bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin B2 Interference with TDx Drugs-of-Abuse Assays
Authors: Kunsman GW , Levine B , Smith ML 
Published: August 2015

Abstract
Migraine is a headache condition found in significant frequency in the general population. One recent study has shown that riboflavin, Vitamin B2, is an effective prophylactic treatment for this headache condition. One subject in a recent study conducted by the Division of Forensic Toxicology. Armed Forces Institute of Pathology (AFIP) was taking 200 mg of riboflavin twice daily for the prevention of migraine headaches. When that subject's urine was tested using Abbott TDx drugs-of-abuse assays a number of tests resulted in a MX BKG error and all samples had BLK I values greater than those observed with normal urine specimens. The MX BKG error occurs when the BLK I value is greater than the upper limit determined by the manufacturer for a particular assay. High BLK I values may result if the specimen being analyzed contains a fluorophore that will compete with the fluorescein-labeled antibody used in the assay. This error serves as a notification that an interfering substance may be present and the assay is not performing according to manufacturer-specifications. Upon termination of riboflavin therapy the subject's BLK I values began to decrease within 60 h of the last 200 mg dose. A second subject began chronic riboflavin use to confirm this interferent effect. Elevated BLK I values resulted within 3 h of a single 200 mg dose and MX BKG errors occurred 1 h after a second 400 mg dose. No false negative results were noted with either subject (both subjects used butalbital and the first subject also used hydrocodone and diazepam during the study), suggesting that riboflavin is not an adulterant. Riboflavin use, however, does interfere with the TDx DAU assays and may result in quantitative values being determined which are of questionable validity in the face of an elevated BLK I value or may result in only an MX BKG error and no quantitative value reported. It is unclear if the interfering fluorophore is simply riboflavin itself or a combination of riboflavin and its metabolic products. Results obtained on urine samples collected from individuals using prophylactic riboflavin for migraine prevention and analyzed by TDx may be of questionable validity. Such samples may require analysis utilizing another immunoassay technique that does not employ a fluorescein-labeled antibody.
Sudden Death in Police Pursuit
Authors: Thogmartin JR 
Published: August 2015

Abstract
A rare complication of sickle cell trait is sudden death and collapse. Military recruits, pilots, and subjects exposed to hypoxic stress such as high altitude and experiencing sudden cardiorespiratory collapse as a result of sickle cell trait have been well described. This is a case of a 13-year-old black male who collapsed after a police pursuit and was found to have sickle cell trait and microscopic evidence of asthma.
In-Vivo Glutaraldehyde Fixation of the Brain Stem and Spinal Cord After Inadvertent Intrathecal Injection
Authors: Davis JH , Mittleman RE 
Published: August 2015

Abstract
A 64-year-old diabetic man underwent total maxillectomy with orbital exenteration because of recurrent carcinoma. In order to decrease pressure at the surgical site, 50 mL of cerebrospinal fluid were withdrawn. After the procedure was completed, 5% glutaraldehyde was inadvertently injected into the subarachnoid space instead of reinjection of the original cerebrospinal fluid. The patient suffered hypotension and coma culminating in death five days after the procedure. Postmortem examination revealed exquisite fixation of the outer cortical shell of the spinal cord and brain stem. The mishap occurred because an unlabeled vial was mistaken for the withdrawn cerebrospinal fluid. Graicunas' theory and formula on relationship complexities in organizations is exemplified by this occurrence. One may calculate the theoretical potential for 24,708 miscommunications during such a complex and lengthy surgical procedure. Proper operating room procedures must be developed and followed in order to prevent such tragedies.
Fatal Heatstroke in a Young Woman with Previously Undiagnosed Hashimoto's Thyroiditis
Authors: Siegler RW 
Published: August 2015

Abstract
Heatstroke represents the most severe form of the heat-related illnesses. Potentially fatal, heatstroke most often affects the elderly, obese, or chronically ill. Thyroid disease, which may interfere with the normal regulation of body temperature, has not previously been reported in cases of heatstroke. A fatal case is reported in a young woman discovered unconscious in a sauna who was found to have preexisting Hashimoto's thyroiditis on subsequent autopsy. The diagnosis of hypothyroidism in heatstroke rests on clinical information and morphologic observations. This case underscores the importance of evaluating the thyroid in unusual cases of heatstroke.
Death Following Minor Head Trauma in Two Adult Individuals with the Chiari I Deformity
Authors: Wolf DA , Veasey SP , Wilson SK , Adame J , Korndorffer WE 
Published: August 2015

Abstract
Reports of sudden death associated with minor head trauma in adults with the Chiari I malformation are rare. We describe two such cases, occurring in a 71-year-old individual and in a 22-year-old individual. In both cases, postmortem examination revealed prominent cerebellar tonsillar herniation and, in one, associated tonsillar sclerosis and hydrocephalus. Evidence of trauma was minimal in both, and was not sufficient to explain these fatalities. We describe the neuropathologic findings and discuss the differential diagnostic considerations in these cases of sudden death. The implications regarding manner of death are also emphasized.
Familial Thoracic Aortic Aneurysms and Dissections
Authors: Prahlow JA , Barnard JJ , Milewicz DM 
Published: August 2015

Abstract
Rupture of thoracic aortic aneurysms and/or dissections is not rare, occurring in approximately 0.6% of all medicolegal autopsies. Most forensic pathologists are aware of the association between thoracic aortic aneurysms/dissections and trauma, atherosclerosis, inflammation and Marfan syndrome. In this report, we discuss a familial form of thoracic aortic dilatation and/or dissection that is distinct from Marfan syndrome. In addition, we review the topic of thoracic aortic aneurysm and dissection and encourage family notification by forensic pathologists when familial forms of aortic disease are suspected at autopsy.
A Fatal Case of Benzene Poisoning
Authors: Barbera N , Bulla G , Romano G 
Published: August 2015

Abstract
Chronic effects following repeated exposure to low doses of benzene have been well assessed, whereas few data are available about acute exposure to benzene. We report a case of fatal acute intoxication which occurred aboard a chemical cargo ship.
Autopsy findings included blood clots inside the heart and main vessels, multi-organ congestion, pulmonary edema and the presence of many vibices in the hypostatic areas.
Toxicological analysis of blood and urine showed a benzene concentration of 31.67 and 2.26 μg/mL, respectively; high concentrations of benzene (μg/g) were also found in the lungs (22.23), liver (378.60), brain (178.66), heart (182.57) and kidneys (75.15). The above data provide evidence for benzene distribution in various organs.
Olanzapine-Related Fatality
Authors: Stephens BG , Coleman DE , Baselt RC 
Published: August 2015

Abstract
A 43-year-old male psychiatric outpatient died within hours of ingesting as much as 600 mg of olanzapine, a newer antipsychotic agent related to clozapine. Analysis of postmortem blood and urine by gas chromatography with nitrogen-selective detection yielded olanzapine concentrations of 1238 and 6987 μg/L, respectively, greatly in excess of levels expected following therapeutic administration of the drug. Based on the toxicology findings, the decedent's known history of suicide attempts, and the circumstances surrounding the death, this case was ruled a suicide by olanzapine overdosage.
Determination of Gestational Age from Lunar Age Assessments in Human Fetal Remains
Authors: Huxley AK , Angevine JB 
Published: August 2015

Abstract
Occasionally forensic fetal remains are submitted to the office of the medical examiner for age determination. A variety of literature and many techniques are available for this assessment depending upon the overall condition of the remains. If one uses traditional forensic anthropological sources, then age is calculated in lunar months; if one uses other sources—embryological, anthropological and sonographic—then age is reported as gestational weeks. For comparison between ages derived from these various studies, especially in cases involving age assessments of incomplete fetal remains that may be partially damaged by taphonomic factors, it is necessary to convert between lunar age and gestational age. The objective of this study is to present a conversion table for exact correspondence between lunar months and gestational weeks from the point of conception to term. This information is useful for developing a forensic profile at any gestational age as well as providing a means to assess the probability of viability at the time of death.
Postmortem Drug Redistribution—Human Cases Related to Results in Experimental Animals
Authors: Hilberg T , Rogde S , Mørland J 
Published: August 2015

Abstract
Femoral blood is widely accepted as the most reliable postmortem specimen for drug analysis in forensic toxicology. There is considerable evidence that the drug concentrations in peripheral blood samples are closer to the antemortem level than the concentration in cardiac blood. In the present study drug concentrations measured in postmortem femoral and/or heart blood samples from eight cases were compared with the concentration found in serum samples from the same subject collected antemortem or perimortem. The drugs involved were amitriptyline, nortriptyline, imipramine, verapamil and chloroquine. Two additional cases with very early postmortem blood samples, as well as femoral blood samples from later autopsy, involved amphetamine and tetrahydrocannabinol. The results from the human cases were compared with results from rat experiments on similar drugs. The samples were analyzed by high performance liquid or gas chromatography. The cases with tricyclic antidepressants had a median postmortern femoral blood to antemortem serum drug concentration ratio of 3.3, the 95% reference range being from 1.1 to 6.0 (pooled data). Large variations of the ratios were seen. The extremes noted were a postmortem femoral blood to antemortem serum drug concentration ratio of 0.9 in a case with nortriptyline and 49 in the case with chloroquine. The low ratio in the former case could be due to attempted resuscitation, while the high ratio in the latter case is probably due to the extremely high apparent volume of distribution and a high blood to plasma concentration ratio for chloroquine. Accordingly, it is dubious whether the drug concentration found in femoral blood at autopsy can be accepted as being representative for the antemortem level. The results obtained from the human cases in the present study were generally in reasonable agreement with previous rat experiments, confirming that the animal studies when interpreted carefully, are indicative of the changes observed in man as well as a previous study in pigs. Studies on drug concentrations in pigs are not necessarily more representative for the findings in humans than experiments with a smaller animal like the rat. The postmortem concentration changes observed for tetrahydrocannabinol in man were found to be unpredictable, while in the accompanying experimental rat study there was a significant postmortem decrease in the tetrahydrocannabinol blood concentration measured in blood from the inferior vena cava. In special cases where the diagnosis of overdose is to be used as judicial evidence, a single sample of blood may prove insufficient. In such cases, analyses of several samples of blood and tissue will increase the possibility of reaching a correct conclusion, but reference values on drug concentrations in tissues are often missing.
Redistribution of Basic Drugs into Cardiac Blood from Surrounding Tissues During Early-Stages Postmortem
Authors: Moriya F , Hashimoto Y 
Published: August 2015

Abstract
The objective of this study was to elucidate the mechanism(s) responsible for increases in the concentrations of basic drugs in cardiac blood of bodies in a supine position during early-stages postmortem. The concentrations of basic drugs in cardiac blood and other fluids and tissues of three individuals who had used one or more basic drugs were examined. The results were compared with those obtained in experiments using rabbits. In the first case, autopsy of whom was performed approximately 12 h after death, methamphetamine was detected and its concentrations were in the order: lung ≫ pulmonary venous blood &gt; blood in the left cardiac chambers (left cardiac blood) ≫ pulmonary arterial blood &gt; blood in the right cardiac chambers (right cardiac blood). In the second case, autopsy of whom was performed approximately 9 h after death, methamphetamine and morphine were detected and their concentrations in the left cardiac blood were roughly twice those in the right cardiac blood. The methamphetamine and morphine concentrations in the lung were 2 to 4 times higher than those in cardiac blood samples. In the third case, autopsy of whom was performed approximately 2.5 days after death, the pulmonary veins and arteries were filled with chicken fat clots. Toxicological examination revealed the presence of four basic drugs: methamphetamine, amitriptyline, nortriptyline and promethazine. Their concentrations in the lung were 5 to 300 times higher than those in cardiac blood, but postmortem increases in the concentrations of these drugs in the cardiac blood were not observed. In the animal experiments, rabbits were given 5 mg/kg methamphetamine intravenously or 20 mg/kg amitriptyline subcutaneously and sacrificed 20 min or 1 h later, respectively. The carcasses were left in a supine position at the ambient temperature for 6 h after or without ligation of the large vessels around the heart. For the groups with ligated vessels, the mean ratios of the drug concentrations in both left and right cardiac blood samples 6 to 0 h postmortem were about 1, whereas in those without ligated vessels, these ratios were about 2 and 1, respectively. The order of the methamphetamine and amitriptyline concentrations in blood and tissue samples were roughly: lungs &gt; myocardium and pulmonary venous blood &gt; cardiac blood, inferior vena caval blood and liver. Our results demonstrate that when bodies are in a supine position, (1) basic drugs in the lungs diffuse rapidly postmortem into the left cardiac chambers via the pulmonary venous blood rather than simply diffusing across concentration gradients, and (2) basic drugs in the myocardium contribute little to the increases in their concentrations in cardiac blood during the early postmortem period.
Metabolic Production of Amphetamine Following Administration of Clobenzorex
Authors: Valtier S , Cody JT 
Published: August 2015

Abstract
Many of the anorectic drugs that are metabolized to amphetamine and/or methamphetamine pose significant concerns in the interpretation of amphetamine-positive drug testing results. One of these drugs—clobenzorex—has been shown to produce amphetamine. Thirty milligrams of clobenzorex hydrochloride, in the form of a single Asenlix capsule (Roussel, Mexico), were administered orally to five human volunteers with no history of amphetamine, methamphetamine or clobenzorex use. Following administration, urine samples (total void volume) were collected ad lib for seven days and pH, specific gravity and creatinine values were determined. To determine the excretion profile of amphetamine and parent drug, samples were extracted, derivatized, and analyzed by gas chromatography/mass spectrometry (GC/MS) using a standard amphetamine procedure with additional monitoring of ions at m/z 91, 118, 125 and 364 for the detection of clobenzorex. Peak concentrations of amphetamine were detected at 4 to 19 h postdose and ranged from approximately 715 to 2474 ng/mL amphetamine. Amphetamine could be detected (&gt;5 ng/mL) in the urine in one subject for up to 116 h postdose. GC/MS was also used to determine the enantiomeric composition of the metabolite, amphetamine. This analysis revealed the metabolically derived amphetamine was only the d-enantiomer. This differs from previous literature which indicates clobenzorex is the racemic N-orthochlorobenzyl derivative of amphetamine.
Methamphetamine as a Risk Factor for Acute Aortic Dissection
Authors: Swalwell CI , Davis GG 
Published: August 2015

Abstract
Acute aortic dissections are catastrophic vascular events that have a high rate of mortality. Aortic dissections have been associated with a variety of factors, particularly hypertension. We reviewed 84 medical examiner autopsies on individuals dying from acute aortic dissections with particular emphasis on the role of drugs. Previous case reports have associated aortic dissections with both cocaine and methamphetamine intoxication.
We found that seven of the 35 cases tested for drugs of abuse were positive for methamphetamine. Our study had no cases of solely cocaine-related dissection, although one of the cases was positive for both methamphetamine and the cocaine metabolite benzoylecgonine. No significant association was found with any other drugs. As with other studies, we found the most common risk factor to be hypertension. Surprisingly, methamphetamine use was the second most common risk factor. The association between methamphetamine use and aortic dissection is most likely due to its hypertensive effect. Although methamphetamine appears to pose a greater risk than cocaine, both drugs should be considered as possible factors in all aortic dissections.
Human Methamphetamine-Related Fatalities in Taiwan During 1991–1996
Authors: Shaw K-P 
Published: August 2015

Abstract
Methamphetamine (MAP) is currently considered to be the major illicit drug in Taiwan, and MAP constitutes the majority of illicit drugs seized by the judicial institutes. Thus, MAP has raised public attention. The purpose of this retrospective study is to observe the trends of MAP-related fatalities in Taiwan with respect to the manners of death so as to determine the epidemiological implications of MAP. Two hundred and forty-four MAP-related fatalities out of a total of 3958 forensic fatalities were collected by the Forensic Medicine Center (Taiwan) during the period of 1991 to 1996. The annual percentages of MAP-related fatalities compared to the total autopsy cases during 1991 through 1996 were 3.4, 10.3, 12.1, 4.2, 4.0 and 5.6%, showing that the number of MAP-related fatalities increased from 1991 to 1993, declined during 1994 and 1995, and rose again in 1996. The mean age of the MAP-related fatalities during this period was 30.7 years and occurred predominantly in males (73%). The manner of deaths included natural, accidental, suicidal, homicidal and uncertain causes of deaths, represented, respectively, by 31 (13%), 143 (59%), 28 (11%), 34 (14%) and 8 (3%) cases. As a consequence of the endemic problem and public hazard created by illicit drug abuse in Taiwan, stronger anti-drug programs and curbs to illicit-drug addiction were required urgently from the government and from the public. The findings of this study represent the results of utilization of an anti-drug program in Taiwan (Support by NSC 85-2331-B-016-092).
Mechanisms of Aortic Injury in Fatalities Occurring in Motor Vehicle Collisions
Authors: Shkrum MJ , McClafferty KJ , Green RN , Nowak ES , Young JG 
Published: August 2015

Abstract
Case reviews based on autopsy studies have shown that motor vehicle collisions cause between 50 and 90% of traumatic aortic ruptures. Very few studies have analyzed the nature and severity of the collision forces associated with this injury. Our passenger car study (1984–1991) examined 36 collisions in which 39 fatally injured victims sustained aortic trauma. In this injury group, a disproportionate number of heavy truck and roadside fixed-object impacts occurred. Vehicle crash forces were generally severe and were either perpendicular or oblique to the vehicle surface. Intrusion into the occupant compartment was a significant factor in most of these fatal injuries. Occupant contact with vehicle interior surfaces was identified in most cases, and occupant restraints were often ineffective, especially in side collisions. The more elderly victims were seen in the least severe collisions.
The most frequent site of aortic rupture was at the isthmus. A majority of victims had rib/sternal fractures indicating significant chest compression. Of the various traumatic aortic injury mechanisms proposed in motor vehicle impacts, the favored theories in the literature combine features of rapid deceleration and chest compression. This study supports that predominant impression, concluding that rapid chest deceleration/compression induces torsional and shearing forces that result in transverse laceration and rupture of the aorta, most commonly in the inherently vulnerable isthmus region.
A Visual Method of Determining the Sex of Skeletal Remains Using the Distal Humerus
Authors: Rogers TL 
Published: August 2015

Abstract
This study introduces a new method of determining sex based on four morphological features of the posterior, distal humerus. The technique was developed on a 20th century anatomy series, the University of Toronto Grant Skeletal Collection, and was tested on 35 known individuals from the University of New Mexico Documented Collection and 93 individuals from the William M. Bass Donated Skeletal Collection. Four statistically significant characteristics relating to the carrying angle of the arm are identified (p &lt; 0.05). Together, they are capable of determining sex with 92% accuracy.
Midline Facial Tissue Thicknesses of Subadults from a Longitudinal Radiographic Study
Authors: Garlie TN , Saunders SR 
Published: August 2015

Abstract
Fourteen midline facial tissue measurements were taken from 615 tracings of lateral radiographs of subadults aged 8 to 20 years. The data were collected to examine two questions: First, are there differences in facial soft tissue measurements between female and male subadults? Second, do facial tissue thicknesses change as children grow? Results indicate that males exhibit greater tissue thickness measurements than females but only significantly so after age 14. Results further indicate a trend of increased facial tissue thickness as individuals grow; however, correlations are weak and suggest that other unknown factors are involved. Data presented here can be of practical application for facial reproduction in forensic cases.