Fat Embolism Fatalities Following Liposuction/Injection in Los Angeles County (2010-2018).

One complication of autologous fat transfer into the buttocks (cosmetic injection of fat into the gluteal region) is inadvertent fat embolization. In 2015, our office published a case of macro fat/adipose tissue embolization following fat transfer surgery. Between 2010 and 2018, we had six additional cases of macro/micro fat embolism that caused death.

National Association of Medical Examiners Position Paper: Recommendations for the Documentation and Certification of Disaster-Related Deaths.

Collecting and reporting accurate disaster mortality data are critical to informing disaster response and recovery efforts. The National Association of Medical Examiners convened an ad hoc committee to provide recommendations for the documentation and certification of disaster-related deaths. This article provides definitions for disasters and direct, indirect, and partially attributable disaster-related deaths; discusses jurisdiction for disaster-related deaths; offers recommendations for medical examiners/coroners (ME/Cs) for indicating the involvement of the disaster on the death certificate; discusses the role of the ME/C and non-ME/C in documenting and certifying disaster-related deaths; identifies existing systems for helping to identify the role of disaster on the death certificate; and describes disaster-related deaths that may require amendments of death certificates.

Forensic cardiac device analysis at the Los Angeles County Department of the Coroner: A 20-year experience.

Cardiac implantable electronic devices (CIEDs) store information continuously; however, the log of these devices is rarely analyzed in forensic practice. We retrospectively reviewed all cases referred for CIED interrogation by the Los Angeles County Department of Medical Examiner-Coroner between 2001 and 2020. According to the Department's practice, CIED interrogation may be requested for decedents in which details or cause of death are not clear from autopsy and clinical history.

Paenibacillus Sepsis and Meningitis in a Premature Infant: A Case Report.

Infections due to bacteria of the genus Paenibacillus are exceedingly rare and therefore predominately described on a case-by-case basis. Here, we present a case of a 25-day-old premature neonate who died from presumed Paenibacillus sepsis and meningitis. Most prior reported cases of Paenibacillus bacteremia were among patients who had prosthetic medical devices, were immunocompromised, or were injection drug users.

Improving Contagious Disease Reporting in a Medical Examiner's Office.

Contagious disease reporting is an important mechanism for public health officials to be informed of emerging and ongoing risks to the community's health. There are several mechanisms for reporting, including automated reporting from computer sources, required reporting from physicians and other health care professionals, and reporting of sales of certain over-the-counter medications such as cold remedies.Reporting by medical examiners is a significant source of information because contagious disease may first come to the medical examiner by causing sudden unexpected death.

COVID-19: Postmortem Diagnostic and Biosafety Considerations.

As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (eg, cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with-but not of-COVID-19 may still be infectious, however.

Postmortem Chikungunya Diagnosis: A Case Report and Literature Review.

Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics.

Fat transfer and fatal macroembolization.

Fat embolism is usually associated with long bone fractures or other trauma. The diagnosis is usually clinical, and in most cases, emboli are not fatal and not usually seen on gross examination. At the Los Angeles County Coroner's Office, we autopsied the victim of fatal macroscopic fat embolization to the lungs.

Sexual assault documentation program.

Since 2001, the Los Angeles County Department of Coroner has collaborated with Los Angeles County-University of Southern California Medical Center Violence Intervention Program and their Sexual Assault Center. The partnership was established at the suggestion of the district attorney's office to enhance the clinical recognition of sexual assault in the medical examiner's office using the extensive experience of experts in the field of sexual assault. As of December 2008, over 5 dozen victims of sexual assault have been evaluated with this collaboration.

Fatalities of the 2008 Los Angeles train crash: autopsy findings.

Introduction: Train crashes represent a devastating multicasualty event. The purpose of this study was to analyze the injury severity, specific organ injuries, and cause of death in the fatalities of the 2008 Chatsworth, Los Angeles train crash.

Methods: This is a review of the medical examiner records of the 25 fatalities in the train crash.

Blunt thoracic aortic injuries: an autopsy study.

Objective: The objective of this study was to identify the incidence and patterns of thoracic aortic injuries in a series of blunt traumatic deaths and describe their associated injuries.

Methods: All autopsies performed by the Los Angeles County Department of Coroner for blunt traumatic deaths in 2005 were retrospectively reviewed. Patients who had a traumatic thoracic aortic (TTA) injury were compared with the victims who did not have this injury for differences in baseline characteristics and patterns of associated injuries.

The choking game: a cause of unintentional strangulation.

A 12-year-old girl was brought to the pediatric emergency department by ambulance after her mother found her hanging from her bunk bed. The patient was resuscitated initially but died 5 days later after support was withdrawn. A sexual assault examination was performed, and the finding was negative.

Subaortic pseudoaneurysm of the left ventricle complicating staphylococcal endocarditis.

Subaortic pseudoaneurysms are rare but can be a cause of sudden death in young individuals. This case report involves a 20-year-old Vietnamese male who died suddenly from rupture of a subaortic pseudoaneurysm with resultant hemopericardium with tamponade. He had a history of bicuspid aortic valve with recent but healed Staphylococcal endocarditis.

Pacemaker/defibrillator evaluation at Los Angeles County Department of Coroner*.

Pacemakers and implantable cardioverter-defibrillators (ICDs) are implanted medical devices for the treatment of cardiac arrhythmias. These devices are now commonly encountered in the postmortem situation. The Los Angeles County Department of the Coroner uses the services of a cardiac electrophysiology consultant to interrogate pacemakers and ICDs, producing a detailed picture of the cardiac events recorded by the device.

Selecting forensic pathology as a career: a survey of the past with an eye on the future.

Background: Each year there are about 30 to 40 physicians who train and become board-certified in the specialty area of forensic pathology, compared with hundreds or thousands in other disciplines. There are not enough board-certified forensic pathologists to cover national need. The National Association of Medical Examiners' (NAME) Forensic Pathology Training Committee conducted a survey of its members to determine which factors influenced them to select forensic pathology as a career, and to offer suggestions about possible recruitment methods in the future.

Investigation of homicides interred in concrete--the Los Angeles experience.

Decedents interred in concrete present unique problems and investigation of these deaths necessitates a team of forensic specialists. The Los Angeles County Department of Coroner has had five such deaths in the past 18 years. The buried cases needed layer-by-layer excavation to establish the time and cause of death.

Restraint asphyxia in in-custody deaths Medical examiner's role in prevention of deaths.

In the United States, the office of the Medical Examiner-Coroner is responsible for investigating all sudden and unexpected deaths and deaths by violence. Its jurisdiction includes deaths during the arrest procedures and deaths in police custody. Police officers are sometimes required to subdue and restrain an individual who is violent, often irrational and resisting arrest.

Quality improvement of patient care - forensic pathologists' perspective.

In the U.S. today, the pathologists, both hospital-based and forensic, are regularly involved in quality assurance (QA) programs, the evaluation of patient safety at all levels of medical care, including treatments in walk-in clinics and medical offices.

The role of the forensic pathologist in quality assurance and safety of patient care.

During this past half century, there has been remarkable increase in the role of forensic pathologists and medical examiners in the determination of cause and manner of deaths in health care facilities and investigations of quality of patient care. Autopsy data are an essential part of this quality assurance (QA) program in patient care, especially in trauma centers' QA programs. Forensic pathologists participate in evaluating appropriateness of patient care where death occurs during or following therapeutic and diagnostic procedures.

Forensic autopsy in a pathology training program.

Objective: To review a satellite facility's autopsy experience with coroner's cases, to determine the volume and type of cases performed; and to evaluate the teaching value of forensic autopsies in a pathology residency training program.

Design: A retrospective review of 65 Los Angeles County Coroner cases performed at Cedars-Sinai Medical Center, Los Angeles, Calif, from 1992 to 1996 was undertaken. Data were retrieved from cause of death statements, medical report forms, and autopsy reports.

Fatal embolization of ball portion of Starr-Edwards aortic valve prosthesis.

We report an unusual case of a Starr-Edwards aortic valve malfunction with fatal dislodgment and embolization of its ball portion to the distal abdominal aorta, just above the bifurcation, leading to sudden death. This case is unusual in that it is, to date, the longest time elapsed between valve placement and ball dislodgment.