Pulmogenic air embolism

Interstitial emphysema and pulmonic hemorrhage alone are not the causes of pulmonic air embolism. The conditions making the entrance of air from the lungs to the vessels of pulmonary circulation are obviously present only if the expiration pressure is suddenly strongly elevated. Based on this point of view, investigations were performed in autopsy cases--falls from a height, being run over, a gunshot in the abdomen. We have succeeded in proving the entrance of air into capillaries and branches of the pulmonary vein. The precipitation of thrombocytes at the margin of large air bubbles in pulmonary veins shows the finding of air in the vessels as a vital or supravital reaction.     

The influence of an air ionizer on the air ionic composition

The air ionic composition in a classroom was determined during the operation of a Neo Tec XJ-2100 ionizer (Germany). The amount of ions in the air was measured before and after the switch-on of the ionizer. It was shown to vary depending on the mode of operation of the device and differ from the recommended normal values. The necessity of checking up the work of air ionizers both in living quarters and at workplaces is discussed with the application of air ion counters making it possible to carry out monitoring of the air ionic composition and estimate its compliance with the sanitary and hygienic norms.     

Acute cerebellar hemorrhage in a patient with Klinefelter syndrome: XXY karyotype obtained postmortem from cells from pericardial fluid

A case of Klinefelter syndrome and a spontaneous cerebellar hemorrhage in a 12-year-old boy is presented. Autopsy revealed that the hemorrhage was due to the rupture of a dilated artery in an arteriovenous malformation in the right cerebellar hemisphere. The small, undescended testes exhibited partial atrophy of the seminiferous tubules. Postmortem chromosome analysis of cells from the pericardial fluid demonstrated a 47, XXY karyotype. He had previous surgical treatment for bilateral thumb polydactyly and patent ductus arteriosus. In juvenile cases of sudden death with overlapping morphological dysgenesis, postmortem karyotyping may provide important diagnostic information.     

Suicide by air rifle and shotgun

We report the case of a 39-year old white male who committed suicide by shooting himself with an air rifle and a shotgun. The ballistics of air guns and rifles, with particular reference to the Sheridan air rifle, are reviewed. Only two cases of multiple firearm suicide have been reported; both involved simultaneously fired handguns. Ours is the first case, to our knowledge, of an air rifle and a shotgun used in sequence to commit suicide.     

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.     

静脉气体栓塞的研究进展

气体栓塞是一种较多见而又威胁生命的医疗操作并发症,在法医学实践中也时有所遇,但易被检验者所忽略;也常因尸体放置较久而给法医学检验和鉴定带来困难。在此综述了静脉气体栓塞的病因、病理生理变化、临床表现及诊断和法医学鉴定的意义及注意事项,认为超声心动图、CT和MRI等现代成像技术在气体栓塞的临床诊断和法医学鉴定中有积极的辅助作用。     

Suicides by starter's pistols and air guns

We report the case of a 25-year-old depressed woman who committed suicide with a starter's pistol loaded with CS tear-gas ammunition. The propellant gases of the contact shot entered her chest through the left sixth intercostal space. Exsanguination was caused by perforations of the pericardium and apex of the heart. Autopsy did not reveal any metallic or other foreign bodies that might have originated from the propellant, the cartridge, or any bulletlike material. Her injuries were thus caused by the propellant alone. 0.5 mg L-1 of the CS degradation product cyanide was detected in the cardiac blood. We also report the case of a 54-year-old man, suffering from depressive psychosis, who committed suicide with an air rifle. The lead-pointed Diabolo bullet entered his brain through the right large wing of the sphenoid bone, traversed the right temporal brain pole, damaged the right middle cerebral artery and the right optic tract, and finally lodged in the left central ganglia. There was extensive basal subdural hemorrhage and tamponade of all cerebral ventricles. Death was attributed to cerebral failure. We furthermore list another 26 cases of suicide by rarely used weapons from 1947 to 1989.     

Acute and subacute fetal CO-poisoning

The main principles of placental CO exchange in cases of CO intoxications of pregnant women are shown. Fetal COHb lags behind maternal COHb by several hours depending on the exposure pattern. During CO elimination the fetal COHb levels again lag behind the mother's. A case of a lethal CO intoxication of a pregnant woman, mens IX, with exposure time of 10-12 h and COHb of 75% for the mother and 46% for the fetus allows to make conclusions about process of intoxication and about different times of death for mother and fetus. In highly acute lethal intoxications of the mother COHb in fetal blood is low or negative. A vital danger of the fetus is not probable when mother survived a short CO exposure.     

Acute epiglottitis (supraglottitis)

During an autopsy the clinician, as well as the pathologist, should insist on a culture and adequate examination of the neck. Failure to examine the neck structures in this catastrophic illness may result in an incorrect determination of the cause of death [12,13]. Many autopsy surgeons assume pneumonia is present but later find only microscopic evidence of pulmonary edema. By then the decedent has been buried. Untreated fatalities are seldom reported [3,5,14]. Future reports should include statistics from the medical examiner's or coroner's office in their jurisdiction. This will promote knowledge of the true incidence of acute epiglottitis.     

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.     

Barotrauma and air embolism in hyperbaric oxygen therapy

A 69-year-old woman underwent hyperbaric oxygen therapy because of a nonhealing ulcer of her foot. During decompression, she developed a left-sided hemiplegia and confusion. Recompression resulted in transient neurologic improvement, but she eventually became comatose. Ventricular dysrhythmias developed and she died without regaining consciousness 17 h after onset of symptoms. An autopsy revealed diffuse interstitial pulmonary fibrosis with severe paracicatricial emphysema, chronic interstitial inflammation, and chronic bronchitis with abundant intrabronchial mucus. There was extensive multifocal ischemic injury of the cerebral cortex. The hippocampi, basal ganglia, and cerebellum were spared. Scattered acute myofiber necrosis was present in the heart. Clinical presentation and autopsy findings strongly support the diagnosis of air embolism and illustrate a potential risk of hyperbaric oxygen therapy in patients with preexisting pulmonary disease.     

Fatal air embolism in diving. A morphologic study

Two cases of barotrauma as a result of excess pulmonary pressure with subsequent air embolism are reported. Both cases involved serious diving safety errors. The morphology of this type of barotrauma is described, with particular reference to the etiology of the phenomena involved. Some specific points regarding the autopsy procedure in connection with such diving accidents are discussed.     

Dental identification problems in the Abu Dhabi air accident

The forensic odontological examination of 112 victims in the 1983 air accident near Abu Dhabi is described with particular reference to the problems encountered in the age assessment of the 26 children, and serves to illustrate that dental identification in aviation accidents may be of only limited application in Asian victims. Following this accident, other means of identification had misguidedly been removed by the recovery teams. Of those identified, half were by dental means alone, but this amounted to only 6.24% of the total number of victims.