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Waterhouse-Friderichsen syndrome

Waterhouse-Friderichsen syndrome is massive, usually bilateral, hemorrhage into the adrenal glands caused by fulminant meningococcemia. more...

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Meningococcus is another term for the species Neisseria meningitidis, which is a cause of the type of meningitis which usually underlies this syndrome. This type of meningitis occurs most commonly in children and young adults, and can occur in epidemics. In the United States it is the cause of about 20% of meningitis cases. At one time it was common among military recruits, but administration of the preventive meningococcal vaccine has greatly reduced this number. Freshman college students living in dormitory housing who have not been vaccinated are another risk group.

Routine vaccination against meningococcus is recommended for people who have poor splenic function (who, for example, have had their spleen removed or who have sickle-cell anemia which damages the spleen), or who have certain immune disorders, such as complement deficiency.

It is sometimes said that the hemorrhage in Waterhouse-Friderichsen syndrome causes an acute adrenal insufficiency, but this is inaccurate, since blood cortisol levels are not decreased. The shock, purpura and intravascular clotting are probably the result of an endotoxin mediated immune reaction caused by sepsis.

The syndrome is named for Rupert Waterhouse (1873-1958), an English physician, and Carl Friderichsen (1886-1979), a Danish physician, who wrote papers on the syndrome, which had been previously described.


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Forensic Pathology Reviews: Volume 1
From Archives of Pathology & Laboratory Medicine, 2/1/05 by Denton, J Scott

Forensic Pathology Reviews: Volume 1

Edited by Michael Tsokos, 353 pp, with tables and illus, Totowa, NJ, Humana Press, 2004.

This is the first in a review series of forensic pathology, starting with the premise that "over the last decade, the field of forensic science has expanded enormously, with the rapid emergence of new autopsy and laboratory techniques, and the identification of many new markers for specific pathological conditions." This book is a good start in attempting to define these recent forensic pathology advances.

The first chapter is a review of burned bodies, with black-and-white photographs that show charring with "puppet organs" and tables that compare grading schemes for thermal injury. Chapter 2 reviews the blunt force trauma experience in Germany from "stomping" and assault. Chapter 3 deals with timing of traumatic brain injury through immunohistochemical analysis. New to me was the extensive text and tables that summarize all the markers and the earliest and average times they are found after injury. Chapter 4 reviews the effects of drug abuse on the central nervous system, with 31 pages of 505 references. Chapter 5 is an up-todate review of sudden cardiac death, and chapters 6 and 7 deal with the problems and pitfalls of neonaticide and sudden infant death syndrome, respectively.

Chapters 8 and 9 review rare fatalities from Mycoplasma pneumonias and Waterhouse-Friderichsen syndrome. Chapter 10 is a review of autoerotic deaths, with the history of the practice the most informative. The chapter on hypothermie deaths concentrates on the pitfall of misdiagnosing paradoxical undressing as homicide and the process of crawling into enclosed spaces during hypothermia called the hide and die syndrome, which is believed to be related to a hibernation reflex. The text, photographs, and concise tables in the review of maternal death from HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) are excellent.

The most encyclopedic chapter is the review of the forensic aspects of postmortem alcohol interpretation, with all the biochemical calculations, pitfalls, and strengths in interpreting alcohol values thoroughly discussed. Cardiopulmonary resuscitation injuries are also reviewed. The last chapter on iliopsoas muscle hemorrhage deals with this rare autopsy finding, most likely related to sepsis, DIC, or trauma.

Generally, the references at the end of the chapters are extensive, but unfortunately many to most in each chapter are in German. This reflects the different perspectives of the European practice environment of the editor and his mainly German coauthors. Some authors also seem to place a heavy emphasis on microscopic studies over the gross findings, which is different from the American forensic pathologist. I appreciated the summary sections at the end of each chapter. Forensic pathology is a visual discipline, and more photographs in the subsequent volumes would be beneficial.

Finally, this volume contains timely, comprehensive reviews for the selected specialized topics. Although these reviews do not define many new advances in forensic pathology techniques or practices, this may reflect the field of forensic pathology itself rather that any deficit of the authors. I would recommend the first book in this series to the practicing forensic pathologist who wishes to fill in some gaps of the standard forensic pathology texts or as a starting point to begin to master the art of traumatic forensic neuroimmunohistochemistry.


Chicago, Ill

Copyright College of American Pathologists Feb 2005
Provided by ProQuest Information and Learning Company. All rights Reserved

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