Browsing by Author "Pollanen, M.S."

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Acute hemorrhagic leukoencephalomyelitis in a man with viral myocarditis
(Humana Press, 2015) Kitulwatte, I.D.G.; Kim, P.J.; Pollanen, M.S.
We report a case of acute hemorrhagic leukoencephalomyelitis in a man with viral myocarditis. A 48-year-old previously healthy male was found dead in his locked apartment. At autopsy he was found to be malnourished, and his lungs showed gross evidence of bilateral pneumonia with abscess formation and bullous emphysema. Multiple petechial hemorrhages were observed in the brain and mainly involved white matter in the cerebral hemispheres including the corpus callosum and internal capsule, as well as the cerebellum, brainstem, and spinal cord. Microscopy of the brain and spinal cord revealed perivenular hemorrhages, central microthrombi in venules with fibrin exudation into the subcortical white matter, and early perivenular demyelination associated with scanty mixed cellular infiltrates. Other microscopic features included widespread diffuse viral myocarditis, extensive suppurative bronchopneumonia, and chronic bronchitis. This case illustrates the death of a man with a rare fatal disease associated with two other potentially lethal diseases. The case also illustrates the importance of a holistic approach when determining the cause of death, especially when there are competing causes of death.
A Case of fatal pressure on the neck in a woman with a stab injury
(College of Forensic Pathologists of Sri Lanka, 2011) Kitulwatte, I.D.G.; Pollanen, M.S.
Evidence of pressure on the neck forms a spectrum of degree from minimal to marked. We report a case of fatal pressure on the neck with minimal external signs. A 27 year old woman was found dead in her home. A blood stained knife and a blood stained bathrobe belt with hair entangled in it were discovered at the scene. Autopsy revealed a stab injury to the chest extending to the right lung and multiple contusions to the head, face and extremities. There were petechial haemorrhages on bilateral eyelids and conjunctivae. There were 2 small contusions on the front of the neck. Special neck dissection revealed a small haemorrhage in the sternocleidomastoid muscle and a haemorrhagic fracture of the right superior horn of the thyroid cartilage. Cause of death was given as pressure on the neck in a woman with stab injury to the right chest. Petechial haemorrhages play a major role in confirming the cause of death when there is minimal evidence for application of pressure on the neck.
A Comparative study of coronary atherosclerosis in young and old
(Masson Publishing USA, 2015) Kitulwatte, I.D.G.; Pollanen, M.S.
INTRODUCTION: Atherosclerotic coronary artery disease is an important cause of sudden and unexpected deaths in the young people. It is assumed that thrombosis and plaque hemorrhage are commonly associated with sudden deaths from coronary atherosclerosis in the young. In this study, we compared the histological patterns of atherosclerosis in young and old populations to see whether an association exists between the histological pattern of atherosclerosis in the young and thrombosis or plaque hemorrhage. METHODS AND RESULTS: All autopsy cases of coronary atherosclerosis in young people (aged younger than 40 years) in comparison with an equal number of randomly selected older people (older than 65 years) over a period of 4 and a half years in the Provincial Forensic Pathology Unit of the Ontario Forensic Pathology Service in Toronto, Canada, were reviewed to characterize the gross and histologic appearance. There were 28 cases of atherosclerosis in young people ("the young"). Twenty-three (82%) of the young had eccentric atherosclerosis compared with 11 (39%) of the old. An inflammatory response was seen in all 28 (100%) of the young in comparison with 17 (61%) of the old. Thirteen (47%) of the young compared with 3 (11%) of the old had thrombosis, whereas 9 (32%) of the young and 17 (61%) of the old had plaque hemorrhage. Pultaceous debris was the principal component in 11 atherosclerotic plaques (39%) in the young, followed by foam cells in 7 (25%). In the older group, pultaceous debris was the principal component in 18 (64%) followed by dense fibrous tissue in 5 (18%). CONCLUSIONS: The morphology in coronary atherosclerosis of the young is significantly different from the old. Coronary atherosclerosis in the young commonly shows an eccentric distribution with associated inflammation. Thrombosis is commoner among the young, whereas plaque hemorrhage is commoner among the old.
Forensic pathology of explosive Injury
(CRC Press, 2011) Kitulwatte, I.D.G.; Pollanen, M.S.
The role of the Armanni-Ebstein lesion, hepatic steatosis, biochemical analysis and second generation anti-psychotic drugs in fatal diabetic ketoacidosis
(Elsevier, 2013) Kodikara, S.; Paranitharan, P.; Pollanen, M.S.
Diabetic ketoacidosis (DKA) is an acute severe complication of diabetes and characterized by a complex disordered metabolic state due to an absolute or relative insulin deficiency, leads to hyperglycaemia, ketoacidosis and ketonuria. DKA can cause sudden unexpected death and often yields minimal and/or subtle autopsy findings or a negative autopsy and the diagnosis mainly depends upon biochemical analysis of body fluids. This communication highlights the role of Armanni-Ebstein lesion, hepatic steatosis, biochemical analysis and second generation anti-psychotic drugs in 25 adult cases of fatal diabetic ketoacidosis. The study recognises and reconfirms that fatal DKA occurs in both type I and II diabetes. The macroscopic autopsy features observed in this study are non-specific and do not guide the pathologist towards the diagnosis offatal DKA. Once other possibilities have been excluded, the Armanni-Ebstein lesion alone or the combination of hepatic steatosis andArmanni-Ebstein lesion in an otherwise negative autopsy of a sudden unexpected death should raise the suspicion of DKA as the cause of death and indicate biochemical analysis of body fluids. Our findings also remind forensic pathologists to search for fatal DKA in sudden unexpected death with a negative autopsy, where there is a history of second generation anti-psychotic treatment. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Sudden death related myocarditis: a study of 56 cases
(Humana Press, 2010) Kitulwatte, I.D.G.; Kim, P.J.; Pollanen, M.S.
Fifty-six cases of sudden death from myocarditis were reviewed to characterize the range of histologic appearances of myocarditis. All autopsy cases of myocarditis over 13 years (1996-2008) in the Toronto Forensic Pathology Unit, Ontario Forensic Pathology Service, were studied. In each case, historical documentation and histological slides were reviewed. The severity of myocarditis was graded qualitatively and quantitatively (the inflammatory index). We established the inflammatory index in order to classify the severity of myocarditis, by counting the mean number of inflammatory foci per section of myocardium. Based on the inflammatory index, myocardial inflammation was classified into four grades. Based on this classification, 47% of the cases were classified as marked myocarditis having an inflammatory index over 5, with the number of foci per slide varying from 3 to more than 10, while 20% were classified as mild myocarditis with an inflammatory index between 1.1 and 1.9 with the number of foci per slide varying from 0 to 6. The diagnosis of mild myocarditis is dependent on adequate sampling. We believe that the use of this inflammatory index enhances the post-mortem diagnostic sensitivity of myocarditis, especially in its mild form and correlates with qualitative assessment of the histologic severity of myocarditis