Biomedical subjects
Publications and source records attributed to T T Noguchi.
A rare iatrogenic complication of subclavian vein catheterization for hemodialysis is massive hydrothorax. A case is presented that illustrates the need for adherence to a standard procedure of prompt roentgenologic examination in conjunction with catheterization, and emphasizes the importance of the autopsy as a means of quality assurance.
In light of recent developments and public interest on the issue of organ transplant and the definition of death by neurological function ("brain death"). A more expansive role of medicolegal investigation of deaths may be needed. This article was presented for the purpose of understanding the medicolegal investigative system in the United States. The traditional coroner system in the United States was taken from the English system and was established as an elected coroner system during a colonial period. The coroner system became more politically involved and the coroner was elected by popular votes. The political aspect was the main driving force and the medicolegal aspect was ignored, thus, the Commonwealth of Massachusetts was the first state to adopt the medical examiner system. In 1991, 41 out of 50 states have adopted the medical examiner system, either state-wide or on a local option. One of the principal differences between coroner and medical examiner systems is the qualification of the head of the agency. The coroner is an elected individual who acts as an administrator and conducts quasi-judicial function of the department. The medical function is delegated to a physician who performs his duty often on a part-time basis. The medical examiner's office is headed by a Board certified Forensic Pathologist who acts as an administrator and directs all functions including medical and scientific investigation. He is a public employee and is protected under the civil service rules, thus, his decision would be less likely influenced by political pressure. The jurisdiction of the coroner and medical examiner is generally the same by law, however a medical examiner's approach and decision-making is more medically oriented and tends to be more expansive and ready to adopt to the needs in medicolegal issues arising from scientific progress.(ABSTRACT TRUNCATED AT 250 WORDS)
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Polymorphic genetic loci of the deoxyribonucleic acid (DNA) present in formalin-fixed, paraffin-embedded tissues were successfully analyzed by utilizing the polymerase chain reaction. Using this analysis, with three different polymorphic loci [human leucocyte antigen (HLA) DQ alpha, low-density lipoprotein receptor, and parathyroid hormone], fixed tissues representing 14 different individuals were genotyped and could be distinguished from each other. The techniques were further applied to the fixed autopsy tissues of a man in which a question of paternity arose postmortem. Since many individuals have surgical procedures or autopsy, these readily available fixed tissues represent an additional resource for the identification of individuals.
Alizarin red S (ARS) is a commonly used organic dye useful in the histologic identification of calcium deposits. ARS also forms colored reaction products with other metal ions, including barium and lead, which are present in primer residue. In histochemical studies, ARS is shown to identify primer residues from several manufacturers as well as primer residue deposited in tissue, either experimentally or in close-range gunshot wounds. This can be easily accomplished with routine histologic techniques. ARS does not stain gunpowder residue, tattoo pigment, melanin, graphite, india ink, or anthracotic pigment.
Infection control in the workplace is becoming an increasingly important issue, not only for health care workers, but also for any workers who could potentially be exposed to infectious material. We discuss the nature, modes of transmission, and infectivity of important infectious agents likely to be encountered in the course of forensic investigations. We provide principles and guidelines for appropriate procedures and practices to be followed in a program of infection control.
The authors reviewed at autopsy the causes of death of 274 patients with evidence of intravenous drug abuse who had been admitted to a large public hospital. There were 127 who died from diseases unrelated to intravenous drug abuse, and in 41% of these, chronic alcoholism was implicated. Deaths from overdose syndromes and drug-related organ pathology comprised only 11% of all cases. The mean age at death was 39 years. There was a male/female ratio of 3.6:1. Half of all patients died from infection--72 from acquired immunodeficiency syndrome (AIDS) alone. These findings indicate that persons hospitalized with a history of intravenous drug abuse usually die from causes other than overdose and that AIDS and chronic alcoholism are significant problems. Emphasis should be placed upon detecting "hidden" intravenous drug deaths to provide more accurate statistical information.
Completing a death certificate properly and promptly is an important duty for physicians, who must understand how the death certificate is used and be able to recognize and employ the concepts of immediate, underlying, and contributing causes of death. Accurate, concise terminology should be used to give in a logical order a sequence of events leading to death. Avoiding mistakes in death certification helps reduce potential medicolegal problems and provides more meaningful statistics for health care personnel.
The paper retrospectively reviews 80 burn fatalities from accidents or attempted suicides with patients admitted to the LAC-USC Medical Center from 1983 to 1987 to determine demographic factors, etiology of the burn injury, and existence of predisposing risk factors. The average age of fatal burn victims was 44 years; 74% were males, 39% were Caucasian, 35% were black, 21% were Hispanic, and 5% were of Asian descent. Blacks and Caucasians were overrepresented and Hispanics underrepresented in relation to all autopsy cases. Major etiologic factors included suicide, falling asleep while smoking, accidents while working with volatile solvents, housefires, scalds, cooking accidents, and accidents involving motor vehicles. Gasoline was the commonest solvent involved with burn fatalities. Significant risk factors for burn fatality were substance abuse (25% of cases) and impaired mental function (19% of cases).
Hypoglycemia involving a serum glucose of 40 mg/dl or less may lead to death from hypoglycemic coma. Hypoglycemia may be a factor in sudden or unexpected deaths investigated by a medical examiner. We reviewed the data from 54,850 autopsies in a large acute-care medical center to investigate the range of underlying conditions leading to hypoglycemic coma and found 123 cases, which included complications of alcoholism in 41 (33%), drugs in 26 (21%), neoplasia in 26 (21%), conditions producing chronic passive congestion of liver in eight (7%), debilitating neurologic disease in eight (7%), endocrine disorders in four (3%), and a variety of miscellaneous conditions in ten (8%) cases. The commonest mechanisms producing hypoglycemia included liver disease with impaired carbohydrate metabolism, endogenous or exogenous drug or hormonal effect, and inanition from decreased intake of food.
The current worldwide epidemic of AIDS will have profound consequences not only for the delivery of health care, but also for forensic pathologists and investigators. AIDS continues to spread in definable risk groups, and deaths within some of these groups may fall under the jurisdiction of the medical examiner. We outline an approach to handling AIDS deaths based upon case definition, diagnosis by available information and procedures, and proper infection control. We also discuss medicolegal issues surrounding deaths due to AIDS.
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This article presents the significance of cyanide in medicolegal investigation of fires. It discusses the various aspects of fire investigation and the pathophysiology of cyanide toxicity and evidence interpretation in fire investigations.
Surveys of medical examiners' records have shown that as many as one-third of suicide victims have serious physical illnesses. We report the case of a 56-year-old woman who committed suicide by drug overdose. At autopsy, she had severe widespread periarteritis nodosa, which had been unsuspected during life. The identification of treatable physical illness in suicide victims is important in suicide prevention, yet such illness may be overlooked after death unless a forensic autopsy is performed.
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A system is described for coding of anatomic--including forensic--pathologic diagnoses from necropsy cases using a microcomputer. The SNOMED software from the College of American Pathologists is utilized. RAM-disk software is employed to enhance the speed of operation of the system. The microcomputer can be operated by clerical staff versed in medical terminology. Speed of entry and retrieval, with minimal manual interaction, is an important aspect of operation. Equipment and storage costs are minimal.
The findings of the Los Angeles County Street Drug Identification Program over the period from 1971 to 1980 for analysis of 1163 samples of street drugs represented as stimulants are presented. Of the 614 alleged cocaine samples, cocaine was found to be absent in 19.2%, found combined with stimulant substitutes in 22.5%, and found by itself in 58.3% of these samples. The validity for 473 alleged amphetamine samples was only 27.1%, with 23.0% of samples found to contain stimulant substitutes along with amphetamine, and 49.9% of the samples lacking any of the alleged drug. Seventy-six alleged methamphetamine samples showed 32.9% validity, with 3.9% of samples having mixtures of alleged drug and substitutes, and 63.2% of samples lacking any methamphetamine. A total of 15 different stimulant substitutes were found in 74 combinations. Caffeine, ephedrine, lidocaine, and procaine were the commonest substitutes.
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