Unusual infant death: dog attack or postmortem mutilation after child abuse?

An unusual form of fatal child abuse is reported in which investigations by the police and the medical examiner were able to distinguish blunt force head trauma followed by postmortem dismemberment from a fatal dog attack. A discussion of the approaches used to ascertain the correct diagnosis is presented, as well as an overview of dog attacks on humans.

Death during percutaneous insertion of an intraaortic balloon pump

Intraaortic balloon counterpulsation is currently the most widely used mechanical technique for temporary support of the circulation. We report a rare fatal case of perforation of the right common iliac artery during percutaneous insertion of an IABP.

Sudden death due to sarcoid heart disease

A case of sudden death due to massive myocardial sarcoidosis is presented. Cardiac sarcoidosis is discussed. Since the deceased was a New York City police officer with death benefit entitlements under the Heart Bill, the implications of the medicolegal autopsy are emphasized.

Child homicide caused by commotio cordis

Cardiac concussion, previously known as commotio cordis, occurs in structurally normal hearts without gross or microscopic injury to the myocardium, cardiac valves, or coronary arteries, as opposed to other sports-related deaths known to occur more frequently in structural or congenital heart disease. We describe the sudden cardiac death of a 2-year-old child, who died as a result of a blunt force impact to the chest. A thorough medicolegal investigation was necessary to determine that the child died as a result of foul play.

Sudden asphyxial death complicating infectious mononucleosis

Infectious mononucleosis (IM) is a disease traditionally defined by a triad of clinical, laboratory, and serologic factors. It is typically a benign, self-limited disease of children and young adults. Upper airway obstruction is a rare but potentially fatal complication of IM resulting from massive tonsillar enlargement, pharyngeal edema, or both. We report a case of sudden death due to airway obstruction in IM.

Carcinoid heart disease with severe hypoxia due to interatrial shunt through patent foramen ovale

Carcinoid heart disease occurs in approximately half of patients who have carcinoid syndrome and is the leading cause of death among these patients. It is typically manifest as right-sided valvular lesions, usually tricuspid insufficiency and pulmonary valve stenosis. This case report describes the unusual presentation of a patient with carcinoid heart disease and a large right-to-left shunt through a patent foramen ovale.

Serum sickness reaction following multiple insect stings

BACKGROUND

Anaphylaxis is the most common systemic allergic reaction caused by stinging insects. Serum sickness reactions occur much less frequently.

OBJECTIVE

To determine the level of venom-specific IgG and IgE antibodies during and after a serum sickness reaction to vespid venom.

METHODS

Case report; ELISA determination of venom-specific IgG and IgE; complement levels and tests for immune complexes were performed.

RESULTS

We report the case of a 66-year-old woman who developed a serum sickness reaction nine days after receiving multiple vespid stings. She developed urticaria, angioedema, fever, and arthralgias. She had elevated IgG and IgE venom-specific titers which declined during the recovery phase. Complement levels were normal and tests for immune complexes were negative. She was successfully treated with venom-specific immunotherapy without any serum sickness reaction.

CONCLUSIONS

A serum sickness reaction with elevated venom-specific IgG and IgE is reported with successful immunotherapy.

Death by fraternity hazing

Fraternity hazing can cause a variety of injuries and deaths. We recently had the opportunity to investigate a heat-related death that occurred during a college fraternity event. The original death investigation did not consider the circumstances of death, environmental conditions, or the subtle autopsy findings related to heat stroke. This case is intended to alert health care professionals that deaths on college campuses may be related to fraternity hazing and may require in-depth investigations. An analysis of the death and a discussion of heat-related injuries are presented.

Optical analyses of eyeglass lens fragments and the unexpected detection of oral sperm in a homicide case

A homicide case in which intact spermatozoa were found in the oral cavity of the deceased forty days after his disappearance is reported. The victim's partially frozen body was found outdoors in a wooded area of upstate New York during the month of January. During a subsequent investigation, pieces of eyeglass lens fragments and bloodstains were found in the suspect's house and vehicle. Chemical and optical analyses of the lens fragments are presented as well as results of the serological tests.

Life masks and death masks

The death of a relative or anyone in a small, tightly knit community with closely shared cultural and religious values has great social impact. As part of the grieving process, people wish to preserve the memory of a loved one or a community leader. Life masks and death masks have been used as art forms to mark life passages, offering permanent reminders of family and continuity with the past. This article discusses the history and technique of life and death masks and their role in 19th-century American culture.

Homicidal traumatic asphyxia associated with pebble impaction of the upper airway

The news media tend to sensationalize murders involving multiple methods because of their inherent brutality. Similarly, when addressing a jury, prosecutors often emphasize the most grisly part of a murder to ensure a speedy conviction. This paper reports a case of a teenage boy who was murdered by the use of multiple methods of asphyxia. The methods of asphyxial death and the reconstruction of the sequence of events by the medical experts during the murder trial played an important role in the conviction and ultimate sentencing of the perpetrators.

Sudden death due to self-treatment of peripheral edema with rubberband tourniquet

A 70-year-old white male alcoholic with a history of congestive heart failure associated with peripheral edema was found dead in a pool of blood with a circumferential laceration of his right leg. A rubberband was found around the leg deep within the wound. The decedent reportedly refused medical treatment for his cardiovascular condition and treated himself by applying rubberbands and bandages around his legs to stop the spread of edema and infection.

Sudden death of an elderly man with multiple malignant neoplasms

With the lengthening of the human life span, cancer has become an increasingly important medical problem for the aged. It is not uncommon to find multiple primary neoplasms in elderly individuals. We recently investigated the death of an elderly man who had died suddenly and had three incidental malignant neoplasms, including a pleural mesothelioma, first diagnosed at autopsy. The importance of performing a complete medicolegal autopsy for epidemiological and statistical purposes is emphasized.

A case of autoerotic asphyxia associated with multiplex paraphilia

During the past 20 years, the sensational aspects of autoerotic fatalities have captured the attention of medical examiners, psychiatrists, law enforcement agents, and the public, as well as the individuals themselves who engage in these dangerous practices. Reports of deaths related to sexual asphyxia have been presented numerous times at national and international meetings and have been the topic of discussion on television talk shows and in the press. Autoerotic fatalities and all the sexual curiosities related to these activities have prompted death scene investigators to publish case reports, and even textbooks, on the subject. The case presented herein is one of a multicomponent paraphilia in which self-asphyxiation (autoasphyxiophilia) led to a fatal autoerotic event.

Sudden asphyxial death due to a prolapsed esophageal fibrolipoma

Fibrolipomas of the esophagus are extremely uncommon benign tumors. Accurate diagnosis and resection are essential, due to their tendency to become impacted and obstruct the airway. The case is presented of a 56-year-old man who died suddenly of asphyxia because of upper airway obstruction by a prolapsed fibrolipoma of the esophagus.

Sudden death due to delayed rupture of hepatic subcapsular hematoma following blunt abdominal trauma

Blunt abdominal trauma can cause sudden, unexpected death due to injuries to internal organs. Rupture of a hepatic subcapsular hematoma is a relatively rare cause of sudden death following minor blunt abdominal trauma. Death may be delayed several days to weeks. The autopsy is an invaluable diagnostic tool that can be utilized to uncover sudden deaths due to abdominal trauma. The case of an alcoholic who died of a ruptured hepatic subcapsular hematoma is presented. The death investigation revealed that the victim had sustained blunt abdominal trauma during a fall a few days prior to death.

Casino-related deaths in Atlantic City, New Jersey 1982-1986

The first legalized casino-hotel opened in Atlantic City, New Jersey in 1978. Annually, more than 30 million people visit the "Gambling Capitol of the East Coast." As a result of this growing influx of people, the Atlantic County Medical Examiner's Office began compiling statistics in 1982 of casino-related deaths. Data on 398 casino-related deaths occurring in 1982-1986 were collected and analyzed: 83% of the total number of fatalities were sudden cardiac deaths. Most of the victims were elderly white retired men who had previously diagnosed medical conditions. Many of the victims' underlying medical problems are of a type known to be associated with compulsive gambling. The majority of deaths occurred during the afternoon hours on weekends in October, January, and May. Of the victims, 86% were from New Jersey, New York, and Pennsylvania. For Atlantic City, a gambling community known to have a relatively high rate of crime and drug-trafficking, only 1% of all deaths were homicides. We speculate that the stress of gambling activities may induce sudden cardiac death. We therefore recommend that communities planning to legalize casino gambling mandate that gambling establishments provide emergency health care services for their patrons.

Religious objection to autopsy. An ethical dilemma for medical examiners

In recent years, religious objection to autopsy has become an ethical dilemma for medical examiners. We present two cases that illustrate these dilemmas, and we also review the history and legal considerations of religious objection to autopsy.

Strangulation. A conceptual approach for courtroom presentation

A conceptual approach is presented herein to assist forensic pathologists in their courtroom explanation of asphyxial deaths due to strangulation. Two-dimensional visual aids have been designed for jurors to understand easily the anatomic structures of the neck, the classic external features of asphyxia, and the directionality of force applied to the neck, as well as internal neck injuries associated with various forces.

Sudden death due to ruptured pancreaticoduodenal artery aneurysm

Superior pancreaticoduodenal artery aneurysms are rare; their rupture often leads to sudden death. We report a case of a 59-year-old hypertensive man who died of a massive retroperitoneal hemorrhage following rupture of an aneurysm of the superior pancreaticoduodenal artery. We also discuss this unusual vascular lesion and review the pertinent literature.

A bizarre case of vehicular suicide

The upper torso of a man was discovered under a highway sign next to tire tread marks leading from the highway and continuing beyond the sign. The victim's lower torso and automobile were also found along the same path 31 m (101 ft) and 41 m (133 ft) beyond the sign, respectively. The decedent was initially thought to be a disposed, homicide victim who had been dismembered by his assailant(s). Accident reconstruction revealed that the victim was the driver of the automobile and was transected by the highway sign stanchion as he protruded through the passenger side window of his moving vehicle. Based on the scene findings, autopsy, and psychological autopsy, the manner of death was classified as suicidal. The criteria used by medical examiners for vehicular suicide are also discussed.

Fatal complications related to diagnostic barium enema

Thousands of barium enemas are performed in the United States each year without incident. Occasionally complications arise, only a few of which are fatal. Perforation is the most frequent serious complication of this procedure. Two instances of fatal perforation, one colonic and the other vaginal, are described, and the relevant literature is reviewed.

Harness racing injuries and deaths. Report of a fatal accident and review of 178 cases

A case of a harness racing accident in which the driver died of head injuries is presented. To evaluate the victim's head injury and corresponding helmet damage, a videotape of the race was reviewed and analyzed. Based on calculations of a simplified trajectory analysis and testing of the helmet, it was determined that the helmet design did not provide adequate protection for the victim. The standards for harness helmet design are being re-evaluated by the harness racing industry to ensure the safety of the drivers. A review of 178 harness racing injuries and deaths, current harness helmet research, and recommendations for safer helmets are discussed. A protocol for the forensic investigation of sports-related injuries and/or deaths is also presented to assist medical examiners in fulfilling their roles as practitioners of preventive medicine.

Rectal impaction following enema with concrete mix

This article describes an unusual rectal foreign body resulting from homosexual anal erotic activities. The patient had used an enema containing a concrete mix which became impacted and required surgical removal. The use, abuse, and complications of enemas are reviewed.

Copper toxicity following massive ingestion of coins

Two hundred seventy-five United States coins were discovered in the stomach of a mentally disturbed individual at autopsy. Many coins containing copper were corroded by prolonged contact with gastric juice, with subsequent absorption and deposition of copper in the liver and kidneys. The patient died from complications related to the acute toxic phase of chronic copper poisoning. A discussion of the case, foreign-body ingestion, gastric bezoars and the mechanism of copper toxicity is presented. To our knowledge, this is the first death due to copper intoxication following a massive ingestion of coins.

An unusual case of compression asphyxia and smothering

Scene investigation is an important part of the medicolegal autopsy. In many cases the cause of death cannot be determined without knowledge of the circumstances. A case is presented in which the diagnosis of compression asphyxia and smothering was made only after analysis of the scene findings.

Herniation of the heart. A death following intrapericardial pneumonectomy

A case is presented involving a patient who underwent an intrapericardial pneumonectomy for lung cancer and died of cerebral hypoxia due to herniation of the heart. The etiology and pathophysiology of cardiac herniation are reviewed.

Clinical forensic medicine

This article discusses the merits of participation by medical examiners in the area of clinical forensic medicine. The present connotation that we deal after the fact should be abandoned with enhanced involvement in assisting the living. The paper focuses on a broad range of categories where forensic scientists by virtue of their training and experience could be most helpful in the application of medical knowledge to the solution of questions of law.

Sudden death resulting from chicken bone perforation of the esophagus

Sudden death caused by foreign-body perforation of the esophagus is distinctly uncommon. We report the death of an elderly patient in a nursing home who exsanguinated after she swallowed a chicken bone that perforated her esophagus and right common carotid artery.

A work-related death due to a penetrating chest injury

Penetrating injuries of the chest are uncommon in the work-place. We report an unusual case of a machinist who was killed when a drill press broke and a flying metallic fragment penetrated his thorax.