American Journal of Forensic Medicine and Pathology最新文献

Abstract: Heart-type fatty acid-binding protein (HFABP) is a 15-kDa substance reported to pass through the renal tubules and be renally excreted. Therefore, it is possible that its concentration in the urine collected postmortem may reflect antemortem blood levels. We measured the postmortem urine concentration of HFABP in 94 forensic autopsy cases and compared it between acute myocardial infarction (AMI), sepsis, heat stroke cases, and asphyxia cases as control cases to examine its diagnostic validity. Kidney tissue collected at autopsy was immunostained with antibodies against HFABP to evaluate the correlation with the urinary measurements. Urinary HFABP was significantly higher in AMI, sepsis, and heat stroke cases than in asphyxia cases. Quantitative immunostaining results showed no significant differences between any 2 groups. The usefulness of kidney immunostaining for HFABP in elucidating the cause of death was low. Two reasons may explain the lack of significant differences in kidney immunostaining: nonspecific leakage of tubular epithelial HFABP into the tubules because of postmortem changes and oliguria due to dehydration caused by heat stroke. In conclusion, the measurement of urinary HFABP may be useful in elucidating the cause of death; however, the kidney HFABP immunostaining was not significantly different from AMI.

Abstract: When a young previously healthy person dies suddenly, occasionally, the scene is noncontributory and the autopsy and drug screen are negative. In such cases, additional studies, including genetic assessment and cardiac conduction system examination, should be performed. We performed a literature search and reviewed our own material to identify possible or definite conduction system anomalies that may cause death. We identified intrinsic conduction system disease including cystic tumor of the atrioventricular node, atrioventricular node (cystic tumor of the AV node), and fibromuscular dysplasia of the atrioventricular node artery to be likely causes of death. Extrinsic causes, in which a generalized disease affects the conduction system, include tumors, autoimmune disease, infiltrative disorders, and others, are a second category of diseases that can affect the conduction system and cause atrioventricular block and sudden death.

Abstract: Paraquat (PQ) is one of the most widely used herbicides in the world, and poisoning is generally associated with accidental, suicidal, or homicidal events. Therefore, in the forensic context, PQ could be in various ways involved as a possible cause of death of a subject. However, even though its systemic toxicity is known, the biological effects exerted on individual viscera have been explored only to some extent, especially in case of victim's survival. Therefore, a case concerning a suicidal ingestion of PQ with survival of 3 days was deemed of interest. Clinical toxicological analyses confirmed acute PQ intoxication, and after the death of the victim, an autopsy was performed showing local and systemic signs of ingestion of a caustic substance. Histologic examination revealed marked cellular damage to the major viscera, particularly the gastroesophageal tract, liver, kidneys, and lungs, with initial alveolar fibrosis noted despite the patient's short survival. This finding represents a new element in the context of PQ lung injury, as it has not been previously documented in the literature. Thus, histological findings in lethal intoxications after survival can reveal specific peculiarities still unknown and, therefore, assume transversal relevance not only at forensic but also clinical level.

Abstract: Female homicide is a broad term that includes any homicide in which the victim is a female, representing the most extreme form of violence against women. This study investigated the characteristics of female homicides to determine the types and characteristics of injury, circumstances of the events, and other aspects in this specific population. The Cook County Medical Examiner's Office files were searched for homicides in female subjects between January 2017 and January 2022, with no limits for age, race, or cause of death. A total of 527 cases met the criteria. Most homicides occurred in Chicago during the summer. The most common cause of death was firearm(s) wounds, followed by sharp force traumas, asphyxia, and blunt force injuries. The remaining deaths were due to combined and "other" mechanisms. Different patterns of injuries were observed at the autopsy. Alleged offenders were mostly male subjects and were frequently in a romantic relationship with the victim, and the reasons for homicide were related to jealousy and personal conflicts. This study offers an overview of homicidal deaths in female subjects in a large metropolitan area.

Abstract: Synthetic cannabinoids are illegal substances designed to mimic the effects of natural cannabinoids, typically smoked, although liquid formulations have emerged recently. This report highlights a series of cases ranging from a 2-year-old child to an adult who presented with symptoms of intoxication after consuming jellybeans containing liquefied synthetic cannabinoids. A 2-year-old child exhibited mental status changes, somnolence, tachycardia, dilated pupils, and flushed skin, and the 8- and 11-year-old children presented with anxiety, abdominal pain, vomiting, and nausea. The adult patient was more complicated, as his symptoms were consistent with acute coronary syndrome, but his angiography showed normal coronary arteries. It is important for forensic medical professionals and emergency physicians to be aware of the possibility of unintentional atypical exposure to synthetic cannabinoids and to handle suspected cases with care as part of their medical approach. These substances can have a range of effects on the body, and their use can lead to serious health consequences and even mortality.

Abstract: 1,2-Dichloropropane (1,2-DCP) is a common industrial solvent and chemical intermediate that can cause acute poisoning to humans through exposure during its production and industrial use. The target organs of 1,2-DCP include the eyes, respiratory system, liver, kidney, central nervous system, and skin. Forensic identification of 1,2-DCP poisoning is difficult because of the lack of characteristic pathological changes. This article reports an autopsy case of acute 1,2-DCP poisoning caused by self-ingestion of rubber cement. A woman developed seizures and coagulation dysfunction after ingesting approximately 10 mL of rubber cement and died 43 hours later. Autopsy revealed generalized subcutaneous hemorrhage, cardiopulmonary multifocal hemorrhage, bronchopneumonia, severe cerebral edema, focal hepatic necrosis, granular deposition in the glomerular capsule and renal tubules, and delipidation of the adrenal cortex. These findings indicate that 1,2-DCP poisoning can induce central nervous system dysfunction, respiratory system damage, liver and kidney function damage, hemolytic anemia, disseminated intravascular coagulation, and adrenal damage. This case may provide useful perspectives for forensic identification of 1,2-DCP poisoning in the future.

Abstract: The aims of this study were to examine the procedures performed during the death examination by scanning the qadi registry books of the Ottoman Empire in the 16th-18th centuries and to compare them with the procedures performed today. In our study, a total of 12 Konya qadi registry records from the period between 16th and 18th centuries (1563-1731) were examined. In our study, a total of 70 cases that underwent death discovery and examination were found out of 12 Konya qadi registry books. When the causes of death were evaluated in the cases in which the dead were discovered, being trapped in the wreckage was found as the most common cause with a total of 9 cases. This was followed by drowning (n = 8), being found dead in the open area (n = 8), and sharp injuries (n = 7). Because of the developments in all fields of medicine, it is understandable that wound descriptions are much more detailed today. However, descriptions such as "black bruise, battery, wounding" were found in the qadi registers as well. This case study is one of the most historic and comprehensive death series.