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Am J Forensic Med Pathol 2019 Apr 10. Epub 2019 Apr 10.

From the Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.

Nasal septum defects may have forensic relevance because they are associated with various mechanisms, including trauma and cocaine abuse. Like all human body tissues, the nasal septum may be affected by maggots' infestation during postmortem decomposition. Postmortem computed tomography (PMCT) can reveal small findings and related details. Read More

Am J Forensic Med Pathol 2019 Apr 8. Epub 2019 Apr 8.

From the Connecticut Office of the Chief Medical Examiner, Farmington, CT.

This study on cremation clearance examines whether physical inspections detect more unnatural unreported deaths than medicolegal investigations without inspections. We reviewed all deaths reported to the medical examiner for cremation clearance during 2 distinct years and compared subsequent amendments of death certificates after 2 different investigative methodologies (1 with and 1 without physical inspection). Of 10,367 deaths in 2012, there were 86 deaths (0. Read More

Am J Forensic Med Pathol 2019 Apr 8. Epub 2019 Apr 8.

Office of the Medical Examiner, Maricopa County, Phoenix, AZ.

Abnormal organ weights often serve as an indicator of underlying disease or other pathological process making assessment of organ weight a critical part of the autopsy examination and interpretation. Unfortunately, normal organ weights for children are often based on studies done in the 1930s and 1960s. Thus, the present study was designed to accurately assess organ weights in children to establish reference ranges for use in autopsy examinations. Read More

Am J Forensic Med Pathol 2019 Apr 2. Epub 2019 Apr 2.

N.C. Office of the Chief Medical Examiner, Raleigh, NC.

Primary central nervous system tumors are an extremely rare cause of sudden, unexpected death in children as most patients develop symptoms because of increased intracranial pressure and seek medical attention. Rarely, a forensic pathologist may encounter a primary intracranial neoplasm in a pediatric decedent that was not suspected before death. Herein, we present a case of a supratentorial neuroepithelial tumor found at autopsy in a 3-year-old African American boy without any reported significant medical history. Read More

Am J Forensic Med Pathol 2019 Mar 30. Epub 2019 Mar 30.

Chronic calcific constrictive pericarditis is a rare condition. It can cause severe morbidity and even mortality. The diagnosis may be difficult to establish due to its variable clinical signs. Read More

Am J Forensic Med Pathol 2019 Mar 23. Epub 2019 Mar 23.

Tuberculosis (TB) is one of the most important public health issues worldwide, and global efforts have altered the TB epidemic. This study analyzed 71 cases of TB at autopsy notified via Taiwan Medical Examiner Surveillance for Lethal Infectious Disease (Taiwan Med-X) between 2012 and 2017 and applied immunohistochemistry to formalin-fixed lung tissue. Tuberculosis was present in 0. Read More

Am J Forensic Med Pathol 2019 Mar 23. Epub 2019 Mar 23.

Section of Legal Medicine, University of Perugia, Perugia, Italy.

Impalement injuries occur when a large foreign body traverses or penetrates a body cavity or extremity. Nowadays, impalement injuries are uncommon and are usually a consequence of a fall onto a blunt object or a road accident. The authors report a case of a woman found dead in her apartment, seemingly killed by a firearm injury to the abdomen. Read More

Am J Forensic Med Pathol 2019 Mar 14. Epub 2019 Mar 14.

Institute of Public Health Section of Legal Medicine Università Cattolica del S. Cuore Rome, Italy Institute of Public Health Section of Legal Medicine Università Cattolica del S. Cuore Rome, Italy Institute of Pathological Anatomy Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del S. Cuore Rome, Italy.

Am J Forensic Med Pathol 2019 Mar 9. Epub 2019 Mar 9.

Firearms Division, Forensic Institute, Zurich, Switzerland.

Occasional case reports have described isolated cases of conducted electrical weapon (CEW) probes piercing the human skull. In an experimental setting, we examined whether these cases were just unfortunate incidents, how deeply such probes can pierce the skull, and whether firing distance and CEW probe type play a role in the skull-piercing capability.We fired 5 different CEW cartridges (XP 10. Read More

Am J Forensic Med Pathol 2019 Mar 9. Epub 2019 Mar 9.

Section of Legal Medicine University of Macerata Macerata, Italy Section of Legal Medicine University of Macerata Macerata, Italy.

Am J Forensic Med Pathol 2019 Mar 9. Epub 2019 Mar 9.

Department of Forensic Medicine, ESIC Medical College, Faridabad, Haryana, India.

Application of color on the external body surface before, during, and after death, such as during a festivity, cultural occasion, or after death ritual, can present as an artifact at forensic autopsy. The present study is a retrospective review of body color artifacts collected from postmortem reports, inquest papers and photographs of each individual case autopsied at our institutes during a 12 year period from 2004 to 2015. The reason for body colorations were various festivities, after death rituals and beautification products, among others. Read More

Am J Forensic Med Pathol 2019 Mar 9. Epub 2019 Mar 9.

From the Section of Legal Medicine, DIM, University of Bari, Bari, Italy.

Age estimation is a crucial matter in several forensic and legal instances. The literature recommends carrying out hand and wrist radiograph to assess skeletal age. Much research has been conducted to examine the application of various methods in different categories. Read More

Am J Forensic Med Pathol 2019 Mar 5. Epub 2019 Mar 5.

Medico-Legal and Pathological-Anatomical Department of Health Care Surveillance Authority, Košice, Slovak Republic.

In this article, we report the autopsy findings of a 23-year-old woman, who was found unconscious at home by her relatives. During the transportation to the hospital, the woman was handed over to the ambulance personnel, who were the first to provide cardiopulmonary resuscitation. In the hospital, after an hour-lasting asystole, the heart activity was restored. Read More

Am J Forensic Med Pathol 2019 Feb 21. Epub 2019 Feb 21.

From the University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND.

When a hunter intentionally fires a weapon and the projectile strikes another human, the manner of death is most often certified as a homicide. The intent of the individual firing the weapon is unknown and the possibility that a hunting "accident" represents a concealed intentional homicide must always be considered. However, in some circumstances such as a documented ricochet, the manner of death may be certified as accident. Read More

Am J Forensic Med Pathol 2019 Feb 15. Epub 2019 Feb 15.

From the Department of Pathology, and.

In 2005, the National Association of Medical Examiners approved the Forensic Autopsy Performance Standards. Standard B3.7 indicates that a forensic pathologist shall perform a forensic autopsy when the death is by apparent intoxication by alcohol, drugs, or poison. Read More

Am J Forensic Med Pathol 2019 Jan 23. Epub 2019 Jan 23.

Kentucky Chief Medical Examiner Office, Louisville, KY.

Sudden unexplained death in infancy is a leading cause of death among infants between 1 month and 1 year of age in the United States. The medical examiner is frequently given the difficult task of attempting to rule out other causes of death such as infantile trauma or child abuse. A thorough postmortem examination of the skin is a crucial component of the autopsy, as is sufficient knowledge of both benign and traumatic skin pathologies. Read More

Am J Forensic Med Pathol 2019 Jan 24. Epub 2019 Jan 24.

Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.

On May 16, 2017, the judgment of the Italian court ended the legal battle concerning the repatriation request of the famous skull, belonging to the "brigand" Giuseppe Villella. During the autopsy examination on the corpse of Villella, Lombroso observed a median occipital dimple on the skull, a feature visible in other mammals, including primates, but absent in humans. This feature could demonstrate an anomalous dimension of the median lobe of Villella's cerebellum. Read More

Am J Forensic Med Pathol 2019 Jan 23. Epub 2019 Jan 23.

Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Acute esophageal necrosis (AEN), also known as black esophagus, is a rare clinical entity. It is recently described to be associated with diabetic ketoacidosis (DKA) in a few case reports. Wischnewsky lesions (WLs) are a classic postmortem finding seen in fatal hypothermia but are recently described to be associated with DKA. Read More

Am J Forensic Med Pathol 2019 Jan 17. Epub 2019 Jan 17.

Departments of Forensic Pathology and.

Streptococcus pneumoniae is the leading cause of adult bacterial meningitis. Differing from Neisseria meningitidis (the second most common cause of acute bacterial meningitis), contact tracing and chemoprophylaxis are not required. At postmortem, the differentiation between S. Read More

Am J Forensic Med Pathol 2019 Jan 17. Epub 2019 Jan 17.

Departments of Forensic Pathology and.

To ascribe a cause of death from drowning in a body immersed in water can be difficult because of the absence of specific postmortem findings and unreliable ancillary tests. Postmortem vitreous biochemical analysis is documented to be a useful adjunct ancillary test to aid the diagnosis of saltwater drowning. A major confounding factor in using postmortem vitreous is the effect of electrolyte diffusion and water osmosis during immersion. Read More

Am J Forensic Med Pathol 2019 Jan 7. Epub 2019 Jan 7.

Section of Legal Medicine, Hospital of Terni, Terni, Italy.

The authors report a case of a man who developed stroke symptoms a few days after a road accident on his motorcycle. Radiographic examinations revealed the presence of bilateral dissection of the extracranial internal carotid arteries with signs of involvement of the brain parenchyma.The location, timing, and presentation lead to the conclusion that the carotid lesions were secondary to the motorcycle collision; in particular, we suppose that it is due to the pressure exerted by the helmet strap worn. Read More

Am J Forensic Med Pathol 2019 Jan 7. Epub 2019 Jan 7.

From the Department of Pathology and Laboratory Medicine, Spectrum Health Blodgett Campus, Grand Rapids, MI.

We describe an 8-year-old white boy with a history of fetal alcohol syndrome and pica, who was found dead on the floor by his mother. The child died from massive intestinal dilatation causing asphyxia. We discuss the potential pathogenetic mechanisms of intestinal dilation in patients with fetal alcohol syndrome. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):1-7

Valdosta State University, Valdosta, GA.

Introduction: It has been suggested that law enforcement officer (LEO) weight on the backs of prone subjects may cause asphyxia.

Methods: Law enforcement officers used their agency-trained "local" single- and double-knee techniques, the "Wisconsin" 3-Point Ground Stabilization, and the Human Factor Research Group Inc single-knee tactical handcuffing techniques, and the weight force was measured.

Results: Forty-one LEOs (36 men, 5 women) participated, aged 38. Read More

Am J Forensic Med Pathol 2018 Dec 18. Epub 2018 Dec 18.

The University of Texas Health Science Center at Houston School of Public Health, Houston, TX.

This study examined medicolegal death investigation records and autopsy reports of a medical examiner's office to identify the circumstances surrounding sudden unexpected infant deaths (SUID) and geospatial analyses to pinpoint areas of infant death concentration. Analysis of 732 records of SUID deaths occurring in a 10-year span resulted in the conclusion that environmental factors associated with the sudden death were to some extent modifiable. Co-sleeping (sharing a sleeping surface, or bed-sharing) on various surfaces (mattress, pallet, couch) occurred in 53. Read More

Am J Forensic Med Pathol 2018 Dec 17. Epub 2018 Dec 17.

Division of Genomic Medicine, Kanazawa Medical University, Ishikawa, Japan.

A case of clinically unsuspected fatal interrupted aortic arch (IAA) is described. A 17-day-old Japanese girl unexpectedly entered respiratory arrest at home. On autopsy, the heart was hypertrophic, with no apparent connection between the ascending and descending aortas. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):52-57

From the University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND.

Envenoming syndrome is a systemic toxic reaction to the inoculation of large volume of insect venom, typically after a swarm attack from bees. Africanized honey bees are notorious for their aggressive nature, and human deaths resulting from Africanized honey bee attacks are consistently reported. Whereas anaphylaxis is the most common lethal mechanism of injury, delayed deaths can also occur as a consequence of severe venom toxicity with resultant end organ damage. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):84-88

Departamento de Anatomía y Embriología Humana Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

Differential diagnosis between normal/variant anatomy and pathological/traumatic findings represents one of the main matters of investigation of the so-called forensic clinical anatomy. In the literature, many anatomical variations of the laryngeal thyroid cartilage have been reported, with potential implications in forensic pathology. They include triticeal cartilages, foramen thyroideum, asymmetry, segmentation or agenesis of the superior thyroid horns, bone connections with the hyoid bone, absence of cricothyroid facets, hypertrophy of the inferior thyroid tubercle, and asymmetries in the thyroid notch, isthmus, or length of the inferior horn. Read More

Am J Forensic Med Pathol 2018 Nov 29. Epub 2018 Nov 29.

Laboratorio de Entomología Aplicada y Forense, Departamento de Ciencia y Técnica, Universidad Nacional de Quilmes, Bernal, Provincia de Buenos Aires, Argentina.

Dermestes maculatus DeGeer beetles feed and can leave marks on bones. This species is of medical, veterinary, and forensic importance. The aim of this work was to determine if the depressions produced on bones by these beetles could be product of pupation. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):8-18

Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.

Cytochrome p450 family 2, subfamily D, polypeptide 6 (CYP2D6) may be used to infer the metabolizer phenotype (MP) of an individual as poor, intermediate, extensive/normal, or ultrarapid. Metabolizer phenotypes may suggest idiosyncratic drug responses as contributing factors to cause and/or manner of death in postmortem investigations. Application of CYP2D6 has used long-range amplification of the locus and restriction enzyme digestion to detect single-nucleotide variants (SNVs) associated with MPs. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):72-76

Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC.

This case report details the unique cause of death of a 37-year-old Caucasian woman with a history significant for intravenous drug abuse. Before her death, she complained of extremity weakness and pain. Although her death was discovered to be the result of endocarditis, her symptoms were similar to that of a stroke. Read More

Am J Forensic Med Pathol 2018 Nov 20. Epub 2018 Nov 20.

Forensic Pathology and.

Biochemical analysis of cerebrospinal fluid (CSF) and vitreous humor (VH) forms an important diagnostic ancillary test at autopsy. Cerebrospinal fluid can be sampled from the ventricular system (VA) and from lumbar puncture (LP), whereas VH can be sampled from the orbits. Biochemical electrolytes seem to vary between VH and CSF collected from different sites, but whether there is any difference in glucose and β-hydroxybutyrate is unclear. Read More

Am J Forensic Med Pathol 2018 Nov 20. Epub 2018 Nov 20.

Forensic Pathology and.

Diagnosing sepsis at postmortem is challenging. With respect to meningococcal sepsis, the postmortem microbiological identification of Neisseria meningitidis is nearly always due to true infection, including in cases of decomposition. Previous case series and case reports were able to isolate N. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):61-64

Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China.

Postmortem computed tomography (PMCT) and PMCT angiography are increasingly used in forensic practice. However, their application in court is still limited because they need professional equipment or software to be displayed. In this article, the authors introduce 3-dimensional (3D) printing technology as a new approach to provide evidence in court. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):43-46

School of Humanities, University of Tasmania, Hobart, Tasmania, Australia.

Scurvy is a multisystem condition that arises from vitamin C deficiency. As humans cannot synthesize vitamin C, serum and tissue levels depend on bioavailability, utilization, and renal excretion. Deficiencies result in defective collagen formation with swelling of gums, leg ulceration, and bleeding manifestations. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):58-60

From the Institute of Forensic Medicine "Milovan Milovanović," University of Belgrade, School of Medicine, Belgrade, Serbia.

We present a case of 19-year-old female patient, who was injured in childhood and subsequently developed hydrocephalus, chronic elevation of intracranial pressure (ICP), and a copper-beaten skull appearance. Chronic hydrocephalus leads to an increase in intraventricular pressure, causing ventricular expansion and dislocation of adjacent cerebral structures. According to literature data, it has been hypothesized that chronically elevated ICP in persons with craniosynostosis, and other developmental structural abnormalities of the skull, may induce bone remodeling. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):19-26

From the Forensic Medicine and Toxicology and Radiology Departments, Faculty of Medicine, Minia University, El-Minia, Egypt.

Sex determination is an initial and essential component of any medicolegal investigations. However, sometimes only cranial remains are available. The objective of this study was to determine sex using 12 craniofacial measurements in multidetector computed tomographic images of 150 Egyptian subjects (80 men and 70 women), with age ranging from 18 to 60 years. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):89-93

Department of Clinical Pathology, ASL 1 Imperiese - Sanremo Hospital, Sanremo, Italy.

Meigs syndrome is the triad of ascites, hydrothorax, and benign ovarian tumor (mostly fibroids). It is a diagnosis of exclusion, and the characteristic symptoms disappear after resection of the tumor. Instead, in Pseudo-Meigs syndrome, the triad includes a nonfibroma ovarian tumor. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):68-71

Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.

Venous malformations (VMs) are the most common vascular malformations, and their diagnosis can be challenging. They may develop in any region of the body, with highly variable clinical presentations. Although they typically present early in life, many case reports have documented the sudden appearance of a previously unrecognized venous malformation in adulthood. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):65-67

From the School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.

A 3-month-old boy presented to hospital in cardiac arrest, dehydrated, with a blood sodium of 158.4 mmol/L. He had been febrile, not feeding normally and refusing fluids. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):27-42

NESMOS Department, School of Medicine and Psychology, Sant'Andrea Hospital, Sapienza - University of Rome, Rome, Italy.

A systematic review of the literature regarding drug packaging methods in body packing and materials used is presented, with the aim (a) to summarize data regarding the packaging methods adopted by drug trafficking organizations, (b) to support forensic pathologists and police forces to classify and describe drug packages, (c) to propose a new classification for drug packaging techniques, and (d) to better clarify the impact of packaging methods on radiological detectability.Packaging methods have been described in 2981 cases, permitting us to summarize the different materials used and to propose a new classification for packaging method based on the materials used. Information concerning the affiliation of body packers and pushers with major (or not) drug trafficking organizations and techniques used to reduce the radiological detectability of the concealed drugs have also been collected. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):81-83

From the Pathology Department, Forensic Council of Turkey, Ministry of Justice, Istanbul, Turkey.

Volatile substance addiction and toxic gas inhalation are now an important health problem. The pleasure-based inhalation of butane gas, also known as lighter refill gas, is especially prevalent among children and young people. The most important reasons for this situation are that they are cheap and easy to obtain and lack of legal supervision. Read More

Am J Forensic Med Pathol 2019 Mar;40(1):77-80

Department of Pathology, University of Michigan, Ann Arbor, MI.

Classic "bread-and-butter" appearance of fibrinous pericarditis had been described in rheumatic disease and other immunologic diseases such as systemic lupus erythematosus, post-myocardial infarct, uremia, tuberculosis, radiation effects, bacterial, and viral etiology. In most of the described cases, pericarditis occurs as a delayed complication. We present a case of a 21-year-old white woman who was seen in the emergency department to rule out pulmonary embolism for shortness of breath, chest pain, and lightheadedness. Read More

Am J Forensic Med Pathol 2018 Dec;39(4):330-336

From the Sezione di Medicina Legale, Dipartimento di Scienze della Sanità Pubblica e Pediatriche, "Università degli Studi di Torino," Torino, Italy.

The diagnosis of lethal commotio cordis (CC) is really complex. The forensic pathologist's task is even more relevant when he/she has to explain a CC diagnosis caused by an assault in a trial. The purpose of this study was to analyze the literature on lethal CC as a result of violent attacks and identify relevant parameters that may help in the diagnosis. Read More