Hanging deaths from investigation standpoint are rarely problematic. Unusual circumstances can on occasion raise suspicion of foul play. Associated neck injuries are reported in the literature with variable frequency (from 0% to 76.8%). This study retrospectively analyzed 755 hanging deaths in Ontario (Canada) to evaluate the demographic features and circumstances of hanging fatalities, and the frequency of hanging-related neck injuries. A number of cases showed unusual/special circumstances (e.g., complex, double suicides, restraints). Among 632 cases with complete autopsies, hyoid and larynx fractures were present in 46 cases (7.3%) with the most common being isolated hyoid fractures. The incidence of cricoid fractures was 0.5% and cervical spine injuries, 1.1%. A higher incidence of neck injuries occurred among males, long drop hangings, and in cases with complete suspension. There was a tendency for the number of fractures to increase with increasing age and weight of the deceased.

Reference charts for body and organ measurements of neonates and infants were derived from data on 900 investigations done by the Office of the Chief Coroner for Ontario. The statistical analyses in this new reference source addressed deficiencies in sources currently available to pathologists.The present study also considered whether organ weights differed based on the classification of infant deaths using the original definition of either sudden infant death syndrome (SIDS) or sudden unexplained death (SUDS) which considers cases occurring in an unsafe sleeping environment or under adverse socioeconomic conditions. Cases of SUDS for both sexes peaked in 5 to 16 weeks of age. The thymus in the SUDS/SIDS age groups less than 25 weeks weighed more than the control group. Adrenal weights in SUDS cases between 9 and 16 weeks weighed less than SIDS cases. This could mean that deaths in unsafe sleep environments are truly sudden in infants who may have a limited adrenal response to acute hypoxia but have been unaffected by preceding chronic stressors.

Pulmonary artery intimal sarcoma (PAIS) is a very rare tumour. The prevalence of PAIS is estimated to be between 0.001% and 0.003%, but this may be an underestimation because of potential misdiagnosis due to its similar presentation to that of pulmonary thromboembolism. The prognosis is very poor, with median overall survival between 11 and 18 months. We report a case of a 36-year-old man who presented to our cardiac surgery clinic reporting nonspecific symptoms and was found to have PAIS requiring surgical resection and adjuvant chemotherapy. We outline the radiologic features, pathologic characteristics, surgical approach, and chemotherapy treatment utilized.

It is common practice in pediatric autopsies to compare the body and organ measurements of the deceased child against the existing reference data. Although a number of resources are available, many are outdated and have significant limitations. The goal of this study was to assess the reference sources currently used by the Ontario pathologists in pediatric autopsies. A survey of 14 Ontario pathologists, who do coroners' pediatric autopsies, identified 20 publications commonly referenced for body and organ measurements. Of all the cited sources, only a few had all the features regarded by the pathologists as ideal for a reference source. These features included accessibility to the source, large sample size, defined control populations, statistical analyses, and sex distinctions. The results of this study will be used to guide the development of a new reference, based on Ontario data, that will enhance measurement standards in pediatric autopsy practice.

The history is that of a 76-year-old woman with a three day history of progressive leg weakness, decreased verbal output and fever. Pertinent details of her past medical history include the fact that she had an autoimmune disease (Crohn's) and was iatrogenically immunosuppressed, although the duration of prednisone treatment was not provided. She was a 55 pack-year smoker, increasing her chances of having an underlying malignancy. She was also described as having an "active" lifestyle, perhaps increasing her exposure to environmental factors, and she presented in August, which may be of further relevance. The initial examination by the medicine team revealed a cardiac murmur and a fever, for which she was started on Ceftriaxone and Acyclovir. No mention was made of any retinal or skin lesions. She was noted by the admitting team to be "staring blankly", although whether this was continuous, as might be expected in an encephalitic or encephalopathic process, or was intermittent, suggesting the possibility of underlying subclinical seizures, was not further described. The neurological examination the following day disclosed that she was "vocalizing more", able to follow commands with reasonable comprehension and oriented to time and person, but not to place. The cranial nerves were normal. Her arms were mildly weak with no specific pattern given, and legs much weaker in a pattern of symmetric involvement of quadriceps to about the same degree as hamstrings, suggesting that this was not solely a "pyramidal pattern" weakness. An important observation was that some deep tendon reflexes were hyperreflexic (biceps and ankles, where there was clonus), but NEUROPATHOLOGICAL CONFERENCE