Journal of forensic sciences
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The recognition and visualization of an arterial gas embolism are difficult. We report a case of sudden death caused by paradoxical air embolism of coronary and cerebral arteries, diagnosed by the pre autopsy computed tomography (CT) scanning. A 54-year-old woman suddenly died after the self-removal of the jugular vein catheter. ⋯ Conventional autopsy revealed a patent foramen ovale of the heart. These results indicated that the patient died of paradoxical air embolization of the coronary and cerebral arteries through a patent foramen ovale because of right-to-left shunting. The use of postmortem imaging as an aid for conventional autopsy has proved to be of advantage in the case of gas embolism.
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This research investigates the frequency of Schmorl's nodes in differing populations, with new data from a skeletal sample from the Central Identification Laboratory (CIL) at the Joint Prisoner of War/Missing in Action Accounting Command, while also reviewing the etiology of Schmorl's node formation. Processes implicated in Schmorl's node formation include trauma, old age, disease, intrinsic abnormalities, and biomechanical factors, and they correlate with Schmorl's node formation to varying degrees. A survey of research from the anthropology and medical literature revealed Schmorl's node population frequencies ranging from 8 to 80%. ⋯ The examined sample yielded a frequency of 73.7%. The disparate frequencies reported are likely due mainly to differences in completeness and observability. It is likely that trauma was a major factor in the formation of Schmorl's nodes in the CIL study.
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The objective of this study was to document patterns of fracture on infant porcine skulls aged 2-28 days (n = 57) because of a single, high energy blunt impact to the parietal bone with rigid (nondeformable) and compliant (deformable) interfaces. Fracture patterns were mapped using Geographic Information System software. ⋯ Several unique characteristics of bone and diastatic fracture were documented as a function of specimen age, impact energy, and interface. These data describe some baseline characteristics of skull fracture using an animal model that may help guide future studies from forensic case files.
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Case Reports
Occlusion of left and right coronary arteries and coronary sinus following blunt chest trauma.
Blunt chest trauma from rapid automobile airbag deployment causing coronary artery occlusion and myocardial infarction is a rare but potentially fatal condition. We present the case of a 37-year-old man who developed extensive anterior and inferior myocardial infarction because of occlusion of both left anterior and right coronary arteries following blunt injury to the chest in a car accident. ⋯ The patient died, and the autopsy revealed external compression by epicardial hematomas involving separately left and right coronary arteries and the coronary sinus without signs of coronary and/or aortic dissection. To our knowledge, this is the first case presenting occlusion of both coronary arteries secondary to blunt chest trauma causing acute myocardial infarction in a young man without signs of prior coronary artery disease.
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Case Reports
Fatality involving complications of bupivacaine toxicity and hypersensitivity reaction.
This case represents unusual findings of elevated bupivacaine and tryptase concentrations following local anesthetic, bupivacaine, administered as a scalene nerve block for elective rotator cuff repair surgery. Following bupivacaine injection, the patient exhibited almost immediate seizure activity, bradycardia, and cardiac arrest. Resuscitative efforts including cardiopulmonary bypass restored a cardiac rhythm. ⋯ Postmortem toxicology results revealed elevated bupivacaine and tryptase concentrations. Elevated postmortem bupivacaine concentrations 7 h following administration and abrupt onset of seizures indicate unintentional intravascular injection instead of nerve and tissue infiltration. An elevated postmortem tryptase concentration points to the possibility of a hypersensitivity reaction to bupivacaine.