American Journal of Forensic Medicine and Pathology最新文献

Abstract: Deaths by homemade suicide machines naturally capture public attention given the sensationalism of the subject matter and the complexity of the mechanisms involved. In this case, a self-made apparatus designed to administer a fatal dose of fentanyl, leading to an intentional acute toxicity, was used. As detailed in his 19-page manifesto discovered posthumously, the decedent engineered this device with the express purpose of testing the Many-Worlds Interpretation of quantum mechanics. This interpretation posits that for every time one outcome is observed, there are "parallel universes" in which a different outcome becomes reality; these "parallel universes" are collectively called the "multiverse." By programming his homemade device to kill the versions of himself in the "parallel universes" where he did not achieve a desired outcome-that is, having the winning numbers of a Powerball lottery drawing-the decedent sought to experience a reality where he did win the lottery, which would somehow through his convoluted logic thereby prove the existence of the "multiverse."Initially, the bizarre details of the scene led investigators to consider possibilities like intentional electrocution or even homicide executed by remote means. Thorough death scene and background investigation was critical to determine that it was an elaborate act of suicide.

Abstract: The sudden death of a previously healthy infant is a devastating event for a family-the death of 2 even more unimaginable. Prior to the debunking of Meadow's law, a legal concept attributing multiple unexplained infant deaths to Munchausen by proxy, these events could lead to the wrongful prosecution of those who had lost their children to "sudden unexpected infant death (SUID)." Today, these cases, wherein multiple infants within one family pass inexplicably, raise suspicion for a possible genetic cause and point toward a need for postmortem genetic testing.We present the case of 2 siblings who passed suddenly in infancy, with no structural cause of death identified at autopsy. Genetic testing in both infants found the same variant of uncertain significance, a heterozygous single nucleotide substitution, denoted c.3191C>T, in SCN10A, which encodes a sodium channel with pathogenic variants possibly implicated in sudden cardiac death syndromes. Although it is unclear at this time if the variant of uncertain significance identified was a contributing factor in the deaths, the case emphasized the importance of involving a multidisciplinary team to ensure appropriate pretest and posttest counseling, interpretation of nuanced testing results, and medical follow-up for surviving family members of SUID.

Abstract: Constipation is found in individuals with intellectual disabilities, autism, and cerebral palsy. Although generally a benign condition, it may lead to life-threatening intestinal obstruction, with or without volvulus, or to stercoral ulceration with enteritis and/or perforation. Two unusual cases of lethal chronic constipation are reported to demonstrate other very rare fatal mechanisms that may occur. Case 1: A 17-year-old male with cerebral palsy and autism was found deceased in bed. Death was due to pulmonary thromboembolism arising from compression of pelvic veins by acquired megacolon due to constipation (fecal mass 4.6 kg). Case 2: A second 17-year-old male with intellectual disability, global developmental delay, attention deficit disorder, seizures, and hypotonia collapsed and died during a medical evacuation from a remote community. Death was due to abdominal compartment syndrome in the context of medical air transport (medical retrieval), chronic constipation with acquired megacolon and megarectum (fecal mass 6.5 kg), global developmental delay, intellectual disability, and a suspected underlying genetic syndrome. These cases demonstrate that individuals with constipation may present for medicolegal assessment following sudden collapse/death and that pulmonary thromboembolism and abdominal compartment syndrome should be considered as rare possibilities in the evaluation of vulnerable individuals.

Abstract: Chronic alcohol exposure is common in all societies and is seen at high rates during coronial (medicolegal) postmortem examinations. In both setting of acute alcohol intoxication and chronic misuse, a wide range of pathologies and mechanisms of death may be encountered, particularly with regard to sudden, unexpected or violent deaths. These warrant special attention. In this review, we examine the approach to postmortem examination where alcohol is likely to have played a key role in death. Attention is given to the scene of death, patterns of traumatic injury, systemic pathology (particularly of chronic alcohol exposure), seizures related to alcohol, and appropriate biochemical investigations.