Autoerotic death. A definition

A definition of autoerotic death is suggested that restricts the use of this term to accidental deaths that occur during individual, usually solitary, sexual activity in which a device, apparatus, or prop that was employed to enhance the sexual stimulation of the deceased in some way caused unintended death. The case of the autoerotic asphyxial death of a 48-year-old man is reported in order to demonstrate the application of this definition.     

US: Supreme Court adopts narrow definition of "disability" under anti-discrimination law

In January 2002, the US Supreme Court issued the latest in a series of court judgments adopting a narrow interpretation of the Americans with Disabilities Act (ADA). The unanimous decision is fundamentally flawed in several important respects. It does not bode well for people with disabilities seeking protection from discrimination in employment.     

Refining the definition of death for Australian legislation

In the article Mr. Smith considers the need for reform in the area of defining when death occurs and the various approaches that exist to define death. He then analyses the stages of the developments in the various Australian jurisdictions and discusses the substantive content of the basic definition adopted and the practical implications of any enactment. The author suggests that the concept of death should be legislatively enacted in relevant pieces of legislation which call for a resolution of the question at the present time and a more general separate statement defining death should be avoided at the moment. Conceptually death should be defined as the permanent and irreversible loss of consciousness of the individual as determined by irreversible cessation of the brain stem function. The actual operational criteria of death should form the subject of a circular published by the relevant statutory health authority for the guidance of medical practitioners in relation to the specific problems they face.     

Aspects of brain death

The different aspects of brain death are discussed. It is pointed out that the diagnosis of poisoning as the cause of brain death can be checked by toxicological examination of brain tissue and of blood in the sinus of the dura mater, since the metabolism in the brain and sinus blood is markedly reduced while drugs and toxic substances continue to be broken down in the other organs. Particular importance attaches to this difference in the case of crimes of violence creating conditions that predispose to brain death when the significance of a further violent act, e.g. stabbing with resultant haemorrhage, has to be assessed. The simple vital reaction of bleeding does not of itself constitute proof in such a situation, unless it is possible to say with a good degree of certainty that brain death did not occur at the moment when the victim was stabbed. It may, however, be possible to state that brain death that could have been caused by violence has not yet occurred if complex vital reactions, such as inflammation of a wound, are seen.     

A deterrence study of the death penalty in Illinois, 1933–1980

The study analyzes the effect of executions and the death penalty on homicides in Illinois. A forty-eight year time series (1933–1980 inclusive) is used as the basis for this analysis. The first series of results are presented in a graph of executions and homicides by year. A second portion of the analysis compares the mean homicide rates for three time periods—years with executions, years when the death penalty was allowed but no executions were performed, and years in which the death penalty was abolished by the U.S. Supreme Court. No notable differences in homicide rates were observed for these three eras. Finally, a regression analysis was performed which included a lag structure and several relevant controls. The deterrence measure (executions) made no contribution to the variation in homicide rates. Thus, the authors conclude that there is no deterrent effect for the death penalty on homicides in Illinois.     

Detection of diphenhydramine in autolytic brain tissue in poison-induced brain death syndrome

A case of accidental monointoxication caused by diphenhydramine is reported. Having taken 12 dragées of Neo-Emedyl (50 mg diphenhydramine), an 18-month-old girl showed the following symptoms: generalized erythema, dyspnoea, vomiting, hyperpyrexia, tremor, convulsions, coma, respiratory arrest and absence of reflexes. Computed tomography (CT) suggested a massive cerebral oedema. Her electroencephalogram was abnormally diffused at first; later on, it flattened significantly and became isoelectric between the 14th day and the final stoppage of circulation (after 5 weeks). Autopsy revealed total necrosis of the brain, with the venous cerebral blood vessels being thrombosed (the morphological basis for dissociated cerebral death). In autolysed brain tissue, diphenhydramine was detected at a concentration of 30 ng/g by GC/MS (gas chromatography, mass spectrometry); the concentration of the substance was less than 10 ng/g in the liver. The relatively high concentration in the brain was due to the previous blocking of the circulation. Cerebral death syndrome caused by intoxication offers the chance of detecting measurable amounts of the unchanged drug in autolysed brain tissue.     

Potential definition of the time of death from autolytic myocardial cells: a morphometric study

Morphometric methods and transmission electron microscopy were used to quantify modifications occurring in the mitochondria of dog myocardium during the first four hours of autolysis. Myocardial fragments were obtained from the outer free wall of the left ventricle, during anesthesia (control-zero) and at 15, 45, 120, and 240 min after cardiac arrest, maintaining the heart "in situ" at 22 degrees C. During the 240 min of autolysis, the main parameters evaluated showed: (a) a decrease in the number of mitochondria from 0.31 to 0.12 per micron 3 of cytoplasm. The decrease over the first 45 min reached 50% of the initial value; (b) an increase in mitochondrial volume, three times greater after the first 45 min (from 0.92 to 2.68 micron 3) and four times greater after 240 min (from 0.92 to 3.79 micron 3); (c) an increase in mitochondrial outer membrane surface area from 5.51 to 12.54 micron 2; (d) an increase in the surface area of individual mitochondria inner membrane and cristae from 27.60 to 56.96 micron 2. The progressive nature of the alterations and the difference in the numerically expressed values allow correlation with the time of somatic death. The authors emphasize the need for further studies in order to complement the present study.     

Simultaneous sudden infant death syndrome: a proposed definition and worldwide review of cases.

Epidemiologic studies of sudden infant death syndrome (SIDS), the leading cause of death of infants during the postperinatal period (7-365 days), have mainly focused on the deaths of single infants. Simultaneous sudden infant death syndrome (SSIDS), the death of a pair of twins occurring at the same time, has received limited attention within the medical community. To the authors' knowledge, this article is the first to describe the 41 SSIDS cases cited in the world literature from 1900 to 1998 by the location of death, a summary of the circumstances surrounding the deaths, and evaluation of these cases in terms of a proposed definition of SSIDS. This evaluation critiques whether the 41 pairs of SSIDS cases adhere to a newly proposed definition of SSIDS. Twin infant deaths must meet all three criteria to be considered SSIDS. The study found that only 12 pairs of twins met all three criteria (29.2%), nine pairs met two criteria (21.9%), alternative cause of death was offered in five pairs of twins (12.1%) and in the remaining 15 pairs (36.6%), only limited information was available; therefore, no conclusions could be reached.     

Sudden death resulting from epidermoid cyst of the brain

Epidermoid cysts of the brain are rare tumor-like lesions, most often of maldevelopmental origin. They are benign in nature, causing symptoms depending on their localization. Surgical resection leads to excellent results. A case is reported of a 68-year-old-man who died suddenly and unexpectedly. Postmortem examination revealed signs of central dysregulation and a bifrontal epidermoid cyst. To the authors' knowledge, death resulting from epidermoid cyst of the brain has not been reported so far.