American Journal of Forensic Medicine and Pathology最新文献

Abstract: Both obesity and opioid abuse are increasing in numbers globally. As these entities may be associated with significant respiratory compromise, it was hypothesized that synergism may occur and that as a result of this obese individuals may be more sensitive to the effects of opiates, that is, that deaths may occur at lower blood levels. To investigate this possibility, case files at Forensic Science SA, Adelaide Australia, were reviewed for all cases that occurred between 2000 and 2019 where deaths had been attributed to heroin or morphine toxicity. There were 259 cases (66 females, 193 males; age range: 18-91; average: 41.5). The average body mass index (BMI) was 26.8 (females, 26.1; males, 27.0). The total number of obese (BMI ≥ 30 < 40) decedents was 50, and the total number of morbidly obese (BMI ≥ 40) decedents was 17. No significant association was found in the obese or morbidly obese between BMI and postmortem drug levels of <0.01, ≥0.1 < 0.3, ≥0.3, <0.4, or ≥0.4 mg/L ( P  = 0.30, Fisher exact test). The lack of association between fatal postmortem opiate levels and BMI suggests that the negative respiratory effects of opioids and a high BMI may in some way be compensated for by as yet unidentified metabolic/pharmacokinetic factors in obesity.

Abstract: Setting oneself on fire, termed self-immolation, has high mortality and morbidity.A 60-year-old female patient with a history of depression and anxiety was found by drone search deceased with thermal injuries in a cornfield. Her abandoned vehicle was found with a dead battery and out of fuel 1/4 mile away. A lighter was lying 8 feet from the decedent, and a string of rosary beads, clothing, cigarettes, pliers, and a glass bottle with a cross on it were found nearby.Autopsy findings were notable for charring of the face, torso, and portions of the extremities, soot deposition in the peripheral airways, erythema of the epiglottis, bilateral lateral tongue hemorrhages, and pulmonary congestion and edema.The toxicology report revealed a blood carbon monoxide level of 23.8%. A blood volatile screen was negative. Blood drug screen was positive for a metabolite of marijuana and loperamide.The patient was determined to be alone at the time of the fire and death. No fuel or ignitable fluid was identified. The origin of the fire and the manner of death were listed as undetermined. The cause of death was determined to be thermal injuries and smoke inhalation. Whether this case represents a deliberate act or a possible accident remains in question.

Abstract: In the course of childbirth, if complications arise during the expulsion of the fetus, instruments can be employed to facilitate delivery. The vacuum extractor, or ventouse, is considered a relatively safe tool associated with a low rate of complications and mortality. However, it is crucial that the instrument be applied in the correct position and that the pulling force is not excessive to minimize damage to the fetal cranial structures. Fractures of the cranial vault following the application of obstetric vacuum extraction are very rare events.This paper presents a case of perinatal death due to cranial vault fracture and subgaleal hematoma following vacuum extractor application. Only through postmortem examination was it possible to identify incorrect positioning of the ventouse, which was lateralized compared to the recommended position. The misplacement of the device led to an imbalance of forces, causing the cranial vault fracture that led to the infant's demise.A thorough postmortem examination is essential in cases of perinatal death resulting from operative delivery to ascertain the cause of death and reconstruct the dynamics of events during childbirth. In particular, the examination of injuries on the decedent neonate may reveal improper positioning of the instrument.