Unusual suicides of young women with tentative cuts and fatal neck injuries by chain saw and circular saw

Suicides with chain saws and circular saws are extreme exceptions, in particular with regard to females and concerning the neck region. We report two of such rare cases involving young women. A 30-year-old female with a known schizoaffective psychosis killed herself with an electric chain saw. The autopsy revealed a deep saw cut of the neck and shoulder with partial transection of the cervical spine. Several tentative saw cuts were present on the right lower jaw. A 29-year-old woman suffering from depression committed suicide by use of a circular saw. She inflicted herself fatal neck injuries with at least three separate cutting procedures. Our cases were characterized by the following features: female sex, young adulthood, no occupational experience with saws, psychiatric disorders, absence of alcohol or drugs, use of an aggressive method of suicide, focus of saw injuries on the right side of the neck, detection of tentative saw cuts or several trials, identical causes of death (exsanguination and blood aspiration).     

Der verfahrene Feiertag

Die Vorschriften über die Ablaufhemmung verfahrensrechtlicher Fristen orientieren sich – wie im Übrigen auch jene über die Anberaumung von Verhandlungen – an den allgemeinen Feiertagsregelungen. Diese bilden im Wesentlichen die religiösen Bedürfnisse der Bevölkerungsmehrheit ab, lassen aber Raum für solche einzelner religiöser Minderheiten. Eine Überprüfung anhand des Gleichheitssatzes fördert verfassungsrechtliche Bedenken zutage, die durch eine kleine gesetzgeberische Korrektur ausgeräumt werden könnten.     

Instability of calcium channel antagonists during sample preparation for LC-MS-MS analysis of serum samples

1,4-Dihydropyridines calcium channel antagonists (1,4-DHP CCAs) are photolabile and the products of their photodecomposition have no pharmaceutical activity. In our previous work we have presented a screening procedure for eleven 1,4-DHPs in plasma by LC-MS-MS using multiple reaction motoring. The laboratory process includes preparation and storage of stock solutions, plasma storage, solid-phase extraction, reconstitution of extracts and storage time in an autosampler for LC-MS-MS analysis. Prior to validation of the analytical procedure, we have tested the stability of these compounds by exposure to light. Methanolic solutions have been exposed to laboratory and UV light and the stability of the compounds in plasma was tested by exposure of spiked plasma samples to laboratory light at room temperature. Stability during freeze-thaw cycles and stability during 2 month storage at -20 degrees C have been tested as well. Products of photodecomposition have been identified after forced degradation and the degree of degradation has been quantified using LC-UV-DAD and LC-MS-MS, respectively. A 96% degradation after only 2h has been observed when solutions of nifedipine or nisoldipine were exposed to laboratory light in clear glass vials. In plasma samples degradation was 25% in only 2h for both compounds. The main degradation product was produced by oxidation of the dihydropyridinic ring resulting in the pyridine analogue that has been described as the first metabolite in the metabolic pathway. Only minor degradation was found for the other tested compounds after 2h light exposure in methanolic solutions. Furthermore, lercanidipine and nicardipine were also degradated by esterhydrolysis. Several additional minor degradation products were found for the other tested 1,4-DHPs, however, some of them could not be identified. Preconditions for storage and handling of plasma samples prior to and during analysis for 1,4-DHP CCAs are suggested in order to avoid photodecomposition of the analytes.     

Anorectic sibutramine detected in a Chinese herbal drug for weight loss

In the presented case, a young healthy woman had ordered a Chinese herbal medicine, called "LiDa Dai Dai Hua Jiao Nang", via internet. She took this product for approximately 1 week, but on the second day she developed severe headache, vertigo and sensation of numbness. After discontinuing medication, symptoms disappeared within 2 days. For identification of the ingredients, a urine sample as well as a sample of the "LiDa" capsule were analysed by GC-MS and HPLC-DAD. One major ingredient was detected in urine as well as in the "LiDa" capsule and was identified as sibutramine. Quantification by HPLC-DAD yielded 27.4 mg sibutramine base, which is approximately two times the amount of the highest authorized single dose available on the pharmaceutical market in Germany. This case demonstrates a common problem with herbal medicines, where adulterations with synthetic therapeutic substances can lead to severe side effects and/or potentially fatal interactions with conventional medicines.     

Survival of severe amlodipine intoxication due to medical intensive care

We report the case of attempted suicide with amlodipine, chlorthalidone and mefenamic acid and subsequent medical intensive care measures which resulted in total recovery of a 42-year-old male. After admission to the medical intensive care unit the intoxicated patient was deeply hypotensive and needed fluid replacement, dobutamine and norepinephrine. Additionally insulin and calcium gluconate were given. Since hypotension persisted and the patient developed oliguria, terlipressin was applied and finally showed an effect on blood pressure and on urinary output. A volume overload of 7 L in the first 24 h resulted in a pulmonary edema. The patient was started on non-invasive ventilation with continuous positive airway pressure (CPAP) and frusemide was added to the therapy with good success. Quantitative determination of amlodipine in plasma samples was performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The highest amlodipine concentrations was measured in the plasma sample collected approximately 8 h after ingestion of the drug, and was 393 microg/L. Four days later, it was possible to stop the treatment with catecholamines, at that time the amlodipine plasma concentration had declined to 132 microg/L, still tenfold higher than therapeutic (5-18 microg/L). Elimination half-life of amlodipine is approximately 55 h. After 6 days in the intensive care unit the patient was transferred to psychiatric treatment. Intensive care management and plasma levels in this intoxication case are compared to data from literature on other cases.     

The potential of venous air embolism ascending retrograde to the brain

A bench study was performed to investigate the potential of air bubbles entering a central vein via a central venous catheter to ascend retrograde to the brain. The results support the hypothesis that air bubbles may rise retrograde against the venous blood flow, depending on bubble size, central vein diameter and cardiac output. A review of radiological findings in published case reports indicates that the occurrence of retrograde cerebral air embolism is underestimated.     

mtDNA investigations after differential lysis

In order to gain information regarding the ethnic origin of an unknown offender in a murder case it was necessary to sequence the HV1 and 2 regions of the mitochondrial DNA (mtDNA). The only evidentiary material that could be linked to the suspect was DNA, extracted from spermatozoa after differential lysis. The observed mtDNA sequences were identical to the sequences of the victim. Therefore, we had to check if this was a coincidence or the result of a technical limitation of the testing procedure. Subsequently, we performed a systematic study. In cases with complete separation of sperm and female cells it wasn't possible to obtain a mtDNA sequence for the sperm fraction. This phenomena is based on the loss of the sperm's flagellum and mid-piece during the first lysis step and a concomitant loss of the sperm's mitochondria. In our murder case, a minor carry-over of female cells to the sperm fraction was responsible for the sequencing result.     

Neo-Voluntarism: A New European Social Policy Regime?

Abstract: The essay begins with a recapitulation of core institutional properties of the European Union as they have evolved over several decades. The leading insight deriving from this exercise is that European social policy will always, for all practical purposes, be made simultaneously at two levels, a supranational one and a national one, and will be shaped by complex interactions between them and among the national systems situated in the integrated market economy of the Union. Proceeding from here, the remainder of the paper examines the two levels of social policy-making, beginning with the supranational and moving on to the national, in an effort to identify the kinds of policies that are most likely to emerge given the constraints and opportunities offered by the institutional framework.     

Time-dependent immunohistochemical detection of proinflammatory cytokines (IL-1beta,IL-6, TNF-alpha) in human skin wounds

The proinflammatory cytokines interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha) hold important functions in the early and late courses of inflammation, trauma and wound healing. In the present study, human skin wounds due to sharp force (n = 105) were collected during surgery and autopsy. The wound age mainly varied from several minutes to 5 h, some specimens aged up to 6 weeks. Control specimens from uninjured skin were available in each case. After preparation of cryostat sections, immunohistochemistry was performed according to the APAAP technique, using monoclonal and polyclonal antibodies. The results were evaluated semiquantitatively. All markers were weakly expressed in normal human skin constitutively. However, the staining pattern changed significantly in vital wounds concerning epidermal layers, subepidermal cells, vessels and sweat glands. IL-1beta and IL-6 showed enhanced expression after 15 and 20 min at the earliest (increase of epidermal reactivity). After 30-60 and 60-90 min, respectively, marked expression was observed with these markers. Similar alterations were detectable with TNF-alpha after 15 and 60-90 min. The reactivity of all three markers persisted over several hours, then decreased to basal levels again and sometimes reappeared after days and in granulation tissue. Leukocytes reacting with IL-1beta and IL-6 appeared after approximately 2 h. CONCLUSION: proinflammatory cytokines can serve as a useful tool for the estimation of vitality and wound age, in particular in the early post-traumatic interval prior to leukocyte reaction. Autolysis did not play a role in the samples investigated (postmortem interval up to 8 days). Problems could sometimes rise from constitutive expression. Therefore, it is recommended to examine control samples from the same individual and to compare the reactivity with wound specimens.