Model organ description protocols for completion by transplant surgeons using organs procured from medical examiner cases.

A significant number of donor organs emanate from the medical examiner's or coroner's offices, because victims of head injuries from vehicular accidents, falls, assaults, gunshot injuries, and unattended cerebrovascular accidents fall under the jurisdiction of the medical examiner or coroner. Unfortunately, many organ procurement organizations may not fully understand the legal responsibilities of the medical examiner. Most of the medical examiner or coroner cases could be used without compromising the medical-legal responsibilities of the medical examiner or coroner if a reliable description of the respective organ could be made after surgical removal by either having a pathologist present or by having the surgeon prepare a description of the respective organ. The objective of this paper is to present a series of protocols that have been designed to describe the heart, lungs, liver, kidney, and spleen for use by organ transplant surgeons. These protocols have proven to be highly successful in making more organs available for transplantation.

Cardiotoxic mechanisms and interrelationships of cocaine: including a single case depicting several of these mechanisms.

The underlying mechanisms of myocardial infarction as a result of cocaine abuse appear to be multifactorial. The various cardiotoxic mechanisms and interrelationships of cocaine are fully reviewed, and a chart has been reconstructed to give the reader a clearer understanding of them. Moreover, an unusual case of a 29-year-old male cocaine abuser is presented because it illustrates many of the reported cardiotoxic effects, all of which are present in the same individual.

Identification of a killer by a definitive sneaker pattern and his beating instruments by their distinctive patterns.

A 39-year-old male service station attendant was found murdered on the floor of a gasoline service area by a passing motorist who had stopped for gas. The victim had been brutally beaten all over his entire body. After carefully examining the body and scene and taking selective photographs, special procedures were implemented in an attempt to preserve and transport the body without disturbing any items of evidence. In addition, specific evidentiary items were noted and collected for processing. The victim was meticulously examined externally at autopsy using a special protocol to locate clues that might assist in identifying a suspect or instrument of injury or death. Patterned impressions and subsequent DNA analysis proved successful in identifying the perpetrator of the crime and the instruments used in inflicting the beating. It is the purpose of this paper to show how a meticulous examination of the body for the presence of patterned injuries and critical studies of these patterns and impressions led to the identification of a killer and the instruments he used in a brutal beating.

Disseminated cryptococcosis and sudden death. Report of an autopsy case.

We report a case of sudden death due to terminal cryptococcal pneumonia in a patient not suspected to have AIDS. The correct diagnosis was found only by microscopic examination and serologic workup, illustrating the hazards faced by forensic pathologists and their assistants working without adequate information about the bodies under study. This case illustrates the need for the highest levels of caution and compliance with universal precautionary measures during autopsy procedures in the present days of the AIDS epidemic.

Identification of a homicide victim by a Casio data bank watch.

A positive identification of a homicide victim was made possible by observing an inconspicuous Casio watch worn by the deceased. Identification of deceased individuals are usually made by fingerprints or dental matching, visual means, DNA studies, X-rays of other bodily structures, tattoos, etc. When all of these methods fail and no suspects are known, medical examiners are caught between Charybdis and Scilla. This assumes greater importance in cases of homicides. It is the purpose of this paper to present a homicide case in which an identification was made by observing an inconspicuous object, a small Casio watch worn by the deceased.

Calcium channel antagonists. What do the second-generation agents have to offer?

Calcium channel antagonists have gained widespread acceptance for treatment of a variety of cardiovascular disorders. Newer drugs of the dihydropyridine class are especially attractive for treating hypertension and angina because of their increased vascular selectivity, favorable side-effect profile, and pharmacokinetics that allow once-daily dosing. In the future, calcium channel antagonists may also play a role in antiatherogenic therapy and in treatment of congestive heart failure and cerebrovascular disease as results of prospective studies become available and new agents are developed.

Hypoplastic coronary artery disease within the spectrum of sudden unexpected death in young and middle age adults.

The etiology of sudden unexpected death in young and middle age adults is frequently listed as undetermined, thereby causing much grief and fear among family members. When careful, methodical autopsies were performed, a significant number of cases of hypoplastic coronary artery disease (HCAD) were found where no other etiological factor could account for the deaths or where there was a solo coronary occlusion proximal to the hypoplastic coronary artery. This is in marked contrast to the small number of cases that have been reported, indicating that HCAD is more common than is generally realized. A representative series of seven cases of sudden death due to HCAD is presented, possible mechanisms of death in HCAD are fully discussed, and recommendations for an autopsy checklist for investigating sudden cardiac death at autopsy are presented.

The Iceman murder: one of a series of contract murders.

A body with a gunshot wound to the head was discovered in a wooded area in mid September 1983 wrapped with about 20 consecutive layers of plastic garbage bags and rope. Examination of the body revealed a bullet hole in the occipital-parietal region and a peculiar decomposition of the body. Following a forensic reconstruction of our autopsy findings, microscopic studies and other ancillary factors, we concluded that the body had been frozen for about 2 and one-quarter years prior to its being dumped along a mountain road here in Rockland County. The means by which we concluded that the victim had been frozen for about 2 and one-quarter years and other important aspects of this case are fully discussed.

Cerebral intraventricular lipoma and sudden death.

A lipoma in the left lateral cerebral ventricle of a 73-year-old male is reported. This rather infrequently occurring lesion was an incidental finding in the patient's postmortem examination and probably accounted for the acute hydrocephalus that lead to his sudden death.

Gunshot wound to the back of the head--self defence vs homicide.

A police officer attended the scene of a burglary in progress and, following a pursuit through the house with his gun in hand, short the burglar in the back of the head. the officer pleased self-defense alleging that the burglar had whirled around holding what was perceived as a gun in this left hand and that he had reflexively pulled the trigger of his own gun. When he examined the body, a black yarmulke was present near the outstretched hand of the burglar. The results of a reconstruction were consistent with the details of the police officer's deposition.

The man in the mask.

A skeletonized body, wearing a black leather bondage mask, was found in a Revolutionary War smokehouse cave with two bullet holes in the back of the head. The body was skeletonized up to the maxillary area but the head region under the mask was well preserved and permitted a positive visual identification. There was evidence that the body had been eaten by small animals and subsequently burned. Investigations into this brutal murder revealed a tale of a bizarre sadomasochistic ritual that attained national prominence.

The confined space-hypoxia syndrome.

Two meter readers of a local water company were found dead in an underground water meter pit. Studies revealed a decrease in oxygen and an increase in carbon dioxide in the pit as a result of aerobic microorganisms present in the pit. Such an atmosphere may be rapidly fatal to the unwary worker who frequents such an environment. It is of paramount importance that this occupational hazard be recognized so that preventative measures may be established. We propose that the term "Confined Space-Hypoxia Syndrome" be adopted to all such confined space accidents occurring in water meter pits, tanks, holds of ships, mines, underground storage bins, and so forth, resulting from oxygen-deficient atmospheres. A series of recommended preventative procedures is included.

Histochemistry of lipid storage diseases.

Diagnosis of lipid storage disturbances by routine histopathological means is fraught with difficulty. This problem was obviated by use of a simplified histochemical protocol, that is herein presented, to differentiate the more common lipidoses, as well as other clinical entities that are frequently confused with some of the lipidoses.

A new method for softening mummified fingers.

Proposed methods for softening mummified fingers have been either unsuccessful in adequately softening the fingers or have been highly destructive. A simple technique based on an entirely new concept utilizing disodium ethylenediamine tetraacetic acid in a detergent solution adjusted to a pH of 7.5 has been successfully used to obtain satisfactory to good fingerprints over the past ten years in every case attempted.

Identification of the murder weapon by intricate patterned injury measurements.

Critical studies of an intricate blunt force injury pattern in a brutal homicide led to the identification of the murder weapon. A 50-year-old male was bludgeoned to death in his apartment during a robbery allegedly engineered by his daughter. Careful measurements and overlay construction of the wounds relative to the magazine catch, lanyard ring, magazine chamber, and butt of a 32-caliber Eistegui Hermanos fibar (España) automatic pistol led to the conclusion that either the alleged weapon or one identical to it caused the fatal injuries.

The jigsaw puzzle identification of a hit-and-run automobile.

A suspected automobile was identified in a hit-and-run death of a 40-year-old male by matching a tiny nonspecific fragment of tissue attached to the gasoline line clip of the undercarriage with an avulsed area on the hypothenar area of the palm of the hand. There was no ostensible damage to the auto and there was an absence of clothing remnants, blood, and other tissues and an absence of paint pigments on the victim or victim's clothing.

Amiodarone pulmonary toxicity. Chest radiography and CT in asymptomatic patients.

Two asymptomatic patients from a group of 30 being treated with the antiarrhythmic drug amiodarone developed roentgenographic pulmonary and pleural reactions. Computed tomography in one patient with an uncommon radiographic pattern of fuzzy nodules showed the spatial distribution of the parenchymal changes, as well as unrecognized pleural thickening. The disease in these asymptomatic patients was presumably detected on the periodic chest roentgenogram at an early stage because the changes disappeared after withdrawal of the drug. Periodic chest radiographs are recommended during amiodarone therapy and CT may be useful in evaluation of patients with unusual chest radiographic findings.

Metropolitan forensic anthropology team (MFAT) case studies in identification: 3. Identification of John J. Sullivan, the missing journalist.

Skeletal remains removed from an unmarked grave in El Salvador were intensively studied by a team of forensic science experts. Even though the skull, teeth, and several major bones were missing, a positive identification was made of the missing journalist. This was contrary to reports submitted to the State Department by Salvadorian officials. All of the methods used in this investigation, which includes a new method for simultaneously assessing sex and race by discriminant function analysis that was tested by application, are fully described. The international background of this case and information regarding the cause of death is discussed.