Mononucleosis is generally considered a benign, self-limited disease. However, though uncommon, fatal complications are sometimes encountered. Deaths from liver failure, splenic rupture, respiratory obstruction, neurological complications, secondary infections and bleeding complications have been described. In the forensic setting, there are a few reports of sudden and unexplained deaths from splenic rupture and upper airway obstruction. We report here the first case of sudden and unexplained death from acute hepatitis in infectious mononucleosis presenting as a suspicious death.
BACKGROUND: 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) has a long half-life of 5-10 years in human beings as a result of its high lipophilicity, and little or no metabolism. We monitored TCDD, its form, distribution, and elimination in Victor Yushchenko after he presented with severe poisoning. METHODS: In late December, 2004, a patient presented with TCDD poisoning; the levels in his blood serum (108000 pg/g lipid weight) were more than 50 000-fold greater than those in the general population. We identified TCDD and its metabolites, and monitored their levels for 3 years using gas chromatography and high-resolution mass spectrometry in samples of blood serum, adipose tissue, faeces, skin, urine, and sweat, after they were extracted and cleaned with different organic solvents. FINDINGS: The amount of unmodified TCDD in the samples that were analysed accounted for about 60% of TCDD eliminated from the body during the same period. Two TCDD metabolites-2,3,7-trichloro-8-hydroxydibenzo-p-dioxin and 1,3,7,8-tetrachloro-2-hydroxydibenzo-p-dioxin-were identified in the faeces, blood serum, and urine. The faeces contained the highest concentration of TCDD metabolites, and were the main route of elimination. Altogether, the different routes of elimination of TCDD and its metabolites accounted for 98% of the loss of the toxin from the body. The half-life of TCDD in our patient was 15.4 months. INTERPRETATION: This case of poisoning with TCDD suggests that the design of methods for routine assessment of TCDD metabolites in human beings should be a main aim of TCDD research in the metabolomic era. FUNDING: University of Geneva Dermatology Fund, and Swiss Centre for Applied Human Toxicology.
Comment In: Lancet. 2009 Oct 3;374(9696):1131-219660808
N-Benzylpiperazine was tested in the beginning of the 1970s as a possible antidepressant drug. However, in both animal and human studies, it was shown to possess amphetamine-like properties, and any further studies were stopped. In a forensic autopsy case in 1999, we found a substance so far unknown to us in the chromatogram of our method used for amphetamines. We could swiftly identify this compound as N-benzylpiperazine because of information given to us by a newly formed network comprising, among others, customs and the police. Since then, we have found N-benzylpiperazine in several cases, among them 11 cases from a number of prisons.
The purpose of this investigation is to evaluate the value of postmortem computerized tomography (CT) for Abbreviated Injury Scale (AIS) scoring and Injury Severity Scoring (ISS) of traffic fatalities.
This is a prospective investigation of a consecutive series of 52 traffic fatalities from Southern Denmark that were CT scanned and autopsied. The AIS and ISS scores based on CT and autopsy (AU) were registered in a computer database and compared. Kappa values for reproducibility of AIS-severity scores and ISS scores were calculated.
On an average, there was a 94% agreement between AU and CT in detecting the presence or absence of lesions in the various anatomic regions, and the severity scores were the same in 90% of all cases (range, 75-100%). When different severity scoring was obtained, CT detected more lesions with a high severity score in the facial skeleton, pelvis, and extremities, whereas AU detected more lesions with high scores in the soft tissues (especially in the aorta), cranium, and ribs. The kappa value for reproducibility of AIS scores confirmed that the agreement between the two methods was good. The lowest kappa values (>0.6) were found for the facial skeleton, cerebellum, meninges, neck organs, lungs, kidneys, and gastrointestinal tract. In these areas, the kappa value provided moderate agreement between CT and AU. For all other areas, there was a substantial agreement between the two methods. The ISS scores obtained by CT and by AU were calculated and were found to be with no or moderate variation in 85%. Rupture of the aorta was often overlooked by CT, resulting in too low ISS scoring.
The most precise postmortem AIS and ISS scorings of traffic fatalities was obtained by a combination of AU and CT. If it is not possible to perform an AU, then CT may be used as an acceptable alternative for AIS scoring. We have identified one important obstacle for postmortem ISS scoring, namely that aorta ruptures are not easily detected by post mortem CT.
We present a case series (N = 46) of individuals apprehended in Sweden for driving under the influence of drugs (DUID). These cases were selected because the concentrations of amphetamine in blood were abnormally high (> 5.0 mg/L), the highest being 17 mg/L. In comparison, the median blood-amphetamine concentration in a population of DUID offenders (N = 6,613) was 0.70 mg/L. Among the DUID suspects with extremely high blood-amphetamine concentrations there were 38 men (83%) with mean age of 37.8 y (SD 6.8 y) and 8 women (17%) with a mean age of 34.1 y (SD 4.3 y). All had previously been registered in our database (mean 12 times, median 9 times) for drug-related offences, including DUID. The concentration of amphetamine in blood of female offenders was slightly higher than the concentration in male offenders (6.6 mg/L vs. 5.8 mg/L), although this difference was not statistically significant (p > 0.05). The drugs other than amphetamine most frequently encountered in the blood samples were tetrahydrocannabinol and benzodiazepines (diazepam and nordiazepam). The commonest signs of drug use reported by the arresting police officers were bloodshot and glazed (watery) eyes, restlessness, talkativeness, exaggerated reflexes and slurred speech. Unsteady gait and dilated pupils were observed in some but not all individuals. These very high concentrations of amphetamine were tolerated without any fatalities indicating a pronounced adaptation to the pharmacologic effects of this central stimulant. Anecdotal information indicated that those with the very highest concentrations of amphetamine in blood had swallowed the drug to prevent being apprehended in possession of an illicit substance.
BACKGROUND: Seasonal variation in suicides has been shown in many countries. We assessed the seasonality and the variation with latitude in suicides and homicides, and the impact of alcohol on the seasonality in suicides. METHODS: Official computerized registers on causes of death in all Greenland during 1968-2002 were used. Sales data on beer from one of the major food store chains for July 2005-June 2006 were examined. Seasonal variation was assessed by Rayleigh's test for circular distributions. RESULTS: There were a total of 1351 suicides and 308 homicides. The suicides rate varied from 4.2/100 000 person-years in 1971 to 128.4/100 000 person-years in 1987. The homicide rate varied from 2.1/100000 person-years in 1969-1970 to 34.8/100 000 person-years in 1988. Out of the 1351 suicides, 80.5% were committed by men and 19.5% by women. Median age was 25 years (n = 1351; Range 11-84 years). Violent methods of suicide were used in 95% of all cases (n = 1286). Out of the 308 homicide victims, 61% were men and 39% were women, and 13% were killed in multiple homicide events.There was a significant seasonal variation with peaks in June and troughs in the winter in all suicide cases (n = 1351, r = 0.07; Z = 7.58, p
The assessment of suspected sexual child abuse demands teamwork where the paediatrician plays a central role. From a juridical point of view, the task of the paediatrician is to evaluate the anatomic, microbiologic and forensic medical findings. In 1995, in order to improve the quality of this work, Norwegian paediatricians established a peer review group which meets on a regular basis. Based on available literature and the experience of the individual members, a classification system for anogenital findings has been developed. The findings are divided into five classes. Class one comprises findings frequently seen in children who have not been abused. Class two comprises findings not considered to be normal, but for which there could be many different causes. Classes three, four and five represent findings which are increasingly predictive with respect to injury penetration or attempted penetration. Since our knowledge of anogenital anatomy in children who have not been abused is limited, our classification system should be updated regularly.
Comment In: Tidsskr Nor Laegeforen. 1998 May 10;118(12):19109638062