Delaware's first serial killer.

The violent murder of Shirley Ellis on November 29, 1987, marked the beginning of the strange and terrible tale of Steven Bryan Pennell's reign as the state of Delaware's first convicted serial killer. Three more bodies followed the first victim, and all had been brutally beaten and sadistically tortured. The body of a fifth woman has never been found. State and county police collaborated with the FBI to identify and hunt down their suspect, forming a task force of over 100 officers and spending about one million dollars. Through their knowledge and experience with other serial killers, the FBI was able to make an amazingly accurate psychological profile of Delaware's serial killer. After months of around-the-clock surveillance, Steven Pennell was arrested on November 29, 1988, one year to the day after the first victim was found. Pennell was found guilty in the deaths of the first two victims on November 29, 1989, and plead no contest to the murder of two others on October 30, 1991. Still maintaining his innocence, he asked for the death penalty so that he could spare his family further agony. Steven Pennell was executed by lethal injection on March 15, 1992.

Spontaneous splenic rupture and infectious mononucleosis in a forensic setting.

In this report we present two fatal cases of spontaneous splenic rupture. The prodromal symptoms, clinical presentations, autopsy findings and histologic findings are discussed, pertinent literature reviewed and the implication for the forensic pathologist stressed.

Three unusual cases of multiple suicidal gunshot wounds to the head.

We describe three unusual cases of suicide involving multiple gunshot wounds, in which all of the victims suffered gunshot wounds to the head, yet none was rendered immediately incapacitated. Injuries were confined to the same area in two of the cases and were located in different areas in the other case. Two of the cases initially appeared to be homicides rather than suicides.

Propane-associated autoerotic fatalities.

We describe 3 unusual autoerotic fatalities in which propane gas was used to induce hypoxia. To our knowledge, these are the first cases of their kind to be reported and described in depth, although brief references to similar cases have appeared. The case histories of 3 white males, aged 22, 42, and 62 years, are described with emphasis on the scene and circumstances and the identification of propane from autopsy materials. In one case, unusual paraphilia and multiple foreign bodies in the rectum were noted. These 3 cases illustrate an unusual form of autoerotic practice in which hypoxia is induced by propane inhalation, unlike the usual neck compression that has been previously described in depth. The importance of scene reconstruction and an awareness of this phenomenon is stressed.

Involvement of mast cells in sudden infant death syndrome.

The pathogenesis of sudden infant death syndrome (SIDS) is elusive and probably multifactorial. The occurrence of mast cell activation in SIDS was assessed in this study by measuring concentrations of tryptase, a neutral protease produced mainly by mast cells, in postmortem sera from term infants with SIDS and from age-matched control infants who died unexpectedly at home from a known cause. Tryptase levels were significantly higher in the 50 infants with SIDS than in the 15 control infants (p = 0.0004). Forty percent of the infants with SIDS and none of the control infants had a tryptase level greater than 10 ng/ml, the threshold chosen to indicate premortem mast cell activation. An infant with SIDS had a 20-fold higher chance of having an elevated tryptase level compared with a control infant. The postmortem interval did not influence these results. Thus mast cell-mediated anaphylaxis is likely to be the pathogenetic mechanism involved in some but not all SIDS cases. Recognition of this pathway as operative in SIDS should facilitate a more precise identification of the allergens involved, the processes leading to mast cell activation, and procedures to identify those infants at risk for anaphylaxis, and should, in time, lead to better therapeutic interventions aimed at preventing this specific cause of SIDS.

Cocaine-induced agitated delirium, forceful struggle, and minor head injury. A further definition of sudden death during restraint.

Four cases from the Philadelphia Medical Examiner's Office are presented and the literature is reviewed to define further the syndrome of sudden death occurring during cocaine-induced agitated delirium and struggle during restraint in individuals who also sustain minor head injury. The mechanism of death involves a terminal arrhythmia, most likely due to sympathetic sensitization of the myocardium by cocaine and the stress of struggle sometimes juxtaposed upon the stratum of minimal natural disease. In the cases described, the head injury in itself was insufficient to be a cause of death. Recognition of the role of the pharmacologic effect of cocaine and the lethal effects of its use in this setting is crucial.