Sevoflurane concentrations in blood, brain, and lung after sevoflurane-induced death

Sevoflurane concentrations in blood, brain, and lung were measured in an individual apparently dying from sevoflurane inhalation. Sevoflurane is a volatile nonflammable fluorinated methyl isopropyl ether inhaled anesthetic, chemically related to desflurane and isoflurane. The incidence of abuse of sevoflurane is lower than that of other drugs of abuse possibly due to its inaccessibility to the general public and less pleasurable and addicting effects. The dead subject was an anesthetist found prone in bed holding an empty bottle of sevoflurane (Ultane). Serum, urine, and liver were screened for numerous drugs and metabolites using enzyme immunoassays and gas chromatography-mass spectrometry. Analysis did not reveal presence of any drug, including ethanol, other than sevoflurane. Sevoflurane was determined by headspace gas chromatography and revealed concentrations of 15 microg/mL in blood and 130 mg/kg in brain and lung. Autopsy revealed pulmonary edema and frothing in the lung, pathological findings associated with death by sevoflurane or hypoxia. The cause of death was ruled as sevoflurane toxicity and the manner of death as accident.     

Nursing home deaths which fall under the jurisdiction of the coroner: an 11-year retrospective study

Twenty percent of deaths in the United States occur in nursing homes, yet less than 1% come to autopsy. The current study analyzed causes and manners of death in all nursing homes between 1993 and 2003, investigated by the coroner of Allegheny County, PA, which has the second highest elderly population in the United States. Two hundred eight decedents were identified, aged 19 to 91 years, 58% women and 42% men, 88% Caucasian and 22% African-American. Fifty-eight percent were accidental and 38.5% were natural manners of death, with 2 homicides, 2 suicides, and 3 undetermined cases. The manner of death was significantly different between Caucasians and African-Americans, with 92.6% of accidental deaths occurring in Caucasians and 6.6% in African-Americans (P < 0.1). Most common natural deaths were arteriosclerotic cardiovascular disease, nonarteriosclerotic cardiovascular disease, pneumonia, pulmonary thromboembolism, chronic obstructive pulmonary disease (COPD), seizure disorder, and atraumatic intracranial hemorrhage. Blunt force trauma was the single most commonly identified traumatic accidental death. Accidental deaths were more common in Caucasians than African-Americans. Homicides and suicides were rare events (<2%). Blunt force trauma is a major autopsy finding in accidental nursing home deaths, and a root-cause analysis may be helpful in developing policies and procedures to decrease the incidence of blunt force trauma.     

Skeletal height reconstruction from measurements of the skull in indigenous South Africans

Stature reconstruction is important as it provides a forensic anthropological estimate of the height of a person in the living state; playing a vital role in the identification of individuals from their skeletal remains. Regression formulae for stature estimation have been generated for indigenous South Africans based on measurements of long bones of upper and lower extremities and the calcaneus. Since these bones are not always available for forensic analysis, it became necessary to use other bones such as the skull for stature estimation. The aim of the present study was to investigate the usefulness of certain measurements of the skull of indigenous South Africans in the estimation of adult stature. Ninety-nine complete skeletons obtained from the Raymond A. Dart Collection, School of Anatomical Sciences of the University of the Witwatersrand, were used. Total skeletal height (TSH) was calculated for each skeleton using the Fully's (anatomical) method. Furthermore, six variables were measured on each skull. TSH was regressed onto these cranial measurements in order to obtain regression formulae. The correlation coefficients obtained ranged between 0.40 and 0.54. The range of the standard errors of estimate from the current study (4.37 and 6.24) is high in comparison to that obtained for stature estimation based on intact long bones and the calcaneus. Therefore, the equations presented in this study should be used with caution in forensic cases when only the skull is available for human identification.     

Radiographic evaluation of third molar development in relation to chronological age among Turkish children and youth

A sharp increase in forensic age estimation of living persons has been observed in recent years. However, ethnic populations residing in different countries have been insufficiently analyzed. According to 2004 data compiled by the Essen-based Turkey Research Center, there are 3.8 million Turkish people living abroad, and 3.2 million of them reside in European Union countries. Despite the high number of Turks living abroad, little is known about third-molar development for forensic application in this population. Hence, it was considered worthwhile to determine the developmental stages of the third molar in a group of Turkish population, to assess chronological age estimation based on the developmental stages, and to compare third molar development according to sex, age and location. Orthopantomograms of 1134 Turkish patients, ages 4-20 years were examined and third-molar developmental stages were evaluated based on Demirjian's classifications. Orthopantomograms were scored by two different observers, and Wilcoxon matched-pairs signed-ranks test used to test intra- and inter-observer reliability revealed a strong agreement between both intra- and inter-observer measurements. Linear regression analysis was performed to correlate third-molar development and chronological age, and further statistical analysis was performed to determine the relation between sex, age and location. Results showed a strong linear correlation between age and molar development (males: r(2)=0.57; females: r(2)=0.56). Mineralizations of left and right third molars were compared using Wilcoxon tests, and no statistical differences were found. No significant differences were found in third-molar development between males and females. Mandibular third molar crypt formation was observed in 2.4% of patients at age seven and maxillary third molar crypt formation was observed in 1.3% of patients at age seven. A strong correlation was found between third-molar development and chronological age. Among the Turkish population, third molar crypt formation is observable at as early as 7 years in both the mandible and maxilla. Agenesis can be determined conclusively if no radiolucent bud is present by age 14.     

Forensic-medical obstetric-gynecological examinations in cases on professional delinquency of medical personnel

We studied the trend in the number of forensic-medical examinations in trials against obstetricians and gynecologists conducted in Primorsky Region in 1997-2005. Most typical defects in obstetric-gynecological care are characterized. These cases are analysed in terms of forensic-medical practice. Detection and forensic-medical analysis of the above defects contribute to optimization of the diagnosis and treatment both in obstetric-gynecological practice and in wide medical practice.     

Effect of clothes on the size of gunshot wounds made by long-distance shots with small-calibre bullets

An experimental study was made on estimation distance of shots made from far distance through clothes with 5.6-mm jacket-free lead bullets. Textile obstructions imitating human clothes were modeled. Contact velocity of the wounding bullet was measured. Almost complete forensic-medical characteristics of inlet gunshot wounds of the body allowing for clothes properties, anatomic structure of the affected body area, deformation of the hitting bullets were obtained.     

Morphology of acute lung injuries in mechanic trauma

The lungs from 60 subjects who had died of polytrauma were studied morphologically. The heads of the corpses were not injuried. The aim of the study was investigation of characteristics and time of development of structural changes associated with lung injury. Early structural changes in trauma were disorders of circulation including microcirculation, acute emphysema, distelectases and atelectases, injury of bronchial and bronchiolar mucosa. Pulmonary edema and systemic inflammatory reaction emerge in the first hours after trauma.     

The role of environmental factors in the causation of sudden death in infants: two cases of sudden unexpected death in two unrelated infants who were cared for by the same babysitter

We report two cases of sudden unexpected death in two unrelated African American female infants, 2 months and 4 months old. Both infants were attended to by the same babysitter in the same apartment and died 39 days apart in the same bed and in the same bedroom. The autopsy of the first infant revealed sudden unexplained death in an infant. Toxicologic analysis for carbon monoxide (CO) was not performed because it was not suspected. When the second infant died, investigation into the ambient air quality within the apartment revealed high levels of CO emanating from a poorly ventilated and defective hot water heater, which was located across a hallway from the bedroom where the two babies died. CO saturation levels in the postmortem blood samples of the two babies were elevated and were similar (13% and 14%). Nicotine and cotinine were not detected in the blood sample of the two infants. Cherry-red livor mortis was absent. Acute CO intoxication was determined to be the underlying cause of these two unexpected deaths. These two cases underscore the need to integrate ambient air analysis and postmortem CO analysis as routine components of the comprehensive death investigation of infants who die suddenly and unexpectedly.