Two cases of acute propane/butane poisoning in prison

Hydrocarbon inhalation is seldom chosen as a means to commit suicide. This practice is exclusively a prerogative of the prison population; it is, however, only exceptionally found in this environment. The two cases of lethal inhalation of propane/butane gas observed by us over a very short time occurred in this context. Toxicologic analyses were performed by means of gas chromatography (head space) and revealed a propane/butane mixture in all specimens (heart blood, bile, and urine) except vitreous humor. Although fatal arrhythmia posthydrocarbon gas abuse is well known, the concentrations of the two hydrocarbons were sufficient to induce death by asphyxiation and were distributed (fairly) homogeneously in all biological fluids and organs examined, a parameter permitting one to assume that death occurred within a relatively short period of time. The absence of finding in vitreous humor and the trace amount in urine suggests that both men died very quickly.     

Distribution of drugs of abuse within specific regions of the human brain

Since concentration of drugs of abuse found in the brain better reflect drug concentration at their site of action, brain specimens are useful in the determination of the role of drugs of abuse in the cause of death. In order to allow for the routine use of brain specimens in this field, a comprehensive database with reliable reference values is needed and should include both post-mortem data for cases where drugs have been taken in therapeutic doses as well as for cases of overdose. In this study, a semi-automated extraction procedure, in combination with gas chromatography/mass spectrometry (GC–MS) using stable isotope internal standards was applied to yield reproducible, quantitative results which could be used to investigate the distribution patterns of drugs of abuse within specific regions of the brain, by analyzing several segments of both medulla oblongata and cerebellum. A homogenous distribution of unconjugated morphine, dihydrocodeine, and benzoylecgonine within the investigated segments of medulla oblongata or cerebellum could be found. However, when these two brain regions from the same case were compared to each other, significantly higher concentrations of unconjugated morphine, dihydrocodeine, and benzoylecgonine were found in the cerebellum than in the medulla oblongata.     

Trends and pattern of drug abuse deaths in Maryland teenagers

The Office of the Chief Medical Examiner of Maryland recorded a total of 149 drug abuse deaths of teenagers aged 13-19 years between 1991 and 2006. Of these deaths, 96 (64.4%) were caused by the use of narcotic drugs only, 29 (19.5%) by both narcotics and cocaine, four (2.7%) by both narcotics and methylenedioxymethamphetamine, six (4.0%) by cocaine only, and 14 (9.4%) by volatile substances (e.g., butane, Freon, nitrous oxide, and propane). The annual death rate from drug abuse for teenagers increased from 1.4 deaths per 100,000 population in 1991 to 2.7 deaths per 100,000 population in 2006 (chi-square test for time trend, p<0.01). The increase in teenager drug abuse deaths occurred in 1999 and since has remained at a higher rate. Further analysis revealed that the increase in drug abuse deaths was attributable to a large degree to narcotic drugs, particularly heroin/morphine and methadone, and was confined to teenagers residing in the suburban and rural areas.     

A Rare Case of Poisoning with a Volatile Substance: Quantitative Determination of n‐Butane in Postmortem Tissue

Poisoning with volatile substances remains exceptional. Authors report the case of a married couple who were found in a car with a butane gas bottle: the woman was dead and her husband alleged it was an unsuccessful suicide pact. A specific research of volatile substances on postmortem samples with headspace gas chromatography–mass spectrometry following a quantitative determination was performed. The n‐butane concentrations detected were composed of 610 μg/L (cardiac blood), 50 μg/kg (brain), 134 μg/kg (lungs), 285 μg/kg (liver), and 4090 μg/kg (heart) and were compatible with the rare lethal concentrations evoked in the literature. The cause of death was determined to be asphyxiation through n‐butane criminal poisoning. Authors recommendation therefore is to take samples immediately and place them in properly sealed containers and hence analyzing the samples as soon as possible after collecting them or storing them under ?30°C (?22°F) if analyses cannot be performed immediately.     

Determination of butane in respiratory gases by means of GC/MS and GC/MS-MS

Butane is inhaled in order to achieve a pleasurable state of intoxication. An overdose can lead to death. In two deaths from our own investigation material the circumstances were suspicious for the inhalation of liquid gas, and the presence of butane should be demonstrated in the respiratory gases. For detection, a method of ion trap gas chromatography/mass spectrometry (GC/MS) and tandem-mass spectrometry (GC/MS-MS) was developed, whereby the gas samples from the lung tissue were directly injected into the GC. The GC/MS tests revealed the presence of butane. Moreover, it was found that during the MS-MS tests reaction products appeared which had formed in the ion trap. Systematic investigations of these reaction products showed that these appeared regularly and could be used as additional backup for the proof of butane. Thus phenomena in the ion trap were used which would not have been expected to occur in normal mass spectrometry or tandem-MS and had not been described in the forensic literature so far. The detected amount of butane could be quantified by means of serial dilutions with nitrogen and room air. The described method shows that small molecules or gases can be demonstrated with the ion trap mass spectrometer.     

Risk Factors Associated with the Chronicity of High Potential for Child Abuse and Neglect

The present 4-year follow-up study involves 56 mothers who were evaluated by social agencies as being abusive and neglectful or at high risk for child abuse and neglect. The aim of the study is to analyze the relationship between psychosocial risk factors (relating to the history and current situation of the mothers) that were present at the time the families were initially recruited and the fact that some of the mothers continue to show a high potential for child abuse and neglect (chronic abuse and neglect), whereas others were able to overcome the problem (transitory abuse and neglect). Results indicate that the following variables are particularly associated with situations involving chronic problems of abuse and neglect: initial level of severity of potential for abuse and neglect; dual-parent status; a large number of children at the time of intervention (3.13 times more risk of chronicity for large families); the fact that as a child the mother herself had been placed in a foster home (3.7 times more risk); that she had been sexually abused (3.5 times more risk); and that as an adolescent she had run away from home (3.02 times more risk). Our results indicate that mothers who have a combination of more than eight risk factors are four times more likely to be in the chronic group.     

Commotio cordis: A case report of a fatal blow

Commotio cordis secondary to a blunt blow to the chest wall can result in ventricular fibrillation and sudden death in children. While it is commonly reported in adolescents during sporting activities, it may result from non-accidental trauma especially in infants and younger children. We report a case of a 6-month-old baby boy who presented to the emergency department in cardiac arrest. The patient's hospital records, postmortem imaging, and the autopsy results were reviewed. External examination of the infant did not reveal any evidence of trauma. Postmortem imaging revealed multiple healing posterior rib fractures and a metaphyseal corner fracture, both considered fractures highly specific for physical abuse. The autopsy revealed a structurally normal heart with no microscopic abnormalities. The infant's father confessed to hitting the child on the chest after which the child became unresponsive. Given the constellation of postmortem imaging and autopsy findings in addition to the father's confession, the child's death was ruled as a homicide secondary to commotio cordis. Since there are no structural and microscopic abnormalities in the heart autopsy in cases of commotio cordis, timely on-scene investigation and a thorough investigation regarding the mechanism of injury are required to make this diagnosis. Early identification of non-accidental trauma is crucial and can prevent further abuse in other siblings.     

Understanding Elder Sexual Abuse and the Criminal Justice System's Response: Comparisons to Elder Physical Abuse

A great deal of research has considered the dynamics of sexual assault and the way that sexual assault cases are processed and handled in the criminal justice system. Most of this research has focused on sexual assault cases involving younger victims. Very little criminological research has considered the dynamics of elder sexual abuse. To fill this void, the current study uses a sample of 127 elder sexual abuse cases and 314 elder physical abuse cases to shed some light on the dynamics of elder sexual abuse and the way the justice system processes these cases. Attention is also given to the way that the processing of elder sexual abuse cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder sexual abuse cases are committed and these cases are processed differently than elder physical abuse cases. Implications are provided.     

STATE CHILD EMOTIONAL ABUSE LAWS: THEIR FAILURE TO PROTECT CHILDREN WITH GENDER IDENTITY DISORDER

Emotional abuse of children with Gender Identity Disorder by parents is very difficult to identify and prevent. State investigators of abuse and neglect often have a hard time determining if the reasons for mental illness and psychological harm in children are due to the actions of their parents, or if they stem from other sources. Once identified, it becomes even harder to prove in court for purposes of ordering services or removing the child from the home if the abuse is severe enough. With children who are gender non‐conforming, this task becomes exponentially more difficult due to the low prevalence rate, discrimination, stereotypes, and a parent's right to bring up their child as they choose. These youth face discrimination and violence in school, work, their communities, and also within their own families. Emotional abuse statutes are too vague to protect youth who are gender non‐conforming. The vague and unclear laws lead to inconsistency in the application of the law and lack of protection of the children because judges and investigators are not aware of how parent's actions harms youth with gender identity disorder. Therefore, states should adopt the model statute within this Note which defines specific actions by parents which would not qualify as abuse when involving gender conforming youth but qualifies as abuse for children with gender identity disorder. Many states already have statutes which define physical abuse, sexual abuse and abandonment by specific actions by parents towards their children. This proposal will enable both the state and the judges to properly identify victims with gender identity disorder of emotional abuse and provide for their protection.     

Fatal Intoxication with Toluene Due to Inhalation of Glue

Two cases of fatal intoxications with toluene due to glue sniffing are described. In case 1, the autopsy did not indicate cause of death, while in case 2, the cause of death was determined to possibly be due to mechanical asphyxia by drowning. As the decedents had a history of glue sniffing, toxicological analyses were performed. Using gas chromatography with flame ionization detector and gas chromatography/mass spectrometry (GC/MS) with headspace method, toluene was detected in biological samples. Toluene ranged from 3.81 to 20.97 μg/g, with the highest concentrations observed in liver and brain (13.82–20.97 μg/g) in both cases. Based upon this data, the cause of death in both cases was determined to be toluene poisoning. Toxicological investigations are extremely important and should be considered mandatory in all deaths thought to be due to volatile substance abuse, as well as all deaths that are thought to be due to poisoning in young people.     

Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy‐based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.     

Semantic and Episodic Autobiographical Memory Recall for Memories Not Directly Associated with Childhood Sexual Abuse

A pattern of overgeneral autobiographical memory recall for memories not directly associated with the abuse has been found in previous research. However, studies with a non psychiatric population are limited. In a non psychiatric student population sample, this study will use two methods of accessing autobiographical memory, The Children's Autobiographical Memory Inventory (CAMI) and the Autobiographical Memory Task (AMT). Contrary to the predictions, this study did not find that episodic recall to the AMT was less specific and episodic recall to the CAMI contained greater detail for both the abuse group and the trauma control group compared to a no trauma control group. Significant differences were found between groups on personal semantic recall with the CSA group reporting significantly lower semantic recall than the two control groups. These findings are relevant to therapeutic interventions as well as having potential implications for interviewing and obtaining statements to be used as evidence.     

Situational factors in female-perpetrated child sexual abuse in organisations: implications for prevention

ABSTRACT

Despite increasing interest in child sexual abuse occurring in organisations, the perpetration of such abuse by females is largely ignored. This study examined situational factors in 136 cases of sexual abuse perpetrated by women working with children in the UK, Canada and the USA between 2000 and 2016. Qualitative and quantitative content analysis of court reports, professional regulator decisions, media reports and an online sentencing database was used, findings indicating that situational and contextual factors are highly relevant in perpetration. Much abuse occurs away from the organisational environment, particularly in perpetrators’ homes and cars, and in virtual environments. However, it also occurs within organisations, generally in unsupervised areas, outside of operating hours and often during mentoring/tutoring or extra-curricular activities. Organisational and local culture can be a facilitator in this abuse and allow it to continue even when concerns are raised. Practical prevention measures are suggested to assist in reducing future abuse.     

Histologic evidence of repetitive blunt force abdominal trauma in four pediatric fatalities

In cases of acute fatal child abuse, certain injuries, including cutaneous blunt force trauma, skull fractures, subdural hematomas, intra-abdominal hemorrhage, and retinal hemorrhages are common and well described in the pediatric and forensic literature. These gross findings at autopsy, when taken into consideration with scene investigation and interviews with caregivers, may indicate both a clear manner and cause of death. In such cases, the discovery of additional pathologic changes attributable to older abusive injuries helps support a conclusion of death due to inflicted trauma. We discuss four cases of fatal child abuse in which acute blunt force abdominal trauma was the cause of death. In each of these cases, careful examination with proper sectioning and microscopy of select abdominal tissues revealed that the acute tissue trauma was superimposed on a background of older, healing injury. This older trauma was characterized by classic histologic elements of tissue repair, including fibroblast proliferation, early scar formation, increased vascularity, and hemosiderin-laden macrophages. Iron and trichrome stains were used to confirm the presence of hemosiderin and fibrosis in all four cases, but the recognition of fibroblast proliferation and a reactive vascular pattern was best seen on routine hematoxylin and eosin stains. The gross and microscopic autopsy findings, along with available investigative information, established the diagnosis of chronic physical abuse.     

Distinct age-related differences among victims in cases of suspected child abuse

Evidence describing age-related differences among children with suspected physical and sexual child abuse is lacking. We describe findings in severe cases of suspected abuse. Cases with 756 children <15 years old were included during 2001–2013 at the Department of Forensic Medicine, Aarhus University, using forensic evaluation documents, medical records, and court proceedings. Eight percent of children <4 years old died from child abuse, 36% through violence resulting in death, and 64% by manslaughter, whereas 1% > 4 years old died, solely by manslaughter. External injuries were mainly located to head and torso in children <4 years old, changing to the upper and lower extremities in older children. Child sexual abuse was suspected in 52% of cases with living children <4 years old, 83% of children 4–7 years of age, 88% of children 8–11 years of age, and 93% of children >12 years old. Anogenital findings were mainly caused by other medical conditions in children <4 years old, hymenal clefts in the superior half of the hymenal rim were almost exclusively found in children between 8 and 11 years of age, whereas both superficial and complete hymenal clefts in the inferior half of the hymenal rim were found in children >12 years old. The present study describes age-related differences in victims of suspected child abuse. Fatal versus nonfatal child physical abuse and the significance of hymenal findings in child sexual abuse could be studied further.     

Postmortem evaluation of barbiturate poisonings

The evaluation of barbiturate intoxication as the cause of death is often difficult when the concentration in body fluids and organs is not extremely high. The problem arises because of the great capacity of barbiturates to produce tolerance after chronic use, a property that is often unknown. Therefore, the most abused barbiturates were studied to assess whether chronic intake causes morphological liver changes or not. It was found that the chronic abuse of drugs containing seco-, cyclo-, brallo-, and/or pentobarbital produces hypertrophy of the smooth endoplasmic reticulum of hepatocytes corresponding to that of phenobarbital. Neither acute barbiturate overdose (without a history of abuse) nor chronic abuse of opiates causes similar liver changes. In conclusion, barbiturate tolerance can be evaluated postmortem by light microscopic examination of the liver.     

Segmental hair analysis for cocaine and heroin abuse determination

Segmental hair analysis was performed to obtain information about the history of drug abuse of subjects in a rehabilitation programme. The analytical data from hair samples were correlated, when possible, with urine analysis and to toxicological anamnesis. Toxicological analysis of hair seems to be a valid tool in this specific field.     

When Loving Means Hurting: An Exploration of Attachment and Intimate Abuse In a Community Sample

Intimate relationship abuse can be understood by considering two critical tenets of attachment. First, attachment fulfills a basic need for survival. Thus, the tenacity of the attachment bond is independent of relationship quality. Second, individuals whose attachment needs have been frustrated may strike out violently to regain proximity to the perceived loss of an intimate partner. We examined how individual differences in attachment were associated with women's and men's relationship abuse. A telephone survey assessed levels of psychological and physical abuse in 1249 Vancouver residents. Of these, 128 completed an attachment interview exploring their interpersonal relationships. Hierarchical regressions revealed that attachment variables contributed significant variance to prediction of both receipt and perpetration of psychological and physical abuse, with preoccupied attachment acting as an independent predictor. There was no evidence that gender moderated these associations. The findings suggest that attachment preoccupation in either partner may increase likelihood of abuse in couples.     

Forms of Social Support That Moderate PTSD in Childhood Sexual Abuse Survivors

Although social support has been found to attenuate psychological symptoms in victims of sexual abuse, literature does not identify the specific forms of social support that mitigate maladjustment following a sexual abuse experience. This study sought to distinguish the specific types of perceived social support that buffer the development of post-traumatic stress disorder (PTSD) in victims of childhood sexual abuse (CSA). One hundred and seventy-two adult females reporting CSA were administered the Interpersonal Support Evaluation List (ISEL) and the Impact of Events Scale (IES). The ISEL measures the perceived availability of 4 support types. The IES measures core PTSD symptoms of intrusion and avoidance. Regression analysis indicated that social support significantly buffered PTSD development. The best model was one which contained self-esteem and appraisal support. Tangible and belonging support added little to prediction. Further, self-esteem support was identified as the most important variable in preventing PTSD development.     

In their own voices: Report of a study on the later effects of child sexual abuse

Abstract

The purpose of this American study was to explore the later effects of sexual abuse in females. in pre or early adolescence. Based on interviews mith a sexually abused group and a comparison group. the study found that incidents of sexual abuse led to numerous harmful later outcomes for their victims. In contrast to a similar but non abused sample, the victim of abuse were characterized by: harboring thoughts of depression. death and suicidal ideation; experiencing lower self-esteem; having fewer close friends; experiencing more verbal altercatfons with their parent or parents; running away from home; having multiple sexual partners; engaging in sexual acti vity a t an earlier age; not using birth control; having an increased chance of becoming pregnant. andor an increased risk of contracting sexually transmitted disease, including HIV and AIDS. Based on these harmful later outcomes. there are many serious implications for child weUm policy and practice. The study's respondents valued assfstance that had helped them recover from the profound emotional trauma. However, they also indlcated that longer term services based in a multi-disciplinary setting, a one-stop facility in essence, would have provided them with more sensltive and effMtive assistance at the point of dfsclasure and subsequently.