American Journal of Forensic Medicine and Pathology最新文献

Abstract: Cervical facet joint neurotomy, also known as cervical radiofrequency ablation (RFA) or cervical facet rhizotomy, is a medical procedure aimed at alleviating chronic neck pain caused by issues related to the cervical facet joints through ablation of neurons ( J Pain Res 2021;14:2807-2831). Although generally safe, adverse events can occur. Infection is a rare consequence of this procedure. Most injection-site infections related to cervical RFA occur spontaneously and resolve with oral antibiotics without sequelae ( World Neurosurg 2018;111:e644-e648). We report a case in which a cervical RFA injection resulted in the development of necrotizing fasciitis and ultimately death. To our knowledge, this has not been previously reported and is the first documented fatality due to infectious sequelae of a cervical RFA procedure.

Abstract: This case report characterizes a unique way in which suicide was accomplished through ingestion of chemicals typically used to create acrylic fingernails that resulted in death. Ethyl methacrylate and acrylic powder are commonly combined to form acrylic nails in nail salons. The process of applying acrylic nails utilizes each substance by mixing both before it typically solidifies within seconds of combining the two compounds. Ingestion of these compounds has not been previously described within the medical literature. The decedent was a nail technician at a local salon. He was found unresponsive in his yard which led to a 911 call. At the scene, a mostly empty 16-oz bottle of ethyl methacrylate, a chemical used at the salon where he worked, was found. At autopsy, the decedent's body had a strong chemical odor consistent with odors present at nail salons. Significant gastrointestinal tract damage was seen including discoloration within the esophagus, and the stomach contained a molded, hardened nail compound. The cause of death was ruled as complications of nail acrylic powder and liquid ethyl methacrylate ingestion. This case shows the unusual findings seen at autopsy from a decedent who committed suicide by ingestion of ethyl methacrylate with acrylic powder.

Abstract: Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification (MAC) usually described as an antemortem finding. We report a case of sudden cardiac arrest in a 39-year-old male with end-stage renal disease undergoing hemodialysis with a history of Fabry disease by kidney biopsy. Autopsy revealed significant circumferential annular calcification in both mitral and aortic valves with a caseous gross appearance. Histologically, these areas consisted of amorphous basophilic material accompanied by a surrounding granulomatous-appearing infiltrate. Von Kossa staining on non-decalcified tissue revealed strong positive staining, confirming CCMA diagnosis. While identifiable, the atrioventricular node was displaced and distorted by caseous deposits. Toluidine blue staining of myocardium showed osmophilic accumulations, and electron microscopy (EM) showed myeloid/zebra bodies, consistent with Fabry disease. We posit that Fabry disease leads to end-stage kidney disease, altering calcium phosphate metabolism, a proposed mechanism for CCMA. This case highlights the multifactorial nature of sudden cardiac death in decedents with various structural cardiac changes and potential renal-disease-induced electrolyte imbalances. We aim to bring awareness to this rare entity, its potential role in a sudden cardiac death, and to highlight the need to use non-decalcified tissue when staining for calcium to establish the diagnosis.

Abstract: Self-inflicted penetrating brain injuries with drills have been reported but are uncommon and typically involve the use of conventional drill bits. We report an unusual case of a 56-year-old man with a history of psychiatric illness who completed suicide using an electric drill and spade-type drill bit. Multiple superficial scalp and deeper bony injuries were sustained, although without breach of the dura, and death was not from brain injury, but secondary to venous air embolism related to entrainment of air into diploic vessels.

Abstract: Ethylene glycol (EG) is a widely available chemical and a well-known toxin in forensic pathology, which can lead to severe metabolic acidosis and death. Its metabolism in the body leads to formation of calcium oxalate (CO) crystals, which can precipitate in the kidney leading to renal failure. Although the identification of CO crystals in the kidney is widely known, the deposition of CO crystals in other organs has only occasionally been reported and seldom studied. This report examines 18 deaths due to EG toxicity for the presence of CO crystals in various organs. CO crystals were identified most often in the kidneys, followed by the brain and lungs. It is hypothesized that crystal deposition in these other organs may contribute to the toxicity of EG.

Abstract: Gunshot injuries are one of the leading causes of death from trauma in the United States. In recent years, the US has experienced an increasing number of fatal pediatric cases related to firearms.A search of the database of the Cook County Medical Examiner's Office over the period January 2016-December 2021 revealed 418 deaths by gunshot wounds (GSWs) among people aged between 0 and 18 years old. Subjects were subcategorized in infants (0 to 1 year), toddlers (≥1 to 3 years), preschool (≥3 to 6 years), preadolescents (≥6 to 12 years), and adolescents (≥12 to 18 years).Most victims were males (n = 374) and adolescents (357 males and 30 females). Homicide (n = 373) was the most common manner of death. Only 2 deaths were accidental. Single GSWs deaths (n = 232) were more common than multiple GSWs (n = 186) and preferentially directed to the head in both homicides and suicides. Gang or robbery related events in areas of readily available firearms explained 4.5% of homicides (17 out of 373 cases). Among deaths by self-inflicted GSWs (n = 36), 7 cases were linked to psychiatric disorders, 3 to family difficulties, 2 to history of playing Russian roulette, and 2 to bullying at school.Pediatric gunshot injuries and deaths are an important public health problem. Understanding and addressing individual and societal risk factors should be the first step toward prevention.

Abstract: Our present understanding of electrocution followed a long path of detours and speculation. It is now hard to appreciate how mysterious was an unexpected sudden death-without visible trauma-and we should be sympathetic to the surprising theories that came from well-intentioned attempts to find something in the autopsy of an electrocution victim.The early hypotheses (1880s) tended to favor effects on the central nervous system, but the emphasis switched to arterial and hematological mechanisms as well as respiratory arrest (ie, asphyxia) along with a widespread publication debate. While careful animal experimentation slowly established that electrocution was due to the induction of VF (ventricular fibrillation), the older hypotheses held sway for many decades. Even today, the neurogenic and asphyxial explanations reappear occasionally.Despite 170 years of research, the phenomenon of electrocution continues to generate new hypotheses for its mechanism.

Abstract: Sudden death in the young (SDY) poses a public health problem affecting thousands of individuals annually in the United States. The SDY Case Registry utilizes existing infrastructure of death investigation programs, including medical examiner/coroner (ME/C) systems, to enhance understanding of SDY causes and risk factors to inform prevention strategies. This includes identifying and promoting screening recommendations for at-risk family members. To explore barriers to family history collection and familial screening recommendation procedures across Registry sites, nine individuals from seven SDY sites were interviewed. Interviews focused on logistics, methods to address barriers, and recommendations for improvements. Despite variability in practices, data analysis revealed three common themes related to barriers of these processes: (1) timing and grief, (2) lack of family history in medical records, and (3) families lost to follow-up. This study offers insights into these processes within the Registry and sheds light on broader practices within the death investigation domain. Data analysis led to recommendations for the improvement of these practices including the prioritization of three key family history questions during the initial death investigation by a designated individual in each office/system.