Sarah Schalinski

Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases

We prospectively investigated six fatal cases of clostridial gas gangrene using autopsy, histology, immunohistochemistry, microbiology, and scanning electron microscopy. The causative pathogen was Clostridium perfringens in four cases, C. sordellii in one case, and a mixed infection with both C. perfringens and C. sordellii in one case. According to the previous medical history and autopsy findings, clostridial infection was related to trauma in three cases. Characterized by extensive tissue necrosis and total absence of an accompanying leukocyte infiltration and tissue inflammatory response, the histopathological picture of clostridial gas gangrene is distinctly different from other bacterial infections. In medicolegal casework, the proof of the source of infection and the portal of entry of the responsible pathogen is not always an easy task, especially in the absence of trauma.

Megaesophagus and Possible Mechanisms of Sudden Death

Abstract:  Achalasia is a neurodegenerative condition characterized by esophageal dysmotility and megaesophagus. Two cases are reported that demonstrate unexpected deaths associated with previously unsuspected achalasia. Case 1: A 66‐year‐old woman was found dead at her home. At autopsy significant stenosing coronary artery atherosclerosis was found with cardiac failure. In addition, a striking finding was narrowing of the distal esophagus with marked proximal dilatation. The esophagus was completely filled with a large amount of soft masticated food and was bulging anteriorly, compressing the left atrium. Death was attributed to ischemic heart disease complicated by previously unsuspected achalasia. Case 2: An 84‐year‐old man collapsed and suffered a respiratory arrest while eating. Internal examination revealed narrowing of the cardioesophageal junction with marked proximal dilatation of the esophagus that contained approximately 50 mL of soft semi‐fluid masticated yellow food paste. Fragments of yellow masticated food remnants were present in upper and lower airways but not within the stomach. There was a history of dementia with symmetrical cerebral ventricular dilatation found at autopsy. Death was attributed to food asphyxia complicating previously unsuspected achalasia with dementia. Megaesophagus may, therefore, be a significant finding at autopsy that may either be a primary cause of unexpected death or else may exacerbate or compound the effects of pre‐existing underlying disease.

Fatal pyomyositis: a report of 8 autopsy cases.

Pyomyositis is an acute bacterial infection manifesting as pyemic abscess formation in the skeletal muscles. We examined 8 autopsy cases (seven males, one female; age range 21–75 years) of fatal nontropical pyomyositis to better describe individual case characteristics and pathologic features of this rare disease. The pathogen most frequently involved was Staphylococcus aureus. In most cases, there were several abscesses and multiple sites involved. The trunk, shoulder girdle, and thigh muscles were most frequently affected and involvement of multiple sites was a common finding. In 6 cases, a recent trauma had occurred to the anatomic location where the pyemic abscesses were found. Three deceased were known as intravenous drug abusers. Except for the presence of pyomyositis, liver diseases such as cirrhosis in 3 cases, and a fatty liver in 2 cases were the most frequent autopsy findings. Death was due to sepsis in all cases. Because pyomyositis may develop in association with intravenous catheterization in the clinical setting, the question whether pyomyositis was caused by an infected or improperly placed indwelling intravenous catheter may be of forensic importance in the light of alleged medical malpractice. According to our observations, severe underlying illnesses seem not always necessary for fatal outcome of pyomyositis. Because a detailed dissection of superficial as well as deep skeletal muscles during autopsy is a prerequisite for the diagnosis, the disease may be overlooked when this essential step is not performed.

Vertebral column kyphoscoliosis and unexpected death

A case of spontaneous gastric perforation is reported in a 75-year-old woman due to massive hemorrhaging from a benign gastric ulcer. Blood was prevented from leaving the stomach due to posterior displacement and rotation of the stomach associated with marked underlying vertebral column kyphoscoliosis. Significant deformity of the spine had caused malpositioning of the stomach as a result of the abnormal shape of the peritoneal and chest cavities. This in turn had led to mechanical obstruction and prevented egress of blood arising from a bleeding arteriole in the base of a chronic gastric ulcer. Rapid distension had resulted from the inability to spontaneously decompress the stomach, which in turn had led to rupture.

Tödliche Kohlenmonoxidintoxikation bei einem Schwarzafrikaner

ZusammenfassungDie Inhalation von Kohlenmonoxid (CO) wird nicht wahrgenommen, da es sich hierbei um ein farb- und geruchsloses Gas handelt. Daher werden neben CO-Intoxikationen aus suizidalem Anlass auch häufig akzidentielle Vorfälle beobachtet. Durch die hohe Hämoglobin- (Hb-)Affinität des CO kann es, bei ausreichender Gaskonzentration in der Luft, innerhalb weniger Minuten zum inneren Ersticken kommen. Daher ist das Erkennen einer CO-Intoxikation bei der äußeren Leichenschau anhand der klassischen Merkmale wie kirschrote Leichenflecke, hellrosa imponierende Augenbindehäute und Fingernagelbetten und einer verzögerten Lösung der Totenstarre sehr wichtig, um einen adäquaten Selbstschutz (Öffnen von Fenstern, Verlassen des Fundorts) und Fremdschutz (Evakuierung anderer Bewohner, Detektion der CO-Emissionsquelle) einleiten zu können. Berichtet wird von einem jungen Schwarzafrikaner, der während eines Besuches bei seinem Bruder einen epileptischen Anfall erlitt. Als für den Krampfanfall ursächlich wurde im Krankenhaus ein Hypophysenadenom diagnostiziert. Zwei Tage nach der Entlassung aus dem Krankenhaus wurde der Mann tot aufgefunden. Bei dem Toten fehlten die klassischen äußeren Merkmale der CO-Intoxikation bzw. wurden erst im Vergleich mit einem anderen toten Schwarzafrikaner augenfällig. So wurde die todesursächliche CO-Intoxikation erst während der Obduktion erkannt.AbstractInhalation of carbon monoxide (CO) is not perceptible because CO is a colourless and odourless gas. Therefore, not only suicides but also accidental CO intoxication can often be observed. Due to its high affinity to haemoglobin, CO can lead to internal asphyxia within a few minutes depending on the concentration in air. Therefore, it is very important to recognise a CO intoxication on the basis of the typical criteria seen at external examination of a body, such as cherry-red livor mortis, light pink conjunctivae and fingernails in order to initiate adequate self-protection (opening of windows, leaving death scene) and protection of others (evacuation of other occupants, detection of the CO source of emission). The present case report concerns a young African male who had an epileptic seizure during a visit to his brother. In hospital, a pituitary adenoma was diagnosed as the cause of the seizure. The young man was found dead 2 days after leaving hospital. He lacked the typical external criteria or they first became obvious after comparison to another dead black African and the lethal CO intoxication was first recognised only at autopsy.