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Davis N.L.,Cornwall Community Hospital | Horan P.M.,Orange County Medical Examiners Office | Romich T.,Orange County Medical Examiners Office | Roman J.L.,North Shore Long Island Jewish Health Care System | And 2 more authors.
American Journal of Forensic Medicine and Pathology | Year: 2010

This is a series reviewing 14 cases of giant saccular aneurysms diagnosed at the Office of the Chief Medical Examiner of New York City collected over an 11-year period. Data collected on all 14 cases included neuropathological findings, comorbidities, and toxicological findings. Of these 14 cases, 8 were in women, and the ages ranged from 3 to 79 years, with a mean and a median of 50 years. Women were overrepresented in the sixth through eighth decades. Of the 14 cases described, 11 presented with a subarachnoid hemorrhage; 3, no hemorrhage; 2, subdural hemorrhage; 8, intraventricular hemorrhage; 2, intracerebral hemorrhage; and 8, more than 1 hemorrhage type. Location of the aneurysms varied with 6 in the left side of the brain, 6 present in the right side of the brain, and 2 at the midline. We described the clinical, pathological, and toxicological findings associated with these giant aneurysms. Copyright © 2010 by Lippincott Williams & Wilkins. Source


Buelow B.,University of Washington | Otjen J.,University of Washington | Sabath A.P.,University of Washington | Harruff R.C.,King County Medical Examiners Office
American Journal of Forensic Medicine and Pathology | Year: 2012

Liver rupture is a serious, life-threatening event that is commonly due to blunt abdominal trauma, which should be suspected in a patient who is unconscious or unable to communicate. We report an autopsy case of a 28-year-old woman with severe developmental delay who presented to the emergency department with hemoperitoneum due to massive liver rupture and subsequently died without a diagnosis. An autopsy performed by the hospital pathology department confirmed hemoperitoneum due to hepatic rupture. The case was then referred to the medical examiner to exclude a traumatic etiology. After review of the clinical data, radiological images, and gross and microscopic pathological features, a diagnosis of peliosis hepatis was established. This rare entity has been reported previously as a cause of spontaneous, nontraumatic liver rupture and is reported here to demonstrate its characteristic features and potential to present as fatal hepatic rupture in circumstances in which occult injury must be excluded. Copyright © 2012 Lippincott Williams & Wilkins. Source


Chisholm K.M.,University of Washington | Harruff R.C.,King County Medical Examiners Office
American Journal of Forensic Medicine and Pathology | Year: 2010

This study analyzed 237 fatal ground-level falls occurring in decedents aged 65 years or older reported to the Seattle-King County Medical Examiner's Office during the year 2007. Head injuries accounted for 109 (46%) of the deaths, and nonhead injuries accounted for 128 (54%) of the deaths. Falls occurred in similar locations in both groups. Compared with those of nonhead injuries, decedents of head injuries were younger (82 vs 87.5 years), were more often male (58% vs 45%), died sooner after their injury (9 days vs 23 days), and were more likely treated with anticoagulants, especially warfarin (48% vs 16%). Subdural hematoma was the most common specific traumatic lesion, occurring in 86% of the decedents of head injury; skull fractures occurred in 13%. Decedents of head injury who were treated with anticoagulants, on average, sustained less severe head injury than those who were not treated with anticoagulants. Copyright © 2010 by Lippincott Williams & Wilkins. Source


Harruff R.C.,King County Medical Examiners Office | Park J.,Miami Dade County Medical Examiner | Smelser B.J.,Washington State Patrol Crime Laboratory
Journal of Forensic Sciences | Year: 2013

Wounds of high-energy centerfire rifles and shotguns represent distinctive injuries of forensic importance. Previous studies of contact wounds have shown variability in the potential of these weapons to produce bursting wounds of the head. The present study analyzed contact head wounds owing to 26 centerfire rifles and nine shotgun slugs and compared them with respect to weapon, ammunition, entry wound site, and projectile kinetic energy. The bursting effect, defined for this study as disruption of at least 50% of the head, occurred in 25/35 of cases and was related to kinetic energy. Bursting was associated with energies <2700 ft-lbs in 12/22 cases and energies >2700 ft-lbs in 13/13 cases. The volume of gunpowder gas injected into the wound was considered as contributing to the bursting phenomenon. There was no relation of bursting to the specific entrance wound site, type of ammunition, or projectile fragmentation. © 2012 American Academy of Forensic Sciences. Source


Petersen T.H.,Duke University | Williams T.,King County Medical Examiners Office | Nuwayhid N.,Forensic Laboratory Services Bureau | Harruff R.,King County Medical Examiners Office
Journal of Forensic Sciences | Year: 2012

Isopropanol (IPA) detected in deaths because of diabetic ketoacidosis (DKA) or alcoholic ketoacidosis (AKA) may cause concern for IPA poisoning. This study addressed this concern in a 15-year retrospective review of 260 deaths in which concentrations of acetone and IPA, as well as their ratios, were compared in DKA (175 cases), AKA (79 cases), and IPA intoxication (six cases). The results demonstrated the frequency of detecting IPA in ketoacidosis when there was no evidence of IPA ingestion. IPA was detectable in 77% of DKA cases with quantifiable concentrations averaging 15.1±13.0 mg/dL; 52% of AKA cases with quantifiable concentrations averaging 18.5±22.1mg/dL; and in cases of IPA intoxication, averaging 326±260mg/dL. There was weak correlation of IPA production with postmortem interval in DKA only (r=-0.48). Although IPA concentrations were much higher with ingestion, potentially toxic concentrations were achievable in DKA without known ingestion. © 2012 American Academy of Forensic Sciences. Source

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