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Denoble P.J.,Divers Alert Network | Nelson C.L.,North Carolina Office of the Chief Medical Examiner | Ranapurwala S.I.,UNC | Caruso J.L.,Office of the Medical Examiner
Undersea and Hyperbaric Medicine | Year: 2014

Although frequently asymptomatic, left ventricular hypertrophy (LVH) is an independent predictor of sudden cardiac death (SCD). We hypothesized that diving may increase the propensity for pre-existent LVH to cause a lethal arrhythmia (and SCD) and therefore the prevalence of LVH may be greater among scuba fatalities than among traffic fatalities. We compared autopsy data for 100 scuba fatalities with 178 traffic fatalities. Extracted data contained information on age, sex, height, body mass, heart mass (HM), left ventricular wall thickness (LVWT), interventricular wall thickness (IVWT), and degree of coronary artery stenosis. A case was classified as LVH if the LVWT was > 15 mm. Log risk models were used to compare HM and LVWT in two groups while controlling for body mass, body length, age and sex. The prevalence of LVH was compared using Pearson's test. The mean HM was 428.3 ± 100 for divers and 387 ± 87 for controls. The crude HM ratio for scuba fatalities vs. controls was 1.11 (1.05, 1.17), and when controlled for sex, age and body mass the ratio was 1.06 (1.01, 1.09). The mean LVWT was 15 ± 3.5 for divers and 14 ± 2.7 for controls (p = 0.0017). HM and LVWT measured at autopsy were greater in scuba than in traffic fatalities. © Copyright 2014 Undersea & Hyperbaric Medical Society, Inc.

Garber M.A.,Engineering Systems Inc. | Canfield D.V.,FAA Civil Aerospace Medical Institute | Lewis R.J.,FAA Civil Aerospace Medical Institute | Simmons S.D.,North Carolina Office of the Chief Medical Examiner | Radisch D.L.,North Carolina Office of the Chief Medical Examiner
American Journal of Forensic Medicine and Pathology | Year: 2013

The pilot of a light aircraft that crashed after a loss of power was found to have ethanol in the vitreous and the blood, but almost none in the urine. The globes of the eyes were intact, and the body was refrigerated after recovery until the autopsy was performed the following morning. The pilot was described as a "nondrinker," and additional specialized toxicology testing results were inconsistent with ethanol ingestion. The pilot's body was extensively exposed to fuel during the prolonged extraction. Investigation determined that the aircraft had been fueled with gasoline that contained 10% ethanol. Although exposure to automotive fuel has not been previously described as a source of ethanol in postmortem specimens, it may represent a source for the ethanol detected during postmortem toxicology testing in this case, and this finding may be relevant to other cases with similar exposure. Copyright © 2013 by Lippincott Williams & Wilkins.

Bishop-Freeman S.C.,North Carolina Office of the Chief Medical Examiner | Miller A.,North Carolina Office of the Chief Medical Examiner | Hensel E.M.,North Carolina Office of the Chief Medical Examiner | Winecker R.E.,North Carolina Office of the Chief Medical Examiner
Journal of Analytical Toxicology | Year: 2015

The North Carolina Office of the Chief Medical Examiner Toxicology Laboratory identified 61 cases from 2002 to 2014 where metaxalone was detected during routine postmortem drug screening in support of a determination of cause and manner of death. Decedents were divided into groups based on the manner of death with the goal of studying metaxalone concentrations in overdose and non-overdose situations (natural, accident, suicide and undetermined). Subgroups were established for cases in which metaxalone contributed to the cause of death (attributed) and cases in which it did not (unattributed). Attributed cases were divided into those where metaxalone additively combined with other drugs and cases in which the drug was present in sufficient amounts to be the primary cause of death, regardless of other drugs present and the concentrations of those drugs. The mean metaxalone concentration for the additive deaths was 14.2 mg/L with a median value of 11 mg/L (n = 18) and a mean metaxalone concentration of 36.7 mg/L with a median value of 32 mg/L (n = 9) for primary deaths. For unattributed metaxalone concentrations, the mean was 3.4 mg/L with a median value of 2.9 mg/L (n = 31). Of the 61 cases, 34% fall at or belowa therapeutic concentration of ≤4 mg/L. The selected case studies offer valuable information regarding postmortem interpretation. © The Author 2015.

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