Forensic medical diagnostics of chronic alcoholic intoxication based on the measurement of bone mineral density in the postcranial skeleton and periodontal complex

The objective of this work was to develop forensic medical criteria for the diagnostics of chronic alcoholic intoxication based on the measurement of bone mineral density in the postcranial skeleton and periodontal complex. The stomatological status of 380 subjects was evaluated. Two hundred patients regularly consumed alcohol (group 1) and 180 ones practically did not use it (group 2). The stomatological status was evaluated based on the simplified oral hygiene index (OHI-s), the decayed, missing and filled teeth (DMF) index, periodontal index (P1) and the papilla bleeding index (PBI). Bone mineral density was measured by X-ray two-photon absorptiometry. The study demonstrated the relationship between variations of the stomatological status and alcohol abuse. Chronic alcoholic intoxication was associated with marked changes of the stomatological status and the loss of bone mineral density that correlated with the results of the orthopantomographic study. It is concluded that the above observations should be taken into consideration in the practical work of forensic medical experts as additional diagnostic criteria of chronic alcoholic intoxication and alcohol-related death.     

Forensic medical assessment of subendocardial hemorrhage in acute blood loss

A retrospective analysis of forensic autopsy protocols for 240 victims who died of acute blood loss aged 17-55 years (186 male and 56 female corpses--76.8 and 23.2%, respectively) has shown that appearance of Minakov's spots (MS) depends on duration of the terminal period. Subendocardial hemorrhages occurred most frequently (61.5%) in the terminal period up to one hour. The terminal period for several minutes was associated with MS appearance in 27.5% cases, for several hours--in 6.6%, for 24 hours and more--in 4.4%. MS incidence rate did not correlate with the group of the study, blood loss volume, severity of alcohol intoxication.     

Current status and prospects for developing chemical-toxicological (forensic chemical) studies in the Russian Federation

The authors discuss modern state and prospects of planning and carrying out research in forensic (toxicological) chemistry within the framework of practical forensic medical expert evaluation, state of forensic medical expert evaluation of alcohol and narcotic intoxication, and other pressing problems of forensic medical expert practice.     

Forensic medical assessment of acute blood loss in combination with craniocerebral trauma and alcohol intoxication

Forensic medical findings have been analysed retrospectively for 242 deceased of acute blood loss: 186 (76.8%) corpses were male and 56 (23.2%) corpses were female. It was found that in acute blood loss (ABL) duration of the terminal period (TP) depended on its combination with craniocerebral trauma (CCT) or alcohol intoxication (AI). A short TP (several minutes) was observed in ABL patients with CCT (39.6%), a long-term TP--in ABL associated with AI (20-60 min, 40.4% cases; several hours, 56.3%; over 24 hours, 54.5%). Slow TP occurred primarily in mild AI (TP for several hours 55.6%, over 24 hours--83.3% cases). In severe AI the number of cases with a short TP exceeded the number of cases with a long TP (over 24 hours) by 53.7%.     

Forensic appraisal of death due to acute alcohol poisoning: three case reports and a literature review

Death due to acute alcohol poisoning lacks specific anatomical characteristics, compared with other deaths due to drug poisoning. We report three forensic cases of death from acute alcohol poisoning due to inhibition of the respiratory centre and eventual asphyxia. Blood alcohol concentrations in the three fatalities were 5.28, 3.33 and 3.78 mg/mL, respectively. Lethal doses and blood alcohol concentrations showed differences between individuals. Detailed auxiliary tests besides autopsy were undertaken. These cases show that forensic scientists should exclude other causes of death, combine the autopsy with auxiliary tests, and then make an appraisal.     

Forensic medical diagnostics of chronic narcotic intoxication based on the morphological findings

The objective of the present work was to develop the forensic medical criteria for chronic narcotic intoxication based on the results of morphological studies. The internal organs from 179 cadavers were available for the examination following death from acute poisoning with narcotic substances or as a result of chronic narcotic intoxication. The studies were carried out with the use of routine histological staining techniques and an immunohistological method. The data obtained provided a basis for the development of criteria to be employed in forensic medical diagnostics of acute poisoning with narcotic drugs and chronic narcotic intoxication. These criteria include ischemia of cerebral neurons, pulmonary emphysema with the formation of foreign body-type granulomas and fibrin/erythrocyte thrombi, morphological signs of ventricular fibrillation, the picture of bacterial endocarditis, follicular hyperplasia of the lymphoid organs, chronic portal hepatitis, and nodular degeneration of the adrenal cortex associated with its atrophy.     

Histochemical changes in the hypothalamus, hypophysis, and adrenal glands observed in ethanol poisoning

A comprehensive morphological-and-histochemical study of neuroendocrinal internals in cases of ethanol poisonings was undertaken. Actual forensic medical materials were used (62 cadavers) to make morphometry examinations of the hypothesis and adrenal glands. Besides, the distribution of alcohol dehydrogenase and acetaldehyde dehydrogenase was investigated in the mediatory differential brain sections, i.e. cerebellum, locus coeruleus, dorsal raphe nucleus, hypothalamus and adrenal glands. A differential distribution of ethanol-oxidizing enzymes as well as their changes in ethanol lethal poisoning were established; additionally, a variety of morphological signs were defined, which enable the differential diagnosis of a death reason in acute alcoholic intoxication.     

Evaluation of alcoholic intoxication depending of the level of brain ethanol-metabolizing enzymes in death from ischemic heart disease

Activities of alcohol dehydrogenases (ADG), aldehyde dehydrogenases (AlDG), and NADH+ dehydrogenases were measured by histochemical methods in neurons and capillaries of the gyrus cinguli and medulla oblongata of subjects dead from coronary disease. Enzymatic activities were found to depend on the stage of alcoholic intoxication. During resorption, characterized by reversible ethanol oxidation, the activities of AlDG and NADH+ dehydrogenases decreased, while during elimination the activities of these enzymes increased. ADG activity in cerebral tissue was increased during the entire period of alcoholic intoxication. The duration of alcoholic intoxication is determined by the amount of consumed ethanol and activity of AlDG. These regularities can be used for forensic medical evaluation of the role of alcoholic intoxication in coronary death.     

Lack of observable intoxication in humans with high plasma alcohol concentrations

Judging the degree of human alcohol intoxication is an important clinical, social, and medicolegal matter. Assessing the degree of intoxication is not always easy by direct patient observation. Observational instruments have been used in forensic science, medical, and social situations in an endeavor to measure alcohol intoxication. The validity of these observational instruments must be questioned. In this study, twenty-one patients with alcohol related complaints presenting to major city emergency departments were studied using one such observational instrument, the Alcohol Symptom Checklist (ASC). Three independent emergency medicine physicians applied the criteria of ASC to the twenty-one patients and obtained a plasma alcohol concentration (PAC) for correlation purposes. Individual correlation coefficients (r = 0.182, r = 0.202, r = 0.200) and a composite correlation coefficient (r = 0.235) demonstrated lack of correlation between PAC and ASC. This lack of correlation is supported by clinical observations of experienced emergency department personnel.     

An unusual accidental death from positional asphyxia

Death from postural or positional asphyxia takes place in circumstances when the victim's body assumes an abnormal position compromising the process of respiration. The diagnosis is usually based on circumstantial evidence in conjunction with excluding other significant underlying causes of death. This case report is about a 37-year-old man who had been drinking the previous night and was found dead in the morning in a knee-chest position. The forensic medical examiner had the opportunity to examine and photograph the scene of death while the body was still in its original position. Apart from a blood alcohol level of 290 mg/100 mL, marked congestion of the face, and petechial hemorrhages on the conjunctivae, autopsy findings were unremarkable. There were no injuries or pathological findings to account for his death. Death was certified as due to postural asphyxia secondary to intoxication by alcohol.     

Cerebral alcohol dehydrogenase-- a marker of individual ethanol tolerance in ethanol intoxication

Brain compartments differing by topical chemical location of alcohol dehydrogenases (ADH) were studied on forensic medical material. ADH were found in magnocytes of giant-cell reticular formation, neuronal nuclei in the blue spot, and capillaries, but not in neurons of the ganglionary layer of the cerebral limbic cortex. ADH activity in the studied brain compartments depended on the level of exogenous ethanolemia. Increased ADH activity in the reticular formation magnocytes characterized the individual tolerance in severe ethanol intoxication. Cerebral ADHs are markers of ethanol intoxication.     

Forensic medical significance of enzymatic products of ethanol oxidation in cadaveric brain

The concentrations of ethanol, acetaldehyde, and the oxidizing enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (AIDH) were measured in neuronal cytoplasm, limbic cortical capillaries, and cardiovascular center of the medulla oblongata. The measurements were carried out by histochemical methods, gas-liquid chromatography, etc. The results were processed with consideration for the degree and stage of ethanol intoxication in case of death from ethanol poisoning and asphyxia in hanging. Increase of ethanol concentration in the blood was associated with a decrease and then increase in the brain concentrations of ADH and with an increase of AIDH concentration. Enzymatic changes predominated in capillary walls; the minimum shifts were observed in the neuronal cytoplasm of the cerebral limbic cortex, which confirms the neurohumoral nature of detoxication regulation. Lethal ethanol poisoning could occur during any stage of ethanol intoxication. The detected changes in ethanol, acetaldehyde, and metabolizing oxidoreductases in brain tissue can be used for forensic medical diagnosis of ethanol poisoning.     

The activity of ethanol- and aldehyde-oxidizing enzymes of the brain in ethanol intoxication

The distributed activity of alcohol dehydrogenase (ADG) and aldehyde dehydrogenase (AldDG) was histochemically studied in neurons of locus coeruleus, nuclei of raphe, substantia nigra and in cerebellar cortex in death or intoxication of ethanol (IE). The enzymatic activity was found to be changing depending on whether there was IE or not. Both higher ADG and lower AldDG were registered in the examined brain sections, which differ by mediatory structure of the neuronic centers. The detected regularities can be used within the forensic medical diagnosis of IE.     

Fatal hemorrhage from an isolated scalp injury

By means of 3 casuistics it is illustrated, that fatal bleeding from a single scalp injury can occur under special preconditions. Beside signs of massive loss of blood at the place of discovery and on the corpse, particularly chronic and acute alcohol intoxication with presumably impaired coagulation and prospective anemic history play a dominant role in these courses.     

血液中乙醇检测结果的法医学分析

目的对交通事故中血液中乙醇检测结果进行法医学分析。方法从检测方法、血液采集方法、采集时间、血液保存、尸体腐败、饮酒量与血液中乙醇质量浓度关系等方面进行血液中乙醇检测结果的法医学分析。结果检测方法、血液采集方法、采集时间、血液保存、尸体腐败等因素直接影响血液中乙醇检测结果。结论为保证交通执法的公正性，对血液中乙醇检测结果应当作法医学分析。     

甲卡西酮对大鼠血浆代谢谱变化研究

目的 应用代谢组学技术研究腹腔注射甲卡西酮大鼠血浆代谢谱的变化,筛选出可用于甲卡西酮吸毒法医学鉴定的入体生物标志物.方法 SD大鼠随机分成低剂量甲卡西酮组(腹腔注射甲卡西酮溶液3mg/kg)、中剂量甲卡西酮组(腹腔注射甲卡西酮溶液12mg/kg)和对照组(腹腔注射等量生理盐水),注射3min后收集大鼠眼眶血,应用超高效...     

Concentrations of zolpidem and zopiclone in venous blood samples from impaired drivers compared with femoral blood from forensic autopsies

The concentrations of zolpidem and zopiclone were determined in peripheral blood samples in two forensic materials collected over a 10-year period (2001-2010). The z-hypnotics were determined in venous blood from living subjects (impaired drivers) and in femoral blood from deceased persons (forensic autopsies), with the latter classified as intoxication or other causes of death. The z-hypnotics were determined in blood by capillary column gas chromatography (GC) with a nitrogen-phosphorous (N-P) detector after solvent extraction with n-butyl acetate. The analytical limit of quantitation (LOQ) was 0.02mg/L for zopiclone and 0.05mg/L for zolpidem and these have remained unchanged throughout the study. When death was attributed to drug intoxication (N=918), the median concentration of zopiclone in blood was 0.20mg/L compared with 0.06mg/L for other causes of death (N=1215) and 0.07mg/L in traffic offenders (N=691) (p<0.001). Likewise, a higher median concentration (0.30mg/L) was found in intoxication deaths involving zolpidem (N=357) compared with 0.13mg/L for other causes of death (N=397) or 0.19mg/L in impaired drivers (N=837) (p<0.001). Median concentration in blood of both z-hypnotics were appreciably higher in intoxication deaths when no other substances were identified; 0 70mg/L (N=12) for zopiclone and 1.35mg/L (N=12) for zolpidem. The median concentrations of z-hypnotics in blood decreased as the number of co-ingested substances increased for intoxication deaths but not other causes of death. The most prevalent co-ingested substances were ethanol in autopsy cases and diazepam in the motorists. This large compilation of forensic cases should prove useful when toxicologists are required to interpret concentrations of z-hypnotics in blood samples in relation to cause of death.     

Sudden death after release from police detention]

3 fatalities shortly after discharge from police custody are reported. Case 1: A 55-year old alcoholic was discharged from police custody after taking a blood sample under violent conditions and found dead in his flat 2 days later. Cause of death: arrhythmia due to acute coronary insufficiency or alcoholic cardiomyopathy. Case 2: A 27-year-old alcoholic was met highly intoxicated twice in the course of one day, was put in the family's care and was found dead the next morning. Cause of death: alcohol/drug intoxication with agonal aspiration. Case 3: A 32-year-old man known to be prone to seizures and to become aggressive under the influence of alcohol was left by the police in medical care confined to a litter in a "hog-tied" fashion with the help of 3 belts. Cause of death: cerebral hypoxia after respiratory and cardiac arrest of unknown reason. A causal relationship with positional restraint is discussed. The cases reported underline the duty of the police to examine prior to discharge from custody with the appropriate lot of care whether the person held in custody has recovered from the helpless state due to disease, injury or intoxication or if medical treatment is required.     

The state of brain ventricles and their ependima in different scenarios of traumatic blood loss

The objective of the present study was to evaluate the state of ependima and the subependimal layer of the brain ventricles after death from the traumatic blood loss and in the cases of the blood loss under conditions of acute alcoholic and narcotic intoxication. The methods used for this purpose included light and scanning electron microscopy. It was shown that in subjects who died from the traumatic blood loss during acute alcoholic and narcotic intoxication ependima showed the signs of progressive polymorphism and had extensive areas of discontinued cell layers. Neuropil contained numerous vacuoles and blood effusion sites. The surface of ependima exhibited pathological erythrocytes, agglomerations of detritus, and crystalloid structures. The blood loss during combined alcoholic and narcotic intoxication resulted in more pronounced alterations in the ventricular walls.