Academic Forensic Pathology最新文献

Mucormycosis is a rare and severe invasive fungal infection caused by ubiquitous fungi of the order Mucorales. Infection often occurs in immunocompromised hosts and includes cutaneous, pulmonary, gastrointestinal, rhinocerebral, and disseminated forms of disease. Although the clinical characteristics of mucormycosis are well established, infection can be difficult to diagnose antemortem, resulting in frequent postmortem diagnoses. Despite this, the gross appearance of mucormycosis at autopsy has not been well described. In the present report we illustrate the gross and histologic findings in four autopsy cases of mucormycosis, including one case of pulmonary disease and three cases of disseminated mucormycosis with cerebral, pulmonary, hepatic, renal, and gastrointestinal involvement. In all cases autopsy examination demonstrated characteristic hemorrhagic infarcts with a targetoid appearance in the affected organs. These findings are secondary to fungal angioinvasion with subsequent thrombosis and tissue necrosis. Mucormycosis should be suspected at autopsy when these characteristic infarcts are identified within the proper clinical context, and a high suspicion for atypical infections should be maintained postmortem in immunosuppressed patients.

The Armed Forces Medical Examiner System (AFMES) is the only medicolegal death investigation system of the US federal government. Its origins can be traced to three dried tissue specimens placed on a shelf by a Civil War Surgeon General in 1862. The collections and the library of the Army Surgeon General spawned the Armed Forces Institute of Pathology (AFIP), the National Museum of Health and Medicine, the Walter Reed Army Institute of Research, and the National Library of Medicine. Pathologists of the Army Medical Museum performed the autopsies of assassinated Presidents Lincoln and Garfield and assisted with that of Kennedy. The now defunct AFIP created the first forensic pathology training program approved by the American Board of Pathology and then the AFMES. Col Ed Johnston, CAPT Charlie Stahl, and Col Dick Froede were the original pioneers of the AFMES.

The easy availability of deadly poisons in 19th-century Britain, Western Europe, and the United States led to widespread public anxiety about the prevalence of murder by poison, resulting in what might be termed a "poison panic." The fear was fed by well-publicized reports of trials and executions which, though not especially numerous, seemed indicative of the dangerous incidence of a unique type of homicide, one that was particularly difficult to prevent or detect. As a result, poisoning crimes stimulated the development of the earliest medicolegal specialism, forensic toxicology, and consequently the careers of some of the best known expert witnesses of the Victorian era, including Mathieu Orfila, Alfred Swaine Taylor, Thomas Stevenson, and Theodore Wormley. This article traces the history of poisoning crimes and the related medico-scientific discipline of forensic toxicology using textbooks, key trials, and crime statistics to examine and evaluate their contribution to the historical development of forensic expertise and practice.

Pheochromocytomas are rare catecholamine-secreting neuroendocrine tumors that can occasionally progress to life-threatening disease, including a multisystem crisis. Patients with Neurofibromatosis type 1 (NF1) may develop pheochromocytomas, and the consequent chronic elevation of plasma catecholamine levels could further complicate various cardiovascular and pulmonary manifestations they may have. A 37-year-old African American female with NF1 presented with severe dyspnea, chills, myalgia, vomiting, and abdominal pain. Within several hours of hospital admission, she developed progressive agitation and died from circulatory collapse. An autopsy revealed disseminated histoplasmosis with necrotizing granulomatosis in her lungs, mediastinum, liver, and spleen, as well as bilateral pheochromocytomas with one tumor showing marked hemorrhage. Additionally, she had cardiac hypertrophy, myocarditis, pulmonary edema, apical bullae, features of pulmonary hypertension and interstitial fibrosis. Disseminated histoplasmosis caused by the fungal organism Histoplasma capsulatum is rarely described in immunocompetent individuals. This case is presented to illustrate that chronic hypercatecholaminemia caused by pheochromocytomas may potentially mask disseminated fungal infections which in turn could induce pheochromocytoma multisystem crisis in susceptible patients with neurofibromatosis.

Introduction: Community donation bins have become more common in the urban setting over the past several years. Many nonprofit organizations use these sturdy metal enclosures for unobserved collection of various donated items such as clothing, books, and household items. Although the donated items are often of low individual value, donation bins may become a target of individuals in low socioeconomic situations seeking desired items for personal use or resale, or for personal shelter within the bin.

Methods: To identify donation bin-associated deaths, we reviewed cases taken under the jurisdiction of the coroner for investigation in the provinces of British Columbia and Ontario, Canada, over the years 2009 to 2019.

Results: We present the circumstances and postmortem findings of five deaths that occurred in British Columbia and Ontario (Canada) between 2009 and 2019, wherein the decedents were each believed to have been reaching into donation bins and became caught within the door mechanism and died as a consequence of compression asphyxia involving the chest and/or neck.

Discussion: Donation bins have the potential for harm when individuals attempt to access the bin contents through the entry portal. We advocate for greater attention and changes in the placement location and/or design of these potentially dangerous devices.

Forensic DNA testing can play a critical role in homicide investigations. Selecting the appropriate evidence on which to perform DNA testing requires foresight and reasoning based on experience and science. Although successful DNA testing can occur using many substrates, including blood, hair, and sweat/epithelial cells, positive results can also result from testing various unorthodox samples. The authors report on a triple-murder investigation where DNA testing of dog feces at the crime scene matched DNA testing of feces found on the shoe of a suspect resulting in successful prosecution of the case.

This paper will trace the history of DVI from nineteenth-century practices of sight recognition to contemporary DVI, detailing when and how different technologies used in DVI entered the disaster morgue. Much of this history is defined by improvisation, as local communities affected by sudden, mass death often relied on known technologies, medical or otherwise, applied under extremely difficult circumstances. Initially, these technologies were not always strictly forensic, but ones that supplemented sight recognition. As more forensic technologies became available in others fields, such as criminology, dentistry, and forensic pathology, disaster responders had greater tools at their disposal. The gradual introduction of these tools allowed DVI to become a more systematic and scientific process.

In 1987, a case report was published in the German journal Archiv für Kriminologie describing an apparently novel method of suicide in which the decedent produced a lethal amount of carbon monoxide by mixing formic acid and sulfuric acid. This method of chemical suicide remained obscure until 2003, when Dr. Philip Nitschke, a vocal supporter of assisted suicide, began promoting a homemade carbon monoxide generator which utilized this same chemical reaction. In 2006, he coauthored The Peaceful Pill Handbook, which provided further details about how the device worked. Pro-voluntary euthanasia organizations and online forums continue to provide information about this method, promoting it as painless and efficient. There have been nine case reports of suicides and attempted suicides using this chemical reaction, with five reported in Europe, three in the United States, and one in Taiwan. Two additional cases were reported in news articles that did not correspond to known case reports, indicating that this method of suicide is more common than the scientific literature would suggest. We present the case of a 44-year-old male who learned about this method of chemical suicide online and filmed the suicidal act while verbally recording carbon monoxide levels prior to losing consciousness.

A 34-year-old male was reported to be snorting a white powder that was believed to contain heroin. Toxicological analysis revealed free morphine (356 μg/L), fentanyl (34.7 μg/L), alprazolam (64.9 μg/L), and acetylfentanyl (32.9 μg/L) in femoral blood and 6-monoacetylmorphine (6-MAM, <10.0 μg/L) in vitreous fluid. Norfentanyl was only detected in stomach contents (<1.00 μg/total). Heroin, fentanyl, and acetylfentanyl were also detected in solid dose evidence submitted by law enforcement. The fentanyl and alprazolam concentrations might normally be associated with a fatal outcome and are supported with the distribution of fentanyl and alprazolam being consistent with an acute intoxication. In addition, the presence of 6-MAM and a free versus total morphine ratio of 67.9% provide supporting evidence of a rapid death following intranasal (IN) administration. However, the presence of illicit acetylfentanyl complicates toxicologic interpretation due to overlapping recreational and fatal concentrations of this compound reported in the literature as well as a potential for postmortem redistribution (PMR). Reported acetylfentanyl concentrations have also varied when presented with significant fentanyl concentrations and underscore the need to consider a wide range of illicit opioid compounds when investigating drug-related deaths. Based on our comprehensive toxicologic analysis, the results suggest an acute intoxication primarily by IN administration of acetylfentanyl and fentanyl. In addition, we suggest the presence of alprazolam, 6-MAM, and a percentage free morphine is also consistent with rapid death. The cause of death was officially attributed to an acute combined intoxication of acetylfentanyl, fentanyl, alprazolam, and heroin, with the manner of death as accidental.