Bullet embolism with radiologic documentation. A case report

A case of bullet embolism is reported wherein a handgun missile, fired during a "shoot-out," perforated (among other structures) the anterior and posterior walls of the thoracic aorta, rebounded into the aortic lumen, and was transported to the left femoral artery where it came to rest. Roentgenographic study was instrumental in promptly locating the errant bullet whose recovery established the identity of the responsible firearm. The implications of bullet embolism of the arterial, venous, and paradoxical types for the forensic pathologist and the clinician are discussed briefly.     

The poisoned pen. A case report

In a case of suicide by overdose of a sedative and hypnotic and a tranquilizer the author analyses the deterioration in writing ability in the time frame recorded by the victim.     

Matricide by person with bipolar disorder and dependent overcompliant personality

Matricide is an infrequent form of homicide. This paper is to present a case of matricide with typical characteristics of the act but interesting particularities as well. The perpetrator was a 43-year-old man, respected member of his community, with over compliant characteristics, eagerness in serving people and caring his parents, good social adaptation before and after the crime. He abandoned his family and work in order to better serve his old, disabled but over demanding mother who frequently insulted and humiliated him. Suddenly he came to a state of "mental confusion" and strangled her. After the crime, the perpetrator manifested the symptoms of a bipolar disorder and also received the diagnosis of dependant personality disorder. Years later, he presented again a crisis of escalating aggressive urge for which he was hospitalized. Many people and associations of his hometown actively demanded the minimal possible punishment for him. The case is discussed especially concerning: a) hypotheses about the aetiopathogeny of the act, b) the constant support provided to the perpetrator by his family and social environment.     

A death due to ethchlorvynol abuse. A case report

A fatal case of ethchlorvynol abuse is reported with blood and tissue determinations.     

Left atrial myxoma. A case report of unusual complication

Atrial myxoma may present in unusual fashion and must be considered in the differential diagnosis of several conditions. A 17-year-old, white male presented with central nervous system symptoms, and the diagnosis was established postmortem. A brief discussion of tumor characteristics and diagnostic methods is made.     

Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample

Background: Evidence suggests the relationship between personality disorder (PD) and violence in offenders might be clarified by considering sub-groups of PD offenders defined by patterns of PD comorbidity. Aim: to identify patterns of PD comorbidity associated with severe violence, defined by its severity, quantity and age of onset (Violence Index: VI) in a forensic sample of 100 PD offenders. Methods: Correlations were first computed between VI and a range of personality and criminological variables; next, patients with antisocial/borderline comorbidity were compared with other PD patients; finally, regression analysis was conducted to identify unique predictors of VI. Results: The antisocial deviance factor of psychopathy and antisocial/borderline comorbidity were each significantly and independently associated with severe violence. Patients showing both a high psychopathy score and antisocial/borderline comorbidity had a significantly greater VI than those without these characteristics. Conclusion: PD patients with high psychopathy co-occurring with borderline and antisocial PDs show a criminal profile characterised by a high degree of serious violence.     

Testing for alpha-chloralose by headspace-GC/MS. A case report.

A case is presented involving an acute fatality resulting from self-administered alpha-chloralose, a rodenticide. A 18-year-old man was found dead at home, with several stains of vomit on the carpet. An empty box of three bags of 5 g 100% alpha-chloralose (Corbeaux nuisibles, Rh?ne Poulenc) was found near the body. The compound was identified and quantified by headspace gas chromatography coupled to mass spectrometry. Alpha-chloralose was converted by concentrated sulphuric acid into chloral, a volatile compound, that was, after chromatography on a HP5-MS capillary column, identified by the following ions, m/z 82, 111 and 148. Peripheral blood concentration was 175.7 mg/l. Alpha-chloralose was quantified in several tissues, indicating kidney sequestration. No other drugs, including ethanol, were detected.     

Chronic extradural haemorrhage. A case report and brief literature review

A case of chronic extradural haemorrhage with a presumed time interval of 5-6 weeks between injury and diagnosis at postmortem examination is presented. The literature relating to this entity has been reviewed, and relevant features commented upon, including time intervals, age, sex, location, clinical features, pathological findings, associated skull fractures, mechanisms involved, and the source of the bleeding.     

Atypical bullet entry injuries. A case report and experimental contribution

In order to elucidate the contradictory findings in cases of suicide or homicide with firearms, firing tests were performed with various weapons shot at textile samples, block gelatine, animal and human skin, and pigs' heads. Ricochets were produced at different angles of incidence and bullets were shot through various materials introduced between the target and muzzle. The morphology and emission spectrum analyses of the entry holes were investigated, and the projectiles were collected and inspected. The morphological and chemical alterations observed at the entry holes were classified and discussed.     

Planning for incapacity by people with bipolar disorder under the Mental Capacity Act 2005

The Mental Capacity Act 2005 provides a variety of legal mechanisms for people to plan for periods of incapacity for decisions relating to personal care, medical treatment, and financial matters. Little research has however been done to determine the degree to which these are actually implemented, and the approach to such advance planning by service users and professionals. This paper looks at the use of advance planning by people with bipolar disorder, using qualitative and quantitative surveys both of people with bipolar disorder and psychiatrists. The study finds that the mechanisms are under-used in this group, despite official policy in support of them, largely because of a lack of knowledge about them among service users, and there is considerable confusion among service users and professionals alike as to how the mechanisms operate. Recording is at best inconsistent, raising questions as to whether the mechanisms will be followed.     

Death associated with fluorocarbon inhalation: report of a case.

This case documents postmortem tissue concentrations of fluorocarbons in an individual whose inhalation of cooking spray vapors was well documented. The data presented here should contribute to the information base which will assist the pathologist in determining the cause of death in cases related to inhalation of these fluorocarbons.     

Suicide by xylene ingestion. A case report and review of literature

A 27-year-old male committed suicide by ingestion of a large quantity of xylene. The presence of xylene in the tissues of the victim was confirmed by chromatographic and spectrometric techniques. High levels of xylene were detected in blood (11 mg/dl), gastric contents (880 mg/dl), and duodenal contents (3,300 mg/dl). Histological examination of the lungs showed severe congestion and acute pulmonary edema. Review of the relevant literature is presented.     

Fatal retropleural hematoma complicating internal jugular vein catheterization. A case report

This report describes a case of fatal retropleural hematoma complicating percutaneous insertion of a central vein catheter. The patient was a 55-year-old female undergoing surgery for severe rheumatic mitral valve disease. Factors responsible for this catastrophic incident are the anticoagulation of the patient, the edematous state of the soft tissues, and the multiple punctures of the wall of the jugular vein.     

Accidental death with tear gas pen gun: a case report.

A case of accidental death resulting from a dropped tear gas pen gun is described. Tear gas pen guns can be easily altered to fire regular ammunition and can accommodate a variety of ammunition. Other similar pocket-sized weapons are mentioned.     

The general toxicology unknown. II. A case report: doxylamine and pyrilamine intoxication

A general toxicology unknown case is presented to demonstrate our systematic approach. A 20-year-old male was found dead with multiple suicide notes. Overdose was suspected but substances were not known. Blood alcohol was negative. Urine was analyzed by enzyme-multiplied immunoassay technique and was negative for all drugs assayed. Urine was then extracted with ethyl acetate:hexane (1:1) at pH 10 and back-extracted into 1.0N sulfuric acid. The acidic layer was adjusted to pH 10, and re-extracted with ethyl acetate:hexane (1:1). The residue was analyzed by gas chromatography (GC) on a 3% OV-101 column. It was found to be negative for all commonly screened substances. However, several unknown peaks were observed. Electron impact mass spectra of these unknown peaks were obtained and searched for in our computer library of more than 25000 mass spectra. These unknown peaks were identified as doxylamine and pyrilamine by gas chromatography/mass spectrometry. The base peak and molecular ion for pyrilamine were at m/z 121 and 285, respectively. The base peak for doxylamine was at m/z 58. No molecular ion was observed for doxylamine. Both doxylamine and pyrilamine are antihistamines, but are promoted and used in the management of insomnia. Quantitation was performed on a GC using dexbrompheniramine as an internal standard. Blood concentrations for doxylamine and pyrilamine were 0.7 and 7.0 mg/L, respectively. Concentrations in other tissues were determined. Death was caused by combined doxylamine and pyrilamine intoxication; the manner of death was suicide.     

Supravalvular aortic stenosis, Williams syndrome and sudden death. A case report

Supravalvular aortic stenosis (SVAS) is an uncommon but well characterized congenital narrowing of the ascending aorta above the level of the coronary arteries. It can be a familial disorder, can occur sporadically, or associated with Williams syndrome (WS) which is a neurodevelopmental disorder affecting connective tissue and the central nervous system. Sudden death is a well-known complication of non-syndromic SVAS but few cases have been reported associated with WS. We present a case of sudden death in a woman with the diagnosis of SVAS and WS since the age of 3 years who refused surgical correction and died at the age of 27 years. At autopsy, the aorta and pulmonary trunk were narrowed and the walls showed peculiar microscopical characteristics. In the cardiac conduction system the His bundle was small and intramyocardial. The incidence, pathology, pathogenesis and prognosis of both conditions (SVAS and WS) are reviewed.     

1例死胎的法医学鉴定

随着我国政府对孕产妇健康的重视和对母婴安全的严格管理,死胎现象明显减少.作者曾对一例死胎进行了法医学鉴定,由于涉及这方面的案例很少,现将鉴定情况作一报告如下.