Document 7RL2bGyJNQD9kM42OZB5YJ8JE

FILE NAME Talc TALC DATE 1997 DOC TALC042 DOCUMENT DESCRIPTION Medical and Autopsy Records 07/14/97 10:42 315 464 7130 SUNY HSC PATHOL 002/006 State University of New York Health Science Center at Syracuse University a DEPARTMENT OF PATHOLOGY 3 10:52 F.R. DAVEY MD CHAIRMAN AUTOPSY REPORT NAME FORSYTH CHARLES UH 000199311 AUTOPSY NO PATIENT NO A97-015 3160 ATTENDING PHYSICIAN WIDELL JARED M SERVICE ER CARDIOLOGY PROSECTOR CHRISTINE FULLER M.D. WITNESS JOHN FALITICO EE 3S DATE & TIME OF DEATH 04/23/97 0857 F, DATE & TIME OF AUTOPSY 04/24/97 0845 efe e DATE OF REPORT 05/26/97 hBetal fNae eb FINAL AUTOPSY DIAGNOSIS 1 2 3 4 Acute myocardial infarction Chronic ischemic heart disease Early bronchopneumonia left lower lobe Pneumoconiosis Asbestosis and Talcosis a Pleural plaques b Diffuse interstitial fibrosis Grade 2-3 for histologic grading of asbestosis " " " " f : AZ JERROLD M.D. G a ae AZ i mie nt CHRISTINE FULLER M.D. . JERROLD L. ABRAHAM M.D. Gimsean 814.00 4, a) Lad ee a 750 EAST ADAMS STREET SYRACUSE NEW YORK 13210 PHONE 315 464 + a. ee ~ . ee vane 4750 FAX 315 464-7130 07/14/97 10:12 315 464 7130 SUNY HSC PATHOL 003/006 NAME FORSYTH CHARLES UH 000199311 AUTOPSY NO A97-015 PATIENT NO 3160 MICROSCOPIC DESCRIPTION CARDIOVASCULAR SYSTEM Coronary arteries Extensive atherosclerosis with focal dystrophic calcification up to 90 occlusion of LAD and 50-70 occlusion of LCA and right coronary . arteries HEART Acute myocardial infarction approximately 24 hours in age with early myocyte coagulative necrosis intense cytoplasmic eosinophilia and nuclear pyknosis and sparse neutrophilic infiltration Scattered areas of fibrosis and accompanying myocyte dropout indicative of chronic ischemia. Numerous hypertrophic myocytes RESPIRATORY SYSTEM Multiple pleural plaques - focally HYALINIZED and calcified collections of dense fibrous tissue with associated sparse lymphoplasmacytic infiltrates LUNGS : Diffuse interstitial fibrosis most prominant in peribronchiolar areas with extension into respiratory bronchioles alveolar ducts and alveoli Focal honeycombing is present There is focal Type 2 pneumocyte hyperplasia with several pneumocytes containing cytoplasmic hyalin accumulations Many asbestos bodies are seen particularly within the lower lobes embedded within the fibrous septae and also free within alveolar spaces counts on one slide were 10+ Abundant fine crystalline material which is weakly birefringent is also present within the left lower the interstitium Early patchy pneumonia is lobe Mild emphysematous changes are noted focally seen within An iron stain best delineates the abundant accumulation of ferruginous bodies Interstitial accumulations of strongly birefringent platy crystals consistent with talc are also noted NOTE the findings listed above would correlate with a Grade 2-3 grading of Asbestosis Sections of pulmonary artery reveal moderate atherosclerosis for histologic FULLER CHRISTINE FULLER M.D. ed WW Yl JERROLD L. ABRAHAM M.D. B14.00 07/14/97 10:42 315 464 7130 SUNY HSC PATHOL 004/006 } 04/25/97 10:52 DEPARTMENT OF PATHOLOGY F.R. DAVEY MD CHAIRMAN AUTOPSY REPORT NAME UH FORSYTH CHARLES 000199311 AUTOPSY NO PATIENT NO A97-015 3160 ATTENDING PHYSICIAN WIDELL JARED M SERVICE ER CARDIOLOGY DATE & TIME OF DEATH 04/23/97 0857 DATE & TIME OF AUTOPSY 04/24/97 0845 DATE OF REPORT 05/13/97 PROSECTOR CHRISTINE FULLER WITNESS JOHN FALITICO M.D. GROSS DESCRIPTION The autopsy is performed approximately 24 hours after death Permission is by the wife of the deceased Authorization states heart and lungs only EXTERNAL APPEARANCE The subject is a 72 year old male The body is well developed well nourished is 75 kilograms The and appears consistent with the stated age The weight is 5 10 There is moderate rigor mortis dependent lividity and algor height mortis The skin is clear There is a blue and black tattoo on the left forearm The head is not deformed and there are no scars The hair is sparse neo and brown The sclerae cornea and lenses are clear The nose and and gray external ears are unremarkable and their passages are clear The lips and gums show no lesions and the patient is edentulous The neck structures are symmetrical and there are no unusual masses There is a puncture mark in the of previous catheter placement The right supraclavicular area indicative the male breasts and nipples are thorax has the normal contour and symmetry and unremarkable There is a 19.0 cm curvilinear healed thin scar in the left thorax The abdomen is slightly protuberant There are no abnormal masses or fluid wave externally palpable There are two 1.0 cm and 11.3 cm healed scars left of the midline the mid epigastric region as well a 21.0 cm in slightly scar that extends from zyphoid process to the pubic ramus The testes are descended and there are no abnormal masses No inguinal masses are palpable 1.0 cm dark brown rough raised lesion in the left is There an approximately in both antecubital fossa as well as on lower quadrant Ecchymoses are present mark in the right the dorsum of the right hand There is also a small puncture Extremities otherwise inguinal area consistent with a prior catheter placement in deformities and there is minimal edema and moderate cyanosis show no scars or the lower extremities 07/14/97 = 10:43 315 484 7130 SUNY HSC PATHOL 1005/008 INTERNAL EXAMINATION The standard thoracic incisions are employed The panniculus adiposus measures The skeletal muscles are brown normally 1.5 cm in thickness at the thorax bulk The rib cage is intact There is no subcutaneous contains firm and of normal or sign of pneumothorax The left pleural cavity contains emphysema 25 cc of cloudy yellow fluid The right pleural cavity approximately fluid The pericardial cavity contains 25 approximately 75 cc of cloudy yellow surfaces are focally dull and gray with yellow fluid The serosal surfaces C eC xteofnsicvleearadhesions present on both pericardial and pleural bilaterally CARDIOVASCULAR SYSTEM wall thickness are right 0.4 cm The heart weighs 650 grams The ventricular The cardiac chambers The muscular wall is minimally hypertrophic left 1.3 cm the left ventricle The auricles and appendages are are dilated particularly are tricuspid and mitral unremarkable The valve ring circumferences aortic and pulmonic 9.0 cm The valve leaflets and is a approximately 12.0 cm aovnedrall delicate pliable and free of lesion There chordae tendineae are of the aortic valve leaflets The commissures moderate amount of calcification are unremarkable The are minimally fused The epicardium and subepicardium thickened by position The vessel walls are coronary arteries arise in normal The lumina are focally markedly focally eccentric calcified ye9l0lowocpclluasqiuoens of LAD and 50-60 stenosis of LCA and compromised Approximately is softened and shows brown right coronary arteries The myocardium left ventricle including the mottling throughout the vast majority of the and inferior walls The endocardium is smooth arteries arise anterior lateral posterior ema? and free of mural thrombi The aortic and pulmonary The foramen transparent in normal anatomic relation The ductus arteriosus is obliterated shows mild focal atheromatous plaquing with ovale is closed The aortic wall There is moderate loss of elasticity The major minimal laminar calcification and show mild atherosclerosis branches of aorta are patent RESPIRATORY SYSTEM and left 650 grams The lungs have the The lung weights are right 950 grams is focally roughened particularly usual shape and lobar divisions The pleura and diaphragmatic surface with adhesion to the numerous posterior and inferior along the lateral edges on the diaphragmatic calcified pleural plaques present The bronchial walls and pericardium There is moderate dark pigmentation dilatation or mucosal change The bronchial tract is intact and free of mass mucoid material The pulmonary arteries lumina contain small amounts of frothy No emboli are present in are opened in situ and founTdherfereeis omfodmearjaotre thatrhoemrboimatous plaquing of pulmonary all the peripheral branches is firm and consolidated throughout arteries The pulmonary parenchyma induration in the left lower lobe small focus of prominant The hilar lymph Lobes There is a fluid with pressure exudes somewhat purulent appearing which free of nodular lesions nodes are anthracotic and are 07/14/97 10:44 315 464 7130 SUNY HSC PATHOL 006/006 04/25/97 10:52 DEPARTMENT OF PATHOLOGY F.R. DAVEY MD CHAIRMAN FORSYTH CHARLES 00019931l A97-015 3160 CLINICAL SUMMARY The patient is a 72 year old male with a past medical history significant for a myocardial infarction at the age of 40 congestive heart failure diabetes hypertension asthma and severe lung disease with occupational exposure to talc 31 years as well as a 40 plus pack year smoking history On 4/22/97 at approximately 3:00 pm he complained of dizziness and experience of dyspnea For several weeks prior to this event he had been experiencing severe exertional dyspnea and orthopnea He was found unresponsive and cyanotic by his law who initiated basic life support and called for paramedic assistance When the ambulance arrived the patient was found with agonal respirations and responsive to noxious stimuli He was diaphoretic and a heart monitor revealed wide only ventricular tachycardia A finger stick showed a glucose level of 292 He was brought to University Hospital emergency room where an ECG revealed wide complex tachycardia right bundle branch block and intermittent ventricular tachycardia Examination revealed increased JVP and bilateral pupils fixed and dilated Antiarrhythmia drugs including lidocaine bretyllium procainamide and magnesium as well as IV dopamine were begun Echocardiogram showed severe left ventricular dysfunction low ejection fraction and mitral and tricuspid regurgitation Lab results included CK = CKMB = 17.5 CKMM = 4.6 He continued to be hemodynamically unstable with blood pressures falling to 40/32 and heart rate in the low 30's Additional lab results on the morning of 4/23/97 showed troponin = 8.2 and CKMB = 28.5 and lactic acid == 12 The continued to deteriorate and became unresponsive at 8:55 am on 4/23/97 patient DNR orders were in place therefore no further resuscitation efforts were initiated He was pronounced dead at 8:57 am by Dr. Nair