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Virchow's Second Protocol; a 21st-Century Review. 维尔霍第二议定书;21 世纪回顾。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-12-01 Epub Date: 2024-07-16 DOI: 10.1097/PAF.0000000000000968
Patrick Hansma

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.

摘要:鲁道夫-维尔乔(Rudolf Virchow)在其 1876 年出版的《尸检》一书中发表了几份尸检规程。这些方案展示了 1875 年条例在医学实践中的应用。该书在 19 世纪余下的时间里经历了多个版本和译本,但第二个尸检规程在 1915 年受到了严厉的批评。本文总结了该规程,并回顾了批评意见、历史背景和结论。文章还尝试应用 21 世纪的实践原则,以检验维肖的方法和规程在不同世纪的持久性。
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引用次数: 0
Illustrated Forensic Pathology: Primary Small Bowel Volvulus-A Rare Cause of Sudden Death. 法医病理学图解》:原发性小肠溃疡--猝死的罕见原因。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-11-05 DOI: 10.1097/PAF.0000000000000999
Catherine Taylor, Peter T Lin
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引用次数: 0
A Rare Case of Neonatal Death Due to a Cranial Vault Fracture Following the Use of Obstetric Vacuum Extractor and Review of Literature. 使用产科真空吸引器造成颅顶骨折导致新生儿死亡的罕见病例及文献综述。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-11-05 DOI: 10.1097/PAF.0000000000000996
Fiorella Caputo, Isabella Caristo, Rosario Barranco, Luca Vallega Bernucci, Flaminia Torielli, Francesco Ventura

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.

摘要:在分娩过程中,如果在胎儿排出过程中出现并发症,可以使用器械促进分娩。真空吸引器或排气罩被认为是一种相对安全的工具,并发症和死亡率较低。然而,至关重要的是,必须在正确的位置使用器械,而且拉力不能过大,以尽量减少对胎儿颅骨结构的损伤。本文介绍了一例围产期死亡病例,原因是使用真空吸引器后出现颅顶骨折和气管下血肿。只有通过尸检才有可能发现排气阀的位置不正确,与推荐位置相比,排气阀偏向一侧。在手术分娩导致围产期死亡的病例中,彻底的尸检对于确定死亡原因和重建分娩过程中的动态变化至关重要。特别是,对新生儿伤痕的检查可能会发现器械位置不当。
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引用次数: 0
Decedents Found in Bathtubs. 在浴缸中发现死者。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-11-05 DOI: 10.1097/PAF.0000000000000987
Bethany Faust, Amanda Dye, James R Gill

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.

摘要:我们调查了在浴缸中死亡的案例,以寻找有助于死亡认证的标准。我们审查了 252 例被发现死于家中浴缸/淋浴间的死亡案例。我们提取了死亡原因、方式、年龄、是否穿衣、浴缸内是否有水、水流情况以及脸部是否浸水。在 252 例死亡中,心脏病是主要死因(129 例),其次是中毒(47 例)、外伤(22 例)、溺水(28 例)和其他疾病(26 例)。死亡方式为自然死亡 155 人,意外死亡 64 人,自杀 30 人,他杀 3 人。所有溺水死亡的死者面部都被淹没。中毒死亡和自然死亡中,脸部浸入水中的比例分别为 15%和 12%。在非溺水死亡原因中,大多数都没有面部浸入水中的情况。在自然死亡中,最主要的情况是在浴缸中发现未穿衣服、脸部未被水淹没。相反,在自杀案中,大多数人被发现时衣衫不整,脸部未被水淹没。需要进行全面调查,包括现场检查、收集病史和心理社会史,通常还需要进行尸检,以确定死因和死亡方式。仅凭面部浸水并不能诊断为溺水,必须结合病史和尸检结果进行解释。
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引用次数: 0
Cardiovascular Disease in Acute Cocaine Compared to Acute Fentanyl Intoxication Deaths. 急性可卡因中毒死亡与急性芬太尼中毒死亡的心血管疾病比较。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-11-05 DOI: 10.1097/PAF.0000000000000994
Olivia Burke, Susan F Ely, James R Gill

Abstract: Cocaine is the most common stimulant drug that causes death in Connecticut. Unlike opioid intoxication deaths, which largely correlate with dose/concentration, cocaine deaths occur more idiosyncratically, with mechanisms of death often related to underlying cardiovascular disease. We examined 78 sole acute cocaine and 306 sole acute fentanyl intoxication deaths to assess their association with cardiovascular disease. In the cocaine cohort, 87% (68/78) had atherosclerotic and/or hypertensive cardiovascular disease while 40% (122/306) in the fentanyl cohort did. Cocaine was detected in 40% of all accidental drug intoxication deaths, 41% of all accidental drug intoxication deaths involving fentanyl, and 37% of all drug intoxication deaths involving heroin. The relatively low number of sole cocaine deaths compared to the much higher proportion of cocaine/opioid deaths may be explained by the synergistic effects encountered in many mixed drug intoxications, the contributory role of cardiovascular disease in sole cocaine deaths, and/or the increased prevalence and potency of fentanyl. The high number of sole cocaine deaths in which the decedents had co-existing heart disease compared to those from sole fentanyl deaths (P < 0.001) suggests that heart disease plays a mechanistic role in sole cocaine deaths, whereas the potency of fentanyl is the dominant mechanism in fentanyl deaths.

摘要:可卡因是康涅狄格州最常见的致人死亡的兴奋剂药物。与阿片类药物中毒死亡(主要与剂量/浓度有关)不同,可卡因死亡的发生更具特异性,其死亡机制通常与潜在的心血管疾病有关。我们研究了 78 例急性可卡因中毒死亡病例和 306 例急性芬太尼中毒死亡病例,以评估它们与心血管疾病的关系。在可卡因队列中,87%(68/78)的人患有动脉粥样硬化和/或高血压性心血管疾病,而在芬太尼队列中,40%(122/306)的人患有此类疾病。在所有意外药物中毒死亡病例中,有 40% 检测出可卡因;在所有涉及芬太尼的意外药物中毒死亡病例中,有 41% 检测出可卡因;在所有涉及海洛因的药物中毒死亡病例中,有 37% 检测出可卡因。与比例高得多的可卡因/类阿片死亡相比,单纯的可卡因死亡人数相对较少,这可能是因为在许多混合药物中毒中出现了协同效应,心血管疾病在单纯的可卡因死亡中起到了推波助澜的作用,和/或芬太尼的流行率和效力有所提高。与单独芬太尼死亡相比,可卡因死亡中死者同时患有心脏病的人数较多(P < 0.001),这表明心脏病在单独可卡因死亡中起着机制性作用,而芬太尼的效力则是芬太尼死亡的主要机制。
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引用次数: 0
Gunshot Residue Deposition With and Without Firearm Suppressors (Silencers). 使用和不使用火器消声器(消音器)时的枪弹残留物沉积。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-15 DOI: 10.1097/PAF.0000000000000990
Samuel P Prahlow, Lee Morgan, Joseph A Prahlow

Abstract: Forensic pathologists recognize the importance of estimating the range of fire for gunshot entrance wounds. Classically described ranges of fire include contact, close range, medium (or intermediate) range, and indeterminate (or distant) range. The presence or absence of gunshot residue (smoke/soot and/or gunpowder) and the characteristics of the gunshot residue are evaluated in order to estimate the range of fire. It is well known that interposed targets can block or otherwise alter gunshot residue deposition. In this preliminary study, a comparison is made between gunshot defects produced on targets using firearms with and without an attached suppressor device (so-called "silencer"). Comparisons are made at various distances from the targets, using multiple weapon/ammunition calibers.

摘要:法医病理学家认识到估计枪弹入口伤口射程的重要性。经典描述的射击范围包括接触、近距离、中距离(或中间距离)和不确定(或远距离)。评估是否存在枪击残留物(烟雾/烟尘和/或火药)以及枪击残留物的特征是为了估计射程。众所周知,穿插的目标会阻挡或以其他方式改变枪击残留物的沉积。在这项初步研究中,对使用带有和不带附加消音装置(所谓的 "消音器")的枪支在目标上产生的枪击残留物进行了比较。比较是在距离目标不同的距离,使用多种武器/弹药口径进行的。
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引用次数: 0
Extralobar Pulmonary Sequestration: A Case of Incidental Autopsy Diagnosis. 肺外封堵:一例偶然的尸检诊断。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-01 Epub Date: 2024-01-16 DOI: 10.1097/PAF.0000000000000894
Hyeonjin Yu, Hojung Kim, Harin Cheong
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引用次数: 0
An Autopsy Case of Saphenous Vein Graft Rupture. 无隐静脉移植破裂的尸检病例
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-01 Epub Date: 2024-02-27 DOI: 10.1097/PAF.0000000000000919
Thomas Auen, Erin Linde

Abstract: Saphenous vein graft aneurysms are rare complications after coronary artery bypass grafting that carry serious complications. Less than 10 case reports of autopsy findings consistent with ruptured saphenous vein grafts exist in the literature. We report a case of a female presenting at autopsy who, after coronary artery bypass grafting 20 years prior, demonstrated findings of a saphenous vein graft aneurysm and rupture. With limited evidence from medical records, this case highlights a need for patients with previous coronary artery bypass grafting to be properly monitored to detect minute graft changes before aneurysm formation and rupture as seen in our decedent.

摘要:隐静脉移植物动脉瘤是冠状动脉旁路移植术后的罕见并发症,具有严重的并发症。文献中与大隐静脉移植物破裂一致的尸检结果不到 10 例。我们报告了一例女性尸检病例,她在 20 年前接受冠状动脉旁路移植术后发现隐静脉移植物动脉瘤和破裂。由于医疗记录中的证据有限,本病例强调了对既往接受过冠状动脉旁路移植术的患者进行适当监测的必要性,以便在动脉瘤形成和破裂之前发现微小的移植物变化,就像我们的死者一样。
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引用次数: 0
Fentanyl Deaths in Infants and Children: A Case Series and Literature Review. 婴儿和儿童死于芬太尼:病例系列和文献综述。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000943
Katrina Monday, Brandy Shattuck, Kristie Barba, Carolyn H Revercomb

Abstract: Death due to fentanyl and its various analogs has resulted in an exponential rise in deaths throughout the United States, overwhelming many medical examiner offices for over a decade. Its potency and prevalence have caused fentanyl to become the most reported substance in overdose fatalities, with an accompanying increase in exposure of the most vulnerable, infants and children. This report provides information about fentanyl in the pediatric population, including case examples, proposed investigative practices, published therapeutic and lethal blood concentrations, and available resources for future cases. Nine cases of pediatric death between 2013 and 2023 due to fentanyl were reviewed. Five case summaries are presented that highlight classic features of fentanyl deaths in infants, children, and teenagers. Deaths due to fentanyl have continued to rise year after year. Infants and children, most of whom are opioid naive, are at ever increased risk for exposure to high levels of fentanyl. The legal ramifications of a positive fentanyl level in a child increase the need for caution on the part of the forensic pathologist. Understanding what can and cannot be proven by autopsy as well as what resources are available to strengthen one's justification for fentanyl being the primary cause of death is critical.

摘要:芬太尼及其各种类似物导致的死亡在全美呈指数级上升,十多年来压垮了许多法医办公室。芬太尼的效力和普遍性使其成为过量使用致死事件中报告最多的物质,最易受到伤害的婴儿和儿童接触芬太尼的机会也随之增加。本报告提供了有关芬太尼在儿科人群中应用的信息,包括案例、建议的调查方法、已公布的治疗和致死血液浓度以及未来案例的可用资源。报告回顾了 2013 年至 2023 年期间因芬太尼致死的九个儿科病例。本文介绍了五例病例摘要,突出了婴儿、儿童和青少年死于芬太尼的典型特征。因芬太尼致死的人数逐年上升。婴儿和儿童中的大多数人对阿片类药物尚无概念,他们接触高浓度芬太尼的风险不断增加。儿童体内芬太尼含量呈阳性所带来的法律后果使法医病理学家更加需要谨慎。了解尸检能证明什么、不能证实什么以及有哪些资源可用于加强芬太尼是主要死因的理由至关重要。
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引用次数: 0
The Effect of the COVID-19 Pandemic on Suicide Trends in Pretoria, South Africa. COVID-19 大流行对南非比勒陀利亚自杀趋势的影响。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000945
Kay-Leigh Robinson, Candice Pretorius, Ryan Blumenthal, Pieter Meyer

Abstract: Suicide is one of the worldwide leading causes of unnatural death. Pretoria is a capital city of South Africa and is the fourth most populated city in South Africa. Between 16 and 22 suicide cases are recorded daily in South Africa.Case files from the Pretoria Medico-Legal Laboratory were reviewed between 1 January 2015 to 31 December 2021, which spanned the COVID-19 pandemic. All cases of possible and probable suicides were included. One-way analysis of variance and Pearson chi 2 tests were conducted to determine statistical significance in the observed trends.A total of 1820 possible and probable suicide cases were identified. The year following the outbreak of the COVID-19 pandemic accounted for the largest number of suicides. White males were the most heavily represented population, followed by Black males. Hanging was the most common method for males, whereas poisoning via ingestion and/or overdose was more commonly used by females.Suicides in Pretoria have increased since previous studies from 9.74% and 10.2% to 13.32%. Methods used have changed among various population groups over the past two decades. This paper examined changes in suicide trends in Pretoria compared to previous studies and highlighted correlations between suicide trends and COVID-19 lockdown measures.

摘要:自杀是全球非正常死亡的主要原因之一。比勒陀利亚是南非的首都,也是南非人口第四多的城市。比勒陀利亚医学法律实验室(Pretoria Medico-Legal Laboratory)对 2015 年 1 月 1 日至 2021 年 12 月 31 日期间的病例档案进行了审查,这段时间跨越了 COVID-19 大流行期间。所有可能和疑似自杀的病例均被纳入其中。对观察到的趋势进行了单向方差分析和 Pearson chi2 检验,以确定其统计意义。COVID-19大流行爆发后的第二年是自杀人数最多的一年。自杀者中白人男性最多,其次是黑人男性。上吊是男性最常用的自杀方式,而摄入和/或过量中毒则是女性最常用的自杀方式。在过去二十年中,不同人群使用的自杀方式也发生了变化。本文探讨了比勒陀利亚自杀趋势与以往研究相比发生的变化,并强调了自杀趋势与 COVID-19 封锁措施之间的相关性。
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引用次数: 0
期刊
American Journal of Forensic Medicine and Pathology
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