Gary T. Simmons

Two acute pediatric abdominal catastrophes from strangulated left paraduodenal hernias.

We present two cases of catastrophic intestinal obstruction from to strangulation of a left paraduodenal hernia (PDH). PDH is the most common internal hernia. Early diagnosis and treatment are essential because of the high morbidity and mortality associated with strangulation. Early involvement of the surgical team without an overly extensive evaluation in the emergency department is important if this diagnostic suspicion exists. PDH should also be considered when there is a history of chronic, intermittent abdominal pain of unclear cause. To our knowledge, these cases are the first described cases of sudden demise within a few hours of onset of symptoms of a left PDH.

FINDINGS IN GUNSHOT WOUNDS FROM TANDEM PROJECTILES

Tandem projectiles are unusual events which can cause erroneous case interpretations if one is unfamiliar with them. This paper presents two such cases. The first case involved three .32 caliber bullets, two of which became lodged in a revolver barrel because of faulty ammunition. A third fired bullet subsequently pushed itself and the lodged bullets out of the barrel resulting in a single entrance wound with three bullets in the body. The second case involved a 20 gauge shotgun shell which apparently was inadvertently loaded into a 12 gauge shotgun. This resulted in an unusual entrance wound and unusual X-rays with fragments of the 20 gauge shotgun shell, as well as 12 gauge shotgun shell wadding, being removed from the same wound. The pertinent findings in such cases are discussed so that they may be correctly identified when they occur.

Etiology of pulmonary thromboembolism in the absence of commonly recognized risk factors.

Pulmonary thromboembolism is an often fatal complication of venous thrombosis. Any component or combination of the components composing Virchow’s triad (venostasis, hypercoagulability, and endothelial damage) increases the propensity for a thrombophilic state. Hypercoagulable states may be inherited or acquired. While the etiology in many cases may be evident either on physical examination or on evaluation of the decedent’s medical history, this is often not the case. We conducted a retrospective study of cases presenting to the Jefferson County Coroner/Medical Examiner’s Office in Birmingham, Alabama, who were given a diagnosis of pulmonary embolism. A search of cases within the past 23 years yielded 81 cases. An underlying cause was determined in 70 cases (86%). The remaining 11 (14%) cases had no identifiable cause. We believe that a number of these cases may represent an underlying thrombophilic disorder. Since these disorders may be of an inherited or acquired nature, the determination of an etiology may be relevant to the decedent’s family. Postmortem blood analyses may in selected cases be useful and appropriate for the detection of some of these disorders. However, such analyses are not practical in all cases, with each case having to be evaluated on its own merits.

Death by power car window. An unrecognized hazard.

The unusual accidental asphyxial death of a 26-month-old girl involving a car power window is reported. The circumstances and investigation results are discussed, as well as how such tragedies may be avoided.

Fatal herpes virus type I infection in a newborn.

The authors present a case of environmentally acquired fatal herpes virus type I infection in a newborn after cesarean section and a discussion of the clinical presentation, pathogenesis and diagnosis of herpes simplex type I (HSV-1) at autopsy. Herpes simplex virus, both type I and type II, are well described infectious agents in newborns. Though herpes simplex type II (HSV-2) is commonly associated with fatal neonatal infections, it is important to consider HSV-1 to make the correct diagnosis. Additionally, although HSV infections are typically acquired during parturition, it is possible to be infected postpartum from the environment as occurred in this case. The diagnosis of neonatal HSV must also be communicated by the forensic pathologist to applicable healthcare providers and health care facilities, because of public health and medicolegal issues.