False-Positive Rate for Suspected Drug-Related Deaths Following Full Autopsy

ABSTRACT

The sharp increase in drug-related deaths has tempted medical examiner/coroner offices to perform external examinations with comprehensive toxicology testing instead of performing a standard autopsy. Compounding the problem of an increasing workload has been the decrease in available forensic pathologists. Opting for external examinations on suspected drug-related fatalities, however, is antithetical to current best practices. The purpose of this study was to review case files, autopsy reports, and toxicologic results of all deaths that were autopsied at the authors' facility and decide whether significant disease processes or injuries that would supersede the results of toxicologic testing and external examination findings alone were being missed.

Pituitary lineage differentiation from human-induced pluripotent stem cells in 2D and 3D cultures

Despite its small size, the pituitary gland plays a central role in the maintenance of normal homeostasis of most physiological systems through its regulation of the function of other endocrine glands. The complexity of the anterior pituitary gland, due to its composition of several different hormone-secreting cell types, begets a plethora of disorders and pathologies due primarily to hypo- or hyper-secretion of hormones. The gonadotrophs, which make up less than 5% of the total number of cells in the anterior pituitary, serve to regulate gonad development and sexual reproduction in males and females. Despite the increased research on the development of models to study pituitary function within the last decade, a model specifically designed to study the gonadotrophs is still lacking. The development of organoid technology has facilitated research in the field of personalized medicine and physiological testing using patient-derived cells. The ability to produce pituitary organoids would allow researchers to construct an in vitro model of the human hypothalamic-pituitary-gonadal (HPG) or -adrenal (HPA) axis to use in further fertility or endocrine research. The application of this technology in patients could revolutionize the treatment of infertility and a variety of neuroendocrine disorders. The impetus behind this stud was to develop a pituitary-like organoid consisting only of gonadotrophs. Despite the lack of success in differentiating gonadotrophs, pituitary-like organoids were differentiated from human-induced pluripotent stem cells. In addition, 2D and 3D differentiated cultures were characterized and compared to human adult cadaveric pituitary tissue.

Forensic Radiology Pitfalls: CT Imaging in Gunshot Wounds of the Head

Computed tomography (CT) imaging is increasingly used in emergency departments and trauma services and is being offered as a supplemental tool with autopsy in coroner's and medical examiner's offices throughout the United States. The availability of CT images in lieu of traditional X-rays for medicolegal autopsies may lead to misinterpretation of images for forensic pathologists who are not familiar with these types of images. Forensic pathologists must become familiar with CT imaging, the basis of CT image formation and how to interpret CT images appropriately. We highlight potential pitfalls of CT image interpretation through two cases of fatal gunshot wounds of the head. Antemortem CT imaging available at the time of autopsy led to discrepancy between the initial image findings and the autopsy due to inexperienced manipulation of the images. With appropriate understanding of CT image interpretation and manipulation, forensic personnel should be able to avoid most sources of misinterpretation.

Coronal cleft vertebra initially suspected as an abusive fracture in an infant

A case of a four-month-old male infant is described who was found unresponsive at home and brought to the emergency room. He lived for four days. During his hospital admission he was diagnosed by radiography with a fracture of the third lumbar vertebra that was presumed abusive in nature. Autopsy examination failed to confirm a fracture. However, a defect in the development of the vertebral bodies was discovered. He was diagnosed with possible failure of the notochord to regress, a condition with no significant sequelae. The cause of death was certified as sudden infant death syndrome after full investigation, and all autopsy studies were negative.

Forensic medicine: matters of life and death

Forensic radiology uses medical imaging to answer a variety of legal questions, including questions about suspicious and violent deaths. This article traces the history of forensic medicine and forensic radiology and outlines radiology's role in investigating death. The authors discuss the physical changes that occur after death and the procedures involved in forensic autopsies, including radiography.

Elimination of fluconazole interference in gas chromatography/mass spectrometric confirmation of benzoylecgonine, the major metabolite of cocaine using pentafluoropropionyl derivative

Cocaine is a widely abused drug and causes death from overdose. Benzoylecgonine, the major metabolite of cocaine in urine is usually confirmed after derivatization by gas chromatography/mass spectrometry to demonstrate cocaine abuse. Recently, Wu et al. demonstrated that fluconazole coelutes with benzoylecgonine after conversion to trimethylsilyl analogs and causes false-negative result in the confirmation test. However, fluconazole did not interfere with the screening assay using a enzyme multiplied immunoassay technique. We demonstrated that by converting benzoylecgonine to the corresponding pentafluoropropionyl derivative, the interference of fluconazole can be completely eliminated. The pentafluoropropionyl derivative of benzoylecgonine eluted at 14.7 min while the derivatized fluconazole eluted at 15.6 min. The mass spectral fragmentation pattern of derivatized benzoylecgonine was distinctively different from the mass spectral features of derivatized fluconazole in both electron ionization and chemical ionization mode of operation of mass spectrometers. The quantitation of benzoylecgonine in positive urine specimens has not affected when the specimens were supplemented with 50 micrograms/mL of fluconazole.