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Schuppener LM, Corliss RF. Infant Death Following Home Birth: A Case Report of Fatal Neonatal Hypoglycemia. J Forensic Sci 2019; 65:995-998. [PMID: 31800970 DOI: 10.1111/1556-4029.14247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Abstract
Infants born to diabetic mothers are at increased risk for symptomatic hypoglycemia and death after birth. A 36-year-old G4P3 mother with a history of gestational diabetes and newly diagnosed type II insulin-dependent diabetes gave birth at home, in the care of a midwife, to a macrosomic infant girl (10 lbs.). Several hours after birth, the infant became lethargic and was found to be hypoglycemic (blood sugar: 28 mg/dL). Glucose and sugar water were administered by the midwife; however, the infant continued to decompensate. Emergency medical services were called, and the infant was transported to the hospital where, despite resuscitative efforts, she died. An autopsy and review of the literature was performed. At autopsy, characteristic features of maternal-fetal glucose dysregulation were identified, including fetal macrosomia, cardiomegaly, hepatomegaly, and severe pancreatic islet cell hypertrophy/hyperplasia. Developmental abnormalities and other potential causes of death were not identified. Although deaths due to hypoglycemia cannot be reliably diagnosed postmortem using vitreous glucose levels, a clinical history of maternal glucose dysregulation in combination with certain gross and histologic findings should prompt a pathologist to consider maternal-fetal glucose dysregulation as a diagnosis of exclusion and cause of death.
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Affiliation(s)
- Leah M Schuppener
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison Hospital and Clinics, 600 Highland Ave, Madison, WI, 53792
| | - Robert F Corliss
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison Hospital and Clinics, 600 Highland Ave, Madison, WI, 53792
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Thompson KM, Sterkel AK, McBride JA, Corliss RF. The Shock of Strep: Rapid Deaths Due to Group a Streptococcus. Acad Forensic Pathol 2018; 8:136-149. [PMID: 31240031 DOI: 10.23907/2018.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/07/2017] [Accepted: 12/02/2017] [Indexed: 11/12/2022]
Abstract
Streptococcus pyogenes, also known as group A beta-hemolytic strep, is a Gram positive coccus responsible for several million infections every year. The types of infections vary widely from pharyngitis to myositis, but all can advance to severe life threatening invasive disease. Of those infected, approximately 1100 to 1600 people die each year due to invasive disease. Why certain individuals contract severe infections is not known, but many strains of Streptococcus pyogenes are known to produce toxins and superantigens. Invasive Streptococcus pyogenes infections have been shown to cause significant morbidity and rapid mortality. In many cases, patients expire before full antemortem testing can be performed, causing physicians and families to look to forensic pathologists for answers. Understanding the pathogenesis of invasive group A strep infections, relevant gross and microscopic findings, and proper culturing techniques is critical for forensic pathologists to diagnosis this condition and assist in the education and protection of the communities they serve.
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Affiliation(s)
- Katrina M Thompson
- University of Wisconsin Hospital and Clinics - Department of Pathology and Laboratory Medicine
| | - Alana K Sterkel
- Wisconsin State Laboratory of Hygiene - Department of Communicable Disease
| | - Joseph A McBride
- University of Wisconsin Hospital and Clinics, Department of Medicine and Pediatrics, Division of Infectious Diseases
| | - Robert F Corliss
- University of Wisconsin Hospital and Clinics - Department of Pathology and Laboratory Medicine
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Matson DR, Accola MA, Rehrauer WM, Corliss RF. Fatal Myocarditis Following Treatment with the PD-1 Inhibitor Nivolumab. J Forensic Sci 2017; 63:954-957. [DOI: 10.1111/1556-4029.13633] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Daniel R. Matson
- Department of Pathology and Laboratory Medicine; University of Wisconsin School of Medicine and Public Health; UWHC - Rm A4/204 - 3224 600 Highland Avenue Madison WI 53792
| | - Molly A. Accola
- University of Wisconsin Hospitals and Clinics; UWHC - Mailcode 2472 600 Highland Avenue Madison WI 53792
| | - William M. Rehrauer
- University of Wisconsin School of Medicine and Public Health; UWHC - Mailcode 2472 600 Highland Avenue Madison WI 53792
| | - Robert F. Corliss
- University of Wisconsin School of Medicine and Public Health; UWHC - L5/151 CSC - 8550 600 Highland Avenue Madison WI 53792
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Schuppener LM, Corliss RF. Death Due to Complications of Bowel Obstruction Following Raw Poppy Seed Ingestion. J Forensic Sci 2017; 63:614-618. [PMID: 28543087 DOI: 10.1111/1556-4029.13562] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023]
Abstract
Eating poppy seeds can cause a positive urine drug screen, but it is unknown whether ingesting large quantities can result in opiate intoxication or toxicity. A 54-year-old woman with intractable vomiting was found unresponsive at home and later pronounced dead. At autopsy, a cast-like large bowel obstruction composed of poppy seeds was identified. Postmortem blood morphine level was < 10 ng/mL. Cause of death was determined to be complications of a bowel obstruction secondary to poppy seed ingestion. Deaths related to eating poppy seeds have not been described in the literature. This case illustrates that consuming raw poppy seeds in large quantities did not cause lethal opiate toxicity. However, overdose deaths associated with ingesting poppy seed tea (PST) have been described. Poppy seed derivatives should be considered a potential source in cases of opiate toxicity without evidence of prescription or street drug abuse.
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Affiliation(s)
- Leah M Schuppener
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI
| | - Robert F Corliss
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI
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Zhang L, Tester DJ, Lang D, Chen Y, Zheng J, Gao R, Corliss RF, Tang S, Kyle JW, Liu C, Ackerman MJ, Makielski JC, Cheng J. Does Sudden Unexplained Nocturnal Death Syndrome Remain the Autopsy-Negative Disorder: A Gross, Microscopic, and Molecular Autopsy Investigation in Southern China. Mayo Clin Proc 2016; 91:1503-1514. [PMID: 27707468 PMCID: PMC5097692 DOI: 10.1016/j.mayocp.2016.06.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/06/2016] [Accepted: 06/24/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To look for previously unrecognized cardiac structural abnormalities and address the genetic cause for sudden unexplained nocturnal death syndrome (SUNDS). METHODS Data for 148 SUNDS victims and 444 controls (matched 1:3 on sex, race, and age of death within 1 year) were collected from Sun Yat-sen University from January 1, 1998, to December 31, 2014, to search morphological changes. An additional 17 patients with Brugada syndrome (BrS) collected from January 1, 2006, to December 31, 2014, served as a comparative disease cohort. Target-captured next-generation sequencing for 80 genes associated with arrhythmia/cardiomyopathy was performed in 44 SUNDS victims and 17 patients with BrS to characterize the molecular spectrum. RESULTS The SUNDS victims had slight but statistically significant increased heart weight and valve circumference compared with controls. Twelve of 44 SUNDS victims (SCN5A, SCN1B, CACNB2, CACNA1C, AKAP9, KCNQ1, KCNH2, KCNJ5, GATA4, NUP155, ABCC9) and 6 of 17 patients with BrS (SCN5A, CACNA1C; P>.05) carried rare variants in primary arrhythmia-susceptibility genes. Only 2 of 44 SUNDS cases compared with 5 of 17 patients with BrS hosted a rare variant in the most common BrS-causing gene, SCN5A (P=.01). Using the strict American College of Medical Genetics guideline-based definition, it was found that only 2 of 44 (KCNQ1) SUNDS and 3 of 17 (SCN5A) patients with BrS hosted a "(likely) pathogenic" variant. Fourteen of 44 SUNDS cases with cardiomyopathy-related variants had a subtle but significantly decreased circumference of cardiac valves, and tended to die on average 5 to 6 years younger compared with the remaining 30 cases (P=.02). CONCLUSION We present the first comprehensive autopsy evidence that SUNDS victims may have concealed cardiac morphological changes. SUNDS and BrS may result from different molecular pathological underpinnings. The distinct association between cardiomyopathy-related rare variants and SUNDS warrants further investigation.
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Affiliation(s)
- Liyong Zhang
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - David J Tester
- Departments of Cardiovascular Diseases (Division of Heart Rhythm Services), Pediatrics (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, MN
| | - Di Lang
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, WI
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jinxiang Zheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Rui Gao
- BGI-Shenzhen, Shenzhen, China
| | - Robert F Corliss
- Department of Pathology and Laboratory Medicine and Waisman Center, University of Wisconsin, Madison, WI
| | - Shuangbo Tang
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - John W Kyle
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, WI
| | | | - Michael J Ackerman
- Departments of Cardiovascular Diseases (Division of Heart Rhythm Services), Pediatrics (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, MN
| | - Jonathan C Makielski
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, WI
| | - Jianding Cheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
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Brooks EG, Paus AM, Corliss RF, Ranheim EA. Enhancing preclinical year pathology exposure: the Angevine approach. Hum Pathol 2016; 53:58-62. [PMID: 27016489 DOI: 10.1016/j.humpath.2016.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/22/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
Less than 2% of graduating US medical seniors select pathology residencies. One major obstacle to attracting prospective residents is the relative "invisibility" of pathology; medical students lacking positive preclinical exposure to pathology are unlikely to later select pathology clerkships or residencies. The Angevine Fellowship is a 10-week competitive pathology internship medical students may apply for the summer following their first year of preclinical training at our institution. We sought to determine whether it was an effective pathology recruitment tool and how it compared with the postsophomore pathology fellowship (PSF). Angevine fellow and PSF data from 2000 to 2014 were retrospectively analyzed. Specialty choices of former fellows already matched into residency programs were tabulated. Data regarding annual percentage of graduating seniors at our institution who matched into pathology during the years former fellow cohorts matched were also examined. Our results showed that of the former Angevine fellow cohorts already matched into residency programs, 40% (8/20) matched in pathology and 20% (4/20) at our own institution. Angevine fellows comprised a disproportionately high number of the graduating seniors matching in pathology at our medical school (26.7%). PSFs comprised 6.67%. Although we have endowment funding for 2 Angevine fellows annually, the level of interest among applicants has increased to the point that our department has consistently contributed funding for 1-2 additional fellowship spots since 2011. We conclude that the Angevine Fellowship offers an effective alternative to the postsophomore fellowship. It has proven successful at our institution and could be implemented at others to potentially improve pathology recruitment trends nationwide.
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Affiliation(s)
- Erin G Brooks
- University of Wisconsin Hospital and Clinics, Department of Pathology and Laboratory Medicine, Madison, WI 53705.
| | - Amanda M Paus
- University of Wisconsin Hospital and Clinics, Graduate Medical Education Office, Madison, WI 53705
| | - Robert F Corliss
- University of Wisconsin Hospital and Clinics, Department of Pathology and Laboratory Medicine, Madison, WI 53705
| | - Erik A Ranheim
- University of Wisconsin Hospital and Clinics, Department of Pathology and Laboratory Medicine, Madison, WI 53705
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Mandal R, Brooks EG, Corliss RF. Eosinophilic Coronary Periarteritis with Arterial Dissection: The Mast Cell Hypothesis. J Forensic Sci 2015; 60:1088-92. [PMID: 25771824 DOI: 10.1111/1556-4029.12752] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/25/2014] [Accepted: 07/09/2014] [Indexed: 01/21/2023]
Abstract
A subset of coronary arterial dissections is associated with eosinophilic coronary periarteritis (ECPA); however, the pathogenesis of the process remains unclear. Mast cells normally reside in coronary arterial adventitia and are known mediators of eosinophilic inflammatory conditions such as type I hypersensitivity reactions. We report two cases in which coronary arterial dissection with ECPA was detected at autopsy. Tryptase, CD68, CD4, CD8, and CD1a immunohistochemical staining was performed to better characterize inflammation. While eosinophils represented a prominent periadventitial inflammatory cell, there were slightly more lymphocytes: CD4/CD8 ratios were within expected reference ranges. There were moderate numbers of macrophages, and few neutrophils or dendritic cells. Numbers of mast cells in dissected versus nondissected sections were compared: adventitial mast cell densities were threefold higher in dissected portions and showed a trend toward increased degranulation. These findings suggest that mast cells may play a role in orchestrating inflammation in cases of ECPA.
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Affiliation(s)
- Rakesh Mandal
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705
| | - Erin G Brooks
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705
| | - Robert F Corliss
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705
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Nichol PF, Corliss RF, Yamada S, Shiota K, Saijoh Y. Muscle patterning in mouse and human abdominal wall development and omphalocele specimens of humans. Anat Rec (Hoboken) 2012; 295:2129-40. [PMID: 22976993 DOI: 10.1002/ar.22556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/21/2012] [Accepted: 07/26/2012] [Indexed: 12/26/2022]
Abstract
Human omphalocele is a congenital defect of the abdominal wall in which the secondary abdominal wall structures (muscle and connective tissue) in an area centered around the umbilicus are replaced by a translucent membranous layer of tissue. Histological examination of omphalocele development and moreover the staging of normal human abdominal wall development has never been described. We hypothesized that omphalocele is the result of an arrest in the secondary abdominal wall development and predicted that we would observe delays in myoblast maturation and an arrest in secondary abdominal wall development. To look for evidence in support of our hypothesis, we performed a histological analysis of normal human abdominal wall development and compared this to mouse. We also conducted the first histological analysis of two human specimens with omphalocele. In these two omphalocele specimens, secondary abdominal wall development appears to have undergone an arrest around Carnegie Stage 19. In both specimens disruptions in the unidirectional orientation of myofibers were observed in the external and internal obliques, and rectus abdominis but not in the transversus abdominis. These latter findings support a model of normal abdominal wall development in which positional information instructs the orientation of myoblasts as they organize into individual muscle groups.
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Affiliation(s)
- Peter F Nichol
- Department of Surgery, Section of Pediatric Surgery, University of Wisconsin SMPH, Madison, Wisconsin, USA
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Nichol PF, Corliss RF, Tyrrell JD, Graham B, Reeder A, Saijoh Y. Conditional mutation of fibroblast growth factor receptors 1 and 2 results in an omphalocele in mice associated with disruptions in ventral body wall muscle formation. J Pediatr Surg 2011; 46:90-6. [PMID: 21238647 PMCID: PMC3979308 DOI: 10.1016/j.jpedsurg.2010.09.066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/30/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE We observed that fibroblast growth factor receptors 1 and 2 (Fgfr1, Fgfr2) are expressed during abdominal wall development in mice and hypothesized that conditional mutation of these genes would result in abdominal wall defects. METHODS Section in situ hybridizations were performed for Fgfr1 and Fgfr2 on wild-type embryos at embryonic day (E) 11.5 and E13.5. Conditional mutation of Fgfr1and Fgfr2 was achieved with a tamoxifen inducible Cre at E8.5. Litters were harvested at E17.5, whole mount photographs were taken, and paraffin sections were generated and stained with hematoxylin and eosin. RESULTS Fgfr1 was expressed in ectoderm, lateral plate mesoderm, and myoblasts, whereas Fgfr2 was expressed almost exclusively in the early dermis and ectoderm of the abdominal wall. Conditional mutation of both Fgfr2 alleles and one Fgfr1 allele resulted in omphalocele in 38.7% of mutants. Histologic examination in mutants demonstrated disruptions in dermal and muscle development. CONCLUSIONS Mutant embryos with omphalocele arising from mutation in Fgfr1 and Fgfr2 exhibit disruptions in the development of the secondary abdominal wall structures. These findings are consistent with a model of ventral abdominal wall development in which organization of the muscles and connective tissue (secondary abdominal wall structures) is influenced by positional information emanating from the primary abdominal wall.
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Affiliation(s)
- Peter F. Nichol
- University of Wisconsin School of Medicine and Public Health Department of Surgery, Madison, WI 53792, USA,Corresponding author. Tel.: +1 608 263 9419; fax: +1 608 261 1876, (P.F. Nichol)
| | - Robert F. Corliss
- University of Wisconsin School of Medicine and Public Health Department of Pathology, Madison, WI 53792, USA
| | - John D. Tyrrell
- Department of Neurobiology and Anatomy, University of Utah, Salt Lake City, UT 84132, USA
| | - Bradley Graham
- Department of Neurobiology and Anatomy, University of Utah, Salt Lake City, UT 84132, USA
| | - Amy Reeder
- University of Wisconsin School of Medicine and Public Health Department of Surgery, Madison, WI 53792, USA
| | - Yukio Saijoh
- Department of Neurobiology and Anatomy, University of Utah, Salt Lake City, UT 84132, USA
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Abstract
A premature neonate had pneumoperitoneum 5 days after discontinuation of extracorporeal membrane oxygenation therapy. A perforated appendix was found at exploratory laparotomy. Pathologic examination of the appendix found mucormycosis.
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Affiliation(s)
- Peter F Nichol
- Department of Surgery, University of Wisconsin, Madison, WI, USA
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Nichol P, Rod R, Corliss RF, Schurr M. Central myonecrosis in a patient with group a beta-hemolytic streptococcus toxic shock syndrome. J Trauma 2003; 55:994-6. [PMID: 14608183 DOI: 10.1097/01.ta.0000027129.46348.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Peter Nichol
- Department of Surgery, University of Wisconsin Hospital, 600 Highland Avenue, Madison, WI 53792, USA
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