Werner U. Spitz

An evaluation of the hazard created by natural death at the wheel.

Abstract Assessment of the hazard associated with sudden natural death of drivers suggests that the magnitude of the problem does not warrant costly and restrictive control efforts. Investigation o...

Necrotizing fasciitis: a fatal outcome following minor trauma. Case report and literature review

The death of a young healthy man, 11 days after he sustained minor trauma, illustrates the potential disaster of undiagnosed necrotizing fasciitis. Difficulty in early diagnosis often arises because the skin is initially spared and only later becomes secondarily involved. In this case, because of the lack of external manifestations, the diagnosis of necrotizing fasciitis was not considered until the postmortem examination. Necrotizing fasciitis should be considered a potentially serious problem that can follow minor trauma and eventually lead to death. The need for a high index of suspicion to make this diagnosis, along with the medicolegal implication of a diagnosis of necrotizing fasciitis, are both addressed in this report. Also of note is the fact that this patient was treated with nonsteroidal antiinflammatory drugs for pain and inflammation, which has recently been reported to be associated with an increased incidence of fulminant evolution of necrotizing fasciitis.

Postmortem cerebrospinal fluid pleocytosis.

We show that postmortem cerebrospinal fluid (CSF) pleocytosis is a common event. Postmortem cerebrospinal or ventricular fluid was obtained from children and adults. The cells were counted and morphologically characterized using several histochemical markers. Infants exhibit a brisk postmortem CSF pleocytosis. Sudden infant death cases have relatively high CSF counts. Typeable cells are mononuclear and consist of ˜60%-70% lymphocytes and 20%-40% macrophages. When postmortem duration is >12 h, the cells become vacuolated and cannot be identified. The etiology of these findings requires further study

Syncope and sudden death caused by mitral valve myxomas.

Two adults experienced syncopal episodes before dying suddenly. The autopsies revealed mitral valve myxomas. Mitral valve myxomas producing syncope and sudden death are discussed.

Sudden death resulting from chicken bone perforation of the esophagus.

Sudden death caused by foreign-body perforation of the esophagus is distinctly uncommon. We report the death of an elderly patient in a nursing home who exsanguinated after she swallowed a chicken bone that perforated her esophagus and right common carotid artery.

Fatal accidents and blood ethanol levels in adolescents and adults. The Wayne County experience, 1978-1988.

The files of 874 fatal traumatic accident victims, aged 12-25 years, examined at the Wayne County Medical Examiners Office during the period 1978-1988 were reviewed. Postmortem blood alcohol results of individuals who died after <15 min of hospitalization were utilized to approximate alcohol levels at the time of the fatal injury. Relationships between types of accidents, sex, age, race, and time of accident were examined. White victims were far more likely to have been drinking than blacks, and the data indicated that underaged drinkers were involved in fatal accidents at lower levels of blood alcohol than their counterparts of legal drinking age. Consistent racial differences in average alcohol levels were not observed, however. Unlike female and black victims, who much less frequently tested positive for alcohol when underage, white male victims 16-21 years of age were just as likely to have been drinking as those aged 21-25. The results of the study show that postmortem blood alcohol level can be used to identify differences in alcohol consumption among groups of accident victims in a major metropolitan area

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.

Sudden Death of an Elderly Man with Multiple Malignant Neoplasms

With the lengthening of the human life span, cancer has become an increasingly important medical problem for the aged. It is not uncommon to find multiple primary neoplasms in elderly individuals. We recently investigated the death of an elderly man who had died suddenly and had three incidental malignant neoplasms, including a pleural mesothelioma, first diagnosed at autopsy. The importance of performing a complete medicolegal autopsy for epidemiological and statistical purposes is emphasized.

Gastrointestinal hemorrhage from an internal jugular abscess in an intravenous drug addict.

The usual death of a long-time heroin user is described. The significance of this case is that death occurred suddenly and unexpectedly during incarceration. In the United States, such deaths are frequently followed by lawsuits against the prison authorities. Drug abuse can cause death in many varied ways.

A work-related death due to a penetrating chest injury

Penetrating injuries of the chest are uncommon in the work-place. We report an unusual case of a machinist who was killed when a drill press broke and a flying metallic fragment penetrated his thorax.