Fatal intoxication with melperone

Melperone is judged to be a safe neuroleptic drug. Until now there has been no report of a melperone fatality, though it has been used in suicide attempts. We report on a case of a 36-year-old woman where no cause of death could be established at autopsy. Criminological investigation pointed to a homicide by poisoning but also the possibility of a suicide had to be taken in account. The toxicological analysis of blood, cerebral spinal fluid and urine revealed extremely high concentrations of melperone which had never been reported before. Furthermore, diazepam, nordazepam and carbamazepine were detected. To our knowledge, this case is the first melperone fatality. Possible interactions with diazepam and carbamazepine are discussed.     

Suicide in pregnancy

The difficulty in establishing the cause of death of a pregnant woman emphasizes the necessity for the careful gathering of evidence. Especially in the case of motor accidents along lonely stretches of road involving a solitary motorist the possibility of suicide should be taken into consideration. Since a televised suicide had apparently served as model for the method of suicide, mention has been made of the "Werther effect". A literature review reveals that little has been written on the subject-suicide during pregnancy.     

Suicide by severing blood vessels using local anesthesia: reduced risk in extraction of HIV infected tissue using a stomacher

Authors report an unusual suicide undertaken by a medical person who after applying the local anesthetic lidocaine, opened a leg vein with a scalpel. The cause of the suicide was presumed advanced AIDS symptoms with a progressive Kaposi sarcoma and Non-Hodgkin lymphoma. For the toxicological investigation of the tissue we used the stomacher extraction system, a method not widely known in Forensic science, however, recommended for the extraction of all infectious tissues.     

Ingestion of lye

This paper reports on the case of a 13-year-old white male who committed suicide by ingestion of heavy duty drain and sewer opener. He left behind a note indicating his suicide. This teenager was grieving over the suicide of one of his friends and was under counseling by a mental health therapist at school. Results of autopsy and toxicological analyses indicated the ingestion of a highly alkaline substance that is consistent with the ingredients of the drain opener mentioned.     

Acute Influence of Alcohol,THC or Central Stimulants on Violent Suicide: A Swedish Population Study

Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico‐legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self‐poisoning and alcohol‐/illicit drug‐negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant‐positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.     

反相高效液相色谱法同时测定人血清中氯丙嗪与氯扎平的浓度

作者建立了同时测定人血清中氯丙嗪与氯扎平浓度的反相高效液相色谱(RP—HPLC)法。以利眠宁为内标,用环己烷—乙醚(1:1)混合溶剂提取血清中氯丙嗪和氯扎平。高浓度中毒者血清(>1ug/ml)则用乙腈沉淀后直接进行色谱测定。血清中氯丙嗪、氯扎平的方法回收率乎均各为98.5±4.0(SD)%,CV4.2%;99.9±4.1(SD)%,CV4.1%。两药在血清中的最低检测浓度为10ng/ml。本法应用于临床氯丙嗪、氯扎平合用药物的血浓度监测及司法中毒案例的分析,结果满意。     

Toxicologic aspects of deaths due to falls from height

A prospective study of 161 victims of falls from height is reported. The aim was to determine the interest of systematic qualitative and quantitative toxicological analysis in such fatalities. The primary cause of death was suicide (84.5%), followed by accidents (7%) and homicide (1%). In the remaining 7.5%, cause of death was undetermined. In the suicides, there was evidence of psychotropic medicines in 57% of the observations, with a much higher proportion of benzodiazepines and antidepressants in women than in men. Quantitative toxicologic analysis showed overdosing on medication in 16 suicide victims, with toxic levels in 11 of these. Systematic qualitative and quantitative toxicologic analysis made a significant contribution to the diagnosis of suicide by revealing either an unknown psychiatric treatment or a toxic level.     

Full term normal delivery following suicidal hanging

A 23-year-old woman was found hanging from the ceiling of her house by the neighbours. A live healthy male newborn baby was found lying on the ground with the umbilical cord in situ and placenta inside the uterus. The woman, a primigravida, married 3 years back, was in labour since morning. Her husband had gone out to call for some help to conduct delivery. During the absence of her husband, the wife bolted the door from inside and committed suicide by hanging. During this process she delivered a healthy male baby. This may be the first documentation of a pregnant woman delivering a healthy baby successfully, following suicide by hanging.     

FORENSIC Autopsy of People Having Committed Suicide in 2002 and in 2012: Comparison of Epidemiological and Sociological Data

This work compares epidemiological and sociological data on persons having committed suicide in 2002 and in 2012 through a retrospective study of every suicide case having led to an autopsy at the Institute for Forensic Medicine of Lyon in 2002 and in 2012. The study included sociodemographic data, medical data, and toxicological data. A total of 486 cases were included (242 cases in 2002 and 244 cases in 2012). People committing suicide were on average older in 2012 than in 2002 with a larger proportion of over 55. There was also an increase in the proportion of psychiatric antecedents (p < 0.001). Whatever the date of death by suicide, the most affected age range is the 45–54. The results highlight the necessity of bolstering the prevention plans, in particular for people over 45.     

A suicide with neuromuscular blocker

We experienced an autopsy case in which a 29-year-old woman committed suicide by parenteral application of a neuromuscular blocker combined with thiobarbital. These medicines were easily accessible to the victim who was an anesthesiologist in a hospital. Paralyzing the respiratory muscles the usual dose of neuromuscular blockers can cause death unless a breathing apparatus is used. Unusual medicines given in small doses are difficult to detect in the autopsy materials. In our case in the course of forensic investigation we successfully identified the traces of a neuromuscular blocker by mass spectrometry.     

Unusual circumstances in a fourfold complex suicide

Complex suicides are defined as suicides using more than one method, which may sometimes suggest homicide. We present the case of a 27-year-old man who killed himself by using four different methods. The man was known as a loner and sufferd from bipolar psychosis. An eyewitness saw him afire and falling out of a window on the 4th floor of a hotel. He was wearing a judo dress with the belt wound twice around his neck. He died in a hospital about two hours later. The autopsy showed signs of neck compression typical of (self)-strangulation, several stab and cut wounds in the thoracic and abdominal region from sharp force, extensive first- to third-degree burns caused by the effect of heat, contusions of internal organs, serial rib fractures and several bone fractures of the extremities as signs of blunt force. The CO-Hb value in the blood amounted to 7%; the other toxicological tests were negative. Death was found to be due to exsanguination from a deep stab wound in the abdomen and multiple trauma caused by the fall from a great height in the course of a suicide. Homicide could be excluded due to the circumstances of the case, which demonstrated again that both the medical findings and the investigation results of the police are indispensable for the differentiation between suicide and homicide.     

Suicide by inhalation of carbon monoxide in a residential fire

Fire deaths are usually accidental, but atypical cases of homicide or suicide have been described. In suicide by fire, the only method reported by several authors consists of self-immolation. We present here the unusual case of an adult female who committed suicide by waiting in the living room after setting fire to her bedroom. The autopsy revealed smoke inhalation and the toxicological analysis revealed carboxyhemoglobin levels of 67%. Very few cases of suicide by fire not of the self-immolation type have been reported, and all have been anecdotal. A review of the literature is presented and a new term, "suicide by inhalation of carbon monoxide in a fire," is proposed for such cases.     

GC—MS同时测定血液中苯海索、氯丙嗪和氯氮平

目的建立GC—MS同时测定血液中苯海索、氯丙嗪和氯氮平的方法。方法血液中加入内标SKFszs。．在pH〉10条件下用V（苯）：v（乙酸乙酯）=1：l提取,用GC—MS全扫描法进行定性检测：以地西泮一d;为内标,样品在pH〉10条件下用V（苯）：v（乙酸乙酯）=l：1提取,用GC—MS选择离子监测方法进行定量检测．结果苯海索、氯丙嗪和氯氮平在20～10000ng／mL范围内呈线性关系,最小检测限分别为0．3、0．3和0．7n幽L（信噪比≥3）,方法回收率为79．9％～85．5％,日内、日间精密度均小于5．1％。结论本方法可同时分析血液中苯海索、氯丙嗪和氯氮平,方法灵敏度高、快速、操作简便,适用于苯海索、氯丙嗪和氯氮平的血药浓度监测和急性中喜案件竹枪测     

A peculiar case of suicide

A young woman was found dead on the floor of an abandoned office in the center of the city. The body showed numerous wounds on the front, a piece of wood was caught in the mouth and the opening of the larynx was completely obstructed by a piece of glass. At the beginning it was thought to be a homicide but later resulted to be a suicide through numerous and unusual means. Before the suicide, the woman tried to kill her young 5 year old son, but the child managed to get away.     

Ingestion of pointed objects in a complex suicide

A 51-year-old woman with a psychiatric history of depression and drug abuse was found hanged in her bedroom. The ligature was a scarf attached to the door handle. The autopsy findings suggested that two methods of suicide had been used one after the other. In the first stage, numerous nails, pins and needles were swallowed; in the second stage, the suicide was completed by hanging.     

Autoamputation of the left arm--a bizarre suicide

A 24-year-old woman committed suicide by amputating her left arm immediately below the shoulder joint with a small kitchen knife. No references to such a suicide were found in an extensive literature search.     

Suicidal incised wound of a fistula for hemodialysis access in an elderly woman: case report

A very rare case of suicide by stab wound of a fistula for hemodialysis access in an elderly woman is reported. The incidence of suicide attempts in people undergoing hemodialysis is well known. Nevertheless, suicide means do not usually include stab wounds of the arteriovenous access. Various pattern differences between homicidal and suicidal stab wounds, characteristics of suicide in the elderly, and approaches to the investigation of such cases are briefly discussed.     

Suicide: a ten-year retrospective study

Suicide is a complex phenomenon associated with psychological, biological, and social factors, claiming approximately 30,000 lives each year in the United States. We retrospectively reviewed all cases referred to the Medical Examiners' Office/Forensic Pathology Section at the Medical University of South Carolina from January 1988 to December 1997. The cases of suicide totaled 678. All of the cases were analyzed as to age/race/sex, method of suicide, time of year, and toxicological results. Files were also reviewed to determine if the victim left behind a suicide note. The ages ranged from 12 to 94 years; males comprised 79.5% of the victims, and whites 78.3%. The male to female and white to black ratios were both 3.9:1. The most common methods were gunshot wounds, accounting for 64.6% of the cases. No correlation existed with time of year, and the number of cases was not increased around major holidays. The group of victims 65 years and older and the pediatric group under the age of 18 were also examined separately.     

Ethylene glycol poisoning

A 40-year-old man was admitted to the emergency department after a suicide attempt. The patient was found at home unconscious, with an open bottle of antifreeze near him. The patient was in a coma on admission, but neurological examination excluded intracranial changes. Results of initial urine and serum toxicological screening tests were negative. Laboratory values indicated metabolic acidosis, leukocytosis, urinalysis revealed hematuria and unrecognized crystals. Osmolality and osmol gap were not determined on patient admission. Treatment with ethanol as an antidote and hemodialysis were started because of metabolic acidosis, anamnestic data and clinical status of the patient, and subsequently led to improvement of his condition. Further toxicological analyses of glycolic and oxalic acids in serum and urine samples were performed by ion-chromatography (IC) method and showed high values in spot urine and serum ultrafiltrate at admission, but during therapy the values progressively decreased. Treatment of poisoned patient for 3 weeks resulted in complete recovery.     

Ethylene glycol poisoning

A 40-year-old man was admitted to the emergency department after a suicide attempt. The patient was found at home unconscious, with an open bottle of antifreeze near him. The patient was in a coma on admission, but neurological examination excluded intracranial changes. Results of initial urine and serum toxicological screening tests were negative. Laboratory values indicated metabolic acidosis, leukocytosis, urinalysis revealed hematuria and unrecognized crystals. Osmolality and osmol gap were not determined on patient admission. Treatment with ethanol as an antidote and hemodialysis were started because of metabolic acidosis, anamnestic data and clinical status of the patient, and subsequently led to improvement of his condition. Further toxicological analyses of glycolic and oxalic acids in serum and urine samples were performed by ion-chromatography (IC) method and showed high values in spot urine and serum ultrafiltrate at admission, but during therapy the values progressively decreased. Treatment of poisoned patient for 3 weeks resulted in complete recovery.