Fatal heat stroke in children found in parked cars: autopsy findings.

UNLABELLED: A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The aim of this study was to analyze the pathological consequences of such grave events. Autopsy reports of all children that were brought to a national forensic medicine center after being found dead in closed vehicles over a 21-year period (1995-2015) were reviewed. Data extracted were the circumstances of the events, child age, sex, height and weight, time, date and duration of entrapment, and environmental temperatures at the time of entrapment and the autopsy findings. Eight deceased children were brought to the forensic medicine center for autopsy, and seven families consented to the procedure. Autopsy findings included diffuse petechiae and hemorrhages of serosal membranes (n = 7/7) and lung congestion (n = 3/7). CONCLUSION: Typical autopsy findings following classical heat stroke in children include diffuse petechiae and hemorrhages and lung involvement. These findings are similar to those reported in adults that had died following exertional heat stroke-a very different mechanism of heat accumulation. Prevention of future events can possibly be obtained by public education on the rapid heating of closed vehicles, the vulnerability of children to heat, and the caregiver role in child entrapment. WHAT IS KNOWN: • A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The pathological consequences of such grave events have not been previously reported. What is New: • This study is the first to describe autopsy findings from children who were found dead in parked cars. • Autopsy findings included diffuse petechiae hemorrhages of serosal membranes and lung congestion. • These findings are identical to those seen in adults following exertional heat stroke.

An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel.

De-identified wound data from 197 homicidal gunshot postmortems were obtained between 2000 and 2008. Forensic ballistics data were only available for cases between 2004 and 2008. Males represent 91% of gunshot victims and were struck in the thorax/abdomen with an average of 2.3 bullets. The type of firearms involved were semi-automatic pistols in the predominant caliber 9-mm Luger and assault rifles in caliber 5.56 × 45 mm and caliber 7.62 × 39 mm Soviet, using full metal jacket bullets. The majority of shootings occurred at ranges of 1 m or greater. The most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back. The most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs were struck by most bullets that entered the thorax.

[Combination of imaging studies and autopsy in death investigations].

The progress in quality and availability of imaging studies has made them an invaluable part of the clinical diagnostic process, so much so that the forensic medical community had to acknowledge their importance and to implement them in death investigations. Since 2011 roughly 200 post-mortem radiographic examinations were conducted, mostly followed by full autopsies. Four of those cases are given as an example of the benefits and limitations of these methods. A review of the literature and our experience so far, show that computed tomography provides better visualization and 3D reconstruction of traumatic bone injuries, as well as good assessment of air in the tissues and vascular system, gunshot wound tracts, and anthropological characteristics for identification. Imaging methods are relatively limited in definite diagnostic findings in cases of sudden death from natural causes, such as pneumonia, pulmonary embolism, acute myocardial infarction or meningitis, problems which can be partially solved with the aid of angiographic studies. These methods also do not allow for sampling of tissues for microscopic examination, nor fluid samples for cultures and toxicology. In the current cultural and social reality in Israel, imaging studies enable minimization of the autopsy and, in certain cases, its relinquishment serves as a compromise between the necessity of death investigation and beliefs in the wholeness of the body. In light of the advantages of imaging, no autopsy of a trauma-related death can be complete without it.

Atlas occipitalization in a supersonic fighter pilot involved in a midair collision: a case report.

We report a case of a midair collision between two F16 fighter aircraft, in which one pilot survived and the other was ejected upon impact and his remains recovered from sea. In autopsy, no patholgy was detected, other than the expected evidence of mechanical trauma. No defects in the aircraft or faults in the parachute or ejection mechanism were found. Reconstruction of the shattered skull base and the cervical vertebrae revealed fusion of the atlanto-occipital joint (occipitalization) and a left paracondylar process. The effective diameter of the spinal canal was decreased by the abnormal articulation. Such malformations can cause a wide range of neurologic deficits. Considering the skill and alertness needed to operate a supersonic fighter aircraft, with the pressure applied by the heavy protective head gear and various G forces endured by the spinal column during flight, we postulate that the collision was related to the pilot's sudden incapacitation.

Sudden cardiac death of a woman during extramarital sex: a case report and review of the literature.

Sudden death of cardiac patients related to sexual activity has been widely reported in the medical and forensic literature, specifically of male partners in heterosexual relationships, usually with extramarital partners. We present a unique case of a 46 year old woman who died during a sexual encounter with her lover. Cause of death was an acute cardiac failure due to hypertensive chronic cardiovascular disease, following sexual activity. The factors which contributed to her death are discussed and reviewed in light of similar reports in men.

["Scared to death"--lethal cardiac arrhythmia caused by emotional stress].

BACKGROUND: The cause of death in cases of sudden and unexpected death is determined by the forensic pathologist based on autopsy findings and toxicological analysis. In cases where no acute pathology or lethal injury are detected, and the circumstances surrounding the death were highly stressful or emotional, it is possible to attribute the inciting event as contributory to the death by causing cardiac dysrhythmia. METHOD: Ten cases of sudden death related to stressful events were examined over a period of 2 years in the National Center of Forensic Pathology, all of which lacked findings of acute disease or serious injury. All suffered from variable degrees of chronic cardiac pathology, which probably contributed to dysrhythmia and death. DISCUSSION: Since the seventies of the previous century, forensic pathologists are entitled to determine mode of death as homicide or manslaughter, due to an acute cardiac event which cannot be diagnosed in an autopsy and which was a direct result of the circumstances prior to death. Later, these conditions were adjusted to include cases where no morphological findings were detected or when death is delayed by medical treatment. The physiological mechanisms responsible include an increase in catecholamine levels, an increase in blood pressure and platelet aggregation and a delay in cardiac and vascular recovery from stress. CONCLUSIONS: Victims of sudden death caused by emotional stress, during a criminal act, usually have a background of chronic cardiac disease and/or are more susceptible physiologically to suffer an amplified reaction to stress. Legally, their deaths are considered as homicide or manslaughter.

[Gunshot wounds to the head--common errors of clinicians in diagnosing direction and range of fire].

BACKGROUND: Evaluating direction and range of fire based on gunshot wound characteristics requires theoretical and/or practical training in terminal ballistics. Clinicians specializing in trauma, surgery and neurosurgery are sometimes called upon to assess direction of fire without prior knowledge or experience in the field. Descriptions of gunshot wounds and determination of bullet direction are documented in medical records. When data from hospital records concerning cases of gunshot wounds to the head were compared with autopsy findings, numerous discrepancies were found with often tragic consequences. OBJECTIVE: To describe possible inconsistencies between evaluations of gunshot wounds by clinicians and autopsy results and interpretation of medical records by forensic pathologists, as well as provide basic tools to facilitate a more accurate description of injuries by physicians. PATIENTS: Three cases of shooting victims treated in medical facilities, two patients underwent autopsy and the third case was re-evaluated by a forensic pathologist based on medical records. CONCLUSIONS: Clinicians often base their diagnosis of direction of fire solely on the size of the head wounds, without taking into consideration additional characteristics, such as the range of fire, powder residue and others. Misdiagnosis of the direction and range of fire has long term psychological and legal consequences. SUMMARY: Clinicians are therefore advised to avoid determining direction and range of fire without prior experience and expertise in the field and, if needed, to consult forensic pathologists proficient in terminal ballistics.

Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature.

Pectus excavatum (PE) is a congenital sternal depression. The two most popular methods of correction are the highly modified Ravitch repair (HMRR) and the Nuss procedure. Presented here is a case of PE surgical correction in a 17.5-year-old male, beginning with the Nuss technique and converting to the HMRR during surgery, due to unsatisfying results. The procedure inadvertently culminated in perforation of the heart and lungs by the inserted pectus bar, with aggravation of the damage by resuscitation efforts. This article analyzes the chain of events leading to the patient's death and reviews the literature on the subject.

Self-inflicted gunshot wound mimicking assault: a rare variant of factitious disorder.

This paper presents the case of 52-year-old man who died in an attempt to prove factitious allegations of persecution. To the best of our knowledge, there are no other reported cases of a self-inflicted, long-distance gunshot injury causing death. We discuss other cases of crime-scene "staging" and review the literature on factitious disorders and malingering in our search for motive, and stress again the importance of crime scene analysis and investigation of circumstances in determining the manner of death.