Haresh G. Mirchandani

Ocular and optic nerve hemorrhages in abused infants with intracranial injuries.

PURPOSE To ascertain whether the pathology of the eye and optic nerve might be useful in determining the manner of death in infants who died after sustaining apparent nonaccidental intracranial injury. METHODS Complete autopsies were performed on 13 infants who died of acute intracranial injuries after nonaccidental trauma. The infants were divided into two groups: nine with physical evidence of blunt trauma to the head, and four without detectable scalp or skull injury whose intracranial injuries were attributed to violent shaking (shaken baby syndrome). Six infants with no intracranial injuries who died suddenly from unidentifiable causes (the so-called sudden infant death syndrome) served as controls. RESULTS Optic nerve sheath hemorrhage, most prominent in the subdural space, was present in all 13 infants with nonaccidental intracranial injury. Multilayered retinal hemorrhage was present in at least one eye of 11 of these 13 infants. The location and quantity of the intraocular and optic nerve sheath hemorrhages did not differ in those with external head trauma and those without scalp or skull lesions. A single control infant had a few erythrocytes in the nerve fiber layer of the anterior optic nerve of one eye. The remainder of the control infants did not have evidence of hemorrhage in the eye or optic nerve sheath. CONCLUSION Histopathologic analysis of optic nerve sheath and intraocular hemorrhages may be helpful in distinguishing traumatic from non-traumatic causes of death in infants.

Heat-related deaths in Philadelphia - 1993

A study of heat-related deaths associated with the 1993 heat wave in Philadelphia, Pennsylvania, was conducted. Most of these deaths were in the susceptible elderly with preexisting natural diseases who lived alone without air conditioning in upstairs bedrooms with windows shut, thus creating an even hotter environment. These excessive deaths under such conditions did not meet the standard clinical criteria for hyperthermia because of varying postmortem intervals. Therefore, the authors stress the utility of a postmortem definition of heat-related death to better define the magnitude of health risk posed by hot weather and warn public health and other agencies to take preventative measures.

Cocaine-induced agitated delirium, forceful struggle, and minor head injury. A further definition of sudden death during restraint.

Four cases from the Philadelphia Medical Examiners Office are presented and the literature is reviewed to define further the syndrome of sudden death occurring during cocaine-induced agitated delirium and struggle during restraint in individuals who also sustain minor head injury. The mechanism of death involves a terminal arrhythmia, most likely due to sympathetic sensitization of the myocardium by cocaine and the stress of struggle sometimes juxtaposed upon the stratum of minimal natural disease. In the cases described, the head injury in itself was insufficient to be a cause of death. Recognition of the role of the pharmacologic effect of cocaine and the lethal effects of its use in this setting is crucial.

Cocaine in Decomposed Human Remains

From March 1988 through March 1990, at the Philadelphia Medical Examiners Office toxicology laboratory, samples from 77 decomposed human bodies were tested for the presence of cocaine, employing gas chromatography/mass spectrometry (GC-MS). The material analyzed included decomposed soft tissue, bloody decomposition fluid, mummified tissue, maggots, and beetle feces. Twenty-two cases (28.6%) were positive for cocaine, many of these cases in states of advanced decomposition. These findings indicate the usefulness of testing decomposed tissue for cocaine in all cases where its presence is suspected. This is contrary to what might be expected, since cocaine is generally labile and rapidly broken down by both enzymatic and nonenzymatic mechanisms.

Commotio cordis, revisited

Nonpenetrating cardiac injuries due to direct precordial blunt impacts are a commonly encountered phenomenon in medicolegal offices. These injuries vary from contusions to valvular lacerations, or papillary muscle rupture to coronary arterial injury with resulting infarction. A less commonly occurring manifestation of nonpenetrating injury is a concussion of the heart (commotio cordis), often with dramatic physiological consequences but no morphologic cardiac injury. We describe four case reports of this entity. The cases were collected over a 5-year period (1978-1983) from the Wayne County Medical Examiners Office in Detroit, Michigan.

Scald burns complicated by isopropyl alcohol intoxication. A case of fatal child abuse.

Scald burns are the most common type of thermal injury in child abuse. Death associated with nonaccidental burns, however, is uncommon. We recently investigated the case of a 4-year-old child who died from extensive body burns due to scalding. A contributory cause of death was isopropyl alcohol intoxication resulting from application of this chemical to the burns.

Human immunodeficiency virus infection in cases presenting to the Philadelphia Medical Examiner's Office.

Serum samples were available from 492 of 1,058 cadavers seen at the Philadelphia Medical Examiners Office between August 4 and December 15, 1989. These sera were tested for the presence of antibodies to human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA) and Western blot. The overall prevalence of HIV in the autopsy population was 2.24%. The following populations snowed increased prevalence as compared to the total sampled population: blacks (3.60%, p < 0.01), males (2.51%, n.s.), and homicide victims (3.74%, n.s.). Seroprevalence data from this study are compared with those from earlier studies of other related populations, with regard to overall prevalence and risk factor analysis.