Endotoxin as a cause of aseptic meningitis after radionuclide cisternography.

The role of pyrogens in aseptic meningitis after radionuclide cisternography was studied by means of the Limulus test, a sensitive detector of endotoxin. During a 15-month period, 39 reactions associated with cisternography were reported. Ten samples of specific lots of the radioactive drugs implicated in 20 of these reactions were tested and all reacted strongly positive to the Limulus test. The less sensitive rabbit pyrogen test was negative for these preparations when tested on a dose-per-weight basis. Our findings apparently provide clinical evidence for the observation made in animals that endotoxin is at least 1,000 times more toxic intrathecally than intravenously. The data implicate endotoxin contamination as a cause of adverse reactions to radionuclide cisternography. We conclude that the USP pyrogen test is insufficiently sensitive for intrathecal injectables and should be supplemented by the Limulus test.     

Assessment of the responsibility between a road traffic accident and medical defects after the traffic accident injury of knee joint

A 48-year-old Chinese woman was hit by a car in a road traffic accident. Local county hospital considered that her right knee was injured, but didn't find any sign of fracture from X-ray imaging. Then the hospital gave diagnosis of soft tissue contusion and the patient started to exercise with burden 21 days after her right lower limb was fixed by plaster slab. Four months later, she had to go back to the county hospital for recheck due to persistent pain on her right knee. Then, the right tibia outer plateau fracture was found. The patient rejected the advice of open reduction and internal fixation of right tibia plateau fracture. Instead, she accepted the unicompartmental knee arthroplasty in a hospital affiliated to a medical college. The patient felt the knee pain alleviated after surgery However, the joint dysfunction was aggravated even more. The patient used the legal procedure for personal compensation. Both driver and the insurance company disputed that the final consequence of the injured knee was due to not only the traffic accident, but also poor medical practice involved. Therefore the court consigned us to make judicial judgment of expertise. After investigation, we found the earliest X-ray graph after the accident had shown the fracture of right tibia outer plateau and right knee valgum, with articular surface involvement, and the traffic accident was considered as the primary cause of sequelae. At the same time, the county hospital missed the diagnosis of fracture, and led to insufficient fixation of right lower limb, which was not good for rehabilitation from fracture and joint injury. This was the secondary cause of sequelae. Additionally, instead of the standard therapy, the affiliated hospital of medical college made the unicompartmental knee arthroplasty four months later, which also had a little defect. It was the minor reason for the result.     

A degloving foot injury in a traffic accident

An unusual human remain found on a road became one key to reconstruct the traffic accident. A woman was found dead on a snow-covered road. Her left foot showed a large deficit of skin and underlying fat tissue. The detached skin and tissue were found into her left sock and shoe lying at a distance of 23 m from the body. There were multiple fractures on her back and occipital cranial bone. Severe injuries revealed in heart, liver, and brain. The neck remained intact. These findings suggested that her back has been strongly hit by the object with the flat surface, for example, the front side of a cab-over or truck, from behind at a high speed. Furthermore, the degloving injury in her left foot suggested that a vehicle ran over the foot which faced the vehicle. We reconstructed the accident as follows. Firstly the wheel of the vehicle ran over the victim's foot, and then, the victim turned away from the vehicle. Finally, the front side hit her twisted body from behind, resulting in a traumatic degloving injury.     

Acute epiglottitis as cause of sudden death

Summary Acute epiglottitis as a cause of sudden death in 2 adults and 2 children within a period of 2 months is reported. The cases illustrate the characteristic course of the disease and its morbid anatomy. Culture of necropsy specimens gave abundant growth ofHaemophilus influenzae in 3 cases, including 2 in which blood, CSF, lung and splenic tissue yielded heavy growth of this organism.

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Zusammenfassung Es werden 4 plötzliche Todesfälle (2 Erwachsene, 2 Kinder) als Folge einer akuten Epiglottitis beschrieben, die innerhalb von 2 Monaten zu Sektion kamen. Die Fälle illustrieren den charakteristischen Krankheitsverlauf und die patologisch-anatomischen Befunde. Bei der bakteriologischen Untersuchung wurde bei 3 Fällen Haemophilus influenzae nachgewiesen (Kultur), davon bei 2 in Blut, Liquor, Lunge und Milz.

     

Cataract as the root cause of fatal road traffic accidents in pedestrians

Senile cataract is an important cause of preventable blindness, affecting 12-15 million people worldwide. In India, approximately 3.8 million people become blind from cataract each year. Moreover, in India, senile cataract develops at a relatively younger age than that seen in developed countries. However, during routine postmortem examination, search for cataract is often ignored, although it could be a major factor responsible for many road traffic accidents. This paper reports two cases of road traffic accident, where the judgement of the court exonerated the accused drivers based on the findings of eye examination during autopsy. Routine examination of the eye for cataract is recommended in every person involved in a road traffic accident irrespective of whether he is a victim or an accused.     

Traumatic basal ganglia hematoma in a fatal traffic accident victim

A 41-year-old male driver involved in a fatal traffic accident presented with a basal ganglia hematoma on postmortem computed tomographic imaging. Clinicians could not exclude the possibility of non-traumatic intracerebral hemorrhage as the underlying cause of the traffic accident. However, analysis of the head injuries showed that the hematoma was caused by an impact to the front-parietal region directed toward the tentorium. The absence of hypertensive arteriolar changes and hemosiderin deposits in the brain supported the traumatic origin of the hematoma.     

Cranial Doppler ultrasonography as a predictor of neurologic sequelae in infants with bacterial meningitis.

OBJECTIVE: To perform transcranial Doppler sonography in newborns and infants with bacterial meningitis to evaluate predictive value of neurologic sequelae. MATERIALS AND METHODS: Thirty-three patients (15 newborn, 18 infant patients) with bacterial meningitis underwent cranial Doppler ultrasonography during acute phase and 3rd and 6th months after disease. Patients were examined regularly for neurologic outcome with electroencephalography and magnetic resonance imaging. The age-matched control group consisted of 20 healthy children underwent cranial Doppler sonography only. RESULTS: To compare with the healthy controls, the mean blood flow velocity was significantly increased (P < 0.001), and pulsatility index was higher than those control group (P < 0.05) during acute bacterial meningitis. None of the patients were diagnosed with stenosis of cerebral artery. According to neurologic outcome, 14 of 33 patients had neurologic sequelae. The mean cerebral blood flow was significantly higher (P < 0.01) in patients without neurologic sequelae; pulsatility index was significantly higher (P < 0.05) in patients with neurologic sequelae when compared with the healthy controls. There was no significant difference between mean cerebral blood flow velocities and mean pulsatility index values of newborn and infant patients, regarding to neurologic outcome (P < 0.05). CONCLUSION: Cranial Doppler ultrasonography is useful for prediction of neurologic sequelae in infants with bacterial meningitis.     

交通事故颅脑伤临床分析

车祸颅脑伤伤情严重,复杂多变。应检查全面与重点相结合,强调动态观察,抢救掌握轻重缓急及多科配合,可提高抢救成功率。     

重庆市某区道路交通事故流行病学分析

目的探讨城市发展新区道路交通事故(简称事故)的分布特征,区域性事故预防和控制研究奠定基础。方法对重庆市道路交通管理局收集2000~2006年的事故登记信息,以流行病学方法进行资料整理,分析描述近年来重庆市城市发展新区(以某区为例)事故发生的现状及分布规律。结果2000~2006年,重庆市某区共发生事故13 685起,其中一般及轻微事故13 170起,重大事故515起。7年间,从事故的时间分布特征看,一般及轻微事故年均发生1 881起,其中2000年、2001年和2005年发生均在1 600起以下,2003年、2004年和2006年发生均超过2 000起,2004年事故最高,为2 102起,占总数的15.96%;月均事故发生为157起,其中1月、7月和11月为事故的高发期;每月的下旬事故有下降趋势;每周星期六发生事故次数最多,周三最低;单日事故发生最高分别是每月的1号和14号;每日24小时事故中,一般从早上7点开始逐渐上升,11点达高峰,以后逐渐下降;白天的事故发生案例明显高于晚上。重大事故的分布特点与一般及轻微事故有一定区别,主要体现在从2002年后发生开始下降,至2006年一直稳定在年60起左右;每年5月、9月和11月和每周的星期三和周四为高发时间;每日以上午10点左右最高,下午在4点左右次高。结论2000~2006年某区事故发生维持在较高的水平,重大事故发生有降低趋势;事故的发生在时间分布上有明显的特征,但一般及轻微事故与重大事故的分布特征有一定的差别,相关分析信息可作为制定交通事故控制措施的参考依据。     

Acute intramural hematoma of the aorta as a cause of positive FDG PET/CT

Type A acute intramural hematoma (IMH) of the ascending aorta is defined as hemorrhage in the aortic wall in the absence of intimal disruption. Proximity to the adventitia may explain the higher incidence of rupture in IMH. We present a case of IMH, diagnosed by the presence of linear intense uptake of FDG on PET/CT, in a 70-year-old woman undergoing staging for colorectal cancer. There is no current role for FDG-PET in the diagnosis of IMH. This case demonstrates that incidental focal FDG activity in the wall of the aorta may indicate the life-threatening diagnosis of IMH.     

Reconstruction of the dynamic in a fatal traffic accident with prolonged dragging of the victim

The post-mortem examination of victims of fatal road crashes and the reconstruction of the dynamic of traffic accidents are fundamental in vehicular homicides, where the degree of negligence/careless of the driver has to be established. Here we present a case in which a pedestrian was dragged along an SUV for 3.5 km, until the vehicle was parked at the house of the driver, arising the suspect of vehicular manslaughter and failure to provide assistance.On the basis of death scene investigation, analysis of video recording from a surveillance camera, post-mortem computerized tomography (PMCT) and complete post-mortem examination, including gross and microscopical findings, the accident was reconstructed as a frontal collision between the right portion of the bumper and the right side of the body of a standing pedestrian, with deformation of the bumper and production of a metal sheet hook; secondary run-over the right feet, cranio-facial trauma against the bodywork of the vehicle and hooking of the right hand of the victim to the metal sheet; prolonged dragging of the pedestrian over the road surface and severe bleeding.A multidisciplinary-multimodal methodology, including PMCT, allowed to assess the cause of death as hemorrhagic shock, suggested that the victim would have likely survived if the vehicle had stopped, and is increasingly recommendable in fatal road accidents.     

Forensic mtDNA hair analysis excludes a dog from having caused a traffic accident

A dog was suspected of having caused a traffic accident. Three hair fragments were recovered from the damaged car and subjected to DNA sequence analysis of the canine mitochondrial D-loop control region. The results were compared to saliva and hair samples from the alleged dog, as well as to control hair samples from four unrelated dogs of different breeds. Two sequence types exhibiting five nucleotide differences in a 377 bp fragment were identified among the four controls. Whereas the evidence hair fragment was identical to the type 1 control sequence, the alleged dog shared the type 2 control sequence except for one position. Thus the dog could be excluded as the origin of the hair fragment. As canine mtDNA appears to exhibit only limited polymorphism, mitochondrial D-loop sequence comparison is currently only suitable for exclusions. Received: 16 November 1998 / Received in revised form: 10 February 1999     

A fatal impaling injury in a road traffic accident: a case report

A 17-year old, thin-built male was sitting in a bus on the right side of the rear seat. The same side of the bus accidentally hit some iron rods, meant for construction work, projecting from the tail end of a small truck. The incident happened when the bus driver tried to manoeuvre the bus towards the left side of the truck, standing at a red traffic light intersection. One of the iron-rods entered the bus through the glass window next to which the victim had been sitting and penetrated his chest cavity from the side, lacerating both the lungs and exiting through the left shoulder blade. The individual died on his way to hospital.     

Decapitation with egg shelling of the skull in a road traffic accident: a case report

A 40-year-old lady was found dead on a road early one morning. She had allegedly been run over by a speeding vehicle. The head of the deceased had been decapitated, with egg shelling of the skull from the scalp and face. The skull was lying a little distance away from the rest of the body. Although decapitation is not an unknown entity in a road traffic accident, subsequent egg shelling of the skull, leaving behind scalp and face tissue, has not been reported in a road traffic accident in the forensic literature.