Deaths due to meningiomas are routinely diagnosed in clinical practice because this neoplasm tends to present with the typical progression of neurological deficits. On the other hand, sudden ...unexpected deaths due to meningiomas are rarely described in the literature. The study presents six fatal cases of previously undiagnosed intracranial meningiomas from the Cook County Medical Examiner's Office from 1998 to 2014. The most common explanation of the mechanism of sudden death due to intracranial neoplasms is a rapid increase in intracranial pressure produced by the mass effect of the neoplasm. Other mechanisms of death include acute intracranial and intratumoral hemorrhage, and benign neoplasms that grow in the vicinity of vital centers altering neural discharge in autonomic pathways leading to cardiac suppression or lethal arrhythmia. Forensic pathologists must keep in mind that sudden unexpected death caused by intracranial meningiomas, although extremely rare, may be encountered in the forensic setting.
Paresthesia-dominant and pain-dominant subgroups have been noted in carpal tunnel syndrome (CTS), a peripheral neuropathic disorder characterized by altered primary somatosensory/motor (S1/M1) ...physiology. We aimed to investigate whether brain morphometry dissociates these subgroups. Subjects with CTS were evaluated with nerve conduction studies, whereas symptom severity ratings were used to allocate subjects into paresthesia-dominant (CTS-paresthesia), pain-dominant (CTS-pain), and pain/paresthesia nondominant (not included in further analysis) subgroups. Structural brain magnetic resonance imaging data were acquired at 3T using a multiecho MPRAGE T1-weighted pulse sequence, and gray matter cortical thickness was calculated across the entire brain using validated, automated methods. CTS-paresthesia subjects demonstrated reduced median sensory nerve conduction velocity (P = 0.05) compared with CTS-pain subjects. In addition, cortical thickness in precentral and postcentral gyri (S1/M1 hand area) contralateral to the more affected hand was significantly reduced in CTS-paresthesia subgroup compared with CTS-pain subgroup. Moreover, in CTS-paresthesia subjects, precentral cortical thickness was negatively correlated with paresthesia severity (r(34) = -0.40, P = 0.016) and positively correlated with median nerve sensory velocity (r(36) = 0.51, P = 0.001), but not with pain severity. Conversely, in CTS-pain subjects, contralesional S1 (r(9) = 0.62, P = 0.042) and M1 (r(9) = 0.61, P = 0.046) cortical thickness were correlated with pain severity, but not median nerve velocity or paresthesia severity. This double dissociation in somatotopically specific S1/M1 areas suggests a neuroanatomical substrate for symptom-based CTS subgroups. Such fine-grained subgrouping of CTS may lead to improved personalized therapeutic approaches, based on superior characterization of the linkage between peripheral and central neuroplasticity.
Death certificates provide epidemiologists and other researchers with statistical data regarding causes of death within the community. When the certificates are filled out erroneously they provide ...misleading and inaccurate information. The aim of our investigation was to determine whether these certificates are being completed correctly by clinicians, how frequently errors are occurring, and what types of errors are being committed by the physicians in our county.
A total of 371 consecutive death certificates issued by community physicians from Broward County between February 2007 and March 2007 were reviewed. Errors were grouped into major categories as follows: unacceptable cause of death (UC), nonspecific cause of death, irrelevant information, incorrect order, and incorrectly completed.
About 48% of death certificates were found to have at least 1 of the 5 types of errors in the cause of death section. These were unacceptable cause errors 30.2%, non-specific errors 14.8%, incorrectly completed errors 6.5%, irrelevant information errors 4.0%, and incorrect order errors 3.5%.
Nearly half of all death certificates reviewed in this study were found to be inaccurate. Using the results of this study, the Broward County Medical Examiner's Office has been able to tailor new physician education programs for the community.
Purpose: The literature is imprecise regarding the ideal tibial site for the posterior cruciate ligament (PCL) placement. We detail anatomic and radiographic landmarks for consistent placement of ...graft fixation in PCL reconstruction. Methods: Fourteen fresh-frozen cadaver knees were sectioned in the sagittal plane. The distance from the posterior cortex of the tibia to the anterior edge of the PCL was measured. Three specimens were fixed in 10% formalin and stained using hematoxylin–eosin and trichrome to determine ligament fiber distribution and insertion. Two knees were used for radiographic analysis of pin placement. Results: The mean distance across the PCL facet from the posterior cortex to the anterior edge of the PCL was 15.6 mm (±1.1 mm). Histologic analysis in three knees showed that the PCL fibers inserting along the PCL facet comprise the bulk of the ligament, while the fibers that insert along the posterior cortex are less than 0.5 mm thick. Conclusions: The bulk of the PCL inserts in the posterior half of the PCL facet. We show that, in the sagittal plane, the center of the working fibers of the PCL lies 7 mm anterior to the posterior cortex of the tibia, measured along the PCL facet. Tunnel placement at the center of the original ligament can be measured along the PCL facet as seen in a true lateral radiographic view. Clinical Relevance: This study provides anatomic and radiographic criteria helpful for guide-pin placement in arthroscopic PCL reconstruction.
The medical examiner's office in Broward County is responsible for determining the cause and manner of death in cases falling under its jurisdiction and issuing death certificates on these decedents. ...Amendments are occasionally required to correct misinformation on death certificates or within the autopsy reports. The purpose of this study was to investigate the major causes for the amendments and to develop strategies to avoid future errors. We found 128 cases from 2006 to 2007 that required amendments; 103 contained sufficient data in the file for further analysis. Over this time period, 3790 death certificates were issued over that same period, resulting in a 3.37% amendment rate. In this study, the cohort included both males and females with a ratio of 2:1. Their ages ranged from newborn to 103 years, with a mean age of 49 years. Of the 103 amended cases, amendments were made to the cause (n = 30) and often the manner (n = 21) of death listed on the death certificate; the remaining changes were limited to the autopsy report. The most common reasons for amendments included reception of delayed laboratory findings (35%), acquisition of additional medical history (22.5%), and typographic errors (15.5%). Typographic errors mainly occurred because of inaccuracies in the names originally provided to our office, the use of aliases by decedents, incorrect personal/demographic history, or various misspellings by funeral homes or medical examiner staff. The most significant reclassifications involved changing certified natural deaths to accidental overdoses and vice versa, based on toxicological analysis. Because of delays in specimen turnaround, these amendments often were made months after the original death certificate was issued. STAT urine drug screening has been helpful in reducing the number of amendments made, but certain drugs of significance are missed by rapid screens. Given that our office performed complete toxicological analysis on all cases over this period, it seems likely that we detected several overdoses that would have been missed if natural deaths were not routinely screened for potential toxins.
: Determination of the time of death is one goal of medicolegal death investigations. Algor mortis has been used as a measure of the postmortem interval (PMI). We prospectively recorded the core ...temperatures of 19 adult bodies entering our morgue cooler and at 3, 6, and 9 h of refrigeration. We then compared the cooling rate with the calculated body mass index (BMI). For each individual body, the rate of cooling was fairly linear with no evidence of a plateau. There was fair to moderate correlation between the BMI and the cooling rate: cooling rate = −0.052 (BMI) + 3.52. The probability of linearity in any given case was 36%. Variables affecting this correlation included the presence and the layers of clothing and if the clothing was wet. Our data confirm that algor mortis is of very limited utility in determining the PMI in bodies that have been refrigerated.
Cardiac dysrhythmia during restraint Cina, Stephen J; Davis, Gregory J
The American journal of forensic medicine and pathology,
12/2010, Letnik:
31, Številka:
4
Journal Article
PDF
