A rare fatal case of silicone resin precursor (SH792) poisoning.

A 39-year-old man committed suicide by ingesting a large quantity of SH792. SH792 is a silicone resin precursor used as a hardener for waterproof paints. It is polymerized in water; this process is then followed by the formation of silicone resin and the release of N,N-diethylhydroxylamine. In this decedent, analysis by infrared spectroscopy showed that polymerized silicone resin was present in the stomach contents. The amount of silica in his tissues was within levels seen in control subjects. N,N-diethylhydroxylamine was detected in the urine (0.7 microliters/ml) but not in the stomach contents. The data suggest that SH792 was polymerized in the stomach and the released N,N-diethylhydroxylamine (DEHA) was absorbed into the body. The mechanism of SH792 poisoning is also discussed.     

子宫内翻致死1例法医学鉴定分析

子宫内翻在妇产科临床中极为少见.因子宫内翻致死者罕见.笔者在实际工作中遇见一例,现报告如下:     

A fatal case of oleandrin poisoning

The study presents a case of fatal poisoning with oleander leaves in an adult diabetic male. After repeated vomiting, and gastrointestinal distress the patient was admitted at the hospital with cardiac symptoms 1h after the ingestion. Urine samples were assayed immunochemically and by GC-MS for drugs of abuse and for general toxicological screen. Blood was analyzed for alcohol and volatiles by static head space GC-MS. Blood and oleander leaves were analyzed by LC-MS/MS for oleandrin and related compounds, the main cardiac glycosides of Nerium oleander. Oleandrin was detected by LC-MS/MS in the blood sample at a concentration of approximately 10 ng/ml. Another cardiac glycoside with pseudo-molecular ion of m/z 577, a likely structural isomer of oleandrin, was also detected in the blood and oleander leaves. However, by using the response as a function of concentration for oleandrin, this cardiac glycoside was roughly estimated at a concentration of approximately 10 ng/ml in the deceased blood. This would give a total fatal blood concentration of cardiac glycosides of about approximately 20 ng/ml in the deceased blood.     

Death Caused by Toxic Epidermal Necrolysis (Lyell Syndrome)

Abstract: Toxic epidermal necrolysis (TEN) is characterized by fever, scalded appearance of the skin, and epidermolysis associated to blister formation and exfoliation, and it is caused by hypersensitivity reaction to a drug. The authors report two cases of death as a result of TEN; both referred to old aged women treated with a polytherapy including allopurinol. Both patients displayed erythematous skin lesions similar to scald burns and epidermolysis at the face, chest, and abdomen and died shortly after hospitalization. Autopsy findings and histological examinations revealed epidermal necrolysis and confirmed the clinical diagnosis. A strict time‐correlation between allopurinol administration and symptoms was evidenced. Because of its iatrogenic origin, TEN often arises suspicions of medical liability; however, because of its unpredictable nature, the occurrence of this syndrome cannot be ascribed to the medical staff whose main task is the rapid diagnosis and the correct management.     

Our experiences with fatal ecstasy abuse (two case reports)

Ecstasy is a psychostimulative drug (ab)used mostly by teenagers and young adults in discotheques and on the “rave” parties. Older adults ecstasy abusing cases are very rare. Among four cases of ecstasy abuse with fatal outcome noticed and examined in Slovenia, two were examined at our Institute of Forensic Medicine in Ljubljana. The first case was the accidental intoxication with 3,4 methylenedioxymethamphetamine (MDMA) on “rave” party, the second case was suicidal intoxication with combination of insulin and MDMA. Because of the increasing popularity of MDMA, it is important for all emergency physicians to be well educated in prompt recognition of MDMA intoxication symptoms. It is important that emergency physician carefully examines the death scene.     

A fatal case involving proparacaine.

A 16-year-old female died soon after inhaling proparacaine. Analysis of the tissues revealed an amphoteric compound consistent with a hydrolysis product prepared in the laboratory by reacting proparacaine with HCl in the presence of heat.     

A case of fatal intoxication from metformin

A case of fatal intoxication from metformin is presented. The decedent was an obese 58-year-old-woman with type II diabetes, in whom severe lactic acidosis secondary to metformin accumulation was precipitated by acute renal failure. She had been on metformin 500 mg twice a day. Postmortem blood was deproteinated with acetonitrile, washed with dichloromethane, and the resulting supernatant injected into high-performance liquid chromatography system. Separation was performed on a analytical 125 x 4 mm i.d. RP-8 column. The wavelength was set at 235 nm. The mobile phase was acetonitrile (40%), sodium lauryl sulfate, and sodium dihydrogen phosphate adjusted to pH 5.1 (60%) at a flow rate of 1.0 mL/min. The concentration of metformin in postmortem blood was 77.3 microg/mL. The qualitative result was also confirmed by LC/APCI/MS/MS analysis.     

A fatal case of pepper poisoning.

An 8 month old infant died as the result of administration of a traditional remedy, given orally as an infusion of a red powder. The symptoms on admission were coughing with diarrhoea and vomiting. Analysis of the powder using high-performance liquid chromatography (HPLC) confirmed the suspicion of capsaicin. Pepper preparations, which are used as traditional medicines, are highly toxic and their use on infants should be discouraged.     

A fatal case of mercuric cyanide poisoning

A 57-year-old pharmacist was found dead 11 days after his disappearance. At the autopsy, samples of blood, urine, gastric content were obtained. Presence of ethanol, cyanide and mercury were detected in some samples. Cyanide and mercury were identified and quantified using high-performance liquid chromatography with diode array detector (HPLC) in fluorescence mode and ICP with mass selective detector (ICP-MS) respectively. Whole blood concentrations of ethanol was 1.72 g/L. Cyanide and mercury concentrations in whole blood were respectively 0.16 and 3.8 mg/L. Concentrations of cyanide (27 mg/L) and mercury (150 mg/L) in gastric contents prove a massive oral ingestion of mercuric cyanide or mercuric oxycyanide occurred. In this case report, the death was attributed to the combined toxicity of cyanide and mercury.     

A fatal case of pure ethanol ingestion

An adult male was found dead in a car with two empty bottles (500 ml x 2) labeled dehydrated ethanol (>99.5%, v/v). At autopsy, extensive pancreatic necrosis with severe hemorrhage was observed. High concentrations of ethanol were detected in blood (8.14 mg/ml), urine (8.12 mg/ml) and tissue specimens. The cause of death was determined to be an acute alcohol intoxication caused by ingesting approximately 1l dehydrated ethanol.     

A fatal case of oral ingestion of benzine

A young woman committed suicide by ingesting benzine. We report the findings obtained at autopsy and the chemical analyses of the gastric contents, blood, and tissues in this case. Fatal concentrations of n-hexane, benzene, toluene and m-, p-xylene were detected. Pulmonary edema and hemorrhage were caused by the primary effect of the chemicals or secondarily by respiratory depression, suffocation due to volatile fluid, or heart failure. Mild hemorrhage around arterioles and venules in the brain cortex suggest hyperpermeability of the vessels. The fragmentation and waviness of the cardiac myofibrils indicate the presence of hypercontraction and possibly arrhythmia.     

A fatal case of oral ingestion of toluene

A 51-year-old male ingested orally a large quantity of toluene and died about 30 min later. The presence of toluene in body fluids and tissues was confirmed by gas chromatography and gas chromatography/mass spectrometry. Tissue distribution of toluene showed that the liver detected the highest content of toluene (433.5 micrograms/g), except for the stomach contents, followed by pancreas (88.2 micrograms/g), brain (85.3 micrograms/g), heart (62.6 micrograms/g), blood (27.6 micrograms/g), fat (12.2 micrograms/g) and finally cerebrospinal fluid (11.1 micrograms/g).     

A fatal case of poisoning with cantharidin.

A case of fatal poisoning due to voluntary ingestion of cantharides powder for aphrodisiac purposes is reported. Clinical history, autopsy and analytical findings are described. Blood and urine samples collected during the 30 h of survival, as well as the cantharides product, were analyzed by gas chromatography-mass spectrometry. On the basis of the percentage of the active principle measured in the powder, an ingested dose of 26-45 mg of cantharidin could be estimated.     

The cocaine "body stuffer" syndrome: a fatal case

Body stuffer, sometimes called "mini packer", is the definition of someone who admits to or is strongly suspected of ingesting illegal drugs in order to escape detection by authorities, and not for recreational purposes or to transport the drug across borders. Cocaine is the drug most commonly involved in the body stuffer syndrome. Reported cases of body stuffer deaths are rare, however a fatality related to the ingestion of a plastic bag containing cocaine is described regarding a 17-year-old dealer. The authors describe how the cocaine body stuffer syndrome differs from the usual body packer. Histological and toxicological findings are examined and discussed for a better definition of this unique syndrome.     

A case of fatal amniotic fluid embolism]

A 31-year-old pregnant woman (multipara), who was near the expected date of birth, was found dead in the joint flat by her partner. She was lying beside the bed and showed burns on the front of the body caused postmortem by contact with a radiator. Autopsy revealed a rupture of the fetal membranes, the inner layers of the uterus and a large vein. After centrifugation, the supernatant of the blood from the right half of the heart was turbid and contained small corpuscular amniotic fluid components. The diagnosis of amniotic fluid embolism could be confirmed histologically. In the pulmonary vessels of the mother meconium, lanugo hairs and epidermic scales could be demonstrated; in addition the fetal horny lamellae were confirmed immunohistochemically (using monoclonal antibody against cytokeratin).     

A fatal case of parenteral paraquat poisoning.

The chief clinical and analytical aspects of the suicide of a 21-year-old male with psychiatric problems by parenteral administration of a 200 g/l aqueous solution of paraquat are described. Paraquat levels were determined in plasma, urine, kidney, liver and lung after autopsy. Tissue damage was studied by electron microscopy. The death ensued from pulmonary dysfunction 15 days after hospital admission.     

A rare fatal case of wood preservative,monochloro-naphthalene (MCN), poisoning

A rare case of poisoning by the wood preservative Xylamon^® TH-Clear (active ingredient: 60% 1-chloronaphthalene) is reported.A mentally disordered carpenter, 44 years old, ingested an unknown amount of Xylamon^® and died in about 2 hours. Analysis for 1-chloronaphthalene was performed by TLC, IR and GC methods. GC analysis for 1-chloronaphthalene showed the concentration in the peripheral blood to be 2.46 μg/ml and the bile concentration to be 75.5 μg/ml. The total amount in the stomach contents was 27.7 g.