ABSTRACT
Medical examiners and coroners, in their compassion for survivors, often certify the interval between injury and death as "instantaneous" only to be confronted in legal proceedings, especially civil proceedings, with the need to detail the actual events and time required to die or to lose consciousness. A review of "pain and suffering" and consciousness is undertaken here and an estimate of actual time to unconsciousness is presented. This clinical pathologic correlation may assist in the scientific determination of the duration of pain and suffering.
Subject(s)
Forensic Medicine , Pain , Unconsciousness , Aorta/injuries , Asphyxia , Cerebral Hemorrhage , Consciousness , Craniocerebral Trauma , Humans , Time Factors , Ventricular FibrillationABSTRACT
The lungs of 42 smokers and 13 nonsmoking males of various ages who died suddenly and unexpectedly were examined grossly using Gough-Wentworth whole-lung sections and by microscopic planimetry to assess the severity and prevalence of emphysema. The bronchioles in representative histologic sections were evaluated for inflammation and epithelial metaplasia as well as for fibrosis and muscular hypertrophy. Postmortem interviews with next of kin established a history of cigarette smoking and excluded possible occupational exposures to toxic or particulate inhalants. Emphysematous changes were not prominent in members of the study group, but they tended to be more severe in smokers (p = 0.059) and increased in severity with age (p less than 0.001). Inflammatory changes (so-called smoker's bronchiolitis) were evident in smokers of all ages, although they were significantly less prominent in the lungs of older smokers. On the other hand, respiratory and membranous bronchiolar wall fibrosis was increasingly evident in older smokers (p less than 0.05). Muscular hypertrophy in the bronchiolar walls was significantly greater in smokers, but a change with age was not observed. These findings strongly suggest that bronchiolar fibrosis is associated with chronic cigarette use. These lesions occur independently of emphysema and may account for some of the subtle physiologic alterations observed in smokers.
Subject(s)
Bronchi/pathology , Smoking/pathology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Cross-Sectional Studies , Fibrosis/pathology , Humans , Inflammation/pathology , Lung/pathology , Male , Middle Aged , Pulmonary Emphysema/etiology , Pulmonary Emphysema/pathology , Smoking/adverse effectsABSTRACT
Sudden cerebral swelling and death secondary to craniocerebral trauma has been noted in children and young adults. This is due to an increase in intracerebral blood, either secondary to an increase in cerebral blood volume or a redistribution of intracranial blood from the pial to the intraparenchymal vessels. Sequential craniocerebral trauma has been associated with the syndrome of "malignant cerebral edema"; the possibility of a "compliance compromised brain" has been suggested as the cause. The additional possibility of asymptomatic encephalitis leading to a compliance compromised brain and malignant cerebral edema is discussed.
Subject(s)
Athletic Injuries/complications , Brain Edema/etiology , Craniocerebral Trauma/complications , Adolescent , Adult , Boxing , Encephalitis/complications , Football , Humans , Male , SkiingABSTRACT
All ski-related accidental deaths in Vermont during the 1979-1980 through 1985-1986 ski seasons are reported. Sixteen deaths occurred in downhill skiers at major ski areas. During the same period 24.17 million skier-days were logged for an estimated rate of one death per 1.5 million skier-days. Of the skiers 81% were male, and 62% were between the ages of 15 and 26 years. Fourteen of 16 cases resulted from collisions with objects, most commonly trees. The predominance of head and upper body injuries was striking, and fractures of the lower extremities were uncommon. Lethal head/neck injuries accounted for all but two of the deaths. Only one skier was wearing a helmet. Speed and loss of control were the two major contributing factors identified in these accidents. The need for research and development in the prevention of this class of ski accidents is emphasized.
Subject(s)
Athletic Injuries/mortality , Skiing , Adolescent , Adult , Age Factors , Aged , Athletic Injuries/epidemiology , Athletic Injuries/etiology , Craniocerebral Trauma/epidemiology , Craniocerebral Trauma/etiology , Craniocerebral Trauma/mortality , Epidemiologic Methods , Ethanol/blood , Female , Humans , Male , Middle Aged , Sex Factors , VermontABSTRACT
A case is presented in which sudden cardiac death was caused by herniation of the heart through a pericardial incision following a gunshot wound to the chest, resulting in acute compression of the coronary arteries. At autopsy the heart protruded through the pericardial incision, which appeared to have elongated, and the cause of death was thought to be acute myocardial infarction secondary to coronary artery constriction.
Subject(s)
Heart Diseases/etiology , Pericardium/surgery , Adolescent , Death, Sudden/etiology , Hernia/etiology , Humans , Iatrogenic Disease , Male , Postoperative ComplicationsABSTRACT
A case of cardiac rhabdomyoma producing sudden unexpected death in an asymptomatic six-year-old boy is reported. Cardiac rhabdomyoma is a rare tumor, and its ability to cause sudden unexpected death in children beyond infancy is not generally known. The great majority of afflicted patients die in the early infancy; few survive beyond five years of age. The signs and symptoms present in most cases are said to be due to interference of interaction blood flow or to interruption of the cardiac conduction system. Numerous cases have been clinically misdiagnosed because of this tumor's ability to mimic other cardiac disease.
