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PubMedDate not supplied

Cause of death in persons aged between 15 and 50 years in the community of Stockholm. A forensic-pathologic and statistical study.

All deaths occurring in the age group 15-50 years in the community of Stockholm during the period November 1st 1979 to April 30th 1980 have been investigated. There were 272 deaths in total (males 176, females 96). The estimated annual death rate was in total 185/100,000 inhabitants (males 238, females 132). The autopsy rate was 82%. The deaths were divided in five main groups: 32 persons (12%) died from cardiovascular diseases, 60 persons (22%) from other natural diseases, 65 persons (25%) from conditions causally associated with exogenous influence (border line cases) such as abuse of alcohol, medicinal drugs and narcotics at sublethal concentrations. Violent deaths amounted to 108 cases (40%) and finally in 7 cases (3%) no plausible cause of death was proven. In 51 cases (19%) the underlying cause of death was attributed solely to chronic abuse of alcohol. Anamnestic information about abuse was available in 42% of all deaths. Deaths due to arteriosclerotic heart disease comprised a small group and were rare under the age of 45; about half of those were considered sudden and unexpected. The estimated annual rates of deaths due to coronary heart disease were 16.2/100,000 inhabitants for males and 1.4 for females. Difficulties were experienced in defining and delimiting the group of border line deaths due to exogenous influences.

Adolescent↗
PubMed2003

Ultrasonographic densitometry of the lungs at autopsy: a preliminary investigation for possible application in forensic pathology.

The aim of the present study was to examine the possible application of ultrasonographic (US) densitometry of the lungs to quantitative evaluation of pulmonary edema at autopsy (n=85). A diagnostic ultrasound device LOGIQ alpha200 (GE Yokogawa Medical Systems) equipped with an LH probe (linear, 7.5 MHz) was used and each lobe of the lungs was scanned on the anterior and posterior surfaces after resection. The US density showed a correlation between the left and right lobes, and also between the anterior and posterior surface scans of each lobe. Although there was a correlation between the US density and combined lung weight in total cases, the density ranged very widely when lung weight was below about 1300 g, depending on the cause of death. The density was high in drowning, asphyxia, poisoning and delayed traumatic death, whereas it was usually low in fire death mainly due to burns, hemorrhagic shock and head injury. In the other causes of death, a considerable case-to-case difference was observed independent of the lung weight. These findings suggested a possible contribution of pulmonary edema to high US density, possibly depending on the survival time and irrespective of the blood contents (congestion or postmortem hypostasis).

Adolescent↗
PubMed1996

Who dies at A&E? The role of forensic pathology in the audit of mortality in an emergency medicine department.

The authors reviewed a total of 481 deaths, which occurred in an accident and emergency (A&E) department of a major general hospital, over a 3-year-period, from 1 January, 1992 to 31 December, 1994. Of these, 428 (89.0%) were referred to the coroner, with full medico-legal autopsies being conducted in 236 (55.1%) of the latter. There was a marked preponderance of male subjects (male:female ratio = 1.86) and, not unexpectedly, the likelihood of an autopsy being performed decreased with the patient's age. Nevertheless, all patients who died from trauma (or unnatural causes) underwent autopsies, irrespective of age. In all, autopsies were conducted for 70 traumatic and 166 natural deaths, with the mean age (95% CI) of the former group being some 19 years less than that of the latter (33.2 (28.4-38.1) vs. 52.0 (48.6-55.4), (P < 0.001). A comparison of the provisional causes of death (as recorded by the attending physicians in their clinical notes) with the autopsy findings yielded a higher diagnostic accuracy for traumatic deaths than for natural fatalities (correct diagnoses: 44/70 vs. 36/166; discordant diagnoses: 2/70 vs. 24/166, P < 0.01). This difference was accentuated after the patients who were dead upon arrival were excluded (44/55 vs. 36/96; 2/55 vs. 24/96, P < 0.005). As the injury severity score (ISS) is closely correlated with mortality, the autopsy findings were also used to calculate these values for 59 of a total of 70 patients who died from trauma or from unnatural causes. This showed that 24 had scores of 75 (incompatible with life), while 33 had ISS values above 16 (poor prognosis). The remaining 11 cases were not amenable to evaluation by means of the ISS. It was estimated that in approximately a third (18/55) of the misdiagnosed and undiagnosed natural fatalities, a correct diagnosis might have substantially altered acute management. This, in turn, could have improved patient survival, at least at the A&E level. By comparison, the perceived clinical impact of wrong diagnoses (two) and failure to diagnose (four) on traumatic deaths would have been almost negligible, as these patients generally had ISS values ranging from 30-75, with only one notable exception where the score was 10. Generally, given the circumstances under which physicians are required to work in A&E departments, the time spent with each patient is necessarily short. Furthermore, as there is usually limited access, if at all, to patients' medical records, very little relevant clinical or thanatological information is available, when death occurs. Therefore, in this instance, the medico-legal autopsy assumes the role of being an important investigative tool for the emergency physician. It may also contribute, substantially, towards medical audit and the enhancement of physicians' clinical acumen.

Adult↗
PubMed1984

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↗
PubMedDate not supplied

Experiences with the hematoxylin basic fuchsin picric acid staining method for morphologic diagnosis of myocardial ischemia - an experimental study in forensic pathology.

An investigation was performed on 148 medicolegal autopsy cases with the purpose of obtaining experience with the hematoxylin basic fuchsin acid staining method for morphologic diagnosis of early myocardial ischemia. A comparative study was performed on rats with induced myocardial infarcts. The uptake of the basic fuchsin stain in myocardial sections agreed well with eosinophilia, often occurred when myocardial infarction was suspected, but very often yielded false positive and negative results. This lack of reliability probably depended on the high sensitivity of the staining procedure, degree of autolysis, fixation time, thickness of the sections and mainpulative lesions. Although the HBFP-technique does not seem sufficiently reliable in medicolegal autopsy cases it probably produces accurate results under controlled experimental conditions.

Adult↗
PubMed2001

The diagnostic relevance of cerebral amyloid angiopathy in the setting of forensic pathology - a report of two cases and review of the literature.

The neuropathological features seen in two cases with cerebral amyloid angiopathy (CAA) are presented. An 85-year-old woman was found comatose at home and died on the way to the hospital. The cause of death was an intracerebral hemorrhage (ICH) in the right parietal lobe. A 93-year-old woman with a history of traumatic subarachnoid hemorrhage was operated on for a chronic subdural hematoma. Intraoperatively, she developed severe ICH and died. The cause of death was an ICH in the parieto-occipital lobe. The morphology of the vessels was studied on differently stained sections and the neuropathological findings of the surrounding brain tissue were investigated. The affected vessels showed the characteristic alterations seen in CAA and included vascular amyloid deposition, fibrinoid necrosis, double-barrel lumen, splitting of the internal elastic lamina, defects of the vessel wall, and microaneurysms. Visualization of beta-amyloid protein was performed by histological and immunohistochemical methods. The immunohistochemistry for beta-amyloid was more sensitive and yielded better results compared with Congo red. In cases of ICH, CAA has to be considered in the differential diagnosis. Besides the use of Congo red stain, the application of beta-amyloid immunohistochemistry is requested to reliably make the diagnosis of CAA. Additional staining with a modified silver impregnation technique (AgNOR) is useful to detect associated neurodegenerative changes.

Journal Article↗
PubMed2003

Pulmonary surfactant-associated protein A as a marker of respiratory distress in forensic pathology: assessment of the immunohistochemical and biochemical findings.

The aim of the present study was to review the immunohistochemical and biochemical findings with reference to the causes of death in routine casework (total, n=492). In the immunohistochemistry (n=283), an increase in intra-alveolar granular SP-A (SP-A score) was often observed in asphyxiation (n=21/34, 61.8%) and freshwater drowning (n=15/24, 62.5%), and also in fire and methamphetamine (MA) fatalities (n=22/76, 28.9% and n=5/16, 31.3%). Serum SP-A level (n=134) was elevated in acute respiratory distress syndrome and in some cases of drowning, fire and MA fatalities, hyperthermia and chest traumas. A quantitative analysis of SP-A subclass-gene expression (SP-A1/A2 mRNA) in the lung tissue specimens (n=126) revealed an increase in the SP-A1/A2 mRNA ratio in asphyxiation (n=17/21, 80.9%), freshwater drowning (n=7/9, 77.7%), fire and MA fatalities (n=20/35, 57.1% and n=8/10, 80.0%). These findings suggested the usefulness of SP-A as a marker of asphyxiation, respiratory distress and alveolar injury.

Asphyxia↗
PubMed1987

Earlobe creases and coronary atherosclerosis. The view from forensic pathology.

In several clinical studies, the diagonal earlobe crease has been statistically related to the presence of ischemic heart disease. Only one study of a relatively small number of hospitalized patients attempts to relate the earlobe crease with amount of stenotic coronary atherosclerosis demonstrated at necropsy. We examined the relationship between the degree of coronary atherosclerosis and the presence of a diagonal earlobe crease in 800 consecutive autopsies performed for medicolegal reasons and thus including a wide spectrum of subjects. Statistical analysis by the chi 2 test demonstrated a positive correlation (p less than 0.01) between the presence of the diagonal earlobe crease and obstructive coronary atherosclerosis narrowing on at least one major coronary artery greater than 75%. We conclude that the autopsy findings support the clinical observations that the diagonal earlobe crease is a cutaneous sign of obstructive coronary atherosclerosis and that the sign should be used accordingly.

Adult↗
PubMed1985

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↗