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Biomedical subjects

R W Byard

Publications and source records attributed to R W Byard.

At least 37 records · Page 2Linked to original sources
PubMed2001

Specific dangers associated with infants sleeping on sofas.

AIM: A study was undertaken to examine specific circumstances that may lead to accidental asphyxial deaths in infants on sofas. METHODS: Coronial files in South Australia (Australia) from 1989 to 1998, and files at the Office of the Medical Examiner in San Diego County (USA) from 1991 to 1998 were searched for all cases of infant deaths occurring on sofas. RESULTS: A total of 10 cases with complete death scene descriptions were found. Four deaths were attributed to sudden infant death syndrome and six deaths to accidental asphyxia, of which four involved shared sleeping with an adult. Lethal circumstances involved infants being overlayed by an adult (n = 2), wedged between an adult and the back of a sofa (n = 1), sleeping with an intoxicated/sedated adult (n = 2), wedged between pillows and the back of a sofa (n = 1), and wedged into the back of a sofa (n = 1). CONCLUSIONS: Although shared sleeping of an adult with an infant on a sofa may result in accidental asphyxia, there is also the potential for wedging and accidental asphyxia of infants sleeping alone on a sofa. For this reason the use of sofas for both shared and solitary infant sleeping is discouraged.

Adult↗
PubMed2001

Unusual motor vehicle suicides.

A review was undertaken of cases in which motor vehicles were used to commit suicide. While the most common methods involved carbon monoxide toxicity or the sustaining of multiple injuries, three unusual cases were found involving: (i) hanging from a car seat belt, (ii) self immolation inside a car, and (iii) setting up a crash situation. The latter two cases were used as a backup to drug overdose. Problems that may occur in determining the manner of death are described.

Journal Article↗
PubMed2001

Sudden and unexpected infant death due to occult lymphoblastic leukaemia.

A 16-week-old boy was found moribund in his crib. At autopsy widespread infiltration of multiple organs by lymphoblastic leukaemia (pre-B cell type) was found. Death was attributed to extensive myocardial infiltration by leukaemic cells. There was no associated intracranial haemorrhage. Home video footage taken on the day before death revealed a non-distressed and relatively normal-appearing infant. This case demonstrates an extremely rare cause of unexpected infant death and emphasizes the need for full autopsy examination in such cases. It also confirms that certain infants may have minimal or no symptoms of illness, even in the presence of severe, systemic, life-threatening disease.

Journal Article↗
PubMed2001

Gastric distension, cerebral palsy and unexpected death.

Two cases of unexpected death from massive gastric dilatation in individuals with severe spastic quadraparesis aged 14 and 20 years, respectively, are reported. Spontaneous rupture of the stomach occurred in one case. Predisposing factors to gastric dilatation associated with cerebral palsy include autonomic neuropathy, neuromuscular incoordination, air swallowing and malposition of the stomach. Death may be due to compromise of respiratory function caused by lung compression by the dilated stomach, or to peritonitis with sepsis. Acute gastric dilatation, with or without rupture, should be considered a potential cause of unexpected death in individuals with severe mental and physical disabilities.

Journal Article↗
PubMed2001

Sigmoid volvulus and unexpected death in the elderly.

An 84-year-old female who was found unexpectedly dead at her home was shown at autopsy to have a massively dilated sigmoid colon with twisting of the lower colon on an unusually long mesentery. The volvulus had caused mechanical obstruction of the bowel with critical reduction of the blood supply resulting in intestinal infarction. Death was due to ischaemic necrosis of the lower large intestine with significant fluid and electrolyte sequestration within the bowel lumen, associated with disseminated sepsis. Gastrointestinal disorders that may result in unexpected death are uncommon in adults and may present atypically in the elderly. The diagnosis of unexpected death due to an infarcted sigmoid volvulus may not be established until an autopsy has been undertaken.

Journal Article↗
PubMed2001

Death due to malathion poisoning.

Malathion is a commonly available insecticide with relatively low toxicity. A study was undertaken in South Australia over a 20-year period to assess the characteristic features of deaths associated with malathion. A total of 5 cases were found, in each of which exposure to malathion had been intentional. The male to female ratio was 2:3 with an age range of 32 to 80 years (mean = 57 yr). In four cases malathion had been ingested and in one case death had resulted from an intravenous injection of insecticide. Ingestion of large volumes of malathion was associated with contamination of the mortuary due to postmortem regurgitation in at least one case. The study also demonstrates that suicides due to malathion poisoning were uncommon in thispopulation, representing only 0.2% of the 3,202 suicides recorded at the Forensic Science Centre over the 20year period.

Journal Article↗
PubMed2001

Diagnostic issues in unusual asphyxial deaths.

Upper airway occlusion may be due to a variety of causes and may result from accidents, suicides or homicides. Underlying natural diseases may also predispose to lethal choking episodes. A series of nine cases is reported to illustrate a range of circumstances that resulted in fatal upper airway compromise. These included suicide from upper airway obstruction due to an impacted blanket, and accidental deaths due to inhalation of soil, a rock, and a video cassette sticker. One death resulted from glottic obstruction due to a mucosal cavernous haemangioma, another from an enlarged tonsil, and two deaths were precipitated by underlying organic disease in the form of dementia and insulin-dependent diabetes mellitus. The manner of death was not clear cut in two cases where there was evidence of possible accidental death or suicide.

Journal Article↗
PubMed2001

Traditional punishment and unexpected death in Central Australia.

Three cases of traditional punishment in Central Australian Aboriginal men are presented in which the thighs were speared or stabbed as part of a "payback" system. In two cases, an unexpected effect of the stabbing or spearing was death due to severing of major leg vessels. The relationship between customary Aboriginal law and general law in Australia has not been clearly defined; however, these cases demonstrate that significant and untoward effects may result from traditional punishments. Pathologists working near traditional Australian Aboriginal communities may still encounter such injuries at autopsy.

Adult↗
PubMed2001

Coprophagic café coronary.

A 74-year-old man who had been institutionalized for severe multiinfarct dementia was found dead in bed. He had a history of compulsive ingestion of food and other materials, including feces. At autopsy, a 65-g bolus of fecal material was impacted within the laryngopharynx, occluding the inlet of the larynx. This case demonstrates an unusual coprophagic variant of cafe coronary syndrome and emphasizes that demented individuals with pica are at risk of sudden death from ingestion of a wide variety of materials, including, but not limited to, food.

Aged↗
PubMed2001

Characteristic features of suicidal drownings: a 20-year study.

A retrospective study of cases of drowning suicide was undertaken at the Forensic Science Centre in Adelaide, South Australia for the period April 1980 to March 2000. A total of 123 cases were found, with 76 males (age, 16-88 years; average, 50.5 years; standard deviation [SD], 20.1 years) and 47 females (age, 34-88 years; average, 60.6 years; SD, 13.9 years). There were 66 fresh water drownings and 57 saltwater drownings. Female victims were significantly older than male victims for both fresh water and saltwater drownings (P < .05 and P < .01, respectively). Deaths in young women were rare. No temporal trend in drowning suicides could be shown, with annual numbers varying from 0 to 12 cases (average, 6.15; median, 7). Women preferentially chose the ocean or bath to drown themselves in, whereas males chose rivers, ditches, and lakes. Swimming pools were rarely used for suicide in this population; alcohol use was not usual; and there was often a significant history of mental illness.

Adolescent↗
PubMed2001

Asphyxiation from shoulder seat belts: an unusual motor vehicle injury.

Two cases of accidental asphyxia caused by lap-shoulder seat belts are reported. Lethal neck injuries from shoulder seat belts are uncommon, and episodes of asphyxiation are even rarer. Positioning of the shoulder belt over the neck, short stature, and incapacitation from other injuries were predisposing factors to upper airway compromise in these cases.

Accidents, Traffic↗
PubMed2001

An analysis of factors contributing to a series of deaths caused by exposure to high environmental temperatures.

Autopsy reports at the Forensic Science Centre, Adelaide, South Australia, were reviewed for the 8 years from January 1991 to December 1998 for cases with unusual features in which deaths had been attributed to exposure to high environmental temperatures. Amphetamine-related hyperpyrexial deaths, anesthetic deaths caused by malignant hyperpyrexia, deaths of elderly incapacitated individuals during heat waves, and deaths of children trapped in the back of cars were excluded from the study. In 9 cases, where heat-related deaths had occurred (age range 21 to 77 years; M:F = 8:1). Predisposing factors included lack of familiarity with Australian environmental conditions, excessive clothing, prolonged sun exposure, acute alcohol intoxication, obesity, benztropine and trifluoperazine medication, and underlying dementia, alcoholic liver disease, and possibly epilepsy.

Adult↗
PubMed2001

Unexpected childhood death due to a rare complication of ventriculoperitoneal shunting.

A 10-year-old boy with Arnold-Chiari malformation, spina bifida, and a ventriculoperitoneal shunt for hydrocephalus died unexpectedly, having appeared to be only mildly unwell with fever on the night before death. At autopsy, the shunt was partially obstructed with an associated enterococcal meningitis. The tip of the shunt was located within the transverse colon, which was embedded in a mass of fibrous adhesions resulting from previous abdominal surgery. Blood cultures were sterile. Intestinal perforation is a rare complication of ventriculoperitoneal shunting that may be associated with the development of meningitis and unexpected death. The autopsy assessment of children with such indwelling devices requires examination of the functional state of the shunt, full septic workup, and determination of the precise location of the tip of the catheter within the peritoneal cavity.

Arnold-Chiari Malformation↗
PubMed2001

Oronasal blood in sudden infant death.

Oronasal secretions are observed frequently in sudden infant death syndrome (SIDS), but overt blood is uncommonly reported. The literature on oronasal blood in sudden infant death is limited. The goal of this study was to determine the frequency of oronasal blood in sudden infant deaths and to examine possible causative factors. Oronasal blood was described in 28 (7%) of 406 cases of sudden infant death. Oronasal blood could not be attributed to cardiopulmonary resuscitation in 14 cases, including 10 (3%) of 300 cases of SIDS, 2 (14%) of 14 accidental suffocation cases, and 2 (15%) of 13 undetermined cases. Eight of the 10 infants in cases of sudden infant death were bedsharing: 5 with both parents, 2 between both parents. The infant in 1 SIDS case was from a family that had had three referrals to Child Protective Services. Oronasal blood not attributable to cardiopulmonary resuscitation occurs rarely in SIDS when the infant is sleeping supine in a safe environment. Bedsharing may place infants at risk of suffocation from overlaying. Oronasal blood observed before cardiopulmonary resuscitation is given is probably of oronasal skin or mucous membrane origin and may be a sign of accidental or inflicted suffocation. Sanguineous secretions that are mucoid or frothy are likely of remote origin, such as lung alveoli. The use of an otoscope to establish the origin of oronasal blood in cases of sudden infant death is recommended.

California↗
PubMed2001

Environmental hyperthermic infant and early childhood death: circumstances, pathologic changes, and manner of death.

Infant and early childhood death caused by environmental hyperthermia (fatal heat stroke) is a rare event, typically occurring in vehicles or beds. The aims of this study were to describe the demographics, circumstances, pathology, and manner of death in infants and young children who died of environmental hyperthermia and to compare these cases with those reported in the literature. Scene investigation, autopsy reports, and the microscopic slides of cases from three jurisdictions were reviewed. The subjects in 10 identified cases ranged in age from 53 days to 9 years. Eight were discovered in vehicles and 2 in beds. When the authors' cases were grouped with reported cases, the profile of those in vehicles differed from those in beds. The former were older, were exposed to rapidly reached higher temperatures, and often had more severe skin damage. The latter were mostly infants and were exposed to lower environmental temperatures. Hepatocellular necrosis and disseminated intravascular coagulation were reported in victims who survived at least 6 hours after the hyperthermic exposure. The consistent postmortem finding among nearly all victims was intrathoracic petechiae, suggesting terminal gasping in an attempt at autoresuscitation before death. The manner of death was either accident or homicide. Recommendations for the scene investigation are made.

Accidents↗