Forensic medical expert evaluation of lethal poisoning with narcotics

Morphological manifestations of lethal narcotic poisoning are analyzed on the basis of results presented in "Acts of Medical Examination of Corpse" and "Expert Conclusions" on 352 cases with lethal narcotic poisoning, suspected (with good grounds) poisoning, and combined poisoning with narcotics and other agents. Causes of failure to detect narcotics in forensic chemical analysis of biological material from the corpse are enumerated.     

Diagnosis of lethal poisoning with some substances used by toxicomaniacs

The authors analyze 62 expert conclusions on deaths from acute and chronic poisoning with various toxic substances used by toxicomaniacs. Forensic medical examination of corpses and forensic chemical analysis identified drugs, toluene, freon, organophosphorus compounds, and other toxins.     

Homicidal poisoning. A dying modality of lethal violence?

Review of the experience of the Cuyahoga County (Cleveland, Ohio and its suburbs) Coroner's Office with homicidal poisonings over the past 3 1/2 decades reveals that this modality of felony homicides constitutes but a tiny fraction of the total case load and small percentages of overall homicides and drug- and chemical-caused deaths of all types. These findings are representative of selected medicolegal establishments across the country, as well as in the United States as a whole. Precise definition of the several types of felonious homicidal poisonings is suggested in the interest of clarity and accuracy of statistical data.     

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.     

Forensic-biochemical indices of serum amilase and cholinesterase activity in lethal poisoning with heroin

The examination of the activity of serum amilase and cholinesterase in the blood from subjects who had died of heroin poisoning showed significant elevation of such activity. These findings allow experts to use the activity of the above enzymes as effective markers in detection of narcotic drugs in cadaveric blood, opiate narcotics, in particular.     

Yellow oleander poisoning--a study of 170 cases

Yellow oleander or Thevetia peruviana is a very common plant in the North of Sri Lanka. Ever since the fact that the fruits and kernel are poisonous was published in the Newspapers, many cases of poisoning due to Thevetia occurred. 170 cases of Thevetia poisoning admitted to the Teaching Hospital, Jaffna in the North of Sri Lanka are studied by the authors. The mortality, morbidity, age distribution, presenting symptoms and clinical findings are analysed. The action of the cardiac glycoside in Thevetia is clearly demonstrated in this study.     

Morphofunctional interaction of adrenal zones in acute lethal carbon monoxide poisoning in people with alcoholic intoxication

Morphological examination of human epinephroses at acute lethal poisoning with carbon monoxide against a background of alcoholic intoxication was done. Acute lethal poisoning with carbon monoxide decreases effect of alcoholic intoxication upon morphofunctional state of epinephroses and disorders characteristics of interzonal interaction. Interaction between zones of one epinephros recedes but interaction between both glands increases.     

Dependence of acute opiate poisoning lethal outcome on the gender, age, and duration of addiction

The article presents toxicological characteristics of 198 cases of acute parenteral poisoning with morphine and heroin in the range of concentrations of their metabolites in the blood and urine which occur in practice. Risk of death is quantified in the range of possible morphine concentrations in the blood in acute opiates intoxication with reference to gender and age. Assessment of the criteria of quantitative opiates toxicity was made according to the method of logit regression and dose-effect curve suitable for analysis of correlations between probability of death and blood concentrations of opiates metabolites. Conditional lethal doses in respect to gender and age are calculated.     

Fournier Gangrene and Unexpected Death

Abstract: Fournier gangrene represents a rare but progressive perineal infection that may result in rapid death. A 70‐year‐old man with poorly controlled diabetes mellitus and alcohol abuse is reported who was found unexpectedly dead. He had last been contacted the night before his death. At autopsy, the most striking finding was deep necrotic ulceration of the scrotum with exposure of underlying deep muscles and testicles, with blood cultures positive for Escherichia coli. Death was, therefore, attributed to necrotic ulceration/gangrene of the perineum (Fournier gangrene) that was due to E. coli sepsis with underlying contributing factors of diabetes mellitus and alcoholism. In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. Fournier gangrene may be an extremely aggressive condition that can result in rapid death, as was demonstrated by the rapid progression in the reported case.     

突发公共事件应急机制建设研究——雪灾后的反思

在全球化的时代,国际问题不断涌现,突发公共事件频繁发生,有效的突发公共事件管理机制,可以让政府对突发公共事件的管理纳入有步骤,有条理的进程中,让突发公共事件对社会的破坏降低到最小程度.本文以雪灾为例分析了我国突发公共事件应急机制建设中存在的问题,最后给出了相应的改善措施.     

Unexpected death due to infectious mononucleosis

A 14-year-old boy with infectious mononucleosis died unexpectedly in hospital. The most significant finding at autopsy was the presence of marked bilateral tonsillar enlargement with considerable narrowing of the upper airway. There were no other underlying organic diseases that could have caused or contributed to death. Narcotic analgesia had been administered less than 2 h before death and may have contributed to respiratory compromise. The blood morphine level was 0.08 mg/L. Toxicological evaluation of individuals with obstructive lesions of the upper airway may, therefore, be a useful adjunct to the autopsy assessment of such cases as it may reveal factors exacerbating mechanical blockage.     

Paraquat poisoning

A fatal case of paraquat poisoning is described. Postmortem concentration of paraquat in different tissues reveals that treatment in this case could not prevent lethal tissue accumulation. Although accumulation was more pronounced in renal tissue, lung toxicity caused death. The formation of enormous fecaliths and the appearance of hypercalcemia are reported. Both were most likely connected with Füllers earth therapy. In spite of the fact that the exact nature of the equilibrium between plasma levels and tissue accumulation of paraquat (static or dynamic) is not understood, aggressive treatment must be recommended, even after the distribution phase and despite likely "fatal" plasma levels.     

Cocaine poisoning

Lethal cocaine intoxications in the Federal republic of Germany are still rather unusual. The present article describes chemical findings in a suicide case after oral/nasal intake. Our experience as well as the results of literature leads to the conclusion that if a cocaine intoxication is suspected, examinations are required which should include parts of the brain, the kidneys and the spleen. The application of RIA or rather the EMIT-Procedure only are not sufficient to clear up an intoxication.     

Fatal propane-butane poisoning

Two lethal poisonings by butane and propane are described, and the corresponding concentrations in the body fluids and organ tissues are evaluated. One case appeared to be an accident after deliberate inhalation for butane, one was a suicide. The mechanism of the inhalation could be reconstructed in both cases. The concentrations in the biological material agreed well with observations in similar cases.     

Fatal diltiazem poisoning

The diagnosis at postmortem examination and the results of the chemical analysis in a case of a diltiazem intoxication are presented. Two metabolites were identified as desacetyldiltiazem and N-desmethyldiltiazem.     

Hydrofluoric acid poisoning

A case of suicidal ingestion of hydrofluoric acid is presented. Death of the victim while in police custody was one of the more unique aspects of the case. This is the sixth case of poisoning of this type reported in Dade County. Clinical, pathological, and toxicological aspects of fluoride poisoning are discussed.     

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.