Hypothermia and hyperthermia medicolegal investigation of morbidity and mortality from exposure to environmental temperature extremes.

Context: The determination of the cause of death from exposure to extreme temperatures is a diagnosis of exclusion. Because both clinical and autopsy findings are nonspecific, a thorough investigation of the background and scene, evaluation of temporally relevant environmental conditions, and assessment of the victim's underlying state of health with appropriate laboratory studies, which frequently include autopsy, are essential to establish the cause of injury and/or death with reasonable medical probability. Individuals may encounter environmental extremes in many settings during any season.

Lethal envenomation: medicolegal aspects of snakebites and religious snake handlers in Kentucky: a report of three cases with comment on medical, legal, and public policy ramifications.

Ritualistic serpent qua snake handling, which rests upon inveterate religious conviction arising out of literal interpretation of selected passages of the New Testament, is a rare ceremony practiced by a distinct minority of Christians predominantly in rural Appalachian regions of the United States commonly referred to as the Bible belt. The fervent, frenzied pursuit by anointed "sign-followers" of intimate contact with a variety of poisonous snakes, however, puts the handler together with sect members or bystanders at risk for lethal envenomation, particularly when prompt medical attention is held by the congregation of faith to contravene God's will. The authors report three separate cases of death due to envenomation by snakebite during a church service and the handler's faith-based refusal to seek treatment.

Forensic evaluation of the elderly.

As the "Baby Boomer Generation" matures, it is pre dicted that greater than 70 million Americans >65 years of age will retire over the next decade. The U.S.

Forensic examination of pediatric patients.

In cases of suspected child abuse, a thorough history and physical exam utilizing clinical forensic principles are essential in distinguishing accidental from inflicted trauma. The Division of Clinical Forensic Medicine (CFM) incorporates a multidisciplinary team approach to the investigation of child abuse. Inclued are members of Child Protecton Services (CPS), law enforcement, and healthcare services who aid in the evaluation of child victims of abuse.

Clinical forensic medicine introduction for healthcare providers.

Clinical forensic medicine (CFM) is "the application of appropriate forensic practices and principles, heretofore reserved for use by the pathologist at autopsy, to living patients in a clinical setting." "Living forensic" patients include survivors of trauma and potentially catastrophic experiences resulting in injury. CFM arose from "clinically" affirming that not all abuse or assault victims sustain fatal injuries.

Risk factors associated with sudden unexplained infant death: a prospective study of infant care practices in Kentucky.

Objective: To ascertain the prevalence of infant care practices in a metropolitan community in the United States with attention to feeding routines and modifiable risk factors associated with sudden unexplained infant death (specifically, prone sleeping position, bed sharing, and maternal smoking).

Methods: We conducted an initial face-to-face meeting followed by a telephone survey of 189 women who gave birth at a level I hospital in Kentucky between October 14 and November 10, 2002, and whose infants were placed in the well-infant nursery. The survey, composed of questions pertaining to infant care practices, was addressed to the women at 1 and 6 months postpartum.

The relationship between elevated body mass index and lethal ischemic heart disease: an eleven-year retrospective review of medical examiners' adult autopsies in Kentucky.

Both childhood and adult overweight (OW) and obesity (OB) currently loom unabated at epidemic proportions in the United States (US), to which Kentucky (KY) is a leading contributor. These conditions are significant risk factors for development of ischemic heart disease (IHD), the primary cause of natural death in the US. These mortality statistics (see below), combined with Kentucky's significantly prevalent OW/OB population, prompted this investigation of the presumptive correlation between body mass index (BMI) and IHD in the medical examiners' office (MEO) autopsy cohort.

Atypical autoerotic death: part II.

Autoerotic fatalities encompass a wide array of means and mechanisms used to attain sexual gratification. The most commonly encountered autoerotic practice, specifically, autoerotic asphyxia, denotes death resulting from failure of a release mechanism of the apparatus designed to attain cerebral hypoxia for heightened arousal. Historically, the majority of victims of autoerotic death are Caucasian males under the age of 30.

Autoerotic asphyxia: part I.

Fatal autoerotic asphyxia refers to death during solitary sexual activity with self-induced asphyxiation meant to be brief and reversible. However, an unexpected fatality results from a failure of a release mechanism apparatus. The large majority of victims of autoerotic death are Caucasian males between the second and fourth decade.

Cosleeping and sudden unexpected infant deaths in Kentucky: a 10-year retrospective case review.

This retrospective case review investigates modifiable risk factors in sudden unexpected infant deaths, including those attributed to sudden infant death syndrome, and examines the impact of cosleeping with adults or siblings. The study examines sudden unexpected infant deaths from 1991 to 2000 in the state of Kentucky, excluding homicides and deaths from identifiable natural causes. Meta-analysis provides a cosleeping prevalence control in normal infants.

Abuse and neglect: a ten-year review of mortality and morbidity in our elders in a large metropolitan area.

Elder abuse and neglect refers to an act or omission resulting in harm, including death, or threatened harm to the health or welfare of an elderly person. Between one and two million elderly Americans experience some form of mistreatment annually. A ten-year (1992-2001) retrospective case review of morbidity and mortality among elders (age > 60 years) was conducted at a State Medical Examiner's Office serving a major metropolitan region in Kentucky and Indiana.

Fatal Kawasaki disease due to coronary aneurysm rupture with massive cardiac tamponade.

Kawasaki disease (KD), an acute febrile childhood vasculitis of unknown etiology, preferentially involves the coronary arteries. Diagnosis typically rests on strict clinical criteria. If untreated, KD may be complicated by coronary arteritis and progress to aneurysm formation, thereby predisposing the child to a small but significant risk of death.

Iatrogenic catheter-related cardiac tamponade: a case report of fatal hydropericardium following subcutaneous implantation of a chemotherapeutic injection port.

The need to obtain dependable access to the vascular system constitutes a significant component in the treatment and management of critically ill patients. Intravenous chemotherapy administered to cancer patients over an extended period of time often results in loss of peripheral vascular access due to vein sclerosis, "exhaustion" or tissue necrosis. Medical investigators have designed and steadily upgraded a variety of devices constructed to improve venous access for long-term utilization.

A comprehensive analysis of forensic science training in forensic pathology fellowship programs.

The purpose of this study is to assess the current nature and extent of forensic science training in the nation's 43 Accreditation Council for Graduate Medical Education (ACGME)-accredited forensic pathology fellowship programs. This manuscript describes the results of a survey of training program directors performed as a project for the College of American Pathologists (CAP) Forensic Identity Committee. The results show a considerable diversity in the forensic sciences training in forensic pathology programs, ranging from one to ten weeks, with an average of 4.

Sudden and unexpected death resulting from splenic artery aneurysm rupture: two case reports of pregnancy-related fatal rupture of splenic artery aneurysm.

Rupture of a splenic artery aneurysm is a rare and usually catastrophic event, most commonly associated with pregnancy. In spite of increasingly common reliance on abdominal angiography, magnetic resonance imaging, and computerized tomography during the past quarter century, clinicians uncommonly recognize any of the various splanchnic arterial aneurysms absent premonitory signs or symptoms. Accordingly, rupture of a visceral aneurysm, including splenic artery aneurysm, typically presents as sudden, unexpected obtundation or death.