Three-dimensional (3-D) imaging in post-mortem examinations: elucidation and identification of cranial and facial fractures in victims of homicide utilizing 3-D computerized imaging reconstruction techniques.

The analysis of cranial and facial fractures in skeletal remains of homicidal victims can prove challenging for forensic anthropologists and forensic pathologists in postmortem examination. In such cases, the use of 3-D computerized imaging to elucidate the fractures and patterns of injuries can provide strong medical evidence that is very useful during litigation and at trial. The authors describe 3-D reconstructions of the skull performed as part of forensic postmortem examination in a recent victim of homicide.

Malignant oncocytoma of the maxillary sinus--an ultrastructural study.

A unique case of a malignant oncocytoma of the maxillary sinus is reviewed in detail. The ultrastructural findings are presented. The histologic and ultrastructural criteria that characterize oncocytes and the clinicopathologic features of benign and malignant oncocytomas are discussed. This case represents the eleventh reported case that would truly qualify as a malignant oncocytoma of the paranasal sinuses.

Ultrastructural and immunohistochemical investigations of the giant cells in nodular fasciitis.

The giant cells of histologically typical cases of nodular fasciitis were studied by electron microscopy and immunohistochemistry. Ultrastructurally, these cells were found to be similar to the adjacent spindle and large fibroblast-like cells in many ways. These giant cells exhibited numerous intracytoplasmic, well-formed longitudinally oriented bundles of myofilaments and hemi-desmosome-like structures with associated basement membrane-like material, abundant endoplasmic reticulum, and numerous dense bodies. The observed myofilaments did not show beading or Z-line formation. Immunohistochemical staining by means of the indirect peroxidase-antiperoxidase technique failed to localize the proven antigenic markers of histiocytes within the giant cells. The results support the concept that the giant cells in nodular fasciitis are of myofibroblastic origin. It is thus proposed that these giant cells are neither histiocytes nor rhabdomyoblasts as previously thought, but are rather modified fibroblasts ("myofibroblasts").

Sulfuric acid poisoning.

Deliberate ingestion of a corrosive acid is an unusual manner of death. Sulfuric acid, often used in electrical industry, chemical laboratories, and agriculture, is fatal at a dosage of 3.5-7.0 ml. The mortality rate is quite high, with only 35% recovery rate. Poisoning by sulfuric acid resembles other mineral acids in that the esophagus is more commonly spared while coagulative necrosis of the stomach is often apparent. A case involving the ingestion of sulfuric acid by a patient with a history of chronic psychiatric illness is presented. The pathological, clinical, and toxicological aspects of this case are discussed.

Cholecystitis and cholelithiasis in children and adolescents.

One hundred patients aged 20 years and younger, admitted to Hurley Medical Center during a ten-year period for treatment of acute or chronic cholecystitis with or without cholelithiasis, were reviewed. Results demonstrated an increasing incidence of pediatric cases compared with previous reports, a predominance in parous teenagers, and only an 8 percent association with hemolytic diseases. The clinical presentation is very similar to that of adults. Maintaining a high index of suspicion in addition to the use of diagnostic aids such as cholecystogram, ultrasonography, and hepatobiliary imaging with technetium 99m PIPIDA (paraisopropylacetanilide iminoacetate) should lead to the diagnosis of gallbladder disease even at a very early age. Elective cholecystectomy in the stable patient is the treatment of choice, and any delays in the diagnosis and treatment will increase morbidity and mortality considerably.

Asymmetric septal hypertrophy of the heart. New findings concerning the possible etiology of sudden deaths in five males.

This report describes certain interesting postmortem findings in the hearts of five subjects who died suddenly, silently, and unexpectedly, and in whom the only significant abnormality at autopsy was asymmetric septal hypertrophy (ASH) of the heart. Deep clefts, cystic faults, and dilated vascular channels were not only seen within the septal myocardium in all the hearts, but also within the left ventricular free walls of two hearts. The septal myocardium and the left ventricular free walls of two hearts and the A-V node and His bundle of one heart demonstrated mural and luminal thrombi of several dilated vascular channels. In another heart, foci of cardiocytic myofibrillar degeneration were seen, especially close to narrowed small coronary vessels. Fetal dispersion and fibrosis of the A-V node and His bundle were evident in one heart. These abnormalities in the conducting system and the ventricular myocardium suggest that the hearts of subjects with ASH are not only excellent anatomic substrates for lethal arrhythmias, but also are bound to be hemodynamically impaired. We believe that conditions such as hypoxia, increased oxygen demand by the heart or abnormal sympathetic stimulus may easily trigger fatal arrhythmias in such individuals, thereby causing sudden death.

A fatal maprotiline intoxication.

A fatal maprotiline intoxication is presented. The postmortem anatomical and toxicologic findings are discussed, as is the mechanism of maprotiline toxicity. This report is, to the best of our knowledge, the sixth fatal maprotiline poisoning in the medical literature.

Testicular gonadal stromal (Sertoli cell) tumor.

Eighty-one cases of testicular gonadal stromal tumor have been reported in the literature. An additional case is herein reported. The pathologic, immunohistologic, and histogenetic aspects are presented.

Invasive pituitary oncocytoma.

A large invasive pituitary neoplasm, surgically resected by left frontotemporal craniotomy, and thought to represent "chromophobe" adenoma by light microscopy, exhibited ultrastructural features characteristic of oncocytoma. Electron microscopic and immunocytochemical studies showed that the tumor did not possess enhanced secretory activity. The indispensable role of electron microscopy in the identification of this rare neoplasm and especially in the classification of all pituitary tumors is emphasized.

Marked concomittant elevations in serum creatine kinase and lactic dehydrogenase in a patient with bowel necrosis.

We report what we believe to be the first proven marked concomittant elevations in serum creatine kinase (CK) and lactic dehydrogenase (LD) in a patient with bowel necrosis. The necrosis was the result of infarction secondary to bowel strangulation. The serum from this patient showed elevation of total CK activity resulting from an abnormal amount of MM, MB, and BB isoenzymes with LD2, LD3, and LD5 yielding 18 per cent, 19 per cent, and 29 per cent, respectively, of the total LD activity.

Ultrastructural features of cerebral amyloid angiopathy.

Ultrastructural studies of the brain in three cases of cerebral amyloid angiopathy demonstrated that the vascular amyloid in this disease is composed of fibrils identical to those in systemic amyloid disease, mixed with a large amount of vesicular debris. Amyloid appears to be derived from circulating protein and is depostied in areas of vascular basement membrane degeneration. The initiating degenerative change is thickening of basement membrane with accumulation of debris. Inflammation, when present, tends to accelerate amyloid deposition locally. Amyloid transport from the vascular wall into the brain parenchyma proceeds by overflow when perivascular astroglial end-feet are disarranged. Structures of perivascular amyloid plaques are similar to the neuritic (senile) plaques in Alzheimer's disease, which were used as control, except that the amyloid core of the plaques in Alzheimer's disease is not related to blood vessels.