Diagnostic implication of blood and urine morphine content in alcohol intoxication

A total of 198 cases of acute parenteral poisoning with opiates are characterized. The range of concentrations of opiates metabolites in the blood and urine, main causes of death due to opiate poisoning in alcohol intoxication are analysed. Opiates toxicity was assessed with the logit-regression method and dose-effect curves valid for analysis of relationships between probability of death and opiate metabolites concentration in blood and urine. Correlation between probability of death and detection of morphine and ethanol in biological media of the victims is considered. Concentrations of morphine in blood and urine definitely indicating opiates poisoning in alcohol intoxication as a cause of death are determined.     

Some observations concerning blood morphine concentrations in narcotic addicts

Blood samples from deceased narcotic addicts were analyzed for morphine, and the results form persons who died from narcotic addiction were compared with those from homicide victims. In most instances morphine was detectable in both types of death, and usually the values obtained were less than 30 microgram/dl. Narcotic addiction deaths involving only morphine, or morphine plus a combination of ethanol, quinine, or diazepam (Valium), were also evaluated. In some cases high quantities of ethanol were present, and death could be attributed to the combined CNS depressant effects of morphine and ethanol. The quinine levels would not normally be considered toxic, however, and it could not be ascertained that the quantity of this drug present contributed to death. Diazepam was present in elevated concentrations, and its depressant effect may have been a factor in some narcotic addiction deaths.     

The role of ethanol abuse in the etiology of heroin-related death

Toxicology analyses and other forensic science data were used to examine the mechanisms through which ethanol increased the risk for death caused by injected street preparations of heroin. The authors studied 505 victims of fatal heroin overdose and compared subjects who had concentrations of blood ethanol greater than 1000 mg/L (n = 306) with those who had concentrations less than, or equal to 1000 mg/L (n = 199). We found significant negative correlations between concentrations of ethanol and morphine (a heroin metabolite) in blood (R2 = 0.11, P = 0.0001 for log10-transformed variables) as well as between concentrations of blood ethanol and bile morphine (R2 = 0.16, P = 0.0001 for log10 bile morphine versus blood morphine). Toxicologic evidence of infrequent heroin use was more common in decedents with blood ethanol concentrations greater than 1000 mg/L than in those with lower concentrations. Our data suggest that ethanol enhances the acute toxicity of heroin, and that ethanol use indirectly influences fatal overdose through its association with infrequent (nonaddictive) heroin use and thus with reduced tolerance to the acute toxic effects of heroin.     

Hydrogen cyanide and carbon monoxide in blood of convicted dead in a polyurethane combustion: a proposition for the data analysis

Carbon monoxide is a well-known toxic component in fire atmospheres. However, the importance of hydrogen cyanide as a toxic agent in fire causalities is under discussion. A tragic polyurethane mattress fire provoked death of 35 convicts in a prison (Unit I, Olmos, Penitenciary Service of Buenos Aires Province, Argentina), in 1990. There is no report of any investigation carried out with such a large amount of victims in Argentina. Carboxihemoglobin (COHb) and hydrogen cyanide (HCN) were quantified in victims blood to elucidate the cause of the death. Saturation of COHb ranged between 4 and 18%, and HCN 2.0-7.2mg/l. These latter values were higher than the lethal levels reported in literature. Other toxic components routinely measured (ethanol, methanol, aldehydes and other volatile compounds) gave negative results on the 35 cases. Neither drugs of abuse nor psychotropics were detected. Statistical chi(2) analysis was applied to find differences between HCN and COHb concentrations. Saturation of COHb and HCN in blood were not independent variables (chi(2)=8.25). Moreover, the ratio COHb/HCN was constant (0.47+/-0.04). In order to evaluate the contribution of each toxic to the diagnosis, a lethal index was defined for each toxic (LI(CO) and LI(HCN)). The most probable cause of death could be inferred by a suitable plot of both indexes. The results indicated that death in the 35 fire victims was probably caused by HCN, generated during the extensive polyurethane decomposition provoked by a rapid increase of temperature.     

A "back door" approach to analysis of ethanol-associated risks and behavior

Ethanol has been detected in the majority of medical examiner cases involving nonnatural death and in a substantial number of natural deaths. The higher the serum alcohol concentration (SAC), the greater were the odds that death was due to external (traumatic) causes. We identified 149 medical examiner cases that were positive for ethanol and negative for 11 major drug of abuse groups, and studied those cases to further clarify ethanol-related risk factors and behaviors. Based on terms of frequency of occurrence, the data identify SACs of 201 mg% to 300 mg% as a particularly high risk factor for sudden, unexpected, traumatic death. Traumatic deaths associated with SACs below 100 mg% were infrequent, and attendant opinions concerning the contributory role of ethanol must be made with circumspection. SACs below 150 mg% could not be used to predict whether or not the decedents had been engaged in active or sedentary behavior prior to death because both situations occurred with equal frequency. At SACs between 151 mg% and 350 mg%, active situations were observed three times as often as sedentary situations. When SACs were 350 mg%, sedentary situations were observed twice as often as active situations. Suicide victims and driver fatalities rarely showed SACs above 350 mg%; therefore finding such SACs in apparent suicidal or driver fatality situations should prompt a thorough investigation to rule out other possibilities.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hyperthermia deaths in Finland in 1970-86

All cases in which hyperthermia had been determined as the basic cause of death during the period 1970-86 were collected from the records of the Central Statistical Office of Finland. Of the total of 230 cases, 228 were included in the present study; the two remaining victims died abroad, and no autopsy was performed in Finland. Most of the hyperthermia deaths occurred while the decedent was taking a sauna bath; most decedents were men aged 42-62 years. An increase in the total number of hyperthermia deaths, and of male victims, was noted from the beginning of the 1970s onward; the number of female victims remained at a relatively steady level throughout, with the exception of a slight rise in 1986. Acute alcohol consumption was detected in most of the victims; in some cases there was also a reference to chronic alcoholism or recent long-term heavy drinking. The findings suggest that in addition to the acute hazardous effect of ethanol on thermoregulatory mechanisms, the long-term consumption of alcohol may have promoted fatal hyperthermia in these subjects.     

Drug and alcohol use as determinants of New York City homicide trends from 1990 to 1998

In this population-level study, we analyzed how well changes in drug and alcohol use among homicide victims explained declining homicide rates in New York City between 1990 and 1998. Victim demographics, cause of death, and toxicology were obtained for all homicide (N = 12573) and accidental death victims (N = 6351) between 1990 and 1998 from the Office of the Chief Medical Examiner of New York (OCME). The proportion of homicide and accident decedents positive for cocaine fell between 1990 and 1998 (13% and 9% respectively); the proportion of homicide and accident decedents positive for opiates and/or alcohol did not change significantly. Changing patterns of drug and alcohol use by homicide victims were comparable to changing patterns of drug and alcohol use in accident victims, suggesting that changes in drug and alcohol use among homicide victims between 1990 and 1998 cannot solely explain the decline in NYC homicide rates.     

Accidental poisonings involving carbon monoxide, heating systems, and confined spaces

Eleven incidents of carbon monoxide (CO) intoxication resulting in sixteen fatalities are reported. All of the cases involved heating systems as either the source or the means of distributing the CO. Blood samples were analyzed for ethanol and CO. Elevated blood CO saturations were found in 14 of the 16 victims while none of the victims had a blood ethanol concentration greater than 0.10% (w/v).     

Harmful alcohol use of those who died a violent death (the extended region of Ljubljana 1995–1999)

Consumption of alcohol increases the risk of dying a violent death. We wanted to establish a connection between harmful alcohol use and dying a violent death. We analyzed all such victims in the extended region of Ljubljana. The research included 1630 deceased, who were autopsied at the Forensic Institute of the Ljubljana, Faculty of Medicine in the period from 1995 to 1999. Presence of alcohol was established in 76.3% of the cases. From all included in the research, 38.2% of all work accident victims, 28.8% of all murder victims, 25.4% of suicides, 24.6% of victims involved in traffic accidents and 19.3% of those who died in accidents at home. 23.2% of all violent death victims had a concentration of alcohol above 1.5 g/kg; among those, victims of traffic accidents, suicides and accidents at home represent the largest part. The lowest values of alcohol in blood were found in those who died because of accidents at work. The highest values were found in males aged 35–44. The research confirmed that consumption of alcohol in Slovenia was strongly connected to violent deaths. The blood levels of alcohol of the victims are distinctively higher where there are practically no limitations of alcohol consumption and lower in the environment or activities where legal restrictions prohibit or at least explicitly limit harmful use of alcohol (working environment).     

Death from thermal effects and burns

One hundred and fifteen unselected autopsy cases of death from thermal effects and/or fire between 1990 and 1999 were analyzed with regard to time of death, signs of vitality at the scene of the fire, the manner and cause of death, and the extent of soft tissue loss. The cases represented approximately 6% of all autopsy cases at the Institute of Legal Medicine responsible for a catchment area with approximately 700,000 inhabitants. In 23 victims suffering burn injuries, death occurred during initial medical care or clinical treatment. The causes of death were primary respiratory arrest due to smoke poisoning or delayed shock caused by thermal injuries to the skin. Death occurred at the scene of the fatal event in 85 cases: eight cases exhibited no thermal effects; the cause of death in one of these cases was polytrauma incurred in a leap from a height; in seven cases there was poisoning due to smoke inhalation. The remaining 77 cases were characterized by signs of intensive thermal and/or fire effects. Clear signs of vitality (carboxyhemoglobin (COHb) in blood, inhalation and/or swallowing of soot) were found in 84.7% of the victims dying at the site of the fatal event. Of the 13 victims showing no signs of vitality at the scene, a cause of death could be determined in only seven cases; death in the other six cases remains unexplained. Quantification of the soft tissue loss revealed a possible correlation with the temperature and time course of heat exposure.     

REASSESSING RACE DISPARITIES IN MARYLAND CAPITAL CASES*

A generation of research studies that were conducted in multiple states and covered different time periods has found evidence that individuals who kill white victims encounter a greater risk of facing the death penalty than killers of black victims. More recently, research has also examined the likelihood of death penalty processing for black defendants who kill white victims in comparison with other defendant–victim race groups. In particular, a study in Maryland conducted by Paternoster et al. (2003) found evidence that offenders in black defendant–white victim cases were more likely to be death noticed by prosecutors and to receive a death sentence than other offenders. A recent analysis by Berk, Li, and Hickman (2005) raised questions about some of these findings. In this article, we conduct new analyses and conclude that black defendants who kill white victims face a greater risk of adverse treatment than other types of defendants.     

The Richard Cory phenomenon: suicide and wealth in Kansas City, Missouri

This case-control study investigates the relationship between suicide and wealth in Kansas City, Missouri. House and personal property appraisal data on all victims of suicide from 1998 and 2002 and victims from a control population of deaths reported to the Jackson County Medical Examiner during the same time interval were obtained from the Jackson County Government website. The controls were matched to suicide cases by race, gender, year of death, and age at death (+/- 1 year). Data from the 426 members of each group of suicides and controls indicate that suicide victims were: 1) 77% more likely than controls to have lived in houses rather than in apartments or trailers, 2) more likely than controls to have lived in more expensive houses (mean values dollar 70,143 versus dolllar 61,513 respectively, p = 0.04) and 3) more likely to have killed themselves because of factors other than financial strain (8.0% of suicides showed financial strain).     

Autoerotic asphyxia: part I

Fatal autoerotic asphyxia refers to death during solitary sexual activity with self-induced asphyxiation meant to be brief and reversible. However, an unexpected fatality results from a failure of a release mechanism apparatus. The large majority of victims of autoerotic death are Caucasian males between the second and fourth decade. While autoerotic death may encompass a myriad of other means of achieving sexual gratification, which includes asphyxia by plastic bag or inhalation of noxious chemicals, the most common method is by ligature about the neck. This study presents a 9-year retrospective review of deaths due to autoerotic asphyxia, specifically ligature asphyxia, in Kentucky between 1993 and 2001. Of the sixteen victims, all were Caucasian males between the ages of 14 and 59 years, with a mean age of 38.3 years. Cross-dressing was a feature in 4 cases. A thorough review of the decedent's background, meticulous scene investigation, and complete postmortem examination may shed light on the mechanism and psychosocial predisposition associated with autoerotic asphyxia.     

死刑与生命权的合致与背离

关于死刑,药家鑫案余音来尽,吴英案再起波澜.死刑体现了对受害人生命的尊重,拯救了潜在的受害人生命,与生命权形成了合致,但同时,死刑又背离了生命权的崇高价值,因为其漠视了加害人的生命,滥用了国家权力,罔顾程序中的不公正因素.转嫁了社会责任,纵容了人们的原始报复心理.保留死刑并严格限制死刑适用是当今中国死刑制度的不二选择.     

Evaluation of post-mortem ethanol concentrations in pericardial fluid and bone marrow aspirate

This study confirmed post-mortem ethanol concentrations in pericardial fluid and bone marrow aspirate in comparison with those in the blood in medicolegal autopsy cases (n = 140, within 48 h post-mortem). The specimens were examined by head-space gas chromatography/mass spectrometry. Ethanol concentrations in the pericardial fluid (y) were approximately equivalent to those in peripheral blood (x): y = 0.99x + 0.02, n = 44, r = 0.972. A high stomach ethanol concentration (>10 mg/ml) appeared to mildly affect the pericardial levels. There was no significant interference in drowning cases. Ethanol concentrations in bone marrow aspirates (y) also showed a good correlation with those in the peripheral blood (x): y = 0.77 x + 0.02, n = 20, r = 0.981. A dissociation was observed in cases of delayed death from hemorrhagic/traumatic shock and elderly victims. These findings suggest that pericardial fluid and bone marrow aspirate can be used as an alternative material when adequate blood specimens are not available.     

A study on house fire victims: age, carboxyhemoglobin, hydrogen cyanide and hemolysis.

Correlation among age, concentrations of carboxyhemoglobin and hydrogen cyanide, oxygen density and hemolysis were studied in 120 house fire victims. Victims aged over 60 years comprised approximately 50% of the pooled subjects. Blood samples were mainly collected from the left ventricle, but sometimes from both the right and left ventricles. The concentration of carboxyhemoglobin ranged from 1-95%, of which 71 persons (59.7%) died with carboxyhemoglobin concentrations below 60%. Carboxyhemoglobin concentrations below 10% were found in 9 persons (7.5%). Most of these cases involved the elderly persons. In this paper, we report on the death of elderly victims as a result of low carboxyhemoglobin concentrations. A significant correlation of blood carboxyhemoglobin concentrations existed between the right and left ventricles. The concentration of carboxyhemoglobin in the left ventricle was significantly higher than that in the right. Two out of 31 victims whose hydrogen cyanide concentrations were determined, succumbed to hydrogen cyanide poisoning, having a high concentration of hydrogen cyanide and a low concentration of carboxyhemoglobin. On analysis, oxygen density was found to be low in 13 persons. A negative correlation was shown between carboxyhemoglobin concentration and hemolysis. Inasmuch as hemolysis may indicate the extent of heat dissociation, hemolysis should provide an index of carbon monoxide dissociation from carboxyhemoglobin. In the present study of victims, possible causes of death i.e., carbon monoxide gas poisoning, hydrogen cyanide poisoning, oxygen deprivation, burning, shock due to burns and others were estimated. The survival time for elderly victims was considered to be short.     

Fatal traffic injuries among children and adolescents in three cities (capital Budapest, Vilnius, and Tallinn)

Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.     

Suicide trends in upper egypt

Suicide is an important problem, ranking among the top 10 causes of death for individuals in all ages in developed countries. This article is a retrospective study evaluating suicide cases in Assiut, one of the largest provinces in Egypt, from 2005 to 2009. There were 117 cases, of which involved 68 male victims (58.12%) and 49 women (41.88%). Suicide rates ranged from 0.6 to 0.8 per 100,000. Age predominance was from 20 to ≤30 years. The method of suicide was different between male and female victims, as male victims tried to use more violent methods than females. The most common cause of death in men was usage of toxins and by hanging 29% and 28%, respectively, while in women was usage of toxins (70%). This study showed that suicide rates have increased since 1987, indicating a grave problem that needs to be solved.     

Analysis of accidental deaths in mountain tourism and sport according to statistics from the Republic of Kabardino-Balkariia

Lethal cases in mountain tourism and sports in the Republic of Kabardino-Balkaria were studied for 1978-1995. A total of 152 accidental deaths were analysed. Most of the victims were males under 30 years of age. The greatest number of the accidents took place on Monday, in July and August. Many amateur visitors from abroad were among the victims. The main cause of death in the mountains of Kabardino-Balkaria for the 18 years studied was multitrauma of the body (69.7%). Hypothermia and obturation asphyxia with snow and compression asphyxia due to snowbreak account for 11.8 and 13.2% deaths, respectively; lightning killed 4%. Combination of high mountain hypoxia with exacerbated chronic somatic disease or hypothermia caused death in 1% victims. The authors propose how to improve forensic-medical expert examination of accidental death and safety in the mountains.