Russian roulette with a knife

The following case report describes an accidental stabbing that occurred on Halloween. The unwitting victim, while preparing for a holiday charade, stabbed himself with an ornamental dagger. By placing himself in a potentially hazardous situation, the victim's behavior entailed risk taking. The psychological implications of such risk taking are complex, and may be compared to such behaviors as russian roulette, gambling, and parasuicide.     

Unusual hanging deaths

Four unrelated hanging deaths involving young white males, all in enlisted status in the United States military, are presented. Taken in a military context, one scene served as a suicide note equivalent with the unmistakable message of extreme defiance toward military regulations. In two cases, the elaborate attire of the decedents could have lead to the misclassification of the manner of death if investigative information had not been considered. Extensive background investigation and review of medical records in the fourth case disclosed that the victim had an eight- to ten-year history of compressing his neck to cause unconsciousness. He left an extensive suicide note in which he concluded that "hanging would be good." Each case has certain unique features, as a group, the cases all demonstrate a continuum from obvious suicide to cases where the manner of death is, at first, equivocal.     

Unusual hanging deaths

We describe the circumstances and medical findings of four unusual hanging deaths. In brief, the unusual features are tracheostomy, delayed death, self-mutilation combined with severe neck injury caused by lengthy drop, and homicidal hanging in a young girl.     

Pregnancy-related maternal deaths

Pregnancy is a normal biologic process, but because of a variety of physiologic factors, it increases a woman's risk for death. Maternal deaths in pregnancy may be due to conditions unique to pregnancy, conditions associated with pregnancy, or conditions unrelated to but exacerbated by pregnancy. Death may occur during any trimester, during labor/birth, or postpartum. In this report, we present 45 cases of pregnancy-related maternal deaths that were investigated and autopsied at the Dallas County Medical Examiners office between 1977 and 1999, and we review the topic of pregnancy-related maternal death.     

Blood alcohol concentrations of sudden unexpected deaths and non natural deaths.

This study reports on the relationships between the blood alcohol concentration (BAC) and the cause of death - which is of course common knowledge for forensic scientists! Our special aim was to gain unselected data for generalizing conclusions. The blood of 2465 consecutive cases (86% of all 2852 sudden unexpected and unnatural fatalities investigated at the Institute for Legal Medicine in Hamburg during the year 1989) was analysed. The BAC was evaluated according to sex, age, cause of death and place of death. In natural causes of death there were 80% cases under 0.05% BAC. Endocrine and digestive system diseases in particular were associated with positive BAC values. In unnatural death cases the BAC under 0.05% was found in 64% of the suicides, 62% of the accidents, 54% of the homicides and 51% of the drug intoxications. The drowning cases showed higher BAC's than traffic accidents. In suicides middle aged males had high BAC's.     

Suicidal deaths using fireworks

The use of commercial explosives is an unusual method of commiting suicide, and only a few cases have been described in the medicolegal literature. In this paper, two cases of suicide are considered that reflect backgrounds of financial problems and psychological illnesses, respectively. Both individuals comitted suicide by detonating an explosive (fireworks). In the first case putting the explosive on his head and in the second case into his mouth. In both cases the cause of death was the destruction of the central nervous system. The following cases emphasize the importance of the forensic pathologist in the recognition of the scene, as well as the systematical collection of trace evidence of the explosion for their subsequent study in the laboratory and their correlation with the autopsy findings.     

Suicidal fire deaths revisited

A study of self-immolation or suicidal fire deaths was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during the 8-year period from 1977 to 1984. A total of 24 cases, representing 0.96% of the suicides that occurred during this period, were collected and analyzed as to age, race, sex cause of death of the victim along with the blood alcohol content at autopsy, drugs detected at autopsy, and the terminal carboxyhemoglobin. Additionally, the scene circumstances, geographic location of the terminal incident, the reason for the suicide, whether or not there was a past suicide attempt, a past psychiatric history, how the fire was started, presence or absence of an outside example, time of occurrence, presence of hospitalization, and presence of a suicide note were also noted. Most of the victims were white women of over 50 years of age who died of thermal injuries. Half of the time the blood alcohol content was negative at autopsy, 1/3 of the time the drug screen was negative, and 1/3 of the time a small amount of carboxyhemoglobin was noted. Most fires originated at home, although motor vehicles were also common. Reasons for the suicide were varied. Of the cases 1/3 had a precious suicide attempt and approximately 1/2 of the cases had a psychiatric history. Commonly, the fire is started by pouring a flammable liquid on one-self as isopropyl (rubbing) alcohol or gasoline and igniting it. No outside media examples were noted. These events occurred more frequently in the afternoon or evening.(ABSTRACT TRUNCATED AT 250 WORDS)     

Methadone-related deaths in Norway

IntroductionThe use of methadone in opioid maintenance treatment (OMT) is potentially associated with a number of adverse effects and the risk of fatal toxicity. Increased methadone availability may lead to an increase in methadone-related deaths. We have investigated methadone-related deaths in Norway over the period 2000–2006.Materials and methodsMethadone-positive samples over the period 2000–2006 were identified from forensic toxicological investigations, and demographic and toxicological data were retrieved. The cases were cross-linked with the Norwegian Cause of Death Registry and regional OMT registers.ResultsA total of 312 individuals had died after taking methadone over the period 2000–2006, predominantly men with a mean age of 36. In 85% of cases (n = 264), the deceased had died of a methadone-related intoxication, most often in combination with other drugs, including benzodiazepines, cannabis and other opioids. Only 22% of the deceased had been in OMT at the time of death. A larger proportion of OMT patients had died of causes other than intoxications compared to those not in OMT (30% vs. 8%, respectively), most commonly related to disease.ConclusionsOne methadone-related death occurred, on average, every week over the time period investigated. Only 22% of the deceased were registered in opioid maintenance treatment (OMT) programs. The findings underline the need to control diversion of medication from OMT programs.     

Atypical autoerotic deaths.

So-called "typical" autoerotic fatalities are the result of asphyxia due to mechanical compression of the neck, chest, or abdomen, whereas "atypical" autoeroticism involves sexual self-stimulation by other means. We present five atypical autoerotic fatalities that involved the use of dichlorodifluoromethane, nitrous oxide, isobutyl nitrite, cocaine, or compounds containing 1-1-1-trichloroethane. Mechanisms of death are discussed in each case and the pertinent literature is reviewed.     

Sniffing-associated deaths in Denmark

An account is given of 20 deaths, which occurred in association with sniffing during the period 1959 – 1978. The annual number of deaths was almost constant during the period. Most of the deaths occurred in males. Ether and trichloroethylene were the predominant toxic substances. The material was divided into two groups. Group A, 14 cases, included real sniffing deaths, the cause of death being poisoning by the substance inhaled. In group B, 6 cases, sniffing was a contributory factor to death: 2 cases of suffocation by obstruction, one case of carbon monoxide poisoning during fire, one case of septicemia/severe anemia caused by bone marrow depression, and one case of bleeding to death from stab wounds inflicted by a sniffer against a non-sniffer. The circumstances before and at the time of death are reported, together with the autopsy and toxicological findings when these were performed.     

Hanging deaths in children

During the 16-year period of 1972-1987, there were 11 hanging deaths in children in Western Australia. We report the circumstances and medical findings of each case.     

Amphetamine derivative related deaths

Amphetamine its methylendioxy (methylendioxyamphetamine methylenedioxymethylamphetamine, methylenedioxyethylamphetamine) and methoxy derivatives (p-methoxyamphetamine and p-methoxymethylamphetamine) are widely abused in Spanish society. We present here the results of a systematic study of all cases of deaths brought to the attention of the Madrid department of the Instituto Nacional de Toxicologia from 1993 to 1995 in which some of these drugs have been found in the cadaveric blood. The cases were divided into three categories: amphetamine and derivatives, amphetamines and alcohol, amphetamines and other drugs. Data on age, sex, clinical symptoms, morphological findings, circumstances of death, when known, and concentration of amphetamine derivatives, alcohol and other drugs in blood are given for each group. The information provided here may prove to be useful for the forensic interpretation of deaths which are directly or indirectly related to abuse of amphetamine derivatives.     

Unusual deaths associated with polyphagia

Perversion of appetite may be manifest in either qualitative (pica), quantitative (polyphagia), or combined derangements of eating. Ingested materials are capable of serving as dangerous physical agents through interference with normal cardiac and/or respiratory function. Since the mechanisms of injury are similar to those that might occur as a result of violence or serious natural disease, a thorough investigation of the history and circumstances immediately preceding the final event is warranted in addition to a complete autopsy. Three cases of asphyxia of unusual etiology are presented along with a rationale regarding the mechanisms believed to be involved. In case 1, sudden subdiaphragmatic viscus expansion with resultant lung volume displacement and impediment of venous return from the lower half of the body are believed to have been operative. In cases 2 and 3, both asphyxial loci are infraglottic. The common denominator in all of these fatalities is the physical impairment of vital air exchange as a complication of an abnormal eating pattern.     

Urinary catecholamines in hyperthermia-related deaths

A group of five hyperthermia-related deaths is presented in which urinary noradrenaline (NA) concentrations were elevated (172.1 +/- 119.4 ng/ml) compared with a control group of rapid violent deaths (43.7 +/- 26.1 ng/ml). Urinary adrenaline (A) concentrations were not elevated in the hyperthermia cases, nor were there any significant differences in urinary dopamine (DA) concentrations between the two groups. All except one of the hyperthermia victims were under the influence of ethanol. It is suggested that a combination of heat stress and ethanol consumption was responsible for the elevated urinary NA in the hyperthermia cases, reflecting increased sympathetic nervous system activity. A combination of high urinary NA with low A seems to be characteristic of hyperthermia fatalities, in contrast to hypothermia deaths, where both NA and A are usually elevated.     

Three deaths involving triazolam--analytical aspects

This case report describes three case histories and the analytical procedures used for the identification and quantification of triazolam. The levels of triazolam detected in the blood are interpreted with reference to those previously reported in the literature.     

Pitbull mauling deaths in Detroit

Between the years 1987 and 2005, there were 6 deaths reported in Wayne County, Michigan, associated with pitbull dog attacks. This article discusses the age incidence, scene investigation, nature of the injuries, and discussion relative to fatal dog attacks, an unusual accidental type of death.     

Nonterrorist suicidal deaths involving explosives

Suicidal deaths involving explosives unconnected to terrorism are rare. The investigation of deaths from explosive devices requires a multidisciplinary collaborative effort, as demonstrated in this study. Reported are 2 cases of nonterrorist suicidal explosive-related deaths with massive craniocerebral destruction. The first case involves a 20-year-old man who was discovered in the basement apartment of his father's home seconds after an explosion. At the scene investigators recovered illegal improvised power-technique explosive devices, specifically M-100s, together with the victim's handwritten suicide note. The victim exhibited extensive craniofacial injuries, which medicolegal officials attributed to the decedent's intentionally placing one of these devices in his mouth. The second case involves a 46-year-old man who was found by his wife at his home. In the victim's facial wound, investigators recovered portions of a detonator blasting cap attached to electrical lead wires extending to his right hand. A suicide note was discovered at the scene. The appropriate collection of physical evidence at the scene of the explosion and a detailed examination of the victim's history is as important as documentation of injury patterns and recovery of trace evidence at autopsy. A basic understanding of the variety of explosive devices is also necessary. This investigatory approach greatly enhances the medicolegal death investigator's ability to reconstruct the fatal event as a means of separating accidental and homicidal explosive-related deaths from this uncommon form of suicide.