Investigation of deaths related to electrical injury.

Even though the use of electricity is an integral part of our lives, the number of accidents and deaths related to electricity is on the decline. This is due to increased awareness of electrical hazards and, in large part, to increased inclusion of safety mechanisms by manufacturers. However rare, electrical injury and related death can present a complicated case in the emergency department and for death investigators. Sometimes the circumstances of the physical scene are unclear because of intentional or accidental alterations or the investigator's inability to reconstruct events leading to the injury. This may hinder the initial clinical assessment. We present cases of typical and atypical deaths from electrical injury and review clinical and investigative procedures to assist in the treatment of patients with electrical injuries.

Wounding effects of the Winchester Black Talon bullet.

Winchester Ammunition has developed a bullet that was specifically designed to perform better than other hollow-point missiles. The resulting cartridge, the Black Talon bullet offers a low-velocity missile that retains its weight, penetrates even when interrupted by intervening objects, and remains capable of expansion in soft tissue. The bullet causes extensive tissue damage and presents a hazard to those responsible for handling it after expansion.

Using counselors in a multideath disaster.

In the worst possible situation, a disaster results in multiple deaths, requiring the involvement of coroner's and medical examiner's offices. Guidelines offered by the National Association of Medical Examiners and by a national funeral directors' association suggest the use of ministers and chaplains to offer "pastoral" care to family members who have lost a loved one in a disaster. This article offers an example of a disaster protocol based upon national guidelines, but using certified and licensed professional counselors to provide preventive outreach counseling to those family members. Furthermore, this protocol uses a counselor in a key position to provide psychological care to investigative and medical personnel involved in the recovery and identification portions of a disaster.

"There's death in the cup, so beware!".

The proper investigation of deaths due to poisoning and the determination of the manner of death often depend upon knowledge and investigative skills that may have been allowed to deteriorate with lack of use. These case reports illustrate a wide variety of substances that people can ingest. This collection of case reports includes the ingestion of two insecticides and three different organic chemicals. A concise review of literature is provided, along with symptoms exhibited by those who ingest these poisons, and methodologies recommended for their determination in this series of cases.

Spontaneous rupture of the spleen. A fatal complication of pregnancy.

Spontaneous splenic rupture in pregnancy is a rare and potentially catastrophic event. As many as 76 cases have been identified in the past 190 years by a variety of authors. This case report describes splenic rupture during the immediate postpartum period. The exact cause of the rupture could not be determined, and it was consistent with a spontaneous rupture.

Death caused by an allergic reaction to ethanol.

Death as a result of anaphylaxis remains rare and is only occasionally related to ingestion of common substances. This article reports a death due to an allergic reaction to ethanol, as well as a review of the reported deaths in the literature attributed to ethanol. This report emphasizes the importance of awareness of such obscure allergies by forensic pathologists, the significance of antemortem testing, and the value of gathering accurate medical information, both antemortem and postmortem.

Death investigations involving personal computers.

Three death investigations are reviewed in which personal computers owned by the deceased were used to provide information regarding their deaths. To obtain the information from computers, however, the death investigator or forensic pathologist must have the investigative skills to secure this evidence for examination by a computer expert. Unless the computer is handled carefully, the information could be lost or even destroyed. This article provides recommendations for the investigation of a death scene where a personal computer has been found, how to secure it, and where to obtain assistance for the examination of the information contained on the computer.

Major vascular injuries of the torso.

We reviewed autopsy data from 802 trauma deaths in northwestern Louisiana from January 1983 to March 1988 and found that 18% of all such deaths involved noncardiac major vascular injuries of the torso. Ninety-four percent of all deaths from blunt trauma and 45% of all deaths from penetrating trauma involved injury to the aorta, either thoracic or abdominal. Injuries to the thoracic aorta accounted for 11% of all trauma-related deaths in northwestern Louisiana; 68% of all victims died at the scene of the trauma. During this period 57 patients with noncardiac major vascular injuries of the torso were treated at the LSU-Shreveport Medical Center. Fifteen (26%) of these patients were transported to LSU-SMC from neighboring rural parishes outside the Shreveport-Bossier City metropolitan area. The mortality was 37%, and there was no difference in survival between those patients transported to LSU-SMC from within the Shreveport-Bossier City area and those transported from the rural parishes. Multivariate analysis of data showed that survival was determined by the complexity of the injury, the patient's ability to reach the hospital, and the stability of the patient's condition on arrival at the hospital. Transport time did not appear to affect survival.

Toxic peripheral neuropathy with demyelination in Sprague-Dawley rats given CGS 21595--a 5-lipoxygenase inhibitor.

Male and female Sprague-Dawley rats were given CGS 21595, a pro-drug that is almost immediately metabolized to CGS 19213, a naphthoquinone that acts as a 5-lipoxygenase inhibitor. The compound was administered by gavage to five groups of Sprague-Dawley rats (group Nos. 1, 5, n = 30; group Nos. 2-4, n = 20) at daily doses of 0, 50, 150, 500, or 1,000 mg/kg for 13 weeks. Rats in the higher dose groups had a reduced weight gain, but significant neurologic signs were not observed. A peripheral neuropathy consisting predominantly of myelin destruction in the spinal nerve roots and sciatic nerves in male rats treated with greater than or equal to 150 mg/kg CGS 21595 and in female rats treated with greater than or equal to 50 mg/kg CGS 21595 for 13 weeks. This lesion was not fully reversible after a recovery period of 4 weeks. Lesions consisted of ballooning of myelin sheaths, infiltration by macrophages, demyelination, and occasional areas of remyelination. Axons were generally preserved, and the brain and spinal cord were not affected. Male and female rats in all treatment groups had cytoplasmic hyaline droplets in the proximal renal tubules. This change was reversible after 4 weeks and was not associated with any other adverse effects on the kidney.

Isometric features of orthostatic tremor: an electromyographic analysis.

A patient is described with "orthostatic" tremor. Electromyography revealed tremor bursts of 15 Hz in the lower extremities while standing and with isometric activation of the muscles, but the bursts disappeared with isotonic activation of muscles. Similar tremor was recorded in the arms with isometric, but not isotonic activation. Review of previously reported cases confirms these findings. The clinical and electrophysiologic features of this tremor distinguish it from other recognized forms of tremor.

Phagocytosis of Mycobacterium leprae by cardiac muscle cells--a preliminary report.

Fetal cardiac muscle cells were shown to ingest M. leprae easily within 20 minutes of exposure in vitro. This phagocytosis is considered nonspecific and facilitated by the lipid coat of the mycobacteria. The presence of M. leprae free in the cytoplasm of the muscle cells did not seriously affect the morphology or rhythmic contractions of the cells. The significance of the presence of M. leprae in somatic cells needs further study.

Vaginal "fisting" as a cause of death.

We describe the death of a young girl that resulted from the insertion of a clenched hand and forearm into her vagina during heterosexual activity. (The male homosexual practice of rectal fist insertion has been described previously.) We believe this death to be the first reported case of a "fisting" death due to vaginal fist insertion during heterosexual activity. This death is reported to alert forensic pathologists, medicolegal death investigators, and coroners aware of the role of aberrant sexual activity and its potential to cause death.

A burning issue. The Japanese "fire basin".

This article presents two deaths due to acute carbon monoxide poisoning that occurred when charcoal-burning hibachis were used as heating sources in enclosed camping facilities. In both deaths, the levels of blood carbon monoxide saturation were at or slightly below the expected lethal level. Coronary arteriosclerosis may have contributed to one death, while oxygen depletion may have been a contributing factor in the other. These cases illustrate the danger of using such heating sources in enclosed spaces, due to their carbon monoxide-generating capability. We suggest that suitable warnings be placed on the hibachis themselves.

An unusual case of child abuse homicide/suicide.

This case report examines a child abuse homicide in which the perpetrator committed suicide a few hours after the infant's death. At the time of the perpetrator's suicide he was not under investigation, nor was he a suspect in the death of the child. Although the literature does not contain reports of similar cases, we are sure they exist. This report raises the question of the degree of social stigma attached to the accusation of child abuse. It also serves as a warning to those who must deal with the potentially suicidal child abuser.

A monoclonal antibody reactive with a second epitope of the 67,000-dalton human T cell antigen.

Hybridomas were produced against the T-cell CLL derived-cell line, SKW3, by the fusion of hyperimmune spleen cells with P3 myeloma cells. One clone, designated DU-SKW3-1, was shown to produce a murine IgG2b antibody reactive with an antigen expressed on normal thymocytes and peripheral blood T cells. This antigen was not detected on human B cells, erythrocytes, monocytes, granulocytes, or platelets. D-SKW3-1 also reacted with T-ALL, T-CLL, and B-CLL cells, but did not react with common ALL or acute myelocytic or monocytic leukemias. Immunoprecipitation of lactoperoxidase-iodinated, detergent-solubilized PBL demonstrated that DU-SKW3-1 reacted with a protein with an apparent mass of 67,000 daltons (p67), which had identical mobility to the antigen precipitated by L17F12, Cocapping experiments suggested that DU-SKW3-1 and L17F12 detected the same molecule: however, DU-SKW3-1 was unable to block the binding of L17F12. In addition, DU-SKW3-1 reacted with the T lymphocytes of both the great apes and old world monkeys, in contrast to L17F12 and two other p67 monoclonals, T101 and 10.2, which reacted only with the cells of the great apes. This data suggests that DU-SKW3-1 may react with a second, less phylogenetically restricted epitope on the p67 T cell-/CLL-associated molecule.

Alpha1-antitrypsin quantitation and Pi typing of stored postmortem blood.

Correlation of necropsy findings with protease inhibitor levels and phenotype is sometimes desirable. This study was designed to determine the feasibility of postmortem protease inhibitor assessment. One hundred fifteen consecutive postmortem samples, stored at -20 C for 24 to 53 months, were analyzed. The time from death to necropsy, storage time, and the pH values of the sera were correlated with alpha1-antitrypsin levels, trypsin inhibitory capacity, and Pi typability. The alpha1-antrypsin level and trypsin inhibitory capacity were not significantly correlated with morgue time, serum storage time, or pH, and mean values were within the expected ranges. A significant decrease in Pi typability occurred when pH was less than 7.0. Moreover, while most (86%) of the sera stored for 2 to 2 1/2 years were typable, only 30% of those stored for more than four years were typable. Determination of alpha1-antitrypsin and trypsin inhibitory capacity are possible with the use of stored postmortem blood. Pi typing is usually possible, provided sera are not acidic and are examined within 2 1/2 years.