Papers by Gregory A Schmunk
Academic forensic pathology, Sep 1, 2013
Academic forensic pathology, Mar 1, 2013
Objective Forensic pathologists play a vital role in the justice system in matters concerning que... more Objective Forensic pathologists play a vital role in the justice system in matters concerning questions of death. Science as applied in the justice system should be objective and neutral. Since the goals of medical examiners and coroners are to determine the cause and manner of death for certification and public health functions (goals different and distinct from the missions of law enforcement agencies), it is important that medicolegal death investigation be independent. Accurate investigation, examination, reporting, and testimony by forensic pathologists are important to determine the cause and manner of death of individuals who die under sudden, unexpected, or violent circumstances. These cases can become the focus of political or legal pressure by individuals or offices seeking to influence the pathologist's findings. This pressure, even if seemingly unsuccessful in an individual case, can introduce error, bias, and corruption into the medicolegal investigation process. This paper reinforces the principle that medical examiners, coroners and forensic pathologists should be allowed to perform medicolegal investigations free of these influences. Participants The ad hoc Committee on Medical Examiner Independence of the National Association of Medical Examiners (NAME), a self-selected volunteer committee, developed this position paper. The findings are based on surveys of the NAME membership regarding members’ experience with, and reaction to, outside influence. Evidence Surveys of NAME members revealed that medical examiner independence was important to most members. Over 70% of survey respondents had been subjected to pressures to influence their findings, and many had suffered negative consequences for resisting those influences. In a separate study, over 30% of respondents indicated that fear of litigation affected their diagnostic decision-making. In 2009, the National Research Council of the National Academies published recommendations to strengthen the forensic sciences; they specifically recommended that medical examiner and coroner offices should be independent from law enforcement agencies and prosecutors’ offices. Consensus Process This position paper represents the consensus of the ad hoc Committee on Medical Examiner Independence, submitted to the Executive Committee and Board of Directors of NAME, and subject to comment and review by the membership. Conclusions It is the position of NAME that forensic pathologists working in or for medical examiner or coroner offices or as private consultants should be permitted to objectively pursue and report the facts and their opinions of those cases which they are investigating independent of political influences from other agencies within their respective jurisdictions and independent of the threat of litigation.
Academic forensic pathology, Mar 1, 2013
The National Association of Medical Examiners (NAME) endorsed a position paper on the medical exa... more The National Association of Medical Examiners (NAME) endorsed a position paper on the medical examiner/coroner (ME/C) release of organs and tissues in cases falling under ME/C jurisdiction in 2007; this paper has now sunsetted. The goal of this paper is to provide an update on ME/C denials and to reaffirm NAME's position on this topic. In sum- mary, it is the position of NAME that ME/Cs should permit the procurement of organs and tis- sues in cases falling under their jurisdiction, providing that there are cooperative agreements in place to ensure that ME/Cs are able to fulfill their legal mandates regarding determination of cause and manner of death and of appropriate collection and preservation of evidence.
Academic forensic pathology, Dec 1, 2014
The medical examiner community plays a key role in the organ and tissue procurement process for t... more The medical examiner community plays a key role in the organ and tissue procurement process for transplantation. Since many, if not most, potential organ or tissue donors fall under medicolegal jurisdiction, the medical examiner bears responsibility to authorize or deny the procurement of organs or tissues on a case-by-case basis. This responsibility engenders a basic dichotomy for the medical examiner's decision-making process. In cases falling under his/her jurisdiction, the medical examiner must balance the medicolegal responsibility centered on the decedent with the societal responsibility to respect the wishes of the decedent and/or next of kin in order to help living patients. Much has been written on this complex issue in both the forensic pathology and the transplantation literature. Several studies and surveys of medical examiner practices as well as suggested protocols for handling certain types of cases are available for reference when concerns arise that procurement may potentially hinder medicolegal death investigation. It is the position of the National Association of Medical Examiners (NAME) that the procurement of organs and/or tissues for transplantation can be accomplished in virtually all cases without detriment to evidence collection, postmortem examination, determination of cause and manner of death, or the conducting of criminal or civil legal proceedings. The purpose of this position paper is to review the available data, the arguments for and against medical examiner release, and to encourage the release of organs and tissues in all but the rarest of circumstances.
Academic Forensic Pathology, 2016
The Journal of Immunology
Populations of interleukin 3 (IL 3)-dependent cells can be derived from mouse bone marrow that di... more Populations of interleukin 3 (IL 3)-dependent cells can be derived from mouse bone marrow that display natural cytotoxicity (NC) against Wehi-164 target cells but do not display natural killing against YAC-1 cells. These bone marrow-derived NC cells cultured up to 2 mo in IL 3 do not contain rearranged T cell receptor beta-chain genes. They appear to be mast-like cells by electron microscopy and contain heterogeneous type granules. The molecules that mediate NC appear to be contained in these granules and are preformed because protein synthesis inhibitors have no effect on the capacity of IL 3-dependent NC cells to lyse Wehi-164 target cells. In addition to the IL 3-dependent bone marrow-derived cells, the basophilic leukemia cells, RBL-1, but not P815 mastocytoma cells were found to mediate NC against Wehi-164 cells. Both bone marrow-derived NC and RBL-1 cells can lyse L929 cells in 18 hr, suggesting that the putative NC mediator may be related to lymphotoxin/tumor necrosis factor ...
Academic Forensic Pathology, 2012
Iowa medicine : journal of the Iowa Medical Society
Neuropsychopharmacology, 2001
To establish whether chronic opiate exposure might impair brain dopaminergic or serotonergic func... more To establish whether chronic opiate exposure might impair brain dopaminergic or serotonergic function in humans, we assessed biochemical indices of monoaminergic neurotransmitter activity and integrity in post mortem striatum of nine chronic heroin users and 14 control subjects. Striatal levels of the vesicular monoamine transporter were normal, suggesting that the density of dopamine nerve terminals is not reduced in heroin users. In nucleus accumbens, levels of tyrosine hydroxylase protein (-25%) and those of the dopamine metabolite homovanillic acid (-33%) were reduced significantly together with a trend for decreased dopamine (-32%) concentration. These changes could reflect either a compensatory downregulation of dopamine biosynthesis in response to prolonged dopaminergic stimulation caused by heroin, or reduced axoplasmic transport of tyrosine hydroxylase. Striatal levels of serotonin were either normal or elevated whereas concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid were decreased by 27-38%. Our data suggest that chronic heroin exposure might produce a modest reduction in dopaminergic and serotonergic activity that could affect motivational state and impulse control, respectively.
Journal of Neurosurgery, 1999
Colloid cysts of the third ventricle are well described in the neuroscience literature; however, ... more Colloid cysts of the third ventricle are well described in the neuroscience literature; however, we were unable to find any reports in which hemorrhagic colloid cysts were described. This 60-year-old man had a 5-year history of follicular mixed lymphoma. After completing chemotherapy, he experienced acute nonlymphocytic leukemia with chronic thrombocytopenia. Magnetic resonance imaging of the head was obtained because the patient complained of persistent nausea and vomiting (Fig. 1). One day later, the patient died unexpectedly from causes unrelated to his malignancy or intracranial disease. On gross examination, the patient’s brain revealed a well-circumscribed dark-brown and black hemorrhagic mass adherent to the roof of the third ventricle with no intraventricular blood. Microscopic sections revealed a well-circumscribed, fibrotic, hemorrhagic colloid cyst containing large amounts of hemorrhage of varying ages (Fig. 2). Freshly extravasated red blood cells were seen, as well as abundant deposits of hemosiderin. At the periphery, focally preserved patches of well-differentiated, mucin-producing, simple cuboidal epithelium were observed (Fig. 3). Also, a few cystic cavities, which were lined by similar epithelium and contained periodic acid/Schiff–positive colloid, were found in the fibrotic capsule. There was no evidence of infiltration of the colloid cyst or other sections of brain by lymphoma. Colloid cysts of the third ventricle have accounted for 0.5 to 2% of
The American Journal of Forensic Medicine and Pathology, 1993
Journal of Forensic Sciences, 2021
Editor, In their study of a possible medical childabuse case, researchers demonstrate how uninten... more Editor, In their study of a possible medical childabuse case, researchers demonstrate how unintentional biases can contaminate decisions on the manner of death [1]. Focusing on medical child abuse is particularly appropriate, as there is widespread evidence of both underdiagnosis and overdiagnosis in these cases, both of which can have disastrous impact on the child, or the parents, respectively [2]. It is also very appropriate (and overdue) that they call attention to the powerful impact that bias can have on our diagnostic decisions more generally. We have known for decades that bias can lead to diagnostic errors in health care, as in every profession that depends on analytical thinking [3], and that overconfidence in the quality of our decisionmaking is similarly ubiquitous [4]. Why would forensic pathology be an exception? Research studies like this should be welcomed by the field. First, the study highlights the need to improve our understanding of biased decision making in the forensic sciences. Further, the study offers important suggestions on how to mitigate the impact of bias, complementing suggestions that are emerging in healthcare diagnosis more generally [5]. Mark L. Graber MD, FACP Founder and President Emeritus, Society to Improve Diagnosis in Medicine, Plymouth, Massachusetts, USA Email: [email protected] ORCID Mark L. Graber https://orcid.org/0000-0002-3600-0446
Journal of Forensic Sciences, 2000
We measured concentrations of cocaine and its major metabolites (benzoylecgonine, ecgonine methyl... more We measured concentrations of cocaine and its major metabolites (benzoylecgonine, ecgonine methylester, norcocaine, and cocaethylene) in 15 autopsied brain regions of 14 human chronic cocaine users. Only slight differences were observed in concentrations of cocaine and its metabolites amongst the examined brain areas. Although it is likely that some postmortem redistribution of the drug must have occurred, our data are consistent with the possibility that behaviorally relevant doses of cocaine are widely distributed throughout the brain of humans who use the drug on a chronic basis. Consideration should therefore be given to the possible pharmacological and toxicological actions of cocaine in both striatal and extra-striatal brain areas in human users of the drug.
Journal of Forensic Sciences, 2001
Despite the increasing incidence of illicit use of gamma-hydroxybutyrate (GHB), little informatio... more Despite the increasing incidence of illicit use of gamma-hydroxybutyrate (GHB), little information is available documenting levels of the drug in GHB fatalities. We measured GHB levels in postmortem blood, brain and hair specimens from a suspected overdose case by gas chromatography/mass spectrometry (GC/MS) following solid phase extraction (SPE) and derivatization with bis(trimethyl-silyl) trifluoroacetamide (BSTFA). Examination found 330 g/mL GHB in femoral blood and 221 ng/mg GHB in frontal cortex brain tissue, values higher than those typically reported in the literature. The hair shaft was negative for GHB whereas the plucked root bulbs with outer root sheath attached (2221 ng/mg) and root bulbs after washing and removal of the outer root sheath (47 ng/mg) contained the drug. Our results are consistent with an acute single dose of GHB and, as the toxicology screen was negative for other drugs of abuse, emphasize the significant danger of this drug.
Forensic Science, Medicine, and Pathology, 2015
Research communications in chemical pathology and pharmacology, 1982
Four calcium channel blockers, verapamil, nifedipine, nisoldipine and nimodipine were studied in ... more Four calcium channel blockers, verapamil, nifedipine, nisoldipine and nimodipine were studied in terms of their ability to inhibit platelet aggregation in cat platelet rich plasma by optical aggregometry. Only verapamil and nisoldipine significantly inhibited aggregation in cat platelets to ADP (2 microM). None of the calcium channel blockers exerted marked inhibition of aggregation induced by 1mM arachidonic acid. However, verapamil produced a moderate but significant inhibition of aggregation to arachidonic acid. Increasing the calcium ion concentration could reverse this inhibition. Thus, there are significant differences in the anti-aggregatory activity of calcium channel blockers in cat platelet rich plasma.
Psychopharmacology, 2008
Research on methamphetamine (MA) toxicity primarily focuses on the possibility that some of the b... more Research on methamphetamine (MA) toxicity primarily focuses on the possibility that some of the behavioural problems in human MA users might be caused by damage to brain dopamine neurones. However, animal data also indicate that MA can damage brain serotonin neurones, and it has been suggested that cognitive problems and aggression in MA users might be explained by serotonergic damage. As information on the brain serotonin system in human MA users is fragmentary, our objective was to determine whether protein levels of serotonin transporter (SERT), a key marker of serotonin neurones, are decreased in brain of chronic MA users. SERT immunoreactivity was measured using an immunoblotting procedure in autopsied brain of 16 chronic MA users testing positive for the drug in blood and brain and matched controls. SERT levels were non-significantly decreased (-14% to -33%) in caudate, putamen and thalamus (normal in hippocampus), and, unlike the robust striatal dopamine reduction, there was marked overlap between control and MA user ranges. Concentrations of SERT were significantly decreased (-23% to -39%) in orbitofrontal and occipital cortices (normal in frontopolar and temporal cortices). Our data suggest that MA might modestly damage brain serotonin neurones and/or inhibit SERT protein expression, with cerebral cortex being more affected than sub-cortical regions. The SERT reduction in orbitofrontal cortex complements other data suggesting involvement of this area in MA-related behaviour. Decreased brain SERT could also be related to the clinical finding that treatment with a selective serotonin re-uptake inhibitor might increase relapse to MA.
Pediatric Cardiology, 1984
An 11-month-old boy with congestive heart failure and an intermittently closing patent ductus art... more An 11-month-old boy with congestive heart failure and an intermittently closing patent ductus arteriosus (PDA) is presented. During cardiac catheterization, the ductus proved responsive to prostaglandin E l. Permanent closure of the PDA could not be attained with indomethacin. The infant underwent surgical ligation of the PDA .
Neurology, 2001
quency of respiratory movements first increased slightly and then decreased with mild reduction i... more quency of respiratory movements first increased slightly and then decreased with mild reduction in amplitude. Snoring reappeared a few seconds after the epileptic discharges ended (figure, B). IS was not associated with arousals, changes of body position, or REM sleep. Discussion. Generalized or partial seizures during sleep can modify respiration. 2 In Case 1, there was mild contraction of the mylohyoideus, without involvement of the deltoids. As snoring is from soft palate vibration during oropharyngeal relaxation, muscular activation in a focal tonic seizure might interrupt snoring by impeding the vibration of the oropharyngeal wall. Sleep-related focal tonic seizures involving only the perioral region have been associated with rhythmic polyspike EEG activity in bilateral central macrogyria. 3 In Case 2, epileptic discharges were associated with a complex respiratory pattern characterized by changes of amplitude and frequency. These breathing modifications might alter the airflow and interrupt snoring. In conclusion, our cases exemplify the interface between epilepsy and sleep disorders in which IS results from muscular and respiratory changes during sleep-related seizures. PSG uncovered these subclinical seizures, illustrating its utility in diagnosing sleep disorders in epilepsy.
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Papers by Gregory A Schmunk