Position Paper: Recommendations for the Investigation, Diagnosis, and Certification of Deaths Related to Opioid and Other Drugs.

The National Association of Medical Examiners convened an expert panel to update the association's evidence-based recommendations for investigating and certifying deaths associated with opioids and other misused substances to improve death certificate and mortality data for public health surveillance. The recommendations are as follows:1. Autopsy provides the best information on a decedent's medical condition for optimal interpretation of toxicology results, circumstances surrounding death, medical history, and scene findings. The panel considers autopsy an essential component of investigating apparent overdose deaths.2. Scene investigation includes reconciling prescription information and medication counts. Investigators should note drug paraphernalia or other evidence of using intoxicating substances.3. Retain blood, urine, and vitreous humor whenever available. Blood from the iliofemoral vein is preferable to blood from more central sites.4. A toxicological panel should be comprehensive, including potent depressant, stimulant, and antidepressant medications. Detecting novel substances present in the community may require special testing.5. When death is attributed to a drug or combination of drugs (as cause or contributing factor), the certifier should list the drugs by generic name in the autopsy report and death certificate.6. The best classification for manner of death in an overdose without any apparent intent of self-harm is "accident."

Multifocal cutaneous and systemic plasmablastic lymphoma in an infant with combined living donor small bowel and liver transplant.

Small bowel allograft recipients have a relatively high risk (approximately 20%) of developing PTLD. Onset of PTLD is usually soon after transplant (median of eight months). Children are at a higher risk than adults. Although PBL was originally described in 1997 by Delecluse et al. as a human immunodeficiency virus-associated neoplasm typically presenting in the oral cavity, it is now recognized as a PTLD. We describe an unusual and interesting case and to our knowledge the first case of an infant who developed diffuse multifocal cutaneous and systemic PBL shortly after small bowel and liver transplant. We report a case of a 14-month-old female child who received a small bowel and liver transplant from her father. She had excellent graft function with no rejection episodes. Five months post-transplant she developed a sudden gastrointestinal bleed and was noted to have a constantly rising EBV titer despite ongoing maximal antiviral therapy. A patchy erythematous rash was noted on her abdomen that was diagnosed as PBL-PTLD. By the time of this diagnosis, she had developed multiorgan failure unresponsive to therapy.

Glomangiomyoma (glomus tumor) of the kidney.

We report herein a case of glomus tumor arising in the kidney of a 55-year-old woman, which was found incidentally on a computed tomographic scan. Partial nephrectomy revealed a 2-cm encapsulated mass that was architecturally similar to glomus tumor. Immunohistochemistry showed positivity of tumor cells for vimentin and smooth muscle actin. On electron microscopy, cytoplasmic thin filaments and dense bodies were seen, confirming the smooth muscle nature of the tumor. Glomus tumors arising in visceral organs are rare, and those arising in kidney are exceedingly rare.