Study of coronary artery atherosclerosis in sudden deaths and its medico-legal relevance.

The coronary artery diseases can play a crucial medico- legal role to decide the cause of sudden death whether natural or unnatural. There are certain occasions, when a person dies on the operating table or soon after surgery, and a coronary attack is probably the cause of death. A final coronary episode may sometimes be associated with an operative procedure supposedly due to hypotensive state. During driving or piloting a person may goes into a state of confusion because heart attack. In this state he may lose control and an accident can happen. These conditions indicate that intervention of Forensic Pathologist is significant to decide the actual cause of death apart from injury or disease of vital organs. We examine coronary arteries for atherosclerotic changes in 50 cases of sudden deaths. We observed that there were marked intimal thickening with luminal narrowing ≤ 75% of luminal diameter in 20 cases (40%) in total hearts. In natural deaths 17 cases (48.57%) showed luminal narrowing ≤ 75% of luminal diameter. These findings are suggestive of medico legal intervention to clarify the mode of death in some instances.

Cardiovascular Abnormalities after Discontinuation of Growth Hormone Treatment in Adults with Childhood-Onset Growth Hormone Deficiency / 대한소아내분비학회지

PURPOSE:Cardiovascular morbidity has recently been demonstrated to potentially reduce life expectancy in growth hormone deficiency(GHD). The aim of this study was to evaluate cardiovascular abnormalities and atherosclerotic changes in adults with childhood-onset GHD in whom GH treatment had been stopped at the achievement of final height. METHODS:Nine patients with childhood-onset GHD(7 idiopathic and 2 organic), with an age of 24.0+/-.0 year, were studied. Clinical characteristics of subjects were determined and blood pressure, body mass index(BMI), and serum concentrations of lipids were measured. Structural and functional evaluation of cardiovascular system was performed by M-mode echocardiography and linear phase array imaging transducer. RESULTS:BMI of patients was 27.3+/-.7 mg/m2, and four patients(44%) were overweight(BMI 25-30 mg/m2), but none was obese(BMI >30 mg/m2). The percentage of patients who had total cholesterol > or = 200 mg/dL, triglyceride > or = 150 mg/dL, LDL cholesterol > or = 140 mg/dL, and HDL cholesterol 2SD) in 3 patients(33%). Three out of four patients with IVST lower than -2SD had increased carotid artery IMT, whereas none of five patients with IVST higher than -2SD had increased carotid artery IMT. There were no differences in echocardiographic findings between groups according to sex, age, duration of disease, duration after GH discontinuation, BMI, and severity of dyslipidemia. CONCLUSION: Decreases in IVST, LVPWT, and LVMI, and an increase in carotid artery IMT were observed in a significant number of patients with childhood-onset GHD. These findings support the need of GH replacement after completion of growth and careful evaluation of cardiovascular changes in patients with childhood-onset GHD.