart surface. A combined autopsy and in vivo computerized tomography study.
The distance between anterior chest surface and intrapericardial surfaces of the heart and great blood vessels was measured on 37 cases (seven with acute fatal hemopericardium) at autopsy and on 24 live persons by computerized tomography. At autopsy, the apex of the heart was always closest to the skin surface except in cases with acute fatal hemopericardium, where the heart was displaced backwards by 10-40 mm. At computerized tomography, chest-heart distances were approximately 16 mm shorter than at autopsy. Changing the position of the patient from supine to prone decreased the distances by about 10 mm. The data presented demonstrate that the topography of the heart and great vessels is changing with the position of the body in vivo and that chest-heart distance tend to increase postmortem; therefore, the depth of a stab wound in the anterior surface of the heart as measured at autopsy should be regarded as a maximal estimate of the length of the stabbing weapon actually having penetrated the tissues.
Adolescent↗
Postmortem findings and possible causes of unexpected death in patients treated with intraventricular pacing.
The study comprises 10 consecutive medicolegal autopsies of patients treated with intraventricular cardiac pacing who died unexpectedly outside of a hospital. The treatment was indicated by AV-block grade I-III in eight cases, by bradyarrhythmia in one case, and sick sinus syndrome in the last case. Four patients died during a sudden epileptiform seizure, three were found dead, and three died in their sleep. Recent hemorrhages close to the AV-node and His bundle were seen in five cases. The local findings in the vicinity of the pacemaker leads were numerous and multiple consisting of thrombosis of the superior vena cava, tortuous and corroded leads, leads attached to the atrial endocardium, constricted orifice of the coronary sinus, and acute ulcerations, endocarditis, shrinking, and ruptures of the cusps of the tricuspid valve. The right atrium of the pacemaker patients was significantly dilated. The mean value of the ratios between right atrial and ventricular length (AV ratio) of the 10 pacemaker patients was 1.2 in contrast to the mean value of the same ratio of 30 controls, which was 0.6. The AV ratio was particularly increased in patients with lesions of the tricuspid valve and with a long history of cardiac pacing. In 3 of the 10 patients the immediate cause of death was related to anatomical and technical complications of long-term intraventricular pacing. Such complications were clinically unrecognized thrombosis of the superior vena cava, rupture of the chordae tendinae, and cable breakage.
Aged↗
Minute angiomatous alterations of the interatrial septum as a possible cause of sudden death: a report of four cases.
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Adult↗
Sudden unexpected child death associated with ingestion of fluid dish detergent.
A case of sudden unexpected death of a 13-month-old child is reported. The immediate cause of death was aspiration of stomach contents. The autopsy and microscopical examinations revealed cerebral oedema, organ congestion and an increased number of neutrophils in germinal centres of mesenterial lymph nodes and spleen. The finding of ethanol and methanol (5.2 and 0.1%) and of significant amounts f a surface-active agent (linear alkyl benzene sulphonate) in the stomach contents indicated consumption of a fluid dish detergent prior to death. The blood ethanol concentration was below 0.1% and urine ethanol and methanol concentrations were 0.28% and 0.04%. The possibility that ethanol-containing detergents may trigger hypoglycemic attacks is discussed.
Detergents↗
Toxic effects of free and DNA-linked daunorubicin on isolated rat cardiac myocytes.
Isolated cardiac myocytes from adult rats were used as a model to study the cardiotoxicity of free and DNA-linked daunorubicin. The toxic effects on the myocytes were evaluated by studying morphological changes, trypan blue exclusion and cell membrane permeability to NADH, as determined by LDH-activity. At a concentration of 100 microM daunorubicin caused an increased plasma membrane permeability within 30 min. Using light microscopy, the myocytic injury induced by daunorubicin could be distinguished from that induced by anoxia or elevated pH. In contrast to the effect of the free drug, no toxic effects could be demonstrated after incubation with DNA-linked daunorubicin (100 microM) for 5 hours. The higher toxicity of the free drug was related to a much higher intracellular accumulation of daunorubicin. No fluorescent metabolites of daunorubicin could be detected in the myocardial cells. Daunorubicin did not induce lipid peroxidation, as judged by the absence of malondialdehyde production and evolution of ethane. It is concluded that daunorubicin exerts toxic effects on rat cardiac myocytes by mechanisms that do not involve lipid peroxidation. Isolated cardiac cells from adult rats seem to be a useful model for the further study of such mechanisms.
Animals↗
Myocardial accumulation of 99Tcm-pyrophosphate and 99Tcm-gluconate compared with morphologic findings in daunorubicin treated rabbits.
In long-term daunorubicin treated rabbits increased myocardial accumulation of 99Tcm-pyrophosphate and 99Tcm-gluconate of a varying degree were recorded, visible at gamma camera examination in more than half of the animals. Chronic cardiomyopathy morphologically and topographically different from the ischemic myocardial injury was demonstrated in most animals at light microscopic examination. The myocardial abnormalities were classified in qualitative and quantitative scores and compared with the degree of isotope accumulation. The rabbits receiving a large single dose of daunorubicin had slightly increased isotope accumulation in the myocardium but no histopathologic changes.
Animals↗