Nicotine is a water-soluble alkaloid extracted from tobacco plants, and most frequently encountered in snuff, chewing tobacco, cigarettes, cigars and pipe tobacco or in a limited number of pesticides. Nicotine overdose or poisoning might be serious or fatal and lead to death; caused by cardiovascular arrest, respiratory muscle paralysis, and/or central respiratory failure due to its toxic effect. Suicide by nicotine ingestion has been rarely reported due to emetic response. We present a case of suicidal nicotine poisoning. A 56-year-old man was found dead and the postmortem examination revealed no injury or disease. We confirmed a high concentration of nicotine in the toxicological test. Through scene investigation, we determined this case as a suicidal nicotine poisoning.
Autopsy ; Eating ; Humans ; Middle Aged ; Nicotine* ; Pesticides ; Poisoning* ; Respiratory Insufficiency ; Respiratory Paralysis ; Suicide ; Tobacco ; Tobacco Products ; Tobacco, Smokeless

Thoracic aortic aneurysms are less common than abdominal aortic aneurysms, however they are life-threatening and usually asymptomatic until acute complications occur. The majority of thoracic aorta aneurysm are associated with medial degeneration rather than atherosclerosis and the fusiform aortic aneurysm is common. Considering that it usually occurs during the sixth and seventh decades of life, its occurrence in a peripartum woman is unusual. Aortic dissection or thoracic aortic aneurysm with aortic insufficiency during pregnancy or peripartum has been reported, however, to our knowledge, the case of ascending thoracic aortic aneurysm in peripartum women, with saccular type without aortic valve involvement but not diffuse dilatation, has not been reported. Herein, we presented two autopsy cases of ascending thoracic aortic aneurysm during postpartum.
Aneurysm ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortic Aneurysm, Thoracic ; Aortic Valve ; Atherosclerosis ; Autopsy ; Dilatation ; Female ; Humans ; Peripartum Period ; Postpartum Period ; Pregnancy ; Rupture

Thyrotoxicosis (thyroid crisis) is a known cause of sudden death; however, only a few cases of death resulting from thyrotoxicosis have been reported. Histopathologic examination and postmortem thyroid function tests may be helpful in postmortem diagnosis, but their usefulness seems to be limited. We report three autopsy cases associated with thyrotoxicosis.
Autopsy ; Death, Sudden ; Thyroid Crisis ; Thyroid Function Tests ; Thyrotoxicosis

Mushroom poisoning widely reported in Oriental and Western literature, is typically caused by accidental ingestion of toxic mushrooms that resemble edible mushrooms. Reports about poisoning due to species of Omphalotus, Amanita, Clitocybe, and other toxic mushroom species have been reported; toxicity depends on the mushroom species and the amount of toxin, which varies according to the climatic and environmental conditions. Symptoms of poisoning, such as unspecific nausea, vomiting, and diarrhea, as well as intestinal, hepatic and renal toxicities, also vary according to the mushroom species. Most patients recover with anti-muscarinic therapy and supportive care for nonspecific symptoms; however some cases of poisoning are fatal in children and elderly people. We report a case of sudden death due to mushroom poisoning in a 74-year-old woman, with hemorrhagic enteritis.
Agaricales* ; Aged ; Amanita ; Child ; Death, Sudden ; Diarrhea ; Eating ; Enteritis* ; Female ; Humans ; Mushroom Poisoning* ; Nausea ; Poisoning ; Vomiting

This study presents a case of sudden cardiac death due to cardiac small vessel vasculitis after coronavirus disease 2019 (COVID-19) mRNA vaccination (BNT162b2). The deceased was a 76-year-old woman with diabetes mellitus (DM) and chronic hypertension (HTN), who experienced generalized pain for a month after the first dose of vaccination, and unexpectedly died. Postmortem examination revealed small vessel vasculitis in the heart, lungs and vaccinated site of the left arm. These features were similar to those observed in a previously reported case of a patient with COVID-19 and cardiac endotheliitis and multisystem inflammatory syndrome. In addition, DM and HTN may contribute to vaccine-induced immunologic changes and vascular dysfunction. However, further studies with additional cases are needed.

Purpose: We analyzed postoperative Frisby-Davis distance (FD2) stereotest scores and changes in the angle of deviation, and the correlation between postoperative FD2 stereotest scores and long-term surgical outcomes, in patients with intermittent exotropia. Methods: This retrospective study included patients aged less than 12 years with intermittent exotropia who underwent at least 28 months of postoperative follow-up. We analyzed the changes in the postoperative angle of deviation and preoperative and postoperative Titmus and FD2 stereotest scores. Surgical success rates at 28 months postoperatively were compared between the good (FD2 at 10 months postoperatively ≤ 10 arcsec) and bad (FD2 at 10 months postoperatively ≥ 15 arcsec) stereotest groups. Surgical success was defined as a horizontal deviation on distance measurement of 5 prism diopter (PD) esodeviation to 10 PD exodeviation at 1 year postoperatively. Results: This study included 101 patients. No significant difference was identified between preoperative and postoperative Titmus test scores. However, the FD2 stereotest scores were significantly improved at 10 months postoperatively (p = 0.001). A significant, positive correlation was observed between FD2 stereotest scores at 10 months postoperatively and the angles of deviation at distance at 10, 16, 22, and 28 months postoperatively (p ≤ 0.001 for all). The surgical success rates at 28 months postoperatively were 73.1% and 43.5% in the good and bad stereotest groups, respectively (p = 0.008). Conclusions Distance stereoacuity within 1 year postoperatively correlated with the postoperative angle of deviation at distance. Good distance stereoacuity (i.e., < 10 arcsec) within 1 year postoperatively correlated with a higher surgical success rate compared to bad distance stereoacuity.

This study presents a case of a patient who experienced sudden death due to fatal nitrite poisoning in the medical setting. It also highlights the pivotal role of postmortem examination in enhancing quality assurance in clinical medicine, as well as in providing resolutions for medicolegal disputes to all pertinent stakeholders, regarding the patient’s death. The patient was found dead during admission after orthopedic surgery. The death certificate was issued by the clinician attributing the cause of death to respiratory failure due to pulmonary embolism. This medical certification of death instigated medicolegal disputes, resulting in allegations of medical negligence or malpractice. Subsequently, a death investigation was initiated, and a postmortem examination confirmed nitrite poisoning as the cause of death. This medical evidence obtained from the autopsy could provide clarity in resolving medicolegal disputes surrounding the patient’s unexpected death in a medical setting. Moreover, a comprehensive review of all information obtained through a death investigation could offer valuable insights even for clinicians, as well as for patient’s family and other stakeholders. This includes guidance on certifying the cause of death based on varying levels of medical evidence and implementing preventive measures to enhance patient safety and mitigate the occurrence of unexpected death in the medical setting.

A 39-year-old man, his 35-year-old wife, and their 13-year-old daughter were found dead in their home. The man and his daughter were found lying in her bedroom, with his head wrapped in a plastic bag connected to four helium gas cylinders by green polypropylene tubes. Fragments of the burnt ignition briquette were found in the bucket located at her feet. His wife was found in a decomposed state lying on her right side in her bedroom. Autopsy findings for the man were unremarkable except for cherry pink lividity; the blood carboxyhemoglobin concentration was 73%. Autopsy findings were unremarkable for the woman as well, except for a few petechial hemorrhages and conjunctival congestion. The daughter showed no definite abnormalities; however, her blood and lung contained helium gas. The deceased man's suicide note, evidence gathered at the scene, and postmortem examination revealed that this was a case of dyadic death.
Adolescent ; Adult ; Asphyxia ; Autopsy* ; Carboxyhemoglobin ; Deception ; Estrogens, Conjugated (USP) ; Female ; Foot ; Head ; Helium* ; Hemorrhage ; Humans ; Lung ; Nuclear Family ; Plastics ; Polypropylenes ; Prunus ; Spouses ; Suicide

Deaths of suspects or inmates while in custody and incarceration is a tragedy for families and could become a public issue. Such deaths occur within a complicated brew of ethical and legal hurdles that must be handled with caution. We conducted a survey about these deaths. We collected and reviewed 85 cases of death that occurred while in custody and incarceration in Seoul and the Gyeonggi province, including e postmortem examinations between 2004 and 2011. Natural causes (most commonly cardiovascular diseases) accounted for nearly half of the deaths in custody, and unnatural causes accounted for nearly all of the remainder. Suicidal strangulation (hanging and self-strangulation) was the most common cause, followed by poisoning. Natural deaths by cardiovascular disease and unnatural deaths by suicidal strangulations, poisoning accounted for most cases of death while in custody and during incarceration. We hope this study can facilitate policy proposals to address this problem, helping authorities to reduce the occurrences of these preventable and untimely deaths of individuals in custody and incarceration.
Autopsy ; Cardiovascular Diseases ; Humans ; Police

We report a case of fatal water intoxication in a schizophrenic patient. A 41-year-old schizophrenic male, who was admitted to a psychiatric hospital, was found dead in the restroom of the hospital. He had drunk many bowls of tap water before. On the postmortem examination, the brain was diffusely edematous, but no apparent herniation was noted. The lung was mildly expanded with edema. The stomach and intestine were diffusely expanded, and the intestine and mesentery were extensively edematous. Bilateral hydronephrosis was observed. A subcapsular hematoma with focal cortical rupture was observed in the right kidney. The vitreous sodium was 102 mEq/l and potassium was 10.5 mEq/l.
Adult ; Autopsy ; Brain ; Edema ; Hematoma ; Hospitals, Psychiatric ; Humans ; Hydronephrosis ; Intestines ; Kidney ; Lung ; Male ; Mesentery ; Potassium ; Rupture ; Sodium ; Stomach ; Water Intoxication