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Biomedical subjects

S D Cohle

Publications and source records attributed to S D Cohle.

At least 19 recordsLinked to original sources
PubMed2000

Fatal hyperthermia secondary to sunbathing in a patient with multiple sclerosis.

A 27-year-old white woman with a history of multiple sclerosis was found dead lying on a lounger, clad in a bathing suit. She had been sunbathing for 4 hours. Significant autopsy findings consisted of numerous variably sized demyelinated plaques involving the periventricular cerebral white matter and cerebellum. Elevation of core temperature in patients with multiple sclerosis leading to transient or permanent adverse neurologic signs and symptoms has been documented for more than 60 years. This case illustrates that a modestly increased core body temperature, even from a usually innocuous activity such as sunbathing, may be fatal in patients with multiple sclerosis.

Adult↗
PubMed1997

Coronary artery compression by teflon pledget granuloma following aortic valve replacement.

We describe a massive fatal posterior myocardial infarct resulting from compression of the right coronary artery by a Teflon pledget granuloma in a patient who had undergone aortic valve replacement six months before death. Other iatrogenic causes of coronary artery occlusion or compression are discussed in this paper. To our knowledge this is the first report of this surgical complication.

Aortic Valve↗
PubMed1996

Pediatric injuries from cardiopulmonary resuscitation.

STUDY OBJECTIVE: To assess the type, rate, and severity of unanticipated complications of CPR (external cardiac compressions and ventilation) in a pediatric population. METHODS: A retrospective review was undertaken of the records from all deceased children ( < 12 years old) who had been given CPR during an 8-year period (1988 through 1995). Patients with historical or physical evidence of preceding trauma were excluded. Clinical and autopsy records were abstracted for patient demographics, clinical findings, duration of CPR, persons administering CPR, and medical examiner summaries. RESULTS: Two hundred eleven children (mean age, 19.0 months) met the inclusion criteria and were entered into the study. The most common cause of cardiac arrest was sudden infant death syndrome (56%), followed by drowning (8%), congenital heart disease (7%), and pneumonia (4%). Mean duration of CPR was 45 minutes (range, 3 to 180 minutes). Fifteen children (7%) had at least one injury as a result of CPR; 7 (3%) had injuries that were considered medically significant. These included retroperitoneal hemorrhage (n = 2), pneumothorax (n = 1), pulmonary hemorrhage (n = 1), epicardial hematoma (n = 1), and gastric perforation (n = 1); in spite of prolonged resuscitation performed with variable degrees of skill, only one patient was noted to have rib fractures. CONCLUSION: Significant iatrogenic injuries are rare in children who receive CPR; they occur in approximately 3% of cases. Recognizing the possibility of a complication may help in the management of children who survive cardiac arrest. Regardless of resuscitation history, abuse should be considered whenever traumatic injuries are encountered.

Cardiopulmonary Resuscitation↗
PubMed1996

Fatal stercoral ulcer perforation: case report.

Stercoral ulcers result from severe, prolonged constipation. Stercoral ulcer perforation is a rare event resulting in severe peritonitis and has a very high associated mortality rate. We describe a 78-year-old man with severe constipation associated with stercoral ulcer perforation undiagnosed prior to autopsy.

Aged↗
PubMed1996

Pericardial tamponade and death from Hickman catheter perforation.

In February 1995, a 56-year-old female was taken to the operating room for routine placement of a Hickman catheter. Her internist planned palliative chemotherapy for metastatic breast cancer. Using the Seldinger technique, the right subclavian vein was entered and a Hickman catheter was placed. Shortly after extubation and arrival in the postoperative recovery unit, the patient had respiratory and cardiac arrest. Resuscitative efforts, including chest tube placement and pericardiocentesis, were unsuccessful. Autopsy findings included perforation of the superior vena cava, with extension of the catheter in the pericardial sac and associated effusion. Despite the low reported incidence of perforation during placement of central venous catheters, we recommend confirmation of placement by fluoroscopy and instillation of radiopaque dye because of the high mortality associated with this complication.

Cardiac Tamponade↗
PubMed1995

Homicidal cardiac lacerations in children.

We report six cases of intentionally inflicted cardiac laceration. The victims ranged in age from 9 weeks to 2 1/2 years. Five victims were girls and in five cases the right atrium was lacerated. The left ventricle was lacerated in the other case. In the three cases with a confession, one victim each was struck with a fist, stomped, and kicked. Four patients had rib fractures, with at least two fractures in each case. Cardiac rupture from blunt trauma most commonly results from compression of the heart between the sternum and vertebral column, but may also occur from compression of the abdomen or legs, deceleration, blast injury, puncture of the heart by a fractured rib, and rupture through a resolving contusion. Accidentally acquired cardiac lacerations usually result from motor vehicle accidents or similarly severe forces. In children there are neither well documented cases of cardiac laceration nor of rib fractures from cardiopulmonary resuscitation. Cardiac lacerations, as with other types of severe trauma acquired at home, are almost never accidental.

Cardiopulmonary Resuscitation↗
PubMed1993

Lingual tonsillar hypertrophy causing failed intubation and cerebral anoxia.

Hypertrophy of the lingual tonsils is an unusual condition that may cause complications such as airway obstruction, abscess, sleep apnea, and recurrent epiglottitis. There have been reports of difficult anesthesic intubation in children with enlarged lingual tonsils. We describe a 24-year-old woman whose markedly hypertrophied lingual tonsils prevented intubation after anesthesic relaxation during preparation for appendectomy.

Adult↗
PubMed1992

Fatal hemothorax from mycotic celiac artery aneurysm.

We present two cases of ruptured mycotic aneurysms infected with Staphylococcus aureus. Each patient had hemoptysis and in each case there was hemothorax caused by a ruptured mycotic aneurysm of the celiac artery. In case 1, the pathogenesis was transient Staphylococcus aureus septicemia infecting an atherosclerotic plaque with subsequent aneurysm formation and rupture. In case 2, the septicemia arose from an infected knee. The presentation of a celiac artery aneurysm as hemoptysis and as the cause of hemothorax is rare.

Aged↗
PubMed1992

Spontaneous clostridial myonecrosis.

Spontaneous, nontraumatic clostridial myonecrosis is a rare infection with an insidious onset and usually fatal outcome. Spontaneous clostridial myonecrosis has a frequent association with colon carcinoma, leukemia, diabetes mellitus, and drug-induced immunosuppression. We present the case of a 73-year-old diabetic man who died of spontaneous Clostridium septicum myonecrosis, who had presented with fulminant gangrene of the right thigh. Clostridium septicum was cultured from the quadriceps muscle postmortem. At autopsy, in addition to the gangrene, there was a Duke's A adenocarcinoma of the cecum, which had not been diagnosed during life. When spontaneous nontraumatic clostridial myonecrosis is diagnosed at autopsy, investigation should include through exam and the obtaining of past medical history in order to elucidate predisposing factors.

Adenocarcinoma↗
PubMed1992

Sudden death associated with aortitis and fibrosclerosing disease of the conduction system.

Aortitis is known to complicate a number of autoimmune diseases and syphilis. In most patients with autoimmune disease, arthritis is the initial presentation followed by aortic insufficiency. We report two cases of ostensibly healthy, middle-aged men in whom the initial manifestation of aortitis was sudden death. In each patient, there was extension of inflammation from the aorta into the atrioventricular node. These cases emphasize the importance of examining the conducting system in cases of sudden death associated with aortitis and no grossly evident cause of death. To our knowledge, this is the first report of aortitis presenting as sudden death.

Aortitis↗
PubMed1992

Dissection of the aorta and coronary arteries associated with acute cocaine intoxication.

Acute myocardial ischemia, cardiac arrhythmias, and conduction disturbances are the most common cardiovascular complications of cocaine and its alkaloidal freebase "crack." Cocaine abuse-related acute aortic dissection has been reported only rarely: three cases in the last 5 years. Described herein, to our knowledge, is the first case of cocaine intoxication-associated acute aortic dissection that also involved the coronary arteries, causing sudden death.

Adult↗