Age-related differences in mechanism, cause, and location of trauma deaths.

BACKGROUND: Trauma death has traditionally been described as primarily occurring in young men exposed to penetrating trauma or road traffic accidents. The epidemiology of trauma fatalities in Europe may change as a result of the increasing proportion of elderly patients. The goal of this study was to describe age-related differences in trauma type, mechanism, cause and location of death in a well-defined European region. METHODS: We prospectively registered all trauma patients and severe burn patients in eastern Denmark over 12 consecutive months. We analyzed all trauma fatalities in our region regarding the trauma type, mechanism, cause and location of death. RESULTS: A total of 2,923 patients were registered, of which 292 (9.9%) died within 30 days. Mortality increased with age, with a mortality of 46.1% in patients older than 80 years old. Blunt trauma was the most frequent trauma type at all ages, but the trauma mechanism differed among ages, with falls constituting 46.8% of trauma deaths in the elderly. The primary cause of death was head and spine injuries across all age-groups. Death took place before arrival at the hospital in 45% of the cases, but death during primary admission became increasingly important with advanced age. CONCLUSION: Increasing age was associated with higher mortality, an increased proportion of falls and fatal head or spine injuries.

Fatal overdose of the herbicide bentazone.

A 59-year-old woman who intentionally ingested 100-200 ml Basagran was taken to the hospital with a cardiac arrest 2 days after she had consumed the herbicide. During this period she suffered vomiting, urination and diarrhoea and she was drowsy with a muddled speech. Biological samples obtained at the autopsy were analysed and presence of bentazone, alcohol and an active metabolite of citalopram were detected. Blood concentrations of bentazone, alcohol and desmethyl-citalopram were 625 mg/kg, 0.62 g/l and 0.03 mg/kg, respectively.

Molecular investigation of transmission of human immunodeficiency virus type 1 in a criminal case.

Very few criminal cases involving human immunodeficiency virus type 1 (HIV-1) transmission have been described. We report on an HIV-1 transmission case with a child being infected by an HIV-1-positive man. The objective was to determine through molecular epidemiology and phylogenetic analyses whether HIV-1 from the HIV-1-positive man could be the source of infection in the HIV-1-positive child, as claimed by the authorities. We conducted genetic analysis of three different parts of the HIV-1 genome (gag, pol, and env) by PCR, direct-sequencing, and phylogenetic analyses. We used maximum likelihood, maximum parsimony, and neighbor-joining methods for the phylogenetic analyses to investigate whether the sequences from the man and the child were related. We found that the viral sequences from the man and the child formed separate clusters in all of the phylogenetic analyses compared to the local controls. A unique amino acid deletion was identified in the C2-V3-C3 region of the env gene in the virus from the man and the child. These results were used in the criminal court to elucidate whether the virus from the man was related to the virus from the child. In summary, the results from the phylogenetic analyses, the sequence distances between the virus from the man and the virus from the child, and the identification of the unique molecular fingerprint in the env gene together indicated that the virus from the man and the virus from the child were epidemiologically linked.

Automobile exhaust as a means of suicide: an experimental study with a proposed model.

Experiments were conducted to investigate the concentration of carbon monoxide (CO) in a car cabin under suicide attempts with different vehicles and different start situations, and a mathematical model describing the concentration of CO in the cabin was constructed. Three cars were set up to donate the exhaust. The first vehicle didn't have any catalyst, the second one was equipped with a malfunctioning three-way catalyst, and the third car was equipped with a well-functioning three-way catalyst. The three different starting situations were cold, tepid and warm engine start, respectively. Measurements of the CO concentrations were made in both the cabin and in the exhaust pipe. Lethal concentrations were measured in the cabin using all three vehicles as the donor car, including the vehicle with the well-functioning catalyst. The model results in most cases gave a good prediction of the CO concentration in the cabin. Four case studies of cars used for suicides were described. In each case measurements of CO were made in both the cabin and the exhaust under different starting conditions, and the mathematical model was tested on these cases. In most cases the model predictions were good.

Alcoholic ketoacidosis as a cause of death in forensic cases.

Forensic pathologists are familiar with alcohol abusers, who are found dead and in whom the cause of death cannot be ascertained. In order to examine the possible role of ketoacidosis for the cause of death in this group of alcohol abusers, the concentrations of ketone bodies (acetone, acetoacetate, D-beta-hydroxybutyrate) were determined in post mortem blood specimens. Determination of the ketone body concentrations were made by a coupled enzymatic head-space gas chromatographic method. The material consisted of blood specimens from 131 deceased persons and was divided into three groups: Group 1: controls, 79 cases of non alcohol abusers; group 2: 35 cases of alcohol abusers with known causes of death and group 3: 17 cases of alcohol abusers without ascertainable cause of death. The geometric means for the sum of the ketone body concentrations in blood were: controls, 109 mumol/l; alcohol abusers with known causes of death, 152 mumol/l; and alcohol abusers without known cause of death, 590 mumol/l. The limit value between the controls and the group of alcoholics with unascertainable cause of death was by logistic regression found to be 531 mumol/l (343-1224 mumol/l). The term 'ketoalcoholic death' is, therefore, suggested, when the measured post mortem blood ketone body concentration in an alcoholic with otherwise unknown cause of death exceeds 531 mumol/l.

[Phlegmonous gastritis in pregnancy--a case with fatal course]. / Flegmonøs gastritis i graviditeten--et dødeligt forløbende tilfaelde.

A case of maternal death and still birth in the 35th week of pregnancy is described where the cause of death was the very rarely diagnosed phlegmonous gastritis. The phlegmonous gastritis is characterised by dangerous, fulminating pyogenic bacterial infection of the gastric wall with alpha-haemolytical streptococci. The entity seems to have been well-known earlier, but has only been reported sparsely in contemporary medical literature. It cannot be ruled out that the disease may have been misdiagnosed on several occasions in recent decades because of symptomatic treatment. In presenting the case, the authors seek to attract attention to this disease--that according to the contemporary medical literature seems mostly to be induced by modern treatment with antacids and after gastroscopy--because it can be effectively treated with modern antibiotics, possibly in combination with gastrectomy.

[Incidence of HIV-1 antibodies in drug addicts autopsied at the Institute of Forensic Medicine in Copenhagen in 1988-1991]. / Forekomst af HIV-1-antistoffer hos stofmisbrugere obduceret på Retspatologisk Institut i København 1988-1991.

During the period 1988-1991 HIV-1-antibody tests were performed on a total of 389 autopsied drug addicts. The HIV-1-incidence rose from 6 per cent in 1988 to 14 per cent in 1990 and 14 per cent in 1991. There was no significant difference between the cumulated incidence in males and females. The HIV-1-positive addicts were compared to the HIV-1-negative addicts with respect to mean age, duration of abuse, residence and cause and manner of death. Except for residence, where significantly more HIV-1-positive than negative addicts lived in Copenhagen, there were no significant differences between the two groups. In about one third of the HIV-1-positive cases, equally for males and females, the HIV-1-positivity was not previously known. The results are discussed in relation to the findings in other countries and to the findings in selected groups of living addicts in Copenhagen. It is concluded that the diagnosis of HIV-1-infection in autopsied drug addicts is important from epidemiological and hygienic points of view.

Terminal ballistics of the 7.62 mm NATO bullet. Autopsy findings.

The 7.62 mm x 51 military rifle bullet (7.62 mm NATO) as manufactured in Denmark, and in some other countries as well, has been claimed to fragment when fired at ranges encountered in forensic practice. All autopsied cases of death due to this bullet in Denmark since 1975 were investigated by studying autopsy reports and the bullets retrieved by the police. With one exception, all bullets that were found in, or known to have passed through the body, had fragmented. This behaviour is assumed to be due to a lack of strength in the jacket causing it to break at the cannelure when hitting the target at high velocity. The fragments will increase the already sizeable lesions and may leave the body through several separate exit wounds, presenting problems both for the surgeon treating survivors and for the forensic scientists when defining the direction of the shot. The legality of this and similar bullets in view of the Hague Declaration of 1899 may be questioned, and we feel that the bullet should be redesigned. A programme to this end has been initiated by the Danish state owned ammunition factory.

[Insect allergy and sudden unexpected death]. / Insektallergi og pludselig, uventet død.

A case of sudden unexpected death after an insect sting in a middle aged man known to be allergic to insect stings is presented. In connection with an allergic shock, many years before death occurred, he had been offered allergological investigation. If the directives in the consensus report on insect sting allergy, recently published by the Danish Association for Allergology had been followed, similar deaths and expensive visits to casualty departments could probably be reduced.

[Accidents with high-pressure cleansing devices--a new mechanism of injury]. / Ulykke med højtryksspuler--en ny skademekanisme.

Air and water powered tools are employed increasingly in industry and involve new possibilities for occupational casualties. A new mechanism of trauma is described where the cause of death was an injury to the head, similar to a firearm wound. The "missile" was the water beam from the victim's own high pressure cleansing device, which was able to produce water pressure up to 900 atmospheres resulting in high water velocity of 300 meters/second. As prophylaxis, new legislations, as a result of understandings between employers and employees in the member states of the Common Market, are under preparation at present.

Prevalence of HIV-1 antibodies in drug addicts autopsied at the University Institute of Forensic Pathology in Copenhagen 1988-1991.

In the period 1988-1991 the HIV-1 antibody test was performed in a total of 389 autopsied drug addicts. The HIV-1 incidence rose from 6% in 1988 to 14% in 1990 and 14% in 1991. There was no significant difference between the cumulated incidence in males and females. The HIV-1-positive addicts were compared to the HIV-1 negative addicts as regards mean age, duration of abuse, residence and cause and manner of death. Except for residence, where significantly more HIV-1-positive than negative addicts lived in Copenhagen, there were no significant differences between the two groups. In about one-third of the HIV-1-positive cases, equal both for males and females, the HIV-1-positivity was not known beforehand. The results are discussed in relation to the findings in other countries and to the findings in selected groups of living addicts in Copenhagen. It is concluded, that the diagnosis of HIV-1 infection in autopsied drug addicts is important from epidemiologic and hygienic points of view.

Modifications of health behaviour in response to air pollution notifications in Copenhagen.

Ambient air quality is a major issue today in large cities all over the world. On the theoretical background of the health belief model and the health locus of control model, we studied the knowledge and beliefs about air pollution and the modifications of health behaviour brought about by information to the public about projected levels of air pollution, with special emphasis on reduction of outdoor activity and avoidance of car driving. Data were collected with a questionnaire among a sample of residents in the Copenhagen area. The respondents were almost universally knowledgeable about the prime emission source and concerned about the possible health effects of the air pollution in the area. Avoidance of outdoor activity was associated with personal experiences of symptoms ascribed to the air pollution, employment status, and with female sex, but not with knowledge or beliefs about the degree or health implications of the air pollution. The willingness to avoid car driving was positively associated with the belief that one can oneself influence one's health and with female sex. Lung diseased respondents were generally more prone to protect themselves than the healthy, both by avoiding outdoor activity and by being less willing to avoid car driving. The present study was conducted in an only moderately polluted city, and it is not clear whether the findings and conclusions can be generalized to more polluted cities. The study partly supported the underlying theories of the determinants of health behaviour, but also indicated a need for a broader theoretical framework, incorporating aspects of the respondents' life situation and personal experience which would be relevant to the specific type of health behaviour under study.

Carbon monoxide poisoning. Five-years' experience in a defined population.

A review is presented of 302 cases in East Denmark in 1982-1986 in which the manner of death was fatal carbon monoxide (CO) poisoning. The incidence of this far too frequent single-substance poisoning has as yet not decreased over the years despite preventive measures. The number of fatal CO poisoning cases may diminish as a result of a natural gas project in progress. The purpose of this survey, therefore, is to contribute to the evaluation of the actual causes of these fatal poisonings in East Denmark, and to discuss existing measures that prevent gas poisonings, in the expectation of a decline both in gas suicides and in accidental gas poisonings within the next few years.

The occurrence of HIV antibodies in drug addicts autopsied at the University Institute of Forensic Medicine in Copenhagen in 1987.

In 1987 a total of 89 intravenous drug addicts were admitted to medico-legal autopsy at the University Institute of Forensic Medicine in Copenhagen. Totally 10 cases were reactive by the Elisa test and five of these, or 7% of the total material tested, could be confirmed by the immuno-blotting test. The other five cases must be considered as false positive, possibly due to antibodies against cellular antigens. Among the five real positive cases, four were known before-hand while in one case the HIV-positivity was not known. These findings - together with the possibility of false negative reactions - especially regarding persons with acute HIV-infection, requires special precautionary measures when autopsies of drug addicts are performed.

Death due to dextropropoxyphene: Copenhagen experiences.

A review of 323 fatal poisonings with dextropropoxyphene is presented. The falling tendency of the poisoning in question and the National Board of Health's attention towards it are discussed.