Journal of forensic sciences
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Review Case Reports
Pregnancy, cesarean, and pheochromocytoma: a case report and literature review.
A 43-year-old full-term pregnant woman (gravida 2, para 1, medical history of gestational diabetes mellitus) developed a sudden and malignant hypertension with hemoptysis, sweat, and tachycardia during a scheduled C-section. A dead newborn was delivered and was successfully resuscitated. The mother died after resistant cardiac arrest. ⋯ In pregnant women, its symptoms can mimic gestational hypertension, preeclampsia or eclampsia, and gestational diabetes mellitus. The gestational diabetes mellitus was presumed to be a symptom of the pheochromocytoma, and cardiopulmonary failure the result from the necrosis of the tumor provoked by gravid uterus compression. From a medico-legal point of view, the tumor could not have been suspected during the pregnancy.
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Comparative Study
Manual and automated cardiopulmonary resuscitation (CPR): a comparison of associated injury patterns.
The purpose of this study was to identify and compare patterns of trauma associated with AutoPulse(®) CPR and manual CPR. Finalized autopsy records from 175 decedents brought to the Harris County Institute of Forensic Sciences were reviewed, 87 received manual-only CPR, and 88 received AutoPulse(®) CPR (in combination with manual CPR as per standard protocol). ⋯ The characteristic pattern observed in AutoPulse(®) CPR use included a high frequency of posterior rib fractures, skin abrasions located along the anterolateral chest and shoulder, vertebral fractures, and a few cases of visceral injuries including liver lacerations, splenic lacerations, and hemoperitoneum. Knowledge of the AutoPulse(®) CPR injury pattern can help forensic pathologists differentiate therapeutic from inflicted injuries and therefore avoid an erroneous assessment of cause and manner of death.
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Case Reports
Acute psychosis induced by bath salts: a case report with clinical and forensic implications.
Bath salts are new designer drugs with stimulant effects on the central nervous system. White or brown powder sold online and in mini-marts under different brand names, bath salts can be used by injecting, snorting, smoking, or ingesting with food or drink. The case of a 30-year-old Caucasian male who developed acute psychosis within a few hours of injecting himself with bath salts is described. ⋯ The psychological effects of the bath salts subsided within a few hours of injection and his reality testing remained consistently intact over the next 3 days of hospitalization. This case brings to attention the fact that bath salts were legal throughout the United States until recently and is still not completely controlled. This report informs clinicians of harmful effects of bath salts, including severe agitation with possible rhabdomyolysis, psychosis, suicidal ideation, hypertension, tachycardia, and death.
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Commotio cordis is a rare and fatal mechano-electric arrhythmogenic syndrome, occurring mainly during sports activities. The present study describes two similar cases of sudden death caused by commotio cordis associated with homicide. The two decedents were both 15-year-old male teenagers. ⋯ Autopsy and forensic morphology both revealed no cardiac or pericardiac structural damage, evident lesions of other internal organs, or underlying diseases, along with negative toxicological analysis, conforming to criteria for diagnosis of commotio cordis. The diagnosis of commotio cordis by forensic pathologists is important in deliberating a verdict of homicide, especially involuntary homicide. In rare instances, a death caused by commotio cordis may have a homicide manner of death.
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Review Case Reports
Forensic epidemiologic and biomechanical analysis of a pelvic cavity blowout injury associated with ejection from a personal watercraft (jet-ski).
Jet-propelled personal watercraft (PWC) or jet-skis have become increasingly popular. The means of propulsion of PWC, which is a jet of water forced out of small nozzle at the rear of the craft, combined with a high risk of falling off of the seat and into close proximity with the water jet stream, raise the potential for a unique type of injury mechanism. The most serious injuries associated with PWC falls are those that occur when the perineum passes in close proximity to the jet nozzle and the high-pressure water stream enters the vaginal or rectal orifice. ⋯ The mean (± standard deviation [SD]) NISS values for reported PWC injuries [not including the NISS of 38 in this case study] were 11.2 (± 9.5), while the mean value for reported water-skiing falls was half that of the PWC group at 5.6 (± 5.2). It was concluded that the analyzed injuries were unique to a PWC ejection versus other previously described non-PWC-associated water sport injuries. It is recommended that PWC manufacturers help consumers understand the potential risks to passengers with highly visible warnings and reduce injury risk with revised seat design, and/or passenger seat "deadman" switches.