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Biomedical subjects

E R Donoghue

Publications and source records attributed to E R Donoghue.

At least 19 recordsLinked to original sources
PubMed1998

Forensic pathology of heat-and cold-related injuries.

The human body must maintain a relatively constant temperature to function. The thermoregulatory system plus human behavior control the balance of heat loss and heat gain. Heat is produced at a relatively constant rate by the body's basal metabolism. Heat production can be increased by increasing skeletal muscular activity. Heat is lost from the body to the environment by conduction, convection, radiation, and evaporation. Illness due to heat stress develops when the body gains more heat than it loses. Illness due to cold stress develops when the body loses more heat than it can produce or gain from external sources. During periods of extreme heat, mortality may rise sharply, sometimes to epidemic proportions. Because nearly all heat-related deaths are preventable, early detection of these deaths will allow appropriate preventive measures to be implemented. The autopsy findings in both heat-related and cold-related deaths are nonspecific. Information about environmental conditions, scene investigation, and the available medical history are very important in formulating the diagnosis.

Body Temperature Regulation↗
PubMed1997

Criteria for the diagnosis of heat-related deaths: National Association of Medical Examiners. Position paper. National Association of Medical Examiners Ad Hoc Committee on the Definition of Heat-Related Fatalities.

The National Association of Medical Examiners Ad Hoc Committee on the Definition of Heat-Related Fatalities recommends the following definition of "heat-related death": a death in which exposure to high ambient temperature either caused the death or significantly contributed to it. The committee also recommends that the diagnosis of heat-related death be based on a history of exposure to high ambient temperature and the reasonable exclusion of other causes of hyperthermia. The diagnosis may be established from the circumstances surrounding the death, investigative reports concerning environmental temperature, and/or measured antemortem body temperature at the time of collapse. In cases where the measured antemortem body temperature at the time of collapse was > or = 105 degrees F (> or = 40.6 degrees C), the cause of death should be certified as heat stroke or hyperthermia. Deaths may also be certified as heat stroke or hyperthermia with lower body temperatures when cooling has been attempted prior to arrival at the hospital and/or when there is a clinical history of mental status changes and elevated liver and muscle enzymes. In cases where the antemortem body temperature cannot be established but the environmental temperature at the time of collapse was high, an appropriate heat-related diagnosis should be listed as the cause of death or as a significant contributing condition.

Adult↗
PubMed1997

Mortality in Chicago attributed to the July 1995 heat wave.

OBJECTIVES: This study assessed mortality associated with the mid-July 1995 heat wave in Chicago. METHODS: Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths. RESULTS: In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths. CONCLUSIONS: The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic.

Age Distribution↗
PubMed1996

Asthma deaths confounded by substance abuse. An assessment of fatal asthma.

BACKGROUND: The Chicago region has been identified as having a very high death rate from asthma in patients aged 5 to 34 years. We investigated circumstances surrounding the fatal attack to determine whether the death was from asthma, of indeterminate cause, or coincidental to asthma. METHODS: Cases of asthma deaths from the Office of the Medical Examiner, where the deceased were younger than 46 years of age, were used to determine clinical, toxicologic, and pathologic findings relevant to asthma. Toxicologic results were compared with homicide victims. RESULTS: From 102 cases of fatal asthma, 46 cases were classified as deaths from asthma and 17 cases were considered probably from asthma as toxicologic tests were negative. Twenty-three cases were of indeterminate cause in that the acute respiratory symptoms were accompanied by substance use or alcohol consumption. Fourteen cases were not caused by asthma but were substance related, primarily cocaine. Overall, 29 of 92 (31.5%) cases were confounded by substance abuse or alcohol ingestion, which is almost as high as in homicide victims (38/82 [46.3%]). Mucus plugging of bronchi and or hyperinflation in fatal asthma occurred in 65 of 93 (69.9%) cases. Anti-inflammatory medications were being utilized by just two patients. Sufficient information was available to identify potentially fatal asthma in 6 of 20 cases (30%). CONCLUSION: Some of the reported rise in asthma deaths is a reflection of substance use or alcohol consumption similar to that seen in victims of homicide. In that patients with asthma are hypersensitive to alpha-adrenergic agonists, the use of cocaine may be especially dangerous and induce fatal ventricular dysrhythmias.

Adult↗
PubMed1996

Deaths due to foreign body aspiration in children: the continuing hazard of toy balloons.

Asphyxia due to aspiration of a foreign body is a common cause of accidental death in children. Foreign body aspiration is the most likely cause of accidental fatalities in children under 1-year-of-age. Children may die due to airway obstruction by food objects such as hot dogs, nuts, candies, grapes, seeds, and egg shells. Non-food objects such as balloons, coins, pop tops of beverage cans, pills, safety pins, ball bearings, marbles, and baby powder also may be fatally aspirated. To better understand and help prevent this well recognized health risk to children, we reviewed 10 years of cases at the Cook County Medical Examiner's Office in which deaths in children 14-years-of-age and younger were due to aspiration of foreign objects. The most common item that caused fatal aspiration in our series was a toy balloon.

Adolescent↗
PubMed1995

Fatal intracranial hemorrhage following pediatric oral surgical procedure.

Deaths during dental and oral surgical procedures may lead to litigation alleging malpractice. For this reason, and because of their sudden and unexpected nature, they often come to the attention of forensic pathologists. We review the clinical and anatomic findings of a 3-year-old boy who expired following an oral surgical procedure in the temporomandibular region. During the operation, perforation of the base of the skull occurred causing laceration of a branch of the middle meningeal artery and fatal subdural and epidural bleeding.

Ankylosis↗
PubMed1994

Deaths due to forklift truck accidents.

Forklift truck accidents are a common cause of occupational injury and death. The authors review deaths resulting from forklift accidents cases in the years 1984-1992 in Cook County, Illinois (which contains the large city of Chicago). The fatal injuries, the characteristics of the victims, and the circumstances of the deaths are examined. A forklift striking a pedestrian or crushing the operator when tipping over or falling off a dock or truck were the most common causes of death in this study. The authors compare their findings with those found in the literature on the characteristics and prevention of forklift accidents. Also, they comment on the role of the medical examiner's or coroner's office in the investigation of these work-related deaths.

Accidents, Occupational↗
PubMed1994

Deaths due to firearms injuries in children.

There has been a marked increase in firearms-related deaths in this country over the past several decades. Especially in urban areas this increase has been correlated with a greater availability of handguns. Children have become more common victims of gunfire. Both accidental and homicidal shooting deaths have increased in the lower age groups. We examined deaths due to gunfire in children ten years and younger in Cook County, Illinois, which contains the large city of Chicago. Homicidal shootings predominated in this age group with the most common circumstances being a child struck by a stray bullet. Accidental shooting deaths always occurred when one or more children were playing with a gun they found in the home.

Accidents↗
PubMed1993

Deaths caused by lightning.

Though a rare cause of death, lightning is reported to be responsible for more fatalities each year in this country than any other type of natural disaster. Lightning injuries differ significantly from other high voltage electrical injuries because of the high current flow, but extremely short duration, of the lightning stroke. We present a series of cases over the period of 1985 to 1991 in Cook County, Illinois in which lightning was the direct cause of death. Our discussion reviews the nature of lightning, the effects it may have on humans, and the ways in which deaths due to lightning might be prevented.

Adolescent↗
PubMed1991

Fetal death following maternal trauma: two case reports and a survey of the literature.

When a fetus dies after its mother has suffered trauma, questions often arise about whether the fetal death was linked to the maternal injury. Many state statutes make it a criminal act to cause the death of a fetus by injuring the mother. The authors present two cases in which fetal death resulted from maternal trauma. In addition, we review the pertinent literature on this subject and offer guidelines that may help forensic pathologists evaluate these difficult and often emotionally charged cases.

Abdominal Injuries↗
PubMed1991

Deaths in custody.

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Attitude to Death↗
PubMed1988

Sudden death in mitral valve prolapse.

Four cases of sudden death in young females with clinical and pathologic features of mitral valve prolapse are discussed. The approach to postmortem examination of the mitral valve is reviewed and various risk factors are stressed. Because of the sudden nature of these deaths, this entity is more commonly seen in medical examiner's populations than hospital autopsies. A practical approach to the investigation of such cases is given.

Adult↗
PubMed1987

Embolization of cotton pledgets following insertion of porcine cardiac valve bioprostheses.

A variety of complications involving heart valve implants have been documented. Embolism originating from thrombosis of the valve has been a recurrent problem in mechanical and to a lesser extent porcine implants. We report two accidental deaths as a result of embolization of cotton pledgets from porcine valves. Hospital personnel failed to remove this cotton material from the valves before surgical placement. In the first case, when portions of the pledgets embolized to both carotid arteries, fatal cerebral infarction occurred. In the second case, portions of the pledgets embolized to a coronary artery producing severe left ventricular failure.

Aged↗
PubMed1986

Dispensing error causing fatal chlorpropamide intoxication in a nondiabetic.

A 38-year-old nondiabetic female developed fatal hypoglycemia when chlorpropamide (Diabinese) was accidentally substituted for acetaminophen (Tylenol) with codeine no. 3 in a pharmacy dispensing error. When found, the patient's serum glucose was less than 20 mg/dL. The serum chlorpropamide level on hospital admission was 124 micrograms/mL. The possibility of dispensing error should be considered whenever unexpected drug effects are encountered. In cases of suspected drug overdose, labels and contents of medicine vials found at the scene should be checked for discrepancy.

Acetaminophen↗
PubMed1985

Methanol intoxication: distribution in postmortem tissues and fluids including vitreous humor.

A 44-year-old man was found unconscious beneath an elevated rapid transit right-of-way. On admission to the emergency room, the patient was comatose in metabolic acidosis with high anion and osmolal gaps. The serum methanol was 583 mg/dL. The serum ethanol and ethylene glycol were negative. The patient was treated with ethanol, bicarbonate, and hemodialysis. He expired 40 h after admission. The postmortem methanol concentrations in body fluids were as follows: bile 175 mg/dL, vitreous humor 173 mg/dL, and blood 142 mg/dL. Urine was not available for analysis. Postmortem methanol concentrations in body tissues are given in decreasing order: brain 159 mg/100 g, kidney 130 mg/100 g, lung 127 mg/100 g, spleen 125 mg/100 g, skeletal muscle 112 mg/100 g, pancreas 109 mg/100 g, liver 107 mg/100 g, and heart 93 mg/100 g. The total amount of methanol in the gastric contents was 73 mg. Methanol determinations were performed on a Hewlett-Packard 5840A gas chromatograph with flame ionization detection using a glass column packed with 0.2% Carbowax 1500 on Carbopack C. The internal standard used was n-propyl alcohol.

Adult↗
PubMed1985

Strut fracture in a Bjork-Shiley aortic valve prosthesis.

Strut fracture can be a life-threatening adverse effect of mechanical prosthetic heart valves. This complication has occurred in the DeBakey, the Beall, the Cooley-Cutter and, most recently, the Bjork-Shiley valves. We report the case of a 35-year-old man who died suddenly 16 months after a 60 degree Bjork-Shiley Convexo-Concave heart valve prosthesis was inserted in the aortic position. At autopsy, the two welded attachments of the valve's outlet strut had fractured. The valve's tilting disc was found in his abdominal aorta.

Adult↗