American Journal of Forensic Medicine and Pathology最新文献

Abstract: Hydrofluoric (HF) acid, an irritating and corrosive acid, is commonly found in cleaning supplies. Fatal HF acid ingestion has been documented, although relatively rare. We report a case of acute fluoride toxicity suicide due to the ingestion of a commercial product containing HF acid and ammonium bifluoride. To our knowledge, this is the first to describe the associated gastrointestinal histopathology in detail.A 56-year-old woman was found deceased near a rust remover product and a notebook containing suicide methods via chemical ingestion. Gross autopsy findings included laryngeal mucosal petechial hemorrhages; patchy esophageal mucosal denudation; and autolyzed, red-black discolored gastric mucosa. Histology of the esophagus demonstrated superficial mucosal ulceration with necrosis of the squamous mucosa, vascular congestion, and lymphoid aggregates in the lamina propria; muscularis mucosae and muscularis propria were unperturbed. The stomach showed superficial coagulative necrosis of the oxyntic crypts, with fresh microhemorrhage dissecting the glandular mucosa away from the muscularis mucosae; muscularis mucosae, submucosa, muscularis propria, and serosa were all spared.Toxicology revealed an elevated fluoride ion concentration (20 mg/L). Death was attributed to acute fluoride toxicity due to intentional ingestion of a commercial product containing HF acid and ammonium bifluoride, and the manner was suicide.

Abstract: Lipid emulsion therapy (LET) is the intravenous administration of lipid solution for parenteral alimentation, especially in preterm infants and adults with debilitating illnesses. It has also been used in attempts of detoxification in suspected cases of drug overdose. Whether this interferes with circulation and/or perfusion is debatable, and it is suggested that it may interfere with coagulation process. The emulsifying agent has been identified microscopically mainly in the lungs of these patients, with rare reports in adults and even more rare ones in the brain; however, although it is rarely reported in other organs, to our knowledge, no reports of gross autopsy findings in the brain are available in the English literature, nor are there reports of pathologic findings after lipid emulsion therapy administration for drug toxicity. Although it is also debated in the literature whether this material forms as an artifact or represents the actual agent, here we report the gross and microscopic autopsy findings in the brain of a patient who received LET for suspected beta-blocker intoxication. It will be beneficial for pathologists who perform autopsies in the forensic or medical settings to be aware of these findings, along with the uses and potential complications of LET.

Abstract: Rudolf Virchow published several autopsy protocols in his 1876 book on postmortem examinations. The protocols demonstrate the application of the 1875 Regulations to medicolegal practice. The book went through several editions and translations throughout the remainder of the 19th century, but the second autopsy protocol was subject to scathing criticism in 1915. This article summarizes the protocol and reviews the criticism, historic context, and conclusions. Application of 21st-century practice principles is also attempted in order to test the durability of Virchow's methods and protocol across centuries.

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.

Abstract: We investigated deaths in bathtubs for criteria to assist in death certification. We reviewed 252 deaths in which the person was found dead in a bathtub/shower at home. We extracted cause, manner, age, clad or unclad, water in the bathtub, water running, and face submersion. Of the 252 deaths, heart disease was the leading cause of death (129), followed by intoxication (47), trauma (22), drowning (28), and other diseases (26). The manners of death were 155 natural, 64 accident, 30 suicide, and 3 homicides. All drowning fatalities involved the decedent having their face submerged. Intoxication and natural deaths had submersion of the face in 15% and 12% of deaths, respectively. For nondrowning causes of death, the majority were without face submersion. For natural deaths, the predominant circumstance was the individual discovered unclad with water in the bathtub and the face not submerged. Conversely, for suicides, the majority were found clad without water. A comprehensive investigation incorporating a scene examination, gathering of the medical and psychosocial history, and typically an autopsy is needed to certify the cause and manner of death. Face submersion alone is not diagnostic of a drowning and must be interpreted with the medical history and autopsy findings.