Accidental poisonings involving carbon monoxide, heating systems, and confined spaces

Eleven incidents of carbon monoxide (CO) intoxication resulting in sixteen fatalities are reported. All of the cases involved heating systems as either the source or the means of distributing the CO. Blood samples were analyzed for ethanol and CO. Elevated blood CO saturations were found in 14 of the 16 victims while none of the victims had a blood ethanol concentration greater than 0.10% (w/v).     

Gas chromatographic and gas chromatographic-mass spectrometric determination of gasoline in a case of gasoline vapor and alcohol poisoning

A case of fatal poisoning due to the combined effect of alcohol and gasoline following an automobile accident is described. Toxicological analyses by means of gas chromatography and gas chromatography-mass spectrometry permitted the identification and quantitation of alcohol and several hydrocarbons in the heart blood and in the gas in the lung. Great variation was found in the estimates of blood gasoline concentration, depending on which of six constituents of gasoline was chosen for quantitation. The cause of this variation is discussed, together with the possible mechanisms leading to death.     

Identification of fentanyl derivatives

An interpretative approach to the identification of fentanyl homologs and analogs is presented. The techniques employed are liquid/liquid extractions; capillary gas chromatography; and infrared, mass, and nuclear magnetic resonance spectral characterization. Spectral data are presented for eight fentanyl derivatives of clandestine origin.     

Detection of cocaine metabolite in perspiration stain, menstrual bloodstain, and hair

Low nanogram and picogram quantities of cocaine metabolite equivalents were detected in extracts from perspiration stains, menstrual bloodstains, and hair using radioimmunoassay. The theory of drug inclusion in hair and its significance are discussed.     

Hyperosmolarity Induces Armanni‐Ebstein‐like Renal Tubular Epithelial Swelling and Cytoplasmic Vacuolization

Armanni–Ebstein lesions have been considered pathognomonic for diabetes mellitus and appear as markedly swollen renal tubular epithelial cells with cytoplasmic clearing and glycogen accumulation. However, the extent to which hyperosmolarity contributes to the Armanni–Ebstein phenotype is unclear. Ten sheep were injected intravenously with 20% mannitol at 11 mOsm/kg, and subsequent histological evaluation of the kidneys showed variable degrees of osmotic nephrosis and cytoplasmic clearing of renal tubular epithelial cells similar to that seen with Armanni–Ebstein lesions. However, although morphological changes similar to Armanni–Ebstein lesions could be produced, no intracytoplasmic glycogen was demonstrated with periodic Acid–Schiff (PAS) stain. This suggests that while hyperosmolarity may contribute to the development of an Armanni–Ebstein phenotype, glycogen accumulation may result from the more complex metabolic effects of glucose on renal tubular epithelial cells. Thus, when Armanni/Ebstein‐like vacuolizations are seen at autopsy, a confirmatory PAS stain is recommended because of the potential effect of hyperosmolar states.     

Comparison of Rehydration Techniques for Fingerprinting the Deceased after Mummification

Postmortem decay causes fingertip decomposition, desiccation, shriveling, and rigidity, reducing the possibility of obtaining sufficiently clear fingerprints for identification. In this study, five rehydration solutions (ammonium hydroxide, sodium carbonate, potassium hydroxide, urea, and warm water) followed by three fingerprint recording methods (photograph, inking roll, and dusting tape) were investigated to process mummified fingertips from an unidentified cadaver. The results show that sodium carbonate treatment is the most effective for minutiae restoration, followed by ammonium hydroxide treatment. This study also demonstrates that even those fingertips that previously failed in urea solution, 1% potassium hydroxide solution, and warm water treatment could be further improved with sodium carbonate solution to obtain qualified minutiae for fingerprint matching. The optimal procedure is rehydrating the desiccated fingertips with sodium carbonate solution for 24 h followed by dusting the finger and transferring the print to adhesive tape.     

Multiple Giant Coronary Artery Aneurysms: A Rare Cause of Sudden Cardiac Death

Multiple giant aneurysms involving the coronary arteries are uncommon and rarely reported. In the presented case, a 63‐year‐old man with poorly controlled hypertension died suddenly. Gross autopsy examination showed multiple giant thrombus‐filled coronary artery aneurysms, atherosclerotic coronary artery disease, and cardiomegaly. Histological sections of the coronary aneurysms showed atherosclerotic changes with both organized and fresh thrombus. Giant coronary aneurysm is defined as a segmental enlargement of a coronary artery with a diameter exceeding 20 mm or more. The main etiology of this nebulous entity is attributed to atherosclerosis and inflammatory or inherited connective tissue disorders with the remainder being congenital, infectious, or idiopathic. Before its cataclysmic presentation, when ruptured or thrombosed, giant coronary aneurysm usually has a silent clinical course. Sudden death owing to giant multiple coronary aneurysms is rare and mandates careful classification of the aneurysms and prudent search for autoimmune‐mediated or genetically based factors for subsequent ancillary autopsy studies.