ABSTRACT
Accidental hypothermia has been described in the forensic literature but reports of occurrence in hospitalized patients are rare. Associated anatomic lesions include acute hemorrhagic pancreatitis and characteristic acute gastric ulcers termed Wischnewski ulcers. We report here two patients with cirrhosis and ascites; one also had hepatocellular carcinoma. Portal vein thrombosis, acute hemorrhagic pancreatitis and Wischnewski ulcers were present in both. The clinical records documented hypothermia that progressed over several days. Temperature nadirs of 31.0 degrees C (87.8 degrees F) and 32.2 degrees C (90.0 degrees F) were recorded in each patient, respectively, one day before death, although each transiently reached temperatures that did not register on standard monitoring devices. This is the first report that chronicles antemortem body temperatures in hypothermic patients with Wischnewski ulcers and pancreatitis at autopsy. Also, the association of these findings with portal vein thrombosis and cirrhosis has not been previously described. We discuss this constellation of findings with regard to possible mechanistic interrelations.
Subject(s)
Hypothermia/complications , Liver Cirrhosis/complications , Pancreatitis/etiology , Portal Vein , Stomach Ulcer/etiology , Venous Thrombosis/complications , Acute Disease , Body Temperature , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/pathology , Fatal Outcome , Female , Forensic Medicine , Hospitalization , Humans , Hypothermia/pathology , Liver Cirrhosis/pathology , Liver Neoplasms/complications , Liver Neoplasms/pathology , Male , Middle Aged , Pancreatitis/pathology , Stomach Ulcer/pathology , Venous Thrombosis/pathologyABSTRACT
Reports of sudden death associated with minor head trauma in adults with the Chiari I malformation are rare. We describe two such cases, occurring in a 71-year-old individual and in a 22-year-old individual. In both cases, postmortem examination revealed prominent cerebellar tonsillar herniation and, in one, associated tonsillar sclerosis and hydrocephalus. Evidence of trauma was minimal in both, and was not sufficient to explain these fatalities. We describe the neuropathologic findings and discuss the differential diagnostic considerations in these cases of sudden death. The implications regarding manner of death are also emphasized.
Subject(s)
Arnold-Chiari Malformation/complications , Brain Injuries/complications , Death, Sudden/etiology , Adult , Aged , Arnold-Chiari Malformation/pathology , Brain Injuries/pathology , Cerebellum/abnormalities , Cerebellum/pathology , Death, Sudden/pathology , Forensic Medicine , Humans , Hydrocephalus/pathology , MaleABSTRACT
We review our experience with the immunoperoxidase technique of staining tissue for prostate-specific antigen in four patients with atypical metastases from prostate cancer. Our results indicate that this test is clinically useful for the diagnosis of metastatic prostate cancer in patients with an unsuspected primary prostate malignancy. Further, application of prostatic-specific antigen testing may confirm metastatic prostate cancer in atypical sites in patients with a previously diagnosed prostate malignancy.
