Fatality due to ingestion of tramadol alone

A rare case of a fatal intoxication in an adult with tramadol alone is reported. In the peripheral blood, tramadol was measured in a concentration of 9.6 mg/l exceeded at least 30-times the normal therapeutic range of 0.1-0.3 mg/l. The concentration of tramadol in liver and kidney, in relation to blood, failed to suggest a major sequestration of drug in either specimen which is consistent with the volume of distribution of 3 l/kg. The concentration of tramadol in the heart and peripheral blood specimens did not suggest a major difference (ratio of 1.36). Similar to morphine tramadol was accumulated significantly in the bile.     

Death due to baclofen and dipyrone ingestion.

A fatal suicidal intoxication with unusual drugs is reported. A 56-year-old man was found dead in his house; near by the corpse several empty drugs boxes were found. An autopsy was performed and the biological fluids were submitted to a full toxicological work-up.The analytical results supported the hypothesis of a death due to the acute baclofen (4-amino-3-(p-chlorophenyl)butyric acid) and dipyrone (sodium [N-(1,5-dimethyl-3-oxo-2-phenylpyrazolin-4-yl)-N-methylamino] methanesulfonate) intoxication.     

Accidental death from hydromorphone ingestion

Abstract: A 15‐year‐old male orally consumed an unknown but fatal amount of sustained release hydromorphone. He was naïve to opioid use. No other drugs or alcohol were involved. The cause of death was acute aspiration‐related bronchopneumonia, secondary to hydromorphone ingestion; the manner of death was accidental. Hydromorphone and hydromorphone‐3‐glucuronide were quantified in postmortem fluids by tandem liquid chromatography–mass spectrometry. The hydromorphone concentrations in the peripheral blood, urine, and vitreous humor were 57, 4460, and 31 ng/mL, respectively. The hydromorphone‐3‐glucuronide concentrations in the corresponding three fluids were 459, 36,400, and 40 ng/mL. Hydromorphone‐3‐glucuronide accumulation probably did not contribute significantly to the opiate toxicity. The proposed minimum lethal hydromorphone blood concentration in the nontolerant user is in the vicinity of 60 ng/mL.     

Acute fatal poisoning cases due to furathiocarb ingestion.

Seven cases involving acute fatalities due to ingestion of furathiocarb, a carbamate insecticide, are presented. Furathiocarb was detected in the gastric contents using thin layer chromatography (TLC) and gas chromatography/mass spectrophotometry (GC/MS), and quantified in the blood using a gas chromatograph equipped with a nitrogen-phosphorus detector (NPD). The fatal levels of furathiocarb in the blood ranged from 0.1 to 21.6 micrograms/ml.     

Sudden death due to streptococcal infection

Sudden unexpected deaths form a large population of medical examiner caseloads. Presented are the clinical, pathologic, and virulence features of sudden death due to Group A beta-hemolytic streptococcus. Emphasis is placed on the importance of post-mortem cultures. Case histories are included to illustrate the sometimes unusual presentation of this disease. Recent publicity has led to a heightened public awareness of this unusually virulent entity.     

Sudden death due to malignant hyperthermia

A case of sudden death in a young athlete, most likely the result of malignant hyperthermia, is reported. This diagnosis was entertained at autopsy and later confirmed by muscle biopsy on the father of the deceased, who was proven to be susceptible to malignant hyperthermia. The condition should be strongly suspected at autopsy in unexplained sudden deaths of young adults occurring during exercise or under stress.     

Sudden death due to diabetic ketoacidosis

Two obese women not known to be diabetic died suddenly of diabetic ketoacidosis (DKA). To our knowledge, sudden unexpected death due to DKA has not been reported as the only manifestation of diabetes mellitus. The investigation of sudden death in patients with risk factors for diabetes, especially in the absence of significant disease of the internal organs, should include determination of vitreous glucose and ketones.     

心脏脂肪瘤猝死1例报告

心脏脂肪瘤是一种十分罕见的良性原发性心脏肿瘤.心脏脂肪瘤引起的猝死国内尚未见有报道.我们在法医检案中偶然遇见一例,现报告如下.     

心脏脂肪瘤猝死1例报告

心脏脂肪瘤是一种十分罕见的良性原发性心脏肿瘤。心脏脂肪瘤引起的猝死国内尚未见有报道。我们在法医检案中偶然遇见一例，现报告如下。死者杨某某，男，48岁，生前有心脏病史。因琐事与邻居发生纠纷，吵打中突然倒地，抢救无效死亡。解剖检验：厂长168cm，发育正常，营养中等。睑球结膜苍白，口唇、指甲青紫，口鼻部有多量血性液体流出。全身体表有数处轻微擦挫伤。右肺和胸壁、隔肌轻度粘连、心脏重369g，外形上常。心外膜光滑，心肌暗红色，有光泽，各瓣膜无异常。冠犬动脉畅，轻度粥样硬化。房间隔卵圆窝上部有-60mm×40mm×40mm肿瘤稍…     

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.     

Fatal poisoning due to ingestion of boiled oleander leaf extract

Nerium oleander is an ornamental evergreen shrub belonging to the family Apocynaceae. The Apocynaceae family includes the attractive evergreen shrub known as oleander. The cardiotoxic glycoside, oleandrin, is present in all portions of the common oleander plant. Oleander consumption can result in deadly situations accidentally or as a suicide attempt. After consuming kettle-boiled oleander leaf extract as part of a suicide attempt, an 80-year-old man was discovered comatose in his home and taken to our emergency room. The patient's heart rate was 30 beats per minute, and he had hypotension. Arterial blood gas analysis revealed remarkable metabolic acidosis and hyperkalemia (K: 7.7 mEq/L). An electrocardiogram showed a wide QRS wave, similar to a sine curve. The patient collapsed following cardiac arrest soon after hospital arrival. Veno-arterial extracorporeal membrane oxygenation was initiated; however, the patient eventually died. The serum level of oleandrin at hospital arrival, subsequently measured by LC–MS/MS, was found to be 33.4 ng/mL, far above the levels reported in previous fatal cases.     

An unusual death by propranolol ingestion

A case of acute intoxication with propranolol is reported. A 60-year-old man was found dead in his car with no evidence of trauma or signs of asphyxia. Near the car, a pharmaceutical box of Inderal, a pharmaceutical formulation containing propranolol, was found. The man was not under therapy with this medication, but circumstantial data suggested the use of this medicine by his sister. High blood levels of propranolol confirmed the suspected drug use and induced us to discuss the probable lethal mechanism of this substance. The analysis of this compound was performed by liquid-liquid extraction followed by gas chromatography/mass spectrometry determination.     

Sudden death due to lymphoplasmacytic hypophysitis.

We report the case of a 37-year-old mentally retarded woman who died suddenly with premortem clinical signs of diabetes insipidus. At autopsy, her pituitary was infiltrated and destroyed by a lymphoplasmacytic infiltrate, affecting the posterior pituitary more severely than the anterior pituitary. Vitreous electrolytes showed a pattern of hypertonic dehydration, compatible with diabetes insipidus.     

Sudden death due to right ventricular cardiomyopathy

A 21-year-old man died suddenly at a small party. He had had no clinical signs of cardiac disease except for a slightly abnormal electrocardiogram (occasional premature ventricular contractions) since he was 15 years of age. Autopsy examination revealed cardiomegaly (469 g), with right atrial and ventricular dilatation. The right ventricular myocardium was massively replaced with adipose tissue, and there was one isolated fatty lesion in the right side of the ventricular septum. There were no congenital malformations such as a septal defect or valvular deformity. Histologically, muscular fibers remaining in the right ventricular wall showed neither degenerative nor inflammatory changes. An isolated lesion of the ventricular septum consisted of almost complete replacement of the muscle bundles with adipose tissue. Such a pathologic condition has recently been termed right ventricular cardiomyopathy. Postmortem examination is necessary to make a definite diagnosis of the disease, because in most adult cases of the disease, sudden death occurs before there have been any critical signs.     

Accidental death due to falls at work

The phenomenon of accidental death due to falls at work was studied: 15 cases that occurred during the years 1983-1987, in which a worker died from a job-related fall, are presented in some detail. A discussion follows in which risk factors for these incidents are presented along with suggestions about how to investigate such cases.     

Sudden infant death due to asplenia syndrome

An apparently healthy 80-day-old boy died suddenly for no apparent reason. The autopsy revealed that the patient had had congenital asplenia, extensive cardiovascular anomalies, and other organ malformations, including trisegmented lungs, hypoplasia of the corpus callosum and cranial bones, a symmetrical liver, accessory hepatic tissue in the adrenal glands, malrotation of the intestine, and hypoplasia of the greater omentum.     

Sudden death due to undiagnosed intracranial hemangiopericytoma

A previously healthy 9-year-old Japanese boy with a 4-day history of vomiting and headache died suddenly and unexpectedly. An external examination revealed no abnormalities other than foam around the mouth and nose. An internal examination revealed severe pulmonary edema and hemorrhagic hemangiopericytoma arising from the choroid plexus of the right lateral ventricle. The cause of death was thought to be neurogenic pulmonary edema caused by the rapid growth of a hemangiopericytoma, with intratumoral hemorrhage.     

Sudden death due to thrombotic thrombocytopenic purpura

This case studies the clinical, laboratory, and pathologic findings observed in thrombotic thrombocytopenic purpura (TTP). Although TTP is a well-recognized syndrome, it is frequently undetected antemortem and represents a rare cause of sudden death. We recently were involved in a case of TTP in which an 18-year-old woman with no previous history died suddenly. The case was referred to our office for consultation because of a recent history of methamphetamine abuse. We report herewith our approach to the diagnostic workup of TTP and review relevant literature.     

Maternal death due to non-traumatic fat embolism

The aim of this report is to document a case of non-traumatic fat embolism (NTFE) and to address the need for considerition of fat embolism in suspicious deaths resulting from respiratory distress in the postpartum period. A 28-years-old woman autopsied at the Morgue Department of the Council of Forensic Medicine is included to the study. This female became unconscious and developed respiratory distress 4 h after delivery, and this was followed by respiratory arrest. External examination revealed resuscitation marks and normal postmortem changes. Light microscopy revealed massive fat embolization involving most of the alveolar capillaries on several sections. Only in one particular area was a bone marrow embolus. Pathological diagnosis of the lung was diffuse pulmonary fat embolism. There was no evidence of other organ involvement with emboli. Other visceral organs showed no striking findings other than mild congestion. The cause of death was considered to be respiratory insufficiency resulting from severe fat embolism of the lungs.