Metastatic cancer of the urinary bladder: can it be a nonnatural death?

Cause and Manner of Death in Traumatic Spinal Cord Injuries: A 20 year Retrospective Review at a Statewide Medical Examiner Office

In the United States approximately 250,000 persons have a traumatic spinal cord injury (TSCI) and most will die from complications related to their injury. Interpretation of TSCI deaths by medical examiners is evolving as understanding of SCI pathophysiology increases. We queried our electronic database for deaths meeting inclusion criteria from 1989 to 2008 and identified 305 cases, of which 81% were males and 19% were females. A full autopsy was performed in 38.7% of cases and an external exam was performed in the remaining cases (61.3%). The manner of death distribution was accident (80%), homicide (7%), natural (7%), suicide (4%) or undetermined (2%). The most common mechanisms of spinal cord injury were motor vehicle accidents (42.6%), fall from a standing height (12.8%), fall from above a standing height (9.2%) and gunshot wounds (8.8%). The mechanism of spinal cord injury significantly impacted survival (p=0.0001) with decedents injured from motor vehicle accidents having a mean survival time of 14.4 years compared to 0.7 year from falling from a standing height. Analyzing patterns of deaths due to TSCI in a medical examiner office provides excellent epidemiological data for injury tracking and prevention as well as a context for medical examiners evaluating TSCI.

Ocular surface squamous neoplasia masquerading as superior limbic keratoconjunctivitis

To report a case of ocular surface squamous neoplasia (OSSN) masquerading as superior limbic keratoconjunctivitis (SLK). A 62-year-old woman was referred with foreign body sensation, irritation, photophobia and decreased vision in the left eye. She was initially treated for 10 months with intermittent topical corticosteroids for a presumed diagnosis of SLK. She underwent excisional biopsy of the superior conjunctiva and was found, on histopathologic evaluation, to have OSSN with moderate to marked dysplasia. This is the first reported case of OSSN masquerading with signs and symptoms of SLK. Any ocular surface lesion refractory to standard medical treatment should raise suspicion for a malignant process and warrant further cytologic or histopathologic evaluation.