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Clarifying the Source of "Off-Gassing" During Postmortem: Organophosphate or Solvent? 澄清死后“脱气”的来源:有机磷还是溶剂?
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-31 DOI: 10.1097/PAF.0000000000001009
Ananth R Kattamreddy, Jitendra D K Allu
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引用次数: 0
Unusual Causes of Death Due to Constipation. 便秘引起的不寻常死亡原因。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-23 DOI: 10.1097/PAF.0000000000001005
Roger W Byard, Marianne Tiemensma

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.

摘要:便秘常见于智障、自闭症和脑瘫患者。虽然通常是良性的,但它可能导致危及生命的肠梗阻,伴有或不伴有肠扭转,或导致伴有肠炎和/或穿孔的后珊瑚溃疡。两个不寻常的致命慢性便秘的情况下,报告显示,其他非常罕见的致命机制可能发生。病例1:一名患有脑瘫和自闭症的17岁男性被发现死在床上。死亡是由于便秘引起的获得性巨结肠压迫盆腔静脉而引起的肺血栓栓塞(粪便质量4.6 kg)。案例2:另一名患有智力残疾、整体发育迟缓、注意力缺陷障碍、癫痫发作和肌张力低下的17岁男性在从偏远社区进行医疗后送时猝死。死亡是由于医疗空运(医疗检索)中的腹部隔室综合征、慢性便秘并获得性巨结肠和巨直肠(粪便质量6.5 kg)、整体发育迟缓、智力残疾和疑似潜在遗传综合征。这些病例表明,患有便秘的个体可能会在突然晕倒/死亡后进行医学评估,而肺血栓栓塞和腹腔隔室综合征在易感个体的评估中应被视为罕见的可能性。
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引用次数: 0
The Postmortem Pathology of Sudden Death in Chronic Alcohol Exposure and Acute Alcohol Intoxication: A Review of Medicolegal Considerations, Traumatic and Systemic Pathology, and Biochemical Mechanisms. 慢性酒精暴露和急性酒精中毒猝死的死后病理:医学法律考虑、创伤性和系统性病理以及生化机制的综述。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-23 DOI: 10.1097/PAF.0000000000001000
Harry R Haynes, Patrick J Gallagher, Maria H Thom, Reza A Morovat, Russell J Delaney, Amanda J Jeffery

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.

摘要:慢性酒精暴露在所有社会中都很常见,并且在冠状(法医)尸检中发现的比例很高。在急性酒精中毒和慢性酒精滥用的情况下,可能会遇到各种各样的病理和死亡机制,特别是在突然、意外或暴力死亡方面。这些值得特别注意。在这篇综述中,我们研究了尸检的方法,其中酒精可能在死亡中发挥了关键作用。应注意死亡现场、外伤模式、全身病理(特别是慢性酒精暴露)、与酒精有关的癫痫发作以及适当的生化调查。
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引用次数: 0
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. 致死性紧张性胃胸2例报告。
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.

摘要:紧张性胃胸是膈疝的一种罕见且可能致命的并发症,在这种情况下,大量扩张的胸内胃压迫肺和纵隔,导致心肺功能受损,其机制类似于紧张性气胸。虽然这是非常罕见的,张力性胃胸在文献中有报道;然而,此类报道几乎完全局限于其临床表现和急诊治疗。据我们所知,在文献中没有成人尸检病例报告张力性胃胸。我们提出了2例成人尸检病例报告,其中我们认为死亡原因是紧张性胃胸,随后讨论了什么是紧张性胃胸及其潜在病因,最后,我们讨论了尸检诊断的困难,包括尸检后计算机断层成像如何在我们的一个病例中发挥巨大的作用。
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引用次数: 0
Illustrated Forensic Pathology: Necklacing. 插图法医病理学:项链。
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
Human Herpesvirus 6 Encephalitis: An Autopsy Case and Literature Review. 人类疱疹病毒6型脑炎:一例尸检病例及文献复习。
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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American Journal of Forensic Medicine and Pathology
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