Cases reported "Drowning"

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1/45. temporal bone pathology findings due to drowning.

    It has been reported that anoxia due to near-drowning or near-suffocation causes brain damage but not inner ear damage. On the other hand, it has been shown that brain death causes both brain damage and inner ear damage. However, studies of temporal bone pathology resulting from sudden death due to drowning are few. We studied temporal bone pathology in six cases of individuals who died of accidents due to drowning. In all temporal bones examined, we found extensive congestion petechiae and haemorrhage in the vessels in the mucosal layers of the middle ear and mastoid air cells, as well as in the vessels around the facial nerve and carotid canal. In the inner ear, there was no abnormality in Corti's organ or the vestibular organs, except in one case who died in the bath. Our findings suggest that petechiae haemorrhage or congestion in the vessels of the mucosal layer and the vessels themselves of the middle ear occurs upon acute death due to drowning.
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2/45. Hydrocution in a case of Coxsackie virus infection.

    An apparently healthy 7-year-old boy attempted to demonstrate his ability to dive into a whirlpool but was retrieved from the water in a state of unconsciousness after several minutes. resuscitation was unsuccessful. No characteristic signs of drowning were found at the autopsy but examination of the lymph nodes and the cardiac muscle indicated a pre-existent infection. The histological examination revealed a slight degree of predominantly lymphocytic infiltration of the cardiac muscle. IgM antibodies against Coxsackie virus were detected in the serum sample by means of ELISA. The reverse transcriptase polymerase chain reaction (RT-PCR) performed on an extract of formalin-fixed, paraffin-embedded cardiac muscle tissue revealed a dna sequence specific for Coxsackie B3 virus. Therefore, cardiac failure was due to a myocardial virus infection and the additional strain caused by diving. This case report emphasizes the importance of modern molecular biological methods in cases of sudden death including death by hydrocution.
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3/45. Limbs found in water: investigation using anthropological analysis and the diatom test.

    We report the investigation, using a multi-disciplinary approach, of five cases of dismembered limbs which were recovered from Lake ontario, Lake Erie and the Niagara River, and examined at the Office of the Chief Coroner for ontario. In all cases, postmortem examination revealed that the limbs had been disarticulated in the postmortem period, by non-human taphonomic processes. In addition to routine gross examination, the femur and/or tibia were assessed using anthropological methods to give estimates of the sex, age, race and stature of the individual. The anthropologic data facilitated the identification of one of the cases. In all cases, nitric acid extracts of the femoral bone marrow were prepared and examined for the presence of diatoms. In all instances, diatom frustules were recovered from marrow extracts, indicating that drowning was the cause of death or at least a significant contributing factor in the cause of death. The use of the diatom test was helpful in excluding the possibility that the limbs were dismembered from individuals who had died by means other than drowning, and had been subsequently 'dumped' into water. The application of anthropological methods and the diatom test for drowning may significantly enhance the medico-legal investigation of body parts recovered from water, and we present an overview of useful techniques here. Anthropological data may facilitate identification, and the diatom test may establish a cause of death.
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4/45. Hypotensive hemorrhagic necrosis in basal ganglia and brainstem.

    Hypotensive hemorrhagic necrosis of the basal ganglia and brainstem has only occasionally been described. Three such cases are reported. Cardiac arrest had occurred in all cases, and it took at least 1 hour to restore adequate circulation. The patients remained comatose for 2 days to 2 weeks until death. Persistent hypotension causing ischemia in the distribution of deep perforating arteries is considered to have been the key underlying mechanism. hemorrhage is thought to have been caused by extravasation of red blood cells through damaged blood vessels.
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5/45. mortality in pediatric epilepsy.

    mortality in pediatric epilepsy is the subject of this review. epilepsy in both adults and children increases the risk of premature death. Conditions that are comorbid with epilepsy may carry an increased mortality risk. patients with neurologic compromise may be at risk for aspiration and critical respiratory disease. epilepsy per se enhances the risks of accidents, particularly drowning. epilepsy may result in unwitnessed or, less frequently, witnessed sudden death. Witnessed sudden death frequently involves an observed seizure. Cardiac and respiratory mechanisms for epileptic sudden death have been proposed. Reducing the number of seizures should reduce the risk for sudden death. awareness of the increased risk for premature death associated with epilepsy may enhance patients' and parents' cooperation with therapy.
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6/45. Postmortem diffusion of drugs from the bladder into femoral venous blood.

    We describe significantly elevated drug concentrations in the femoral venous blood due probably to postmortem diffusion from the bladder. A 16-year-old deceased male was found in a shallow ditch in winter. The estimated postmortem interval was 9 days and putrefaction was not advanced. The cardiac chambers contained fluid and coagulated blood and a small amount of buffy coat clots. Diffused hemorrhages were found in the gastric mucosa. The bladder contained approximately 600 ml of clear urine. Gas chromatographic-mass spectrometric analysis of the urine disclosed allylisopropylacetylurea (a fatty acid ureide sedative), diphenhydramine, chlorpheniramine and dihydrocodeine. The cause of death was considered to be drowning due to a drug overdose and cold exposure. The concentrations of diphenhydramine, free dihydrocodeine and total dihydrocodeine in the femoral venous blood (1.89, 3.27 and 3.30 microg/ml, respectively) were much higher than those in blood from the right cardiac chambers (0.294, 0.237 and 0.240 microg/ml, respectively). urine concentrations of diphenhydramine, free dihydrocodeine and total dihydrocodeine were 22.6, 37.3 and 43.1 microg/ml, respectively. The stomach contained negligible amounts of diphenhydramine, free dihydrocodeine and total dihydrocodeine (0.029, 0.018 and 0.024 mg, respectively); concentrations of these drugs in the femoral muscle were 0.270, 0.246 and 0.314 microg/g, respectively. These results indicate that postmortem diffusion of diphenhydramine and dihydrocodeine from the bladder resulted in the elevated concentrations of these drugs in the femoral venous blood. Not only high urinary drug concentrations but also a large volume of urine in the bladder might accelerate the postmortem diffusion.
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7/45. drowning as a cause of death in angelman syndrome.

    angelman syndrome is characterized by mental retardation, seizures, ataxia, inappropriate laughter, lack of speech, a particular facial appearance, and generally a chromosome 15q11-q13 deletion. Recently, a fascination with water and water-related activities has been reported in individuals with the syndrome. We report on a 9.6-year-old male previously diagnosed with angelman syndrome who died unexpectedly by drowning in a shallow backyard wading pool. This case further illustrates the fascination with water by individuals with angelman syndrome and highlights that this fascination may lead to death. We wish to alert careproviders that this fascination with water and water-related activities may contribute to death and that these individuals should be closely supervised when in the presence of water.
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8/45. Did he drown or was he murdered?

    An unemployed, 60-year-old Singaporean gentleman died during a brief overseas trip to another South-East Asian country. He had, presumably, drowned in the bathtub of his hotel room, which he shared with his then 44-year-old companion, who was supposedly his nephew. The relevant public health and medico-legal authorities of the host country conducted an external examination of the body at the scene, whereupon they agreed with the police that his death was probably due to accidental drowning following an episode of syncope. It would appear that this verdict was based almost entirely on circumstantial and hearsay evidence. No autopsy was performed. In its place, considerable reliance was placed on the observation that abdominal compression resulted in the outflow of a small amount of water from the mouth, as being proof of drowning. A few days later, the body was cremated in the host country and the remains (ashes) were subsequently repatriated to singapore. It later transpired that, shortly before they embarked on the ill-fated trip, the deceased's 'nephew' had purchased, on the former's behalf, travel insurance policies (covering accidental injury and death) amounting to a total of S$800,000 from five different insurance companies, as well as a separate life policy for a further S$100,000, most of which had been issued within the fortnight prior to their departure. Interestingly, the beneficiary (later the plaintiff in the ensuing civil trial some three years later) of all of these policies, was the ex-wife of the deceased's 'nephew', with whom he had, in fact, continued to live although they were officially divorced several years ago. Whilst the claim against the life policy had been settled, the first five insurers declined to issue payment on grounds of suspicion that the deceased had been the victim of a homicide, planned or executed by the 'nephew', wherein the beneficiary was a conspirator of sorts. The author was approached by defence counsel (representing the various insurers), for assistance in this matter. It was felt that a proper forensic review was seriously hampered by the lack of a full autopsy which would have been indispensable in ascertaining the actual cause of death and in eliminating other possibilities, apart from drowning, such as death from natural causes, other forms of injury, poisoning, or homicide. It was also emphasized that the mere presence of ingested water is not diagnostic of drowning. Eventually, after a protracted but unsuccessful attempt at mediation (in the course of which, the plaintiff rejected the offer of a reduced, although apparently sizable quantum), the matter came before the High Court, which found in favour of the defendants. It appeared that the judge was more than convinced that the deceased was indeed the victim of a homicide of which the plaintiff was a conspirator and her ex-husband, the perpetrator, as even a cursory perusal of the written judgement would indicate. Accordingly, the court ruled that the plaintiff (in her capacity as both the beneficiary of the insurance policies and executor of the estate) and her ex-husband had, effectively, deprived the insurers of their contractual right (as stipulated in the insurance policies) to have an autopsy conducted on the body of the deceased and they were, therefore, entitled to deny liability. This case illustrates the difficulties inherent in conducting an independent review of a putative instance of drowning, where convincing and reliable forensic evidence and documentation are largely wanting; this being compounded by its occurrence in a foreign jurisdiction whose medico-legal practices differ substantially from that to which one is accustomed. It may even be said that the corpus delecti was destroyed, in this instance, by cremation. It is also unusual in that a de-facto finding of murder was made in a civil court (whose standard of proof is that of a balance of probabilities) and that this had, subsequently, spurred the police to undertake a criminal investigation for conspiracy to murder. In the event, the civil appeal was dismissed by the Court of Appeal, but no charge was laid against any of the suspects for want of sufficient forensic or investigative evidence of a criminal offence having been committed.
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9/45. Death by drowning? Geelong 1959 to 1974.

    This paper reviews the circumstances of 142 deaths by drowning which occurred in Geelong and district during the years 1959 to 1974. The effectiveness of safety nets and protective fences as a means of preventing the accidental submersion of young children in home swimming pools is questioned. Consumption of alcohol before submersion played a major role in the death of many adult males. Of males aged 26 years and over, 79% imbibed alcohol before death, and 57% had a blood alcohol concentration greater than 0.1% at autopsy. Of males aged 17 to 25 years of age, 25% imbibed alcohol before death and only half of these had a blood alcohol concentration greater than 0.1% at autopsy. The age preponderance for consumption of alcohol and drowning is opposite to that for fatal motor vehicular accidents (in these males aged 17 to 25 years more frequently have significant blood alcohol concentrations at autopsy than males aged 26 years and over). No female consumed alcohol before submersion. The writer suggests that the public, and in particular males aged 26 years and over, should be warned as forcibly against the dangers of "swimming and drinking" and "boating and drinking" as they are against the dangers of "driving and drinking".
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10/45. Use of the infant transwarmer mattress as an external warming modality in resuscitation from hypothermia.

    Normothermia must be established in drowning victims before death may be declared, as the myocardium may remain resistant to stimulation at subnormal temperatures, and complete neurological recovery from submersion associated hypothermia has been reported. A safe and effective method of external re-warming is described that may prove particularly useful in the paediatric population.
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