Phencyclidine and violent deaths in St. Louis, Missouri: a survey of medical examiners' cases from 1977 through 1986.

A survey of 104 deaths involving phencyclidine (PCP) occurring from 1981 through 1986 in metropolitan St. Louis, Missouri, is presented. Four black males (22-33 yr) died from fatal PCP intoxication. PCP was detected in an additional 100 deaths: 81 homicides, 13 suicides, and 6 accidental deaths. Seventy-five of these deaths were homicides of Black males (mean age 27 years) typically dying from gunshot wounds, 64 cases. In 50% of deaths where PCP was detected, other drugs were co-administered: ethanol (35%) and cocaine (20%) being the most common mixtures. A dramatic continuous increase in PCP abuse from 1984 through 1986 was demonstrated by drug abuse indicator data: treatment admissions, emergency room episodes, police exhibits, and driving under the influence of PCP arrests. Increased abuse of PCP in St. Louis has been associated with increased medical emergencies and violence against persons.

Operational criteria for the determination of suicide.

Suicide is an important public health problem for which we have an inadequate public health database. In the United States, decisions about whether deaths are listed as suicides on death certificates are usually made by a coroner or medical examiner. These certification decisions are frequently marked by a lack of consistency and clarity, and laws and procedures for guiding these decisions vary from state to state and even from county to county. Without explicit criteria to aid in this decision making, coroners or medical examiners may be more susceptible to pressures from families or communities not to certify specific deaths as suicide. In addition, coroners or medical examiners may certify similar deaths differently at different times. The degree to which suicides may be underreported or misclassified is unknown. This makes it impossible to estimate accurately the number of deaths by suicide, to identify risk factors, or to plan and evaluate preventive interventions. To remedy these problems, a working group representing coroners, medical examiners, statisticians, and public health agencies developed operational criteria to assist in the determination of suicide. These criteria are based on a definition of suicide as "death arising from an act inflicted upon oneself with the intent to kill oneself." The purpose of these criteria is to improve the validity and reliability of suicide statistics by: (1) promoting consistent and uniform classifications; (2) making the criteria for decision making in death certification explicit; (3) increasing the amount of information used in decision making; (4) aiding certifiers in exercising their professional judgment; and (5) establishing common standards of practice for the determination of suicide.

An unsuspected arsenic poisoning murder disclosed by forensic autopsy.

An unsuspected case of homicidal arsenic poisoning, clinically thought to be a primary hematopoietic disorder, was uncovered by an expanded toxicologic screen which is performed in all medical examiner's cases in which the decedent displays gastrointestinal symptoms prior to death. Arsenic concentrations were: blood, 7.2 mg/liter; liver, 15 mg/kg; and kidney, 6 mg/kg.

Tissue mineral levels in victims of sudden infant death syndrome I. Toxic metals--lead and cadmium.

Lung, liver, kidney, and rib specimens were obtained at autopsy from 66 sudden infant death syndrome (SIDS) infants and 23 infants who died suddenly from other causes between the ages of 4-26 wk. Tissue levels of lead and cadmium were measured by atomic absorption spectroscopy and are expressed as microgram/g dry weight. Because these metals are cumulative with age in storage tissues, the levels were corrected for age (adjusted to age 13 wk). The SIDS liver and rib specimens contained significantly more lead than non-SIDS tissues (liver, 1.095 microgram/g versus 0.761 microgram/g, P less than 0.05; rib, 1.754 microgram/g versus 1.041 microgram/g, P less than 0.01, respectively). There were no significant differences in cadmium concentration between the SIDS and non-SIDS tissues. All four tissues showed significant increases with age in both lead and cadmium concentrations in SIDS. The increase in lung lead concentration with age was significantly greater in SIDS than in non-SIDS cases, P less than 0.05. In non-SIDS only kidney cadmium showed an increase with age (P less than 0.0001). These data collectively suggest an increased exposure of the SIDS infant to lead either prenatally and/or postnatally. Any physiologic effects of the increased tissue lead levels are unknown. They may be only a marker of the known epidemiology of SIDS.

Tissue mineral levels in victims of sudden infant death syndrome II. Essential minerals: copper, zinc, calcium, and magnesium.

Deficiencies of various vitamin and minerals per se have been suggested as possible causes of sudden infant death syndrome (SIDS). Further, a deficiency of essential minerals may lead to enhanced toxicity of toxic elements, in particular, lead and cadmium to explore the possibility of mineral deficiencies or interactions with the toxic metals, lead and cadmium, lung, liver, kidney, and rib specimens were obtained at autopsy from 66 SIDS infants and 23 infants who died suddenly from other cases. Tissue copper, zinc, calcium, and magnesium were measured by atomic absorption spectroscopy. No differences were found between SIDS and non-SIDS for any element in any tissue except for more magnesium in the liver (P less than 0.0001) and less copper in the lungs (P less than 0.02) in the SIDS group. Only sporadic interactions between toxic and essential elements could be found. We found no evidence of any essential mineral deficiencies per se or significant interactions of essential and toxic minerals that might potentiate the effects of toxic metals. The physiologic significance, if any, of the higher liver magnesium and lower lung copper found in SIDS is unclear.

Evaluation of medicolegal investigators' suspicions and positive toxicology findings in 100 drug deaths.

The performance of trained medicolegal investigators was evaluated in 100 consecutive drug deaths, which occurred from January 1978 to May 1980 in St. Louis City and County. Carbon monoxide deaths were excluded from the study. The toxic agent responsible for death, as indicated by scene investigators and the decedent's drug history, was compared to the actual toxicology laboratory findings. In 84 of the cases, the toxicant was correctly indicated by the investigators. In the remaining 16 cases, 12 were suspected to be drug deaths but the major toxicant was not indicated, and in 4 cases no drugs were suspected. The manner of death had no influence on the investigators' performance. This study demonstrates the value of trained medicolegal investigators in providing helpful information to the pathologist and toxicologist before autopsy and laboratory analyses in cases of drug deaths.

Radiologic examination of anatomic parts and skeletonized remains.

During a 28-month interval, the radiographs of eight cases of skeletonized remains were evaluated by a radiologist. Radiologic evaluation of limited anatomic parts (four cases) was used to establish human or nonhuman origin and was helpful in the assessment of the relative social importance of the part. Radiologic evaluation of more complete skeletons (four cases) contributed data toward estimation of sex, age, stature, and past medical history. It confirmed the presumptive identity in two cases, excluded two possible identities in a third, and could still be useful if a presumptive identity is ever established for the fourth. Therefore, radiologic evaluation of skeletonized remains by a trained observer may be a useful adjunct to a forensic science investigation.

Drug deaths in St. Louis City and County: a brief survey, 1977-1979.

The vast majority of drug deaths in St. Louis City and County through 1977-1979 were of adults who ingested multiple drugs with suicidal intent. In this 3-year survey, seven deaths were due to accidental overdose of ethanol, seven to "over-the-counter" products or laboratory reagents, eight from "classic poisons," and only eight to drug abuse. The remaining 117 deaths (80%) resulted from ingestion of legally obtained prescription drugs. Sixty-two percent of all deaths were due to multiple drug administration. Only one child was fatally poisoned. Barbiturates, benzodiazepines, ethanol, propoxyphene, and tricyclic antidepressants were the most common agents encountered.

Interaction of the alkylating antitumor agent 2,3,5-tris(ethyleneimino)benzoquinone with the plasma membrane of Ehrlich ascites tumor cells.

The effect of the alkylating agent 2,3,5-tris(ethyleneimino)benzoquinone (Trenimon) on the uptake of 2-aminoisobutyric acid, 1-aminocyclopentane-1-carboxylic acid (cycloleucine), 3-O-methyl-D-glucose, and 86Rb was studied. All transport studies were performed at nonsaturating conditions where the specific transport system was rate limiting for the uptake. The activities of all systems are reduced after treatment with the alkylating agent. The impairment of the plasma membrane is expressed 30 sec after exposure to the drug, as measured by the 86Rb uptake, and lasts for at least 12 hr according to the reduced 3-O-methyl-D-glucose uptake. Inhibition of protein synthesis by cycloheximide for 2 hr does not affect the uptake of 86Rb. The short interval which is necessary before an inhibition of 86Rb uptake can be registered and the resistance of the 86Rb transport system to an inhibition of protein synthesis are considered as indicative for a direct alkylation of a membrane constituent. Treatment with the alkylating agent increases the cyclic adenosine 3':5'-monophosphate of the cells. This effect is not due to an effect on adenylate cyclase or the membrane-bound cyclic adenosine 3':5'-monophosphate phosphodiesterase. In view of the known correlations between plasma membrane functions and the regulation of cell division, it is proposed that the growth inhibition by Trenimon of Ehrlich ascites tumor cells may be caused by its interaction with the plasma membrane.

Radiologic identification of unknown human remains.

During the 15 months from April 1978 through July 1979, 3964 cases were referred to the City of St. Louis, Office of the Medical Examiner. Of these, 71 (1.8%) required investigation to establish identification (ID). All cases were rigorously investigated to establish the most scientifically sound ID possible. In addition to evidence from the scene, fingerprint, dental, and X-ray studies were attempted. Fifty (80.4%) individuals were scientifically identified, 17 (24%) were circumstantially identified, and 4 (5.6%) remain unidentified. Thirty (60%) of the 50 scientific IDs were by comparison of premortem and postmortem radiographs. Positive ID was accomplished in 22 cases of decomposition, 4 fire victims, 2 inadvertent body misidentifications, 1 submersion victim, and 1 suicide. Although all regions of the body were useful for ID, chest, skull, and abdominal radiographs were most frequently helpful. Anatomic, disease, and postsurgical features provided the unique features necessary for identification.

Concern for the quality of life and future importance of the forensic sciences (the living and working environment).

The quality of life concerns the well-being of man and his environment. The disciplines that are an essential part of the professional activities of the forensic scientist ideally suit him to address and to find solutions for the many serious and contradictory problems facing man and his ever more complicated enviornment.