Summit County Medical Examiners Office

Akron, OH, United States

Summit County Medical Examiners Office

Akron, OH, United States
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Watterson J.H.,Laurentian University | Desrosiers N.A.,Laurentian University | Betit C.C.,Laurentian University | Dean D.,Summit County Medical Examiners Office | Wyman J.F.,Franklin County Coroners Office
Journal of Analytical Toxicology | Year: 2010

Skeletal tissues from a domestic pig exposed to amitriptyline, diazepam, and pentobarbital were analyzed to determine the relative distribution of these drugs in bone. Following drug exposure and euthanasia, remains were allowed to decompose outdoors to complete skeletonization between summer 2007 and fall 2009. Remains were recovered and separated according to bone type. Twelve different bone types were pulverized and sampled in triplicate. Each bone sample underwent methanolic extraction (96 h, 50°C), followed by solid-phase extraction and gas chromatography-mass spectrometry in the selected ion monitoring mode. Mass-normalized assay responses underwent ANOVA with post-hoc testing, revealing bone type as a main effect for all three drugs, but not for the diazepam metabolite (nordiazepam). The assay response varied with respect to bone type by factors of 27, 39, and 20 for pentobarbital, diazepam, and amitriptyline, respectively. The relative distribution between bone type was qualitatively similar for the three administered drugs analyzed for, with the largest response obtained from rib for all three drugs. This is the first study, to the authors' knowledge, of the distribution of different drugs in various decomposed skeletal tissues in a controlled experiment using an animal model of comparable physiology to humans. These data have implications for the interpretive value of forensic drug measurements in skeletal tissues. © 2010 Publishing Technology.

Dean D.E.,Summit County Medical Examiners Office | Jamison J.M.,Wright State University | Lane J.L.,Summa Akron City Hospital
Journal of Forensic Sciences | Year: 2014

Peritonitis secondary to spontaneous rupture/perforation of the gall bladder is a rare condition overall and is even less common in the forensic population. We report the case of a middle-aged man who died from generalized peritonitis from gall bladder perforation due to acute acalculous cholecystitis. This condition usually occurs in critical patients with systemic illness, and although the exact pathogenesis remains unclear, the development of acalculous cholecystitis appears to be multifactorial. Antemortem diagnosis is reliant upon clinical presentation, laboratory data, and radiologic studies. Surgery and appropriate antibiotics are mainstays of treatment; however, there is an emerging role for minimally invasive procedures. Histopathologic features show significant overlap with the calculous type. Although increasing numbers of acalculous cholecystitis have been diagnosed in the critically ill, the fatal presentation of a perforated gall bladder following an undiagnosed case of acute acalculous cholecystitis is unusual in a nonhospitalized and ambulatory man. © 2014 American Academy of Forensic Sciences.

Woods S.A.,Akron Children’s Hospital | Robinson H.B.,Akron Children’s Hospital | Kohler L.J.,Summit County Medical Examiners Office | Agamanolis D.,Akron Children’s Hospital | And 2 more authors.
American Journal of Medical Genetics, Part A | Year: 2014

Rubinstein-Taybi syndrome (RTS) and Cornelia de Lange syndrome (CdLS) are genetically heterogeneous multiple anomalies syndromes, each having a distinctive facial gestalt. Two genes (CREBBP and EP300) are known to cause RTS, and five (NIPBL, SMC1A, SMC3, RAD21, and HDAC8) have been associated with CdLS. A diagnosis of RTS or CdLS is molecularly confirmed in only 65% of clinically identified cases, suggesting that additional causative genes exist for both conditions. In addition, although EP300 and CREBBP encode homologous proteins and perform similar functions, only eight EP300 positive RTS patients have been reported, suggesting that patients with EP300 mutations might be escaping clinical recognition. We report on a child with multiple congenital abnormalities and intellectual disability whose facial features and complex phenotype resemble CdLS. However, no mutations in CdLS-related genes were identified. Rather, a novel EP300 mutation was found on whole exome sequencing. Possible links between EP300 and genes causing CdLS are evident in the literature. Both EP300 and HDAC8 are involved in the regulation of TP53 transcriptional activity. In addition, p300 and other chromatin associated proteins, including NIPBL, SMCA1, and SMC3, have been found at enhancer regions in different cell types. It is therefore possible that EP300 and CdLS-related genes are involved in additional shared pathways, producing overlapping phenotypes. As whole exome sequencing becomes more widely utilized, the diverse phenotypes associated with EP300 mutations should be better understood. In the meantime, testing for EP300 mutations in those with features of CdLS may be warranted. © 2013 Wiley Periodicals, Inc.

Ramos J.,HealthCare Partners | Dean D.E.,Summit County Medical Examiners Office | Tarakji E.,Valley Gastroenterology Consultants | Rich J.,HealthCare Partners Institute for Applied Research and Education
Clinical Journal of Gastroenterology | Year: 2011

We report on a patient with left-sided abdominal pain thought to be caused by recurring diverticulitis. Computed tomography of the sigmoid colon revealed diverticulosis without the presence of a foreign body. During colonoscopy, a phytobezoar in the form of a vegetable stem was discovered transversely impacted within two diverticular openings in the lumen of the sigmoid colon. A localized inflammatory reaction was present without obstruction or perforation. After endoscopic removal of the phytobezoar, the abdominal pain resolved. The patient's presumed diverticulitis was an inflammatory reaction caused by the phytobezoar. This case highlights the importance of early detection and endoscopic removal of a colonic foreign body to prevent abscess formation, fistulas, obstruction, perforation, or peritonitis. Foreign bodies masquerading as colonic diverticulitis should be considered in the absence of more common diseases. © 2011 Springer.

Desrosiers N.A.,Laurentian University | Watterson J.H.,Laurentian University | Dean D.,Summit County Medical Examiners Office | Wyman J.F.,Cuyahoga County Regional Forensic Science Laboratory
Journal of Forensic Sciences | Year: 2012

Skeletal remains of a domestic pig were assessed for relative distribution of amitriptyline, citalopram, and metabolites. Following acute exposure and outdoor decomposition for 2years, drugs and metabolites were analyzed in 13 different bones. Bones were pulverized following a simple wash procedure, and drugs were extracted by passive incubation in methanol, followed by solid-phase extraction. Samples were analyzed by ultra-high performance liquid chromatography (UHPLC) and confirmed with gas chromatography-mass spectrometry. The Kruskall-Wallis test showed that bone type was a main effect with respect to drug level for all analytes, with levels varying from 33- to 166-fold. Ratios of levels of drug to that of the corresponding metabolite were less variable, varying roughly one- to eightfold. This suggests limitations in the interpretive value of drug measurements in bone and that relative levels of drug and metabolites should be further investigated in terms of forensic value. © 2011 American Academy of Forensic Sciences.

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