Tumescent liposuction can be fatal, perhaps in part because of lidocaine toxicity or lidocaine-related drug interactions.

Context In March 2009, a novel swine-origin influenza A/H1N1 virus was identified. After global spread, the World Health Organization in June declared the first influenza pandemic in 41 years. Objective To describe the clinicopathologic characteristics of 34 people who died following confirmed A/H1N1 infection with emphasis on the pulmonary pathology findings. Design We reviewed medical records, autopsy reports, microbiologic studies, and microscopic slides of 34 people who died between May 15 and July 9, 2009, and were investigated either by the New York City Office of Chief Medical Examiner (32 deaths) or through the consultation service of a coauthor (2 deaths). Results Most of the 34 decedents (62%) were between 25 and 49 years old (median, 41.5 years). Tracheitis, bronchiolitis, and diffuse alveolar damage were noted in most cases. Influenza viral antigen was observed most commonly in the epithelium of the tracheobronchial tree but also in alveolar epithelial cells and macrophages. Most cases were reverse transcription–polymerase chain reaction positive for influenza. Histologic and microbiologic autopsy evidence of bacterial pneumonia was detected in 55% of cases. Underlying medical conditions including cardiorespiratory diseases and immunosuppression were present in 91% of cases. Obesity (body mass index, >30) was noted in 72% of adult and adolescent cases. Conclusions The pulmonary pathologic findings in fatal disease caused by the novel pandemic influenza virus are similar to findings identified in past pandemics. Superimposed bacterial infections of the respiratory tract were common. Preexisting obesity, cardiorespiratory diseases, and other comorbidities also were prominent findings among the decedents.

Conjunctival and facial petechiae, although nonspecific findings, are considered hallmarks of asphyxial deaths. Consensus in the literature suggests that their pathogenesis is related to the combined effects of increased cephalic venous pressure and hypoxic damage to endothelial cells. Despite the common knowledge that they are neither predictable findings in all asphyxial deaths nor rare in natural, nonaphyxial deaths, the belief persists that petechiae are corroborative evidence of asphyxia. We suggest that a clear, physiologically based understanding of the pathogenesis of petechiae of the head is critical for their appropriate interpretation. We present a review of the literature and the basis of our conclusion that conjunctival and facial petechiae are the product of purely mechanical vascular phenomena, unrelated to asphyxia or hypoxia.

The words, "you have breast cancer," is possibly one of the most devastating statements an individual could image hearing from his or her physician even though breast cancer is the most common cancer among women. The diagnosis bears a significant amount of anxiety and fear in regards to treatment and overall survival. However, research has increased healthcare professionals' knowledge on the benefits of early screening, diagnosis, and treatments, which has steadily reduced the death rate from breast cancer over the past 20 years. Physicians are better able to predict how particular breast cancers will react to treatment; therefore, they are able to choose more effective treatment options based on these findings. The goal of this article is to highlight the incidence, staging and diagnostic studies, types, treatments, and follow-up of breast cancer dispelling some of the common societal stigmas and unfounded fears surrounding this diagnosis.

The authors describe three accidental deaths resulting from occupational hazards involving environmental gas alterations. One involved the displacement of oxygen caused by leakage of liquid nitrogen during the installation of a magnetic resonance imaging system. Two involved elevated environmental carbon dioxide concentrations: dry ice sublimation in a walk-in refrigerator in a research laboratory, and activation of a carbon dioxide fire alarm-extinguisher system by a woman locked in a bank vault. The autopsy findings, scene investigations, and certifications of these deaths, as related to the mechanisms of death, are discussed.

Pulmonary thromboembolism (PE) is found commonly in forensic pathology practice, as it typically causes sudden death. It is attributed to a wide variety of predominantly acquired etiologies. Although likely etiologically multifactorial, some common proximate causes include: surgery, pregnancy, injury, inactivity of any cause, cancer, obesity, or serum hyperviscosity. On occasion, no apparent predisposing condition is identified. In these instances, occult hereditary thrombophilias may play a causal role. Deaths referred to the Office of Chief Medical Examiner (OCME) of New York City between December, 2000 and September, 2003 and due to PE were retrospectively reviewed. Molecular analysis (FRET) was performed on selected cases for three common hereditary thrombophilias: mutations in factor V Leiden (FVL), prothrombin G20210A (PT), and methylenetetrahydrofolate reductase (MTHFR).During the study period, 124 of 15,280 deaths were primarily attributable to PE. Of those, 34 were selected for molecular analysis. One or more mutations were detected in 35% of those, five of which were clearly causally related to death. Given the potential benefits to surviving family members, our data indicate that postmortem molecular testing for the common hereditary thrombophilias is warranted in at least selected cases.

Homicides due to neck compression have been noted to commonly occur with sexual assault motives. We reviewed all female homicides in which the cause of death involved neck compression, smothering, and/or asphyxia. Medical examiner records included autopsy, toxicology, and investigators' reports. There were 78 homicides: age from 8-81 years (mean 35 years). The causes of death involved: 68 neck compressions, eight smotherings, and two homicidal asphyxias. Of the deaths caused by neck compression: 93% had injury of the soft tissues of the neck, 80% had external neck injury, 79% had petechiae of the eyes/face, and 28% had a fractured hyoid and/ or thyroid cartilage. Three decedents (4%) had no external injury or petechiae but did have soft tissue injury on internal examination. There was evidence of recent sexual activity/assault in 34/78 (44%) decedents. Although the majority of deaths due to compression of the neck had evidence of external injury and petechiae, deaths due to compression of the neck can be missed without an internal examination (20% had no external neck injury, and 4% had no external neck injury or petechiae). The absence of external injury or hyoid/thyroid cartilage fracture does not exclude fatal neck compression. The association of recent sexual activity/assault in 44% of the decedents supports the common forensic maxim to consider sexual assault (and collect sexual assault evidence) in instances of suspected neck compression/smothering deaths. Similarly, one should suspect neck compression in deaths with evidence of a sexual assault.

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