bluuebunny/crossref_metadata_2025 huggingface dataset:
Pitfalls and Artifacts in the Neck at Autopsy
Authors: Pollanen Michael S.
Published: April 2017

The diagnosis of strangulation at autopsy is a persistent challenge for the forensic pathologist. The main difficulty is interpreting the observations made at the postmortem table and deciding whether the observations are a sufficient basis to render an expert opinion that death was caused by external compression of the neck. This may have considerable importance to the criminal justice system and may lead to a conviction for murder. There are five main pitfalls and artifacts encountered in the neck at postmortem examination. These five areas provide the majority of the interpretative difficulties experienced by the pathologist. These challenges include: 1) developmental anatomy of the hyoid bone; 2) triticeous cartilages; 3) Prinsloo-Gordon hemorrhage; 4) postmortem hypostatic hemorrhage; and 5) resuscitation-related neck injury. This review explores these five areas. Awareness of the pitfalls and artifacts in the neck is essential for a satisfactory and evidence-based approach to interpreting observations of the neck at autopsy.
Postmortem Changes as Documented in Postmortem Computed Tomography Scans
Authors: Andrews Sam W.
Published: April 2017

The benefits and uses of postmortem computed tomography (PMCT) have been well documented in the forensic pathology and radiology literature in recent years and research into its utility continue in earnest. Opinions and policies regarding who actually interprets the PMCT scans vary between institutions, but in general, scans will be read by a forensic pathologist, a clinical radiologist, or a clinical radiologist with a special interest or training in postmortem imaging. Differences between clinical computed tomography scans and PMCT scans have been well documented and knowledge of these differences, typically those due to postmortem changes, is essential to the reader of the PMCT scan so as to minimize the risk of misinterpretation and, potentially, misdiagnoses.
Implications of Death Certification on Sudden Unexpected Death in Epilepsy (SUDEP) Research
Authors: Atherton Daniel S. , Devinsky Orrin , Hesdorffer Dale C. , Wright Cyndi , Davis Gregory G.
Published: April 2017

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in individuals with chronic, uncontrolled epilepsy. Epidemiologists use information on death certificates to study SUDEP. Certification of seizure-related deaths varies. Multiple classification schemes have been proposed to categorize SUDEP type deaths. Nashef et al. recently proposed categorizing death into Definite SUDEP, Definite SUDEP Plus, Probable SUDEP, Possible SUDEP, Near-SUDEP, and Not SUDEP. This study analyzes certification of seizure-related deaths by our office and considers how it relates to Nashef's classifications. Investigative reports from 2011-2015 from the archives of the Jefferson County Coroner/Medical Examiner's Office were searched for the terms “seizure(s)” and “epilepsy.” Cases (N=61) were categorized as Definite SUDEP (n=13), Definite SUDEP Plus (n=12), Probable SUDEP (n=1), Possible SUDEP (n=2), and Not SUDEP (n=33). The term SUDEP was only used in one case of Definite SUDEP. The other 12 cases were certified with variations of terms “seizure” and “epilepsy.” Cases categorized as Definite SUDEP Plus were overwhelmingly certified as deaths due to heart disease. Categories Probable SUDEP or Possible SUDEP comprised three cases, and in one of those a seizure-related term was used on the death certificate. Thirty-three cases were classified as Not SUDEP. The finding that the majority of cases of Definite SUDEP were certified as some variation of “seizure” or “epilepsy” but not “SUDEP” has important implications for SUDEP research. Our study also suggests that cases of Definite SUDEP Plus would be difficult for epidemiologists to identify because cardiovascular diseases are more frequently implicated.
Tandem Bullet Homicide
Authors: Prahlow Samuel P. , Wolfenbarger Ray , Prahlow Joseph A.
Published: April 2017

The phenomenon referred to as “tandem bullets” occurs when two (or more) projectiles are expelled from a firearm barrel in a single pull of the trigger. A “tandem gunshot wound” occurs when tandem bullets produce injuries. Several scenarios can occur, including the occurrence of multiple entrance wounds produced by separate tandem projectiles as well as a single entrance wound through which multiple tandem projectiles enter the body. We present a case of homicide by tandem bullets in which two tandem bullets entered a single entrance wound, with one projectile exiting the body and one remaining within the body. In addition, we review the topic of tandem projectiles and summarize other situations that may cause initial confusion when attempting to account for all gunshot wounds on the skin and projectiles as viewed on pre-autopsy imaging.
The Determination of Insulin Overdose in Postmortem Investigations
Authors: Labay Laura M. , Bitting Casey P. , Legg Kevin M. , Logan Barry K.
Published: April 2017

The analysis of biological specimens for the presence of exogenous insulin is of special interest in select postmortem investigations. Insulin analogues are primarily used to mediate the regulation of blood glucose concentrations; however, their use has also been implicated or suspected as a cause of death in suicides, accidents, and homicides. Toxicological analysis for these compounds is challenging due to the large molecular weight, the limited stability of insulin in whole blood, and complexities associated with sample preparation and instrumental testing. As a consequence, determination of insulin in postmortem specimens is not routinely offered by most forensic toxicology laboratories. Forensic death investigation is further complicated by interpretative difficulties such as the frequent absence of anatomical findings, concentration interpretation in known insulin users, and addressing the impact of chemical instability and postmortem redistribution. There are ongoing efforts, however, to develop and validate robust methods that may be used for this analysis on these challenging samples and that are capable of withstanding scientific and legal scrutiny for forensic use. In this regard, in recent years, methods for the detection of exogenous insulin in postmortem samples have been reported and results of this testing has been published in a handful of cases. The purpose of this article is to review the primary functions of insulin, the disease states associated with the therapeutic use of exogenous insulin, the current state of laboratory testing, and to provide case summaries that summarize the timeline of advancements and underscore the importance of this work.
Addison Disease: The First Presentation of the Condition May be at Autopsy
Authors: Kemp Walter L. , Koponen Mark A. , Meyers Sarah E.
Published: April 2017

Addison disease is chronic primary adrenal insufficiency, which, in developed countries, is most commonly due to autoimmune destruction of the cortex (termed autoimmune or idiopathic Addison disease). Although the disease process has some classic features, such as increased pigmentation, salt craving, and signs and symptoms related to decreased blood pressure, the initial clinical presentation may be vague and/or insidious. Following an acute stressor such as a gastrointestinal (GI) infection, the patient may experience an adrenal crisis, which can cause sudden death. As such, knowledge of this disease process and the diagnostic criteria in the postmortem period is essential for the practicing forensic pathologist. The diagnosis of autoimmune Addison disease at autopsy is aided by several factors including 1) history, including salt craving, features consistent with orthostatic hypotension, and GI complaints including nausea, vomiting and pain, 2) physical examination findings of increased pigmentation and small or unidentifiable adrenal glands, 3) serologic testing for 21-hydroxylase antibodies, 4) serum cortisol concentrations, and 5) vitreous electrolyte testing. While the listed historical information, the increased pigmentation, decreased serum cortisol concentrations, and evidence of hyponatremia may be found in all forms of Addison disease, small or unidentifiable adrenal glands and 21-hydroxylase antibodies are found exclusively in the autoimmune form of Addison disease. While other causes of Addison disease, such as tuberculosis, metastatic tumor, or other infiltrative processes would have enlarged adrenal glands, these diseases would lack 21-hydroxylase antibodies. The purpose of this paper is to focus on the diagnosis of autoimmune Addison disease.
A Practical Forensic Approach to Fatal Pediatric Endocrinopathies
Authors: Caplan Michael J.
Published: April 2017

Of all of the organ systems in clinical medicine, the endocrine system is among the most difficult to master since it requires a detailed and knowledgeable integration of many of the body's separate systems. In forensic pathology, the evaluation of a sudden unexplained death can be challenging depending upon the particular disease processes and the organ systems that are affected. It is therefore not surprising that the investigation of sudden unexplained deaths involving the endocrine system can be particularly daunting. This review attempts to focus upon three of the major endocrine/metabolic conditions that may be potentially life-threatening and fatal in the pediatric population — hypoglycemia, adrenal insufficiency, and hyperthyroidism — and to provide forensic pathologists with a practical strategy for working up these cases. By adopting a more focused and selective approach to pediatric endocrine conditions rather than an exhaustive and comprehensive study of them, it is the intention of this review to make these disorders more manageable conceptually and to optimize the chance of arriving at a decisive and ultimately accurate postmortem diagnosis.
Surveillance of Drug Overdoses Using Google Fusion Tables
Authors: Cain Matthew D. , McGwin Gerald , Atherton Daniel
Published: April 2017

Introduction

Drug use is a constantly evolving public health challenge. We present the use of Google Fusion Tables and Google Maps for the surveillance of drug-related deaths and discuss its potential large-scale use.

Methods

Demographic and geographic data for deaths related to cocaine and heroin use occurring from 2012-2014 was queried from the Jefferson County Coroner/Medical Examiner's Office. Fusion Tables was then used to plot each address onto a map.

Results

We developed a method to automatically import data into Fusion Tables. Individualized icons were then used to denote specific demographics and locations on a Google Map where filters could be applied to visualize findings such as only 18-25 year old white males. These features provided an easy means to visualize the relative high frequency of heroin-related deaths in white males. Furthermore, the date filters highlighted heroin-related deaths more than doubled in 2014 compared to previous years.

Conclusions

Mapping of health-related data has a long-standing history in public health, though its use in the forensic pathology community is limited. Fusion Tables provides users with the ability to visualize and analyze patterns and share data. Many geocoding solutions exist; however, we found this software to be user friendly and flexible. Our office now includes these visualizations into the annual summary that is provided to local law enforcement, public health officials, and the general public.
An Unusual Feature of Graze Gunshot Wounds
Authors: Heninger Michael M.
Published: April 2017

All graze wounds that occurred in the jurisdiction of the Fulton County Medical Examiners Center over a ten-year period (2005-2014) were inspected. Of a total of 227 graze wounds, 31 (14%) exhibited a previously not well-described feature. At one end of the graze wound, two small, subtle, parallel abrasions separated by a band of spared skin extended away from the wound. This finding occurred more often at the proximal corner (16 times) than the distal corner (seven times) when a direction was able to be determined. The mechanism of this feature does not appear to be related to jacketed ammunition expected to deform into petals. Possible mechanisms for the creation of this feature are random irregularities in skin resistance along with slight wobble (yaw) of the bullet or pressure waves generated by the bullet that causes buckling of the skin.
Fatal Catecholamine-Induced Cardiotoxicity Associated with Pheochromocytoma: Report of a Postpartum Case and Review of the Literature
Authors: Wang Amber R. , Dean Stephanie A. , Grebe Stefan K. , Hood Ian C.
Published: April 2017

Pheochromocytomas and paragangliomas are catecholamine-secreting tumors characterized by excessive adrenergic stimulation. Common manifestations include hypertension, headache, sweating, and palpitations; however, rare life-threatening conditions have also been reported and include cardiovascular shock, myocardial infarction, arrhythmias, and cardiomyopathy. We report a case of a previously healthy 31-year-old postpartum female presenting with headache who died suddenly in an emergency room. Autopsy revealed a pheochromocytoma of the right adrenal with significantly elevated metanephrine concentrations and acute “myocarditis.” Sudden excessive catecholamine release can cause cardiovascular complications and be rapidly fatal without significant elevation of blood pressure. Awareness of this association by the medical examiner/coroner is vital in order to properly classify the death and apprise relatives of the potential utility of genetic screening.
An Autopsy Case of Spontaneous Splenic Rupture Due to Isolated Splenic Peliosis and Review of the Literature
Authors: Prats Mariana Moreno , Aronson Judith F.
Published: April 2017

Peliosis is a rare entity that is characterized by cystic or blood-filled spaces in the parenchyma of solid organs. It is most commonly seen in the spleen in patients who also have peliosis hepatis. Isolated splenic peliosis is very rare and spontaneous rupture due to splenic peliosis is even more uncommon. This diagnosis has high importance in forensic pathology as it is a rare cause of atraumatic splenic rupture. We present a case in which the diagnosis of isolated splenic peliosis with massive hemoperitoneum was made at autopsy.
Progress in the Accreditation of Anthropology Laboratories
Authors: Pierce Michal L. , Wiersema Jason M. , Crowder Christian M.
Published: April 2017

While crime laboratories are commonly accredited under programs utilizing international standards, options for forensic anthropologists to do the same were limited, until recently. The American National Standards Institute-American Society for Quality (ANSI-ASQ) National Accreditation Board (ANAB) and the American Association for Laboratory Accreditation (A2LA) both offer accreditation programs for forensic anthropology services using either the International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) 17025 or ISO/IEC 17020 standard. The significant efforts made to specifically include forensic anthropology, and also forensic pathology, in these national programs demonstrate the importance for all practitioners in the field of forensic science to develop and maintain quality assurance programs consistent with international standards. Among the requirements for quality assurance is validation of methods, a practice that was previously identified as needing improvement within the forensic anthropology community.
The Biological Profile of Unidentified Human Remains in a Forensic Context
Authors: Austin Dana , King Rebecca E.
Published: April 2017

Estimation of the biological profile of unidentified human remains is a critical component of an anthropologic evaluation of unidentified human remains. The profile is used to search for missing persons that may match the decedent. The individual components of sex, ancestry, stature, and age at death require reliable methods to ensure accurate recording of these biological markers. This article showcases an unidentified skeleton that was misclassified as a female when the original evaluation was done in 1963. The revaluation in 2004 quickly led to resolution of the identity. Methods used today to evaluate the components of the biological profile are reviewed along with a limited review of the historic literature.
Metric Methods for the Biological Profile in Forensic Anthropology: Sex, Ancestry, and Stature
Authors: Spradley M. Kate
Published: April 2017

The biological profile, conducted by a forensic anthropologist, is necessary for severely decomposed or skeletonized remains. The biological profile consists of estimates of sex, age, ancestry, and stature. It is crucial to have a correct estimate of sex, as this designation will narrow down the search through missing persons reports by half (e.g., searching through NamUs). However, sex estimates can be population specific, necessitating accurate ancestry estimation. When estimates of age and stature are added, the search narrows further. If these estimates are incorrect, the unidentified human remains may never be identified. These biological profile components are estimated based on either metric or nonmetric methods (visual observation and recording of categorical data). While age is inherently nonmetric, stature is inherently metric. Estimates of sex and ancestry can take a metric or nonmetric approach. The purpose of this review article is to review metric methods in forensic anthropology (sex, ancestry, and stature), to provide general knowledge of why and how these metric methods work, and to highlight that estimates of sex, ancestry, and stature do not subscribe to a “one size fits all” model.
Ancestry Estimation Using Macromorphoscopic Traits
Authors: Plemons Amber , Hefner Joseph T.
Published: April 2017

Anthropologists have a lengthy history using cranial nonmetric traits to assess biological distances between populations. These concepts were adopted by forensic anthropologists to estimate ancestry at the individual level using population-based human variation. However, this method of estimation must adhere to the Daubert guidelines to be applied in the modern court system. To that end, a set of cranial macromorphoscopic traits have been proffered to generate a methodological approach to the estimation of ancestry that can be empirically tested and verified. Additionally, various statistical frameworks, parametric and nonparametric, have been employed to calculate error rates and provide probabilistic statements of the strength of these estimations. Recent studies have further advanced the reliability and validity of macromorphoscopic trait analysis through reference datasets, validation studies, and demonstrable exploration of the complex population histories impacting human variation between and within populations worldwide.
The Role of the Anthropologist in the Application of NamUs
Authors: Craig Emily
Published: April 2017

The National Missing and Unidentified Person System (NamUs) provides a web-based platform where forensic scientists, law enforcement investigators, and the public can share information related to missing person and unidentified decedent cases across the United States. Through this secure online database, forensic anthropologists, along with medical examiners, coroners, law enforcement officers, family members of missing persons, and concerned citizens, can access varying levels of information on a common platform to assist in the resolution of these cases. Conventional wisdom and experience allows that an individual who is known within the community and has been dead a very short time is more likely to be identified than someone who is badly decomposed and/or skeletal. For others, even when there has been an extended postmortem interval, circumstances, associated evidence, and location of the remains are just some of the elements that direct the investigation and help establish the identity of the decedent. When the remains are degraded by factors such as extended postmortem interval, mechanical disruption, scattering, or burning, however, the identification becomes much more difficult. In the first week of May 2016, there were 10 767 open cases of unidentified remains in NamUs. Of these, 7257 were classified as unrecognizable by a variety of aforementioned factors. By the very nature of their work, anthropologists can develop key pieces of information from decomposed and/or skeletal elements and NamUs can provide the technology to consolidate and share their findings as well as those of all subject matter experts involved with the investigation.
The Role of the Anthropologist in the Identification of Migrant Remains in the American Southwest
Authors: Anderson Bruce E. , Spradley M. Kate
Published: April 2017

This article focuses on the role of the forensic anthropologist in the identification of migrant remains in the American Southwest. These migrant cases present a unique set of circumstances that necessitate a regional approach to identification. The Pima County Office of the Medical Examiner (PCOME), located in Tucson, Arizona has developed best practices that facilitate high identification rates of migrant deaths. These best practices have provided a foundation for other agencies that are faced with similar issues; namely, developing specific protocols for migrant deaths, working with nongovernmental humanitarian organizations, and sharing information have maximized identification efforts. In 2012, Texas surpassed Arizona in the number of migrant deaths. The Forensic Anthropology Center at Texas State (FACTS) began identification efforts for migrant remains found in Brooks County, Texas in 2013. Informed by best practices from the PCOME, FACTS has made successful identifications. Descriptions of the processes at both the PCOME and FACTS are described in detail.
The Value of Anthropology in Medicolegal Death Investigation of Pediatric Nonaccidental Injury
Authors: Love Jennifer C.
Published: April 2017

Forensic anthropologists have made remarkable contributions to the medicolegal investigation of nonaccidental injury in pediatric cases. They have created standard nomenclature for fracture descriptions. Anthropologists have developed novel techniques that increase the sensitivity of the pediatric autopsy. They have performed biomechanical research that enables reconstruction of events surrounding death. Also, anthropology practitioners have developed several reference guides on the subject of nonaccidental injury that are of value to forensic pathologists. These advancements assist forensic pathologists in the accurate classification of cause and manner of death in pediatric cases.
The Laryngohyoid Complex in Medicolegal Death Investigations
Authors: Pinto Deborrah C.
Published: April 2017

The laryngohyoid complex, composed of the hyoid bone and laryngeal cartilages, can be of interest in the autopsy setting, particularly when injuries are observed. Analysis of trauma to this structure can assist in establishing cause and manner of death. In many situations, the forensic anthropologist, with their expertise in analyzing bone and cartilage trauma, can assist in analyzing trauma to this complex. Although researchers have tried to study the relationships between causes of trauma to the osseocartilaginous structure and the observed injury pattern, they have not been successful in identifying unique signatures associated with different causes of trauma. This is because different causes can result in the same or similar injury patterns. In addition, variation due to growth and development or due to remote injury may change the structure's biomechanical response. The goal of this paper is to address issues that a forensic pathologist may encounter when assessing potential trauma to the osseocartilaginous structures of the laryngohyoid complex; in particular, it focuses on anatomical variants and trauma resulting from various causes.
Association of Antemortem Central Nervous System Symptoms and Location of Aortic Dissections; A Retrospective Study from 2001-2014
Authors: MacKerricher Wendy , Klein Robert R. , Winston David C.
Published: April 2017

Aortic dissections (AD) are a frequent cause of sudden death and are typically associated with chest, back, and/or abdominal pain. Several cases of AD with neurologic presenting symptoms, such as paresthesia, headache, and seizures were noted at the Pima County Office of the Medical Examiner (PCOME) in Tucson, Arizona. Our aim was to compare the location of AD with central nervous system (CNS) versus classic symptoms. Retrospective data were collected from the archives at the PCOME from 2001-2014. There were 61 natural death cases involving the aorta with known antemortem symptoms; 43 cases of AD with classic (non-CNS) symptoms and 18 cases with CNS symptoms. The cases were classified based on Debakey and Stanford classification systems. Patients with CNS symptoms had a greater proportion of Debakey type II dissections (44%) than without CNS symptoms (16%). This association was statistically significant ( p = 0.0337, chi-square test). Seventeen percent of cases with CNS symptoms had AD involving the carotid arteries, and involvement of the carotid arteries was significantly associated with CNS symptoms ( p = 0.0227, Fisher's exact test). There were a higher percentage of females with CNS symptoms (44%), than without CNS symptoms (23%). Our findings suggest a need for a higher index of suspicion and further investigation of cases with neurologic symptoms, focusing particularly on the aortic arch and its branches.
Additive Effects of Cointoxicants in Single-Opioid Induced Deaths
Authors: Sorg Marcella H. , Long D. Leann , Abate Marie A. , Kaplan James A. , Kraner James C. , Greenwald Margaret S. , Andrew Thomas A. , Shapiro Steven L. , Wren Jamie A.
Published: April 2017

A forensic drug database (FDD) was used to capture comprehensive data from all drug-related deaths in West Virginia, with deaths also included from the northern New England states of Maine, Vermont, and New Hampshire. All four states serve predominantly rural populations under two million and all have similar state medical examiner systems that employ statewide uniform death certification policies and practices. This study focused on 1482 single opioid deaths (fentanyl, hydrocodone, methadone, and oxycodone) in the FDD from 2007-2011. We modeled relationships between the opioid concentrations and the presence or absence of the following commonly occurring non-opioid cointoxicants: benzodiazepines (alprazolam and diazepam), alcohol, tricyclic antidepressants, selective serotonin reuptake inhibitors, and diphenhydramine. Additional covariates of state, age, body mass index, and sex were included. Results showed that the presence of alcohol, benzodiazepines, and antidepressants were each associated with statistically significant lower concentrations of some but not all of the opioids studied, which may obscure the interpretation of postmortem toxicology results alone. Fentanyl concentrations appeared to be the least associated with the presence or absence of the variables studied, and cointoxicant alcohol appeared to be associated with lower concentrations in opioid concentrations than were most of the other factors in the model studied. These findings underscore the importance of documenting all potential cointoxicants in opioid-related deaths.
Amyloidosis and Unexpected Death: A Review of Seven Cases
Authors: Presnell Susan E. , Schandl Cynthia A.
Published: April 2017

Amyloidosis, deposition of improperly folded insoluble proteins, may affect one organ or may be systemic. Although plasma cell dyscrasia is frequently implicated in etiology and is due to immunoglobulin light chain production (AL amyloidosis), age-related amyloidosis is believed to be secondary to transthyretin production (ATTR), chronic inflammation-related amyloidosis is thought due to acute phase reactants (AA amyloidosis), and dozens of others are also described. Clinical presentation is dependent upon the organ(s) involved and those associated with unexpected death are expected to involve the cardiovascular system. All cases received for forensic postmortem examination at the Medical University of South Carolina from 2008 to May 15, 2015 were searched to identify any in which amyloidosis was listed as a final diagnosis. Seven cases were identified that met the criteria and were reviewed for demographic information, presentation, cause and manner of death, and assessment of pertinence of the diagnosis of amyloidosis to the cause and manner of death. Interestingly, gross examination of the heart was suggestive of amyloidosis or other infiltrative process in only two of the cases reviewed and a history of myeloma was only noted in one individual. Common gross and microscopic findings are described and relevant medical history and toxicology findings are compared.
Are There Hallmarks of Child Abuse? I. Osseous Injuries
Authors: Walker Alfredo , Kepron Charis , Milroy Christopher M.
Published: April 2017

Fractures are commonly found in cases regarded as child abuse. The most commonly encountered fractures are to the ribs and the metaphyses. This paper examines the specificity of the classical metaphyseal lesion (CML) and rib fractures as hallmarks of child abuse. Recently, vitamin D deficiency (rickets) has been proposed as an alternative cause for the appearances typically described in CML. The literature in this area is examined. Rib fractures have also been highly associated with child abuse, particularly posterior rib fractures. As well as metabolic bone disease, resuscitation has been examined as a cause of rib fractures in young children. The current literature remains strongly supportive of rib fractures and metaphyseal fractures being indicators of child abuse.
Are There Hallmarks of Child Abuse? II. Non-Osseous Injuries
Authors: Kepron Charis , Walker Alfredo , Milroy Christopher M.
Published: April 2017

Certain conditions have been considered hallmarks of child abuse. Such pathognomonic conditions have led to an inevitable diagnosis of inflicted injury. Forensic pathologists are faced with complex analyses and decisions related to what is and what is not child abuse. In this review, we examine the literature on the specificity of five conditions that have been linked to inflicted injury to varying degrees of certainty. The conditions examined include tears of the labial frena (frenula), cigarette burns, pulmonary hemorrhage and intraalveolar hemosiderin-laden macrophages as markers of upper airway obstruction, intraabdominal injuries, and anogenital injuries and postmortem changes.

Analysis of the literature indicates that frena tears are not uniquely an inflicted injury. Cigarette burns are highly indicative of child abuse, though isolated cigarette burns may be accidental. Pulmonary hemorrhage is seen more commonly in cases with a history suggestive of upper airway obstruction, but is not diagnostic in an individual case. Hemosiderin-laden macrophages may be seen in cases with inflicted injuries and in natural deaths. Abdominal injuries may be seen in accidents and from resuscitation, though panreatico-duodenal complex injuries in children under five years of age are not reported to be seen in falls or resuscitation. The understanding of anogenital injuries is increasing, but misunderstanding of postmortem changes has led to miscarriages of justice.
A Conceptual Overview of Axonopathy in Infants and Children with Allegedly Inflicted Head Trauma
Authors: Snyder Vivian S. , Hansen Lawrence A.
Published: April 2017

Fatal, allegedly inflicted pediatric head trauma remains a controversial topic in forensic pathology. Recommendations for systematic neuropathologic evaluation of the brains of supposedly injured infants and children usually include the assessment of long white matter tracts in search of axonopathy — specifically, diffuse axonal injury. The ability to recognize, document, and interpret injuries to axons has significant academic and medicolegal implications. For example, more than two decades of inconsistent nosology have resulted in confusion about the definition of diffuse axonal injury between various medical disciplines including radiology, neurosurgery, pediatrics, neuropathology, and forensic pathology. Furthermore, in the pediatric setting, acceptance that “pure” shaking can cause axonal shearing in infants and young children is not widespread. Additionally, controversy abounds whether or not axonal trauma can be identified within regions of white matter ischemia — a debate with very significant implications. Immunohistochemistry is often used not only to document axonal injury, but also to estimate the time since injury. As a result, the estimated post-injury interval may then be used by law enforcement officers and prosecutors to narrow “exclusive opportunity” and thus, identify potential suspects. Fundamental to these highly complicated and controversial topics is a philosophical understanding of the diffuse axonal injury spectrum disorders.
Modeling the Distribution of Scald Type Burns in a Child
Authors: Alexander Russell T. , Fowler David R.
Published: April 2017

Splash or spill scald burns may be seen by medical examiners in the setting of intentional trauma or accidental injury. In order to model various scald burn scenarios, an 8-year-old subject dressed in white had colored water spilled or dropped onto her. The results were recorded by video and still photography. Five trials were performed and included: liquid in a cup thrown towards the anterior body surfaces; liquid in a cup thrown towards the posterior body surfaces; a cup of liquid spilled across a table into the lap of a seated subject; a saucepan pulled down onto the anterior torso; and a cup of liquid spilled onto the top of the head. In each of the spill and splash models described above, a large often confluent zone of staining at the site of initial liquid contact with the body was often accompanied by elongate runoff patterns following gravity; droplet staining was often noted on adjacent areas. When seated, an inverted U-shaped staining pattern was on the buttocks. Anticipation of the splash event in one trial resulted in the subject instinctively turning the anterior body away from the oncoming liquid. When presented with a scalded victim, modeling of the reported history may provide a pattern of staining that supports or refutes the explanation offered for the burn. A mobile and neurologically intact subject who can anticipate an incipient scald injury may move prior to and during contact with the liquid resulting in unique staining patterns on multiple surfaces of the body.
Certification of Vehicular Hyperthermia Deaths in the Pediatric Population
Authors: Quinton Reade A.
Published: April 2017

The investigation of vehicular hyperthermia deaths in infants and children requires coordination between the autopsy, clinical history, and scene investigation. Unfortunately, autopsy findings can be limited or nonspecific, clinical history may be unavailable, and details concerning ambient temperature and vehicular temperature may be vague. In cases where hyperthermia is established as the cause of death, the certification of manner of death can be challenging and inconsistent among medical examiners. This article provides an overview of vehicular hyperthermia deaths and the certification of cause and manner of death in these cases.
Maternal Abortifacient use for Clandestine Abortion
Authors: Hopson Dana L. , Ross Jennifer
Published: April 2017

Abortion is a highly debated topic. In the United States and other developed countries, the vast majority of abortions performed are done in a clinical setting or under the supervision of clinical staff. However, clandestine abortions still occur. Previously published reports have described clandestine abortions performed using crude and often dangerous methods. In the United States, published reports on the clandestine use of medications for abortions is rare. We report a series of cases in which maternal use of misoprostol and or a combination of misoprostol and mifepristone was used or suspected to have been used for the purpose of at-home pregnancy termination. These medications, purchased from Internet sites, were believed to have been shipped from countries outside of the United States. With ready accessibility to and increased prevalence of these sites on the Internet, it is likely that maternal abortifacient use will become more common in the future. This paper will provide guidance for the investigation and workup of these cases that come to the attention of the medical examiner or coroner.
Computed Tomographic Findings in Unsuspected Aortic Dissection and Adult Polycystic Kidney Disease
Authors: Harcke H. Theodore , Warren Wendy S. , Gordon Christopher J. , Mazuchowski Edward L.
Published: April 2017

The coexistence of adult polycystic kidney disease and aortic dissection should be recognized by forensic pathologists and radiologists. Two cases with postmortem computed tomography prior to autopsy illustrate the appearance of polycystic kidneys and the hemorrhage patterns that provide clues to the presence and approximate location of the aortic dissections. Optimal imaging technique is discussed.
Dissecting and Streamlining the Medical Record Acquisition Process in Death Investigation Systems
Authors: Croom Nicole A. , Melinek Judy
Published: April 2017

Though medicolegal death investigation (MDI) systems are generally associated with criminal justice, they serve an integral role in the realm of public health and safety. Medicolegal death investigation offices collect information, including medical records, from a variety of outside sources. For data to travel efficiently, transmission should be fully integrated between the MDI office and external organizations. This is often not the case. Delays in the transmission of medical records in particular lead to subsequent delays in autopsy report completion and death certification or to resource waste in cases where a timely record would have let the pathologist know an autopsy was not required. Almost no peer-reviewed literature currently exists regarding the problem of record acquisition by MDI systems. To develop a better understanding of how electronic medical records have impacted MDI systems, we conducted a mixed methods survey through the National Association of Medical Examiners (NAME) e-mail listserv. We inquired about the medical records acquisition processes at MDI systems around the nation to gauge opinions about the use of electronic health data and the integration of MDI data in public health. Concurrently, we piloted a quality improvement project at the Alameda County Sheriff-Coroner's Office (ACSCO) in Oakland, California, in which we worked with various hospitals to get ACSCO employees direct access to decedents' electronic health records. With data from the survey and pilot project, we were able to document the barriers encountered when attempting to reform medical record acquisition and to suggest systemic changes to reduce delays and wasted resources.
Fatal Gunshot Wounds in Young Children
Authors: Prahlow Joseph A.
Published: April 2017

Deaths related to firearms are common within the United States. Although relatively rare compared to other age groups, deaths occurring in young children represent a particularly tragic subcategory of firearms-related fatalities. This manuscript provides details regarding several cases of gunshot wound deaths occurring in young children. Included are a variety of situations and scenarios: the child was an innocent bystander struck by gunfire that was intended for another individual; unsafe firearm handling and manipulation by another individual, resulting in the child being shot; unsafe storage of a loaded firearm with resultant accidental discharge of the weapon; a young child having ready access to a loaded handgun and subsequently shooting him/herself; and the child being considered a potential intended target and being shot by another individual. The details of each case are provided, and discussion will focus on realistic strategies that, if implemented, might prevent such deaths from occurring in the future.
Death Resulting from Pneumocephalus Complicating Endoscopic Food Bolus Retrieval in a Patient with Eosinophilic Esophagitis
Authors: Fuhs Amy K. , Prahlow Joseph A.
Published: April 2017

Pneumocephalus is a rare complication of esophagogastroduodenoscopy (EGD), but existing literature does not discuss pneumocephalus surrounding endoscopic food bolus retrieval. We present a death involving pneumocephalus complicating endoscopic food removal from the esophagus.

A 40-year-old man presented with dysphagia and suprasternal discomfort 12 hours following chicken ingestion. On flexible endoscopy, chicken was visualized in the distal esophagus. After successful retrieval, a mucosal laceration was noted where the chicken had been lodged. He was unarousable following the procedure and was emergently transported to a hospital, where computed tomography scanning showed pneumocephalus. He was later declared brain dead. The case was referred for medicolegal autopsy.

The brain was examined first, revealing rare air bubbles within meningeal vessels and numerous, diffuse petechiae-like hemorrhages within the brain parenchyma. The esophageal mucosa had focal discoloration and a partial thickness laceration; microscopic examination revealed eosinophilic esophagitis.

Eosinophilic esophagitis is a known risk factor for food bolus impaction and should be suspected in such patients. Pneumocephalus is a rare possible complication of EGD for food bolus retrieval. In patients unresponsive after endoscopy, radiographic detection of potential pneumocephalus should be encouraged to enable timely therapy and improved outcomes, or to supplement autopsy in the event of patient death. Forensic pathologists should understand that pneumocephalus is a potential mechanism of injury/death in patients experiencing esophageal trauma, including injury incurred during EGD.
A Sudden Infant Death Due to Congenital Diaphragmatic Hernia
Authors: Solomon Nadia , Hayes Jonathan
Published: April 2017

Congenital diaphragmatic hernia (CDH) is an uncommon condition in which the embryological elements of the diaphragm fail to fuse completely, leaving a defect in the barrier separating the thorax from the abdomen. Although most cases are symptomatic at birth and lead to prompt treatment, asymptomatic cases may go undetected, presenting later on as a result of sudden or exacerbated herniation of abdominal contents into the thoracic cavity. Presented here is the sudden death of a 6-week-old girl. At autopsy, the abdominal organs were found to be filling the left chest cavity, having herniated through a previously undetected posterior diaphragmatic hernia of Bochdalek. The literature on CDH is reviewed, including discussion of the embryological origin, clinical presentation, diagnosis, and treatment of the condition. Special emphasis is placed on the challenges posed by these late-presenting cases, particularly in their diagnosis and management, highlighting the importance of developing more direct methods of detection for these very reasons.
A Complex Case of Loeys-Dietz Syndrome: A Case Report and Review of the Literature
Authors: Caza Tiffany N. , Mercedes Ana , Stoppacher Robert , Catanese Charles A.
Published: April 2017

Loeys-Dietz syndrome is a rare autosomal dominant connective tissue disorder with a genetic predisposition to aneurysm formation and congenital cardiofacial defects through genetic mutation affecting the transforming growth factor-beta (TGFβ) signaling pathway. We present a case of a 6-year-old female patient with Loeys-Dietz syndrome who developed an annular aortic valve abscess and ascending aortic dissection due to Staphylococcus aureus endocarditis. Within this case, multiple complications from Loeys-Dietz syndrome were identified, including prosthetic valve infection, aneurysm formation and dissection, septic embolism, and aspiration pneumonia. The clinical presentation, pathologic findings, and pathophysiology will be discussed.
ВЛИЯНИЕ КОМПЬЮТЕРНЫХ ИГР НА ЭМОЦИОНАЛЬНОЕ СОСТОЯНИЕ МЛАДШИХ ШКОЛЬНИКОВ
Authors: Илюкович Татьяна Петровна
Published: April 2017

В статье рассматриваются результаты эмпирического исследования влияния игровой деятельности (одиночные компьютерные и настольные игры) на эмоциональную сферу младших школьников и их социальную идентичность.
ПСИХОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПРОФЕССИОНАЛИЗАЦИИ ЛИЦ С ОГРАНИЧЕННЫМИ ВОЗМОЖНОСТЯМИ ЗДОРОВЬЯ В УСЛОВИЯХ ОБУЧЕНИЯ В ВУЗЕ
Authors: Ложечкина Анна Дмитриевна , Христыч Екатерина Алексеевна
Published: April 2017

В статье рассматриваются основные направления деятельности и реализация практик инклюзивного образования в вузах при подготовке будущих специалистов с ограниченными возможностями здоровья и инвалидностью в России, на примере Северо-Кавказского федерального университета. Обозначены ключевые аспекты построения модели инклюзивного образования в вузах: особенности профориентационной, адаптационной деятельности, процесса сопровождения и профессионализации.
Prevalence of metabolic syndrome and its risk factors in Canadian children and adolescents: Canadian Health Measures Survey Cycle 1
(2007–2009) and Cycle 2 (2009–2011)
Authors: MacPherson M. , de Groh M. , Loukine L. , Prud'homme D. , Dubois L.
Published: April 2017

Introduction

We investigated the prevalence of metabolic syndrome (MetS) and its risk factors, and the influence of socioeconomic status, in Canadian children and adolescents.

Methods

Canadian Health Measures Survey cycle 1 (2007–2009) and cycle 2 (2009–2011) respondents aged 10 to 18 years who provided fasting blood samples were included (n = 1228).
The International Diabetes Federation (IDF) consensus definition for children and adolescents (10–15 years) and worldwide adult definition (≥ 16 years) were used to diagnose MetS.
Prevalence of MetS and its risk factors were calculated and differences by socioeconomic status were examined using χ2 tests.

Results

The prevalence of MetS was 2.1%. One-third 37.7%) of participants had at least one risk factor, with the most prevalent being abdominal obesity (21.6%),
low HDL-C (19.1%) and elevated triglyceride levels (7.9%). This combination of abdominal obesity, low HDL-C and elevated triglyceride levels accounted for 61.5% of MetS cases.
Participants from households with the highest income adequacy and educational attainment levels had the lowest prevalence of one or more MetS risk factors, abdominal obesity and
low HDL-C.

Conclusion

The prevalence of MetS (2.1%) was lower than previously reported in Canada (3.5%) and the USA (4.2%¬–9.2%), potentially due to the strict application of
the IDF criteria for studying MetS. One-third of Canadian children and adolescents have at least one risk factor for MetS. Given that the risk for MetS increases with age,
these prevalence estimates, coupled with a national obesity prevalence of almost 10% among youth, point to a growing risk of MetS and other chronic diseases for Canadian youth.