The time interval between lethal infant shaking and onset of symptoms. A review of the shaken baby syndrome literature.

Many health care professionals believe that there is a very short interval between an act of ultimately lethal infant shaking and the onset of symptoms (altered consciousness, convulsions, respiratory distress, and so on). We reviewed the English-language medical literature on the shaken baby syndrome for case reports or other information that documents the time of onset of symptoms after an act of ultimately lethal infant shaking. The medical literature contains minimal data that substantiate or contradict the contention that is stated here.

Homicide facilitated by inhalation of chloroform.

Three related homicides in which each decedent had significant concentrations of chloroform in blood, fat, brain and/or liver are described. The tissue concentrations of chloroform in one of three decedents were within reported lethal ranges. The concentrations in the remaining two decedents were less than lethal but were well above blood levels in nonoccupationally exposed, healthy subjects. The cause of death in one decedent with sublethal chloroform concentrations was suffocation; the cause of death in the other decedent could not be determined with certainty. The manner of death in each case was homicide. Through a review of the literature the authors discuss the history of chloroform as an inhalation anesthetic and the history of chloroform as an agent of abuse, suicide, assault, and homicide. Blood and/or tissue concentrations of chloroform in nonoccupationally exposed, healthy subjects and victims of suicide or homicide from previous reports are compared and contrasted with the amounts in blood and/or tissue in the three subjects described in this study. The authors conclude that, in addition to a direct lethal effect, chloroform may be used to incapacitate a victim of assault who then dies by another cause.

Bones, blood, pellets, glass, and no body.

A man was found guilty of killing his wife, although her body was never found. The case centered on her car, which contained fragments of bone, glass, shotgun pellets, and dried blood. Deoxyribonucleic acid (DNA) fingerprinting techniques were used to establish the decedent's identity. Examination of the bone fragments revealed that they were from the skull. These two pieces of information, added to other evidence, proved that the defendant's wife had received a fatal injury in her car, and a guilty verdict was rendered.

Dragging deaths: a case in point.

A 16-year-old boy was riding his bicycle when he was struck by a truck. He was dragged over 2 1/2 miles (4 km) before he was deposited on the side of the road. The injuries evident at autopsy revealed the boy died from dragging and not from the initial impact. The scene, and the autopsy findings, will be discussed.

Missouri's lakes and the disposal of homicide victims.

This paper presents the circumstances surrounding the retrieval and subsequent autopsies of four bodies accidentally discovered weighted down in Missouri's lakes. The bodies, representing four separate cases of homicide, were sunken for a period of three weeks to ten months. The relationship of adipocere formation to the postmortem interval and the problems of injury interpretation are discussed.

Central pontine myelinolysis: a complication of hyponatremia or of therapeutic intervention?

We report four cases of central pontine myelinolysis (CPM) that illustrate important features of the disorder. The condition is described mainly in the neurological literature and, to our knowledge, is not discussed in the forensic science journals. This disorder must be recognized and understood by the forensic science expert who addresses issues of liability. In cases of multiple motor deficits and death with a history of hyponatremia, CPM must be included in the differential diagnosis. Careful examination of the pons and adjoining structures must be performed. Myelin stains are advisable. The association of CPM with major illnesses, hyponatremia and the correction of hyponatremia by intravenous saline infusions is discussed.

Homicide by insulin administration.

This report describes a case of homicide by insulin administration and a study of the effects of storage conditions on insulin in serum. The study revealed insulin to be remarkably stable at refrigerator temperatures. Therefore, for forensic science purposes, insulin immunoassay data are interpretable even when serum is not stored by the standard laboratory method of freezing.

Nosocomial pulmonary mucormycosis with fatal massive hemoptysis.

We postulate that the previously healthy woman reported here developed abnormal host defense mechanisms because of acute renal failure, metabolic acidosis, hyperglycemia, and glucocorticosteroid administration. Pneumonia unresponsive to antibiotics terminated in massive fatal hemoptysis that was due to mucormycosis with rupture of the pulmonary artery into the tracheobronchial tree.

Symptomatic cardiac amyloidosis in an American family.

This report describes an American family with a high incidence of symptomatic cardiac amyloidosis among four siblings, and explores the role of echocardiography and technetium pyrophosphate myocardial scintigraphy in the detection of this infiltrative cardiomyopathy within the involved family.

Abnormal left cardiac border due to an atherosclerotic coronary artery aneurysm.

A 57-year-old man had an aneurysm of the left anterior descending coronary artery that appeared as a bulge of the left cardiac border on plain chest roentgenograms. The aneurysm enlarged over a four-year period, and death resulted from myocardial infarction. The importance of recognizing this uncommon cause of an abnormal left cardiac border is stressed because further investigation by coronary angiography should be done before resection or bypass of the aneurysm.