Death following injection sclerotherapy due to phenol toxicity

Prolapse rectum (PR) or protrusion of the rectum beyond the anus occurs frequently in populations at both extremes of age. In the pediatric population, in developed countries, the commonest cause for PR is thought to be cystic fibrosis (CF). Treatment options for CF include conservative management, surgical resection and fixation, suturing, and injection sclerotherapy (IS). The last is considered an attractive treatment option because it is minimally invasive. In this case report, the authors present the details about a 2-year-old female child, with PR and CF, who died after IS, using phenol as the sclerotherapeutic agent. Autopsy findings and toxicology tests performed to establish phenol toxicity are documented. The available literature is reviewed. This case report underscores the risks of using phenol for IS and emphasizes the point that the procedure is not innocuous and an adverse outcome including fatality is a possibility.     

Community Risk Management of High-Risk Sex Offenders in Canada: Findings From a Quasi-Experimental Study

Although considerable controversy surrounds capital punishment, there is no disagreement about the injustice of executing innocent persons. While critics of the death penalty have cited the risk of executing the innocent as a reason for its abolition, adherents have dismissed the risk of error as negligible, if not inevitable, and insufficient reason to halt capital punishment. Still others have proposed or enacted reforms designed to minimize the risk of erroneous capital convictions and sentences and, hence, allow executions to go forward in deserving cases in which doubts about guilt have largely been eradicated. In this article, we examine the principled tensions that accompany attempts simultaneously to safeguard the innocent from execution while promoting the objectives of capital punishment. We focus, in particular, on reforms recently incorporated into Maryland’s death penalty law. We suggest that the existing tensions between protecting the innocent from execution and promoting the objectives of capital punishment are so pronounced that attempted reconciliation of the competing interests is difficult to defend, either in principle or in practice.     

Trigemino‐Cardiac Reflex as Lethal Mechanism in a Suicidal Fire Death Case

In the vast majority of immediate fire deaths, the mechanism of death is inhalation of toxic gases (especially carbon monoxide), direct thermal injury, or neurogenic shock due to the redistribution of the body's blood volume produced by surface heat on the skin. We present a suicidal case that is unusual because the mechanism of immediate fire death could arguably be explained in terms of a primitive autonomic reflex/the trigemino‐cardiac reflex. Although this reflex is well known to surgeons and anesthetists, with possible lethal consequences in the course of invasive surgical procedures on the head and neck region, it is much less familiar to forensic pathologists.     

Radiocarbon Analysis of Human Remains: A Review of Forensic Applications

Radiocarbon analysis of organic materials, with the comparison of values with those of the post‐1950 modern bomb curve, has proven useful in forensic science to help evaluate the antiquity of evidence. Applications are particularly helpful in the study of human remains, especially with those displaying advanced decomposition of soft tissues. Radiocarbon analysis can reveal if the remains relate to the modern, post‐1950 era and if so, also provide information needed to evaluate the death and birth date. Sample selection and interpretation of results must be guided by knowledge of the formation and remodeling of different human tissues, as well as contextual information and the approximate age at death of the individual represented. Dental enamel does not remodel and thus captures dietary radiocarbon values at the time of juvenile formation. Most other human tissues do remodel but at differing rates and therefore collectively offer key information relative to the estimation of the death date.     

The Drowning Index: Implementation in Drowning,Mechanical Asphyxia,and Acute Myocardial Infarct Cases

Drowning is a diagnosis of exclusion based on circumstantial and autopsy correlation. Sugimura proposed a threshold value of 14.1 for the Drowning Index (DI), the ratio of lung and pleural fluid to spleen weight, as a surrogate marker to diagnose drowning. We questioned the use of DI in diagnosing drowning. We compared DI between three groups—drowning, mechanical asphyxia, and myocardial infarct—seen at Broward MEO from 2008 to 2009. Only 9.4% of 53 drownings exceeded the DI threshold of 14.1, while 30% of 10 mechanical asphyxias and 40% of 10 myocardial infarcts had DI >14.1. Sensitivity for the DI test was <10% and specificity 60–70%. Median DI values for all groups were <10. Mann–Whitney U‐test was not statistically significant between groups. The DI is neither sensitive nor specific and lacks any utility in the diagnosis of drowning.     

Offending and Early Death in the Cambridge Study in Delinquent Development

Criminal offending has many negative outcomes. Researchers have recently begun to consider the impact offending has on offenders' health, with a few studies focusing on differential mortality risk. Yet, prior research has been limited due to selective samples, restricted range of follow-up time period, limited set of explanatory variables, and lack of theoretical guidance. This paper examines the risk of early death among 411 South London males in the Cambridge Study in Delinquent Development followed into their late 50s. Attention is paid not only to differential risk of death between nonoffenders and offenders, but also to the risk within the population of offenders and through consideration of theoretical frameworks and associated predictor variables. Results show that high-rate chronic offenders evince the highest risk of death, an effect that continues even after controlling for childhood individual and environmental risk factors as well as participation in a range of analogous behaviors.     

非典型自杀的法医学鉴定

根据辖区内自杀案件的特点,对其中自杀方式较为特殊或复杂的案件进行分析总结,将之归结为非典型自杀,根据其损伤方式,伤口形态等的不同将其分为多种方式自杀和特殊创伤型自杀,分别进行阐述,通过对这些非典型自杀的法医学特点的分析,为非正常死亡案件性质的正确判定提供帮助.     

Sudden death in an adolescent due to undiagnosed classic Hodgkin lymphoma

Few cases of natural sudden death presenting as an undiagnosed lymphoma have been reported in the literature, especially in adolescents. Herein we provide a report of sudden death caused by undiagnosed classic Hodgkin lymphoma (cHL). We describe an 18-year-old female who collapsed after several weeks of weight loss, decreased appetite, and dyspnea. At autopsy, a bulky mass arising in the mediastinum and neck compressed the esophagus and trachea, surrounded the great vessels, obliterated the pericardial sac, and infiltrated the myocardium. The lungs were collapsed and large pleural effusions were present. The tumor burden, which weighed at least 2710 g in aggregate, was entirely above the diaphragm. Microscopic examination of the masses showed features typical for nodular sclerosis cHL including large bands of sclerosis, numerous Hodgkin/Reed-Sternberg (HRS) cells, and an eosinophil-rich mixed inflammatory cell infiltrate. Immunohistochemical stains showed the HRS cells to be uniformly positive for CD30 and CD15 and negative for CD3, CD20, CD45, and PAX5. This case exemplifies a rare sudden natural death due to previously undiagnosed cHL in a young patient.     

Towards molecular autopsies: Development of a FFPE tissue DNA extraction workflow

Sudden unexpected death (SUD) is a devastating event and forms a substantial proportion of the cases investigated at forensic mortuaries each year. Despite post-mortem investigations, the cause of death may remain undetermined. There is potential for these unresolved cases to benefit from retrospective molecular autopsies for investigation into genetic mutations which may have contributed towards death. Often, formalin fixed paraffin embedded tissues (FFPET) are the only archival sources of DNA available for retrospective analyses. However, extracting usable DNA from FFPET is challenging as current methods yield poor quality and quantity DNA. Thus, this study aimed to optimise DNA recovery from FFPET by investigating several variables within the DNA extraction workflow, including the selection of tissue type, number and thickness of tissue sections, deparaffinisation method, and DNA extraction kit. The quantity and quality of DNA recovered were assessed using spectrophotometry, real time PCR, digital capillary electrophoresis and DNA profiling. This study was the first to implement a nuclei quantification using microscopy to guide the selection of the best tissue type to use for DNA analysis. The use of a greater number of thinner tissue sections (100 sections, each 1 μm) significantly improved DNA concentration, purity and fragment length. Additionally, the combination of Deparaffinization Solution with the QIAamp® DNA FFPE Tissue Kit proved most favourable with a median DNA yield of 320 ng and 55% of DNA fragments greater than 400 bp. Isolated DNA was of single source, indicating no contamination in the workflow, and FFPET blocks that were stored for up to 3.5 years did not significantly affect DNA degradation (p = 0.1764). These results are especially informative for designing library preparation and sequencing workflows for determining cause of death in unresolved SUD cases.     

刺激犬体表感受器对心脏表面神经元和心脏功能的影响

为了给“抑制死”提供实验根据和理论依据,模拟“抑制死”的体表刺激,用3.0kg触压麻醉开胸犬的心前区、剑突下,同步记录大右心房神经节丛神经元内单位放电的频数及心脏变时。变力性反应。静脉给入普来洛尔（1mg／kg）或阿托品（1mg／kg）及心脏急性会神经支配后,重复上述刺激。结果显示：触压犬心前区可直接引起心脏表面神经节丛内的副交感神经元兴奋,窦房结自律性降低,引起负性频率作用;在此基础上刺激兴奋心脏表面交感神经元可诱发室性心律失常。提示刺激心前区、剑突下引起的“抑制死”,不仅与迷走神经对心脏的抑制有关,可能还与交感神经元对心室的兴奋有关。