Fatal asphyxia due to laryngomucocele

Laryngocele is a rare benign lesion of the larynx resulting from an abnormal dilation of the laryngeal saccule, however, severe airway obstruction and even asphyxia may occur. We report the case of a 55-year-old woman who presented with a feeling of discomfort and mild asphyxia. There was a smooth, firm swelling, 2 cm in diameter, upon palpation on the right side of the neck. Laryngoscopy revealed a bulging near the ventricular and right aryepiglottic folds. CT scan, MRI investigation and in-hospital observation were suggested, the patient, however, refused acute treatment and hospitalization and died suddenly, a few minutes after leaving. Autopsy revealed combined laryngocele with internal and external components. As the presented case shows, the internal part of the laryngocele may cause rapid and complete obstruction. The examining physician should therefore call the patient's attention to this potential life threatening condition.     

Death due to dextropropoxyphene: Copenhagen experiences

A review of 323 fatal poisonings with dextropropoxyphene is presented. The falling tendency of the poisoning in question and the National Board of Health's attention towards it are discussed.     

Death due to concussion and alcohol

We encountered 5 deaths following blunt trauma to the face and head in which the injuries were predominantly soft tissue in nature with absence of skull fractures, intracranial bleeding, or detectable injury to the brain. All individuals were intoxicated, with blood ethanol levels ranging from 0.22 to 0.33 g/dl. We feel that in these deaths, ethanol augmentation of the effects of concussive brain injury, with resultant posttraumatic apnea, was the mechanism of death.     

Death due to hydrofluoric acid

A case of death caused by an acid attack is presented. The victim, a young woman, was attacked by a person who threw acid onto her face. She reached the casualty department of a hospital where she died, a few hours later, from acute respiratory insufficiency due to the inhalation of acid vapors. The autopsy revealed severe chemical burns of her skin and lungs, with intense pulmonary hemorrhagic edema caused by the acid and its vapor. The subsequent chemical-toxicological analysis and the police investigation confirmed that death was due to hydrofluoric acid.     

机械性窒息和CO中毒联合致死1例

在法医学实践中,死亡原因确定有时较为困难,尤其在多种原因并存时,更为困难。但死亡原因又是法医病理检验后必须回答的问题。笔者在最近的法医学实践中遇到1例机械性窒息和CO中毒联合致死案例,死亡原因分析较为困难,现报告如后。案例资料某女,40岁,农民。某日晨被邻居发现死在地上。同日进行法医病理解剖:尸斑呈淡红色,分别布于背侧,指压褪色。双侧睑结膜见多个针尖大小的点状出血。右口角附有血迹,右上唇内面一0.6cm×0.2cm浅裂创,左上、下唇见数个细小裂创伴出血,右上、下唇及口腔粘膜出血,上颌右第一切牙,左第一、二切牙缺失,缺失牙龈窝…     

机械性窒息和CO中毒联合致死1例

在法医学实践中，死亡原因确定有时较为困难．尤其在多种原因并存时，更为困难。但死亡原因又是法医病理检验后必须回答的问题。笔者在最近的法医学实践中遇到1例机械性窒息和CO中毒联合致死案例，死亡原因分析较为困难，现报告如后。     

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.     

Death due to inhalation of ethyl chloride

A 30-year-old white male was found dead in a locked apartment with a rag held loosely in his mouth. Four cans (3 empty, 1 partially empty) containing ethyl chloride and labeled as VCR head cleaner were found next to the body. Phenylpropanolamine and low therapeutic levels of diazepam (64 microg/L) and nordiazepam (126 microg/L) were detected during toxicological analysis. An unidentified peak was observed when performing ethanol analysis by headspace gas chromatography. The peak was identified as ethyl chloride and the concentrations in the blood, urine, vitreous, brain, and lungs of the deceased were 423 mg/L, 35 mg/L, 12 mg/L, 858 mg/kg, and 86 mg/kg, respectively. The results were compared with previously reported levels of ethyl chloride in blood and vitreous and, based on a literature search, we believe that this is the first report of ethyl chloride levels in tissue.     

Death due to Ehlers-Danlos syndrome type IV

Ehlers-Danlos syndrome (EDS) represents a group of collagen connective tissue disorders characterized by joint laxity, easy bruising, and various skin manifestations. Persons with type IV EDS are at risk for gastrointestinal, uterine, and arterial rupture. Mutations in the COL3A1 gene that encodes for type III procollagen underlie the pathologic abnormalities. Forensic pathologists must be aware of this rare, autosomal-dominant connective tissue disorder. Postmortem diagnosis is possible but requires specialized testing (fibroblast culture and subsequent biochemical assays, with or without molecular studies). When the condition is diagnosed or suspected at autopsy, it is important for forensic pathologists to notify family members of this potentially lethal disorder. Three cases of type IV EDS diagnosed by forensic pathologists are presented, followed by a discussion of the disorder.     

Morphologic determinants of asphyxia in lungs: a semiquantitative study in forensic autopsies

Asphyxia is a name given to different kinds of lesions that can produce similar histologic findings. Thus, because of the varied nature of the different kinds of lesions, as well as the incidence of similar qualitative histologic findings with different causes, the aim of this work was to study special kinds of injuries with particular subsequent impairment. These include some diagnostic problems of sudden death of natural causes, including aspiration, suffocation, drowning, and strangulation. Ranking was made of 167 victims based on the diagnosis as having: aspiration (n = 35), suffocation (n = 88), drowning (n = 27), and strangulation (n = 17). Stepwise discriminant analysis of the resulting data showed that lung necropsies from victims of these four events could be distinguished from one another. Statistical differences among the four groups were observed for eight morphologic parameters. A robust discriminant function permitted an adequate classification of the four groups of disease in 85.03% of the cases. Lung autopsies with congestion, septal hemorrhage, and foreign body showed a specificity of 100% for victims of aspiration, whereas ductal overinsufflation, interstitial edema, and bronchiolar constriction showed a specificity of 81.8% in victims of suffocation. Intraalveolar edema and dilatation of the alveolar spaces with secondary compression of the septal capillaries characterized drowning. Victims of strangulation showed a strong alveolar hemorrhage, with alveolar collapse and overinsufflation, associated with bronchiolar dilatation. It is concluded that semiquantitative analysis of lung autopsies might be a useful supplementary histologic criterion to support the diagnosis of asphyxia.     

Legal and ethical considerations of forensic anthropological research

In the UK, Forensic Anthropology is maturing rapidly, consequently demanding discussion of previously overlooked yet fundamental principles of this discipline. UK law and ethics are interpreted from a forensic anthropological standpoint. First, the influence of UK law and ethics on the stages of forensic anthropological research (the collection, analysis and storage of human remains) are discussed. Existing ethical codes of conduct are investigated for their relevance to researching forensic anthropologists. It is concluded that: when appropriately interpreted, UK law and ethics are extremely influential on forensic anthropological research; debate within this area is required; and that an understanding of the law and ethical thought is vital for the successful growth of forensic anthropology in the UK.     

Sudden Death due to Brainstem Leukemic Hemorrhage: A Case Report

Introduction Leukemia is a hematologic neoplasm character- ized by potential infectious and hemorrhagic com- plications. In adult patients with acute leukemia, in- fection is the most common complication. Intracra- nial hemorrhage （ICH） is the second most common complication. However, ICH has been identified as the major cause of morbidity and mortality in pa- tients with leukemia[1-6].     

Death following injection sclerotherapy due to phenol toxicity

Prolapse rectum (PR) or protrusion of the rectum beyond the anus occurs frequently in populations at both extremes of age. In the pediatric population, in developed countries, the commonest cause for PR is thought to be cystic fibrosis (CF). Treatment options for CF include conservative management, surgical resection and fixation, suturing, and injection sclerotherapy (IS). The last is considered an attractive treatment option because it is minimally invasive. In this case report, the authors present the details about a 2-year-old female child, with PR and CF, who died after IS, using phenol as the sclerotherapeutic agent. Autopsy findings and toxicology tests performed to establish phenol toxicity are documented. The available literature is reviewed. This case report underscores the risks of using phenol for IS and emphasizes the point that the procedure is not innocuous and an adverse outcome including fatality is a possibility.     

主动脉瓣畸形猝死1例

1案例某女,72岁,平素无身体不适。2005年10月10日上午8时许,与他人发生纠纷时,争吵中突然倒地,不治身亡。尸体检验:尸长150cm,角膜透明,结膜充血,双瞳孔散大,直径0.5cm,口腔无出血,牙齿无损伤脱落,鼻孔无出血。尸斑位于背侧未受压部位,呈暗紫红色。     

Death due to attack from chow dog.

It is estimated that between one and four million persons per year are bitten by dogs in the United States. While most injuries associated with the bites are minor, serious sequelae, and even death, may occur. Most victims of fatal dog attacks are children < 1 year of age or elderly women. The most frequent cause of death is hemorrhage and shock from major vessel damage. A case is reported in which an elderly woman was attacked by her pet Chow dog. The victim received multiple superficial abrasions, contusions, and lacerations from the dog attack. A large perforation of the right external pudendal vein and three perforations of the left superficial femoral vein resulted in exsanguination and death. Fractures of the left 2nd through 4th ribs with underlying pulmonary contusion were also found.