Coagulation and Hematologic Disorders
By far the largest literature on natural causes of SDH in children relates to hematologic and coagulation disorders. These disorders can affect the fetus, newborn, infant, and juvenile but are all considered in this section. Because of the shear number of papers, particularly in relation to hemophilia, only selected references are given to relevant conditions. Severe hemophilia A factor VIII deficiency can present with intracranial hemorrhage in neonates. This condition can result from...
Method
The vitreous is obtained by puncturing the posterior chamber of the eye with a 15- or 17-gauge needle on a 5- or 10-ml syringe, taking care to avoid cosmetically unsightly disruption of the iris and the pupil. 1. Ensure that the eye is fluctuant and therefore contains fluid by putting slight pressure on the eye with the index finger and thumb of one hand. These fingers should then move apart slightly when you press the eye gently with the index finger of the other hand. Insert the needle into...
Sepsis Severe Sepsis and Septic Shock
Systemic inflammatory response syndrome can result from either a noninfectious or an infectious condition. The presence of at least two of the SIRS components when triggered by infection is termed sepsis.69 Infection leading to sepsis can be bacterial, fungal, parasitic, protozoan, or viral. As mentioned earlier, sepsis and other critical illnesses produce a biphasic inflammatory immunologic, hormonal, and metabolic response. The acute phase is marked by an abrupt rise in the secretion of...
Summary Qhk
Ophthalmic pathology at autopsy can seem a daunting business to the uninitiated. However, it has much to offer scientifically and diagnostically once the initial fears are overcome. The procedures are no more difficult - once learned - than those in many other branches of pathology. As ever, the secret is in good preparation and thoughtful and careful execution of all of the technical procedures. Therefore I encourage you to consider working in this extremely interesting area of pathology. The...
Spleen
In sepsis, the spleen usually is enlarged and swollen. The capsule has a tense appearance and is easily accidentally torn open during evisceration. The cut surface shows a soft and hyperemic parenchyma with a reddish-gray, sometimes muddy-brown appearance. At gross examination, the pathologist's attention should also focus on the splenic vein, because septic thrombophlebitis of this vessel can cause pyelophlebitic liver abscesses either by per continuitatem spread or via the hema-togenous...
Genetics Oxt
A total of seven genes causing LQTS have been identified.101104 The mutant ion channel that causes clinical LQTS is inherited in an autosomal dominant fashion with incomplete penetrance and originally was known as the Romano-Ward syndrome. With the advent of genetic testing, it has become clear that each LQTS genetic subtype is a unique disease with different triggers to arrhythmias. The genes that encode the potassium channels KVLQT1 on chromosome 11 and minK on chromosome 21 interact to form...
Vascular Disease Malformations and Flow Abnormalities
Subdural hematomas may occur in children as a presenting symptom of vascular disease or vascular malformations. Kawasaki disease is a multisystem disorder characterized by vasculitis of small and medium arteries. Neurologic complications, including meningoencephalitis, monocyte-predominant pleocytosis in the CSF, facial nerve palsy, seizures, hemiplegia, and sensorineural hearing loss have been reported to occur in 1.1 to 3.7 of affected children.103105 Two papers detailing seven cases of SDH...
Vitamin Deficiencies
Subdural hematomas may occur in childhood with vitamin C, and K abnormalities. No reports exist of SDH with vitamin A, B, or E abnormalities. A single case related to vitamin D deficiency is discussed in the following. The majority of papers on the association of SDH and vitamin deficiency abnormalities relate to vitamin K. This finding may be the result of either maternal vitamin K deficiency with SDH arising in the developing fetus97 or postdelivery neonatal vitamin K deficiency known as...
Hemorrhagic Shock and Encephalopathy Syndrome
Hemorrhagic shock and encephalopathy syndrome HSES was first reported by Levin et al.65 in 1983. This acute, frequently lethal syndrome usually occurs at about 3 to 4 months of age.66 The cause remains unknown.67 There is a prodromal period lasting on average 2 to 3 days during which the child exhibits fever, irritability, diarrhea, or signs of an upper respiratory tract infection. It then deteriorates into profound shock, seizures, coma, DIC, and oliguria. Cerebral edema, hypoxia, and boundary...
Contributors
Chief of Electrophysiology, Professor of Medicine, Department of Cardiology and Intensive Care, Hopital Louis Pradel, Lyon, France Associate Professor of Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, CA, USA Consultant Home Office Pathologist, Senior Lecturer in Forensic Pathology, Forensic Medicine Unit, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne, UK Assistant Professor of Medicine,...
Autopsy Bacteriology
Determining the species and strain of a pathogenetic germ can be of evidential value in reaching etiopathogenetic conclusions about a causal relationship among portal of entry, infection, and fatal outcome. Therefore, the pathologist may have to decide on the value of obtaining samples for postmortem microbiologic investigations at autopsy. Although the diagnostic value of postmortem microbiology for the diagnosis of antemortem infection has been discussed controversially for decades, the...
Skin Subdural Hematoma
Circumscribed bleedings of the skin are a clinically well-known manifestation of DIC during the course of sepsis and are still apparent postmortem on the outer body surface Figure 3.33 . Sometimes these bleedings appear in a discreet petechial pattern, occasionally taking the shape of extensive, confluent hemorrhages. Metastatic spread of septic microemboli may lead to circumscribed cutaneous bleedings in distinct locations Figures 3.34 and 3.35 and must be differentiated from DIC-related skin...
Postmortem Diagnosis of Death Due to Sepsis A Substantial Challenge in Forensic
In clinical practice, sepsis currently is diagnosed by cardinal signs such as tachypnea, fever or hypothermia, tachycardia, and leukocytosis or leukopenia, clinical manifestations that are neither specific nor sensitive for sepsis.69'71 Although diagnosing a septic condition may present a problem even in the living patient, the primary diagnosis of sepsis after death is far more difficult because the major limitation to a precise postmortem diagnosis of sepsis is the frequent nonspecificity of...
Current Methods and Modern Trends
Guy N. Rutty, MD, MBBS, FRCPath, DipRCPath Forensic Consultant Home Office Pathologist Professor of Forensic Pathology and Head of Division Forensic Pathology Unit University of Leicester Leicester, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Control Number 2005925982 ISBN-10 1-85233-967-5 e-ISBN 1-84628-026-5 Printed on acid-free paper Springer-Verlag London Limited 2006 Apart from any fair...
Forensic Nursing Defined
There is a preconceived misconception in the United Kingdom that forensic nursing involves only mental health psychiatric nursing within institutional care units and prisons. This is not the case. In fact, women have been practicing forensic-type services as early as the 13th century, when they were involved in examinations confirming the virginity of women who were marrying into royalty or evaluations of sexual assault victims. Nevertheless, the 1990s saw a significant paradigm shift from...
Agonal Spread of Bacteria
According to Roberts,46 certain bowel conditions, such as ulcers, infarction, or congestion, can be associated with bacteremia from the gut shortly before death or in the agonal period leading to multiplication of bowel flora organisms in internal organs, resulting in rapid putrefaction contrastive to the length of the postmortem interval. However, whether bacterial invasion prior to death or during the agonal period actually occurs is still a matter of debate. In my belief, in nonseptic...
References 1
1. Escobedo LG, Zack MM. Comparisons of sudden and nonsudden coronary deaths in the United States. Circulation 1996 93 2033-2036. 2. Goraya TY, Jacobsen SJ, Kottke TE, et al. Coronary heart disease death and sudden cardiac death. Am J Epidemiol 2003 157 763-770. 3. Zheng ZJ, Croft BJ, Giles WH, et al. Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001 104 2158-2163. 4. Fineschi V, Pomara C. A forensic pathological approach to sudden cardiac death. In Tsokos M, editor....
Liver
The highly complex pathophysiology of the liver in shock is determined by a variety of overlapping inflammatory reactions. At gross inspection, the liver in shock is enlarged, showing a tense Glisson capsule and rounded edges. The weight of the liver in sepsis often is increased because of accumulation of leukocytes and interstitial edema. In septic shock complicated by DIC, spotty hemorrhages are a frequent feature on cut sections. Despite the high incidence of cholecystitis, appendicitis, and...