Suicide by hydrogen sulfide inhalation.

The authors report a case of suicide by hydrogen sulfide in Australia. A young woman was located in a car wearing protective eyewear. A tub of foamy yellow substance and a quantity of hydrochloric acid and lime sulfur were also located in the rear of the vehicle. Morphological findings at autopsy were nonspecific. Toxicologic analysis of a specimen of leg blood detected elevated levels of methemoglobin. If Australia follows a similar trend to Japan and the United States, it is possible that incidences of such cases will rise, probably because of Internet dissemination. From a public health perspective, emergency service providers and forensic case workers should be aware of the potential hazards to themselves and others when dealing with such cases.

Sudden death due to aortic rupture complicating undiagnosed coarctation of the aorta in a teenager - a case report and review of the literature.

Coarctation of the aorta is one of the more common congenital cardiac defects accounting for between 5 and 10% of cases of congenital heart disease. It has traditionally been divided into infantile (pre-ductal) and adult (ductal) types. Prior to the development of surgical treatment for coarctation, the condition was associated with significant morbidity and mortality with the most common causes of death being aortic rupture, congestive cardiac failure, endocarditis and intracerebral haemorrhage. Presentation of undiagnosed aortic coarctation as sudden and unexpected death is today a distinctly uncommon phenomenon. We report one such case, that of an adolescent male who at autopsy was noted to have coarctation of ductal type with aortic dissection and haemopericardium. The presence of this condition should be considered by the forensic pathologist confronted with aortic dissection, particularly in a young person.

Incidental lung cancers identified at coronial autopsy: implications for overdiagnosis of lung cancer by screening.

BACKGROUND: The extent to which overdiagnosis occurs in lung cancer screening programmes has been debated. Overdiagnosis refers to the detection by screening of cancers that would not have become clinically apparent or symptomatic before that individual died of other causes. METHODS: A retrospective review of coronial autopsies performed in Victoria between April 1991 and February 2002 was conducted to determine the rate of incidental lung cancer in individuals who died of natural causes. RESULTS: A total of 24,708 autopsy reports were searched electronically. We estimated that in 56% of these death was from natural causes. Amongst individuals who died naturally there were 167 cases of lung cancer, 47 of these were incidental including five carcinoid tumours, three small cell tumours, 11 cases of carcinoma in situ and 28 invasive nonsmall cell lung cancers. Of the incidental invasive nonsmall cell lung cancers, 86% were stage I. CONCLUSIONS: Although incidental lung cancer is uncommon, there are some lung cancers that remain undetected during life and do not contribute to death. These findings support the hypothesis that some lung cancers detected by screening may never progress to cause symptoms or death in that individual's lifetime and therefore may be overdiagnosed by screening.