Faculty Bibliography

Fibrolipomas of the esophagus are extremely uncommon benign tumors. Accurate diagnosis and resection are essential, due to their tendency to become impacted and obstruct the airway. The case is presented of a 56-year-old man who died suddenly of asphyxia because of upper airway obstruction by a prolapsed fibrolipoma of the esophagus.

During the past 20 years, the sensational aspects of autoerotic fatalities have captured the attention of medical examiners, psychiatrists, law enforcement agents, and the public, as well as the individuals themselves who engage in these dangerous practices. Reports of deaths related to sexual asphyxia have been presented numerous times at national and international meetings and have been the topic of discussion on television talk shows and in the press. Autoerotic fatalities and all the sexual curiosities related to these activities have prompted death scene investigators to publish case reports, and even textbooks, on the subject. The case presented herein is one of a multicomponent paraphilia in which self-asphyxiation (autoasphyxiophilia) led to a fatal autoerotic event.

Blunt abdominal trauma can cause sudden, unexpected death due to injuries to internal organs. Rupture of a hepatic subcapsular hematoma is a relatively rare cause of sudden death following minor blunt abdominal trauma. Death may be delayed several days to weeks. The autopsy is an invaluable diagnostic tool that can be utilized to uncover sudden deaths due to abdominal trauma. The case of an alcoholic who died of a ruptured hepatic subcapsular hematoma is presented. The death investigation revealed that the victim had sustained blunt abdominal trauma during a fall a few days prior to death.

The first legalized casino-hotel opened in Atlantic City, New Jersey in 1978. Annually, more than 30 million people visit the "Gambling Capitol of the East Coast." As a result of this growing influx of people, the Atlantic County Medical Examiner's Office began compiling statistics in 1982 of casino-related deaths. Data on 398 casino-related deaths occurring in 1982-1986 were collected and analyzed: 83% of the total number of fatalities were sudden cardiac deaths. Most of the victims were elderly white retired men who had previously diagnosed medical conditions. Many of the victims' underlying medical problems are of a type known to be associated with compulsive gambling. The majority of deaths occurred during the afternoon hours on weekends in October, January, and May. Of the victims, 86% were from New Jersey, New York, and Pennsylvania. For Atlantic City, a gambling community known to have a relatively high rate of crime and drug-trafficking, only 1% of all deaths were homicides. We speculate that the stress of gambling activities may induce sudden cardiac death. We therefore recommend that communities planning to legalize casino gambling mandate that gambling establishments provide emergency health care services for their patrons.

The medical examiner is responsible for certifying and determining the cause of death of any person dying from criminal violence, accident, suicide, when unattended by a physician, in police custody, or in any suspicious or unusual manner. A less well-recognized, but no less important, responsibility of the medical examiner is the investigation of deaths of individuals who die at the workplace. The manner of death of most job-related fatalities has been traditionally classified as accidental. In recent times, prosecutors have scrutinized these cases more carefully. The results of some investigations have prompted them to bring criminal charges against employers for blatant negligence that contributed directly to injuries and deaths of employees. This paper is devoted to a review of the controversy surrounding the issue of industrial homicide, illustrative cases, and the role of the medical examiner in the investigation of deaths at the workplace.

In recent years, religious objection to autopsy has become an ethical dilemma for medical examiners. We present two cases that illustrate these dilemmas, and we also review the history and legal considerations of religious objection to autopsy.

A conceptual approach is presented herein to assist forensic pathologists in their courtroom explanation of asphyxial deaths due to strangulation. Two-dimensional visual aids have been designed for jurors to understand easily the anatomic structures of the neck, the classic external features of asphyxia, and the directionality of force applied to the neck, as well as internal neck injuries associated with various forces.

Superior pancreaticoduodenal artery aneurysms are rare; their rupture often leads to sudden death. We report a case of a 59-year-old hypertensive man who died of a massive retroperitoneal hemorrhage following rupture of an aneurysm of the superior pancreaticoduodenal artery. We also discuss this unusual vascular lesion and review the pertinent literature.

The upper torso of a man was discovered under a highway sign next to tire tread marks leading from the highway and continuing beyond the sign. The victim's lower torso and automobile were also found along the same path 31 m (101 ft) and 41 m (133 ft) beyond the sign, respectively. The decedent was initially thought to be a disposed, homicide victim who had been dismembered by his assailant(s). Accident reconstruction revealed that the victim was the driver of the automobile and was transected by the highway sign stanchion as he protruded through the passenger side window of his moving vehicle. Based on the scene findings, autopsy, and psychological autopsy, the manner of death was classified as suicidal. The criteria used by medical examiners for vehicular suicide are also discussed.

A case of a harness racing accident in which the driver died of head injuries is presented. To evaluate the victim's head injury and corresponding helmet damage, a videotape of the race was reviewed and analyzed. Based on calculations of a simplified trajectory analysis and testing of the helmet, it was determined that the helmet design did not provide adequate protection for the victim. The standards for harness helmet design are being re-evaluated by the harness racing industry to ensure the safety of the drivers. A review of 178 harness racing injuries and deaths, current harness helmet research, and recommendations for safer helmets are discussed. A protocol for the forensic investigation of sports-related injuries and/or deaths is also presented to assist medical examiners in fulfilling their roles as practitioners of preventive medicine.