The Impact of Donor Preparation for Tissue Procurement on Postmortem Vitreous Isopropanol Concentration.

ABSTRACT: Volatile chemicals can be relevant in the determination of the cause and manner of death by forensic pathologists. Isopropanol is a secondary alcohol that is occasionally seen on postmortem toxicology testing. A series of 11 forensic autopsy cases was previously reported in which the presence of isopropanol in the vitreous humor was suspected to be due to postmortem contamination from the body preparation process for tissue procurement.In collaboration with a tissue procurement agency, donor vitreous humor was collected from one eye before body preparation for procurement and from the other eye postpreparation. The specimens underwent testing for volatile substances by headspace gas chromatography.Of the 50 cases, 8 (16%) showed statistically significant changes in the prepreparation and postpreparation isopropanol concentrations. Postpreparation isopropanol concentrations ranged from 5 to 104 mg/dL (median, 18 mg/dL). Seven of the 8 cases had undetectable prepreparation isopropanol, whereas the remaining case had a detectable prepreparation isopropanol.In conclusion, surface contamination of the decedent's body with chemicals used in body preparation can lead to the passive absorption into the body, resulting in the presence of isopropanol in postmortem toxicology samples. Forensic pathologists need to be aware of this when interpreting postmortem samples after tissue procurement.

The Difficulties in Assessing Wounds Created by .410 Bore Ammunition and Weapons.

When interpreting firearm injuries, the distinction between gunshot wounds and shotgun wounds is important, and separation of these categories is typically straightforward. However, .410 bore firearms can make the classification difficult. Shotguns and revolvers that can fire the same .410 bore ammunition are readily available. This study investigates the soot and gunpowder deposits and pellet patterning of these two types of weapons using cartridges specially designed for .410 bore revolvers and standard birdshot pellet ammunition. For both ammunition types, the revolver had more prompt pellet dispersion and positive detection of gunpowder at greater distances compared to the shotgun. Additionally, .410 bore slugs are of similar caliber to many common bullets. In comparing the .410 bore slugs to equivalent bullets, some morphologic differences may be imparted on the skin by the slugs, but the greatest insight into the weapon remained with the retained projectiles.

Acetyl Fentanyl: Trends and Concentrations in Metro Detroit.

Acetyl fentanyl (N-[1-phenethylpiperidin-4-yl]-N-phenylacetamide) is a potent opioid analgesic with no medicinal uses. We report deaths between 2016 and 2017 at the Medical Examiner's Office in Detroit, MI where acetyl fentanyl was found in the decedent's blood and compare them to previously published deaths between 2015 and 2016. The recent cases (cohort B) had a mean acetyl fentanyl concentration of 0.9 ng/mL (range: 0.1-5.3 ng/mL) and an associated higher concentration of fentanyl along with multiple other drugs present. The older cases (cohort A) had higher concentrations of acetyl fentanyl (mean: 8.9 ng/mL; range: 0.28-37 ng/mL) with lower, yet still toxic, concentrations of fentanyl. We conclude that the cause of death in these recent cases was likely multiple drug toxicity with fentanyl and that the consistently observed lower peripheral blood concentrations of acetyl fentanyl are most likely an artifact in the manufacture of the consumed illicit fentanyl.

The Modern Compound Bow.

Bows and arrows are ancient weapons that have risen and fallen as the preeminent armaments used by man. Because of the ubiquity of firearms, fatalities from archery injuries in the United States have radically declined. However, when deaths involving this weapon do present themselves, the paucity of reference materials can be a hurdle for forensic pathologists and other forensic scientists. This article will provide a brief history of the origins of the bow and the inception of the compound bow. Comparing and contrasting the structures comprising a traditional bow to those of the modern compound bow will provide insight into how these components function in unison to propel arrows.

The Targetable Epigenetic Tumor Protein EZH2 is Enriched in Intraocular Medulloepithelioma.

Purpose: Intraocular medulloepithelioma (IM), the second most common primary neuroepithelial tumor of the eye, can lead to blindness in the affected eye and in rare cases, is deadly. Intraocular medulloepithelioma lacks targetable biomarkers for potential pharmacologic therapy. The purpose of this study was to identify actionable, tumor-specific proteins for potential diagnostic or therapeutic strategies. We hypothesize that the tumor-specific epigenetic enzyme EZH2 is selectively expressed in IM. Methods: We conducted a retrospective case series study of five IM from five eyes of four children and one adult. Hematoxylin and eosin (H&E) stains of sections from formalin-fixed, paraffin-embedded blocks of IM tumors were used to localize IM tumor cells in each case. Using an EZH2-specific antibody for immunohistochemistry, we semiquantitatively calculated the proportion of IM tumor cells positive for EZH2, and also assayed for EZH2 staining intensity. Results: We found that EZH2 was expressed in all IM cases but this protein was absent in nontumor ciliary body or retinal tissues. However, not all IM tumor cells expressed EZH2. Similar to retinoblastoma, moderately to poorly differentiated (primitive appearing) IM tumor cells strongly expressed EZH2; expression was weaker or absent in areas of well-formed neuroepithelial units. Conclusions: To our knowledge, this is the first study to identify an actionable tumor-specific maker, EZH2, in IM. Our findings point to the possibility of exploring the potential of EZH2 inhibitors, already in clinical trials for other cancers, for IM.

Examination of Ricochet Gunshot Wounds From Commonly Encountered Surfaces.

Proper interpretation of gunshot wounds is vital for the forensic pathologist and requires experience and expertise, as well as consultation with a firearms and ballistics expert and careful scene investigation in cases of atypical gunshot wounds. This study is the first large-series examining ricochet gunshot wounds involving different firearm calibers. Typical gunshot wounds created from 4 handgun calibers (22 Long Rifle, 9 × 19 mm Parabellum, .40 Smith &Wesson, and .45 Automatic Colt Pistol) and 2 rifle calibers (5.56 and 7.62 mm) were compared with wounds caused by bullets of those same calibers ricocheting off commonly encountered surfaces (concrete, asphalt, aluminum traffic signs, clay brick, and dry wall). Porcine skin, a human skin analog, attached to sheets of cardboard serviced as witness panels for capturing the entrance wounds. Examination of over 150 handgun and rifle entrance wounds established that every caliber and every ricochet surface resulted in atypical features, including irregularity in size or shape, lack of marginal abrasion, or other injuries on the surrounding skin. The most significant factor influencing the variability of the ricochet wounds was the surface the bullet deflected off before striking the body.

Fatal Cryocrystalglobulinemia With Intravascular and Renal Tubular Crystalline Deposits.

Cryocrystalglobulinemia is a rare variant of cryoglobulinemia in which monoclonal immunoglobulins self-assemble into crystalline arrays. We report a case of a 53-year-old man who presented with systemic thrombotic microangiopathy causing multiorgan failure, including decreased kidney, lung, and gastrointestinal function; skin necrosis; and mental status changes. Skin and kidney biopsy specimens showed intravascular thrombi, along with intravascular, intratubular, and periglomerular crystalline deposits. Typical morphologic features of cryoglobulinemia, such as a leukocytoclastic vasculitis and pseudothrombi, were absent. Spindled crystals precipitated in the cryoglobulin assay, and immunofixation showed them to be composed of monoclonal immunoglobulin G κ light chains. Ultrastructural analysis demonstrated deposits to have an array-like substructure. The patient was successfully treated with a combination of plasmapheresis, steroids, and bortezomib, but experienced a relapse and died 12 months after his initial diagnosis. Cryocrystalglobulinemia causes significant morbidity and mortality and should be classified as a monoclonal gammopathy of renal significance when it occurs in patients not meeting diagnostic criteria for multiple myeloma.