Molecular study of hairy cell leukemia variant with biclonal paraproteinemia.

We report an unusual case of hairy cell leukemia variant with IgA and IgG-lambda biclonal gammopathy exhibiting light chain and a surface immunoglobulin class different from that of the paraproteins. In addition, we documented by gene rearrangement study that the hairy cell leukemia variant clone appears independent from the paraprotein-producing cells. The kappa light chain was expressed on the surface of hairy cell leukemia variant cells. Southern blot analysis revealed rearrangement of the kappa-light-chain gene and germline configuration of lambda-light-chain gene. We observed significant clinical improvement and reduction in the leukemic infiltrate in the patient after treatment with 2-chlorodeoxyadenosine (2-CdA). The intensity of the rearranged kappa-light-chain gene band decreased with therapy and increased at relapse without significant change of the paraproteins. Previously reported cases of hairy cell leukemia variant with paraproteins are reviewed, and our patient's contribution to the understanding of this association is stressed.

Megakaryocytes in bronchial brush cytology. A case report.

Megakaryocytes were detected in a transbronchial brush cytology specimen. Their detection led to a diagnosis of essential thrombocythemia.

Suicide among AIDS patients.

I studied 25 cases of suicide in people diagnosed as having the acquired immunodeficiency syndrome (AIDS) or who thought that they had that disorder, during 1985-1989. Case reports are presented. A discussion ensues concerning the occurrence of this phenomenon and the medical examiner's role in AIDS' public health situation in general.

Pedestrian fatalities. The Metropolitan Dade County experience, 1984-1988.

The case files of the Dade County Medical Examiner Department of Metropolitan Dade County were used to study pedestrian fatalities. Epidemiologic data are correlated and compared with those of other studies.

Childhood firearms fatalities: the Metropolitan Dade County experience.

I reviewed the cases of childhood firearms fatalities in the files of the Medical Examiner Department of Metropolitan Dade County, in Miami, Florida. Comparison of cases during the 5-year period from 1966 through 1970 to those during the 5-year period from 1984 through 1988, noting basic epidemiologic parameters, showed that death due to firearms is increasing among children aged 14 years and younger.

Suicide by jumping from buildings.

A study of 82 suicides during 1982-1986 that were committed by jumping from buildings was performed using the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, U.S.A. The analysis involved the age, race, and sex of the victim along with the results of toxicologic studies and the cause of death. Additionally, the decedent's place of residence, location of the suicide, height of the building, and the reason for the suicide were investigated. Whether or not a note was left by the decedent was also ascertained. The suicidal "jumper" most commonly was a white man who was greater than 60 years of age who died from the resultant multiple injuries. The victim commonly was sober and drug free at the time of the incident. In approximately two-thirds of the cases, the location of the suicide was the victim's residence, which frequently was an apartment or condominium-type dwelling that was seven floors or higher from the ground. The victim often had experienced depression prior to the incident and did not usually leave a suicide note. This article compares the Dade County cases with others that have been studied and discusses the reasons why jumping from a building may have been chosen as the suicidal mechanism.

Fatal suicidal hangings among prisoners in jail.

A study of suicidal death by hanging, which occurred when the victim was in jail, was performed on the case files of the Metropolitan Dade County Medical Examiner Department in Miami, Florida, for the ten-year period July 1978 to July 1988. A total of 23 fatalities occurred. These were categorized epidemiologically. A discussion ensues concerning what can be done to prevent such tragedies.

Accidental railway-related fatalities. The Metro Dade County experience, 1980-1984.

A study of accidental railway-related fatalities was performed using the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during the years 1980-1984. The nine cases that were collected are presented here in some detail. A discussion ensues concerning the most common type of accidental railway-related fatalities, why they occur, and what future work remains in order to avoid such fatalities. Evidently, fatalities more frequently result from victims' disregard for safety--either by crossing the tracks despite warning, or by utilizing railroad trestles as a fishing pier--than from mass disaster. Future work involving forensic engineers, forensic pathologists, and lawyers along with community activists should include both public education and a design of less accessible trestles to avoid such tragedies. In conclusion, it is hoped that this article will serve as a catalyst for further research on this subject.

Multiple homicides.

A study of multiple homicides or multiple deaths involving a solitary incident of violence by another individual was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during 1983-1987. A total of 107 multiple homicides were studied: 88 double, 17 triple, one quadruple, and one quintuple. The 236 victims were analyzed regarding age, race, sex, cause of death, toxicologic data, perpetrator, locale of the incident, and reason for the incident. This article compares this type of slaying with other types of homicide including those perpetrated by serial killers. Suggestions for future research in this field are offered.

The microscopic pathology of the liver in fatal cocaine intoxication.

The microscopic pathology of the liver in fatal cocaine intoxication was studied. Data from cases of cocaine intoxication during the years 1981-1986 were collected and analysed. Thirty cases with a negative past history for intravenous drug abuse, and in which the terminal drug testing revealed solely cocaine or its metabolites, were compared with a control group of nineteen people who had died in motor vehicle accidents, with a terminal negative blood alcohol, negative drug screen and no history of drug abuse. A comparison of liver histology was made along with gross anatomical liver weight. These findings are compared to other studies of hepatotoxicity in drug abuse.

Traffic fatalities among the elderly population: the Metro Dade County experience from 1981 to 1983.

Traffic fatalities among victims aged 65 years or older were studied in Metro Dade County between the years 1981 and 1983. The cases were then analysed as to the age, race, sex, cause of death and blood alcohol content of the victim. Furthermore, the nature of the accident, the fault, the role of the victim along with seat belt usage, and reason for accident were noted. A discussion ensues as to what advice should be given to the elderly to avoid being a highway statistic.

Suicide among nonwhites. The Metro Dade County experience, 1982-1986.

Suicide among nonwhites was studied using the case files of the office of the Medical Examiner of Metropolitan Dade County in Miami, Florida. A total of 116 cases, during the years 1982-1986, were analyzed as to the age, sex, cultural background, cause of death, blood alcohol content at autopsy, and reason for the suicide of the victim. By analyzing the ethnic/cultural backgrounds of the victims, it was noted that the overall rate of suicide among nonwhites in Dade County was 5 per 100,000 population per year. However, the rate varies within the overall group such that black-Hispanics, American Indians, and Haitians have suicide rates of 13.9, 11, and 3.1 per 100,000 population per year, respectively. Some of these rates are higher than the U.S. national nonwhite suicide rate of 7 per 100,000 population. Interestingly, while suicide rates are variable, the reasons listed for the suicide and the high frequency of young adult victims are similar to those for whites. A discussion ensues concerning this similarity and what future work in the field remains to be done.

Accidental death due to falls at work.

The phenomenon of accidental death due to falls at work was studied: 15 cases that occurred during the years 1983-1987, in which a worker died from a job-related fall, are presented in some detail. A discussion follows in which risk factors for these incidents are presented along with suggestions about how to investigate such cases.

Organophosphate related fatalities--a violitional biohazard?

A study of deaths due to organophosphate and related "cholinesterase-inhibiting" pesticides was performed on the case files of the office of the Medical Examiner in Metropolitan Dade County in Miami, Florida, USA. Briefly, a comparison was performed between cases which occurred between the years 1961-1965, when such pesticides were used indiscriminately and before stricter laws regulating their use were enacted, and with a series of cases occurring between the years, 1981-85, after such stricter laws were enacted. The occurrence of such deaths dropped dramatically with the decease in organophosphate use. A discussion ensues, along with specific information for the reader, on how the forensic scientist may help ameliorate their environment.

A case of panhypogammaglobulinemia masquerading as child abuse.

A case of panhypogammaglobulinemia in a 15-month old boy is presented. The child was followed at a local university teaching hospital for pneumonia, failure to thrive, and possible child abuse/neglect. Following minor trauma to the face, massive sepsis developed in the child. The mother was afraid to seek medical care because she was fearful of legal action against her. Upon the child's demise at home, police and medical examiner involvement ensued. The correct diagnosis was established at autopsy.

Deaths resulting from police pursuit.

This study concerns deaths that result from police pursuit i.e., high-speed police chases. The case files from the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during the years 1980-1986, were examined. Presented in some detail are 18 cases, along with a discussion of the "patterns" or types of cases involved. Recommendations for future work are then noted.

Ultralight aircraft fatalities. Report of five cases.

A study of ultralight aircraft fatalities was performed based on the cases files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida. A total of five cases were collected during the years 1981-1985. These are presented in some detail. A discussion ensues concerning the safety of ultralight aircraft and whether people should be allowed to fly them.