| Riedel's thyroiditis is a rare chronic inflammatory disease of unknown aetiology and may be one manifestation of multifocal fibrosis. Four patients were seen over a period of 12 years and unusual presentations in 3 of them caused difficulty in diagnosis. The aetiology and methods of treatment are discussed. ( info) |
2/300. A resuscitated case from asphyxia by large bronchial cast. A 62-year-old woman with bronchiectasis suffered from asphyxia due to a large bronchial cast that obstructed the bronchial tree. Immediate bronchoscopic suction of a bronchial cast of 17 cm in length through the intubated tube relieved the patients without any complications. Large bronchial casts appear to be rare in this century but it should be considered in patients with acute exacerbation of excessive sputa not only in patients with asthma or allergy but also in patients with respiratory tract infection. ( info) |
3/300. Concealed homicidal strangulation by burning. Compression of the neck, either with the hands or by a ligature, is not an uncommon method of homicide. Burning of the body to try to conceal the homicide may complicate the situation by making it difficult to interpret the findings. We hereby report two cases of homicidal ligature strangulation with extensive burning of the bodies. In both cases, external findings included the presence of a soft piece of fabric around the neck that, when removed, disclosed a portion of pale, unburned skin that vividly contrasted with surrounding areas. Osteocartilaginous lesions were present in only one case. carboxyhemoglobin levels in both cases were very low, and the histopathologic examination of distal airways for soot particles was negative. ( info) |
4/300. Variants of congenital ocular motor apraxia: associations with hydrocephalus, pontocerebellar tumor, and a deficit of vertical saccades. BACKGROUND: Congenital ocular motor apraxia (coma) is characterized by the inability to generate volitional horizontal saccadic eye movements in the absence of other focal neurologic abnormalities. SUBJECTS: We report on two children (ages 5 months and 3 years) whose coma did not adhere to these classic criteria. The children were followed up clinically with serial ocular motor examinations and neuroimaging over a period of 3 years. RESULTS: In the first child horizontal coma was associated initially with neonatal communicating hydrocephalus. Two and one half years after the first signs of coma, a fourth ventricle medulloblastoma appeared. The second child, who recovered from a periventricular hemorrhage caused by perinatal asphyxia, manifested vertical coma and compensatory vertical head thrusts. CONCLUSIONS: coma may be associated with hydrocephalus, pontocerebellar tumor, and periventricular hemorrhage. These rare variants of coma emphasize that the eye movement deficits may arise from several locations, cerebral as well as pontocerebellar, in the neuronal pathways generating saccades. ( info) |
5/300. Recurrent psychogenic coma following tracheal stenosis repair. Medication, intracranial hemorrhage, infarction, infection, hypoxia, organ failure, and nutritional deficiency may cause unconsciousness following successful emergence from anesthesia. A 39-year-old woman with a history of tracheal stenosis, depression, and anxiety had complete unconsciousness on 3 separate occasions following surgical repair of her tracheal stenosis. In each case, the patient's endotracheal tube had been removed; she was alert and oriented to person, time, and place; and she was admitted to the hospital for observation. Within a few hours after the tube was removed, the patient became abruptly unconscious for periods of 36, 18, and 30 hours. Each time, the results of cardiac, pulmonary, metabolic, and neurologic examinations and radiological studies were normal. We hypothesize that the patient's apparent comas were the result of an underlying conversion disorder precipitated by unresolved psychological conflict surrounding a long history of abuse in which she was repeatedly smothered by a pillow. ( info) |
6/300. Accidental hanging with delayed death in a lift. While hanging is a common method of committing suicide in india, accidental hanging is uncommon. However, it does occur when people are engaged in auto-erotic practices. An adult male who was helping passengers trapped in the lift of an outpatient department at a teaching hospital was accidentally hanged. He survived for 39 days. This case highlights a rare but serious hazard in the use of lifts. ( info) |
7/300. Accidental ligature strangulation due to a roller-type massage device. A case is reported in which a woman was accidentally strangled when her blouse became entangled in a roller-type electric massage device that she was using to massage the back of her neck. Accidental strangulation in adults, outside of the workplace, is uncommon, and to our knowledge this is the first reported case of a strangulation due to this type of device. The findings of this interesting and unusual case are presented. ( info) |
| A double homicide by smothering with halothane-moistened towels is described and the blood and tissue concentrations of halothane are discussed in comparison to the literature. ( info) |
| OBJECTIVE: To determine whether there are specific situations which may increase the risk of accidental asphyxia during sleep in children with physical and mental disabilities. METHODOLOGY: review of all cases where death was attributed to accidental asphyxia caused by unsafe sleeping situations in children listed in the Department of Histopathology database over a 10-year period from March 1989 to February 1999. RESULTS: A total of 26 cases were found (M:F, 19:7; age range, 1-48 months; average age, 7.4 months). Of those cases, two involved children with significant mental and physical impairment. Case 1: A 4-year-old boy with klippel-trenaunay-weber syndrome, macrocephaly and severe developmental delay, was found dead with his head hanging over a wooden board attached to the side of his bed. Case 2: A 4-year-old boy with lissencephaly and severe developmental delay was found dead wedged between a retractable mesh cot side and the side of his bed. In both cases the devices resulting in death had been put in place to prevent the boys from falling out of bed. CONCLUSIONS: Accidental asphyxia in physically and mentally impaired children may be caused by devices that have been used to prevent injury from falling out of bed. Careful assessment of the specific developmental problems that children suffer should be undertaken before their beds are modified. It may be safer for these children either to have no barrier, or to have drop-sided cots/beds that meet recognized safety standards. ( info) |
10/300. Asphyxial death during prone restraint revisited: a report of 21 cases. Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death. ( info) |