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D L Contostavlos

Publications and source records attributed to D L Contostavlos.

13 recordsLinked to original sources
PubMed1998

Exsanguination from impact head trauma; the explanation for the "empty heart" sign.

Twenty-four autopsied cases of lethal closed head trauma occurring sufficiently rapidly for the salient pathologic features to remain unobscured by medical intervention, and selected to exclude the possibility of exsanguination by other means, were analyzed for the presence or absence of exsanguination from basal skull fracture. The purpose of this study was to test the validity of the "Empty Heart" sign in head injuries, attributed by Hirsch and Zumwalt [C.S., Hirsch, R.E., Zumwalt, The "Empty Heart" sign. The American Journal of Forensic Medicine and Pathology 7 (2) (1986) 112-114] to a hypothetical neurologic reflex causing occult intra-corporeal sequestration of blood. The study revealed that the twelve cases with more severe injuries showed clear cut exsanguination (with "empty" hearts) due to basal skull fractures, while the twelve milder injury cases showed no signs of exsanguination, including the empty heart sign. No cases of cryptogenic empty heart were found. These findings demonstrate that the "empty heart" sign is merely an indication of exsanguination due to basilar skull fracture. The mechanism of exsanguination in these cases is discussed. The author's method for the determination of depleted blood volume at autopsy is described. The routine estimation of blood volume at autopsy and the inclusion of investigative data in forensic case assessment are recommended.

Adolescent↗
PubMed1996

Traumatic seromuscular rupture of intestine: the acute and chronic forms.

BACKGROUND: Traumatic seromuscular rupture of intestine in the acute form is recognized by surgeons and pathologists and has received mention in the medical literature. The authors encountered two cases of this lesion presenting in the chronic form, in one case initially going unrecognized, both in battered children. To our knowledge, the chronic form of the injury has not been previously described in the literature. Three lesions in the acute stage were used to analyze the evolutionary stages of the chronic presentation. METHODS: The two chronic cases are described, together with gross and microscopic photographs. Three acute lesions are also described, with illustrations, two in battered children and one in a pedestrian/vehicle fatality. RESULTS: The three acute cases illustrate the pathogenesis and gradation of the injury that, in the absence of surgical therapy, will develop into the chronic lesion. The two chronic case descriptions illustrate the gross and microscopic pathology and the pathognomonic features. CONCLUSION: Seromuscular rupture of the intestine, when left untreated, develops in time into a lesion that may appear cryptogenic to the surgeon or the pathologist. This paper defines that lesion and its pathogenesis.

Adult↗
PubMed1995

Isolated basilar traumatic subarachnoid hemorrhage: an observer's 25 year re-evaluation of the pathogenetic possibilities.

This paper was inspired by Leadbeatter's recent review [1] on the subject, and consists primarily of a recapitulation of this author's observations in the 25 years since publication of his paper [2] describing three cases of traumatic basilar subarachnoid hemorrhage resulting from direct trauma to the upper lateral neck. Those observations include personal experience and case reports personally communicated or published. Leadbeatter's analysis makes the following three salient points to which the author considers a response to be appropriate: 1. For the ten years following Contostavlos' paper, all traumatic basilar subarachnoid hemorrhages were considered to have resulted exclusively from direct extracranial trauma to the vertebral artery. That belief has since gradually been eroded. 2. The mechanisms of injury and hemorrhage have been inadequately explored and demonstrated due to absence of appropriate and adequate anatomic dissection. 3. Attention has been increasingly turned toward other factors besides direct arterial injury such as indirect mechanisms of injury, hyperextension of head on neck, hemodynamic effects and congenital anomalies of the craniocervical articulation. This author responds to these assertions thus: 1. Traumatic subarachnoid hemorrhages do not have one mechanism only. The lesion described in Contostavlos' paper merely represents one commonly observed syndrome, as supported by the numerous case reports which have followed and also preceded his account. There may have been a tendency to 'pigeon-hole' too many cases into that category but this author's personal experience in the past 25 years has shown that approximately 50% of traumatic isolated basilar subarachnoid hemorrhage fall into that category (direct trauma to lateral or posterolateral neck). 2. The anatomic location of the injury virtually prevents effective demonstration by dissection, and the possibilities of misleading artefacts incurred during the autopsy are such that many erroneous conclusions are reached by prosectors, as well as many sites of significant trauma remaining undiscovered. Accordingly, empirical factors have to be considered for a diagnosis in most cases. Four diagnostic criteria have been established for a firm conclusion of death due to traumatic basilar subarachnoid hemorrhage. 3. While over half of traumatic basilar subarachnoid hemorrhages involve a completely different site of trauma, and many indirect mechanisms of injury may come into play, the author still considers that in the commonly observed syndrome as described by him in 1971, direct trauma to the vertebral artery is the primary causative factor.

Adult↗
PubMed1992

Sagittal liver transection--an injury from improperly worn shoulder harness seatbelts: a report of two cases.

We have identified two cases which exemplify the typical injury caused by the under-the-arm placement of a shoulder harness (without the associated lap belt) in frontal collisions, namely, fatal liver laceration in the sagittal plane. Trauma care personnel should be alert for this type of rapidly fatal abdominal injury that occurs even in low-speed impacts. A prominent warning label on these belts regarding proper placement and the need for use of the associated lap belt may be appropriate.

Accidents, Traffic↗