Biomedical subjects
Publications and source records attributed to L Sathyavagiswaran.
We report an unusual case of a Starr-Edwards aortic valve malfunction with fatal dislodgment and embolization of its ball portion to the distal abdominal aorta, just above the bifurcation, leading to sudden death. This case is unusual in that it is, to date, the longest time elapsed between valve placement and ball dislodgment.
OBJECTIVE: To review a satellite facility's autopsy experience with coroner's cases, to determine the volume and type of cases performed; and to evaluate the teaching value of forensic autopsies in a pathology residency training program. DESIGN: A retrospective review of 65 Los Angeles County Coroner cases performed at Cedars-Sinai Medical Center, Los Angeles, Calif, from 1992 to 1996 was undertaken. Data were retrieved from cause of death statements, medical report forms, and autopsy reports. RESULTS: In the 65 coroner's cases performed from 1992 to 1996, ages ranged from 6 months to 97 years. During this time period, the cases comprised 6.1% (65/1059) of all autopsies at Cedars-Sinai Medical Center and 11.3% (65/575) of autopsies excluding fetal and neonatal examinations. Manners of death in the cases were accidental (53.8%), natural (40.0%), suicide (4.6%), and undetermined (1.5%). The most common cause of death in natural deaths was related to heart disease (12/26 [46.2%]). Motor vehicle collisions were the most common cause of death (15/35 [42.9%]) in the accidental group. The remainder of the causes of death in both the natural and accidental groups encompassed a wide variety of pathologic processes and injuries. CONCLUSIONS: Forensic autopsies in a pathology residency training program have the potential to supplement a diminishing number of hospital autopsies. A wide variety of diseases are encountered through coroner's cases. Forensic autopsies contribute to residency training by providing experience in trauma cases and a variety of medical disorders.
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The incidence of retinal hemorrhage in child abuse victims was studied in cadavers of children that underwent autopsy in the Los Angeles County Coroner's office. One hundred ninety consecutive cases of childrens' eyes received at Doheny Eye Institute from 1985 to 1989 were included in the study. Retinal hemorrhage is the most common form of eye damage due to child abuse and is more likely to occur in infants who have been shaken than after blunt trauma to the head. Accordingly, retinal involvement is seen more frequently in younger children. The mechanism of retinal hemorrhage is unknown, but the authors' evidence suggests that it is not a direct result of submeningeal hemorrhage. The retinal hemorrhages are found most frequently in the bipolar and nerve fiber layers. They may be severe and widespread or small, scattered foci; both forms are indicative of abuse type injury. Any child who is comatose or who has other unexplained neurologic symptoms should have a thorough eye examination with the pupils dilated with emphasis on studies of the retina.
The authors studied 77 pairs of eyes removed from children who had died of suspected child abuse. Forty-seven of the cases had retinal hemorrhages. Those showing retinal hemorrhages were younger children and had fewer other stigmata of child abuse. Hemorrhages are more likely to occur in cases where the child was shaken or swung than in those with severe direct head trauma. The authors recommend that examination of the eyes be included in the autopsies of all small children who died without an obvious cause of death. Experience in both processing and reading of ocular material is necessary for reliable results.
The crossbow is an uncommon source of fatal injury. In Los Angeles County, two crossbow homicides have occurred in the past 20 years. Following the second case, a crossbow was test-fired into a fresh pork thigh, resulting in distinctive wounds. Experimental studies also showed that the vanes of the bolt (arrow) may be a source of trace material found in the wound.
Multifocal, lymphangiomatous lesions were found in the right lobe of the liver of a 9-year-old girl who died seven days after head trauma. We believe the lesions represent a cystic and pseudoneoplastic dilatation of liver lymphatics secondary to a posttraumatic complication, acute and chronic inflammation primarily of small bile ducts, and canaliculi (pericholangiolitis). The findings provide new evidence that inflammation and fluid overload, in the absence of a congenital malformation, are cardinal factors in the pathogenesis of some forms of lymphangiomatosis.
Disopyramide is an oral antiarrhythmic drug which reduces conduction velocity, prolongs duration of action potential and the effective refractory period, and exerts vagolytic properties. The drug is usually well absorbed orally. The principal use of the drug is to suppress ventricular extrasystoles with usual oral dosage of 100 to 200 mg every 6 h, until blood levels of 2 to 4 micrograms/mL are attained. The use of the drug for suicide is uncommon as it is a prescription drug. Two cases of fatal disopyramide intoxication seen at the Los Angeles County Medical Examiner's Office will be discussed followed by a review of the literature of fatal suicidal disopyramide overdose. Case 1 was a 31-year-old male pharmacist with known history of depression and no history of heart disease. His decomposed remains were found with a suicide note and with several disopyramide tablets. At autopsy the blood level for disopyramide was 146 micrograms/mL. Case 2 is a 40-year-old male with history of alcoholism and prior suicidal attempts who regularly took disopyramide to control ventricular arrhythmias. He apparently ingested 36 100-mg tablets of disopyramide before his final collapse. At autopsy his blood level of disopyramide was 63 micrograms/mL.
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Two fatalities resulting from suicidal ingestion of flecainide are described. The decedents, ages 33 and 15, were otherwise healthy; both took their mothers' medications. In one case, from electrocardiographic data, there was found a high-grade conduction block with idioventricular rhythm. Blood and tissue samples from autopsy were analyzed for flecainide by gas chromatography/nitrogen-phosphorous detection and gas chromatography/mass spectrometry. Blood concentrations of 93.7 and 100 mg/L flecainide were found.