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Incidental Finding of an Early-Stage Intrauterine Pregnancy at Autopsy. 尸检意外发现早期宫内妊娠
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-20 DOI: 10.1097/PAF.0000000000001007
Garrett Phillips
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引用次数: 0
Fatal Tension Gastrothorax: Two Case Reports.
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-13 DOI: 10.1097/PAF.0000000000001003
Michael Andrew Johnstone, Sam Hoggard, Joanna Dixon

Abstract: Tension gastrothorax is a rare and potentially fatal complication of a diaphragmatic hernia, in which a massively dilated, intrathoracic stomach compresses the lungs and mediastinum, causing cardiorespiratory compromise, in a mechanism akin to tension pneumothorax. Although it is very rare, tension gastrothorax has been reported in the literature; however, such reports are almost exclusively restricted to its clinical presentation and treatment in emergency departments. To the best of our knowledge, no adult autopsy case reports of tension gastrothorax have been reported in the literature. We present 2 adult autopsy case reports in which we believe the cause of death was tension gastrothorax, followed by a discussion of what a tension gastrothorax is and its potential etiology, and finally, we discuss the difficulties of making the diagnosis at autopsy, including how postmortem computed tomography imaging can be hugely beneficial as it was in one of our cases.

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引用次数: 0
Illustrated Forensic Pathology: Necklacing.
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-11 DOI: 10.1097/PAF.0000000000001004
Ryan Blumenthal, Robert Maximilian
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引用次数: 0
Fat Embolism Fatalities Following Liposuction/Injection in Los Angeles County (2010-2018).
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-05 DOI: 10.1097/PAF.0000000000000993
Christopher Rogers, Denis Astarita, Lakshmanan Sathyavagiswaran, Patrick Pazmiño, Arturo Ramírez-Montañana

Abstract: One complication of autologous fat transfer into the buttocks (cosmetic injection of fat into the gluteal region) is inadvertent fat embolization. In 2015, our office published a case of macro fat/adipose tissue embolization following fat transfer surgery. Between 2010 and 2018, we had six additional cases of macro/micro fat embolism that caused death. Professional associations and plastic surgeons have recommended ways to avoid fat embolism during fat transfer. In our experience, the risk of fat embolism has decreased in Los Angeles in recent years. Our office has had only one case since 2018 where an unlicensed individual performed the procedure. However, fat embolism is still possible in cases where professional recommendations are not followed. We recommend that the evaluation of possible fat embolus cases include full autopsy with gluteal dissection, microscopic examination of intravascular fat, review of medical and anesthesia records, including whether ultrasound was used during fat grafting, toxicological examination of specimens taken as close to the time of arrest as possible, and anesthesiology consultation.

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引用次数: 0
Human Herpesvirus 6 Encephalitis: An Autopsy Case and Literature Review.
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-02 DOI: 10.1097/PAF.0000000000001002
Naoto Tani, Takaki Ishikawa
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引用次数: 0
Tolerant or Intolerant? Learning From Studying Drug Concentrations in the Living and the Dead. 宽容还是不宽容?从研究活人和死人体内的药物浓度中学习。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-01 Epub Date: 2024-06-12 DOI: 10.1097/PAF.0000000000000962
Laura M Labay, Sherri L Kacinko, Brittany K Casey, Justin O Brower

A bstract: Tolerance is the diminished response to a drug that occurs when that drug is repeatedly used, and the body adapts to its continued presence. This means that greater blood concentrations are required to achieve desired effects, produce impairment, or cause death. Without case-specific information, the pharmacodynamic impacts of a drug on an individual are difficult to ascertain based on its concentration alone. One starting point, however, is to compare reported findings with reference ranges associated with therapeutic, toxic, and lethal outcomes. Toxicologists have observed concentrations dramatically increase over time in the living population for some drugs to concentrations that can easily be associated with impairment and lethal outcomes. It is, therefore, important to continually monitor and be familiar with drug concentrations found in the living to interpret postmortem concentrations. To emphasize this approach, we compared fentanyl concentrations from JAN 2010 to OCT 2023 in individuals investigated for driving under the influence of drugs to postmortem cases. This comparison highlights the changing nature of tolerance, stresses the importance of not relying solely on reference ranges for result interpretations, and discusses the importance of the autopsy in identifying or ruling out other potential causes of death.

摘要:耐受性是指反复使用某种药物后,身体对该药物的反应减弱,从而适应了药物的持续存在。这意味着需要更高的血药浓度才能达到预期效果、产生损害或导致死亡。在没有特定病例信息的情况下,仅凭药物浓度很难确定药物对个体的药效学影响。不过,一个起点是将报告结果与治疗、毒性和致死结果的相关参考范围进行比较。毒理学家观察到,某些药物在活人体内的浓度会随着时间的推移而急剧增加,其浓度很容易与损害和致死结果相关联。因此,持续监测并熟悉活人体内的药物浓度对解释死后浓度非常重要。为了强调这一方法,我们比较了 2010 年 1 月至 2023 年 10 月期间因药后驾驶而接受调查的人体内的芬太尼浓度和死后案例的芬太尼浓度。这种比较突显了耐受性的变化,强调了不完全依赖参考范围来解释结果的重要性,并讨论了尸检在确定或排除其他潜在死因方面的重要性。
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引用次数: 0
Circumstances and Pathological Findings in Civilian Helicopter-Related Fatalities. 与民用直升机相关的死亡事故的情况和病理结果。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-01 Epub Date: 2024-08-20 DOI: 10.1097/PAF.0000000000000964
Marianne Tiemensma, Salona Prahladh, Roger W Byard

Abstract: Helicopters are used worldwide in a range of commercial and private industries and are particularly useful in northern Australia due to the sparse population scattered over large distances with remote regions difficult to access by any other means of transport. Nine civilian helicopter-related fatalities were reported to the Northern Territory coroner between January 2004 and December 2023. The victims were all male (age range, 34-74 years; mean, 52 years). All fatal crashes occurred in remote areas, the majority on cattle stations. Pilots were the sole occupants in 5/9 incidents; in 4 incidents, there were injured survivors. All fatal incidents involved Robinson piston engine helicopters (Robinson R44 models in 2 incidents and Robinson R22 models in the remaining 7). Scene investigations, postmortem examinations, and ancillary investigations were frequently hampered by decomposition of the remains, resulting from difficult search operations and delayed location, retrieval, and storage. Head injuries were present in all cases with chest and spinal injuries in more than half. Integrated assessment of injuries with toxicological and aviation investigations facilitated understanding of the crash dynamics.

摘要:直升机在全球范围内被广泛应用于各种商业和私营行业,在澳大利亚北部,由于人口稀少,且分布在偏远地区,任何其他交通工具都难以到达,因此直升机的作用尤为突出。2004 年 1 月至 2023 年 12 月期间,北部地区验尸官共收到 9 起与民用直升机相关的死亡报告。受害者均为男性(年龄在 34-74 岁之间,平均 52 岁)。所有致命的坠机事故都发生在偏远地区,大多数发生在牧场。在 5/9 起事故中,飞行员是唯一的乘客;在 4 起事故中,有受伤的幸存者。所有致命事故均涉及罗宾逊活塞发动机直升机(2 起事故为罗宾逊 R44 型直升机,其余 7 起事故为罗宾逊 R22 型直升机)。现场调查、尸检和辅助调查经常因遗体腐烂而受阻,原因是搜索行动困难,以及定位、检索和储存延误。所有案件中都有头部受伤,半数以上有胸部和脊柱受伤。将伤情评估与毒理学和航空调查相结合,有助于了解坠机的动态。
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引用次数: 0
The Forensic Perspective of Infectious Endocarditis: A Retrospective Study With Recommendations for the Future. 从法医角度看感染性心内膜炎:一项回顾性研究及对未来的建议。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000942
Alison Krywanczyk, Thomas Gilson

Increasing rates of infectious endocarditis (IE) are well-described in the United States and worldwide, yet forensic literature regarding IE is sparse. Autopsy databases may help identify subsets of patients at increased risk of mortality. We reviewed all deaths due to IE in our office between 2010 and 2022 (with full autopsy performed) and found 29. The average age was 44 years. Manners of death included natural (69%), accident (28%), and homicide (3%). For all accidental deaths, acute intoxication was included in either part I or II. The aortic valve was most affected (62%), followed by tricuspid (28%) and mitral (24%). Seventy-six percent of affected valves were native, and 24% were prosthetic. Common risk factors included intravenous drug use (48%) and chronic ethanolism (21%). No sustained increase in deaths due to IE was identified. These data show marked differences from clinical literature, including a lower average age and higher incidence of substance use disorders, and it is unlikely selection bias is the sole reason. There was inconsistency in death certification, most notably by not including pertinent IE risk factors. Improving consistency and quality of IE death certification will aid in detecting regional trends and assist multi-institutional collaboration efforts.

在美国和全世界,感染性心内膜炎(IE)的发病率不断上升,但有关 IE 的法医文献却很少。尸检数据库可能有助于确定死亡风险增加的患者群体。我们回顾了 2010 年至 2022 年期间我院所有因 IE 死亡的病例(进行了全面尸检),共发现 29 例。平均年龄为 44 岁。死亡方式包括自然死亡(69%)、意外死亡(28%)和他杀死亡(3%)。在所有意外死亡病例中,急性中毒包括在第一部分或第二部分中。受影响最大的是主动脉瓣(62%),其次是三尖瓣(28%)和二尖瓣(24%)。76%的受影响瓣膜为原生瓣膜,24%为人工瓣膜。常见的风险因素包括静脉注射毒品(48%)和慢性乙醇中毒(21%)。未发现因IE导致的死亡人数持续增加。这些数据显示出与临床文献的明显差异,包括平均年龄较低和药物使用障碍的发生率较高,而选择偏差不太可能是唯一的原因。死亡证明不一致,最明显的是没有包括相关的 IE 危险因素。提高 IE 死亡证明的一致性和质量将有助于发现地区趋势并协助多机构合作。
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引用次数: 0
When Vaping Isn't Actually Safer: A Death From Toxic Alcohol Contaminated Vape Juice. 当吸食电子烟实际上并不更安全时:死于受有毒酒精污染的 Vape Juice。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000951
Timothy Ogburn, Irfan Chaudhry, Laura D Knight

Abstract: Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing "ethylene glycol") and THC for "endometriosis-related pain relief." Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.

摘要:Vape果汁是电子烟有效成分尼古丁或四氢大麻酚(THC)的稀释剂。一名 43 岁的女性在摄入自制的 Vape 果汁后被救护车送往医院,当时她没有任何反应,并伴有肢体瘫痪的姿势。据报道,她为了 "缓解子宫内膜异位症相关疼痛",将网购的 Vape 果汁(含 "乙二醇")和 THC 混合制成了酊剂。实验室评估显示,她出现了阴离子间隙性代谢性酸中毒、血清乳酸升高和高血清渗透压。尿液在伍德灯下发出荧光,作为乙二醇解毒剂使用了福美匹唑,但她于第二天下午死亡。死后的临床血清毒理结果显示,甲醇含量为 235 毫克/分升,没有乙二醇。尸检结果包括胃肠道缺血性病变和脑水肿并伴有脑疝。对入院血液进行的尸检毒理学检查发现了甲醇(220 毫克/分升)、丙二醇(59 毫克/分升)、Δ-9 THC 和代谢物以及住院期间服用的药物。据我们所知,这是首例因摄入被有毒酒精污染的 Vape 果汁而意外死亡的报告。
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引用次数: 0
Letter to the Editor: Self-Manipulation Inaccurately Associated With the Chiropractic Profession. 致编辑的信:自我操纵与脊骨神经科学专业的联系不准确。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000950
Kevin W Meyer, Robert J Trager, Clinton J Daniels, Zachary A Cupler
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引用次数: 0
期刊
American Journal of Forensic Medicine and Pathology
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