Category Archives: Forensic pathology

Journal articles relating to forensic pathology including coronial autopsies and Disaster victim identification.

Potentially preventable infant and child deaths identified at autopsy; findings and implications

Forensic Science, Medicine, and Pathology June 2015

The purpose of the study was to determine the proportion of pediatric deaths investigated by HM Coronial autopsy which were potentially preventable deaths due to treatable natural disease, and what implications such findings may have for health policies to reduce their occurrence.

A retrospective study of 1779 autopsies of individuals between 7 days and 14 years of age requested by HM Coroner, taking place in one specialist pediatric autopsy center, was undertaken. Cases were included if they involved a definite natural disease process in which appropriate recognition and treatment was likely to have affected their outcome. Strict criteria were used and cases were excluded where the individual had any longstanding condition which might have predisposed them to, or altered the recognition of, acute illness, or its response to therapy.

Almost 8 % (134/1779) of the study group were potentially preventable deaths as a result of natural disease, the majority occurring in children younger than 2 years of age. Most individuals reported between 1 and 7 days of symptoms before their death, and the majority had sought medical advice during this period, including from general practitioners within working hours, and hospital emergency departments. Of those who had sought medical attention, around one-third had done so more than once (28 %, 15/53). Sepsis and pneumonia accounted for the majority of deaths (46 and 34 % respectively), with all infections (sepsis, pneumonia and meningitis) accounting for 110/134 (82 %).

Around 10 % of pediatric deaths referred to HM Coroner are potentially preventable, being the result of treatable natural acute illnesses. In many cases medical advice had been sought during the final illness. The results highlight how a review of autopsy data can identify significant findings with the potential to reduce mortality, and the importance of centralized investigation and reporting of pediatric deaths.

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Cyanide poisoning related deaths, a four-year experience and review of the literature

Australian Journal of Forensic Sciences  Published online: 03 Jun 2015

Cyanide has been used as a poison for thousands of years. Symptoms of cyanide poisoning begin quickly and death occurs within minutes. In this study, we review 52 cyanide poisoning cases in Tehran, Iran, over a four-year interval, from 30 December 2009 to 1 January 2014. Toxicological analysis and post-mortem findings are discussed. Colour test (Prussian Blue) was used for screening for cyanide with confirmation using the voltammetry method. The youngest decedent was a 2-month old girl. Men constituted 76.9% (40) of the total 52 victims. Peak age prevalence of cases was seen in age groups 21–40 years (32 cases, i.e. 61.5%). Methadone and opioid alkaloids were the most common drugs detected in biological samples in this study. A suicide attempt was the main cause of poisoning in 33 cases. The results showed that cyanide-poisoning-related deaths are among the most public health problems in Iran. Restricted access to cyanide and stricter buying and selling controls may reduce intentional self-poisoning with this dangerous substance.

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Prevalence of new psychoactive substances in Victorian fatally-injured drivers

Australian Journal of Forensic Sciences Published online: 16 Jun 2015

The presence of new psychoactive substances (NPS) in Victorian drivers was determined in the blood of 253 Victorian fatally-injured drivers covering a 2-year period, from 2012 to 2013. The validated LC-MS/MS methods was used to detect 56 synthetic cannabinoids and 32 synthetic cathinones. In only two of the drivers were cathinones detected; 4-methylenedioxypyrovalerone (MDPV) and α-pyrrolidinopentiophenone (α-PVP) in one driver and methylone in another. Synthetic cannabinoids were detected in four of the fatally-injured drivers, and comprised four different drugs: JWH-122, JWH-122-pentenyl derivative, CRA-13 and PB-22, all at quite low concentrations (less than 1 ng/mL). The prevalence of NPS was 2.4% compared with about 29% for the presence of all psychoactive drugs in this period.

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Case of the month – Academic Forensic Pathology

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Volume 5, number 2, June 2015.

Fatal hemoptysis due to undiagnosed pulmonary tuberculosis

Amnestic somnambulism and nocturnal eating disorder associated with zolpidem use as a contributing factor in accidental death

Cerebral toxoplasmosis presenting as a Medical Examiner case

Contact gunshot wound characteristics associated with muzzle modification


Original articles – Academic Forensic Pathology

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Volume 5, number 2, June 2015.

Computer extraction of data from autopsy and toxicology reports

Creation of a queryable toxicology database available to Forensic Pathologists

Forensic entomology in the Medical Examiner’s office

Trauma of the pericardial sac and heart: an autopsy series

Comparison of the distribution of cranial fractures by mechanism of formation


Invited reviews – Academic Forensic Pathology

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Volume 5,  number 2. June 2015.

The value-added forensic autopsy: public health, other uses, and relevance to forensic pathology’s future / Hanzlick, Randy.

Moritz revisited: modern mistakes about how we think about Forensic Pathology / Oliver William

Teaching the forensic autopsy / Hamilton, Leslie.

Evolution of a molecular autopsy program within a death investigation system / Dunningham, K.S., Pollanen, M.

Establishing a multidisciplinary network for the workup of sudden cardiac death / Duncanson, E., Lynch, K., Baker, A.M., Abdelhadi, R.H., Mackey-Bojack, S.

Five-day turnaround time for hospital medical autopsies: a five-year experience / Tormos, L.M., Schandl, C., Batalis, N., Presnell, S.E.

Overview of technological development, complications and grossing techniques in percutaneous coronary intervention / Ball, C.G., Veinot, J.

A brief history of ‘Asphyxia’ / Milroy, C.

Histological aging of bruising: a historical and ongoing challenge / Parai, J., Milroy, C.

The medicolegal issues surrounding the case of Steven Truscott: a forensic pathology perspective / Williams, K., Milroy, C.

Beyond the autopsy: special procedures performed postmortem / Collins, K.


Autopsy report for a caffeine intoxication case and review of the current literature

Journal of Toxicologic Pathology  Vol. 28 (2015) No. 1 p. 33-36;  DOI:  10.1293/tox.2014-0044

Caffeine (1,3,7-trimethylxanthine) is a popular mild central nervous system stimulant found in the leaves, seeds and fruits of various plants and in foodstuffs such as coffee, tea, and chocolate, among others. Caffeine is widely used and is not associated with severe side effects when consumed at relatively low doses. Although rarely observed, overdoses can occur. However, only a few fatal caffeine intoxication cases have been reported in the literature. Herein, we report the pathological examination results and information on caffeine concentrations in the blood, urine and main organs in a fatal caffeine intoxication case. Even though high caffeine concentrations were found in the systemic organs, no caffeine-related pathological changes were detected.

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