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Atlanta, GA, United States

Batalis N.I.,Medical University of South Carolina | Marcus B.J.,Professional Pathology Services | Papadea C.N.,Medical University of South Carolina | Collins K.A.,Fulton County Medical Examiners Office
Journal of Forensic Sciences | Year: 2010

Sudden cardiac deaths because of acute myocardial infarction (MI) constitute a significant percentage of the caseload for death investigators, coroners, and forensic pathologists. Clinicians use cardiac markers, highly sensitive and specific for myocardial damage, to screen living patients for acute MI; however, to this point, the utility of these markers in the autopsy setting has not been fully established. The current study included 10 decedents, five who died of acute MI, and five subjects who died of noncardiac disease. Samples of pericardial fluid and blood from multiple sites were tested for creatine kinase, creatinine kinase MB, and troponin-I. Three main conclusions were drawn: the levels of cardiac markers from all patients are significantly higher than the reference range for living patients, there are significant differences in cardiac marker levels between samples from different anatomic locations, and only three cardiac marker/anatomic site combinations were significantly different between the control and study groups. © 2010 American Academy of Forensic Sciences. Source


Hughes R.L.,San Antonio Military Medical Center | Collins K.A.,Fulton County Medical Examiners Office | Sullivan K.E.,Fulton County Medical Examiners Office
American Journal of Forensic Medicine and Pathology | Year: 2013

May-Thurner syndrome results from long-standing compression of the left common iliac vein (LCIV) and is characterized by the formation of intraluminal spurs leading to obstruction of blood flow and deep vein thrombosis (DVT). Increased intraluminal pressures may occur as a consequence of venous obstruction, which when coupled with other factors thought to further weaken venous wall integrity (ie, inflammation or hormonal imbalances) may produce spontaneous (nontraumatic) and potential lethal venous rupture.We report a case of DVT in a woman with previously undiagnosed May-Thurner syndrome and heterozygosity for factor V Leiden mutation on exogenous hormone therapy, with subsequent spontaneous rupture of the LCIV leading to fatal hemoperitoneum. Autopsy revealed fibrous obliteration of the junction between the LCIV and inferior vena cava with associated DVT, transmural venous rupture, and thrombophlebitis. Copyright © 2013 by Lippincott Williams & Wilkins. Source


Heninger M.,Fulton County Medical Examiners Office | Collins K.A.,Fulton County Medical Examiners Office
Journal of Forensic Sciences | Year: 2013

Methamphetamine is a synthetic stimulant that can adversely affect the central nervous system and the immune system. Through various mechanisms, methamphetamine is toxic to neurons, endothelial cells, lymphocytes, granulocytes, and macrophages resulting in systemic damage. Reported is the sudden demise of an otherwise healthy 31-year-old woman with a history of stimulant abuse. At autopsy, acute bacterial meningitis was identified. Microbiology cultures grew a single isolate of Streptococcus pneumoniae. Toxicology was positive for amphetamine (0.13 mg/L) and methamphetamine (0.8 mg/L). The cause of death was classified as acute bacterial meningitis with methamphetamine use. Either the acute bacterial meningitis or the methamphetamine toxicity would have been sufficient to result in death; however, the concurrent pathophysiology of the two entities must be understood. A review of the current literature assesses the mechanisms of injury attributed to acute and chronic methamphetamine use, bacterial meningitis, and the synergy between the two. © 2013 American Academy of Forensic Sciences. Source


Schier J.G.,Centers for Disease Control and Prevention | Heninger M.,Fulton County Medical Examiners Office | Wolkin A.,Centers for Disease Control and Prevention | Kieszak S.,Centers for Disease Control and Prevention | And 7 more authors.
Journal of Analytical Toxicology | Year: 2010

This study's goal was to determine cadmium (Cd), lead (Pb), total mercury (THg), and inorganic mercury (IHg) levels in human cadavers to compare measured levels with established reference ranges for living persons and to determine whether blood levels varied with time from death to sample collection or by body collection site. Subjects (n = 66) recruited from the Fulton County Medical Examiner's Office in Atlanta, GA, were 20 years of age or older, had no penetrating trauma, no obvious source of environmental contamination of the vasculature, and had whole blood accessible from the femoral (F) site, the cardiac © site, or both. Geometric mean results were as follows: 2.59 μg/L F-Cd; 11.81 μg/L C-Cd; 1.03 μg/L F-THg; 2.01 μg/L C-THg; 0.29 μg/L F-IHg; 0.49 μg/L C-IHg; 1.78 μg/dL F-Pb; and 1.87 μg/dL C-Pb. Both F- and C-Cd levels as well as C-THg levels were significantly higher than reference values among living persons (C- and F-Cd, p < 0.0001 and C-THg, p = 0.0001, respectively). Based on regression modeling, as the postmortem interval increased, blood Cd levels increased (p < 0.006). Postmortem blood Cd concentrations were elevated compared to population values and varied with respect to sampling location and postmortem interval. Source

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