Forensic Pathologist Testimony, Part 1: Common Questions and Considerations.

Introduction: Forensic pathologists are the only medical specialists who routinely testify in courts of law as part of their occupation. As such, one element of their training involves learning how to testify responsibly and competently. Individuals qualified as experts are permitted to offer opinions in order to assist the triers of fact.

Forensic Pathologist Testimony, Part 2: Special Issues and Considerations.

Introduction: Forensic pathologists routinely testify in courts of law as part of their occupation. As such, part of their training involves learning how to testify responsibly and competently. As experts, they are permitted to offer opinions in order to assist the triers of fact.

Cardiovascular Disease in Acute Cocaine Compared to Acute Fentanyl Intoxication Deaths.

Cocaine is the most common stimulant drug that causes death in Connecticut. Unlike opioid intoxication deaths, which largely correlate with dose/concentration, cocaine deaths occur more idiosyncratically, with mechanisms of death often related to underlying cardiovascular disease. We examined 78 sole acute cocaine and 306 sole acute fentanyl intoxication deaths to assess their association with cardiovascular disease.

The National Association of Medical Examiners Position Paper on the Investigation and Certification of Pediatric Deaths From Environmental Neglect.

Pediatric deaths that occur because of environmental neglect often involve 4 common scenarios: (1) hyperthermia due to environmental exposure, (2) ingestion of an accessible drug or poison, (3) unwitnessed/unsupervised drownings, and (4) unsafe sleep practices. Given the same fact pattern, the manner of death will vary from accident to homicide to undetermined based on local custom and/or the certifier's training and experience. Medical examiner/coroner death certifications are administrative public health determinations made for vital statistical purposes.

Assessing Neglect in Pediatric Environmental Deaths: A Survey of Manner of Death Determinations.

There are 4 common types of environmental pediatric deaths that may involve various degrees of neglect: hyperthermia, ingestion, drownings, and unsafe infant sleep practices. Because the circumstances surrounding each are disparate, there is no set of standards by which these factors may be weighed and interpreted. Given the same facts, the manner of death certification may differ depending upon training/experience and/or local practice.

Sudden Death Related to Diabetes Mellitus: Current and Emerging Relevance to the Forensic Pathologist.

While diabetes mellitus (DM) has historically accounted for substantial worldwide morbidity and mortality, new and evolving epidemiologic trends are forcing the scientific community to view it as a type of emerging disease. This review will summarize the pathophysiology of the disease, present an update of current national statistics and changing epidemiologic patterns, discuss how DM might specifically lead to acute deaths falling under the jurisdiction of the medical examiner/coroner, and suggest a medicolegal standard of practice to maximize their capture and reporting.

Fatal diabetic ketoacidosis and antipsychotic medication.

Hyperglycemia and new onset diabetes have been described with certain antipsychotic medications and some of the initial presentations are fatal diabetic ketoacidosis (DKA). We report 17 deaths due to DKA in psychiatric patients treated with second generation antipsychotic medications. Death certificates and toxicology data were searched for DKA and hyperglycemia.

Pulmonary pathologic findings of fatal 2009 pandemic influenza A/H1N1 viral infections.

Context: In March 2009, a novel swine-origin influenza A/H1N1 virus was identified. After global spread, the World Health Organization in June declared the first influenza pandemic in 41 years.

Objective: To describe the clinicopathologic characteristics of 34 people who died following confirmed A/H1N1 infection with emphasis on the pulmonary pathology findings.

Pseudo-stab wounds: putrefactive dehiscence of remote surgical incisions masquerading as stab wounds.

Artifacts due to decomposition can be mistaken for antemortem injury leading to an incorrect suspicion of foul play. We describe an instance of postmortem wound dehiscence that mimicked antemortem stab wounds. A man with a history of colon cancer and substance abuse was found dead.

Breast cancer overview.

The words, "you have breast cancer," is possibly one of the most devastating statements an individual could image hearing from his or her physician even though breast cancer is the most common cancer among women. The diagnosis bears a significant amount of anxiety and fear in regards to treatment and overall survival. However, research has increased healthcare professionals' knowledge on the benefits of early screening, diagnosis, and treatments, which has steadily reduced the death rate from breast cancer over the past 20 years.

Fatal pulmonary thromboembolism and hereditary thrombophilias.

Pulmonary thromboembolism (PE) is found commonly in forensic pathology practice, as it typically causes sudden death. It is attributed to a wide variety of predominantly acquired etiologies. Although likely etiologically multifactorial, some common proximate causes include: surgery, pregnancy, injury, inactivity of any cause, cancer, obesity, or serum hyperviscosity.

Environmental gas displacement: three accidental deaths in the workplace.

The authors describe three accidental deaths resulting from occupational hazards involving environmental gas alterations. One involved the displacement of oxygen caused by leakage of liquid nitrogen during the installation of a magnetic resonance imaging system. Two involved elevated environmental carbon dioxide concentrations: dry ice sublimation in a walk-in refrigerator in a research laboratory, and activation of a carbon dioxide fire alarm-extinguisher system by a woman locked in a bank vault.