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Fat embolism syndrome (FES) can be challenging to diagnose by forensic pathologists. For the diagnosis of FES, there is no benchmark test. Postmortem diagnosis requires a full autopsy and specific ancillary examination. However, the high variability in the clinical presentation of FES represents a relevant issue, and there is no consensus on the postmortem assessment. This is the case of a 33-year-old man who died of FES one week after a car accident. He suffered multiple fractures, but was hemodynamically stable and showed no neurological changes. The patient died a few days after hospital discharge. Additionally, he had osteogenesis imperfecta type III, a genetic disorder associated with bone fragility. To the best of our knowledge, no study has assessed whether and how osteogenesis imperfecta contributes to the onset of FES. Despite the heterogeneous manifestations of FES, the present case met many of the proposed clinical and histological diagnostic criteria. Therefore, we briefly review FES diagnostic criteria, show the postmortem diagnostic workup, and discuss the hypothetical link between osteogenesis imperfecta and FES. [ABSTRACT FROM AUTHOR]

Two cases in a row demonstrate the importance of autopsy in the investigation of the cause of death, even when circumstantial information and preliminary examinations suggest potentially lethal pathology, such as sub-arachnoidal or intracranial haemorrhage, arteriovenous malformation (AVM) rupture, sudden cardiac death, aortic dissection, pulmonary embolism, intoxication, etc. These two cases show how every sudden death needs further investigation to figure out what the real cause is because there are so many fatal pathologies that can cause it. Indeed, the duodenal ulcer detected in these cases cannot be diagnosed without an autopsy. External examination only may be insufficient or too generic being able, if not followed by an autopsy, to direct towards incorrect causes of death. [ABSTRACT FROM AUTHOR]

Abstract: “Autoerotic asphyxia” typically involves an individual hanging or ligature, resulting in self-induced oxygen deprivation brought about by neck compression during sexual activity. Little about the so-called “atypical forms” of autoerotic asphyxia, which also involve compression of the chest or abdomen, has been published in forensic literature. When death results from such practices, they are usually deemed accidental, however, suicide or homicide must also be considered. The authors present a single case of accidental fatal asphyxia by the simultaneous compression of the neck, chest, and abdomen using a chair-bed. The victim was known to have had masochistic tendencies. In order to confirm the hypothesis of accidental death, the results of crime scene investigations, and autopsy findings, including histological and toxicological analysis, are summarized here. [ABSTRACT FROM AUTHOR]

Abstract: Nicotine, a lipid-soluble alkaloid obtained from the dried leaves of Nicotiana, is most frequently encountered in tobacco products for smoking, chewing or sniffing as well as in a limited number of pesticides. Though nicotine is one of the most toxic drugs of abuse, it has rarely led to fatalities. Sudden death can be caused by cardiovascular arrest, respiratory muscle paralysis and/or central respiratory failure. A 42-year-old man was found dead by his wife. He was lying on the floor, next to a box containing many empty bottles of beer and vodka. Some labeled chemical bottles found at the scene contained various substances, including nicotine and brucine. Gross examination of the organs at autopsy revealed no specific findings. The toxicological examination failed to disclose any lethal toxic agents other than a high concentration of nicotine and its primary metabolite cotinine in femoral venous blood (2.2μg/mL). Blood alcohol was determined to be 2.1g/L in femoral venous blood. Only a paucity of fatal cases of nicotine poisoning has been reported in the literature so far. [Copyright &y& Elsevier]

In forensic sciences, bone marrow (BM) is an alternative matrix in postmortem toxicology because of its good resistance to autolysis and contaminations. Nevertheless, few studies have been focused on postmortem BM morphological changes after pathological stimuli. We examined 73 BM samples from forensic autopsies; causes of death were both natural and traumatic. BM samples were collected from the sternum by needle aspiration and biopsy; in selected cases, immunohistochemistry was performed. Few autolytic changes were found; BM cellularity decreased with increasing age and postmortem interval. Notable cell changes were detected in 45 cases (61.64%): neoplastic (n = 4), and non-neoplastic BM findings (n = 41), including multiorgan failure/sepsis (n = 26), myelodisplastic-like conditions (n = 11), and anaphylactic reactions (n = 4). The results showed that BM cellularity supported circumstantial and autopsy findings, suggesting that BM samples could be a useful tool in forensic science applications. [ABSTRACT FROM AUTHOR]