American Journal of Forensic Medicine and Pathology最新文献

Abstract: While abrasions and lacerations are typically easily identified, darker pigmentation of the skin may obscure contusions. Forensic pathology literature shows a disproportionate number of illustrations of contusions on lighter skin tones compared to darker ones. Skin and soft tissue dissection is the most reliable method to confirm contusions.The authors seek to establish a correlation between skin tone and the visual identification of contusions, confirmed by soft tissue dissection. Additionally, they aim to determine the utility of specialized dissections for identifying contusions on different skin tones to identify cases that may benefit from such procedures.A review of cases from the Cook County Medical Examiner's Office from 2014 to 2024 was conducted. The office database was searched for deaths in custody, causes including "assault," and "child abuse." Autopsy photos were compiled into predissection and postdissection sets, reviewed for skin tone, visual identification of contusions, and final confirmation of soft tissue hemorrhage.Results found a negative association between skin color and accurate visual identification of contusions and determined that decedents with a skin tone of 7 or higher on the Massey-Martin scale may benefit from specialized dissections.

Abstract: A 65-year-old man with a history of hypertension and coronary artery disease was found dead at home after having fallen about 6 days prior. Autopsy examination revealed unexplained penetrating trauma of the skull with a circular defect in the frontal bone with associated cerebral laceration and organizing subdural hemorrhage. As the cause of the penetrating injury was unknown, the forensic pathologist instigated further investigation. Through interviews, the medicolegal death investigator identified the primary scene of injury, which was different from the scene of death; she elucidated the injury scenario, including the culprit object, which she photographed during the follow-up investigation. The etiology of the injury allowed the medical examiner to correctly certify manner of death. This case represents an interesting example of penetrating cranial injury, with minimal external injury and extensive internal lethal damage to the brain. Furthermore, it highlights the importance of investigating the primary scene of injury, especially when death is delayed and the deceased is no longer at the injury location.

Abstract: Calciphylaxis, or calcific uremic arteriolopathy, is a rare condition with a poorly understood pathophysiology. It is often associated with diseases that cause abnormalities in calcium metabolism, such as end-stage renal disease (ESRD) and hyperparathyroidism. While it most often affects the skin, involvement of extracutaneous organs, called systemic calciphylaxis, has been reported.Interestingly, other risk factors have now been identified with the development of calciphylaxis including recent infections, corticosteroid or warfarin use as well as diabetes mellitus, autoimmune diseases, and protein C or S deficiency.We present a 48-year-old female patient with a history of human immunodeficiency virus infection, and recent hospitalizations for acute pancreatitis and COVID-19 who presents with nonspecific abdominal pain, weakness, and mild erythematous skin lesions. Subsequently, the patient developed acute vision loss, severe hypertension, and acute kidney injury with significantly worsening skin lesions. Ultimately, the patient deteriorated rapidly and succumbed. At autopsy, cutaneous calciphylaxis was confirmed, affecting over 50% of body surface area as well as widespread organ involvement by visceral calciphylaxis, most strikingly in the heart and lungs. This case highlights the importance of considering COVID-19 and other nonuremic risk factors as being a trigger for developing catastrophic systemic calciphylaxis.

Abstract: Wischnewsky spots are disseminated, dark lesions in gastric mucosa reflecting hemorrhage associated with fatal hypothermia, and are a phenomenon well known to forensic pathologists. We applied luminol and leucomalachite green tests to formalin-fixed gastric mucosa with Wischnewsky spots in autopsy cases of hypothermia. Both luminol and leucomalachite green tests showed positive reactions. We describe the technical significance of these tests in forensic diagnosis, in that luminol and leucomalachite green tests may be useful in forensic autopsy cases, and may also be useful for formalin-fixed organs.

Abstract: An epidemic of fentanyl overdose deaths has led to community naloxone use to save lives, and it has been suggested that businesses face legal liability for failing to provide naloxone. This study reviewed Maryland fentanyl-related overdose deaths in 2022. A death was considered preventable by widespread availability and use of naloxone in the following circumstances: a witnessed arrest, a person suffering an overdose found within 30 minutes of last being known alive, a person found unresponsive who showed potential to be resuscitated by emergency medical services, or the person being "found dead" in a public area such that a reasonable opportunity existed for someone else to find the decedent earlier and administer naloxone before death occurred. Of the 2047 overdose deaths in the study, 13.5% were deemed possibly preventable, and 2.7% were found such that a business could have possibly provided naloxone. The preventable overdoses were most commonly found by a "close contact" (family, friend, boy/girlfriend, and room/housemate) in a residence. A targeted effort to educate and supply naloxone to people who use drugs and their close contacts offers the best chance of reducing fentanyl overdose deaths. Mandating all businesses to carry naloxone is not supported by this study.

Abstract: Knowledge about Carl Rokitansky's autopsy method has been regrettably obscured by the fact that he never published his own method, and by subsequent errors and assumptions introduced by generations of pathologists publishing without primary source material. This article shows that Rokitansky's autopsy method was probably never truly lost, but was hiding in plain sight for those who would seek it through rather esoteric secondary sources. His method is reconstructed here for the first time in over a century for an English-speaking audience.

Abstract: The ossa cordis (OC), or cardiac bone, is a bony structure within the cardiac skeleton of mammals, believed to maintain heart shape during systole and enhance contraction efficiency. Found in large mammals, especially ruminants, and has recently been described in chimpanzees; however, OC has not previously been described in humans. Herein, we present an incidental finding of OC in the heart of a 39-year-old man who suffered a stab wound to chest. A thorough postmortem examination revealed a 0.8 × 0.6 × 0.4-cm, well-defined, boomerang-shaped, bony structure embedded in atrioventricular node location in the right atrium within the triangle of Koch. The heart showed cardiomegaly and moderate atherosclerosis in the left anterior descending and right coronary arteries but was otherwise normal, without fibrosis, valvular abnormalities, or degenerative changes. Histological analysis revealed mature bone with trilineage hematopoietic elements. This finding highlights anatomical similarities between human hearts and other species, raising questions about whether OC in humans and primates is linked solely to degenerative cardiac disorders or represents a normal aspect of mammalian heart development and aging. To our knowledge, this is the first reported case of an OC in a human.

Abstract: Flecainide is among the most prescribed antiarrhythmic medications and is used to effectively treat recurrent arrhythmia and maintain normal sinus rhythm by acting as a sodium channel blocker. However, its potent effects and narrow therapeutic window pose increasing risks of flecainide intoxication and ensuing morbidity and mortality. Here we report an unusual case of suicide by intentional flecainide overdose. This case demonstrates the importance of early recognition and treatment in avoiding the adverse consequences of flecainide intoxication, and it also demonstrates the importance of appropriate use and safe storage of flecainide.