An unusual death in water

A case of combined suicide involving the explosion of a handgranate in water demonstrates the possible misinterpretation of external injuries.     

An unusual case of double death

The report presents the case of an alleged double homicide or a homicide followed by suicide of a couple, in which the court-ordered autopsy of both victims revealed that the homicide had been committed by the husband immediately before he died himself from cardiac failure. The article gives a short summary of the pathophysiological relations between emotional tension (stress) and physical strain and the effects on the cardiovascular system. The case report describes a homicide by strangulation immediately followed by the perpetuator's death from a natural cause.     

An unusual death caused by strangulation

An accidental case of strangulation is reported in which the victim caught his head in the gap of a wooden shed. Before passing into unconsciousness rescue was attempted.     

An unusual death by propranolol ingestion

A case of acute intoxication with propranolol is reported. A 60-year-old man was found dead in his car with no evidence of trauma or signs of asphyxia. Near the car, a pharmaceutical box of Inderal, a pharmaceutical formulation containing propranolol, was found. The man was not under therapy with this medication, but circumstantial data suggested the use of this medicine by his sister. High blood levels of propranolol confirmed the suspected drug use and induced us to discuss the probable lethal mechanism of this substance. The analysis of this compound was performed by liquid-liquid extraction followed by gas chromatography/mass spectrometry determination.     

An unusual cause of sudden child death

Since the rise of HIV/AIDS in Sub-Saharan Africa, there has been a massive promotion of condom use. Unfortunately, this promotion has not always been accompanied with instructions for safe use. In this case report, we describe a small child who aspirated a condom and subsequently died.     

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.     

An unusual accidental death from reverse suspension.

Deaths involving prolonged suspension head downwards have received little or no attention in the English-language literature, doubtless because they are extremely rare. An example, involving alcoholic intoxication as the sole complicating factor, is reported. The mechanism of death is also considered since this is plainly a subject of some interest and likely to provoke further thought and discussion.     

Dental anesthetic death. An unusual autoerotic episode

The details of an unusual autoerotic death are presented; the postulated method of induction of cerebral hypoxia was inhalation of nitrous oxide from a dental anesthetic machine; the theme of dental anesthesia, presumably an elaborate bondage fetish, recurred in documentary material found at the scene.     

Rolled up to death. An unusual autoerotic fatality

Recently, an unusual case of autoerotic death in which a man died of hypoxia after having enclosed himself in plastic was reported in this Journal (1). We present a second case showing many similarities to the one published previously.     

An unusual autoerotic death: asphyxia with an abdominal ligature

A case of accidental death resulting from an autoerotic episode involving a high abdominal ligature is reported. Pathologic findings, physical evidence, and the psychological investigation are discussed.     

A death involving probenecid.

A death following deliberate ingestion of approximately 75 g of probenecid in a 36-year-old man is described. Tissue concentrations of probenecid were highest in serum (710 mg/L) and liver (550 mg/kg). Probenecid was also detected in vitreous and bile. Ethanol was also detected in blood at 0.13 g/100 mL.     

An autopsy case of combined drug intoxication involving verapamil,metoprolol and digoxin

We present here a fatal poisoning case involving verapamil, metoprolol and digoxin. A 39-year-old male was found dead in his room, and a lot of empty packets of prescribed drugs were found near the corpse. The blood concentrations of verapamil, metoprolol and digoxin were 9.2 microg/ml, 3.6 microg/ml and 3.2 ng/ml, respectively. The cause of death was given as cardiac failure, hypotension and bradycardia due to a mixed drug overdose of verapamil, metoprolol and digoxin, based on the results of the autopsy and toxicological examination. We speculate that the toxicity of verapamil is potentiated by drug interaction with metoprolol and digoxin.     

Three unusual neuropathologic-related causes of sudden death

We discuss the autopsy findings of three medico-legal cases of sudden death associated with uncommon neuropathologic findings of which the general forensic pathologist may not be familiar. Case 1 was a 43-year-old man who died of a seizure due to malignant melanoma of the temporal lobe associated with neurocutaneous melanosis (NCM). Case 2 was a 57-year-old woman with a history of mental retardation and incoordination because of chronic lead poisoning, who died of a pulmonary thromboembolism due to deep venous thrombosis status post left leg fracture after a fall down a staircase. Autopsy revealed atrophy and gliosis of her cerebellum as a result of childhood lead poisoning. The third patient was a 75-year-old woman who died as a result of acute bacterial leptomeningitis at the cervico-medullary junction with acute inflammation of the connective tissue of her upper cervical spinal column associated with subluxation of her atlantoaxial (AA) joint, also known as Grisel's syndrome.     

Unexpected sudden death from coronary sinus thrombosis. An unusual complication of central venous catheterization

Coronary sinus thrombosis is an unusual but potentially serious complication of the use of central venous devices. We report a fatal case of coronary sinus thrombosis in relation to a malpositioned central venous catheter. The death occurred very soon following the beginning of symptoms and the cause could not be suspected. Direct trauma of the catheter on the coronary sinus endothelium seems the most probable cause of the thrombosis.     

Casuistics of unusual death from loss of blood

7 cases of unusual natural and unnatural death due to loss of blood are reported. The case reports show the important role of acute and chronic alcohol abuse in this context. They also demonstrate the problems of necropsy caused by the unusual and suspicious situation, in which the corpses are often found; even in cases of natural death sometimes the first aspect arouses the suspicion of a crime.     

病毒性心肌炎累及传导系统致死1例报告

在临床上因心脏疾病致死者死因明确，死者家属一般不要求进行尸体解剖检验，但病毒性心肌炎(viral myocarditis)累及传导系统(cardic conduction svstem，CCS)致死时，一般需借助病理学检验才能明确诊断。本文现介绍一例临床拟诊为病毒性心肌炎，在持续心电监护下死亡的案例。     

A multi-chemical death involving caffeine, nicotine and malathion

Death of a 21-year-old man who was found in a shower stall in his residence is described in the study. At the scene, a 3/4 filled blue glass bottle labeled "Black Leaf 40" (an insecticide containing nicotine), a white plastic pitcher 1/3 full of thick white fluid, a beer mug 1/4 full of thick white fluid, and an empty carton of milk were found. In addition, a can of malathion and an empty bottle labeled caffeine also were found in the vicinity. Autopsy was performed, and the gross examinations of organs revealed no specific findings to account for the death. However, marked congestion in lung, liver, spleen and kidney were noted at microscopic level. Autolytic degenerative changes were also observed in stomach, small bowel and colon. Toxicological analyses of the autopsy samples (blood, urine, liver and gastric contents) revealed the presence of caffeine and nicotine in each sample. Malathion was found to be present only in gastric content. Caffeine and nicotine were analyzed by utilizing gas liquid chromatography-nitrogen phosphorus detector, while malathion was by gas liquid chromatography-flame photometric detector. Analyses of the fluids from the bottle, pitcher and mug disclosed the presence of nicotine in the concentrations of 17.8%, 3.7% and 5.7% (w/w), respectively. The fluids from the pitcher and mug also contained 2.7-2.9% malathion. Results conclude the death was associated with caffeine, nicotine and malathion.