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Biomedical subjects

K B Nolte

Publications and source records attributed to K B Nolte.

At least 37 records · Page 2Linked to original sources
PubMed1996

Hantaviral biosafety issues in the autopsy room and laboratory: concerns and recommendations.

The need to perform autopsies on and examine laboratory specimens from patients with hantavirus pulmonary syndrome (HPS) has raised questions about biosafety. Human illness associated with hantaviruses is usually the result of exposure to infectious aerosols from saliva or excreta of wild rodents. It is unclear whether or nor certain autopsy and laboratory procedures can also generate similar potentially infectious aerosols. As the biosafety information developed for the HPS agent is limited and the consequences of infection are serious we recommend a cautious approach. Autopsy prosectors should use N-95 particulate respirators as a minimum standard. If aerosols will be generated they should use N-100 particulate respirators or powered air purifying respirators with high-efficiency particulate air (HEPA) filters. Centrifugation and cytocentrifugation of blood or body fluid samples should be performed in bio-contained systems and these specimen containers should be opened in a class II biological safety cabinet.

Autopsy↗
PubMed1996

Evidence against person-to-person transmission of hantavirus to health care workers.

Unusual, primarily pulmonary, manifestations of hantaviral illness occurring in the southwestern United States raised the possibility of person-to-person transmission of a recently recognized hantavirus, Sin Nombre virus. To determine whether such transmission had occurred among health care workers (HCWs) exposed to patients with confirmed hantavirus pulmonary syndrome, we evaluated HCWs who had cared for patients with hantavirus pulmonary syndrome or who had processed specimens from these patients. Information about exposure to these patients and about recent illnesses was obtained via a standardized questionnaire. Serum specimens were tested for IgM and IgG antibodies to hantaviruses with use of ELISAs. Of the 396 HCWs, 266 (67%) reported that they had been exposed to patients with hantavirus pulmonary syndrome or to their body fluids or that they had processed laboratory specimens from these patients. Although 108 (27%) of the HCWs reported fever, myalgias, or respiratory illnesses during the 3 months before the serum specimens were obtained, hantavirus antibodies were not detected in any HCW. These data suggest that person-to-person transmission of Sin Nombre virus is unlikely to occur in health care settings.

Adolescent↗
PubMed1996

Intracranial hemorrhage associated with cocaine abuse: a prospective autopsy study.

OBJECTIVES: To determine the incidence of cocaine abuse in cases of fatal intracranial hemorrhage and to examine potential pathophysiologic mechanisms. DESIGN: Prospective clinical, autopsy, and toxicologic evaluation of all cases of fatal non-traumatic intracranial hemorrhage examined during 1 year (April 11, 1989 to April 10, 1990) at the Connecticut Office of the Chief Medical Examiner. Autopsy examination included exhaustive histologic evaluation of cerebral vessels and parenchyma for vasculitis and other vasculopathies. RESULTS: Ten of 17 (59%) of all non-traumatic intracranial hemorrhages were associated with a positive toxicology for cocaine. Seven (70%) of these were parenchymal hemorrhages, and the remaining three (30%) were subarachnoid hemorrhages (ruptured berry aneurysms). No vasculitis or other vasculopathy was identified. CONCLUSIONS: These findings implicate cocaine use as a significant risk factor for fatal brain hemorrhage and may explain, in part, the increased incidence of hemorrhagic stroke in some drug-using cohorts. The lack of specific pathologic findings suggests that cocaine-associated intracranial hemorrhages are a consequence of the pharmacodynamic effect of cocaine and not a cocaine-induced vasculopathy.

Adult↗
PubMed1996

Incidence of spontaneous intracerebral hemorrhage among Hispanics and non-Hispanic whites in New Mexico.

OBJECTIVE: To compare the incidence of spontaneous intracerebral hemorrhage (ICH) among Hispanics and non-Hispanic whites living in Bernalillo County, NM. BACKGROUND: There are differences in cerebrovascular disease incidence between racial and ethnic groups. Knowing these differences is likely to optimize stroke prevention and evaluation. METHODS: Medical records review of all possible cases of ICH occurring between January 1, 1993 and December 31, 1993 among residents of Bernalillo County, NM, in all local hospitals. Hospital records were identified by ICD-9-CM codes. Also, State Medical Examiner records review for additional ICH cases occurring during the same time interval. The 1990 U.S. census provided the population base. RESULTS: There were 47 spontaneous ICHs among 267,965 non-Hispanic whites and 39 spontaneous ICHs among 178,310 Hispanics. Incidence of ICH rises exponentially with age in both groups. The age- and sex-adjusted total annual incidence of ICH per 100,000 people is 16.6 among non-Hispanic whites and 34.9 among Hispanics (relative risk for Hispanics 2.10, 95% confidence interval 1.35 to 3.26, p = 0.001). The age-adjusted incidence rates among men and women are not significantly different in either ethnic group. CONCLUSION: The incidence of spontaneous ICH among Hispanic residents of Bernalillo County, NM, is approximately twice that among non-Hispanic whites. The reasons for this difference require further investigation.

Adult↗
PubMed1996

Prevention of occupational cyanide exposure in autopsy prosectors.

Autopsy prosectors examining individuals with cyanide poisoning are at risk for occupational cyanide exposure. No protective autopsy precautions to mitigate this risk have been published. We report an autopsy on an individual with cyanide poisoning where the procedure was performed in a negatively pressured isolation room and the stomach was opened under a biosafety cabinet hood. None of the three autopsy prosectors had measurable cyanide in pre or post procedure blood specimens. We recommend that similar precautions be taken in all autopsies where cyanide is suspected as a possible cause of death.

Adult↗
PubMed1995

Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent.

An outbreak of an acute respiratory disease in the southwestern United States has led to the recognition of a new hantaviral illness. This report describes a unique spectrum of antemortem and postmortem pathological findings seen in a case series of nine surviving patients and 13 who died. Clinical, laboratory, and autopsy findings were derived from a consecutive series of individuals confirmed to have hantavirus pulmonary syndrome. Laboratory studies included chemical, hematological, and bone marrow analyses as well as flow cytometric and immunohistochemical phenotyping. Autopsy tissues were examined by routine histological stains, immunohistochemical methods, and transmission electron microscopy. The lung is the primary target organ in this illness. Pulmonary abnormalities include pleural effusions, alveolar edema and fibrin, and an interstitial mononuclear cell infiltrate. Large immunoblast type cells are seen in the lungs, blood, bone marrow, lymph nodes, liver, and spleen. A tetrad of hematological findings includes left-shifted neutrophilic leukocytosis, thrombocytopenia, hemoconcentration in severe cases, and circulating immunoblasts. In contrast to previously described nephropathic hantaviral syndromes, hantavirus pulmonary syndrome is characterized by a unique constellation of pulmonary, hematological, and reticuloendothelial pathological findings. The pulmonary findings are distinguishable from fatal adult respiratory distress syndrome. The data suggest a capillary leak syndrome restricted to the pulmonary circulation. Likewise, the hematological picture is unique and may be valuable in the rapid identification of cases for further diagnostic studies.

Adolescent↗
PubMed1995

Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease.

A recent outbreak of a severe pulmonary disease in the southwestern United States was etiologically linked to a previously unrecognized hantavirus. The virus has been isolated from its major reservoir, the deer mouse, Peromyscus maniculatus, and recently named Sin Nombre virus. Clinically, the disease has become known as the hantavirus pulmonary syndrome (HPS). Since May 1993, 44 fatal cases of HPS have been identified through clinicopathological review and immunohistochemical (IHC) testing of tissues from 273 patients who died of an unexplained noncardiogenic pulmonary edema. In 158 cases for which suitable specimens were available, serological testing and/or reverse transcription-polymerase chain reaction (RT-PCR) amplification of extracted RNA was also performed. IHC, serological, and PCR results were concordant for virtually all HPS and non-HPS patients when more than one assay was performed. The prodromal illness of HPS is similar to that of many other viral diseases. Consistent hematological features include thrombocytopenia, hemoconcentration, neutrophilic leukocytosis with a left shift, and reactive lymphocytes. Pulmonary histopathological features were similar in most of the fatal HPS cases (40/44) and consisted of an interstitial pneumonitis with a variable mononuclear cell infiltrate, edema, and focal hyaline membranes. In four cases, however, pulmonary features were significantly different and included diffuse alveolar damage and variable degrees of severe air space disorganization. IHC analysis showed widespread presence of hantaviral antigens in endothelial cells of the microvasculature, particularly in the lung. Hantaviral antigens were also observed within follicular dendritic cells, macrophages, and lymphocytes. Hantaviral inclusions were observed in endothelial cells of lungs by thinsection electron microscopy, and their identity was verified by immunogold labeling. Virus-like particles were seen in pulmonary endothelial cells and macrophages. HPS is a newly recognized, often fatal disease, with a spectrum of microscopic morphological changes, which may be an important cause of severe and fatal illness presenting as adult respiratory distress syndrome.

Adolescent↗
PubMed1994

Hantavirus pulmonary syndrome: radiographic findings in 16 patients.

PURPOSE: To characterize chest radiographic features of Hantavirus pulmonary syndrome. MATERIALS AND METHODS: Initial and follow-up chest radiographs from 16 patients with confirmed Hantavirus pulmonary syndrome were reviewed for radiographic findings of either cardiogenic pulmonary edema or pulmonary edema due to increased permeability of the alveolar capillary membranes. RESULTS: Findings indicative of interstitial edema were present more frequently (14 [88%] of 16 patients) than is typically seen in adult respiratory distress syndrome (5%). Alveolar flooding subsequently developed in 11 (69%) of 16 patients and was not the peripheral pattern usually seen in the acute phase of adult respiratory distress syndrome. Overall mortality was 43%. Lung specimens obtained at autopsy showed a pattern of endothelial leak with minimal epithelial injury. CONCLUSION: The lung disease caused by Hantavirus in these patients may explain the findings of interstitial edema and central alveolar filling atypical of adult respiratory distress syndrome. Recognition of the radiographic pattern will be important in identifying this apparently widespread cause of increased permeability pulmonary edema.

Acute Disease↗
PubMed1994

Outbreak of Hantavirus pulmonary syndrome in the southwestern United States. Response of pathologists and other laboratorians.

During late spring and early summer of 1993, national and international media called worldwide attention to a cluster of deaths in the southwestern United States. These patients succumbed to a rapidly progressive severe respiratory distress syndrome. After notification of state and national health agencies in mid-May, a major effort was launched to determine the cause of this often fatal respiratory distress syndrome, to advise the public on safety measures, and to determine the method of spread of this "mystery illness." Within weeks of recognition of the early cases, the Centers for Disease Control and Prevention announced the probable agent, a Hantavirus. This report details the response of pathologists, medical technologists, and other laboratory scientists to this new viral epidemic, with emphasis on activities that occurred within New Mexico.

Adolescent↗
PubMed1993

Esophageal foreign bodies as child abuse. Potential fatal mechanisms.

Foreign bodies being forced into the esophagus as a form of fatal child abuse is rare. A 4.5-month-old female infant presented to clinicians with respiratory distress. Several coins were recovered from the esophagus. One month later, she was found dead in her crib. At autopsy, there were three coins in the esophagus. In addition, there were cutaneous contusions of various ages, acute and partially healed fractures of the extremities, old aspirated foreign material in the lungs, and pulmonary fat emboli. Although the fat emboli may have contributed to the death, several potentially fatal mechanisms from the esophageal foreign bodies deserve consideration. These include vagal stimulation from esophageal distention, aspiration of swallowed fluids after esophageal obstruction, compression of the trachea or the heart by the coins, and cardiac compression or airway occlusion by the introducing finger.

Cause of Death↗
PubMed1993

Stroke associated with ephedrine use.

Several sympathomimetic agents have been associated with ischemic and hemorrhagic stroke. Ephedrine, a sympathomimetic drug that has a high potential for abuse and can be readily obtained without a prescription in unrestricted quantities, has rarely been associated with stroke. We report ephedrine-related stroke in three patients. One patient developed a thalamic infarct after ingesting known quantities of ephedrine as street-purchased "speed" for weight loss. Two patients had fatal intracranial hemorrhages after ingesting unknown quantities of ephedrine; one of them had a history of drug abuse, and one lacked a history of ephedrine use or drug abuse. Ephedrine appears to predispose to both ischemic and hemorrhagic stroke. The mechanisms responsible for the different cerebrovascular complications remain to be proven. Restriction of ephedrine availability should be considered.

Adult↗
PubMed1992

Insect larvae used to detect cocaine poisoning in a decomposed body.

Insect larvae are often found on human remains long after disappearance of the usual toxicologic specimens. It is important for forensic pathologists and toxicologists to recognize the potential of this unique specimen when routine specimens are not available. Cocaine and benzoylecgonine was extracted from Calliphorid larvae found on a badly decomposed body of a man who had been missing 5 months and was also identified in the decomposing skeletal muscle. This toxicologic information combined with the autopsy findings and the circumstances of the death and disappearance was essential in the determination of cocaine poisoning as the cause of death.

Adult↗
PubMed1991

Rhabdomyolysis associated with cocaine abuse.

There have been recent reports of rhabdomyolysis associated with cocaine abuse. The pathologic findings from these cases have not been described. Pathologic abnormalities in two fatalities with cocaine-associated rhabdomyolysis, including one with hyperpyrexia, acute renal failure, and disseminated intravascular coagulation, are discussed in detail. Skeletal muscle in both cases showed necrosis without evidence of vasculitis, polarizable foreign crystals, or other specific lesions. The individual with renal failure showed acute tubular necrosis with granular myoglobin casts in tubules. The mechanism of cocaine-associated rhabdomyolysis is unclear, but potentially includes ischemia due to vasoconstriction, direct toxicity, hyperpyrexia, and increased muscle activity from agitation or seizure. Adulterants may also play a role. In unexplained cases of rhabdomyolysis, toxicologic evidence of cocaine should be sought. In those cases of rhabdomyolysis associated with acute renal failure, the presence of cocaine in blood may be prolonged because of impaired renal clearance.

Adult↗
PubMed1991

Cocaine, fetal loss, and the role of the forensic pathologist.

Adverse obstetrical outcomes are often associated with maternal cocaine use. These have included intrauterine growth retardation, abruptio placentae, and an increased incidence of spontaneous abortion and pre-term labor. This report details the case of an 18-week-gestation fetus recovered from a sewage treatment plant. A brain specimen was positive for cocaine. With the present epidemic of cocaine abuse, it is important for the forensic pathologist to seek toxicologic evidence of cocaine in all suspicious fetal and neonatal deaths.

Brain Chemistry↗
PubMed1990

The tubular "cookie cutter" bullet: a unique projectile.

Recently marketed PMC (Pan Metal Corporation) Ultramag tubular hollow point ammunition is uniquely constructed with a two-part projectile composed of a tubular copper bullet and a Teflon wad. A fatal gunshot wound with this ammunition is described. A unique radiographic pattern and the results of test firing are also presented.

Adult↗