Hypoplastic coronary artery disease, as a cause of sudden death

ABSTRACT Hypoplastic coronary artery disease (HCAD) is a rare coronary artery anomaly that may be the cause of sudden death. It can involve a single or all coronary arteries. This anomaly may cause circulatory insufficiency leading to myocardial infarction. HCAD has no symptoms or may exhibit cardiovascular signs like syncope, dyspnea, chest discomfort, or dizziness. It is often diagnosed at autopsy, and early diagnosis is made with a coronary angiogram. We report HCAD as the cause of the sudden death of a 25-year-old female with a history of loss of consciousness following exertion. On autopsy, all the coronary arteries' lumen was narrowed with thin vessel walls. Histopathological examination shows an underdeveloped and missing muscular layer of the left anterior descending and circumflex coronary arteries' vascular wall. Many cases of HCAD diagnosed by radiographic imaging in living patients have been reported in the literature, but a structural anomaly of coronaries leading to HCAD has not been reported. We report a case of HCAD describing the histopathological examination findings of the vascular wall of coronary vessels illustrating the structural difference.

Sex identification from cranial capacity of adult human skulls.

Cranial capacity constitutes one of the most important characters for determining the racial differences. However, few studies exist that have evaluated the sexual dimorphism of cranial capacity and its significance in determining the sex of an individual. A craniometric study was conducted to differentiate sex from intracranial volumes of dry human skulls. The study was done on 160 dry human skulls (100 males and 60 females) in the department of forensic medicine, Gandhi Medical College, Bhopal (M.P.), during the year 2005 – 2006. Skulls chosen for the present study were of adult age only. Dry, hard mustard seed of uniform size were used to fill the cranial cavity to determine the capacity. Mean cranial capacity of male skulls was found to be 1302.95 + 108.8 c.c. (range 1070 – 1560 c.c.), while in female skulls the mean cranial capacity was found 1179.92 + 97.08 c.c. (range 1000 – 1420 c.c.). A highly significant difference (p value <0.01) was observed between the intracranial volume of male and female skulls were compared. This data is expected to be of Clinical, Forensic, Anthropological and Genetic Importance

Nomenclature for knot position in hanging A study of 200 cases.

Hanging is one of the common methods of committing suicide world wide. Position of the knot, in hanging cases is important as it determines the post-mortem findings of the head and face and can also be used to predict the expected autopsy findings. Although hanging has been described in forensic literature since ages, there has been no proper scientific nomenclature for classifying the position of knot in hanging cases. This paper describes a new nomenclature of exact knot position on the neck based on commonly used anatomical landmarks with self explanatory terms of classification, so that it can be understood and used by the autopsy surgeons and the pathologists with ease. In the present study 200 cases of hanging were studied retrospectively and position of knot is classified according to a newly described nomenclature. The new nomenclature classifies the position of knot into 6 major classes each of which are further subdivided into 3 subcategories thus making 18 different positions on each side of neck. The most common position of knot was found at occipitomastoid region (32%) and the least common position being at mental region (2%).

Adult choroid plexus papilloma: cause of sudden death.

Choroid plexus papilloma (CPP) is a rare, benign neoplasm, relatively more common in childhood. It is associated with signs and symptoms of increased intracranial pressure, frequently in association with obstructive hydrocephalus. CT and MRI are the investigations of choice and are diagnostic. Sudden deaths have been reported, but are very unusual. A 41 year old male was brought for medico-legal autopsy examination on ground of sudden death. He was reported to have headaches over a long period of time. On autopsy examination, massive sub-arachnoid hemorrhage was seen on both the cerebral hemispheres and cerebellum. A cyst measuring about 1 cm diameter was found in choroid plexus of right lateral ventricle. On histopathological examination, it was found to be a choroid plexus papilloma. Calcification was also evident in the papilloma. From medico-legal aspect, the present case reveals an unusual cause for sudden death in an adult male. The pathology could have been diagnosed easily by CT scan or MRI. When diagnosed, it has good survival rate, the morbidity depending on the extent of pathological effects. The present case was likely to have survived having minimal effects with appropriate treatment had he been diagnosed. The pathology is rare and a suspicion for this pathology in the adult male was not expected, but a CT scan to investigate chronic headache was warranted. Absence of such a suggestion leading to death, which could have been preventable, is sufficient ground for charge of professional negligence.

A study of serum enzymal changes after death and its correlation with time since death.

A prospective study was underteken as a part of postgraduate thesis work on quantitative serum enzymal changes after death in the Deptt. of Forensic Medicine GMC Bhopal (M.P.) in 1999-2002. A total of one hundred study cases and ten control cases were randomly selected after screening. The sera was assayed biochemically by photoelectric colorimetry for an imotransfereases (AST & ALT) and serum acid phosphatase. The enzymal levels were plotted against known postmortem interval. The graphical records were studied with a view to ascertain whether such assyas could be of any help to calculate time since death routinely.