Sudden death resulting from lesions of the cardiac conduction system

Sudden unexpected deaths in young persons with noncontributory histories, autopsy results, and drug screen results are a common problem in forensic pathology. As part of the evaluation of such cases, the cardiac conduction system (CCS) should be studied. To determine the type and incidence of lethal CCS lesions, the authors reviewed their files of sudden unexpected cardiac deaths with particular attention to cases with causes of death in the conduction system. Cases of sudden cardiac death in patients aged < or=40 years during a 10-year period (Michigan) and a 4 year-period (Spain) were selected from the files. From this group, cases were identified in which the cause of death was a lethal change in the CCS. The portions of the heart containing the CCS were excised, and at least one hematoxylin and eosin slide and at least one trichrome or elastic trichrome slide per block were studied. In the two centers, 381 cases of sudden cardiac death were identified. The most common causes of sudden cardiac death were arteriosclerotic narrowing of the coronary arteries, cardiomyopathy, and myocarditis. In 82 cases, there was no identifiable cause of death even after complete gross and microscopic autopsy was performed, a medical history was obtained, and a drug screen was performed. In 11 cases, the CCS contained lesions that were considered lethal: narrowing of the atrioventricular node artery by fibromuscular hyperplasia (7 cases) and atrioventricular node tumors (4 cases). The 11 cases accounted for 2.9% of the 381 cases of sudden cardiac death and 11.8% of the indeterminable cases. It was concluded that examination of the CCS in deaths in which the gross and microscopic autopsy, history, and drug screen fail to provide a cause of death can yield a cause of death in a significant percentage of cases. If heart block was not documented during life and no explanatory lesions were found during routine cardiac examination, examination of the CCS can yield valuable information.     

Extension of the color suite available for chemical enhancement of fingerprints in blood

The use of ortho- and para-phenylenediamine (OPD & PPD respectively) for the enhancement of fingerprints in blood has been investigated. Optimal pH conditions and H2O2 concentrations have been determined using UV/Vis spectroscopy. Both OPD and PPD are effective and less hazardous alternatives to the presently used 3,3'-diaminobenzidine (DAB) for the development of blood fingerprints, especially on porous surfaces. The orange color of OPD and the purple color of PPD offer alternative colors to the brown color of DAB and the light green color of ABTS for standing out against particular backgrounds. Both OPD and PPD can be used after ninhydrin treatment, but the reverse is not the case.     

Interpretation of glass composition measurements: the effects of match criteria on discrimination capability

The concentrations of ten elements in 209 unrelated glass specimens received as evidence were used to assess the frequencies of errors of false association (Type II errors) using several comparison criteria at specified significance levels (Type I errors). Pairwise comparisons of the samples using either the equal-variance t-test or Welch's modification (unequal variances) result in a small number of errors of false association, even when adjusting the significance level (Bonferroni correction) for multivariate comparisons. At the 95% confidence level (overall Type I error of 0.05, or individual element comparison error of 0.005), only two Type II errors are made in 21736 comparisons (0.009%) when using the equal-variance t-test for comparison of sample means. In this study, the range overlap test using three replicate measurements per specimen results in no errors of false association. Most specimen pairs in this data set are readily discriminated either by differences in the concentrations of several elements or by an extremely large difference in the concentrations of one or more element.     

Deaths associated with liposuction: case reports and review of the literature

Tumescent liposuction is a common cosmetic procedure that is performed as an outpatient service in physician's offices and is largely believed to be safe. The protuberant areas of the body containing the undesirable fat deposits are injected with normal saline containing lidocaine and epinephrine for pain control and hemostasis, and the waterlogged cells are suctioned out via cannula through a small incision. We recently encountered three cases in which deaths were attributed to this procedure. Two showed fat embolization in the lung and one died from fluid overload. The osmium tetroxide post-fixed lung sections showed fat emboli in the interstitial capillaries and arterioles. We reviewed the recent literature and found that pulmonary thromboemboli, fat embolization, fluid overload, and lidocaine and epinephrine intoxication are found at autopsy in many cases. Forensic pathologists responsible for determining the cause and manner of death should become familiar with the postmortem findings and risks of liposuction therapy and communicate them to their clinical colleagues and communities.     

A more sensitive method for the quantitation of genomic DNA by Alu amplification

Current procedures for human DNA quantitation reach their limit at 150 pg DNA, which is above the limit of the PCR profiling range using Profiler-Plus (Applied Biosystems, CA). This study tested the potential for the use of primate specific Alu sequences in forensic science for the sensitive detection and quantitaion of DNA. A fluorescently labelled primer pair was designed enabling high efficiency amplification of the core Alu sequence within primate DNA. Quantitation was performed by measurement of fluorescence intensity and comparison to a series of standard template DNA amounts via the construction of a standard curve. The new Alu-based quantitation protocol developed has shown its feasibility in more sensitively quantitating (100-2.5 pg) unknown amounts of human DNA for forensic use. The method is compatible with the use and throughput of current forensic procedures.