Document M0JG4d9pgX6JdbB9xw168jYj

FILE NAME: Talc (TALC) DATE: 1997 DOC#: TALC042 DOCUMENT DESCRIPTION: Medical and Autopsy Records 0 7 ' 14'97 10:42 313 464 7130 SUNT HSC PATHOL @ 002/006 Stic* Uniwarjir/ of N o w York Health Science Center at Syracuse UniversityHospItal DEPARTMENT OF PATHOLOGY 10; 52 F.R. DAVET, MD, CHAIRMAN AUTOPSY REPORT NAME; FORSYTH,CHARLES UH#: 000199311 AUTOPSY N O . ; A97-015 PATIENT NO.: AAP-31S0 ATTENDING PHYSICIAN: WIDELL,JARED M SERVICE: ER. CARDIOLOGY PROSECTOR; CHRISTINE FULLER, WITNESS: JOHN FALITICO DATE & TIME OF DEATH: 04/23/97 0857 DATE 5 TIME OF AUTOPSY: 04/24/97 0845 DATE OF REPORT: 05/26/97 M-D. FINAL AUTOPSY DIAGNOSIS 1. Acute myocardial infarction. 2. Chronic ischemic heart disease. 3. Early bronchopneumonia (left lower lobe). 1 4. pneumoconiosis (Asfaestosis and Talcosis). a. Pleural plaques. . b. Diffuse interstitial fibrosis (Grade 2-3 for histologic grading of asbestosis). JERRQLD L. ABRAHAM, M.D. , 314.00 -! 3 "I i 750EASTADAMS STREET SYRACUSE. NEW YORK 13210 PHONE: (315)464-4750 FAX:(315)464-7130 07/14^97 10:42 315 464 7130 SUNT ESC PATHOL @003/006 NAME: FORSYTH,CHARLES OH#: 000199311 AUTOPSY NO.: A97-015 PATIENT NO.s AAE-3160 MICROSCOPIC DESCRIPTION CARDIOVASCULAR SYSTEM: Coronary arteries: Extensive atherosclerosis with focal dystrophic calcification (up to 90% occlusion of LAD and 30-70% occlusion of LCA and right coronary arteries). HEART: , Aeute myocardial infarction (approximately 24 hours in age) with early myocyte coagulative necrosis (intense cytoplasmic eosinophilia and nuclear pytaiosia) 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 lymphoplagmacytic 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 septaa and also free within alveolar spaces (counts on one slide were 10+) . Abundant fine crystalline material which is weafcly birfringent, is also present within the interstitium. Early patchy broncho-pneumonia is seen within the left lower lobe. Mild emphysematous changes are noted focally. An iron stain best delineates the abundant accumulation of ferruginous bodies. Interstitial accumulations of strongly birfringent platy crystals consistent with talc are also noted. NOTE: the findings listed above would correlate with a Grade 2-3 for histologic grading of Aabestosis. _ Sections of pulmonary artery reveal moderate atherosclerosis, JERROLD L. ABRAHAM, M.D. B14.0Q 07'14/97 10:42 315 464 7130 SUNY HSC PATHOL 0004/008 04/25/97 10:52 DEPARTMENT OF PATHOLOGY F.R. DAVEY , MD, CHAIRMAN AUTOPSY REPORT NAME: FORSYTH,CHARLES CJH#: 000199311 AUTOPSY NO.: A97-Q15 PATIENT NO.: AAP-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, M.D. WITNESS: JOHN FALITICO The autopsy is performed approximately 24 hours after death. Permission is by the wife of the deceased. Authorization states heart and lungs only. T h f ^ S j e c t ' S T ^ ' y e a r old male. The body is well L2S ^ - ^ r s S ^ ,iSi23r i - ^ r S ? S . T h . ,ki. is d . . There i. a blue and black tattoo on tj* l.tt forearm. The head is not deformed and there are no scars. The hair is sparse and gray and brown. The sclerae, cornea and lenses are clear. The nose and S t e r n a l 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 ,,t^The riaht supraclavicular area indicative of previous catheter placement. .The S S L S th. normal contour and symmetry, a n d t h e male unremarkable. There is a 19.0 cm curvilinear well-healed thin l9 tl thorax. The abdomen is slightly protuberant. There are no fluid wave externally palpable. There are two 1,0 cm and 11.3 cm healed scars slightly left of the midline- in the'mid epigastric region, as well a 21.0 cm scar that extends from zyphoid process to the pubic r a m u s T h e ^ t e s a r e descended and there are no abnormal masses. No inguinal masses are palpable- There is an approximately 1.0 cm dark brown rough raised lesion in the left CS Ecchymoses nr* p r M . n t in borh Mcobitnl *u. dorsum of the right hand. There is also a small puncture mark in ^he right i i L ? n S ^ r e a c o L i s ? e L with a prior catheter placement. Extremities otherwise s h L no scars or deformities and there is minimal edema and moderate cyanosis m the lower extremities. 7/ 14-'97 10:43 313 484 7130 SUNY HSC PATHOL @003/008 INTERNAL EXAMINATION: *mn1ovsd The panniculus adiposus measures The standard thoracic inciaiona ara w l o y a d . TB^pannicnx g normally !.3 cm in =Y T ; * b ` . no subcutaheous firm and o f norma -,,anwiothorax emphysema or sign of pneumothorax The left pleural cavity contains ^ right pleural cavity contains .,,roximately 25 cc of clondy yollow fluid, tt. Lnt.ins 25 appr,, r a t e l y 5 oc ,t =l=udy y.lloJiUidjic=5 { dull and gray .ith a * L S ai: i ^ a " S a . t on both pericardial abd pl.nr.1 surface bilaterally. CARDIOVASCULAR SYSTEM: ventricular wall thickness are right 0.4 cm., Tha heart weighs 650 grams. *"e * _i_i M n v hvoertroohic- The cardiac chambers left 1.3 cm. The muscular wall as ^ h f l l l t c l e s and appendages are are dilated, particularly the l e f t u t r i c l e and micrai unremarkable. The valve ring c,rc . 9 0 tan. The valve leaflets and approximately 12.0 cm and aortJ* t ^ S ^ l e andfree of lesion. There is a chordae tendineae are overall deli < -* valve leaflets. The commissures moderate amount of c a l c i n a t i o n subeoicardium are unremarkable. The are minimally fused. The <"^ S a f ^ s i t i o n ^ The vessel walls are thickened by coronary arteries arise in noTM aJ; p?amiss' The Iumina are focally markedly fcoomcparlolmyiseecdc.entr(iAcppcraoixciimfaiteedlyy90% onrc?cilUuSsiioonn*ooff LLAADD aanndd o5u0-60% sternoesdi.sbroowfnLCA and right coronary arteries). The ^ a r d i u m is including the mottling throughout the vast ma^or-ty ^ alls The endocardium is smooth, anterior, lateral, posterior, ^ i n f e r r o r w a l l s . arteries arise ' transparent and free of mural thrombi . ^ h ^ a o r t x ^ a n a The foramen aortic 1 1 s h e - mild RESPIRATORY SYSTEM: The lung weights ere: right 9 g __d left qsq grams. The lungs have the .Qura is focally roughened, particularly usual shape and lobar diVial" s ' * L .Ion, th, l . n l * ' - " t e calcified pleural plaques present on th surface with adhesion to the numerous d S S S - S i o posterior u d inferior P 'i ntaT;ion. -The' bronchial alls, and pericardimt. t h S u S t i chan,,. The bronchial tract la Intact and Y l s T f r o t h y m u c o i d material. Th* pulmonary arteries Iumina contain small amounts of fr 3T thrQabi. No emboli are present in are opened in situ and foun .moderate atheromatous plaquing of pulmonary Cbe peripheral branchas. There is moderat. r o m a ,, U d a t e d throughout all arteries. The pulmonary parenchyma g j f f f n n in the laft lever lobe E 'c i^ js v s s - ia r " - - - 07/14/97 10:44 0 3 1 5 464 7130 SUNY E SC PATHOL 04/25/97 10:52 DEPARTMENT OF PATHOLOGY F.K. DAVEY, MD, CHAIRMAN FORSYTH,CHARLES 000199311 A97-015 AAP-3160 CLINICAL SUMMARY: .... . ... ^ _ _ The patient is a 72 year old mala with a past medical history significant -or 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 nistory. On 4/22/97 attov-oximately 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 son in-law who initiated basic life support and called for paramedic _assistance. When the ambulance arrived, the patient was found with agonal respirations and responsive only to noxious stimuli. He was diaphoretic and a heart m ni*r *eJ**led 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 JV>, and oilateral pupils_fixed a dilated. Antiarrhythmia drugs, including lidocaine, bretyIlium, and magnesium (as well as IV dopamine) were begun. 2 SSVere left ventricular dysfunction, low enaction fraction 15%),and mitral and tricuspid regurgitation. Lab results included CK * 1099,CKMB = 17.5, CKMM 4.6. He continued to be hemodynamically unstable with olood to 40/32 and heart rate in the low 30's. Additional lab results on -he 0 TM ^ of 4/23/97 showed troponin = 8.2 and CKMB - 28.3, and lactic acid * 12. -h patient continued to deteriorate, and became unresponsive at 8::5 aa on 4/23/97. DNR orders were in place, therefore no further resuscitation efforts were initiated. He was pronounced dead at B:57 am by Dr. Nair.