Shotgun slug wads as a marker of range of fire: A case report and novel firearm testing data.

Assessment of wound characteristics and the identification of various constituents of firearm discharge at autopsy play a key role in the determination of range of fire. In relation to wounds caused by shotguns, identification of the wad within the wound track, or of injury caused by the wad, is typically thought to suggest a fairly close range of fire. We present a case of a fatality due to a shotgun slug wound where the presence of the wad within the decedent's body was proposed by defense at criminal trial to favor accidental close range discharge during a struggle for the weapon-as opposed to the prosecution's contention of intentional firing of the weapon from a greater range and through an intermediate target. We undertook test firing of a shotgun of similar design to that which was fired during the interaction (a 12-gauge pump-action shotgun) using shotshells consistent with the slug that was recovered from the body (Winchester Super X brand), which demonstrated that the non-attached fiber wad present in this shotshell design can accompany the slug over distances of at least up to 22 feet (6.7 m) and even after transit through intermediate targets such as a vehicle headrest. These novel data provide assistance with estimation of range of fire in instances of injuries caused by shotgun slugs.

The Association of Inflammatory Cytokines in the Pulmonary Pathophysiology of Respiratory Failure in Critically Ill Patients With Coronavirus Disease 2019.

OBJECTIVES: The majority of coronavirus disease 2019 mortality and morbidity is attributable to respiratory failure from severe acute respiratory syndrome coronavirus 2 infection. The pathogenesis underpinning coronavirus disease 2019-induced respiratory failure may be attributable to a dysregulated host immune response. Our objective was to investigate the pathophysiological relationship between proinflammatory cytokines and respiratory failure in severe coronavirus disease 2019. DESIGN: Multicenter prospective observational study. SETTING: ICU. PATIENTS: Critically ill patients with coronavirus disease 2019 and noncoronavirus disease 2019 critically ill patients with respiratory failure (ICU control group). INTERVENTIONS: Daily measurement of serum inflammatory cytokines. MEASUREMENTS AND MAIN RESULTS: Demographics, comorbidities, clinical, physiologic, and laboratory data were collected daily. Daily serum samples were drawn for measurements of interleukin-1ß, interleukin-6, interleukin-10, and tumor necrosis factor-α. Pulmonary outcomes were the ratio of Pao2/Fio2 and static lung compliance. Twenty-six patients with coronavirus disease 2019 and 22 ICU controls were enrolled. Of the patients with coronavirus disease 2019, 58% developed acute respiratory distress syndrome, 62% required mechanical ventilation, 12% underwent extracorporeal membrane oxygenation, and 23% died. A negative correlation between interleukin-6 and Pao2/Fio2 (rho, -0.531; p = 0.0052) and static lung compliance (rho, -0.579; p = 0.033) was found selectively in the coronavirus disease 2019 group. Diagnosis of acute respiratory distress syndrome was associated with significantly elevated serum interleukin-6 and interleukin-1ß on the day of diagnosis. CONCLUSIONS: The inverse relationship between serum interleukin-6 and Pao2/Fio2 and static lung compliance is specific to severe acute respiratory syndrome coronavirus 2 infection in critically ill patients with respiratory failure. Similar observations were not found with interleukin-ß or tumor necrosis factor-α.

Non-Traumatic Acute Subdural Hemorrhage Due To Cranial Venous Hypertension.

Acute subdural hemorrhage is typically associated with a history of head trauma, and as such it is a finding with significant potential medicolegal consequences. In this article, 37 adult and post-infantile pediatric sudden death autopsy cases with small volume ("thin film" or "smear") acute subdural hemorrhage are presented-in which there is either no further evidence of head trauma or only features of minor head injury. The possible underlying pathophysiological mechanisms are explored, and it is concluded that a common thread in many of these cases is likely to have been cranial venous hypertension at around the time of death. These findings may have implications in instances where small volume subdural hemorrhage is identified in the absence of other evidence of significant head injury.

Human papillomavirus and Epstein Barr virus in prostate cancer: Koilocytes indicate potential oncogenic influences of human papillomavirus in prostate cancer.

INTRODUCTION: The purpose of this study is to determine if high risk human papillomaviruses (HPV) and Epstein Barr virus (EBV) are both present in the same prostate cancer specimens. METHODS: We used a range of analytical techniques including in situ polymerase chain reaction (IS-PCR) and standard liquid PCR followed by sequencing of the product to seek to identify HPV and EBV in normal, benign, and malignant prostate tissues. RESULTS: Both HPV type 18 and EBV gene sequences were identified in a high and approximately equal proportion of normal, benign, and prostate cancer specimens. These sequences were located in the nuclei of prostate epithelial cells. HPV associated koilocytes were identified in 24% of prostate cancer specimens. CONCLUSIONS: The presence of both HPV and EBV gene sequences in most of the same normal, benign, and malignant prostate specimens is particularly noteworthy because of recent experimental evidence demonstrating that EBV and HPV can collaborate to increase proliferation of cultured cervical cells. Because the presence of EBV and HPV in normal, benign, and malignant prostate tissues appears to be ubiquitous, it is possible that they are harmless. On the other hand HPV type 18 in particular, has high oncogenic potential and may be associated with some prostate cancers. The identification of HPV associated koilocytes in prostate cancer specimens is an indication of HPV infection and potential oncogenic influences of human papillomavirus in prostate cancer.

Myocardial pathology in pulmonary thromboembolism.

OBJECTIVE: To assess the nature of necroinflammatory changes identified in postmortem histological sections of the right ventricular myocardium in cases of fatal pulmonary thromboembolism (PTE). DESIGN/SETTING: A retrospective study examining coronial autopsy cases (n = 28, age 58 ± 21 years, 9 men/19 women) of PTE in which isolated right ventricular myocardial pathology was encountered. Detailed immunohistological analysis was undertaken on sections of myocardium, and comparison was made to age- and sex-matched controls (n=28, age 57 ± 21 years, 9 men/19 women) without significant cardiorespiratory disease. RESULTS: The PTE was considered extensive in 86% of cases, and histological features of organisation were observed in 68%. PTE cases had similar body mass indices to controls (32 ± 2 kg/m(2) vs 28 ± 2 kg/m(2), p = 0.13) but greater heart weights (414 ± 17 g vs 358 ± 18 g, p = 0.02) and, where documented, thicker right ventricular walls (4.8 ± 0.3 mm (n = 18) vs 3.4 ± 0.2 mm (n = 15), p = 0.0008). The inflammatory infiltrate in PTE cases comprised predominantly macrophages and T cells, though neutrophilic inflammation was a frequent accompaniment. Myocyte necrosis was identified in association with the inflammatory foci in 64%. There was a 6.6-fold greater amount of diffuse macrophage recruitment within the right ventricle in cases of PTE compared to controls (p<0.0001), and there was a 6.1-fold increase in right ventricular fibrosis (p = 0.01). Right ventricular fatty replacement was similar between the two groups (p = 0.46). CONCLUSIONS: We conclude that PTE may result in right ventricular myocardial inflammation and necrosis, distinct from that seen in typical myocardial infarction due to atherosclerotic coronary artery disease, or myocarditis. This observation may be explained, in part, by local stretch and strain of the right ventricle due to increased afterload, possibly compounded by diminished diastolic blood flow to the right ventricular myocardium and the effects of global myocardial hypoxia.

High prevalence of prostatic neoplasia in Australian men.

AIMS: The purpose of this study was to document the extremely high level of prostatic neoplasia among Australian men. METHODS: The study was based on histological assessment of prostate tissue sampled from an unselected series of 133 cadavers referred for coronial autopsy at the Department of Forensic Medicine, Sydney South West Area Health Service, New South Wales. RESULTS: Evidence of neoplastic growth was identified in prostate tissue sampled from 30% of the 70 men aged 50 years and over, with invasive carcinoma present in 25.7% of subjects, and suspected prostatic intraepithelial neoplasia (PIN) in a further 4.3% of subjects. These findings were in marked contrast to the 63 subjects under 50 years of age. In this age group one subject had invasive prostate carcinoma, and one other had suspected PIN. CONCLUSIONS: The prevalence of invasive prostate carcinoma is extraordinarily high in this sample of Australian men. Among those subjects who were 50 years of age or over, more than one in four had apparently undiagnosed invasive cancer of the prostate gland.