Sudden Adult Death: A Medico-Legal Series of 77 Cases between 1995 and 2000

Abstract

Among all the autopsies performed between 1995 and 2000 in our Department, 77 adult cases of sudden death were selected. Sex, age, place of death, circumstances of death, causes of death and heart weight were reported from these 77 post-mortem records. A complete forensic autopsy was performed in every case. Sudden death occurred more frequently in males at rest. Strenuous activity was rarely involved in sudden death and 72.7% of the cases died from cardiovascular disease, mainly coronary atherosclerosis. Non-cardiac causes were dominated by pulmonary and neurological diseases. Cardiomegaly was a frequent finding in cases who died from cardiac pathology. This study underlines the importance of complete medico-legal investigations in case of sudden death. Multiple heart samples are required in order to detect focal microscopic lesions, such as myocarditis and some forms of cardiomyopathy with minimal gross abnormalities. The post-mortem diagnosis of such cardiomyopathies is very important because the family of the deceased may undergo a possible screening. Toxicology is useful in the diagnosis of epileptic seizure and in identifying drugs like metamphetamine as a risk factor for some lethal cardiovascular pathologies such as aortic dissection. Molecular biology can also be helpful when limits of morphological diagnosis have been reached.

Adli Otopsilerde Rastlantısal Tiroit Patolojileri

“…Otopsilerde rastlanılan tiroit mikrokarsinomalarının prevelansının klinikte belirlenenlerden 100-1000 kat fazla olduğu da bildirilmektedir (3,5,6). Gizli (occult) papiller karsinom olarak adlandırılan mikrokarsinoma tipinin iyot alım düzeyleri, cinsiyet ve nodularite ile ilişkisinin olmadığı ve erkeklerde daha sık görüldüğü de belirtilmektedir (6,27,28) Guatemala'da, bir yıl süresince adli otopsileri yapılan 150 olgunun tiroit örneklerinin araştırıldığı bir çalışmada, 150 olgu içinde occult papiller tiroit karsinom prevelansının % 2 olduğu ve cinsiyetten bağımsız olduğu bildirilmektedir (5).…”

“…Rastlantısal olarak belirlenen tiroit patolojilerinin prevelansının klinik tanılarda rastlananlardan daha yüksek olduğu bilinmektedir (2). Antemortem bilinen bir tiroid hastalığı olmayanların otopsilerinde tiroid nodülleri prevelansının %13-50 arasında değiştiği bildirilmektedir (3,4).…”

“…Birçok otopsi çalışmasında olguların 1/3-1/4'ünde hiperplazik tiroid nodüllerine r a s t l a n d ı ğ ı v e e n s ı k e r k e k l e r d e g ö z l e n d i ğ i aktarılmaktadır (3,7,8). 420 olgunun dahil edildiği bir otopsi serisinde, 4. dekattan (30-40 yaş arası) sonra guatr insidansının %20-30 arttığı da bildirilmektedir (8).…”

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

“…In a subsequent animal study aortic, right atrial and thoracic pressure were measured during CPR. Three different ventilation rates were studied (12,20 and 30 breaths per minute) and the ventilation was initiated during the decompression phase. These results showed that excessive ventilation rates significantly decreased coronary perfusion and survival rates.…”

“…However, only a minority (26-39%) of persons who die after attempted resuscitation undergo autopsy. 17,19,20 In most cases, the patient's physician determines the COD according to clinical history. Only if the cause is unknown, if there are reasons to suspect a specific condition or there are legal requirements is an autopsy requested.…”