A fatal maprotiline intoxication

A fatal maprotiline intoxication is presented. The postmortem anatomical and toxicologic findings are discussed, as is the mechanism of maprotiline toxicity. This report is, to the best of our knowledge, the sixth fatal maprotiline poisoning in the medical literature.     

Cocaine-associated rhabdomyolysis and excited delirium: different stages of the same syndrome.

Previous case reports indicate that cocaine-associated rhabdomyolysis and excited delirium share many similar features, suggesting that they may be different stages of the same syndrome. We tested this hypothesis by comparing data from 150 cases of cocaine-associated rhabdomyolysis reported in the medical literature with data from an autopsy registry for 58 victims of fatal excited delirium and 125 victims of fatal acute cocaine toxicity. Patients with rhabdomyolysis are similar to victims of fatal excited delirium with regard to age; gender; race; route of cocaine administration; the experiencing of excitement, delirium, and hyperthermia; and the absence of seizures. Compared with victims of fatal acute cocaine toxicity, patients with rhabdomyolysis are different with regard to each of these variables. Compared with victims of fatal acute cocaine toxicity, both victims of rhabdomyolysis and fatal excited delirium are more likely to be black, male, and younger; to have administered cocaine by smoking or injection; and to have experienced excitement, delirium, and hyperthermia; they are also less likely to have had seizures. Because cocaine-associated rhabdomyolysis and excited delirium have similar clinical features and risk factors, occur in similar populations of drug users, and can be explained by the same pathophysiologic processes, we conclude that they are different stages of the same syndrome. It appears that this syndrome is caused by changes in dopamine processing induced by chronic and intense use of cocaine rather than by the acute toxic effects of the drug.     

3例致命伤后行为能力分析探讨

法医在命案现场勘查中,正确分析致命伤后行为能力至关重要,这对重构现场、准确分析解释现场疑点、判断案件性质等有重要意义,同时也是法医工作中的难点和热点问题。人体受到致命伤后不一定立即死亡,其是否具有行为能力及行为能力的大小受多种因素影响,因此分析致命伤后行为能力要结合现场和案情谨慎考虑推断。通过3例案例对致命伤后行为能力进行分析探讨,得出一些关于致命伤后行为能力的思考和观点,以供同行参考。     

Fatal positional asphyxia associated with rollover crashes

Motor vehicle rollover crashes result in complex occupant kinematics with the potential for severe injury. Five cases of fatal asphyxia in occupants suspended from their safety belt upside down after a rollover crash are presented. These fatalities accounted for 13.5% of all motor vehicle related asphyxia deaths in San Diego County over a 10-year period. This study supports previous research noting that incapacitation due to other injuries, alcohol, or obesity may be associated with fatal positional asphyxia due to inversion during rollovers. Safety belts are proven to prevent serious injury in motor vehicle crashes and should always be worn. However, redesign of the buckle could be considered to permit easier release by an occupant. We also suggest that pre-existing heart disease may contribute to the possibility of a fatal asphyxia outcome. Although this is a rare cause of motor vehicle related death, our results suggest that these are potentially preventable deaths.     

Teenage Drivers and Fatal Crash Responsibility

Data from national files on fatal crashes are analyzed to reveal that young drivers, especially sixteen and seventeen year olds, are more often responsible for fatal crashes than are older drivers. This is particularly the case for young males. Moreover, those killed in crashes for which teenagers are responsible are disproportionately people other than the teenaged drivers. A possible explanation for these facts lies in the "macho" culture of teenaged males. Potential countermeasures include those directed to limiting the driving exposure of teenagers as well as technological devices to moderate the injury-producing forces in crashes.     

Kawasaki disease: a review of pathologic features of stage IV disease and two cases of sudden death among asymptotic young adults

Kawasaki disease (KD) primarily affects infants and is rarely fatal in young adults. The sequelae of KD can result in death months to years after the exposure to the causative agent. Such deaths are defined as Stage IV KD, which is characterized by the formation of multiple aneurysms in the coronary arteries, calcification and recanalization of the obstructed portions of the coronary arteries, and myocardial infarction and ischemia. A 10-year retrospective review of sudden deaths in Allegheny County, Pennsylvania, identified two fatal cases of Stage IV KD involving young adults. These two young adults were healthy and completely asymptomatic; they had no identifiable risk factors for cardiovascular disease before the fatal event. One adult was involved in vigorous exercise, and the other was recumbent in bed at the time of death.     

Fatal venlafaxine overdose with acinar zone 3 liver cell necrosis

We present a case of fatal venlafaxine overdose in a 34-year-old male with a history of depression and previous suicide attempts. He presented unwell, and his condition deteriorated with the development of rhabdomyocytolysis and renal failure. Although treatment was provided, this was unsuccessful, and he died within a day of his admission. A postmortem examination was performed, and the findings included an acinar zone 3 pattern of liver cell necrosis and a very high level of serum venlafaxine in the deceased. No other elevated drug levels were detected. From this case, it is clear that venlafaxine overdose was the primary cause of a fatal acinar zone 3 pattern of liver cell necrosis. As far as we are aware, this is the first reported case of fatal acinar zone 3 liver necrosis caused by venlafaxine overdose alone.     

Acute fatal poisoning with cyamemazine

A case of fatal poisoning with cyamemazine is presented. The cyamemazine was identified in post-mortem blood using a specific gas chromatographic/mass spectrometry method. The autopsy blood concentration of cyamemazine was 1800 ng/ml. Chronic use of cyamemazine was demonstrated by the presence of the drug in hair. Two other drugs were also detected (bromazepam and trimeprazine). We think that this current blood concentration (1800 ng/ml) is a fatal blood concentration because of the negativity of the other parameters, but careful interpretation of analytical findings are important, the possibility that this death was a consequence of the toxicity of combined drugs could not be excluded. Not many therapeutics and toxic levels were previously reported in overdosage cases in which cyamemazine was involved. We consider that this concentration is only of guidance value for a fatal cyamemazine poisoning.     

Bear attack--A unique fatality in Finland

Fatalities due to animal bites, the vast majority of which are associated with dogs and big cats, are relatively uncommon and rarely described in the literature. Especially rare are fatal bear attacks on humans. We herein present a forensic investigation of a fatal assault, involving numerous bites on a 42-year-old man in Finland by an European brown bear (Ursus arctos arctos).     

A case of sudden cardiac death in connection with Salmonella typhimurium infection

A case of fatal myocarditis in a 24-year-old otherwise healthy man is described. It was possible to cultivate Salmonella typhimurium from the alimentary tract, the blood, the liver and skeletal muscles. The possibility of a solitary myocarditis with fatal outcome due to Salmonella typhimurium infection is discussed. Such a case seems not to have been mentioned previously in the literature.The problems concerning the statistical registration of such a death are briefly discussed.     

Suicide by the use of a chain saw

The paper describes a case of suicide by the use of a chain saw. Visceral and tissue damage caused by vibrations are documented in occupational medicine, but fatal damage is not often seen at autopsy. This paper gives an account of the damage to viscera and tissues that has been noted when strong vibrations of low frequency have been directed to the body for a very short time with fatal result after a few minutes survival time.     

Fatal verapamil poisoning

A case of fatal verapamil poisoning is reported. The pathologic and toxicologic findings are discussed.     

The determination of toxic metals in simulated stomach contents by energy dispersive X-ray fluorescence analysis and a fatal case of mercury poisoning

Soup is used as a simulated stomach contents matrix to determine the lower level of detection for 16 metals. All of the metals can be detected at the levels which might be expected for acute fatal doses even if the stomach contents are considerably diluted. However where small doses are administered over a prolonged period this method may not be sufficiently sensitive. A case of fatal poisoning by the ingestion of mercuric chloride is described to illustrate the effectiveness of the method. In this case mercury was also detected and determined at highly significant levels in blood and liver by the same technique. This energy dispersive X-ray fluorescence (EDXRF) method is easy to use, rapid and non-destructive.     

Fatal exsanguination following complete transection of femoral vessels due to angle grinder injury in an industrial accident

Angle grinders are one of the most dangerous and frequently used tools in industrial settings. Angle grinder injuries range from superficial cuts to deep penetrating injuries with underlying fracture-dislocation and vascular trauma. The injuries caused by angle grinders mostly involve the head, face, or upper limbs, while the lower limb is an unusual site. The high-speed rotating disc of the angle grinders does not respect anatomical boundaries or structures; therefore, the injuries caused may be disfiguring, permanently incapacitating, or even fatal. We report a fatal case of an angle grinder injury to the lower limb. The victim sustained a sharp cut over the left thigh while woodworking in an industrial setup. The rotating disc of an angle grinder had transected the skin, subcutaneous fat and muscles, and both the femoral vessels of the left side, which led to fatal exsanguination within 10 min of the incident.     

A single fatal penetrating chest wound caused by a dagger-shaped fragment of broken door glass

A 19-year-old woman ran against a glass door, and, breaking it, was struck in the left anterior chest by a single dagger-like fragment of broken door glass. This fragment deeply penetrated her chest and wounded the anterior wall of the left ventricle of her heart. She rapidly died from loss of blood. The majority of single fatal penetrating chest wounds seen at postmortem examinations are caused by firearms and bladed weapons. While penetrating chest wounds occasionally result from fragments of glass, most severe and fatal wounds from glass result from one's falling into or through plate glass and sustaining wounds of the head, face, abdomen, or extremities. A single fatal wound from a dagger-shaped piece of glass is distinctly uncommon. To prevent such an accident from occurring, safety glass must be used in front doors of public institutions.     

Fatal ethanol poisonings in 1984-1986

Analysis of statistical data on the number of fatal ethanol intoxications in 1984-1986 is presented. A steady tendency to reduction in fatal ethanol intoxications is stressed.     

Suicide by sodium tetraoxoselenate(VI) poisoning

Selenium is one of the most toxic elements necessary for the life of mammals. Only a narrow range separates therapeutic (connected with a protective effect) and toxic doses. Selenium incorporated into animal or human tissues in larger amounts can exceed normal human levels and may be toxic (only elemental selenium and selenium sulphide are poorly absorbed). Acute poisonings with selenium or its compounds, especially fatal ones, occur extremely rarely in humans. Levels of selenium in four fatal cases are reviewed, and the levels in a fatal poisoning with sodium tetraoxoselenate(VI) are evaluated. Postmortem tissue selenium contents in the latter case were the following: brain, 1.45 and 1.60 microg/g; stomach, 6.12 and 6.37 microg/g; small intestine, 4.37 and 4.13 microg/g; large intestine, 4.53 and 4.43 microg/g; liver, 4.20 and 4.35 microg/g; kidney, 3.35 and 3.60 microg/g; lung, 1.80 and 1.60 microg/g; blood, 1.43 and 1.41 microg/ml measured by the use of ETA-AAS and fluorimetric methods, respectively.     

Fatal diphenhydramine intoxication in infants

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death. Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation. The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.     

A fatal complication of a vena caval filter associated with pulmonary thromboembolism

Vena caval filters are increasingly used for the prevention of pulmonary thromboembolism in patients with deep vein thrombosis ever since the introduction of the stainless steel Greenfield filter in the 1970s. Although complications associated with their use are rare, they can be fatal, and therefore it is important for forensic pathologists to be aware of their occurrence. Because of the ramifications of a medical device failure, a thorough documentation of the autopsy findings is essential. We describe an unusual case of a 75-year-old woman who developed a fatal pulmonary thromboembolism with concurrent migration of a lesser known type of vena caval filter to the right ventricle occurring 19 days after filter placement. A review of the types of vena caval filters in current use, and their complications, are discussed.