Fatal hyperthermia in hot baths in individuals with multiple sclerosis

The authors report the case of a 47-year-old black man with a history of multiple sclerosis who was found dead in a bathtub, head above water, with a body temperature of 105.7 F. Results of a complete autopsy and toxicologic screen were negative. Individuals with multiple sclerosis, if immersed in hot water, develop motor weakness, which may be so severe as to prevent them from getting out of the water, whether they be in a bathtub or whirlpool bath. In this case, the individual was trapped in a bathtub in which there was a continuous flow of hot water. This overwhelmed an already impaired thermoregulatory mechanism, causing hyperthermia and death.     

Numerous cortical tubers and rhabdomyomas in a case of sudden unexpected infant death

Sudden infant death syndrome is the leading cause of death in infants between the ages of 1 month to 1 year. Sudden infant death syndrome, a diagnosis of exclusion, can only be made after other explanations for unexpected death have been ruled out. Tuberous sclerosis complex is occasionally the findings in these patients with unexpected infant death. Here, we present a case of an unexpected infant death during sleep with multiple factors that confound the cause of death. We discuss these factors and attempt to delineate their contributions to arrive at a cause and mechanism of death.     

Endemic clustering of multiple sclerosis in time and place, 1934-1984. Confirmation of a hypothesis

The occurrence of multiple sclerosis in clustered groups of cases that are often related to others in time and place has been observed on several occasions in the last 50 years. Selected clusters are here reviewed in relation to suspected sources of heavy metal (mercury, lead) poisoning as background for the analysis of the 1983-1985 "outbreak" of 30-40 cases of multiple sclerosis in Key West, Florida. Evidence is presented that the time-place clustering resulted from environmental pollution stemming from a nearby dump pile of rocky debris. The probable mechanism is discussed.     

Incidental cardiac rhabdomyomas: a significant finding necessitating additional investigation at the time of autopsy

Cardiac rhabdomyomas are rare lesions forming part of the tuberous sclerosis complex that may be responsible for sudden death. As well as remaining clinically occult for variable periods of time, they may, along with other manifestations of tuberous sclerosis, be quite difficult to detect clinically and pathologically. A patient is described in whom multiple cardiac rhabdomyomas were an incidental finding at autopsy following fatal potassium fluoride poisoning. Other gross pathological lesions typical of tuberous sclerosis were present but were quite subtle in appearance. Awareness of the association of cardiac rhabdomyomas with tuberous sclerosis is important so that full examination of organ systems for characteristic lesions can be undertaken during the autopsy, and so that fresh and frozen tissue can be obtained at the time of dissection for further investigation.     

Clustering of multiple sclerosis in Galion, Ohio, 1982-1985

Epidemiologic evidence indicates that the outbreak of 30-40 cases of multiple sclerosis and other demyelinating syndromes in Galion, Ohio, USA, during 1982-1985 was related to an excess concentration of heavy-metal wastes, especially of cadmium and chromium in sewage and river water. Both multiple sclerosis and myasthenia gravis were diagnosed by board-certified neurologists.     

应用多元逐步回归分析建立ART推算PTT的数学模型

既往国外文献报道用ART推算PTT，但结果差异较大。选择正常听力和感音神经性聋的400例大样本，将全部有关数据用Foxbase数据软件建立相应数据库，再运用SPSS数据分析软件包中多元逐步分析程序，建立了用纯音ART和WNART推算PTT的数学模型。经配合适度和偏回归系数等显著检验（P＜0．00001），且新建方程的准确率和可信性较过去方法为好。年龄、轻度中耳阻抗异常对推算准确性无显著影响。作者认为，新建数学模型可作为法医听力学评定中常规方法。     

The forensic medical significance of morphometry of the spleen in drug addiction and chronic alcoholic intoxication

Data on histomorphologic damage to the spleen in chronic narcotic and alcoholic intoxication are described. The below features are recommended for the diagnosis of chronic exogenous intoxication: thickening and sclerosis of the spleen connective structures and a lower count of lymphocytes in the white pulp. The diagnosis criteria of chronic intoxication by intravenously administered opiates are: hyperplasia of the spleen follicles as well as a higher quantity of plasmocytes and of eosinophiles in the white pulp. Hypotrophy of the spleen lymphoid follicles and higher counts of monocytes and macrophages in the lymphoid follicles should be also regarded as a sign of chronic alcoholic intoxication. The obtained data can be used by forensic medical experts in the diagnosis of chronic narcotic intoxication and in its differential diagnosis versus alcoholic intoxication.     

Constitutional challenge to "medical inadmissibility" provisions in the Immigration Act

In a case with significant implications for people living with HIV/AIDS who wish to immigrate to Canada, in January 2002 a woman with multiple sclerosis launched a constitutional challenge to the "medical inadmissibility" provisions in the Immigration Act. The provisions state that any would-be immigrant may be denied permission to immigrate "if their admission would cause or might reasonably be expected to cause excessive demands on health or social services."     

White collar crime and the definitional quagmire: A provisional solution

More than virtually any other realm of criminological scholarship, white collar crime study is plagued by unresolved definitional, conceptual, and typological issues. The present confused and contradictory invocations of the core terminology pertaining to white collar crime introduce a significant element of incoherence into the field. In this paper the seminal origins of the concept of white collar crime, in the work of E. A. Ross and E. H. Sutherland, are explored. The principal elements of subsequent efforts to define white collar crime are identified. It is claimed that a war of white collar criminologists' has emerged, principally pitting critical white collar criminologists against positivist white collar criminologists. Some of the strengths and weaknesses of each of the principal constituencies in this definitional war are examined. The paper concludes with the argument that the concept of white collar crime is defined on three different levels—presentational, typological, and operational —and that any definition of white collar crime is meaningful only in relation to its stated purpose.     

Suicide by air rifle and shotgun

We report the case of a 39-year old white male who committed suicide by shooting himself with an air rifle and a shotgun. The ballistics of air guns and rifles, with particular reference to the Sheridan air rifle, are reviewed. Only two cases of multiple firearm suicide have been reported; both involved simultaneously fired handguns. Ours is the first case, to our knowledge, of an air rifle and a shotgun used in sequence to commit suicide.     

Two consecutive fatal cases of acute myocardial infarction caused by free floating thrombus in the ascending aorta and review of literature

Free floating thrombus in the ascending aorta is an uncommon source of acute myocardial infarction. We report on two cases of young women who died of acute myocardial infarction caused by a free floating thrombus in the sinus of Valsalva obstructing the coronary arteries' ostia. The first case reports on a 30-year-old pregnant woman who anamnestically had episodes with short loss of consciousness and weakness. The second case presents a 37-year-old woman suffering from multiple sclerosis with no previous history of thrombotic events. The review of literature revealed a predominance of women (eight females and three males). Interestingly, the coronary arteries bear no preference concerning the right (RCA) or left coronary artery (LCA) being more often occluded by a free floating thrombus. Especially, younger women (mean age 45.5 years, range 30-59 years) with no history of cardiac symptoms and without atherosclerotic changes seem to be predispositioned. The hypothesis that thrombus formation in cases without plaque disruption may depend on an endothelial erosion which seems to be more common in younger women and promoted by a hyperthrombogenic state is supported by our two cases. A comprehensive literature search revealed, that these are the first two reports on a free floating thrombus being the cause of fatal acute myocardial infarction in a pregnant woman, respectively, a woman suffering from multiple sclerosis.     

REASSESSING RACE DISPARITIES IN MARYLAND CAPITAL CASES*

A generation of research studies that were conducted in multiple states and covered different time periods has found evidence that individuals who kill white victims encounter a greater risk of facing the death penalty than killers of black victims. More recently, research has also examined the likelihood of death penalty processing for black defendants who kill white victims in comparison with other defendant–victim race groups. In particular, a study in Maryland conducted by Paternoster et al. (2003) found evidence that offenders in black defendant–white victim cases were more likely to be death noticed by prosecutors and to receive a death sentence than other offenders. A recent analysis by Berk, Li, and Hickman (2005) raised questions about some of these findings. In this article, we conduct new analyses and conclude that black defendants who kill white victims face a greater risk of adverse treatment than other types of defendants.     

Age estimation by pulp/tooth ratio in lower premolars by orthopantomography

Accurate age estimation has always been a problem for forensic scientists, and apposition of secondary dentine is often used as an indicator of age. Since 2004, in order to examine patterns of secondary dentine apposition, Cameriere et al. have been extensively studying the pulp/tooth area ratio of the canines by panoramic and peri-apical X-ray images. The main aim of this paper is to examine the relationship between age and age-related changes in the pulp/tooth area ratio in monoradicular teeth, with the exception of canines, by orthopantomography. A total of 606 orthopantomograms of Spanish white Caucasian patients (289 women and 317 men), aged between 18 and 75 years and coming from Bilbao and Granada (Spain), was analysed. Regression analysis of age of monoradicular teeth indicated that the lower premolars were the most closely correlated with age. An ANCOVA did not show significant differences between men and women. Multiple regression analysis, with age as dependent variable and pulp/tooth area ratio as predictor, yielded several formulae. R(2) ranged from 0.69 to 0.75 for a single lower premolar tooth and from 0.79 to 0.86 for multiple lower premolar teeth. Depending on the available number of premolar teeth, the mean of the absolute values of residual standard error, at 95% confidence interval, ranged between 4.34 and 6.02 years, showing that the pulp/tooth area ratio is a useful variable for assessing age with reasonable accuracy.     

Influence of electricity on post-mortal body temperature

In a case of suicidal application of electricity differences between the rectal temperature of the body and the suspected time of death were observed. In order to answer the question whether an electric current from hand to hand over >30 min led to a rise in body temperature FEM-based computer simulations and animal experiments were carried out. Both resulted in a warming of the soft parts in the arm without warming the body core. Thus a temperature-based estimation of the time since death can also be used in cases with electricity as the cause of death. Besides, in the animal experiment we found a spontaneous rise in the body core temperature even without application of electricity which may be a reason for the typical temperature plateau after death.     

Influence of electricity on post-mortal body temperature

In a case of suicidal application of electricity differences between the rectal temperature of the body and the suspected time of death were observed.In order to answer the question whether an electric current from hand to hand over >30 min led to a rise in body temperature FEM-based computer simulations and animal experiments were carried out. Both resulted in a warming of the soft parts in the arm without warming the body core. Thus a temperature-based estimation of the time since death can also be used in cases with electricity as the cause of death. Besides, in the animal experiment we found a spontaneous rise in the body core temperature even without application of electricity which may be a reason for the typical temperature plateau after death.     

The investigation of alleged insecticide toxicity: a case involving chlordane exposure, multiple sclerosis, and peripheral neuropathy

A man with no previous medical problems had two documented exposures to an insecticide containing the organophosphorous compounds chlordane and heptachlor. Six months to one year later, he began to experience neurological symptoms which progressed until his death. At autopsy, his brain showed classic findings of multiple sclerosis, and he had a severe peripheral neuropathy. Review of the literature indicates that the findings are not compatible with chlordane toxicity. Some of the factors to be used in determining the casual relationship between toxic exposure and disease processes are discussed.     

Do individual factors and neighborhood context explain ethnic differences in juvenile delinquency?

Individually measured factors and neighborhood context were related to juvenile delinquency in a community sample of 506 urban, public-school boys. Neighborhood context was measured with an objective, census-based score that classified neighborhoods as underclass or not underclass. When African American youths and white youths were compared without regard to neighborhood context, African American youths were more frequently and more seriously delinquent than white youths. When African American youths didnot live in underclass neighborhoods, their delinquent behavior was similar to that of the white youths. Hierarchical multiple regression analyses showed that boys' hyperactivity and parental supervision were the strongest correlates of delinquency. Single-parent status and poverty/welfare use were not related to delinquent behavior. Once individually measured factors were accounted for, residence in underclass neighborhoods was significantly related to delinquent behavior while ethnicity was not. This study points to the importance of including the neighborhood context when addressing the social problems of African American youths.     

RACIAL THREAT,CONCENTRATED DISADVANTAGE AND SOCIAL CONTROL: CONSIDERING THE MACRO‐LEVEL SOURCES OF VARIATION IN ARRESTS*

Several studies have examined the relationship between racial threat (measured by the size of black population) and social control imposed on blacks, but evidence of this hypothesis has been mixed. Although dependency on percent black as the main indicator of racial threat in many studies has contributed to the inconsistency in findings, we argue that this literature has also neglected to consider other important conceptual and methodological issues. Using 2000 census and arrest data, we estimate the impact of multiple measures of racial economic threat, such as the size of the black population, racial inequality and black immigration patterns on black arrest rates. Furthermore, by integrating racial competition and race‐relations arguments, we examine how the concentration of black disadvantage may temper the extent to which blacks pose a threat to white interests. Our findings reveal important and conceptually distinct relationships between racial threat, concentrated disadvantage and the use of social control against blacks, particularly when compared to white arrests.     

Sudden death due to asphyxia by esophageal polyp: two case reports and review of asphyxial deaths

Asphyxia, not an uncommon cause of sudden death, may result from numerous etiologies. Foreign-body aspiration and strangulation are 2 extrinsic causes. Airway obstruction may also be caused by laryngeal edema, asthma, infection, or anaphylaxis. Chronic causes of asphyxia include musculoskeletal diseases (eg, muscular dystrophy, amyotrophic lateral sclerosis), neurologic disorders (eg, myasthenia gravis, multiple sclerosis), respiratory disease (eg, emphysema, chronic bronchitis), or tumors. The manner of death in cases of asphyxiation may be natural, accidental, homicide, or suicide. For the death investigator, determining the cause and manner of death can often be quite challenging.We report here 2 cases of an esophageal fibrovascular polyp causing sudden asphyxial death, review of the literature, and discussion of other differential diagnoses in the case of asphyxial death.     

Mechanisms of unexpected death in tuberous sclerosis

Tuberous sclerosis complex is a protean autosomal dominant disorder characterized by multifocal tissue lesions arising from defects in cellular migration, proliferation, and differentiation. It has an association with sudden death. In the current study, review of all cases of sudden death due to tuberous sclerosis was undertaken at the Forensic Science Centre in Adelaide, Australia from 1991 to 2001, in addition to an analysis of cases from the literature. There were two local cases where unexpected death had occurred in individuals with known tuberous sclerosis, involving a 31-year-old male (epilepsy), and a 24-year-old female (massive hemorrhage into a renal angiomyolipoma). Fatal mechanisms in cases of tuberous sclerosis may be associated with underlying cardiovascular, renal and cerebral abnormalities. Sudden death may be due to cardiac arrhythmia, epilepsy, and intra-tumoral hemorrhage with additional complications including cardiac outflow obstruction, obstructive hydrocephalus, aneurysm rupture, and spontaneous pneumothorax. An awareness of the highly variable tissue manifestations of tuberous sclerosis and the mechanisms that may be responsible for death is necessary to establish correctly the diagnosis in occult cases (possibly with molecular confirmation), and to chart accurately organ changes in individuals with established disease.