Theophylline fatalities

Two fatal cases are presented involving the acute ingestion of theophylline resulting in blood theophylline concentrations greater than one hundred times the accepted therapeutic range.     

Firearm fatalities.

One hundred and twenty eight cases of shooting fatalities were investigated during an 11-year period. Of these 57% were homicidal shootings with 34% suicidal in nature. Only two suicidal fatalities were female. Analysis of the sites of entrance wounds confirmed the 'sites of election' in suicidal shootings, whilst homicidal wounds showed a much wider distribution. Multiple entrance wounds were seen in 42% of homicidal shootings. Injuries to hands were seen in 7 homicidal fatalities.     

Analysis of cocaine-positive fatalities

A review of all autopsy and toxicology reports for persons dying in New York City in an 11-month period found 935 persons dying with cocaine in their bodies. Cocaine-positive fatalities were more likely in the young black and Hispanic and male population. In addition to cocaine and its metabolites, heroin and other opiates were found in 39% of persons and ethanol in 33% and barbiturates and minor tranquilizers in only 2% of the deceased. Cocaine overdose was responsible for 4% of the deaths and overdose with heroin and cocaine for 12% of the deaths. Violence was often the cause of death. Thirty-eight percent died of homicide, seven percent of suicide, and eight percent from accidents. Of particular interest were 6 persons who died of acute cardiac events directly related to cocaine as well as 4 cases of ruptured dissections of the ascending aorta, and 9 cases of cerebral hemorrhage. Autopsy findings for these individuals are described, and possible mechanisms of death are discussed.     

Unemployment and highway fatalities

We considered unemployment, an often overlooked covariate of highway fatalities, hypothesizing that (1) as unemployment rises, aggregate driving decreases, especially among the unemployed, and as driving decreases, fatalities should decrease; (2) unemployment may influence drinking--some among the unemployed may drink less due to lower incomes, while others may drink more due to stress so the net effect would be ambiguous; and (3) unemployment may increase aggregate levels of stress and unhappiness, which can result in poor concentration on driving and thus, in turn, should result in more accidents and deaths. We used data from fifty states and the District of Columbia from 1976-1980, representing 255 observations. (No prior study has as many observations or controls for as many covariates.) Using econometric models of the data, we present evidence for two of the three hypothesized effects of unemployment. We conclude that, if the number of miles driven is held constant, worsening unemployment leads to higher fatality rates, most likely due to stress effects. But because more unemployment means less driving, increases in unemployment, on balance, are associated with decreases in fatalities.     

Accidental firearm fatalities during hunting

Swedish legislation concerning firearms is highly restrictive. It is illegal to possess weapons (except airguns) without a license. From 1970 through 1982, there were 79 accidental firearm fatalities in Sweden. This number, corresponding to 0.074/100,000/year, is very low in comparison with similar statistics worldwide. Of these fatalities, 47 were associated with hunting and were studied carefully. Despite an increase in both the popularity of hunting and in licensing of weapons, on change in the number of accidents per year could be confirmed. Twenty-nine accidents occurred during small game hunting, of which 24 involved shotguns, and 18 occurred during moose hunting. The mean age overall was 46 years. All victims and shooters were men. Most accidents occurred before noon and during the autumn. During moose hunting, the victim most commonly was either mistaken for game or was standing beyond game. During small game hunting, the most common reason for death was improper handling of the weapon. Firing of defective weapons caused at least 10 fatal accidents. Alcohol inebriation was uncommon. It is unlikely that more restrictive firearm legislation would further decrease the number of fatal accidents. Instead, we believe that accidental firearm fatalities during hunting can be prevented by safer and more careful handling of weapons, including unloading weapons before transporting them; by replacing older weapons with more modern and safer ones; and by not allowing children to handle weapons. No shots should be fired until it is clarified that the target really is a game animal, and when hunting with rifles, the fields of fire should be clarified beforehand. Shooters at stand must be instructed not to leave their stands until explicitly told to do so.     

Autoerotic fatalities in Greater Dusseldorf

Autoerotic fatalities in the Greater Dusseldorf area correspond to the relevant medicolegal literature. Our results included exclusively young to middle-aged, usually single men who were found dead in their city apartments. Clothing and devices used showed a great variety. Women's or fetish clothing and complex shackling or hanging devices were disproportionately frequent. In most cases, death occurred due to hanging or ligature strangulation. There was no increased incidence of underlying psychiatric disorders. In most of the deceased no or at least no remarkable alcohol intoxication was found. Occasionally, it may be difficult to reliably differentiate autoerotic accidents, accidents occurring in connection with practices of bondage & discipline, dominance & submission (BDSM) from natural death, suicide or homicide.     

Unusual phenomenology of autoerotic fatalities

Between 1983 and 2003 forty accidental autoerotic deaths (all males, 13–79 years old) have been investigated at the Institute of Legal Medicine in Hamburg. Three cases with a rather unusual scenery are described in detail: (1) a 28-year-old fireworker was found hanging under a bridge in a peculiar bound belt system. The autopsy and the reconstruction revealed signs of asphyxiation, feminine underwear, and several layers of plastic clothing. (2) A 16-year-old pupil dressed with feminine plastic and rubber utensils fixed and strangulated himself with an electric wire. (3) A 28-year-old handicapped man suffered from progressive muscular dystrophy and was nearly unable to move. His bizarre sexual fantasies were exaggerating: he induced a nurse to draw plastic bags over his body, close his mouth with plastic strips, and put him in a rubbish container where he died from suffocation.     

Accidental sharp force injury fatalities.

The authors review all accidental sharp force injury deaths investigated at the Southwestern Institute of Forensic Sciences from 1990 to 1999. Twenty-two cases of accidental sharp force injury were identified, accounting for 0.29% of all accidental deaths (9,562) during the 10-year study period. Included in this series are 5 incised wounds, 11 stab wounds, 4 chop wounds, and 2 deaths caused by dog attacks. About half of the cases involved some type of motorized machinery. The victims' ages ranged from 2 years to 71 years, with most deaths occurring in older teenagers and younger adults. Male subjects (17) were involved much more frequently than female subjects (5). In 50% of the cases, ethanol or other drug use was a possible underlying contributing factor in the accident. The cases are briefly reviewed, and the importance of detailed investigation in manner-of-death certification is emphasized.     

Intra- and perioral shooting fatalities.

Determination of the manner of death in the case of intra- and perioral firearm wounds can be difficult especially if death scene investigation is unclear and inadequate. In this study, we investigated some characteristics of these firearm wounds which were autopsied in Istanbul. During the 5-year period from 1991 through 1995, there were 15 intra- and perioral firearm fatalities investigated. In all the cases, only one shot was fired into the mouth. They constituted 1% of all the firearm fatalities. The mean age of the victims was 27 years and males constituted 73.3% of the victims. Most of the wounds were caused by handguns. Homicides accounted for 53.3% of these deaths. Three of 15 cases could not be identified as intraoral firearm wounds by general practitioners during the scene investigations.     

Pathologic features of childhood pedestrian fatalities

A retrospective analysis of 68 cases of fatal childhood pedestrian accidents in South Australia that occurred over a 20-year period from January 1977 to December 1996 was undertaken. The age range was 12 months to 16 years (average, 7.6 years), with a male to female ratio of 41:27. The most common site of significant injury was the head (91.2%), followed by the abdomen (50%), chest (47.1%), and neck (38.2%). The most frequently encountered significant injury combinations involved the head, chest, and abdomen (14.7%); the head and chest (11.8%); and the head, neck, and abdomen (11.8%). Injuries were severe, consisting of extensive compound and comminuted skull fractures, neck fractures, and massive intraparenchymal brain and internal organ damage with avulsions and fragmentation. Non-life-threatening limb injuries occurred in 88% of cases. A distinct subgroup involved infants and younger children playing in driveways at home who were hit by reversing vehicles. The injuries were often of such a severe nature that death was instantaneous and with no possibility of successful medical intervention. More deaths occurred during the winter than summer months.     

Analysis of fatalities in road accidents

This paper is based on the analysis of 524 autopsies carried out on the victims of road accidents at the Office of the Judicial Medical Officer, Colombo for a 2-year period ending December 1985. 51.4% of the fatalities were among pedestrians. The highest number of fatalities were in the age group 20-29 years. Cranio-cerebral injury was the commonest cause of death in all groups of victims.     

Gas taxes and motor vehicle fatalities

Economists view taxes as a more efficient means of reducing the consumption of a product than regulation. They have therefore suggested raising cigarette and alcohol taxes to reduce the undesirable effects of tobacco and alcohol on the public's health. This essay suggests that a gasoline tax can have similar beneficial influences on reducing highway deaths and injuries. Moreover, if some proceeds of the tax are used to finance mass transit, the regressivity of the tax can be ameliorated.     

Amoxapine fatalities: three case studies

Amoxapine (Asendin), a recently introduced dibenzoxazepine, has been effective in clinical studies for the treatment of various types of depression. Three amoxapine-related deaths are reported. Quantitation of amoxapine was carried out by gas chromatography using 3% OV-17 column. Blood amoxapine concentrations were 11.5 mg/l, 2.8 mg/l, and 0.89 mg/l. The concentrations are many-fold higher than the reported therapeutic serum concentrations of 0.21 mg/l. These cases illustrate the potential toxicity and lethality of amoxapine overdose and the need for caution in prescribing a large amount of amoxapine to patients with suicidal tendencies.     

Investigation of hot air balloon fatalities

The rising popularity of the sport of hot air ballooning has been accompanied by several recent incidents, both in this country and other parts of the world, where mechanical defects and the improper operation of balloons have resulted in several fatalities. A study was conducted to identify the location and frequency of hot air ballooning accidents. Furthermore, the study attempted to identify those accidents that were the result of improper handling on the part of the balloon operators and those that were related to specific defects in the construction of the balloon. This paper presents a background of the sport of hot air ballooning, together with an analysis of the construction of a typical hot air balloon, pointing out the specific areas where defects may occur that could result in a potential fatal balloon crash. Specific attention is given to the two recent balloon crashes that occurred in Albuquerque, N.M., hot air balloon capital of the world, and that resulted in multiple fatalities.     

Injury patterns in motor vehicle fatalities

A retrospective pilot study of motor vehicle incident fatalities was conducted to determine what relationships exist between injuries received by deceased drivers, passengers, and a control population of pedestrians, and some of the environmental factors existing at the time of the incident. A number of correlations were established between the types and locations of injuries received, seat belt use, position of the injured party, and so forth. A study of this type, if performed on a large enough population, could lead to predictive models for the determination of position of the victims within a motor vehicle at the time of a fatal crash, based on a unique clustering of injuries.     

Acute cardiovascular fatalities following cannabis use.

We report six cases of possible acute cardiovascular death in young adults, where very recent cannabis ingestion was documented by the presence of tetrahydrocannabinol (THC) in postmortem blood samples. A broad toxicological blood analysis could not reveal other drugs. Similar cases have been reported in the literature, but the toxicological analysis has been absent or limited to urine samples, which represent a much broader time window for cannabis intake. This paper presents six case reports, where cannabis alone was detected in blood. Further, an overview over previously published cases, clinical trials and possible patho-physiological mechanisms are presented.     

Sharp injury fatalities in New York City

We reviewed the case records of all fatalities due to sharp injuries in New York City in 1999. The epidemiological profile, circumstances, toxicology results, location, and injuries were examined. There were 120 deaths: 101 homicides, 17 suicides, and 2 accidents. The causes of death included: 112 due to stab(s) with or without incised wounds and 8 pure incised wound fatalities of which 5 were suicides. The detection of ethanol and/or illicit drugs was 61% in the homicide and 12% in the suicide groups. "Defense wounds" were reported in 49% of the homicides and "hesitation" wounds were found in 65% of the suicides. There were no self-inflicted sharp injuries of the face. Deaths due to a single stab wound occurred in 34% (34/101) of the homicides and 24% (4/17) of the suicides. Of these 38 deaths, 58% were of the anterior thorax (chest) and 71% injured the heart and/or great vessels. The remaining deaths with single stab wounds involved the femoral artery, abdominal organs, or head. There were no sharp injury suicides by Hispanics, Asians, or anyone under the age of 18 years. Over half of the suicides at home occurred in the bathroom and 78% of these occurred in the bathtub. Suicide notes were found in 24% of suicides, and an additional 24% verbally expressed a plan to commit suicide.     

Firearms fatalities in Denmark 1970-1979

In the 10-year period from 1970 to 1979 933 firearm fatalities occurred in Denmark which represent an increase of 45% during a little more than 10 years. Eighty-eight per cent were suicides, 8% homicides, and 4% accidents. Accidental shootings have decreased from 8% to 4% and the fall seems to be a result of fewer accidents in connection with hunting, probably due to a more restrictive legislation about hunting. An increasing share of the total number of deaths, now responsible for 57% of the fatalities, are by shotgun. There has been a remarkable increase in the use of sawn-off long barreled weapons. Still considering the marked increase of firearm fatalities, fatal shootings are of very limited importance in Denmark, especially homicidal shootings of which there are 2-3 per year. Shotguns are at the present time the only procurable dangerous weapons which have led to an increased share of the total firearm fatalities. Restrictions in the use of shotguns during hunting seem to have had positive effects on the reduction of hunting accidents. As mentioned above, the most valuable method of bringing the firearm fatalities under further control seems to be increased control over the procurement and possession of shotguns.