the leading cause of death in infants in the us from 1 month to 1 year
SIDS
why?
b/c those children that are born with RDS and prematurity issues and other lethal congenital anomalies tend to die in the first month so after that age, then SIDS is the leading cause of death
Is SIDS a legitimate cause of death
yes.
it is an exclusionary diagnosis
what is the mechanism for SIDS?
we don’t actually know
do you have to put a mechanism on a death certificate? no
SIDS is an exclusionary diagnosis therefore an autopsy is an optional exercise
no
exclusionary diagnosis = you must do autopsy
SIDS most commonly occurs b/w …
2-4 months
table 10-7
ALTE
apparent life threatening event
the most common morphologic finding in a child dying of SIDS?
***astrogliosis in brain stem
petechiae- don’t have same distribution as patients who are asyphyxiated
following the death of a sibling from SIDS, subsequent infants ….
have an increased risk
sudden death in a child less than 1 year of age not attributable to SIDS (or known genetic/congenital disease) is typically due to ….
infection
the most common tumor of infancy
hemangioma
generally not very large
not precursor to malignancy
month old female born at home full term appear healthy gaining weight has a reddish brown cystic lesion measuring 6.2 cm in the sacrococcygeal region diagnosis?
benign cystic teratoma
the sacrococcygeal region teratoma is more common in females
vast majority of teratomas that occur before 4 months are benign
the ones that are malignant tend to be seen in older indivisuals
4 year old
thrombocytopenia
elevated white count
CBC differential notes approximately 20% blasts (undifferentiated cells) in the peripheral blood?
B cell ALL (acute lymphocytic leukemia)
table 10-8 Robbins, pg 475
–blast at the end of tumor name is typically a child tumor
blasts are NOT found in the peripheral blood and are abnormal
20 month old distended abdomen fever and weight loss proptossi bilaterlally blood pressure is unremarkable
neuroblastoma is the diagnosis
serum catecholamines
-vast majorities of neuroblastomas elaborate serum catecholamines
metastatic neuroblastoma in the previous child. which of the following is a good prognostic indicator ?
TRKA expression
stage 4S is only given to children 1 year of age or less , but it is a good prognostic indicator
7 year old boy
samll abdominal mass
aniridia
genital anomalies
mentally challenged
PAX 6 deletions and the WTI assays are reported as exhibiting mutations
what is most likely occurring in this child?
Wilms tumor
classically and primarily, CF was considered to be a disease of the …
lower respiratory tract
but we know its not just involving the lower respiratory tract!!
it is not a disease of the sweat glands
most common genetic lethal disease of caucasians so KNOW IT
what are the sever classes of CF
I, II, and III
there are 6 classes
in the us most CF patients die of …
cardiorespiratory disease
gonadoblastomas are most commonly associated with …
Denys-Drash syndrome (Wilms)
as an appointed coroner in your county you list homicide on a death certificate… this means what?
a death was caused by another individual or entity
what is the manner of death of an executed prisoner? homicide- but its not synonymous with murder! it is a legal homicide
if you are an appointed coroner you CAN put homicide on a death certificate (cause of death other than natural) but you must be careful if you have no evidence or autopsy
body of a 42 year old obese male arrived
no sign of significant disease
family notes he was a smoker
no evidence of trauma
you find proximal atherosclerotic plaques in his main coronary arteries and concentric left ventricular hypertrophy….
most likely cause of death>
most likely mechanism of death
cause? ASCVD (atherosclerotic cardiovascular disease) who has sudden death
NOT malignant HTN b/c this has to do with decreased cognitive abilities, very high blood pressure, etc.
NOT myocardial infarction b/c there is no evidence of this… it takes 6-8 hours to see microscopic changes in the myocardium
mechanism? cardiac arrhythmia
why not MI? most patients do not have MI’s they have arrhythmias
Advanced ASC–> sudden death is usually due to arrhythmias
27 year old male
lying prone in an alley in february outside a bar
round wound in his right face just inferior and lateral to this right eye
marginal abrasion but there is no soot or residue in the depths of the wound and nothing surrounding it. A 6.2 cm wound is noted on the left lateral skull just posterior to the ear.
it has extruded, lacerated, and hemorrhagic brain tissue which drapes from the wound onto the adjacent asphalt
the soft tissue surrounded the right eye is distended and purplish with some proptosis of the eye itself
there is a pool of blood under his head
fixed liver mortis is noted on his face and chest
rigor morits
green patch in the right lower quadrant of his abdomen
general assessment?
general assessment? suspect foul play
marginal abrasion- gunshot wound of entry
bullet traveled front to back and from right to left
have an idea of where the shooter was standing
because there is an exit wound it was probably a high velocity weapon
he has been dead for many hours.
at room temp rigor takes 3-4 hours
he is not at room temp and has probably been there for 5-6 hours
he has signs of decomposition - green patch
Gun shot wound range/features of close /contact
marginal wound abrasion for wound of entry
soot and dirt in the depths of the wound
no stippling around the wound from deposition of gun powder
intermediate
stippling
distant GSW
no soot or gunpowder
no stippling
characteristics of GSW’s and velocities
entry- marginal abrasion
exit- high velocity exit is larger, low velocity it can have an exit of the same size, no exit
head shots
inner and outer table of skull
entry- sharp circumscription of the outer table, and beveling on the inner table, blows out the inner table
weapons
Handguns: revolvers and semiautomatics
Long guns: rifled and smooth bore
rigor mortis
stiffening of the body
at room temp it reaches its peak
at 24 hours it goes away - secondary flaccidity
algor mortis
cooling of the body
livor mortis
after death where there is no longer funcitonal circulation, the blood sinks to the dependent parts of the body
aids in position of a dead body
livor mortis after a while becomes fixed
aids in timing of events
putrefactive decomposition
bacteria in the body
lipid-laden foul smelling fluid
liquefactive necrosis
flies lay their eggs hatch into maggots
mummification
happens in very dry climates
dehydrated
adipocere formation
occurs with a body that is in water for a long period of time
fats cover the external surface of the body
more painful to die in freshwater–> causes massive hemolysis, involuntary gasp and you suck in water
lacerations are always due to…
blunt force
split in the skin
mass disasters…
what kind of disaster is this?
The living- get them out of there!
General approach
- organization- grid
- photographs/video
Collection of evidence
-biologic/organic–> don’t put in plastic! b/c they can then be exposed to water/condensation or sunlight, put it in a paper bag
-inorganic –> bullets, knifes, not liable to breakdown and can be put in plastic
label everything
DNA
-mitochondrial from bones/osteoblasts
what is sudden infant death sydrnome
the sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy examination of the death scene and review of the clinical history
SIDS is the leading cause of death b/w age 1 month and 1 year in this country
approximately 90% of all SIDS deaths occur during the first 6 months of life b/w ages 2-4 months
is SIDS the only cause of sudden unexpected death in infancy?
no it is rather a diagnosis of exclusion and therefore, performance of an autopsy may often reveal findings that would explain the cause of sudden unexpected death
what are the parental risk factors associated with SIDS
young maternal adult < 20 years of age maternal smoking drug abuse in either parents, paternal marijuana and maternal opiate or cocaine use short intergestational intervals low socioeconomic group
african american and american indian ethnicity
what are the infant risk factors associated with SIDS
brain stem abnormalities, associated with delayed development of arousal and cardiorespiratory control
prematurity and/or low birth weight
male sex
product of multiple birth
SIDS in a prior sibling
antecedent respiratory infections
germline polymorphisms in autonomic nervous stystem genes
