[Wrong statement of manner of death after insufficient post-mortem examination]. / Fehlerhafte Angabe der Todesart nach insuffizienter Leichenschau.

When death certificates already completed are submitted during forensic post-mortem examinations or autopsies, blatant errors are often found, especially with regard to the classification of the manner of death. This is partly attributable to insufficient knowledge of the classification criteria, but also to the fact that the post-mortem examination was not properly performed and even clear signs of unnatural death (e.g. a strangulation mark or sharp force injuries) are overlooked. To avoid such misinterpretations, a thorough reformation of the post-mortem examination system and a regular continuing specialized training of the physicians performing post-mortems seem necessary.

Fatal intoxication with melperone.

Melperone is judged to be a safe neuroleptic drug. Until now there has been no report of a melperone fatality, though it has been used in suicide attempts. We report on a case of a 36-year-old woman where no cause of death could be established at autopsy. Criminological investigation pointed to a homicide by poisoning but also the possibility of a suicide had to be taken in account. The toxicological analysis of blood, cerebral spinal fluid and urine revealed extremely high concentrations of melperone which had never been reported before. Furthermore, diazepam, nordazepam and carbamazepine were detected. To our knowledge, this case is the first melperone fatality. Possible interactions with diazepam and carbamazepine are discussed.

Phenothiazine and butyrophenone intoxication in children.

Antipsychotic agents are widely used for the treatment of psychotic disorders as well as for the acute treatment of nausea and vomiting, cough and cold treatments, and as supplementary agents for sedation for minor surgical or diagnostic procedures. There are many different circumstances in which the clinician may encounter a child who has experienced antipsychotic drug toxicity, such as from an acute accidental ingestion or as a side effect from therapeutic use. The phenothiazines and butyrophenone drugs have many pharmacologic actions. Thus, a wide range of clinical symptoms and signs may be encountered with their use. Treatment of antipsychotic drug toxicity includes general supportive care and monitoring, along with specific treatment of certain situations such as acute extrapyramidal syndromes and neuroleptic malignant syndrome. An awareness of the diverse and complex manifestations that may be associated with these agents will greatly aid in the evaluation of a child who presents with unusual behavioral or neurologic problems. Due to the unpredictable toxicity of these drugs, routine therapeutic use for such conditions as nausea and vomiting and as cough or cold aids is not recommended.