Variation in Methods of Cardiac Dissection—A Potential Confounder in Measuring Cardiac Weight at Autopsy

To evaluate whether the weight of the heart measured at autopsy may be affected by the type of dissection, a prospective study was undertaken of the weights of sequential cases of nonpediatric hearts. Four hundred fifty‐eight hearts were examined (age range 17–96 years; mean 55.9 years; M:F = 3:1). The hearts were each weighed fresh, once the apex had been sliced, the auricles of the atria opened and blood drained, and again once the cardiac chambers had been opened completely. The difference in the partially and fully opened heart weights (range 146–1028 g; mean 434.8 g; range 134–1011 g; mean 420.8 g, respectively) (p < 0.05) ranged from 0 to 100 g (mean 14 g). In the most extreme example, the weight of the partially opened heart was 30.3% higher than that of the fully opened specimen. Failure to fully open the heart prior to weighing may result in significant error.     

Primary intimal sarcoma of the pulmonary artery misdiagnosed as pulmonary thromboembolism: A case confirmed at medicolegal autopsy

Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54‐year‐old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.     

Necropsy Findings in Dogs that Died During Grooming or other Pet Service Procedures

Procedures involved in grooming, bathing, and other pet services can often lead animals to death. Of the necropsies of 1391 animals carried out at a private diagnostic laboratory in Sao Paulo, Brazil from 2004 to 2009, 94 were dogs that died during the above‐mentioned procedures. Young male dogs and small breeds like Poodle Miniature, Yorkshire Terrier, and Lhasa Apso were most frequently observed. Blunt‐force trauma was responsible for the deaths of 31% of the animals, with a higher incidence of trauma to the head, characterized chiefly by fractures and nervous tissue lesions. In the other 69% of cases, the animals showed signs of stress, and died due to pulmonary edema and hemorrhage. As we cannot rule out the intentional character in some situations, this article provides veterinary forensic support for veterinarians and pet owners, especially in lawsuits, helping in finding the cause of animal's death in such pet services.     

Renal Cortical Pallor—A Useful Macroscopic Marker for Metabolic Derangements at Autopsy

Renal cortical pallor was studied as a potential marker at autopsy of diabetic ketoacidosis in 23 cases, hyperglycemic nonketotic coma in eight cases, and alcoholic ketoacidosis in five cases (vitreous humor glucose level ≥11.1 mM; β‐hydroxybutyrate level ≥5 mM). Renal cortical pallor was noted on macroscopic examination in 10 of 23 cases of lethal diabetic ketoacidosis (43.5%), three of eight cases of fatal hyperglycemic nonketotic coma (37.5%), and in two of five cases of alcoholic ketoacidosis (40%). Histologic examination revealed basal vacuolization of renal tubular epithelial cells in 12 cases, Armanni–Ebstein lesions in 10, and osmotic nephrosis in three. Although renal cortical pallor did not appear to be a particularly sensitive marker for hyperglycemia or ketoacidosis, and did not correlate with the severity of these parameters, it may still represent a useful macroscopic marker for underlying metabolic conditions at autopsy and should therefore prompt measurement of vitreous humor glucose and β‐hydroxybutyrate levels.     

Unnatural and Violent Death in Cases with High Blood Alcohol Concentration— Autopsy Study

The use of alcohol increases the risk of dying from unnatural or violent causes. The presented study explored the distribution of age, gender, cause, and circumstances of death in persons who died in an unnatural and violent manner, with a blood alcohol concentration (BAC) higher than 0.3 g/dL, and where the cause of death was not alcohol intoxication. We defined the control (0 < BAC < 0.3 g/dL) and study (BAC ≥ 0.3 g/dL) groups, as in subjects with these concentrations, there is a significant risk of gross intoxication, stupor, and death. The subjects from the study group were older, with no difference in gender distribution. Traffic accidents were the most common fatal event in both groups, followed by suicides. Other accidents (choking on food and exposure to fire) were more frequent in the study group. Compared to the control group, subjects from the study group were older persons whose deaths were mainly accidental.     

Laryngeal Choking on Food and Acute Ethanol Intoxication in Adults—An Autopsy Study*

Abstract: The retrospective autopsy study included 98 adults who died because of laryngeal choking on a bolus of food: 67 men and 31 women (χ² = 6.843, p < 0.01), average age 58.61 ± 15.87 years (range 26–92 years). Most of the subjects had poor dentition (χ² = 34.327, p < 0.01). Twenty individuals died in medical institutions, and 78 were nonhospitalized individuals. More than a third of the nonhospitalized individuals were under the influence of ethanol at the moment of death: average blood concentration 8.3 g/dL (SD = 11.0), ranged from 5.0 to 36.0. Nonhospitalized persons were at the moment of event more often under influence of ethanol than the subjects in control group (χ² = 38.874, p < 0.01), and at the same time significantly more intoxicated (z = −7.126, p < 0.01). Our study pointed out that poor dentition and impairment of the swallowing reflex, as a consequence of ethanol intoxication in individuals without mental disorders, were the most important risk factors for bolus death.     

Renal Tubular Epithelial Vacuoles—A Marker for Both Hyperlipidemia and Ketoacidosis at Autopsy

Review of 15 cases of nephrotic syndrome found that eight had significant hyperlipidemia with serum cholesterol levels ranging between 10.59 and 18.60 mmol/L (mean 12.88) and serum triglyceride levels between 2.30 and 9.92 mmol/L (mean 4.58); all of these cases displayed basal lipid vacuolization. Seven of the 15 study cases had normal–mild hyperlipidemia with serum cholesterol levels ranging between 4.71 and 7.54 mmol/L (mean 6.02) and serum triglyceride levels between 0.65 and 4.1 mmol/L (mean 1.57). Six of the seven cases had basal lipid vacuoles (86%). Of these, five cases were hyperlipidemic and one case had borderline hyperlipidemia with a serum cholesterol level of 4.71 mmol/L. Although hyperlipidemia was associated with renal tubular epithelial vacuolization, the vacuoles appeared morphologically different to those found in ketoacidosis. This study has shown that while hyperlipidemia in isolation may result in basal lipid vacuolization within renal tubular epithelial cells, the phenotype differs from that observed in ketoacidosis.     

Amussat’s Sign in Hanging—A Prospective Autopsy Study

Abstract: Amussat’s sign is typically a transverse laceration of the intimal layer of carotid arteries described in cases of hanging. Subtotal laceration of the carotid artery is not strictly specific for hanging and can be also caused by blunt neck trauma, extreme overstretching, or whiplash‐injuries. In a prospective autopsy study of 178 cases of hanging, Amussat’s sign was found in 29 cases (a relative frequency of 16.1%). A statistically significant association between the occurrence of tears in the intimal layer of carotid arteries and the victims’ age was discovered in the cases studied (the frequency increased with age; p < 0.05). The occurrence of Amussat’s sign was independent of gender, weight, completeness of the victim’s body suspension, and position of the ligature knot on the neck. The study demonstrates the fact that the most probable cause of Amussat’s sign is a combination of direct compression of the artery by the rope and indirect stretching because of the gravitational drag produced by the weight of the body.     

Antidepressants at Autopsy in Hispanic Suicidal Youth in Miami‐Dade County,Florida*

Abstract: Controversy has surrounded the use of antidepressants and suicidal behaviors in youth. This study reviewed the Medical Examiner’s Office records of 253 persons aged 24 years or younger classified as suicides in Miami‐Dade County, Florida, from 1990 to 2007. Information was collected regarding demographic information, suicidal characteristics, psychiatric and psychosocial factors, and toxicology results. Eighty‐five percent of the sample was men, and 53.4% of the subjects were Hispanic. Consistent with previous literature, the existence of antidepressants at autopsy was rare; present in only 6% (n = 15) of the victims. The occurrence of antidepressants was not significantly different between Hispanics (n = 7) and non‐Hispanics (n = 8). The incidence of antidepressants was weakly correlated with a tendency to be men and no history of psychiatric illness. The presence of antidepressants in Hispanic youth suicide victims was similar to non‐Hispanics.     

Severe Sexual Sadism—An Underdiagnosed Disorder? Evidence from a Sample of Forensic Inpatients

Abstract:  Severe sexual sadism is a disorder of sexual preference that focuses on humiliation and subjugation of the victim, sometimes causing grievous injury or death. Sexual sadists pose a particular risk. However, the diagnosis as such is unreliable and prevalence estimates vary. In a sample of male high-security forensic inpatients who had committed sexual offenses, we found two-thirds of sexual sadists had not been identified as such prior to commitment. Possible reasons for missing the diagnosis are many fold. Present data support the notion that unrecognized sexual sadists more closely resembled non-sadistic sex offenders than accurately diagnosed sadists. In particular, initially unrecognized sexual sadists had less severe previous convictions, less vocational training, and experienced a less supportive upbringing than their correctly identified sadistic counterparts. The latter, in contrast, more often reached media coverage through their offense(s). We conclude that severe sexual sadism is likely an underdiagnosed, yet forensically highly relevant disorder.     

Less is More—Optimization of DNA Extraction from Canine Feces

Although most DNA crime laboratories may not encounter fecal samples often, they are a familiar sample type in non‐human forensic laboratories due to their prevalence in the environment. Fecal matter can be challenging due to low numbers of nucleated cells and the presence of inhibitors that impede amplification success. Sampling location (internal vs. external), sampling quantity (10–200 mg), and various extraction protocols (silica matrix, bead beating, and clean‐up column) were evaluated to maximize DNA yield. The greatest yield of intact DNA was obtained using a modified silica matrix extraction protocol (VGL‐Fecal) on 30–50 mg of fecal matter collected from the external surface of a stool that had been dried for 24 h. This optimized sampling and extraction protocol was applied to a pilot study where DNA yield and genotyping success were evaluated. By optimizing our collection, sampling, and extraction procedures, a reliable method for maximizing the yield of canine fecal DNA was developed.     

Photogrammetric Documentation of Regions of Interest at Autopsy—A Pilot Study

In this pilot study, the authors tested whether photogrammetry can replace or supplement physical measurements made during autopsies and, based on such measurements, whether virtual computer models may be applicable in forensic reconstructions. Photogrammetric and physical measurements of markers denoting wounds on five volunteers were compared. Virtual models of the volunteers were made, and the precision of the markers' locations on the models was tested. Twelve of 13 mean differences between photogrammetric and physical measurements were below 1 cm, which indicates that the photogrammetric method has a high accuracy. The precision of the markers' location on the models was somewhat less, although the method is still promising and potentially superior to the current procedures used for reconstructions. The possibility to measure any distance on a body, even after the autopsy is concluded and the corpse is no longer available, is one of the biggest benefits of photogrammetry.     

Evolution of the Psychological Autopsy: Fifty Years of Experience at the Los Angeles County Chief Medical Examiner‐Coroner's Office

The origin of the psychological autopsy was in the late 1950s and the result of a collaboration between the Los Angeles County Chief Medical Examiner‐Coroner's Office and the Los Angeles Suicide Prevention Center. It was conceptualized as a thorough retrospective analysis of the decedent's state of mind and intention at the time of death. It was used initially in “equivocal” deaths where the manner of death was possibly either suicide or accident. Later, it was used in cases where a party (primarily family members) protested the Medical Examiner‐Coroner's suicide determination. Over the past 25 years, the University of Southern California Institute of Psychiatry, Law, and Behavioral Science has served as the psychiatric/psychological consultants to the Coroner's Department. Research findings, the use of this approach in high‐profile cases, and the most recent manner in which the psychological autopsy is conducted are discussed.     

Arsenic Poisoning Caused by Intentional Contamination of Coffee at a Church Gathering—An Epidemiological Approach to a Forensic Investigation

Abstract: An outbreak of apparent food‐borne illness following a church gathering was promptly reported to the Maine Bureau of Health. Gastrointestinal symptoms among church attendees were initially attributed to consumption of leftover sandwiches that had been served the previous day. However, a rapid epidemiological and laboratory assessment revealed the etiology of illness, including the death of an elderly gentleman, was not food‐borne in origin. A criminal investigation determined that deliberate arsenic contamination of the brewed coffee by one of the church members was the source of the outbreak. Public health officials and criminal investigators must be aware that intentional biologic aggression can initially present as typical unintentional disease outbreaks. Practitioners must also consider the need to properly maintain and preserve potential forensic evidence. This case demonstrates the key role public health practitioners may play in criminal investigations.     

An Unusual Cause of Headache and Sudden Death of a Young Sailor—Postmortem Computed Tomography and Histological Findings of a Fatal Retroperitoneal Malignant Mixed Germ Cell Tumor

A 26‐year‐old Caucasian sailor, with no past medical history aside from headache for the last 1 week, was found dead in his cabin. The body was stored in a refrigerator on board and disembarked for autopsy 3 days later. Autopsy showed a large, nodular, necrotic and hemorrhagic retroperitoneal mass, and smaller hemorrhagic nodules in the brain, lungs, liver, and left kidney, with the brain being markedly edematous. Both testes were descended and normal. Histologically, the retroperitoneal mass showed a malignant mixed germ cell tumor comprising choriocarcinoma, embryonal carcinoma, and teratoma components. Retroperitoneal extragonadal germ cell tumors are uncommon, and this case of a young male who presented with headache and sudden death due to metastases is extremely rare.