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Biomedical subjects

T D Koelmeyer

Publications and source records attributed to T D Koelmeyer.

At least 19 recordsLinked to original sources
PubMed1992

Death certification in Auckland.

AIMS: to investigate the reasons behind general practitioner referral of cases of natural death to the coroner, and also the understanding of general practitioners of the relevant legislation. METHODS: as cases of natural death were referred to the coroner over a seven month period, the deceased's general practitioner was contacted by telephone and questioned regarding his/her knowledge of the death and willingness to sign a cause of death certificate. Based upon this interview, cases were divided according to whether their general practitioner could have signed the death certificate or not. RESULTS: there were 314 cases where there was a contactable general practitioner. In 257 instances, the general practitioner would not have signed the death certificate: 183 found the death unexpected, and 74 had not seen the patient recently enough. In 57 instances the general practitioner would have signed the death certificate, but did not because: 23 were unaware of the death, 13 could not be contacted, 14 did sign a death certificate but this was rejected by the medical referee, and seven would have signed but did not for miscellaneous reasons. CONCLUSION: a disturbing finding was the general lack of understanding of certification legislation in particular the concept that the patient must have been seen in their last illness to be able to sign the death certificate. When signing death certificates, doctors should be thinking in terms of last illness rather than a vague period of time between two weeks and three months.

Cause of Death↗
PubMed1992

Homicides in Auckland, New Zealand. A 14-year study.

In the 14-year period from 1976 to 1989, there have been 174 homicide victims in the Auckland colonial area. Data accessed from autopsy and police reports show that victims of marital conflict, family dispute, and arguments developing between nonmarried couples made up the largest proportion of homicide cases. Stabbing and assault with a blunt weapon were the most common causes of death. The data also show that homicide is relatively uncommon in Auckland in comparison with other cities of similar size.

Adolescent↗
PubMed1992

Does advancing age modify the presentation of disease?

A group of patients who had died of either cardiac tamponade due to ruptured myocardial infarct, perforated peptic ulcer, or diverticulitis with perforation were studied to determine the effect that age has on the presentation of these three potentially fatal diseases. With advanced age, a decrease in the number of patients who had symptoms typical for the disease that was ultimately the cause of death was found. We also noted a number of patients who did not experience any symptoms, and some patients who experienced symptoms that were not typical of their disease. In many instances, the disparity between disease severity and symptoms had resulted in the disease not being diagnosed either because the patient did not seek medical advice or because the doctor was unable to make the appropriate diagnosis from the patient's symptoms.

Age Factors↗
PubMed1991

Self inflicted deaths in Auckland: a study of 1057 cases.

In the eleven year period from 1 January 1976 to 31 December 1986, 1057 people took their own lives in the Auckland colonial area. These cases were analysed with respect to age, sex and mode of death. The totals have increased from 68 (1976) to 116 (1986). There were 723 males and 334 females. The total number of males has increased from 41 (1976) to 80 (1986) and the females from 27 (1976) to 36 (1986). This shows that over the period studied there was a significant difference between male and female suicide rates and a greater increase in male rate compared with female rate. The largest number of deaths for both males and females occurred in the 20-29 years age group. Drugs and poisons were the most common method used followed by hanging and the inhalation of carbon monoxide from car exhausts.

Adolescent↗
PubMed1988

Evolution of Swan-Ganz catheter-related pulmonary valve nonbacterial endocarditis.

Invasive resuscitative and supportive therapy subsequent to accidental trauma, assault, or medical mishap may create lesions that forensic pathologists must interpret. Pulmonary valve nonbacterial endocarditis sometimes complicates placement of flow-directed pulmonary artery (Swan-Ganz) catheters. We examined ten cases of endocarditis from patients dying 0-10 days after removal of a Swan-Ganz catheter, and compared the natural evolution of vegetations in critically ill patients with the reported evolution of similar vegetations in experimental animals in the Freedman model. There was wide variation in macroscopic, as well as in the light- and scanning electron-microscopic, appearances in our cases and we could not establish a direct relationship between vegetation structure and time elapsed after removal of the catheter. These findings suggest that parameters related to critical illness and species account for the differences between this disease in human and animal models.

Catheterization, Swan-Ganz↗
PubMed1987

Deaths from trauma in Auckland: a one year study.

We report a one year prospective study of all deaths from trauma in the Auckland region. Data was collected on the circumstances of death from coroner's, police and hospital records. All cases had autopsies and the injuries were scored using the abbreviated injury scale (AIS) system. The group of 236 had a median age of 27 years and 73% were under the age of 45. Seventy-two percent were male. Blunt trauma, predominantly the result of road crashes, accounted for 89% of the fatalities. Most deaths occurred at the site of injury and only 37% survived to reach hospital. Cases were audited if death occurred without a critical or unsurvivable injury. Thirteen cases were considered to be potentially salvageable if medical treatment had been optimal. The implications for the organisation of prehospital and inhospital trauma care are discussed.

Accidents, Traffic↗
PubMed1986

Fatal postpartum coronary artery dissection. A light- and electron-microscope study.

A case report of fatal spontaneous dissection of the distal left circumflex coronary artery in a 37-year-old postpartum female is presented. Samples of arterial wall from this patient and from six other postpartum females who died of unrelated causes were examined by light (LM), scanning electron (SEM), and transmission electron (TEM) microscopy. Morphological changes to explain the recognized predisposition of this cohort to coronary artery dissection were sought. The origin of the dissection was demonstrated by serial LM sections to be in midmedia with no intimal extension. The predominant plane of dissection was the junction of media and adventitia. Sarcolemmal blebbing and accumulation of amorphous intercellular material were demonstrated at the dissection site by SEM but were not seen elsewhere in the affected heart or in any of the six control hearts. These changes could not be distinguished by TEM from prolonged ischemic injury. There was no accumulation of eosinophilic leukocytes in the vessel wall or adventitia, and adventitial mast cells were not consistently more frequent than in the controls. No increase of stainable intramural mucopolysaccharides was seen in the fatal case. The results indicated no generalized arterial change in postpartum coronary arteries to account for the increased frequency of dissection. A focal degenerative process remains the most likely possibility.

Adult↗
PubMed1985

Fatal injuries to bicycle riders in Auckland.

Twenty bicycle riders were fatally injured in Auckland between 1974 and 1984. Eighteen were male and nine aged under 15 years. The age distribution of fatalities corresponds closely to the known age distribution of the cycling population. Few differences in pattern of injury were demonstrable between younger (under 15 years) and older riders. Sixteen died of fatal injury to multiple organ systems. Fourteen had fatal injury to brain, including four with no other significant organ injury. Fatal cardiopulmonary trauma was seen in seven riders and fatal abdominal trauma in seven. Cervical and high thoracic fracture dislocation with cord injury were seen in seven riders. Compared to the population base, incidence of fatalities is low, and no recent significant increase is detected.

Adolescent↗
PubMed1985

Accidental drownings in Auckland children.

We consider the circumstances surrounding 60 consecutive cases of accidental drowning of children in the Auckland coronial district. More deaths occurred around the home than anywhere else. Forty-one of the fatalities occurred around the home with only two being over the age of six years. The unfenced or inadequately fenced domestic swimming pool was the most common hazard. The household bath and partly filled buckets represent further although less frequent dangers. The study reaffirms the need for legislation making the fencing of domestic swimming pools mandatory. Elsewhere, young children playing in or near water need constant supervision. More victims received either no resuscitation or inadequate resuscitation until an ambulance crew arrived at the home. This further emphasises the value of a sound knowledge of cardiopulmonary resuscitation techniques in the general population.

Accident Prevention↗
PubMed1985

Complete heart block and bowel infarction secondary to rheumatoid disease.

A case of complete heart block secondary to rheumatoid involvement of the conduction system is presented. The same patient died after infarction of the colon as a consequence of arterial spasm superimposed upon pre-existing rheumatoid changes in the mesenteric arteries. The coexistence of rheumatoid involvement of the heart and of the bowel vasculature has not previously been reported.

Arthritis, Rheumatoid↗
PubMed1984

Deaths from electricity.

This paper reviews the circumstances of 95 fatalities from electrical injuries. Eighty-nine were accidental, four were suicides and two occurred during autoerotic electrical stimulation. Forty-nine of the accidental fatalities occurred at work, Twenty-eight in the home and twelve in the course of outside recreational activities. In many accidents the circumstances were distressingly similar and included: (1) Contact with overhead distribution lines by a length of conductor such as a yacht mast or crane. (2) Faulty wiring or electrical repairs performed by unqualified people. (3) Badly deteriorated cords, plugs and occasionally appliances. (4) Failure to use isolating transformers when indicated. Deaths involving children are a particular cause of concern. Nine fatalites involved children under the age of five years who contacted inadequately protected wires.

Accidents, Home↗
PubMed1984

Deaths from drowning.

During an eight year period in the Auckland coronial district, 225 persons over the age of fifteen years died from drowning and were subject to autopsy. Of these, 129 males and 21 females drowned because of accidents whilst 31 males and 29 females committed suicide by drowning. There was one homicide and in 14 cases it was unclear as to whether drowning was accidental or suicidal. At least half of the accidents showed analytical evidence of having consumed alcohol and in 37% of these the blood alcohol level was over 100 mg per 100 ml of blood. The activities in which the accidentally drowned were engaged at the time of their deaths are documented and the role of intercurrent illnesses in some drownings illustrated.

Accidents↗
PubMed1983

Deaths from drugs and poisons.

In the eight years from 1975 to 1982, 11 262 ***coronial**autopsies were performed in the School of Medicine, Auckland. Three hundred and ninety-four of the deaths were due to the action of a drug or poison. In this paper we examine the motives and circumstances, age and sex distribution, drugs used and other aspects of these 394 deaths.

Accidents↗
PubMed1983

Pulmonary fat and bone marrow embolism in aircraft accident victims.

On 28 November 1979, an Air New Zealand DC10 aircraft crashed into Mt Erebus, Antarctica with the loss of 257 passengers and crew. Postmortem examinations were carried out on 231 victims in Auckland, 4641 kilometres north of the crash site, and lung tissue was present in 205 cases. Pulmonary fat emboli were present in 134 cases (65%), pulmonary bone marrow emboli in 60 (29%) and pulmonary edema in 76 cases (37%). Clear relationships were demonstrated, firstly between the extent of fat and bone marrow embolism, secondly between the extent of fat and bone marrow embolism and the presence of pulmonary edema, and thirdly between the extent of fat and bone marrow embolism and the extent of cardiovascular damage. It was apparent that death had occurred immediately following impact, and the extent of fat and bone marrow embolism varied inversely with the severity of the injuries found. The most severely injured victims were those seated in the rear cabin of the aircraft suggesting that this was the site of impact with the ground. Our studies show that pulmonary fat embolism occurs very rapidly after severe injury and is followed by increasing numbers of fat and bone marrow emboli depending on the nature of the mortal injuries.

Accidents, Aviation↗