Case Series: Hepatic and Splenic Titanium Dioxide Deposition in Association With Intravenous Drug Use.

Titanium dioxide is a versatile compound that is found in a variety of consumer products, medical hardware, and pharmaceuticals. Although oral and topical ingestion of this compound is common, intravenous introduction is much less common. We present three cases where significant titanium dioxide deposits were identified in liver and splenic tissue of three decedents, all of whom died of illicit drug overdose in the same geographic area and had fentanyl and its metabolites in blood on postmortem toxicologic testing.

Ultrasound Elastographic Measurement of Rigor Mortis in an Animal Model: A Feasibility Study for Improved Time-of-Death Estimates in Forensic Investigations.

The purpose of our study was to assess the feasibility of 2D shear wave ultrasound elastography to quantitatively measure changes of rigor mortis. Muscle stiffness of two live pigs and nine sacrificed pigs was measured in kilopascals using ultrasound elastography. The nine sacrificed pigs were divided into three groups of three pigs each and placed in one of three environments at 90°F (32°C), 70°F (21°C), or 34°F (1°C).

Infant Death Following Home Birth: A Case Report of Fatal Neonatal Hypoglycemia.

Infants born to diabetic mothers are at increased risk for symptomatic hypoglycemia and death after birth. A 36-year-old G4P3 mother with a history of gestational diabetes and newly diagnosed type II insulin-dependent diabetes gave birth at home, in the care of a midwife, to a macrosomic infant girl (10 lbs.).

Fatal adrenal crisis due to Addison's disease arising in the context of autoimmune polyglandular syndrome type 1.

The autoimmune polyglandular syndromes (APS) are rare immune-mediated endocrinopathies causing destruction of multiple endocrine and non-endocrine organs. Involvement of adrenal glands associated with any type of APS results in Addison's disease. While patients with Addison's disease often suffer from symptoms of neuroglycopenia, lethal hypotension and hypoglycemia are uncommon.

The Shock of Strep: Rapid Deaths Due to Group a Streptococcus.

, also known as group A beta-hemolytic strep, is a Gram positive coccus responsible for several million infections every year. The types of infections vary widely from pharyngitis to myositis, but all can advance to severe life threatening invasive disease. Of those infected, approximately 1100 to 1600 people die each year due to invasive disease.

Fatal Myocarditis Following Treatment with the PD-1 Inhibitor Nivolumab.

Therapeutic antibodies targeting the programmed cell death protein 1 (PD-1) pathway function as immune checkpoint inhibitors, allowing the immune system to recognize tumors which otherwise escape immune surveillance. However, these agents can also elicit an autoimmune response by inhibiting the ability of non-neoplastic tissues and regulatory cells to suppress the immune system. Here we present a fatal case of active myocarditis in a 55-year-old man with non-small-cell lung cancer which occurred following monotherapy with the PD-1 inhibitor nivolumab (Opdivo).

Death Due to Complications of Bowel Obstruction Following Raw Poppy Seed Ingestion.

Eating poppy seeds can cause a positive urine drug screen, but it is unknown whether ingesting large quantities can result in opiate intoxication or toxicity. A 54-year-old woman with intractable vomiting was found unresponsive at home and later pronounced dead. At autopsy, a cast-like large bowel obstruction composed of poppy seeds was identified.

Does Sudden Unexplained Nocturnal Death Syndrome Remain the Autopsy-Negative Disorder: A Gross, Microscopic, and Molecular Autopsy Investigation in Southern China.

Objective: To look for previously unrecognized cardiac structural abnormalities and address the genetic cause for sudden unexplained nocturnal death syndrome (SUNDS).

Methods: Data for 148 SUNDS victims and 444 controls (matched 1:3 on sex, race, and age of death within 1 year) were collected from Sun Yat-sen University from January 1, 1998, to December 31, 2014, to search morphological changes. An additional 17 patients with Brugada syndrome (BrS) collected from January 1, 2006, to December 31, 2014, served as a comparative disease cohort.

Enhancing preclinical year pathology exposure: the Angevine approach.

Less than 2% of graduating US medical seniors select pathology residencies. One major obstacle to attracting prospective residents is the relative "invisibility" of pathology; medical students lacking positive preclinical exposure to pathology are unlikely to later select pathology clerkships or residencies. The Angevine Fellowship is a 10-week competitive pathology internship medical students may apply for the summer following their first year of preclinical training at our institution.

Eosinophilic Coronary Periarteritis with Arterial Dissection: The Mast Cell Hypothesis.

A subset of coronary arterial dissections is associated with eosinophilic coronary periarteritis (ECPA); however, the pathogenesis of the process remains unclear. Mast cells normally reside in coronary arterial adventitia and are known mediators of eosinophilic inflammatory conditions such as type I hypersensitivity reactions. We report two cases in which coronary arterial dissection with ECPA was detected at autopsy.

Bilateral acute necrosis of the globi pallidi and rhabdomyolysis due to combined methadone and benzodiazepine toxicity.

Methadone continues to be a widely used maintenance therapy for opiate dependence. However, methadone-related deaths have been reported frequently for over 4 decades now. Anoxic brain injury with pulmonary edema secondary to respiratory depression is the recognized mechanism of methadone death, although pathological intracranial findings are rarely described in methadone deaths.

Muscle patterning in mouse and human abdominal wall development and omphalocele specimens of humans.

Human omphalocele is a congenital defect of the abdominal wall in which the secondary abdominal wall structures (muscle and connective tissue) in an area centered around the umbilicus are replaced by a translucent membranous layer of tissue. Histological examination of omphalocele development and moreover the staging of normal human abdominal wall development has never been described. We hypothesized that omphalocele is the result of an arrest in the secondary abdominal wall development and predicted that we would observe delays in myoblast maturation and an arrest in secondary abdominal wall development.

Conditional mutation of fibroblast growth factor receptors 1 and 2 results in an omphalocele in mice associated with disruptions in ventral body wall muscle formation.

Background/purpose: We observed that fibroblast growth factor receptors 1 and 2 (Fgfr1, Fgfr2) are expressed during abdominal wall development in mice and hypothesized that conditional mutation of these genes would result in abdominal wall defects.

Methods: Section in situ hybridizations were performed for Fgfr1 and Fgfr2 on wild-type embryos at embryonic day (E) 11.5 and E13.

Fatal subarachnoid hemorrhage due to ruptured vertebrobasilar aneurysm associated with giant cell arteritis in a child.

A 3 ½-year-old previously healthy female experienced an episode of sudden unresponsiveness witnessed by her mother. Upon arrival to the local hospital, imaging studies of the still unresponsive child revealed severe bilateral "flash" pulmonary edema and diffuse anoxic brain injury. Aggressive resuscitative efforts were unsuccessful, and she was pronounced dead.

Perforation of the appendix from intestinal mucormycosis in a neonate.

A premature neonate had pneumoperitoneum 5 days after discontinuation of extracorporeal membrane oxygenation therapy. A perforated appendix was found at exploratory laparotomy. Pathologic examination of the appendix found mucormycosis.