Sudden death by Lepomis macrochirus (the killer fish)

In this unusual case, death was not caused by either anaphylactoid reaction to fish or by fish poisoning. Death was due to asphyxia caused by a live, whole fish occluding the mouth and upper airway.     

The case of a corpse found in a fox's den--forensic and criminological aspects

Whenever foul play is suspected in a death, the forensic pathologist is required to examine the corpse where it is found. In the case described here, the unusual location of the corpse initially led investigators to suspect a crime was involved. A thorough examination of the site and the autopsy results ultimately pointed to a not-violent manner of death, although the advanced state of decomposition made it impossible to determine the exact cause of death. The fact that the victim crawled into a fox's den to die can be interpreted as a primitive reaction in a case of death due to hypothermia. Criminological aspects of the case are also discussed.     

Fatal anaphylactic shock during a fluorescein angiography.

The Authors describe an extremely rare fatal case (sixth case in the literature) of anaphylactic shock following a fluorescein angiography. This is the first report in which the diagnosis of anaphylactic reaction to the dye was made through laboratory analyses. The diagnosis of fatal shock due to sodium fluorescein was made based on clinical, laboratory and immunohistochemical data. Mast-cell tryptase was dosed in serum and a pulmonary immunohistochemical evaluation was performed. Tryptase, a neutral protease of human mast-cells is a potentially important indicator of mast-cell involvement in anaphylactic events.     

Fatal case of BOTOX-related anaphylaxis?

Anaphylactic drug reactions are rare and often serious events. The Botulinum toxin A, marketed as BOTOX, was recently approved by the Food and Drug Administration for cervical dystonia and glabellar wrinkles, after its approved use and success with blepharospasm, strabismus, and disorders of the 7th cranial nerve. It has been well received due to its efficacy in improving facial lines. This case report documents the first death associated with a Botox-lidocaine mixture given to a woman for chronic neck and back pain. Based on the medical records, autopsy, and laboratory findings, the cause of death was determined to be anaphylaxis to the Botox-lidocaine mixture. The history, indications, off-label uses and possible future applications of Botox are reviewed as well as the uses and complications of lidocaine. Although the anaphylaxis cannot be definitively proven to be due to Botox alone, this case warns of an adverse reaction related to Botox, a drug that is rapidly expanding in range of use as well as increased usage.     

Sex determination of human blood micro-stains and single hairs using specific DNA amplification with polymerase chain reaction

Amplification of Y chromosome specific DNA in vitro enables a rapid and reliable sex determination of human minute traces such as blood stains and hairs. In presence of male DNA a band of 154 bp is visualized by agarose gel electrophoresis after amplification, this band is lacking in case of female DNA alone. Amplification of a sex independent DNA locus (such as a fragment from the alcohol dehydrogenase gene) generates identical reaction products for both sexes. This shows that the absence of a band is not due to the lack of trace DNA. It is possible to perform this technique with as little as 0.5 microliters of blood or with a single hair.     

A Fatal Mediastinitis Due to a Neck Trauma from an Undeclared Assault

History of neck trauma should be promptly investigated in patients with severe infections of the chest as mediastinitis. We present a forensic case of a death due to a mediastinitis in a patient with an undetected fracture of the superior horn of the thyroid cartilage that was exclusively revealed at autopsy examination. Histological analyses of the neck tissues showed signs of pharyngeal mucosal microperforation caused by the fracture and surrounded by an inflammatory reaction. The fracture was caused by a not declared manual strangulation attempt, happened several days before medical evaluations. We share our experience to emphasize the importance of revealing the etiologies of fatal infections of the mediastinum both for clinical and forensic purposes.     

Sudden death from tubercular myocarditis

Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.     

Philemon and Baucis Deaths: Case Reports and Postmortem Biochemistry Contribution

The death of a person as a reaction to the death of another is known as Philemon and Baucis death and may represent a difficult challenge for pathologists, especially due to the decompositional changes that often characterized these situations. In this article, we describe two cases of Philemon and Baucis deaths, the first concerning a married couple and the second concerning a father and son. Postmortem investigations including radiology and biochemistry were performed. Based on the results of all investigations, deaths were attributed to natural causes. Third‐party involvement could be excluded in both situations. In one case, biochemical analysis results revealed potentially contributing causes of death. The reported cases emphasize the importance of correlating findings from different postmortem investigations to identify causes of death, precipitating conditions and predisposing disorders, thus allowing the conclusion of natural death to be reached and third‐party involvement to be excluded.     

风险最糟糕情景认知模式及行政法制之改革

以行为决策学关于风险认知的两种模式及其相互关系的理论,阐述了政府官员（公众）对风险最糟糕情景的判断过程,从个体情感角度揭示其过度反应或反应不足的原因;运用社会心理学中的易（非易）得性启示及概率忽视的原理,进一步分析了政府官员（公众）过度反应或反应不足的机理。从行政法角度而言,政府对风险的最糟糕情景反应不足或过度反应都是不具有合法性的行政行为。为确保政府科学管理风险最糟糕情景,行政法需要进行制度变革。这些改革措施包括：组建风险最糟糕情景模拟实验室,定期公布模拟结果;建立并更新风险最糟糕情景信息超级数据库,以及确定相应的预警标准;成立超级风险规制机构以及设计更为精致和灵敏的分析性工具。     

Sudden death associated with food and exercise

Exercised-induced anaphylaxis occurs in conjunction with significant physical exertion. Anaphylaxis occurring when an individual exercise within a few hours of ingesting a particular food is an unusual variant. Cardiovascular symptoms can be the sole manifestation of exercise-induced food allergies, in which case death may mimic sudden cardiac death during physical exertion due to other pathologic causes. We report the sudden and unexpected death of an individual following the ingestion of hazelnuts and almonds, to which the individual was not previously known to be allergic. The decedent collapsed during vigorous dancing. The death was not associated with cutaneous or laryngeal manifestations of anaphylaxis. Awareness of the variable manifestations of food-precipitated anaphylaxis is necessary to correctly establish the diagnosis. An elevated serum tryptase level may be indicative of an allergic reaction, and allergen-specific IgE levels may be used to confirm the particular antigen.     

Time of firing of shot shells.

The possibility of ascertaining approximate time of firing by utilizing the phenomenon of rate of escape of gaseous products of combustion has been investigated with special reference to 12-bore, 2 1/2-in. (6.35-mm), fired cartridges made by the Indian Ordnance Factory. The relative rate of escape of gases has been determined indirectly by ascertaining the time needed to develop color in reagents by escaping gases by diazotization and coupling reaction. It has been observed that although the time to develop color tends to increase with the time lapse after firing, the observations are not interpretable for all possible time intervals due to overlapping and insignificant increase in certain intervals. A choice of suitable time intervals may be found to be useful in ascertaining the approximate time of firing, which may be determined experimentally in each case. Normal variation due to atmospheric conditions has been found not to have significant influence under certain limits. The method suggested has been found to be comparatively more useful than the already existing methods.     

Demonstration of a fatal hemolytic transfusion reaction using immunoperoxidase techniques.

An immunoperoxidase technique coupled with monoclonal antibodies to the ABO blood group antigens was used to document a fatal ABO hemolytic transfusion reaction in a medical examiner's case. A case report with explanation of the technique is presented.     

DNA typing of forensic material with mixed genotypes using allele-specific enzymatic amplification (polymerase chain reaction).

Biological material in forensic casework frequently contains a mixture of genotypes, with a predominance of material from the victim and only trace amounts from the person committing the crime. Physical separation of the two genotypes or preferential lysis of different cell types may sometimes be possible. However, it is often difficult to achieve complete separation due to the lysis of cells or lack of material. We have developed an enzymatic amplification system for the HLA DQA1 locus, that will allow the presence of individual alleles in a sample with mixed genotypes to be determined, independent of their initial proportion in the sample. This system permits the identification of an allele representing less than 10(-4) of the background genotype. Use of polymerase chain reaction (PCR) with general primers allows only alleles representing more than about 1% to be detected, while the allele-specific amplification represents up to a 1000-fold increase in sensitivity. This method was applied to a rape case and a combined rape and murder case; in both cases the biological evidential materials contained a mixture of alleles from the victim and the rapist. Allele-specific PCR revealed the presence of alleles identical to those of the suspect using DNA from a vaginal swab taken after a rape incident, whereas by using general primers in the PCR only trace amounts of alleles other than those of the victim were found. Similarly, allele-specific amplification of DNA from vaginal swabs from the murder case revealed the presence of alleles identical to those of the suspect, while standard PCR only indicated the presence of genetic material from the victim.     

Beta-tryptase and quantitative mast-cell increase in a sudden infant death following hexavalent immunization

The association between sudden infant death syndrome and immunization is frequently discussed. Serious adverse events following vaccination have generally been defined as those adverse events that result in permanent disability, hospitalization or prolongation of hospitalization, life threatening illness, congenital anomaly or death. They are generally referred to the inherent properties of the vaccine (vaccine reaction) or some error in the immunization process (programme error). The event could also be totally unrelated but only temporally linked to immunization (coincidental event). A fatal case of a 3-month-old female infant, who died within 24 h of vaccination with hexavalent vaccine is presented. Clinical data, post-mortem findings (acute pulmonary oedema, acute pulmonary emphysema), quali-quantitative data collected from immunohistochemical staining (degranulating mast cells) and laboratory analysis with a high level of beta-tryptase in serum, 43.3 microg/l, allows us to conclude that acute respiratory failure likely due to post hexavalent immunization-related shock was the cause of death.     

Pellagra: a rare disease observed in a victim of mental and physical abuse

Lesions of the brain stem and cerebellum due to nutritional deficiencies are mostly seen in chronic alcohol abuse and more rarely in severe malnutrition. We report the case of a 27-year-old woman, found dead in the family flat. She presented cachexia (167 cm, 25 kg) and multiple hematomas of the limbs. Postmortem examination revealed lesions due to peritonitis. Neuropathological examination showed severe atrophy of the corpus callosum and central neuronal chromatolysis, which are observed in pellagra. Inflammatory colitis or celiac disease was not found. Toxicological analysis was negative, in particular no alcohol absorption. Pellagra, which is due to nicotinamide deficiency, is a disease rarely seen in this country. In this case, nutritional deficiency was the consequence of failure to eat in a context of abuse. The woman was born of an incestuous relationship and presented intellectual retardation due to poor affective relations with her mother.     

Systemic Dissemination of Injected Foreign Material

A 32‐year‐old woman collapsed following an intravenous injection of material that included crushed pharmaceutical tablets. Resuscitation was attempted but was unsuccessful. She had an extensive past medical history of complications resulting from intravenous drug use. Death was due to mixed drug toxicity. The major findings at autopsy included a 10 mm deep skin sinus over the right femoral vein that was used as an injection site. Polarizable foreign material was present at the injection site and also within the lungs with a granulomatous reaction. Of note, a probe‐patent foramen ovale had permitted paradoxical embolization of this material into the systemic circulation with lodgement within the liver, portal lymph nodes, myocardium, spleen, kidneys, and pancreas. This case highlights the importance of checking for any intracardiac shunts, which may be quite small, and systemic dissemination of foreign material to multiple organs in intravenous drug users who present for medicolegal assessment.     

Predicting type of sexual assault case closure from victim, suspect, and case characteristics

Relatively little research has examined the impact of victim, suspect and case characteristics on the probability of various case closures in regard to personal crimes requiring police investigation. The present article examines the effect of individual and case characteristics (i.e. victim–offender relationship, initially available evidence) on the police unfounding decision, and the probability of four other types of case closure (Arrest, Exceptional due to lack of victim cooperation, Exceptional due to lack of “prosecutorial merit”, and Open) among a sample of felony sexual assault cases. Using data from a large municipal police department's sexual assault investigative unit, results indicate that the race of the victim and suspect plays no role in determining any of the case outcomes in this sample, while prior relationship does appear to have a strong impact. Variable impacts for indicators of the strength of evidence, victim's cooperation, and the seriousness of the case are also discussed.     

Accidental ligature strangulation due to a roller-type massage device

A case is reported in which a woman was accidentally strangled when her blouse became entangled in a roller-type electric massage device that she was using to massage the back of her neck. Accidental strangulation in adults, outside of the workplace, is uncommon, and to our knowledge this is the first reported case of a strangulation due to this type of device. The findings of this interesting and unusual case are presented.     

Chronic hydrocephalus and alcohol abuse in a young male suicide

The paper describes a case of suicide in a young man affected by compensated chronic hydrocephalus who was subject to alcohol abuse. The case was studied by means of a complex set of analyses, including circumstantial and clinical data, anatomohistopathological findings, and chemicotoxicologic tests. What clearly emerges in the case is the importance of a continuing neuropsychological follow-up in patients with shunted hydrocephalus. The forensic interest in the case is due to the peculiar autopsy findings discussed in relation to the possible causes of sudden death in subjects with hydrocephalus.     

破产实体要件的审理程序研究

我国现行《破产法》并未明确将破产原因等破产实体要件作为当事人争议和法院审理的对象为其设定正式的审理程序。司法实践中,不少法院是把实体要件和形式要件都放在破产受理这一程序中进行审查的,这样做虽可在一定程度上消除人们对程序启动及案件受理效力等方面有关程序正当性的怀疑,但毕竟受理程序并非正式的审理程序,其程序空间较为狭小,难以承受审理破产实体要件的沉重任务。从增加整个破产程序运行的正当性和保障当事人的程序权利出发,新《破产法》有必要为破产实体要件设立较为正式的审理程序。