1/12. The application of immunohistochemical findings in the diagnosis in methamphetamine-related death-two forensic autopsy cases-.Forensic autopsy cases detecting methamphetamine (MA) are usually diagnosed according to its toxicological concentration. It has been reported that the lethal blood concentration of MA is 4.48 microg/ml (3.0 micromol/dl). We autopsied two MA-detected cadavers, and immunohistochemical staining was performed on the skeletal muscle with an anti-myoglobin antibody, and on the kidney with an anti-the 70 kDa heat shock protein (HSP70) antibody. One case showed a high rectal temperature (40 degrees C). The toxicological examination revealed 0.75 microg/ml of MA in the blood, and 16.8 microg/ml in the urine. myoglobin was negative and HSP70 was positive in the kidney immunohistochemically. From the toxicological and immunohistochemical findings, it was considered that the subject died of hyperthermia and acidosis caused by muscular hyperactivity. In another case, the autopsy revealed highly congested lungs, with dark-red bloody fluid and foam in the trachea and bronchus. MA (17.0 microg/ml) was detected in the blood. HSP70 was negative and myoglobin was positive immunohistochemically. It was thought that the subject died of acute MA intoxication based on the high MA concentration, although rhabdomyolysis was suspected. It is suggested that myoglobin and HSP70 immunostaining are useful to diagnose MA poisoning.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/12. Sudden death during arrest and phencyclidine intoxication.Deaths of individuals being arrested are important and complex medicolegal cases. Conclusions regarding the cause and manner of death for such cases must take into account multiple factors that may have played a role, as well as anticipate the forensic issues that will arise. In this article, we review the deaths of 2 individuals in which phencyclidine intoxication was a factor that contributed to death during arrest. Most cases of sudden death during arrest have involved cocaine intoxication; because phencyclidine's pharmacologic properties are quite different from those of cocaine, these cases allow for comparisons to those factors that may have greater importance.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
3/12. Occidental beriberi and sudden death.beriberi, thiamine deficiency, is classified as "dry" (neurologic) or "wet" (cardiovascular) and may be mixed. Deficiency of this vitamin may be nutritional or secondary to alcohol intoxication. In Western societies (occidental beriberi), the disorder is more commonly observed in long-term alcohol abusers. However, it may go undiagnosed because it is relatively uncommon. In some cases (acute cardiovascular beriberi), early treatment with parenteral vitamin B1 is required to prevent the development of low-output state and sudden death. We report a case of occidental beriberi with fatal outcome despite therapy.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
4/12. A sudden death during a saline drip in a schizophrenic patient with polydipsia.A young woman with polydipsia died suddenly while receiving a normal saline drip in a hospital for psychiatric care. Slight symptoms due to water intoxication, more specifically, nausea, vomiting, and anorexia, appeared and her serum sodium and potassium measured 106 and 1.7 mEq/l, respectively. General convulsions are thought to be the most common result of water intoxication in emergency cases, however, when she was found with circulatory collapse, no severe neurological symptoms were present. The cause of her collapse did not seem to be due to hyponatremia but to hypopotassemia. Although epinephrine is contraindicated with some psychiatric drugs, the doctor used it to raise blood pressure in treating circulatory collapse. It is possible that epinephrine induced cardiac arrest.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
5/12. Sudden death due to a paraganglioma of the organs of Zuckerkandl.A 20-year-old woman died suddenly in a hospital emergency room after presenting with nausea, vomiting, back pain, and hypertension. At autopsy, an extra-adrenal pheochromocytoma (paraganglioma) of the organs of Zuckerkandl was found, with microscopic focal myocardial necrosis similar to that described in death from adrenal pheochromocytomas. Tumors of the organs of Zuckerkandl are extremely rare; less than 100 such cases have been reported in the world's literature, and only six, including the present case, have presented as a sudden, unexpected death. The symptoms of catecholamine storm may mimic those of acute drug intoxications, leading to misdiagnosis by both clinical physicians and pathologists.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
6/12. Delayed sudden death after ingestion of MCPP and ioxynil: an unusual presentation of hormonal weedkiller intoxication.A patient who died in asystole less than 18 h after ingestion of 'Clovercide Extra', a combination hormonal weedkiller containing ioxynil and 4-chloro-2-methyl phenoxypropionic acid, is described. Previous reports describe coma as an early event following ingestion of these herbicides. In contrast our patient, although showing other characteristic features, including metabolic acidosis, tachycardia, pupillary constriction and pyrexia, remained conscious until the terminal event. Absence of coma does not appear to be related to a more favourable outcome.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
7/12. cocaine-induced psychosis and sudden death in recreational cocaine users.Fatal cocaine intoxication presenting as an excited delirium is described in seven recreational cocaine users. Symptoms began with the acute onset of an intense paranoia, followed by bizarre and violent behavior necessitating forcible restraint. The symptoms were frequently accompanied by unexpected strength and hyperthermia. Fatal respiratory collapse occurred suddenly and without warning, generally within a few minutes to an hour after the victim was restrained. Five of the seven died while in police custody. Blood concentration of cocaine averaged 0.6 mg/L, about ten times lower than that seen in fatal cocaine overdoses. police, rescue personnel, and emergency room physicians should be aware that excited delirium may be the result of a potentially fatal cocaine intoxication; its appearance should prompt immediate transport of the victim to a medical facility. Continuous monitoring, administration of appropriate cocaine antagonists, and respiratory support will hopefully avert a fatal outcome.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
8/12. Accidental fatal monochloroacetic acid poisoning.A case of accidental lethal monochloroacetic acid poisoning is presented, along with a brief review of the mechanisms of intoxication. Although lethal skin exposures have been previously reported, this case appears to be the first instance of oral-route poisoning to be documented.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
9/12. death due to benzhexol toxicity.A rare case of death due to benzhexol toxicity is reported in a 48-year-old schizophrenic male with a resolving empyema and underlying patchy, mild bronchopneumonia. Toxicological analysis revealed the benzhexol blood and liver concentrations to be 0.12 mg/l and 0.5 mg/kg, respectively. Gastric contents contained 0.4 mg of benzhexol. Other drugs were not detected. It is suggested that for fatalities to occur following benzhexol intoxication, secondary contributory factors, which probably further alter the patient's conscious state, are necessary.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
10/12. Laryngeal cyst and sudden death.Laryngeal cysts are relatively uncommon and account for about five per cent of benign laryngeal lesions. The commonest location is the epiglottis. Pathologically these lesions may be divided into epithelial, tonsillar or oncocytic types. The patients may be asymptomatic or present with hoarseness, dysphagia, cough or airway obstruction. Epithelial cysts of the larynx, although histologically benign, may produce sudden and unexpected death from asphyxia. A case is presented of a 32-year-old female who was sexually assaulted and later found dead. death was most likely due to laryngeal obstruction caused by an epiglottic cyst. Alcohol intoxication (BAC = 0.25g%) is likely to have been a contributory factor. In this case the results of the autopsy helped to exonerate the accused from being charged with murder. Other medico-legal problems that may be encountered with laryngeal cysts are difficulty in intubation and accidental rupture of a cyst during intubation or otolaryngeal examination.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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