Immune responses in fatalities involving opioids.

In some cases of fatalities involving opioid use, the concentrations of detected opioids are not in the toxic range. Immune reactions can be triggered by opioid use, suggesting that immune response may be a factor in these cases. Autopsy cases from 2002-2012 were reviewed.

Anatomical changes correlated with chronic pain in forensic medicine.

This study was performed to determine the relationships between chronic pain and anatomic changes that may occur in the body. Autopsies were performed on fatalities that required death investigation in Linn County, IA, or adjacent and nearby areas. Persons with chronic pain were older than the control population at the time of death.

The medium, not the message. How tattoos correlate with early mortality.

Objectives: At autopsy, tattoos are recorded as part of the external examination. An investigation was undertaken to determine whether negative messages that are tattooed on a decedent may indicate a predisposition to certain fatal outcomes.

Methods: Tattooed and nontattooed persons were classified by demography and forensics.

Patterns of ecchymoses caused by manner of death and collateral injuries sustained in bruising incidents: decedent injuries, profiles, comparisons, and clinicopathologic significance.

We investigated how ecchymoses could be used to predict other injuries, or help establish the cause of death. Ecchymoses, fractures, lacerations, abrasions, and other data were recorded. Eleven percent of decedents had ecchymoses.

Optic nerve trauma with unilateral edema as a result of head injury.

We encountered a patient who suffered a head injury that translated to the optic nerves, leading to dramatic unilateral right optic nerve edema. The decedent was a 20-year-old unsecured passenger in a convertible. The car collided with a pickup truck.

A fatality involving an unusual route of fentanyl delivery: Chewing and aspirating the transdermal patch.

We recently encountered a subject who died from an uncommon misuse of a fentanyl transdermal patch, chewing, followed by complications of aspiration of the patch. We report this case to alert medical examiners to the troubling trend of increased fentanyl patch abuse and its expanding range of misuses and associated morbidities. The decedent was a 28-year-old white male with a past medical history of prescription drug abuse who was pronounced dead in the emergency department shortly after arrival.

Unexpected death following single blow to the orbit.

Severe brain injury is rare after assault to the head with a fist. Our patient was a 39-year-old white male who was punched in a parking lot. The subject fell on his right head.

Identification at autopsy of pulverized pills in lungs of a first-time methadone user.

We recently encountered a 25-year-old white man who died of substance abuse including methadone. The route of administration of the drug(s) appears to have been insufflation. He was found dead at home.

Mast cell tryptase in a case of anaphylaxis due to repeat antibiotic exposure.

Mast cell tryptase can be an indicator of type I hypersensitivity reaction and thus may serve as a surrogate marker of anaphylaxis. A 34-year-old white male patient presented with a history of systemic lupus erythematosus. Shortly after administration of cefazolin for dialysis, he developed pruritus and shortness of breath.

Brain trauma in head injuries presenting with and without concurrent skull fractures.

Head injuries and skull fractures may be problematic in cause and manner of death. Over a 10-year period, 54 cases showing head injuries were studied. Of these, 34 had skull fractures and 20 had no skull fractures.

Death from undiagnosed glioblastoma multiforme and toxic self-medication presenting with concurrent dysfunctional behavior.

We encountered a decedent with an unexpected glioblastoma multiforme. A 61-year-old retired African-American woman was found dead in her home, fully clothed in her bathtub, with a pillow under her head. At autopsy, the brain showed a glioblastoma multiforme.

Massive internal injury in the absence of significant external injury after collisions of passenger vehicles with much larger vehicles.

We have encountered cases of motor vehicle collisions in which there was relatively little external trauma, but there were massive internal injuries that were much more extensive than might be expected from the external examination. Two cases were collisions between trains and pickup trucks, the third a collision between a semi trailer and a van. In all three cases, the external examination showed minor abrasions and lacerations.

Immunoperoxidase in the interpretation of discordant histologic and urease findings for Helicobacter pylori.

Azure A and methylene blue ("Diff-Quik," DQ) and tissue urease (U) tests are popular methods to diagnose Helicobacter pylori. These tests usually correlate well but sometimes produce discordant results. This study evaluates the DQ and U tests by comparing them with the immunoperoxidase reference method to resolve discordant results.

Metastasis of colonic adenocarcinoma to the external ear canal: an unusual case with a complex-pattern of disease progression.

We report on a patient who developed far-ranging metastases of adenocarcinoma of the colon that followed a gradual cephalad progression, including the right external ear canal, and led to hearing loss. The patient was a 63-year-old white male with stage III adenocarcinoma of the colon. After 2 years with metastases elsewhere, he developed hearing loss on the right side.

Visceral botryomycosis in a case of Erysipelothrix rhusiopathiae endocarditis.

Botryomycosis is a rare bacterial infection of the skin and, rarely, viscera that is characterized by the formation of characteristic hyaline grains. We encountered a patient with Erysipelothrix rhusiopathiae endocarditis who developed visceral botryomycosis. He was a 54-year-old black man who presented in sepsis with a history of progressive weakness and severe weight loss.