Cerebral phaeohyphomycosis caused by a dematiaceous scopulariopsis species.

This report describes a rapidly fatal case of cerebral phaeohyphomycosis in a 33-year-old immunocompetent male. The infection presented as a single large lesion in the deep white matter of one temporal lobe, which was then removed surgically. Histologic features observed in the lobectomy specimen were characterized by perivascular sleeves of mononuclear cells accompanied by hemorrhages. These were reminiscent of acute hemorrhagic leukoencephalitis except for the presence of rare fungal organisms and sparse multinucleated giant cells similar to those occurring in AIDS. During the four days following surgery, a large focus of cerebritis with massive invasion of fungi developed in each centrum semiovale around the ventriculostomy sites. Fungal culture of the brain obtained at autopsy grew an organism consistent with a Scopulariopsis species.

Immunohistochemical detection of human basophils in postmortem cases of fatal asthma.

The role of human basophils in bronchial asthma has been hard to define. In this study, we used the basophil-specific monoclonal antibody (mAb), 2D7, in postmortem lung sections from individuals who die in status asthmaticus (fatal asthma [FA]) to determine if the pathology of FA is associated with an increase in basophil numbers in the lung. As controls, we used lung sections of patients who had a history of asthma but died from nonasthmatic causes (nonfatal asthma [NFA]) as well as patients with no history of asthma (control [C]). In lung sections from all three groups, basophils were scattered throughout the large and small airways, airway epithelium, submucosa, and alveolar walls. The numbers of basophils in the lungs of patients with FA ranged from 41 to 119 cells/mm(2), significantly more than the numbers of basophils in lungs from individuals with a history of asthma (NFA; 0 to 16 cells/ mm(2)) and in the control lungs (C; 0 to 13 cells/mm(2)). In contrast, CD45-positive cells were not significantly different in the airways of FA and NFA, although there were significant increases in the two groups compared with control subjects. In summary, basophil infiltration was significantly increased in lungs from individuals who died from asthma, supporting the hypothesis that basophils are involved in the pathogenesis of FA.

Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent.

An outbreak of an acute respiratory disease in the southwestern United States has led to the recognition of a new hantaviral illness. This report describes a unique spectrum of antemortem and postmortem pathological findings seen in a case series of nine surviving patients and 13 who died. Clinical, laboratory, and autopsy findings were derived from a consecutive series of individuals confirmed to have hantavirus pulmonary syndrome. Laboratory studies included chemical, hematological, and bone marrow analyses as well as flow cytometric and immunohistochemical phenotyping. Autopsy tissues were examined by routine histological stains, immunohistochemical methods, and transmission electron microscopy. The lung is the primary target organ in this illness. Pulmonary abnormalities include pleural effusions, alveolar edema and fibrin, and an interstitial mononuclear cell infiltrate. Large immunoblast type cells are seen in the lungs, blood, bone marrow, lymph nodes, liver, and spleen. A tetrad of hematological findings includes left-shifted neutrophilic leukocytosis, thrombocytopenia, hemoconcentration in severe cases, and circulating immunoblasts. In contrast to previously described nephropathic hantaviral syndromes, hantavirus pulmonary syndrome is characterized by a unique constellation of pulmonary, hematological, and reticuloendothelial pathological findings. The pulmonary findings are distinguishable from fatal adult respiratory distress syndrome. The data suggest a capillary leak syndrome restricted to the pulmonary circulation. Likewise, the hematological picture is unique and may be valuable in the rapid identification of cases for further diagnostic studies.

Rare electrocution due to powerline contact in a hot-air balloon: comparison with fatalities from blunt trauma.

Powerline contact by hot-air balloons is one of the most frequent concurrences in balloon accidents resulting in injury or death. Injuries and deaths are usually a result of blunt trauma from falls. In this report, we describe the aircraft, the circumstances of the accidents and the autopsy data in two powerline contact accidents involving three deaths, one from electrocution and two, from blunt trauma sustained in falls. Appropriate pilot behavior is briefly discussed.

Motorcycle fatalities in New Mexico: the association of helmet nonuse with alcohol intoxication.

STUDY OBJECTIVE: To determine the relationship among helmet use, alcohol use, and ethnicity in people killed on motorcycles. DESIGN: Retrospective review of all motorcycle fatalities in New Mexico from 1984 through 1988. SETTING: Office of the Medical Investigator, State of New Mexico. TYPE OF PARTICIPANTS: All decedents of motorcycle crashes in New Mexico from 1984 through 1988. INTERVENTIONS: Review of all autopsies, medical investigator reports, traffic fatality reports, and toxicological studies on fatally injured motorcyclists. RESULTS: Nine of the helmeted drivers (18%) were legally intoxicated compared with 67 of the nonhelmeted drivers (51%) (chi 2 = 15.7, P less than .0001); 42 of the white nonHispanic decedents (37%), ten of Hispanic decedents (12%), and none of the Native-American decedents were wearing helmets. The head and neck region was the most severely injured body region in 42 of the nonhelmeted cases (84%) and in eight of the helmeted cases (50%) (Fisher's exact test, P less than .02). CONCLUSION: There is an association between nonuse of helmets and alcohol intoxication in fatally injured motorcyclists in New Mexico. Strategies for preventing motorcycle fatalities should address alcohol abuse and ethnicity in conjunction with helmet use.

Causes of death of patients in an institution for the developmentally disabled.

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.

The spectrum of neuropathologic findings in deaths associated with seizure disorders.

The pathologic and neuropathologic findings in 90 autopsied cases of death associated with a seizure disorder or complication thereof were reviewed. Most (69%) of the deceased individuals were between 21 and 40 years of age; two thirds were male. In 58% of patients, no cause of death other than seizure disorder was found. The ultimate cause of death in those patients was assumed to be a cardiac arrhythmia or respiratory arrest. Drowning accounted for 19% of deaths, and 17% of patients died of other contributory causes such as suicide, exposure, or atherosclerotic coronary vascular disease. Aspiration was found in the remaining 6%. Tongue lacerations or bite marks were observed in only one third of cases. The brain was normal in approximately two thirds of cases, with no focus for the origination of seizure found on neuropathologic examination. In the remainder of cases, a variety of lesions was found, with cavitary lesions, contusions, and dural lesions being the most common ones.

Delayed traumatic intracerebral hematoma (DTICH) and the determination of the manner of death. A case report and review of the literature.

The concept of a traumatic incident resulting in death when there has been a prolonged interval between the two events raises questions for medical examiners. A case is presented in which a 33-year-old man was found dead in his locked home. Although there was no evidence of foul play at the scene, the death was subsequently found to be directly related to an episode of head trauma sustained in an altercation approximately 1 1/2 months before. The fatal lesion was a large intraparenchymal hematoma in the right frontal lobe of the brain which had developed in an area of contusion identified by computerized tomography (CT) scan while he was hospitalized following the trauma. The literature regarding delayed traumatic intracerebral hematoma (DTICH) is reviewed and its relevance to cases coming under the jurisdiction of a medical examiner is discussed.

Medicolegal aspects of necrotizing fasciitis of the neck.

Necrotizing fasciitis of the neck (NFN) is a relatively rare, fulminating infectious process of the cervicofacial tissues which may cause sudden and unexpected death. Although often the result of a dental infection, injuries of the soft tissues of the neck may also initiate rampant cellulitis, and recognition of the underlying etiology of such cases is necessary to determine properly the manner of death. Five cases of NFN are presented with a review of the causative factors and usual bacteriology, and specific factors of medicolegal interest are addressed.

The investigation of alleged insecticide toxicity: a case involving chlordane exposure, multiple sclerosis, and peripheral neuropathy.

A man with no previous medical problems had two documented exposures to an insecticide containing the organophosphorous compounds chlordane and heptachlor. Six months to one year later, he began to experience neurological symptoms which progressed until his death. At autopsy, his brain showed classic findings of multiple sclerosis, and he had a severe peripheral neuropathy. Review of the literature indicates that the findings are not compatible with chlordane toxicity. Some of the factors to be used in determining the casual relationship between toxic exposure and disease processes are discussed.