Subacute measles encephalitis in an immunocompetent adult.

Subacute sclerosing panencephalitis (SSPE) and subacute measles encephalitis (SME) are both rare complications of measles virus infection. SSPE typically affects immunocompetent children, has an insidious onset and follows a steadily progressive course. SME mainly occurs in immunosuppressed children and has a rapidly progressive course. We describe a 43 year old immunocompetent man who presented with a rapidly progressive fatal encephalopathy. Histological examination of the brain showed a meningoencephalitis with inclusion bodies. Complement fixing antibody to measles virus was present in his serum and CSF. Measles virus RNA was found in the brain, spinal cord and eye, but not in the CSF. Analysis of the nucleoprotein gene isolated from this patient did not show similarity to SSPE strains of the measles virus. This patient demonstrates that subacute encephalitis secondary to measles virus infection can develop in an immunocompetent adult host.

A fatal case of ovarian hyperstimulation syndrome with cerebral infarction.

The ovarian hyperstimulation syndrome (OHSS) as a cause of death in infertile patients involved in in vitro fertilization is an extremely rare phenomenon. Reported here are the clinical and pathological feature of just such a case together with a discussion of the pathophysiology thought to be involved.

Superficial soft-tissue injury.

In 1992, Lee and Opeskin published an article on the little-recognized problem of death related to multiple superficial soft-tissue injuries following an assault. These deaths resulted from an acute assault and were restricted to young aboriginal women with a history of alcoholism. Presented here is a similar case occurring in a 22-year-old Polynesian woman. However, there are some significant differences. Aside from the final acute assault, there was evidence of chronic repeated episodes of superficial soft-tissue injury that resulted in undermining of connections between large areas of different tissue planes. These injuries produced pockets and spaces lined by fibrous tissue and numerous old intramuscular and subcutaneous hematomas, some of which showed secondary infection. There was also dense soft-tissue and subcutaneous fibrosis, and myositis ossificans.

Delayed paradoxical air embolism following caesarian section for placenta previa--a case history.

To the Forensic Pathologist air embolism is a well recognized cause of sudden death arising due to a variety of causes, be they therapeutic, accidental or criminal. Two variations of this theme have been reported in the literature. These are: paradoxical air embolism, where air entering the venous circulation finds its way, usually via a congenital heart abnormality, into the systemic circulation; and the phenomenon of delayed air embolism where death does not immediately ensue, but occurs often some hours after air enters the circulation. Presented here is a case illustrating both of the above features occurring in a woman who underwent a Caesarian section for placenta previa.

The relationship between pulmonary interstitial emphysema and clinical features in fatal asthma.

Using retrospective histological material and clinical data from the New Zealand National Asthma Mortality Study, we investigated whether there was a relationship between the presence of pulmonary interstitial emphysema (PIE) and different clinical features in fatal asthma, in particular precipitous asthma death. Histological evidence of PIE was determined in sections from 12 of the 60 patients who had died from asthma who fulfilled the pathological criteria for inclusion in the study. No significant correlation was found between the presence of PIE and the different clinical features examined. For example, of the 13 cases with precipitous fatal asthma (i.e., death occurred within 10 min of the onset of the attack), only two had PIE. This suggests that PIE is not an uncommon histological feature of fatal asthma and may, in fact, significantly contribute to an asthma death, but its presence does not appear to be associated with the specific clinical subgroups studied here.

Racial differences between Maori and European New Zealanders in aneurysmal subarachnoid haemorrhage.

Racial differences in the incidence and rate of rupture of intracranial aneurysms are well recognized. A retrospective study of racial differences between Maori and European New Zealanders presenting to the Auckland Regional Neurosurgical Unit between 1985 and 1990 was conducted. It was found that the incidence per 100,000 of the population for all aneurysms was 14.3 for Europeans and 25.7 for Maoris. The mean age at rupture was 10 years earlier in Maoris with single aneurysms. A strong association between aneurysmal subarachnoid haemorrhage and cigarette smoking was found in both groups not only for single, but also for multiple aneurysms. Maoris were also found to have an abnormally high incidence of middle cerebral artery aneurysms and a low incidence of vertebrobasilar ones compared with Europeans.

Combined pathological and radiological study of the effect of atherosclerosis on the ostia of segmental branches of the abdominal aorta.

A combined pathological and radiological study of descending aortae from 15 subjects from 2 to 80 yrs of age was conducted to investigate changes in the segmental vessels with advancing aortic atherosclerosis. There were (i) small hillocks of musculo-elastic intimal thickening adjacent to the apex (centre of the flow divider) in the ostia of the segmental vessels in young subjects, (ii) progressive intimal thickening, distortion and narrowing of the ostia of the segmental vessels (iii) obliteration or loss of some ostia in advanced atherosclerosis of the distal abdominal aorta and (iv) gross discrepancy in severity of atherosclerosis between the aorta and its branches, the intimal proliferation tapering rapidly in the branches and often being minimal in the outer part of their intramural courses. Distal ramifications exhibited occlusions which radiographically were probably embolic or possibly artifactual. Atherosclerosis was rarely of significant degree histologically within the proximal 2 cm of the segmental branches.