Postmortem grading of cerebral contusions : A proposed modification of the adams' contusion index with re-definition of anatomic markers.

In the 1970s, J. H. Adams and other researchers at the Institute of Neurological Sciences, Glasgow, Scotland introduced a grading system for the quantification and analysis of contusions of the brain. They derived a brain contusion index based on regional surface distribution and parenchymal depth of contusions of the brain. Following a subsequent modification of this scheme in the 1980s, they recommended evolving modifications that will fit a variety of possible applications. Having tested the applicability of this grading system for the forensic/medico-legal autopsy, we have encountered some applied anatomic limitations and have derived a modification that addresses these limitations in reference to the forensic/medico-legal autopsy.We recommend a two-tier system based on the Adams' system, which quantifies contusions of the brain by the gyral spread of contusions and by the parenchymal depth of penetration of contusions with a re-definition of the lobar distinctions and classifications of the brain. Gyral spread is assigned a grading scheme of 0-3 and the parenchymal depth of contusions is assigned a grading scheme of 0-4. A lobar contusion score is derived by multiplying the two assigned grades. A total brain contusion index is derived by summating all the lobar contusion scores. This reproducible grading system can be applied to routine bench forensic neuropathology reporting, court room illustrations and in comparative research analysis of brain trauma subjects.

Forensic pathology and forensic epidemiology of suicides in allegheny county, pennsylvania : A 10-year retrospective review (1990-1999).

Suicide has assumed epidemic proportions and constitutes a major public health issue throughout the United States. Suicide remains one of the top eight leading causes of death, accounting for approximately 30,000 deaths annually. The understanding and prevention of suicide requires a multidisciplinary approach that involves psychosocial and medical specialties starting with a forensic analysis of the characteristics of suicide. The aim of this 10-year (1990-1999) retrospective study was threefold: first, to examine the forensic epidemiological characteristics of suicides examined by the Allegheny County Coroner's Office; second, to describe emerging epidemiological patterns of suicide; and finally, to make recommendations for preventive measures. A total of 1447 suicides were identified, with 1164 males (80%) and 283 females (20%) resulting in a male to female ratio of 4:1. The race distribution comprised 90% whites, 9% blacks, and 1% other races. The age of suicide victims ranged from 13 to 96 years old with a peak within the 31- to 40-year-old age group, which represented 24.5% of all suicides. Overall, 40% of the victims were single and more blacks than whites were single. The greatest number of suicides occurred in July, with the least in December. Suicides most frequently occurred between 9:01 AM and 3:00 PM. Suicide notes were present in 29% of all suicides. Firearm injuries, hanging, and drug overdose were the leading methods of suicide. Use of firearms was the leading method of suicide among both sexes. Female drug overdose deaths outnumbered male drug overdose deaths. The 10 most common overdose drugs were all central nervous system depressants, with amitriptyline being the most common prescription overdose drug. Based on reported antecedent trends in suicides, we make two recommendations regarding suicide prevention: (1) physicians should be educated to replace the prescription of older and more toxic antidepressants such as amitriptyline with newer and less toxic antidepressants such as serotonin reuptake inhibitors; and (2) firearms should be made inaccessible to individuals with risk factors for suicide, especially in the home.

Postbariatric surgery deaths, which fall under the jurisdiction of the coroner.

Obesity has attained epidemic proportions in the United States, with more than 50% of adults classified as overweight or obese. If untreated, morbidly obese patients have a 1 in 7 chance of reaching normal life expectancy. The surgical treatment of obesity has emerged as the most effective treatment modality in long-term weight control and has become increasingly popular, with attendant postoperative complications and death. We performed a cross-sectional, coroner based, 2-year retrospective review of archival case records for decedents who died following bariatric surgery for the treatment of obesity to identify underlying causes of death and forensic characteristics of this cohort. Fifteen (0.5%) out of 3097 archival cases died following bariatric surgery, with approximately 73% of decedents dying within 6 months of surgery. The underlying causes of death in 80% of decedents were natural comorbidities of obesity, with cardiovascular diseases (33%) being the most frequent causes of death, followed by gastrointestinal diseases (20%), acute pulmonary thromboembolism (13%), and acute bacterial pneumonia (13%). The majority of decedents were white females who remained morbidly obese after bariatric surgery. Only 2 decedents died of direct inadvertent/accidental surgical complications.