The American journal of forensic medicine and pathology
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Am J Forensic Med Pathol · Jun 2010
ReviewExcited delirium, restraints, and unexpected death: a review of pathogenesis.
Unexpected deaths periodically occur in individuals held in police custody. These decedents usually have had significant physical exertion associated with violent and/or bizarre behavior, have been restrained by the police, and often have drug intoxication. Autopsy material from these cases may not provide a satisfactory explanation for the cause of death, and these deaths are then attributed to the excited delirium syndrome. ⋯ People who die under unusual circumstances associated with high catecholamine levels have contraction bands in their myocardium. Consequently, the pathogenesis of the excited delirium syndrome could be evaluated by using echocardiograms in patients brought to the emergency centers, and by more careful assessment of the myocardium and coronary vessels at autopsy. Treatment should focus on prevention through the reduction of stress.
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Occasionally, individuals accused of inflicting fatal injuries on infants and young children will claim some variant of the "CPR defense," that is, they attribute the cause of injuries found at autopsy to their "untrained" resuscitative efforts. A 10-year (1994-2003) historical fixed cohort study of all pediatric forensic autopsies at the Miami-Dade County Medical Examiner Department was undertaken. To be eligible for inclusion in the study, children had to have died of atraumatic causes, with or without resuscitative efforts (N(atraumatic) = 546). ⋯ This study indicates that in the pediatric population, injuries secondary to resuscitative efforts are infrequent or rare, pathophysiologically inconsequential, and predominantly orofacial in location. In our population, CPR did not result in any rib fractures or significant visceral injuries. Participation of nonmedical or untrained individuals in resuscitation did not increase the likelihood of injury.
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Am J Forensic Med Pathol · Jun 2010
Chronic traumatic encephalopathy, suicides and parasuicides in professional American athletes: the role of the forensic pathologist.
We present 5 cases of professional American contact sport athletes who committed parasuicides and suicides aged 50, 45, 44, 36, and 40 years old. Full forensic autopsies and immunohistochemical analyses of the brains revealed chronic traumatic encephalopathy (CTE). The brains appeared grossly normal at autopsy without gross evidence of remote traumatic injuries or neurodegenerative disease. ⋯ CTE can only be definitively diagnosed by direct tissue examination. Without full autopsies and immunohistochemical brain analyses these cases would never have been identified. Forensic pathologists will play a vital and central role in the emerging disease surveillance of CTE in professional American athletes, in the identification of CTE cases, and in the establishment of the epidemiology of CTE, with the goal of eventually developing preventive and interventional therapeutic protocols for CTE outcomes.
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Farm tractors are the major cause of occupational fatalities in agricultural regions. Fatalities typically result from being run over or crushed by the tractor, becoming entangled in the moving parts of the tractor, accidents on roadways, and tractor rollovers, which involve the tractor tipping sideways or backwards and crushing the operator. In this study, tractor-related fatalities in the Konya province of Turkey are retrospectively evaluated. ⋯ In 32 (37.2%) of the cases, the deaths due to tractor accidents occurred when the tractor overturned. In 37 (43.0%) of the cases, the tractor-related fatalities involved the passengers and the drivers were involved in 34 (39.5%) of the cases. In conclusion, tractor accidents are preventable and deaths from tractor accidents can be significantly reduced if drivers are required to wear safety belts and helmets and frequent checks are implemented to enforce the ban on carrying passengers.
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Rigor mortis is conventionally a postmortem change. Its occurrence suggests that death has occurred at least a few hours ago. The authors report a case of "Rigor Mortis" in a live patient after cardiac surgery. ⋯ Such an event may be of importance while determining the time of death in individuals such as described in the report. It may also suggest requirement of careful examination of patients with muscle stiffening prior to declaration of death. This report is being published to point out the likely controversies that might arise out of muscle stiffening, which should not always be termed rigor mortis and/ or postmortem.