Accidental head explosion: an unusual blast wave injury as a result of self-made fireworks

A 33-year old hobby pyrotechnician sustained a lethal craniofacial trauma secondary to a salute fireworks blast. He was examining a misfire of a self-constructed salute gun, when it detonated, causing an explosively rupture of his forehead, which led to his immediate death. An autopsy was performed to achieve knowledge of the injury and to be able to reconstruct the events that lead to it. The pressure effect of the explosion caused a shredded rupture of the forehead with a regional spread of brain tissue and small polygonal skull fragments up to 30m from the detonation site. Furthermore multiple cinderlike fragments of black powder were embedded in the skin of the face and the anterior aspect of the neck (s.c. blast tattoo). The complete destruction of the forehead in combination with the multiple blast tattooing suggested that the explosion detonated while he was leaning over the device.     

遥控类爆炸装置的爆炸残片分析

目的为了推断遥控爆炸犯罪案件中所制作的遥控爆炸装置种类;方法首先制作常见的两类共3种遥控爆炸装置,进行爆炸实验;接着通过对爆炸残片的检验,研究各种遥控爆炸装置的爆炸残片特征;结果在不多于400克药量的常见炸药爆炸后,3种遥控爆炸装置爆炸后都可以在现场收集到大多数的爆炸装置残片可供检验;结论通过对爆炸残片的特征检验,基本上可以推断遥控爆炸装置的种类与外包装的种类,以及是否使用电池电源。     

Principles of records and coding causes of death as a result of craniocerebral injury

Discusses modern requirements to coding of death causes in cases of craniocerebral injury in accordance with the 10th revision of International Statistical Classification of Diseases and Health-Related Problems (ICD-10). Offers the ways to fill in medical certificates of death with consideration for the items of ICD-10 and classification of craniocerebral injuries.     

Decapitation as a result of suicidal hanging

A report is presented on a 47 year old man who committed suicide by hanging himself from a staircase bannister of an apartment house. The man, weighing 144 kg jumped with the noose of a 2 cm thick and 2 m long hemp rope around his neck and was completely decapitated. Death from typical "normal" suicidal hanging is usually due to cerebral ischaemia caused by compression of the carotid (and vertebral) arteries. Except for bleeding at the clavicular insertions of the sternocleidomastoid muscles there are only occasional injuries to the cervical soft parts or hyoid bone and/or laryngeal cartilage. A fall with a noose around the neck, on the other hand, is associated with more frequent injuries to cervical structures through additional axial traction and radial shearing forces of the tightening noose. Complete decapitation can occur in rare cases under extreme conditions (heavy body weight, inelastic and/or thin rope material, fall from a great height).     

Unexpected death as a result of infective endocarditis

Thirteen cases of infective endocarditis (IE) diagnosed for the first time at autopsy or, in those patients with a previous diagnosis of IE, not thought to be active at the time of death, are presented. Of the six patients who died within 24 h of the onset of symptoms, two died of obstruction of a valve orifice, two died of sepsis, one died of sepsis and alcoholic cardiomyopathy, and one died of a coronary artery embolus. Of the five patients with symptoms lasting more than 24 h, three died of sepsis and congestive heart failure. One died from sepsis alone and one died from congestive heart failure (CHF). In two patients whose duration of symptoms is unknown, one died of sepsis and CHF, and in the other the mechanism of death is unknown. Predisposing factors present in 11 of 13 patients included alcoholism (three), intravenous (IV) drug abuse (three), prosthetic valves (three), aortic stenosis (two), past rheumatic fever (one), and nonstenotic congenitally bicuspid valves (two). The reasons for no antemortem diagnosis were a missed or incorrect clinical diagnosis in three patients seen by a physician shortly before death, no signs or symptoms or found dead (four), non-specific signs and symptoms (three), refusal of medical treatment (one), and a solitary lifestyle (one); there was insufficient information about one patient. Individuals with needle tracks, generalized petechiae. Osler's nodes, splinter hemorrhages, intravenous catheters, pacemaker wires, and infected aortic-valve (A-V) shunts are at risk of IE. Blood and the vegetations should be cultured. The attending physician should be notified of the diagnosis in such cases.     

A double homicide as a result of chloroform poisoning

Homicidal poisoning using chloroform has been reported infrequently. Presented is a case of a double homicide involving a 29-year-old male and his 23-year-old fiance. Gas chromatographic methodology and tissue concentrations of chloroform are presented. Evidence strongly suggests forced inhalation using an impregnated cloth.     

The reduction of male abusiveness as a result of treatment: Reality or myth?

A 6-month outpatient treatment program for male abusers emphasized honesty, shame reduction, and group support for change. Ratings on the Abusive Behavior Inventory (ABI) obtained before and immediately after treatment demonstrated a significant decrease in physical and psychological abuse as rated by both the abusers and their female partners. This decrease in male abusiveness was maintained 6 months and two years after completion of treatment for those couples who cooperated in followup. No decrease in male abusiveness was observed during treatment, however, for those couples who did not cooperate in the followup. The authors suggest that the noncooperative female partners may have been afraid to rate their partners because of continued abuse. Therefore, the selective attrition of subjects who did not improve is a major problem in evaluating the apparent long-term success of treatment.     

Sudden death in a neonate as a result of herpes simplex infection

This paper describes a case of a neonate with disseminated herpes simplex born to a 14-year-old asymptomatic mother. The infant's physical examination was normal at birth, and subsequent abnormalities were so subtle that infection was not recognized during life. Postmortem cultures of liver and spleen grew herpes simplex virus, and immunofluorescent direct antibody typing revealed Type 2. A cervical culture of the mother obtained after the infant's death was negative.     

Variations in vitreous humor chemical values as a result of instrumentation

Urea nitrogen, glucose, sodium, potassium, and chloride were measured in common vitreous humor samples using a variety of instruments. There was found to be variation in values obtained by the different procedures for each of these constituents. The variation in electrolyte values between the different procedures can pose real problems in attempting to determine the presence of an antemortem dehydration or low salt condition. Possible reasons for these variations are discussed, and the normal range of values of both sodium and chloride for the different instrumentalities is provided. However, variations in values for both urea nitrogen and glucose would not pose any problems of interpretation for forensic science evaluations.     

Cervical airway injuries as a result of impact with steering wheel rim

Motor vehicle occupants may suffer severe cervical airway injuries as the result of impaction with the steering wheel, dashboard, windshield, backseat, and seat belt. Although the steering column is well recognized as a general site of injury infliction, less attention has been directed to components which may be the actual focal point of contact, such as the steering wheel rim. Two cases of cervical airway injury as a result of impact with the steering wheel rim are presented, including one instance of complete laryngotracheal transection. Correlation of injury with crash and postcrash sequences as well as the damaged vehicle will often provide excellent crash injury reconstruction.     

Variations in vitreous humor chemical values as a result of pre-analytical treatment

Vitreous humor (VH) is used for postmortem diagnosis of metabolic diseases and to clarify the postmortem interval. Because of its viscous nature, this fluid has to be liquefied prior to analysis; however variations in measured concentrations of the analytes are ascribed to different pre-analytical treatment methods with regard to. The aim of this study was to compare different pre-analytical methods. Centrifugation, heat treatment, enzymatic digestion and liquefying by ultrasound were compared using a collection of 120 samples obtained from 2003 to 2007. The determined parameters were: sodium, potassium, chloride, calcium, glucose, creatinine, urea and lactate. Analyses were performed either photometrically or by using ion-selective electrodes. Heat and hyaluronidase treatment generate slightly higher and lower values in the measurement of electrolytes and glucose. However, in the determination of calcium concentration, both methods (heat especially) are associated with extreme low or high values. Only differences between ultrasound and centrifugation treatment show comparatively small variations and are close to instrument accuracy. Therefore, we recommend centrifugation, combined with mixing, as the best and easiest method in which to prepare frozen samples for analysis. Additionally, the measurement of lactate shows that analytical methods, calibrated for serum and urine, cannot be easily applied for VH.     

Asphyxial deaths as a result of aspiration of dental appliances: a report of three cases

Three cases of asphyxial deaths as a result of aspiration of dental appliances are presented. The possible association of this condition with resuscitative effort and patient debilitation is discussed. A recommendation to improve diagnosis and facilitate resuscitation is offered.     

Commotio cordis as a result of a fight: Report of a case considered to be imprudent homicide

Commotio cordis is a clinic-pathological syndrome related to sudden death in young people involved in sports activities. It has been described, mainly, in athletes without previous cardiac anomalies who received a minor blow to the chest which produces ventricular fibrillation and cardiac arrest in the absence of structural damage to the ribs, sternum, or heart. There are few reported cases of commotio cordis associated with violent, non-sports related actions, which are commonly considered to be imprudent homicides. We present the case of a 20-year-old man, who was kicked in the chest during a fight; he suddenly collapsed although advanced cardio-respiratory resuscitation started shortly. Autopsy showed no cardiac lesions concluding that death was due to commotio cordis (blunt trauma to the chest). Toxicological analysis determined the presence of 5.14 mg/L benzoylecgonine in blood. On the basis of medico-legal investigation, the official prosecution considered the death to be imprudent homicide and the aggressor was sentenced to 4 years in prison. We emphasize the importance of the knowledge of the death circumstances through the witnesses’ testimony, prior to beginning the autopsy, to confirm this important medico-legal diagnosis. Arrhythmogenic effects of cocaine and its contribution in the production of these deaths are also exposed.     

Three fatalities involving phosphine gas, produced as a result of methamphetamine manufacturing.

In August of 1996, Sheriff's deputies investigated the deaths of three individuals suspected to have been overcome by phosphine gas. Phosphine is an extremely toxic gas, and is generally seen in the farming industry where it is used as a grain fumigant. It can also be generated as a by-product during the manufacturing of methamphetamine. Chemicals and equipment consistent with the manufacturing of methamphetamine were noted at the location, as well as an apparent reaction mixture heated to near dryness. Dr?ger tubes detected an atmospheric phosphine concentration in excess of 0.3 parts per million (ppm), the Threshold Limit Value. Deputies had initially assessed the scene with no protective equipment, raising concerns about phosphine toxicity and the effects of exposure. The objectives of this paper are to describe how phosphine is formed during the manufacture of methamphetamine, to review the toxicity, health effects and symptoms of exposure, to address the safety concerns regarding potential exposure to law enforcement personnel, and to describe the protective equipment available for personnel who respond to clandestine laboratories.