Cardiac concussion: definition, differential diagnosis, and cases presentation and the legal ramification of a misdiagnosis

A cardiac concussion is caused by a sudden, nonpenetrating, localized impact to the chest that is theorized to result in almost simultaneous sudden death from a disruption to the conductive system. The detailed external/internal forensic examination of the body reveals no evidence of structural, pathologic, or histologic signs of trauma to the heart. A cardiac concussion is a rare and often overlooked cause of sudden death. This type of sudden death is typically seen among younger individuals participating in sports involving projectiles and, to a lesser degree, where collisions occur. Cardiac concussions are clinically, pathologically, and chemically different from a cardiac contusion. The objective of this paper will be to define cardiac concussion, differentiate between cardiac concussion and cardiac contusion, and describe the clinical and pathologic features of a 32-year-old white male who died of a cardiac concussion following a collision with a catcher during a softball game. The civil ramification of incorrectly diagnosing the manner of death in cases of death involving a cardiac concussion will also be addressed.     

Childhood panhypopituitarism presenting as child abuse: a case report and review of the literature

Childhood panhypopituitarism may be acquired or congenital. Children with panhypopituitarism can present clinically with diabetes, growth failure, decreased bone density, and morbid obesity. In the forensic setting without the proper history, it can be misdiagnosed as child abuse or neglect. We report a case of a 3-year-old black girl who was admitted to the emergency room with apnea and subsequently died. While at the emergency department, it was discovered that the child had a fractured left hip and was severely growth retarded for age. The coroner wanted to rule out child abuse and/or neglect and requested an autopsy based on the physical findings identified by hospital staff. Significant findings at autopsy included small for age (15th percentile for age), hypoplastic brain/pituitary gland/adrenal gland/thyroid gland, abnormally formed skull with an occipital protuberance, a fractured left hip with decreased bone density, and central adiposity. Subsequent to the autopsy, it was discovered that at 6 weeks of age the child suffered from group B streptococci meningitis that resulted in panhypopituitarism. The panhypopituitarism then resulted in seizure activity, diabetes insipidus, and growth retardation. The authors hope this case report and review of the literature will assist investigators, pathologists, and clinicians in making a distinction between neglect or inflicted injury of child abuse and panhypopituitarism that can present with similar signs and symptoms.     

About the Authors

Biography

About the Authors     

Analysis and classification of common vegetable oils

The analysis of fatty acids from common vegetable oils was investigated for application to forensic casework. A base-catalyzed transesterification of the fatty acids to fatty acid methyl esters using tetramethylammonium hydroxide was simple, rapid, straightforward and inexpensive. Canola, corn, olive, peanut, safflower, soybean and sunflower oils were able to be classified based on their fatty acid methyl ester profiles. Using gas chromatography-mass spectrometry, the detection limits for canola, corn, olive, peanut and safflower oils were determined to be 0.4 mg/mL or less and 0.2 mg/mL or less for soybean and sunflower oils.     

Fetal death. A 10-year retrospective study

Fetal death has been defined by the World Health Organization as death before complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy. Certain causes of fetal death, including syphilis, Rh isoimmunization, toxemia, and diabetes, have shown significant declines over the past several decades. However, many fetal losses continue to occur from intrauterine infections, lethal malformations, fetal growth retardation, and abruptio placentae. Fetal death with no identifiable specific cause is another consideration when dealing with these cases. Other risk factors can include maternal, sociodemographic, and medical care factors. The authors reviewed all forensic cases referred for autopsy to the Forensic Section of the Medical University of South Carolina, Medical Examiners' Office over the 10-year period 1990-1999. All cases listed as fetal death or stillbirth were included. The 42 cases were analyzed as to fetus' gestational age, sex, race, weight, location of delivery, history of prenatal care, maternal drug use, chromosomal abnormalities, cause and manner of death, and autopsy findings. The black:white ratio was approximately 2:1, and the male:female ratio was virtually 1:1. Most fetuses were older than 20 weeks' gestational age, with one third between 20 and 29 weeks. The majority were externally normal aside from maceration. Only 7.5% had congenital anomalies. Twenty-one of 38 placentas were grossly and microscopically normal. Of cases with toxicologic analysis, 21% were positive for drugs, and 17% were positive for cocaine/benzoylecgonine. The manner of death was classified as natural (28), accident (2), and undetermined (12). Few studies have reported the specific causes of fetal death, and the lack of uniformity in data collection and classification of causes of fetal death has made comparisons difficult. The authors present this retrospective study to better determine the factors leading to fetal demise in the hope of assisting death investigators in this challenging arena.     

Sex role and dating orientation

The assumption that males approach dating from a pronounced psychobiological orientation while females approach it from a psychoaffectional orientation was questioned. The sex role adopted by the individual was considered to be as important a variable as biological sex. Male and female subjects from three age groups, 16–17 years, 19–20 years, and 24–25 years, completed questionnaires designed to measure their sex roles and dating orientations. All groups of males were found to approach the dating relationship from both a psychoaffectional and psychobiological orientation, while all groups of females approached it from a psychoaffectional orientation and showed an increase in psychobiological orientation with increasing age and increasing depth of relationship. Significant differences were also found in dating attitudes between male and female subjects adopting different sex roles. It was concluded that neither masculinity and femininity, nor psychobiological and psychoaffectional attitudes to dating, lie on single continua. Masculine and feminine sex roles as independent dimensions influence psychobiological and psychoaffectional orientations to dating which are in themselves independent dimensions and not ends of a single continuum.Received her B.A. (Hons. 1) at Macquarie University and Dip. Teaching from Syndney Teachers' College. Current research interest is adolescent sexuality.Received M.A. (Hons. I) and Ph.D. at University of Sydney. Fellow of the Australian Psychological Society. Chairman (Sydney Branch) of the Australian Psychological Society. Current research interest is the psychology of adolescence.     

Drawings of the opposite sex: Continued use of the draw a person test and young state hospital patients

The Draw A Person test has continued to be one of the most frequently utilized psychological tests with children and adolescents. This is especially true for the child/adolescent populations in state hospitals. Because of the frequent criticism leveled against the DAP's validity, this study was undertaken in order to provide normative data for the DAP with this particular clinical population. Previous research has focused on the drawings of the same sex as the subjects; this study deals with the characteristics of the drawings of the opposite sex. The subjects were 84 male and 66 female psychiatric patients from the Adolescent Unit (AU) at Rusk State Hospital. As each patient was admitted to the AU, he was scheduled for psychological testing, with the DAP, the Revised Beta, and the MMPI being a part of this testing. The results of this study indicate that IQ ranking is the most significant factor affecting DAP test performance by male subjects. IQ ranking was not found to significantly influence the drawings by females. Neither MMPI test performance nor social background factors were shown to significantly affect DAP test performance. It is suggested that in order for the DAP to become a more objectively utilized personality technique, a scoring method should be developed that takes into account the overall quality of the drawing in conjunction with the individual details of each area of the figure drawn. More focus should also be given to the characteristics of the opposite-sex figure drawn by the subjects and its potential interpretation.Received his M.S. degree in psychology from North Texas State University in 1968. Current interests include establishment of residential psychiatric facilties for children and adolescents, development of new treatment modalities for children and adolescents (i.e., Wilderness Camping Programs for emotionally disturbed children and adolescents), and understanding and developing working knowledge of the criminally insane child or adolescent.Received his Ph.D. in experimental psychology from the University of Alabama. His research interests include program evaluation and psychometric studies of psychological tests.Received his B.A. degree in mathematics at the University of South Florida in 1968 and his M.S. degree in statistics from Virginia Polytechnic Institute in 1970. His current interest is mental health statistics.Received his Ph.D. from Texas Tech University in 1975. His current interest is in assertion training.     

A decade of pediatric homicide: a retrospective study at the Medical University of South Carolina.

More than 3 million children are abused and/or neglected each year in the United States. Unfortunately, a significant percentage of these cases result in homicide by child abuse or child neglect. Causes of death range from blunt force trauma and shaking to asphyxia to immolation. We retrospectively reviewed all pediatric forensic cases referred to the Medical University of South Carolina Forensic Pathology Section over the past 10 years, from January 1986 to December 1995. Of these, we looked only at children < or =5 years of age. The majority (342 cases, 69%) of these deaths were classified as natural, 96 (19%) as accident, and 60 (12%) as homicide. Of the homicides, we examined the cause of death; age, gender, and race of the victim; relationship to the perpetrator; time interval between injury and death; and the initial history given as to the cause of the injury. The cause of death fell into nine categories, the number one category being head trauma. Forty-five percent of the homicides were by head trauma, 12% by abdominal or body trauma, 25% by asphyxia (with half of these due to drowning), 10% by carbon monoxide poisoning or thermal injury, and the remaining 8% involving cases of neglect, stabbing, and poisoning. The majority of the homicide victims were male (67%) and black (67%). Forty-six percent were < or =1 year of age. Approximately 25% of the homicide cases were designated as shaken baby syndrome (SBS). In 97% of the cases, the assailant was known to the victim and was a family relative in 77%. Sixty-three percent of the assailants were female and 45% of the assailants were male; in 12%, the assailants were both parents, and in 1 case, the assailant remains unknown. Of the asphyxia deaths, 87% of the assailants were female. The time interval between injury and death ranged from minutes to hours in most cases to months in cases of repeated abuse and chronic injury and sequelae. The time interval between injury and the onset of symptoms remains unknown in most cases due to inconsistencies in the history and lack of credibility of the caretaker. The most common initial history given was "a fall" (20%). We report our findings of a decade of pediatric homicides to increase awareness of the common scenarios and case histories, demographics of the victims, causes of death, and perpetrators of pediatric homicide.     

Not All are Aboard: Decolonizing Exodus in Joon-ho Bong’s Snowpiercer

This article interprets Joon-ho Bong’s Snowpiercer (2013) as a political allegory. First, we compare Bong’s film to Danny Boyle’s Sunshine (2007) and Christopher Nolan’s Interstellar (2014), two contemporaneous films about ecological crises. We argue that Snowpiercer exposes the limits of technocratic environmentalisms that obscure the links between ecological degradation, capitalist development, and colonial domination. Second, we put Bong’s film into conversation with autonomist Marxist and postcolonial accounts of social domination and transformation. We argue that Snowpiercer is about whether or not contemporary political economy has rendered the emancipatory strategies of recent centuries obsolete. Framed this way, the film proposes that global order is still capitalist and colonialist, but that Left projects must surpass state socialism and anti-colonial nationalism. What we call Bong’s “decolonial exodus” is the demand for a real alternative to both the ideology that there is no alternative to the existing order and the pseudo-alternative of authoritarian populism.