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Forensic Science
Suicide by Ligature Strangulation: Three Case Reports
by Demirci, Serafettin; Dogan, Kamil Hakan; Erkol, Zerrin; Gunaydin, Gursel
[30 Nov 2009 at 6:00pm]
Suicide by ligature strangulation, which gives the initial impression of a homicide, is very rare. In this article, 3 suicidal death cases caused by ligature strangulation in Konya between 2001 and 2006 are presented. The first victim was a 68-year-old man who suffered from depression and lived alone in a cottage house. He terminated his life by applying a tourniquet to his neck after leaving a suicide note. The second victim was a 70-year-old woman who was found dead on the floor of the living room in her house. After she cut the vessels in her wrist, she tied pantyhose with 3 knots around her neck. It was reported that she had been intermittently receiving treatment for bronchial asthma and depression for 20 years. The third victim was a 30-year-old woman who suffered from schizophrenia for 6 years. She tied a scarf around her neck with 3 knots and died in the hospital after 1 day due to "hypoxic brain syndrome." As a result of the death scene investigations, autopsies, and judicial inquiries, it was concluded that death was by suicide in all 3 cases. Because the use of the ligature strangulation method, and particularly the tourniquet method, in suicidal cases is extremely rare in the literature, our aim is to present and discuss these cases.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Death Due to Hemorrhagic Shock After Delayed Rupture of Spleen: A Rare Phenom...
by Kodikara, Sarathchandra
[30 Nov 2009 at 6:00pm]
Delayed splenic rupture after blunt trauma is rare and contributes to a significant mortality rate. As this is accompanied by a period of clinical quiescence, a close clinical vigilance is required for early diagnosis and surgical intervention. A case report on death because of delayed rupture of healthy spleen after blunt trauma is presented. The pathophysiology of delayed rupture and importance of early detection are discussed. The case presented is the first known case of death due to delayed splenic rupture in Sri Lanka.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Death of a Child From Topical Diphenhydramine
by Turner, Jane Willman
[30 Nov 2009 at 6:00pm]
Diphenhydramine is a drug readily available over the counter in the form of capsules, tablets, and syrup used for allergy relief. A topical form is sold as a cream without a prescription to alleviate itching. Diphenhydramine is a drug commonly found in postmortem toxicology reports. In rare instances, death is attributed to ingestion of lethal concentrations of the drug. Herein is a report of a toddler who died of lethal concentrations of diphenhydramine from topical application.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Sudden Death due to Nontraumatic Diaphragmatic Hernia in an Adult
by DeAlwis, Kanthi; Mitsunaga, Erin M.
[30 Nov 2009 at 6:00pm]
Sudden death in an adult due to an undiagnosed congenital diaphragmatic hernia (CDH) is a very rare occurrence. The majority of adults who experience discomfort related to their condition have experienced some kind of trauma prior to symptom manifestation; however, there can be the cases that are exceptions to a medical trend. In the following, we present a case of an adult female who died from an undiagnosed congenital diaphragmatic hernia without any prior traumatic event or significant medical history. In these situations, early diagnosis and rapid surgical intervention are necessary for successful treatment of affected individuals.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Parasailing Fatalities in Southwest Florida
by Wolf, Barbara C.; Harding, Brett E.
[30 Nov 2009 at 6:00pm]
Parasailing is a recreational sport that is generally considered to be of little risk to the participants. Typically, the passenger launches from a motorboat with a specially designed winch that pulls him or her back to the boat at the end of the ride. The sport is not regulated at the federal, state, or county level. There have been few reports of injuries to parasailors. Additionally, there have been only 2 fatalities reported to the United States Coast Guard in a 10-year review. We report the details of these 2 deaths, those of a mother and daughter riding in a tandem parasail, which occurred on Fort Myers Beach in 2001, as well as an additional case of a parasailing fatality that occurred in southwest Florida in 1999. These cases illustrate the injuries seen in such fatalities and the hazards posed by adverse weather conditions and faulty equipment, as well as the impairment of passenger judgment by drugs and/or alcohol.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Head Motions While Riding Roller Coasters: Implications for Brain Injury
by Pfister, Bryan J.; Chickola, Larry; Smith, Douglas H.
[30 Nov 2009 at 6:00pm]
The risk of traumatic brain injury (TBI) while riding roller coasters has received substantial attention. Case reports of TBI around the time of riding roller coasters have led many medical professionals to assert that the high gravitational forces (G-forces) induced by roller coasters pose a significant TBI risk. Head injury research, however, has shown that G-forces alone cannot predict TBI. Established head injury criterions and procedures were employed to compare the potential of TBI between daily activities and roller coaster riding. Three-dimensional head motions were measured during 3 different roller coaster rides, a pillow fight, and car crash simulations. Data was analyzed and compared with published data, using similar analyses of head motions. An 8.05 m/s car crash lead to the largest head injury criterion measure of 28.1 and head impact power of 3.41, over 6 times larger than the roller coaster rides of 4.1 and 0.36. Notably, the linear and rotational components of head acceleration during roller coaster rides were milder than those induced by many common activities. As such, there appears to be an extremely low risk of TBI due to the head motions induced by roller coaster rides.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Subcutaneous Corn Oil Injections, Fat Embolization Syndrome, and Death
by Hain, John Randolph
[30 Nov 2009 at 6:00pm]
An unlicensed practitioner performing subcutaneous injections of large volumes of corn oil caused the death of one of her clients and life-threatening neurologic complications of a second client from systemic fat embolism. Several additional clients also came forward to report other serious complications they had suffered from similar procedures. The clinicopathologic and investigative findings from these cases are described. In both instances of fat embolization, the diagnosis was overlooked by hospital staff because of insufficient or misleading clinical history. The local and systemic pathologic manifestations of corn oil injections in 1 victim who died several days later from multiple organ failure are described. The clinical history and course of another who survived after 8 days of hospitalization are also presented. Similarities with complications from other forms of cosmetic oil injections are discussed. Laboratory analyses applied to confirm the nature of the injected oil and the course of criminal prosecution are also described.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Postmortem Findings After Anaphylactic Reactions to Drugs in Turkey
by Yilmaz, Riza; Yuksekbas, Ozlem; Erkol, Zerrin; Bulut, Erkut R.; Arslan, Murat N.
[30 Nov 2009 at 6:00pm]
Aims: To determine the frequency of anaphylactic deaths at autopsies performed in Turkey between January 2001 and June 2006 and to review the circumstances of death and autopsy findings.
Methods: The Council of Forensic Medicine database in Istanbul was searched for anaphylactic deaths. Postmortem reports and medical records were reviewed to determine the circumstances of death. Data about basic demographics, medical history, drugs responsible for allergic reactions, and pathologic findings at autopsy were collected.
Results: A total of 36 anaphylactic deaths from drugs were identified for the study period. Death was due to antibiotics in 26 cases, analgesics in 7 cases, an intraoperative drug in 1 case, an H2 receptor in 1 case, and intravenous contrast medium in 1 case. Out of 36 cases, 19 were male and 17 female. They were aged between 1 and 74 years with the median age of 26.7 years. Death occurred within 1 hour of the onset of anaphylaxis in 27 cases. Findings at autopsy included nonspecific pulmonary edema and congestion, upper airway edema, cerebral hypoxia, and cutaneous edema. Serum tryptase levels were not measured in all cases.
Conclusion: Anaphylactic reaction is an uncommon cause of sudden death. In many cases, no specific macroscopic or microscopic findings were detected at autopsy. When serum tryptase levels cannot be determined, in the presence of typical clinical records, eye witness reports and autopsy findings can be useful diagnostic aids.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Survey of Sudden Death From Aneurysmal Subarachnoid Hemorrhage in Cadavers Re...
by Sheikhazadi, Ardeshir; Gharehdaghi, Jaber
[30 Nov 2009 at 6:00pm]
Background and Aim: Some cases with aneurysmal subarachnoid hemorrhage (SAH) never reach the medical centre alive and they are not included in most studies of SAH. To explain the clinical profile of sudden death from aneurysmal SAH, we examined the epidemiology and clinicopathologic characteristics of patients with aneurysmal SAH who never reached medical attention or died within first 24 hours of the onset of first symptoms.
Materials and Methods: Using the autopsy records in Legal Medicine Organization of Tehran, we identified all cadavers who were diagnosed with aneurysmal SAH between 2001 and 2005.
Results: There were 85 women and 60 men with a mean age of 50 years. Twenty patients (14%) died without reaching medical care and 58 (40%) died within first 24 hours of the onset of first symptoms. The remnant had died after 24 hours to 28 days of hospitalization. In comparing patients with sudden death versus remnant, the main variables were the frequency of posterior circulation aneurysms that was found in 59% compared with 19.4% in those who had died after 24 hours, intraventricular hemorrhage 53.8% versus 19.4%, and pulmonary edema 92.3% versus 34.3% (P = 0.01).
Conclusion: In our population, the frequency of sudden death from aneurysmal SAH has not changed during the last 5 years. The typical clinical profile of sudden death in SAH includes intraventricular hemorrhage, pulmonary edema, and a ruptured posterior circulation aneurysm. Intracerebral hemorrhage is rarely connected to sudden death from aneurysmal SAH.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Observations on Increased Accidental Asphyxia Deaths in Infancy While Cosleep...
by Li, Ling; Zhang, Yang; Zielke, Ron H.; Ping, Yan; Fowler, David R.
[30 Nov 2009 at 6:00pm]
The Office of the Chief Medical Examiner (OCME) has recorded a significant increase of accidental asphyxia deaths in infancy associated with cosleeping in the state of Maryland in 2003. A total of 102 infants died suddenly and unexpectedly during 2003 in the state of Maryland. Of the 102 infants, 46 (45%) were found cosleeping. The frequency of cosleeping among these 102 infants was 28% (29/102) for black infants and 15% (15/102) for white infants. Ten of the 46 cosleeping infant deaths (20%) were determined to be the result of accidental asphyxia, and 28 cosleeping infant deaths (59%) were classified as "undetermined" because the possibility of asphyxia due to overlay while cosleeping could not be ruled out. Only 21 cases were determined to be Sudden Infant Death Syndrome (SIDS), which is consistent with the continuous decline of SIDS death in Maryland since 1994. The age of asphyxiated cosleeping infants ranged from 15 days to 9 months. Nine out of the 10 asphyxia deaths were black infants. The most common sleeping location of the asphyxia infants was on a couch/sofa, followed by an adult bed.
Crib availability was documented in all of the cosleeping cases. A majority (61%) of the cosleeping infants (28/46) had an available crib or bassinet at home and 9 out of 10 asphyxiated cosleeping infants had a crib at home at the time of the incident.
This report focuses on the detailed scene investigation findings of infant victims who died of asphyxia while cosleeping. The shift of diagnosis in sudden infant death investigation is also addressed.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Hemorrhagic Lividity of the Neck: Controlled Induction of Postmortem Hypostat...
by Pollanen, Michael S.; Perera, S D. Channa; Clutterbuck, David J.
[30 Nov 2009 at 6:00pm]
Postmortem hypostasis (livor mortis or lividity) is classically defined as the intravascular pooling of blood in gravitationally dependent parts of the body after death. However, intense lividity can be associated with small hemorrhages in the skin, so-called postmortem hypostatic hemorrhages (Tardieu spots). Postmortem hypostatic hemorrhages seem to contradict the usual understanding of lividity, since hemorrhage is by definition an extravascular phenomenon. Substantive medicolegal difficulties can arise if such hemorrhagic lividity develops in the necks of bodies that have ventral lividity due to prone position at the death scene. To study this phenomenon, we have developed a model for the controlled formation of hypostatic hemorrhages in human cadavers. In this model, extensive hypostatic hemorrhages or hemorrhagic lividity could be reproducibly but not universally induced in the soft tissues of the anterior neck and strap muscles. Histologic examination revealed hemorrhage that was microscopically indistinguishable from the acute hemorrhages observed in contusions. In addition, some larger areas of interstitially extravasated blood showed "buffy coat"-sedimentation separation of neutrophils that closely mimicked acute inflammation, further confounding the correct diagnosis. This research implies that hypostatic hemorrhages form after the progressive development of increasing gravitational hydrostatic pressure in an autolysing venous plexus. Thus, this phenomenon can mimic soft tissue injury ("pseudo-bruising") and the internal injuries related to strangulation. Caution must be exercised when diagnosing strangulation in bodies with anterior neck lividity.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Cardiac Contusion and Hemopericardium in the Absence of External Thoracic Tra...
by Gonin, Julie; de la Grandmaison, Geoffroy Lorin; Durigon, Michel; Paraire, François
[30 Nov 2009 at 6:00pm]
The case of an unusual homicidal cardiac contusion is described. A previously healthy 24-year-old woman suddenly died after being kicked on the chest by her boyfriend. A forensic autopsy was performed showing no external sign of thoracic trauma. An hemopericardium and a cardiac contusion of the basal and posterior surface of the left ventricle were found to be the cause of the death. Death could be a direct consequence of the myocardial contusion through electrical instability or/and consequence of the hemopericardium because its volume and sudden apparition were sufficient to cause tamponade. Numerous associated recent skin contusions mainly located on the face were consistent with inflicted blunt force trauma, supporting homicide as a manner of death. This case report underlines the importance of a systematic complete autopsy in all cases of sudden death occurring in a young adults, to rule out a possible homicide. The present case also shows that myocardial injury must be ruled out in every living patient presenting blunt chest trauma even in the absence of external sign.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Delayed Homicides and the Proximate Cause
by Lin, Peter; Gill, James R.
[30 Nov 2009 at 6:00pm]
Delayed homicides result from complications of remote injuries inflicted by "the hands of another." The investigation of delayed homicides may be a challenge due to a number of factors including: failure to report the death to the proper authorities, lack of ready and adequate documentation of the original injury and circumstances, and jurisdictional differences between the places of injury and death. The certification of these deaths also requires the demonstration of a pathophysiologic link between the remote injury and death. In sorting through these issues, it is helpful to rely upon the definition of the proximate cause of death.
Over a 2-year period in New York City, there were 1211 deaths certified as homicide of which 42 were due to injuries sustained greater than 1 year before death. The survival interval ranged from 1.3 to 43.2 years. The most common immediate causes of death were: infections (22), seizures (7), and intestinal obstructions/hernias (6). Common patterns of complications included infection following a gunshot wound of the spinal cord, seizure disorder due to blunt head trauma, and intestinal obstruction/hernia due to adhesions from an abdominal stab wound. Spinal cord injuries resulted in paraplegia in 14 instances and quadriplegia in 8. The mean survival interval for paraplegics was 20.3 years and 14.8 years for quadriplegics; infections were a frequent immediate cause of death in both groups, particularly infections due to chronic bladder catheterization.
The definition of proximate cause originated with civil law cases and was later applied to death certification as the proximate cause of death. The gradual extinction of the "year and a day rule" for the limitation of bringing homicide charges in delayed deaths may result in more of these deaths going to trial. Medical examiners/coroners must be able to explain the reasoning behind these death certifications and maintain consistent standards for the certification of all delayed deaths due to any injury (homicides, suicides, and accidents).
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Drug-Facilitated Sexual Assault Provoked by the Victim's Religious Beliefs: A...
by Maravelias, Constantine; Stefanidou, Maria; Dona, Artemis; Athanaselis, Sotiris; Spiliopoulou, Chara
[30 Nov 2009 at 6:00pm]
The number of drug-facilitated sexual assault incidents has lately been increased all over the world leading law enforcement agencies and hospital doctors to constant alert. The drugs involved may be benzodiazepines, hypnotics, other sedatives, anesthetics, drugs of abuse or ethanol. The detection of these agents in biologic fluids is difficult, since most of them are shortly acting, and provoke victim's amnesia which in turn leads the victim to report the allegation late. An unusual case-study of a 35-year-old, married woman who was admitted to the hospital with dizziness and loss of memory for a period of 10 days is here reported. The toxicological analysis of the victim's blood and urine for unknown sedative drugs, achieved by GC-MS, revealed the presence of zolpidem (Stilnox), a nonbenzodiazepine hypnotic. Concentration of zolpidem in blood, 11 hours after the last supposedly intake, was 47 [mu]g/L. After family counseling at the hospital, the victim's husband confessed that he was replacing the contents of Losec capsules of his wife, with Stilnox tablets. This unjust act was committed by the husband in order for him to have sex with his wife, since she was not willing to participate in a sexual intercourse due to her religious restraints for a fasting period of 40 days. The aim of this article is 2-fold. First, to emphasize the fact that a sexual assault can take place not only between 2 strangers, but also within a happily married couple. Second, to remind doctors that any case of sexual assault must be examined toxicologically, for a better and thorough investigation.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Black Powder Handgun Deaths Remain an Uncommon Event
by Hartwig, Sven; Tsokos, Michael; Byard, Roger W.
[30 Nov 2009 at 6:00pm]
Although it was predicted that there would be an increase in the use of black powder guns due to their greater ease of procurement with less government control on sales, this does not seem to have been the general experience. To determine the rate of use of black powder handguns in shooting deaths in Berlin, Germany, review of the files of the Institute of Legal Medicine and Forensic Sciences, Charite-Universitatsmedizin Berlin was conducted over a 10-year period from 1997 to 2006. Out of total 85 gunshot deaths, there were only 3 where black powder handguns were used (3.5%). The cases involved 3 males aged 55, 62, and 63 years, respectively, all of whom had committed suicide with black powder percussion handguns, using 0.45, 0.56, and 0.36 caliber weapons. The source of the guns could not be determined. Wounds were characterized by excessive soot and propellant soiling and tattooing. The low number of fatalities involving black powder guns in a large forensic institution in Berlin, Germany, suggests that limiting access to such weapons would have little effect on total numbers of gunshot deaths. Simple loading mechanisms and reliability appear to be more important features influencing the choice of a handgun, rather than mere availability.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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The Medical Examiner/Coroner's Guide for Contaminated Deceased Body Management
by Hanzlick, Randy; Nolte, Kurt; deJong, Joyce; The National Association of Medical Examiners Bioterrorism and Infectious Disease Committee
[30 Nov 2009 at 6:00pm]
In the past few years, a number of publications and other resources have appeared concerning the management of mass fatality incidents. Some are geared toward the general management of incidents while others cover more specific topics such as decontamination procedures. Still others cover selected agents, including chemical, biologic, or radiologic ones. Few publications have been written specifically for medical examiners and coroners.
The Medical Examiner and Coroner's Guide for Contaminated Deceased Body Management is written specifically for the medical examiner or coroner who will be in charge of investigations of fatalities that result from terrorism or other events that result in contaminated remains. In some such cases, agents may be used that will require mitigation of environmental hazards and decontamination of human bodies. To that end, this Guide provides information and suggestions that may be useful in understanding the principles involved in decontamination procedures, recognizing that it may not be the medical examiner or coroner staff who actually conducts decontamination procedures.
The suggestions in this guide may differ slightly from those in other publications. However, those who have contributed to this guide believe that the recommendations are practical, workable, have a scientific basis, and do not differ much in substance when compared with other relevant publications.
The contents of this Guide may be reproduced for practical use but the Guide may not be sold and it may not be cited for advertisement purposes. Reference to specific commercial products is for informational purposes only and does not constitute endorsement of the product or company which produces the product.
The recommendations contained in this Guide are not mandated nor are they required by federal, state, or local law. Rather, the recommendations are intended to assist medical examiners and coroners for the purposes of planning and providing a set of reasonable practice guidelines for incident response.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Reconstruction of the Weapon in a Case of Homicidal Decapitation
by Turillazzi, Emanuela; Di Donato, Sabina; Fiore, Carmela; Fineschi, Vittorio
[30 Nov 2009 at 6:00pm]
Decapitation as homicidal mode of death is relatively rare. In most cases of decapitation, the differentiation between the modes of death might be difficult to some extent, particularly in cases where essential investigative elements, like the decedent's head and the weapon, are unavailable. Our report concerns a case of homicide by decapitation without any further mutilation of the victim, where only the combination of autopsy results, histologic findings, and engineering technical reconstruction allowed us to identify with certainty the mode of death as vital decapitation. The technical reconstruction of the alleged weapon allowed the identification and the discovery of the hand saw used by the murderer to decapitate the victim.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Three Cases of Death Caused by Shots From Blank Cartridge
by Zdravkovic, Miodrag; Milic, Miroslav; Stojanovic, Miroslav; Kostov, Milos
[30 Nov 2009 at 6:00pm]
The authors describe 3 cases of lethal injuries caused by 7.62 mm blank cartridge shots from military automatic rifle of domestic origin (AK 47, 7.62 mm). In 1 case, the cartridge was fired from a weapon that had been leaned on the head, with subsequent destruction of brain, and in other 2 cases, the weapon had been leaned on the chests, which led to destruction of heart parts. The injuries were caused by the action of striking wave of gunpowder explosion, the air blast type. The cases demonstrate that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall and the skull.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Unexpected Intrauterine Fetal Death in Parvovirus B19 Fetal Infection
by Silingardi, Enrico; Santunione, Anna Laura; Rivasi, Francesco; Gasser, Bernard; Zago, Silvia; Garagnani, Lorella
[30 Nov 2009 at 6:00pm]
Parvovirus B19 infection during pregnancy can be transmitted to the fetus through the placenta. The consequences for the health of the fetus are very variable and can be very serious. They include intrauterine fetal death (IUFD) and miscarriage, which can lead to medico-forensic questions. For the most part, cases of IUFD take place during the second trimester of gestation and present an anatomopathologic picture characteristic of fetal infection with hydrops, placental edema, serous effusion, and erythroblastosis with nuclear inclusions. Endocardial fibroelastosis, medullar and thymic hypoplasia, and hepatic hemosiderosis are frequently present. In the third trimester, the cases are less frequent, not accompanied by hydrops, and can depend more on placental compromise than on direct infection of the fetus. We present 5 cases of IUFD resulting from parvovirus B19 and we discuss the pathogenetic and anatomopathologic aspects and obstetric liability. In 4 cases, the IUFD took place suddenly, in the absence of symptoms, in women who had not previously shown any symptom of the viral infection. In one case, the patient was hospitalized following an ultrasound diagnosis of fetal hydrops and IUFD took place 5 days after admission. Of these cases 3 were verified in the second trimester and 2 in the third trimester. Only the cases of the second trimester and one of the 2 cases of the third trimester presented the characteristic aspects of fetal infection. The other case of third trimester was characterized by placental involvement.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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A Survey of Self-Mutilation From Forensic Medicine Viewpoint
by Taghaddosinejad, Fakhredin; Sheikhazadi, Ardeshir; Yaghmaei, Asadolah; Vakili, Vida; Saberi, Seyed Mehdi; Behnoush, Behnam
[30 Nov 2009 at 6:00pm]
Objectives: Currently little research exists examining self-mutilation (SM) in samples of forensic referrals. The present study provides a comprehensive review on the frequency, etiology, and morphologic characteristics of self-inflicted injuries in a sample of outpatients' forensic referrals.
Methods: In a prospective cross-sectional study, during 3 years, we examined 9874 outpatients' forensic referrals and found 1248 SM cases in Ghouchan (an urban and suburban area of Iran).
Results: Based on forensic medical examinations, it was found that 12.6% of all outpatients' forensic referrals had engaged in SM behavior at sometime. Males had significantly higher rates of SM than females (76.9 vs. 23.1%, respectively). The mean age was found to be significantly lower in patients with SM (23.6 +/- 8.5) than patients without SM (40.0 +/- 10.5) (P < 0.001). Rate of being single and unemployed was higher in the SM group (58.2, 56.1%, respectively) than in the group without SM (19.1, 22.8%, respectively). Superficial cuts and scratches were found to be the most common type of SM (79.5%), followed by bruises (10.8%), burns (3.4%), deep cuts (3.2%), fractures (0.6%), and other miscellaneous injuries (2.5%). Upper extremities including forearms, wrists, and arms opposite the dominant hand were the most common areas of injury.
Conclusions: Nonsuicidal self-injury, the deliberate-direct destruction of body tissue without suicidal intent is a relatively common event in forensic referrals. It is very important to distinguish between this and other types from forensic point of view. Forensic practitioners must be expert and trained for this purpose.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Epidemiology of Intimate Partner Homicide-Suicide Events Among Women of Child...
by Krulewitch, Cara J.
[30 Nov 2009 at 6:00pm]
Intimate partner homicide-suicide (IPH-IPS) among women during the childbearing years leaves irreversible outcomes that are devastating and have lasting repercussions for surviving children, families, and communities. An estimated one-third of all intimate partner homicides of women aged 15 to 50 end in suicide. The purpose of this study was to describe the temporal trends and characteristics of both victims of IPH-IPS. Data were collected using a retrospective, cross-sectional analysis of medical examiner records for women aged 10 to 50 in Maryland, during 1994-2003. Seventy-five IPH-IPS incidents were identified over the 10-year period. Of those, 94.7% were a female homicide followed by a male suicide. The average rate of IPH-IPS was 0.52 per 100,000 women aged 10 to 50. About half of the couples were within 5 years of the age of each other, married or separated and the same race. Eleven percent of the women were pregnant/1-year postpartum when they died. The findings presented represent a significant public health problem that has a unique pattern compared with other populations studied. Understanding this problem involves a more comprehensive assessment of both victims. There is a need for a national surveillance system that identifies IPH-IPS events and provides information on both victims that includes individual and relationship characteristics.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Sudden Death After Exercise in an Adolescent With Hemoglobin SE
by Arbefeville, Elise F.; Tebbi, Cameron K.; Chrostowski, Leszek; Adams, Vernard I.
[30 Nov 2011 at 6:00pm]
Abstract: Hemoglobin (Hb) S and Hb E are the most common variant hemoglobins, but because of the geographical separation of the areas where they are prevalent, the combination of the 2 is uncommon. Approximately 46 cases of hemoglobin SE compound heterozygosity have been reported. No deaths from the condition have been reported previously, whereas death after vigorous physical activity in individuals with sickle cell trait (hemoglobin AS) has been described in a few case reports. Here we report previously undiagnosed hemoglobinopathy SE in a 12-year-old American boy who collapsed during football practice and had a cardiac arrest on the field after a brief lucid interval. The autopsy was significant only for postmortem intravascular sickling. A postmortem hemoglobin electrophoresis test revealed 57% S, 34% E, and 1% F hemoglobins. The death is attributed to cardiac ischemia from functional vaso-occlusion by sickled erythrocytes.
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Two-Handed Cardiopulmonary Resuscitation Can Cause Rib Fractures in Infants
by Matshes, Evan W.; Lew, Emma O.
[30 Nov 2010 at 6:00pm]
The discovery of acute rib fractures in deceased infants and young children can be unsettling. Although significant injuries may occur subsequent to resuscitative efforts in adults, it is well documented that such injuries are rare in much younger individuals. In particular, it is considered exceptional for rib fractures to follow cardiopulmonary resuscitation (CPR) on an infant; thus, some pathologists will consider such a discovery to be evidence of abuse. However, little is known about what, if any, injuries might occur subsequent to the delivery of "2-handed" CPR. Five unrelated, nonsequential cases of infant death are reported where multiple acute anterolateral rib arc fractures followed 2-handed CPR delivered by trained medical personnel.
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Deaths Related to Chemical Burns
by Pavelites, Joseph J.; Kemp, Walter L.; Barnard, Jeffrey J.; Prahlow, Joseph A.
[30 Nov 2011 at 6:00pm]
Abstract: The authors present a series of 6 deaths due to the uncommon cause of chemical burns. Of the 6 deaths due to chemical burns, 4 deaths were due to ingestion of a chemical, 1 death was caused by chemical burns of the skin, and 1 death resulted from rectal insufflation of a chemical. Seven additional cases where chemical burns may have been a contributing factor to the death or an incidental finding are also presented. Four cases are related to an incident involving chemical exposure during an industrial explosion. Three cases involve motor fuel burns of the skin. Two cases concern a plane crash incident, and 1 case involved a vehicular collision. Cases are derived from the records of the Dallas County Medical Examiner?s Office and those of the authors? consultation practices. Each of the cases is presented, followed by a discussion of the various mechanisms of chemical injury.
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Usefulness of Catheter Guide Wires for Identifying Sites of Vascular Injuries
by Takahashi, Shirushi; Kinoshita, Hiroshi; Funayama, Masato
[30 Nov 2011 at 6:00pm]
Abstract: We report 2 cases in which catheter guide wires were useful for detection of vascular injury site. Case 1: A woman was died of hemorrhagic shock after being slashed at the extremities, but the vessels were so collapsed that it was not easy to find the injured site. After a wound track on the left forearm was cut open and a guide wire was inserted, the injury site was detected expeditiously at the left radial artery. Case 2: A woman was stabbed and died of hemorrhagic shock. An autopsy revealed 2 stab wounds in the back, one of which made a cut in the left lung. The wound track was cut open, and the injured vessel was revealed. It was too small in diameter to macroscopically determine whether the injured branch arose from, and so a guide wire was introduced from the injured site, and the injured vessel was easily determined to be a branch of the left pulmonary artery. Guide wires have many features, such as elasticity, flexibility, and hydrophilicity, which are considered to be applicable to forensic uses. The guide wire technique is easy, less invasive, highly vasoselective, and reproducible in identifying vascular injury sites.
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Foreign Body Penetration of the Fontanelle: Mechanisms and Manner of Death
by Byard, Roger W.; Blumbergs, Peter
[31 Aug 2011 at 7:00pm]
Penetrating injuries of the anterior fontanelle are exceedingly uncommon and are most often associated with inflicted injury. This report of an 11-month-old boy, who fell backward onto a lampshade strut that penetrated his anterior fontanelle and left frontal lobe, demonstrates that accidental injuries may also rarely occur. Death was due to hypoxic-ischemic encephalopathy complicating raised intracranial pressure after a penetrating injury of the brain. Careful evaluation of the death scene with reconstruction incorporating the autopsy findings was required to establish the veracity of the history and the credibility of the proposed sequence of events. Mechanisms of death after penetrating injuries of the fontanelle include immediate effects from direct damage to cerebral vital structures or blood vessels with hemorrhage or delayed effects from either cerebral edema with hypoxic-ischemic encephalopathy or sepsis.
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Double Suicide
by Marcikic, Mladen; Vuksic, Zeljka; Dumencic, Boris; Matuzalem, Elizabeta; Cacinovic, Vesna
[31 Aug 2011 at 7:00pm]
Most suicides are solitary and private; but few result from a pact between 2 people to die together. Two young men made a pact to commit suicide by hanging from a tree. It was the first case among 1320 single suicides in more than 2 decades in eastern Croatia. Double suicide between people of the same gander is an unusual event. It is predominantly made by male-female partners and by less violent methods. One of the 2 members experienced depression. He may have been the initiator and the other partner may have been the dependent. The initiator usually plans the act and stimulates the other party.
Whether the decision was evenly shared by both partners and initiative came from one of the two or it was result of 2 independent decisions remains open for analysis. Double suicide is also very interesting from the perspective of medical examiners. They need to make comprehensive postmortem examination to finally conclude the proper cause and the manner of death.
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An Unusual Case of Lead Snowstorm Caused by Fragmentation of Buckshot
by Pavelites, Joseph J.; Prahlow, Joseph A.; Landrum, Jeffry E.; Zollinger, David; Vermillion, Daniel
[31 Aug 2011 at 7:00pm]
This article reports the unusual radiographic findings of 2 cases of a shotgun shooting incident involving the homicide of a plant manager and the subsequent suicide of the assailant. Radiologic examination of wounds produced by the no. 00 copper-plated buckshot used in the incident revealed images with striking similarity to the lead snowstorm appearance generally associated with high-velocity, soft-point rifle bullets.
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State of the Art in Forensic Investigation of Sudden Cardiac Death
by Oliva, Antonio; Brugada, Ramon; D'Aloja, Ernesto; Boschi, Ilaria; Partemi, Sara; Brugada, Josep; Pascali, Vincenzo L.
[28 Feb 2011 at 6:00pm]
The sudden death of a young person is a devastating event for both the family and community. Over the last decade, significant advances have been made in understanding both the clinical and genetic basis of sudden cardiac death. Many of the causes of sudden death are due to genetic heart disorders, which can lead to both structural (eg, hypertrophic cardiomyopathy) and arrhythmogenic abnormalities (eg, familial long QT syndrome, Brugada syndrome). Most commonly, sudden cardiac death can be the first presentation of an underlying heart problem, leaving the family at a loss as to why an otherwise healthy young person has died. Not only is this a tragic event for those involved, but it also presents a great challenge to the forensic pathologist involved in the management of the surviving family members. Evaluation of families requires a multidisciplinary approach, which should include cardiologists, a clinical geneticist, a genetic counselor, and the forensic pathologist directly involved in the sudden death case. This multifaceted cardiac genetic service is crucial in the evaluation and management of the clinical, genetic, psychological, and social complexities observed in families in which there has been a young sudden cardiac death. The present study will address the spectrum of structural substrates of cardiac sudden death with particular emphasis given to the possible role of forensic molecular biology techniques in identifying subtle or even merely functional disorders accounting for electrical instability.
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Numerous Cortical Tubers and Rhabdomyomas in a Case of Sudden Unexpected Infa...
by Izevbaye, Iyare; Sun, Jianlan; Fazlollah, Loghmanee
[30 Nov 2011 at 6:00pm]
Abstract: Sudden infant death syndrome is the leading cause of death in infants between the ages of 1 month to 1 year. Sudden infant death syndrome, a diagnosis of exclusion, can only be made after other explanations for unexpected death have been ruled out. Tuberous sclerosis complex is occasionally the findings in these patients with unexpected infant death. Here, we present a case of an unexpected infant death during sleep with multiple factors that confound the cause of death. We discuss these factors and attempt to delineate their contributions to arrive at a cause and mechanism of death.
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Accidental Fetal Decapitation: A Case of Medical and Ethical Mishap
by Hiss, Jehuda; Kahana, Tzipi; Burshtein, Irad
[31 Aug 2011 at 7:00pm]
Blunt trauma to the head and neck of a newborn during delivery process is a rare event. We report a peculiar case of decapitation of a live fetus during vacuum-assisted delivery, where excessive traction on the head of the full-term macrosomic fetus with shoulder dystocia resulted in overstretching of the neck up to the point of decapitation. The ethical considerations related to the case are discussed in light of the policy of complete transparency advocated by the medical profession. Despite the existence of regulations regarding full disclosure of errors to the medical institution, the Ministry of Health and to the patient, medical practitioners are reluctant to divulge all the details of adverse events to the patient.
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Sudden Death Due to Coronary Tree Hypoplasia
by Dermengiu, Dan; Dermengiu, Silvia; Curca, Cristian G.; Ceausu, Mihai
[31 Aug 2011 at 7:00pm]
A 20-year-old woman complained for several weeks before her death of unspecific epigastric pains. Such episodes were labeled as "dyspeptic episode." A month later, once again she started to complain about stomach pains, then she collapsed unconscious. She was rushed to a hospital, where she was admitted in cardiorespiratory arrest. An electrocardiogram revealed a ventricular fibrillation. All resuscitation efforts were unsuccessful.
The autopsy revealed nonspecific general changes (subpleural petechiae and blood pooling). Dissection of the coronary arteries revealed a normal topography of coronary arteries but a marked hypoplasia of all the subepicardial coronary arteries (maximum diameter of left anterior descending coronary artery = 1.9 mm, maximum diameter of right coronary artery = 1.43 mm). Furthermore, the left anterior descending coronary artery was slightly compressed by a fibrous bridge at about 1.5 cm of its origin; a fibrinoleukocytic thrombus has formed immediately above this bottleneck, obstructing the entire lumen of the artery.
Microscopic examination revealed an area of recent myocardial necrosis; diffuse subendocardial fibrosis, with extension into the subjacent myocardium, disorganizing the myocardial fibers; and variable thickening of the vascular walls with periarteriolar fibrosis. Weigert stain has shown marked intimal hyperplasia, either focal or diffuse, in different segments of vascular wall, accompanied by disruption of the internal elastic lamina due to subintimal cellular proliferation, in the medium branches of coronary arteries. The micrometric measurements showed that intimal thickening was at least the size of the media (?358 vs 356.8 ?m) and sometimes double.
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Dead Bodies Found in Wells
by Dogan, Kamil Hakan; Demirci, Serafettin; Erkol, Zerrin; Gulmen, Mete Korkut; Deniz, Idris
[31 Aug 2010 at 7:00pm]
Corpses found in wells or lime pits must be identified and the cause and manner of death must be determined. There are several circumstances that may lead to the presence of corpses in wells. In this study, 3940 death examinations and autopsies, performed at the Konya Branch of Forensic Medicine Council (Turkey) between 2000 and 2007, were retrospectively investigated, and it was found that 18 (0.46%) of the bodies had been recovered from wells. The cases were evaluated in terms of their demographic features, manner of death (accidental, suicidal, or homicidal), autopsy findings, cause of death, and the characteristics of the wells in which they were found. The ages of the victims ranged from 4 to 74 years, and the average age was 40. 4 +/- 20.6 years. Of total, 16 cases were males and 2 were females. The manner of death was determined to be accidental in 10 of the cases, suicide in 6 of the cases, and homicide in the remaining 2 cases. In 7 of the cases, death had occurred as a result of drowning in water. A comprehensive scene investigation and autopsy must be performed for corpses recovered from wells and pits for both identification and determination of the cause and manner of death. Wells should be covered and kept closed at all times to reduce the number of accidental deaths resulting from falls into wells.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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The Effect of Threat of Litigation on Forensic Pathologist Diagnostic Decisio...
by Oliver, William Russell
[30 Nov 2011 at 6:00pm]
Background: Recent litigation involving medical examiners has caused concern over certifying deaths.
Methods: We administered a survey of 716 medical examiners regarding the effects of the threat of litigation.
Results: Two hundred twenty-two medical examiners responded (31%). Of those who responded, approximately 13.5% admitted to having modified their diagnostic findings due to threat of litigation, and approximately 32.5% stated these considerations would affect their decisions in the future. Physicians who indicated they had or would modify their diagnoses expressed more concern over the possibility of litigation. Chiefs of services were less likely than staff members to indicate changing diagnoses. Practitioners whose jurisdictions included rural areas were significantly more likely to indicate that litigation considerations would affect their diagnoses in the future, although this was not true with those who had already modified their diagnoses. No correlation was found with elected versus appointed positions, accreditation status, sex, race, geographic location, or board certification.
Conclusions: Although very few medical examiners have actually been sued because of their diagnoses, a demonstrated threat of litigation has a substantial effect on diagnostic decision making.
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Accidental Drug Deaths in Fulton County, Georgia, 2002: Characteristics, Case...
by Graham, Jason K.; Hanzlick, Randy
[31 Aug 2008 at 7:00pm]
Background and Objectives: Historically, the duty of the medical examiner in assigning cause and manner of death in drug-related death cases has been fraught with controversial challenges. The lack of standardization in certifying drug-related deaths may involve differences among practicing forensic pathologists in their approach to such cases. The central objectives of the present study include characterization of current drug death patterns and the variability among medical examiners with respect to autopsy performance and death certification practices in one county medical examiner's office.
Materials and Methods: Death certificates, scene information/investigative reports, autopsy reports, and toxicological laboratory results for each of the 100 cases of drug-related death occurring in 2002 in Fulton County, Georgia were reviewed. Comparison of overall autopsy rates and autopsy rates in drug-related death cases for each medical examiner individually and for the group collectively was performed. In examining cocaine-related deaths (most common), statistical analysis was performed for comparison of drug concentrations (cocaine and benzoylecgonine) between deaths certified as cocaine toxicity (poisoning) versus cocaine-complicating disease or causing an adverse event such as cerebral hemorrhage.
Results: Causes of accidental drug deaths included cocaine 40%, mixed drug intoxication 37%, opioids 10%, ethanol 7%, and prescription medication (nonopioid) 5%. Overall total autopsy rates in 2002 for each of the 6 independent medical examiners ranged from 51% to 69% (mean 64%), whereas autopsy rates in drug-related death ranged from 55% to 91% (mean 81%). In review of the subset of 40 cocaine-related deaths, 25% were certified as cocaine toxicity (poisoning), with the remaining 75% certified as cocaine-complicating disease or causing and adverse event. Autopsy rates in cocaine-related deaths were as follows: cocaine toxicity 80%, cocaine-complicating disease 77.3%, and cocaine causing adverse event 62.5%. Thirty-eight percent of cocaine-related deaths were considered to be of "low suspicion" for drug involvement at the time the death was reported to the medical examiner with the remaining 62% being of "high suspicion". Autopsy rates were somewhat lower in the low suspicion group (67%) versus the high suspicion group (72%). Comparison of drug levels between cocaine-related death certification groups was performed. No statistically significant difference was shown in drug levels (cocaine, P > 0.3; benzoylecgonine, P > 0.2) between deaths certified as cocaine toxicity versus those certified as cocaine-complicating disease or causing adverse event.
Conclusions: In Fulton County, accidental drug deaths in 2002 most often involved cocaine either alone or in combination with opiates and/or alcohol. Cocaine, opiates, or both were involved in greater than three-fourths (77%) of all drug-related deaths. The majority of all decedents were black (57%) and male (76%) with an average age of 42.2 years. Cocaine and ethanol were more frequently detected in black decedents, whereas opiates and polydrug abuse were more common in white decedents throughout the period studied. Preliminary investigation showed a high index of suspicion for the specific drug involved in virtually all opiate and alcohol cases, and in 62% of cocaine-related cases. Overall, the 100 accidental drug deaths in 2002 accounted for 7.5% of all deaths investigated and certified by the Fulton County Medical Examiner's Office.
Our study provides further evidence to support the lack of correlation between serum drug levels and the mechanism of drug toxicity in cocaine-related deaths. No statistically significant differences were shown in parent cocaine or benzoylecgonine concentrations between those cases certified as toxicities or poisonings versus those cases certified as aggravating underlying disease or causing an adverse event. In addition, 62% of the cocaine-related death cases were considered initially to be of high suspicion for drug-related death, thus emphasizing the strong importance of scene information/investigative reports in evaluating drug-death cases and in formulating plans of action to handle each individual case. Among the drug-death cases handled by 6 staff medical examiners at the Fulton County Medical Examiner's Office, variation existed in autopsy performance and death certification practices. These issues are discussed in the context of the National Association of Medical Examiners' (NAME) Position Paper on Cocaine, NAME Forensic Autopsy Performance Standards, and other relevant literature. Most variations relate to completeness of the cause-of-death statement (whether or not comorbid conditions are included) rather than classification of manner of death within the office. However, specific wording in the cause of death may have significant ramifications regarding drug-related mortality statistics processed by the vital statistics system, with possible under-representation of drug-related deaths in single-cause mortality data.
(C) 2008 Lippincott Williams & Wilkins, Inc.
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Iatrogenic Endocardial Injury Associated With Preexisting Atrial Abnormalities
by Jolley, Tracie M.; Guileyardo, Joseph M.
[30 Nov 2009 at 6:00pm]
Considering the rising number of cardiac catheterization and pacemaker placement procedures being performed each year, it is likely that increasing numbers of deaths associated with complications from these procedures will require certification by the medical examiner. We report 2 cases of iatrogenic atrial injury related to pacemaker placement in which a preexisting cardiac abnormality increased the risk of such complications. One case was associated with an embryologic remnant known as Chiari's network, and the other case was associated with lipomatous hypertrophy of the interatrial septum. The identification of an anatomic abnormality, which results in a predisposition to iatrogenic injury may decrease the risk of costly or unnecessary litigation commonly associated with these deaths.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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A Toxicology-Based Review of Fentanyl-Related Deaths in New Mexico (1986?2007)
by Krinsky, Clarissa S.; Lathrop, Sarah L.; Crossey, Michael; Baker, Ginger; Zumwalt, Ross
[30 Nov 2011 at 6:00pm]
Abstract: Since its approval in the United States, fentanyl has become increasingly popular for the medical management of pain and as a substance of abuse. Fentanyl is unique among the opioids in its widespread use with a transdermal delivery system, which contributes to its unique pharmacokinetics and abuse potential. We examined the demographics of deaths with fentanyl identified on toxicologic analysis and reviewed specific challenges in the laboratory detection of postmortem fentanyl levels. The New Mexico Office of the Medical Investigator database was searched for all cases from January 1986 through December 2007 with fentanyl reported as present or quantified. Those deaths with a cause of death identified as drug overdose were then analyzed separately. From 1986 to 2007, 154 cases were identified with fentanyl present in postmortem samples, with 96 of the cases identified as fentanyl-related drug overdoses. The number of fentanyl-related deaths has increased over the past 20 years, corresponding to both statewide increases in the medical use of fentanyl and the abuse of prescription opioids. The demographics of these fentanyl-related overdoses showed that subjects were more likely to be female, white non-Hispanic, and older than those in previously described overdose deaths. Several cases were identified with central and peripheral blood samples and antemortem and postmortem samples available for fentanyl quantification. Given the uncharacteristic demographics of fentanyl-related deaths and the complexity of the laboratory analysis of fentanyl, forensic scientists must use caution in both the detection and interpretation of fentanyl concentrations.
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Medical Homicide and Extreme Negligence
by Duncanson, Emily; Richards, Virginia; Luce, Kasey M.; Gill, James R.
[28 Feb 2009 at 6:00pm]
Deaths that occur during medical care for the treatment of a disease are rarely certified as homicides. Some "medical" deaths, however, have been criminally prosecuted for manslaughter, reckless endangerment, or reckless homicide. We describe 5 deaths due to medical complications that underwent criminal prosecution. Three of the deaths were certified as homicides. Deaths certified as homicides due to the actions (or inactions) of a caregiver occur in 3 circumstances. The first is when the medical caregiver intentionally causes the death of the patient. The second is a death due to treatment by an unlicensed fraud or quack. The final circumstance is due to extreme medical negligence that involves a gross and wanton disregard for the well-being of the patient and is the most controversial in the medical community. The law defines reckless endangerment as the conscious disregard of a known substantial likelihood of injury to the patient. Criminal neglect typically is defined as the failure to provide timely, safe, adequate, and appropriate services, treatment, and/or care to a patient. In instances of extreme medical negligence, a homicide manner of death is appropriate because the fatality is due to the criminal acts (or inactions) of another. It also furthers one of the major goals of the medicolegal death investigation system, which is to safeguard the public health.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Gerhart Panning (1900-1944): a German Forensic Pathologist and His Involvemen...
by Preuss, Johanna; Madea, Burkhard
[28 Feb 2009 at 6:00pm]
Twenty years after the Second World War the public were made aware of War Crimes committed by the German forensic pathologist, Gerhart Panning (1900-1944). From 1942 till 1944, Panning was professor at the Institute of Forensic Medicine at the University of Bonn. Panning died of tuberculosis on 22 March 1944. After the Second World War, Panning's widow tried to obtain denazification for her husband. There were no particularly serious doubts. In 1965, Konrad Graf von Moltke, the son of Helmuth James Graf von Moltke (1907-1944), presented to the court a private letter from his father to his mother. In this letter, written in 1941, Panning's experiments on Soviet prisoners are described. In the so-called Callsen trial in the court of Darmstadt from 1960 to 1968, the experiments were confirmed by witnesses. In 1941, Panning performed experiments in cooperation with the Sicherheitsstaffel (Nazi special police) in the Ukraine to prove that captured ammunition of the soviet infantry violated international law. For this purpose, different parts of the bodies of living Soviets were used as firing targets. He published the results of these experiments in a scientific journal without any evidence of the origin of these observations. In this article, Panning's life and crimes have been described.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Autopsy Diagnosis of Fat Embolism Syndrome
by Miller, Peter; Prahlow, Joseph A.
[31 Aug 2011 at 7:00pm]
The fat embolism syndrome (FES) is considered a clinical diagnosis. It typically occurs within several days following major traumatic injury, usually involving fractures of the pelvis and/or lower extremities. Fat embolism syndrome is characterized by the onset of respiratory, neurological, cutaneous, and hematologic manifestations and is thought to be related to intravascular embolization of fat, presumably arising from within the fractured bone marrow space. In its most severe form, FES can be lethal. The presence of fat emboli within the microvasculature of the lungs, brain, and sometimes other organs verifies the clinical impression of FES. Despite its relatively well-known clinical characterization, debate exists within the clinical literature regarding the most appropriate diagnostic criteria for FES. Given this fact, along with the fact that FES is a clinical diagnosis, it is not surprising that forensic pathologists may be somewhat reluctant to make a postmortem diagnosis of FES, especially in cases where insufficient clinical information is available. A case of fatal FES is presented in which rapid clinical deterioration occurred, followed by death, such that a clinical diagnosis of FES was never rendered. We propose that, given the correct circumstances, clinical scenario, and autopsy findings, it is appropriate and acceptable to make a postmortem diagnosis of FES. A multitiered approach to the postmortem diagnosis of FES is presented.
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Sauna Deaths in Sweden, 1992-2003
by Rodhe, Axel; Eriksson, Anders
[29 Feb 2008 at 6:00pm]
Deaths from 1992 through 2003 related to sauna bathing in Sweden were collected from a national computer data base comprising all medicolegal autopsies, generating 77 cases included in this study. Of all deaths, 82% were men, most of them middle-aged. The geographic distribution seemed to be roughly related to the population density. Most bathers died on a weekend, and 84% were found dead in a sauna. In 69 cases, the blood alcohol concentration was determined; 49 (71%) of these tested positive, often with high concentrations. In 65 cases, a major disease/state that could explain death was identified; 34 (44%) of these deaths were related to alcohol and 18 (23%) cardiovascular. Other causes of death were drowning, CO poisoning, O2 deprivation, amphetamine intoxication, and burn injuries. In 13 cases, the cause of death remained undetermined. The results indicate that sauna habits in Sweden are similar to those in Finland but probably less common. The most important risk group is middle-aged men, especially those with heavy alcohol consumption. Among the cases found dead in a sauna, all but 2 were found alone. Obviously, bathing alone is a risk factor that can easily be avoided and should perhaps be emphasized more.
(C) 2008 Lippincott Williams & Wilkins, Inc.
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Precautions Taken to Avoid Abandoning the Act of Hanging and Reducing Pain in...
by Demirci, Serafettin; Dogan, Kamil Hakan; Erkol, Zerrin; Deniz, Idris
[28 Feb 2009 at 6:00pm]
This study presents 17 cases of hanging with some preventative measures, when compared with usual hanging fatalities, between 2002 and 2006 in the province of Konya, Turkey. We observed in 4 cases that the victim had only tied together their hands, whereas in 1 case both the hands (with a clothesline) and mouth (with a plastic bag) had been fastened. In a further case, the oral orifice had been closed using a scarf and in the remaining 11 cases, soft materials such as a scarf, hood, the collar of a coat or shirt had been used as padding against the ligature loop. At first glance, the cases where the victim's hands and/or mouth were found tied were thought to be homicides. However, an investigation of the death scene, together with the autopsy findings and inquiry data, showed the cause of death was from suicide.
Thus, in suicidal hanging cases certain precautions and preventative measures were observed. For example, tying the hands together was regarded as a means to make self-release impossible; closure of the oral orifice as a means to prevent the victim from calling out for help, and placing soft material against the ligature loop was thought to be an attempt to lessen the feeling of pain.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Fatal Overdose Due to Prescription Fentanyl Patches in a Patient With Sickle ...
by Biedrzycki, Olaf J.; Bevan, David; Lucas, Sebastian
[31 May 2009 at 7:00pm]
Introduced into clinical practice in the 1960s, the analgesic fentanyl is 100 times more potent than morphine. Various methods of administration exist including the transdermal Duragesic patch system, widely used in chronic pain and palliative care settings. Numerous, often imaginative methods of abuse of fentanyl patches have been reported; the majority of fatal fentanyl overdose cases resulting from deliberate abuse or suicide. We describe the accidental overdose of a young black male with sickle cell/[beta]-thalassemia who had been using the Duragesic system for almost 2 years.
At autopsy the macroscopic findings were of nonspecific opiate overdose with congested heavy lungs. Histopathological examination revealed severe sickling of red blood cells in the lungs (acute chest syndrome). Toxicological examination revealed blood and urine fentanyl levels of 40 [mu]g/L and 400 [mu]g/L (10 fold and 100 fold higher than therapeutic levels). The mast cell tryptase was also significantly elevated at 76 [mu]g/L, (Normal 2-14 [mu]g/L). We discuss the relevance of these findings with regard to the cause of death, and stress the need to consider fentanyl when confronted with nonspecific signs of opiate overdose as it is not detected in routine toxicological drug screens.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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The Fourth Incision: A Cosmetic Autopsy Incision Technique
by Patowary, Amarjyoti
[28 Feb 2010 at 6:00pm]
Autopsy procedure includes thorough external examination as well as internal examination including opening of all the body cavities for proper visualization of all the visceral organs. As such, there remains incision marks with stitches which harts the sentiment of the already traumatized relatives of the deceased. Moreover, it looks odd especially in cases of otherwise healthy dead bodies.
So, autopsy incisions should be such that, we can get maximum possible visualization of the body cavities, particularly the thorax and abdomen, and at the same time the incision as well as the stitch marks are also hidden.
This article is aimed to describe few modifications in the autopsy incisions for opening the thorax and abdomen and also proper visualization of the neck structures during autopsy where the incisions and the stitches are kept hidden.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Analysis of Mitochondrial DNA From the Teeth of a Cadaver Maintained in Forma...
by Remualdo, Vanessa Rosalia; Oliveira, Rogerio Nogueira
[31 May 2007 at 7:00pm]
This was a case that brought great commotion to a university in the interior of Brazil since it was suspected that one of the human bodies used for teaching anatomy was a relative of one of the students. Analysis of fragments of hypervariable region 2 of mitochondrial DNA (mtDNA) was performed using a miniprimer set (MPS), indicating that there had been a mistake in evaluation by the student, reinforcing the need to base the process of human identification in technical parameters.
(C) 2007 Lippincott Williams & Wilkins, Inc.
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Familicide?Suicide: A Cluster of 3 Cases in Los Angeles County
by Scheinin, Lisa; Rogers, Christopher B.; Sathyavagiswaran, Lakshmanan
[30 Nov 2011 at 6:00pm]
Abstract: Familicide and familicide-suicide have not been extensively documented or adequately defined in forensic and psychiatric literature. Such incidents occupy a distinct epidemiological niche and are often precipitated by financial stressors. We present a cluster of 3 such cases, all of which occurred within a 4-month period in Los Angeles County, Calif. The dynamics of these cases are evaluated relative to the literature.
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