Toxicological findings in a multi-drug death involving propoxyphene, caffeine, phenacetin, acetaminophen and salicylate

The toxicological findings of a multi-drug related fatal poisoning are described here. A 35-year-old Caucasian male found dead on the kitchen floor was a known user of abused drugs and had been taking aspirin alone or in combination with phenacetin and caffeine for the relief of joint pains. The gross examination of the organs at autopsy revealed slight grooving of the uncus and various stages of necrosis in the renal papillae. Histological examination confirmed the gross appearance of pulmonary congestion and edema, cerebral edema and interstitial nephritis of the tubules. Toxicological evaluation of the blood and urine samples disclosed the presence of propoxyphene (51 and 250 mg/l), salicylate (185 and 2750 mg/l), caffeine (16 and 37 mg/l), and phenacetin (9.6 and 20 mg/l). Furthermore, acetaminophen also was present in the plasma (54 mg/l) and urine. A gas liquid chromatographic method for simultaneous analysis of phenacetin and caffeine utilizing a nitrogen phosphorus detector was proposed.     

A dynamic test of the marginality hypothesis

The marginality hypothesis is an attempt to relate the voting margins of members of Congress to their subsequent legislative behavior. A major corollary of the hypothesis is that members of Congress with small victory margins will be more responsive to constituents than those with large victory margins. This has been assumed to mean that electorally secure representatives can afford to be more loyal to their congressional parties, since they have less cause to worry about their chances for reelection. Previous empirical studies have produced mixed results. We ask the question in a different way: Do changes in marginality affect party voting within Congress? If so, major shifts in the electorate potentially can have a fundamental impact on the behavior of Congress itself. We find that this is not true. Electoral margin is simply not related to party loyalty.     

Initials: A question of identity

It has been a generally accepted practice among document examiners to request known handwriting standards which duplicate the questioned material under examination.When initials are questioned it is not always possible to have initials duplicated and known signatures are sometimes substituted.A research study was conducted using a sample of 65 writers to determine if the letters in a group of initials were written in the same manner as the capital letters in a signature. The study showed that 69% of the writers in the sample made one or more changes or additions to their initials which were not present when they wrote their signatures.     

Sudden death by inhalation of cyclopropane

This paper reports the case of a 22-year-old white male who was found dead in a storage room as a result of a fatal ingestion of cyclopropane. Cyclopropane is a sweet-smelling, irritating gas. Autopsy findings revealed congestion and hemorrhagic edema of the lungs, congestion of the trachea, and early autolysis. Cyclopropane was determined by headspace gas chromatography and mass spectrometry. To our knowledge, this is the first reported fatality involving cyclopropane.     

The impact of the right to refuse treatment in a forensic patient population: six-month review

In December of 1987, the Wisconsin supreme court held that all involuntarily committed mental patients in the state had the right to refuse psychotropic medication unless a court held that they were incompetent to make treatment decisions. The authors studied the effects of this decision in a 165-bed forensic hospital over the first six months after implementation of the decision. They found that 29 percent of patients already on psychotropic medication initially refused further treatment as opposed to 75 percent of newly admitted patients. Of refusers, 32 percent eventually resumed taking medication voluntarily; courts overturned the refusals of all the 51 percent who maintained their refusals, after an average delay of over a month. The length of procedural delays actually increased over the six months of the study as the courts learned of the decision. The authors compare their findings with other reported studies of implementation of right to refuse treatment decisions and discuss differences between the right to refuse treatment for civilly and criminally committed patients.     

The mechanism of fatal cardiopulmonary injury caused by a blow from a golf club

In the course of a scuffle, a youth of 18 years was struck a single blow across the chest with a golf club. He collapsed dead on the spot. At autopsy, a precisely located and highly distinctive patterned imprint abrasion of the precordial region was revealed providing an excellent match with the weapon. The heart showed multiple internal ruptures and there was a laceration of the lingula of the left lung. Injury to the chest wall was confined to the soft tissues, the rib cage and sternum being intact. We postulate a novel mechanism to explain the cardiac rupture.