Glycine toxicity and unexpected intra-operative death

A rare complication of the use of glycine irrigation fluid during prostatic surgery in a 69-year-old man is described. Following cystolithopexy and transurethral resection of the prostate for benign prostatomegaly, abdominal distension developed with increasing ventilatory pressures. Despite retroperitoneal fluid evacuation at subsequent urgent laparotomy, cardiac arrest occurred that was not amenable to resuscitation. At autopsy a traumatic defect in the posterior bladder wall filled with calculus debris was confirmed that did not communicate with the peritoneal cavity. Hyponatremia with markedly elevated levels of blood, urine, and body fluid glycine were demonstrated. Death was, therefore, attributed to glycine toxicity following tracking of glycine through a surgical defect in the posterior bladder wall. Careful dissection of surgical sites is required in such cases to demonstrate any additional trauma that may be associated with the fatal episode. Analysis of body fluids for glycine and electrolytes is also necessary to assist in the determination of possible mechanisms of death.     

Forensic chemical testing of cadaveric material for acetonitrile

Gas chromatographic conditions for qualitative and quantitative evaluation of acetonitrile in biological material were determined, including those for reactive gas chromatography. Absolute and relative time of acetonitrile and concomitant substances retention in three columns of different polarity was determined. Study of the time of acetonitrile retention in biological material showed that acetonitrile concentration in the blood virtually did not change in cadaveric material stored in a hermetically closed flask for 2 weeks at 20 +/- 3 degrees C, while its concentration in the stomach decreased by 10-15%. Distribution of acetonitrile in human viscera in lethal poisoning was studied; the agent was evenly distributed in the gastric wall, intestine, liver, and kidney, while its concentrations in the lung and brain were 2-3 times higher. Forensic chemical expert analyses of the blood, urine, and viscera from corpses of humans dead from lethal acetonitrile poisoning showed that lethal concentration in the blood was 28.3-57.0 mg and in the urine 23.2-40.6 mg/100 ml.     

Clinico-morphological parameters of heroin abuse and pathology connected with it

Morphological manifestations of narcomania in heroin users are described. Diseases associated with heroin narcomania and causes of death of heroin users are presented. Morphological manifestations at the site of injections and inflammatory reactions in parenchymatous organs are characterized. The authors pay special attention to the productive inflammation which can serve as one of the signs that confirm narcomania in cases with parenteral injections of crude heroin. The authors refer the granulomas to toxic allergic form of granulomatous hypersensitive inflammation.     

A novel hunting accident. Discharge of a firearm by a hunting dog

The authors report the case of a 21-year-old man who was killed while duck hunting when a shotgun accidentally discharged, shooting him in the head. The loaded weapon, which had been lying on the ground with the safety off and the muzzle pointed toward a river a few feet away, discharged when a hunting dog stepped on the trigger. Scene investigation confirmed that the victim had been standing in the river, planting decoys, with his head approximately level with the adjacent bank. Autopsy examination and ballistic testing confirmed a range of fire consistent with the witness' statements. Examination of the weapon in question documented a light trigger pull but no mechanical defects. The authors review the epidemiology and causality of hunting accidents and discuss the various safety rules that were violated in this highly unusual case. The importance of a complete death investigation, including autopsy, when dealing with a firearm death is emphasized.