Sudden death by Lepomis macrochirus (the killer fish)

In this unusual case, death was not caused by either anaphylactoid reaction to fish or by fish poisoning. Death was due to asphyxia caused by a live, whole fish occluding the mouth and upper airway.     

Study by next generation sequencing of sudden cardiac death (SCD)

Sudden cardiac death (SCD) is one of the most common causes of death; most SCD are related to secondary arrhythmias, to structural heart disease, or to primary electrical abnormalities of the heart.A significant number of SCD, especially among young people, are due to genetic heart disorders, both with structural and arrhythmogenic abnormalities. However SCD occurs also in patients with negative clinical history, autopsy is not always conclusive for a diagnosis.Recent technological advances in DNA sequencing, have led to the commercialization of genetic testing now widely available in clinical practice. In particular, next generation sequencing, allows the large-scale and rapid assessment of entire genomes.Analysis of SCD with a NGS panel of 174 genes was performed in our laboratory in order to identify the genetic causes and thus to direct the clinician to an accurate clinical and genetic screening of relatives.Two SDC were studied:Case 1: female, 57, without story of syncope and no previously highlighted cardiac alteration, died post cardiac arrest; negative family history. Autopsy was apparently negative.Case 2: male, 52, who died during a football game; negative family history, neurological episodes occurred before death was reported by close relative. Autopsy was positive for ventricular hypertrophic.In both cases we made a genetic diagnosis.     

Nonnatural death masquerading as SIDS (sudden infant death syndrome)

This article relates our experiences with accidental and homicidal deaths in reported sudden infant death syndrome (SIDS) cases. Our intent is to alert personnel in medical and health-related professions as well as death investigators (coroners, law enforcement officials, etc.) that a thorough scene investigation and history need to be obtained when a child's death has been reported, since this may modify the type of autopsy to be performed. It should not be assumed that all children less than 1 year of age who die suddenly die from SIDS.     

Delayed death following strangulation (hanging)

6 cases of suicide by hanging with delayed death are presented in tables laying out the circumstances and the findings. All the persons involved remained continuously unconscious after initially successful reanimation; two were at this time already dead. The survival times lay between 18 hours and 4 days. In two cases intravital vertebral death occurred. In the other cases death was due indirectly to hypoxial brain-damage which had led to a greater or lesser extent to elective parenchymal necrosis. In 3 of 4 histologically investigated cases there was evidence of extensive cell destruction in the PCA muscle which was, however, not specifically related to the process of hanging since lesions of this nature also occur with other cases of delayed death after reanimation. In 7th case the problems encountered in compiling an expert opinion are discussed in cases where there are no corresponding procedural details. A 44 year old man died 3 weeks after having been submitted to bondage in a brothel at his own request (including binding of the neck). Compression of the throat with emphasis on one side was evident resulting in extensive ganglial cell damage in one half of the cerebral cortex.     

Unexpected perinatal death and sudden infant death syndrome (SIDS): anatomopathologic and legal aspects

This work intends to be a review of the recent histopathological findings elicited by research into sudden and unexpected perinatal death and sudden infant death syndrome (SIDS) that have dictated a novel approach to the inherent problems by pathologists, especially those entrusted with forensic medical authority. The new approach stems from the recent advances made in the understanding of neuro- and/or cardiac-conduction-system diseases present in unexpected perinatal death and SIDS. These demand that an accurate morphologic examination be performed of these structures, which modulate respiratory, cardiovascular, digestive, and arousal activities, in all victims of sudden death. A histopathologic study of an ample register of cases of victims of sudden death, either perinatally or in early infancy, has demonstrated frequent alterations both of the autonomic nervous system (especially hypoplasia of the arcuate nucleus) and of the cardiac conduction system (accessory atrioventricular pathways). The present research provides an in-depth study of the many still-controversial aspects underlying perinatal unexpected death and SIDS and is recommended for professionals working in the forensic field, whose greater insight into this problem will allow more complete medicolegal documentation.     

Maternal death associated with intravenous methylphenidate (Ritalin) and pentazocine (Talwin) abuse

A case of maternal death from pulmonary hypertension secondary to pulmonary granulomatosis is presented. The granulomas are associated with a history of intravenous injection of medications (Ritalin and Talwin) intended for oral use.     

胃内容推断死亡时间的误差(附2例报告)

尽管有许多推断死亡时间的方法,但运用胃内容消化和排空情况推断死亡时间简单易行,具有相当重要的实践意义.在法医学教科书中,运用胃内容消化和排空情况推断死亡时间已有论述.一般说来,食后不久即死亡者, 胃内容移向十二指肠,约在食后2～3h;胃、十二指肠均已空虚,则死亡可能发生在食后6h以上[1].但在实际检案中,有时我们感到运用胃内容消化和排空情况推断餐后死亡时间,与书中提供的时间相差较大.现对本地区两例凶杀案件根据教科书介绍的胃内容推断死亡时间方法造成错误推断,谈谈我们的体会.     

乌头属植物生物碱高效液相色谱研究Ⅱ

目的 建立高效液相色谱法测定多种乌头属植物生物碱的方法 .方法 XTerraTMRP185μm,(250×4.6mm)色谱柱;流动相为乙腈:30mmol/L碳酸氢铵梯度洗脱;流速1.0ml/min;检测波长233nm.结果 该方法可成功应用于黄草乌、紫草乌、短距牛扁、保山乌头4种乌头属植物生物碱成分分析.结论 本研究结果提示乌头属植物中毒案件检验应注意是否含有8-O-乙酰基-14-茴香酰基生物碱.     

Morphology of bullet entrance wounds in palms and plantae (author's transl)

Tests shots with hand weapons of .22, .25, .32, .357, and .45 calibre were made to find out whether bullet entrance wounds in palms and plantae are very different from such wounds in other parts of the body. As far as shots without contact between muzzle and skin were concerned, the following characteristics were noticed: (1) Entrance holes from pistols and revolvers of the same calibre were smaller in palms and plantae than in other parts of the body. (2) There is no abrasion collar as typically found in other regions. (3) The corneum of epidermis around the entrance hole is lifted off and torn radially. These unusual findings are most probably the result of the particular texture of the palmar and plantar epithelium.     

婴儿猝死综合征的法医学鉴定

近20多年来,婴儿猝死综合征（sudden infant death syndrome,SIDS）一直是西方发达国家医学界尤其是法医学和儿科学领域研究的热点。目前,随着对SIDS广泛而深入的研究,对其病因、发病特点、危险因素以及致病机制等都有了更明确的认识。虽说近年来SIDS的发病率已有明显下降,在欧美洲、澳洲等发达国家,SIDS仍然是导致1个月到1岁婴儿死亡的首要原因。在亚洲国家和地区,尤其是发展中国家SIDS的报道很少见。本文通过总结文献并结合美国马里兰州近20年（1990—2006）来对SIDS的调查研究资料,介绍SIDS的发展历史、研究现状和新的发展趋势,并对SIDS法医学鉴定程序及鉴定要素进行讨论。     

Study of the brainstem, particularly the arcuate nucleus, in sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD)

Complete examination of the brainstem involves transverse serial 5-microm sections made throughout the entire brainstem. The number of serial sections varies from 360 in sudden intrauterine unexplained death (SIUD) to 600 in term fetuses to over 1400 sections in sudden infant death syndrome (SIDS) victims. The procedure is not applicable in all histopathological laboratories, owing to the need for additional technical personnel. The simplified procedure allows a remarkable reduction of the number of sections. The brainstem is divided into 3 blocks. The first, cranial block, extends from the border between the medulla oblongata and pons up to the upper pole of the olivary nucleus. The second, intermediate block, corresponding to the submedian area of the inferior olivary nucleus, has as reference point the obex and extends 2 to 3 mm above and below the obex itself. The third, caudal block, includes the lower pole of the inferior olivary nucleus and the lower adjacent area of the medulla oblongata. Examinations of the brainstems from 106 SIDS victims, 30 controls, and 51 stillborns underlined a remarkable variability, particularly of the arcuate nucleus. The simplified examination of the brainstem makes it possible to evaluate the structures, examining 3 specific levels, defined by morphologic reference points.     

Intrathoracic and subconjunctival petechiae in sudden infant death syndrome (SIDS)

The frequency and density of intrathoracic and subconjunctival petechiae was studied in 250 cases of SIDS and 69 controls. The control group included 37 infants with natural and 32 infants with traumatic causes of death. Intrathoracic petechiae were found significantly more frequently in the SIDS group (91.2% SIDS; 42% controls; p < 0.001) and were present at a higher density (p < 0.001). Subepicardial and thymic petechiae were detected at high density in older SIDS infants. Subconjunctival petechiae were low in density and found only in 2.4% of the SIDS group but they were detected in 8.1% of the natural death group and 21.9% (p < 0.05) of the lethal trauma group. Subconjunctival petechiae were found at highest density in strangulation. Intrathoracic petechiae are commonly found in SIDS but are not specific for SIDS. Subconjunctival petechiae are typical but not specific for strangulation. In SIDS, subconjunctival petechiae are rare and appear at low density.     

Study of 5-hydroxytryptamine (serotonin) in pericardial fluid in different causes of death (II.). Experimental study of 5-HT levels in two types of shocks (hemorrhagic and septic) in dogs

In the present work we studied the levels of 5-HT in the pericardial fluid of 160 cadavers according to cause of death; such as myocardial infarction, violent asphyxia, pulmonary embolism, infections, bronchopulmonary diseases, traumatic and hemorrhagic diseases in the CNS, and multiple traumatism. We did not find significant differences in the various causes of death. A complementary study of 20 dead dogs having suffered induced shock, either hemorrhagic or septic, was made. In both series we studied the serum levels of 5-HT and the following parameters: systolic and diastolic arterial pressures, central venous pressure, hematocrit value, pH value, total proteins, albumin, PO2, and PCO2. We found the significant correlation (r = 0.828, P less than 0.01) only between 5-HT serum levels and the systolic arterial pressure in the hemorrhagic shock.     

Choking death on a live fish (Dicologoglossa cuneata)

A choking death of a healthy fisherman, who put a type of live sole between his jaws to free up his hands so that he could collect more fish to put into his basket, is described. The fish squirmed into the larynx and upper trachea and the attempts to rescue the man by his colleagues who used pliers did not succeed, and the man died. Other published cases are reviewed, and risk factors and rescue possibilities discussed.     

Toxic environmental factors in sudden infant death (SIDS)

The increasing number of discussions on the influence of toxic environmental factors, including SIDS, prompted systematic postmortem chemical-toxicological investigations to be carried out on 54 SIDS cases and 2 control cases of the same age group. Tissue levels of arsenic, lead, cadmium, mercury, and pentachlorphenol, as well as other organic noxious agents, were measured in several organs. In addition, the COHb concentrations were determined. In spite of the widely scattered values, the extreme levels measured and the arithmetic means and median averages of As, Pb, Cd, Hg, PCP, and COHb had no more range in concentrations than can be expected for toxic effects - according to present knowledge anyway. It was observed that infants from an urban environment showed no greater concentration of noxious agents than did infants from rural regions. There were also no differences between SIDS cases and the controls, nor was there a correlation between infections of the respiratory system that are often morphologically detected - including laryngitis - and higher concentrations of these agents in the organs of SIDS cases.     

Cardiac troponin T (cTn T) and the postmortem diagnosis of sudden death

PURPOSE: To evaluate the effectiveness of the increase of postmortem cardiac troponin T (cTn T) in acute disease-related deaths. METHODS: Peripheral venous blood was sampled from 39 autopsies performed. Thirty nonhemolyzed specimens were considered in the final analysis (n = 30).Only the calculation of the cTn T was performed using the Roche Diagnostics Elecsys 2010 Immunoassay System. The high limit and the cutoff are 25 ng/mL.Deaths were divided into 2 groups, according to sudden cardiac deaths (group 1, n = 15) and non-cardiac-related deaths without resuscitation (group 2, n = 15). RESULTS: All the cases with visual myocardial infarction had elevated concentrations of cTn T. The difference of the postmortem cTn T concentrations between resuscitated and nonresuscitated is nonsignificant.In the non-cardiac-related deaths, the elevated concentrations of cTn T were only noted in all cases of electrocution. CONCLUSION: In clinical practice, several biochemical markers are used for the diagnosis of myocardial infarction. Because of its extreme specificity for myocardial damage, cTn T and cardiac troponin I (cTn I) are frequently used. The results of these assays could then be used to facilitate selection for cases that may be released following histologic examinations.