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  • 1
    Online Resource
    Online Resource
    National Association of Medical Examiners Position Paper: Recommendations for the Postmortem Assessment of Suspected Head Trauma in Infants and Young Children
    SAGE Publications ; 2014
    In:  Academic Forensic Pathology Vol. 4, No. 2 ( 2014-06), p. 206-213
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 4, No. 2 ( 2014-06), p. 206-213
    Abstract: The National Association of Medical Examiners convened a panel to create a position paper for recommendations for the investigation of infant deaths due to inflicted head trauma. The correct certification of both the cause and manner of death is dependent upon an evaluation of all available data including information derived from the investigation, scene, postmortem examination, and ancillary studies. This paper provides recommendations for the forensic pathologist on what constitutes the dataset to be produced during the postmortem examination of infants who have died of, or have apparently died of, inflicted head trauma. Specifically, this paper describes 1) procedures, 2) ancillary laboratory tests, and 3) forms of documentation that are important in the investigation of these deaths. The evaluation and documentation of such infant deaths involves the production of a detail oriented and thoroughly documented examination that is independently reviewable to support the multitude of inquiries that may follow from the public and the criminal justice system.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2014.032
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 2
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    Online Resource
    Investigation of Deaths in Seizure Patients
    SAGE Publications ; 2014
    In:  Academic Forensic Pathology Vol. 4, No. 3 ( 2014-09), p. 331-337
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 4, No. 3 ( 2014-09), p. 331-337
    Abstract: Epilepsy is commonly encountered in forensic pathology and is ultimately determined to be the cause of death in 1–2% of medicolegal death investigations. Epilepsy is a risk factor for death from external causes, including accidents and drowning. More commonly, deaths result from the underlying epilepsy pathology, including intracranial neoplasms, cerebrovascular disease, status epilepticus, and sudden unexpected death in epilepsy (SUDEP). SUDEP refers to the sudden death in an epilepsy patient that lacks an alternative anatomic or toxicological cause of death. At autopsy, intracranial pathology is present in the majority of epilepsy-related deaths and is more likely to be identified following brain fixation. Common findings include brain tumors, mesial temporal sclerosis, and malformations of cortical development. Death investigators should pay particular attention to clinical history to establish a clear history of epilepsy and to determine seizure type, frequency, underlying etiology, and prior medical and surgical treatments as well as other comorbid medical conditions. A complete autopsy with toxicology is necessary to identify other causes of death, particularly in cases of suspected SUDEP. While toxicology may be helpful in some cases, caution must be taken in interpreting postmortem antiepileptic drug concentrations as levels decrease postmortem.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2014.045
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 3
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    Online Resource
    Critical Diagnoses in Forensic Pathology: Ethics of Disclosure
    SAGE Publications ; 2013
    In:  Academic Forensic Pathology Vol. 3, No. 3 ( 2013-09), p. 289-293
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 3, No. 3 ( 2013-09), p. 289-293
    Abstract: A complex set of systems exists in the United States to manage and regulate the practice of medicine, and forensic pathologists (FPs) are bound by the associated ethical guidelines and associated statutory obligations. Individual FPs, for example, are required to have and maintain a state medical license that requires continuing medical education and provides oversight of many aspects of the practice of medicine. The laboratories in which forensic pathology is practiced, however, generally do not have to be accredited. In contrast, the College of American Pathologists (CAP) is the recognized accrediting body that “regulates” the majority of anatomic pathology and laboratory medicine, including hospital (consented) autopsies. Unlike hospital-based pathology practices, few incentives are present that encourage or require forensic pathology practices to pursue accreditation. Since the preponderance of forensic pathology practices do not fall under the purview of CAP, this relatively small subset of pathologists are left to determine their own set of professional and ethical standards. The National Association of Medical Examiners (NAME) laboratory accreditation and published autopsy guidelines provides a foundation for development of a quality management program, but does not specifically address disclosure of test results. Defining “critical diagnoses” in forensic pathology is challenging, and communicating these important findings to the proper individual(s) or organizations may not fall under statutory or accrediting requirements, and thus may become an ethical issue for the medical examiner/coroner.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2013.038
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
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  • 4
    Online Resource
    Online Resource
    Cause and Manner of Death in Traumatic Spinal Cord Injuries: A 20 year Retrospective Review at a Statewide Medical Examiner Office
    SAGE Publications ; 2011
    In:  Academic Forensic Pathology Vol. 1, No. 1 ( 2011-07), p. 128-137
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 1, No. 1 ( 2011-07), p. 128-137
    Abstract: In the United States approximately 250,000 persons have a traumatic spinal cord injury (TSCI) and most will die from complications related to their injury. Interpretation of TSCI deaths by medical examiners is evolving as understanding of SCI pathophysiology increases. We queried our electronic database for deaths meeting inclusion criteria from 1989 to 2008 and identified 305 cases, of which 81% were males and 19% were females. A full autopsy was performed in 38.7% of cases and an external exam was performed in the remaining cases (61.3%). The manner of death distribution was accident (80%), homicide (7%), natural (7%), suicide (4%) or undetermined (2%). The most common mechanisms of spinal cord injury were motor vehicle accidents (42.6%), fall from a standing height (12.8%), fall from above a standing height (9.2%) and gunshot wounds (8.8%). The mechanism of spinal cord injury significantly impacted survival (p=0.0001) with decedents injured from motor vehicle accidents having a mean survival time of 14.4 years compared to 0.7 year from falling from a standing height. Analyzing patterns of deaths due to TSCI in a medical examiner office provides excellent epidemiological data for injury tracking and prevention as well as a context for medical examiners evaluating TSCI.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2011.015
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
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  • 5
    Online Resource
    Online Resource
    Autopsy Neuropathology
    SAGE Publications ; 2012
    In:  Academic Forensic Pathology Vol. 2, No. 1 ( 2012-03), p. x-xi
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 2, No. 1 ( 2012-03), p. x-xi
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.1177/192536211200200103
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
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  • 6
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    Online Resource
    Exploding Targets in Recreational Use
    SAGE Publications ; 2015
    In:  Academic Forensic Pathology Vol. 5, No. 3 ( 2015-09), p. 507-513
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 5, No. 3 ( 2015-09), p. 507-513
    Abstract: Exploding targets are marketed for their ability to indicate long-range marksmanship by detonating upon high velocity impact. The Internet has popularized recreational use of these targets outside of the scope of their intended design. We present a case of a 47-year-old man who was a bystander during recreational use of exploding targets. A .300 Winchester Magnum rifle was used to detonate an exploding target, on top of which was placed a fire extinguisher inside an aluminum pipe. The decedent was struck in the abdomen by a fragment of aluminum and collapsed. Despite emergency efforts at the scene, he was pronounced dead. Scene investigation revealed aluminum fragments throughout the blast radius. External examination and postmortem radiograph showed an entry wound of the left mid-abdomen without evidence of retained shrapnel. The autopsy findings included a hemoperitoneum due to transection of the right common iliac artery and inferior vena cava. A 10.6 g fragment of aluminum was recovered from within the abdomen. This case illustrates a dangerous misuse of exploding targets that has been popularized in the media. It also exemplifies a potential pitfall of a negative radiograph, despite the presence of metal shrapnel, because of the radiolucency of aluminum.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2015.056
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 7
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    Online Resource
    A Quality Assurance Strategy for Forensic Pathology
    SAGE Publications ; 2011
    In:  Academic Forensic Pathology Vol. 1, No. 1 ( 2011-07), p. 8-13
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 1, No. 1 ( 2011-07), p. 8-13
    Abstract: This article will present an overview of, and a strategy for, designing a comprehensive quality assurance and improvement program for forensic pathology. Quality forensic pathology, as in anatomic pathology in general, depends on creating accurate, timely, complete, and usable reports. A successful quality assurance program requires a well-developed plan to accurately monitor and evaluate the myriad of processes (performance metrics) required to practice quality forensic pathology. A quality assurance program should address all three phases (preanalytic, analytic, and postanalytic) of the forensic autopsy “test cycle” as well as laboratory accreditation and monitoring requirements. A flourishing quality assurance program combined with the appropriate organizational culture is the cornerstone of continuous quality improvement. Many of the components (e.g. quality assurance of the toxicology laboratory) that fold into the practice of forensic pathology should be evaluated using the same quality assurance principles, but will not be addressed specifically in this article.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2011.002
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
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  • 8
    Online Resource
    Online Resource
    Chasing the Dragon: A Review of Toxic Leukoencephalopathy
    SAGE Publications ; 2012
    In:  Academic Forensic Pathology Vol. 2, No. 1 ( 2012-03), p. 67-73
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 2, No. 1 ( 2012-03), p. 67-73
    Abstract: The report begins with the case of an 18-year-old male who presented to a community hospital with difficulty walking and speaking. His illicit drug use history included smoking heroin. After admission to the hospital, a thorough workup was consistent with toxic heroin related leukoencephalopathy. The young man continued to decline and died approximately 2 months after his initial presentation and diagnosis. An autopsy and a thorough neuropathology examination were completed. Sections through the cerebral hemispheres and the cerebellum revealed diffuse and profound softening and discoloration of the white matter, most prominently in the occipital lobes. Microscopically, there was vacuolization and spongiosis of the white matter. The pathologic findings were consistent with the diagnosis of toxic or heroin related leukoencephalopathy. Toxic leukoencephalopathy is a rare disorder of unknown etiology linked to the smoking of heroin, known as “chasing the dragon.” The exact mechanism of the disorder is unknown, but it is thought that impurities cut into the heroin may become toxic substances upon sublimation, as the disorder is not seen with injected heroin. Currently, therapy is supportive with no effective cures available. The natural history of the disorder is variable, with an approximately 25% mortality rate. The popularity of smoking heroin is growing in the United States, and it is particularly seen with increasing frequency in new heroin users. Thus, this is an important, and likely increasingly common, effect of illicit drug use that should be recognized by forensic pathologists.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2012.009
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
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  • 9
    Online Resource
    Online Resource
    Myoglobinuria in Autopsy Pathology: Relevant and Potentially Unrecognized
    SAGE Publications ; 2014
    In:  Academic Forensic Pathology Vol. 4, No. 2 ( 2014-06), p. 226-234
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 4, No. 2 ( 2014-06), p. 226-234
    Abstract: Myoglobin-related renal injury (MRRI) is a significant cause of acute renal injury and may result in death. Common etiologies in forensic pathology include trauma and drug abuse. This study sought to determine the prevalence and causes of MRRI at autopsy and discuss diagnostic challenges. Methods The institutional autopsy archives were queried for cases in which a myoglobin (MG) immunohistochemical stain was performed or MRRI was diagnosed or considered. The clinicopathological characteristics of this population were described. Results Of 9996 cases over a period of 19.5 years, 17 cases (0.2%) fulfilled the criteria. Patient age ranged from 15 to 74 years; 11 were men. The MG stain was performed in 13 cases. In 11 (65%) cases, MRRI was diagnosed with or without immunohistochemistry. The clinical backgrounds were varied; sepsis and liver injury predominated. Time between original insult and death ranged from seven hours to four months. Patterns of MRRI included cast formation or fine brush border staining in the proximal tubules. Discussion MRRI is infrequently considered in the autopsy setting. Many causes of MRRI identified in this series involved circumstances placing the death into medical examiner jurisdiction; the MG stain contributed to understanding the mechanism of death. Acute tubular injury with cast formation was observed in the majority of cases. Conclusion MRRI is common in a select group of autopsies but may be underappreciated. The MG stain is a useful and inexpensive tool to aid in the diagnosis of MRRI in autopsy pathology.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2014.035
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 10
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    Online Resource
    The Utility of Routine Brain Histology in Forensic Cases
    SAGE Publications ; 2012
    In:  Academic Forensic Pathology Vol. 2, No. 1 ( 2012-03), p. 42-45
    Details
    In: Academic Forensic Pathology, SAGE Publications, Vol. 2, No. 1 ( 2012-03), p. 42-45
    Abstract: The medicolegal autopsy is part of a death investigation that determines the cause and manner of death and the extent of the testing performed is variable and is directed by the specifics of a particular case. Published studies disagree on the value of routine examination of microscopic sections of internal organs in forensic cases and no studies have specifically reviewed the utility of routine neuropathology microscopic sections. We reviewed the Miami-Dade County Medical Examiner Department and Mayo Clinic computer databases to determine whether routine brain histology is of value in medicolegal autopsies and the impact on the cause and manner of death. Consecutive cases from each institution were analyzed to determine whether the microscopic neuropathological findings revealed a previously unrecognized disease, changed the cause or manner of death, or significantly impacted the death investigation. In the cases in which the immediate cause of death was attributable to central nervous system (CNS) pathology, the cause of death was readily apparent from the gross brain examination. If CNS pathology was the proximate cause of death, contributed significantly to the death, or was a significant part of the death investigation, full appreciation of the neuropathology required microscopic examination and often additional special/immunostains. We conclude that microscopic brain examination is needed in selected medicolegal autopsies to exclude and/or diagnose underlying disease processes, particularly if the gross examination doesn't reveal an obvious explanation of the CNS pathology or the clinical history suggests underlying neuropathology.
    Type of Medium: Online Resource
    ISSN: 1925-3621 , 1925-3621
    URL: Article
    DOI: 10.23907/2012.006
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
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