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.