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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.058 Byline: D. Poli (a)(b), B. Solarino (c), G. Di Vella (c), L. Tattoli (c), G. Strisciullo (c), M. Goldoni (a)(b), A. Mutti (b), R. Gagliano-Candela (c) Keywords: Work related death; Environmental findings; Toxicological analyses; Hydrogen sulfide Abstract: During a routine truck-tank washing operation, five healthy workers were found motionless inside an empty tanker. Four of them died inside the tanker while the fifth died the following day in hospital. Since the true nature of the fatal compound(s) were not known, a rigorous environmental and toxicological approach supported by autopsy findings was essential to clarify the cause of death. Environmental results indicated that H.sub.2S fumes arising from the liquid sulfur previously shipped were responsible for the serial deaths, also confirmed by a simulation performed on two similar truck-tanks. These environmental findings were supported by toxicological analyses through the measurement of thiosulfate, one of the main H.sub.2S metabolites. Abnormal thiosulfate concentrations from 1.1 to 186.2mg/kg were revealed in all post-mortem biological samples (blood, lung, liver, kidney, brain and fat). Finally, the cluster analysis performed on thiosulfate body distribution contributed to establishing the time of death according to the accident scene reconstruction. This report presents valuable findings in correctly identifying the cause of death in gas asphyxiation cases by unknown compound(s). Author Affiliation: (a) National Institute of Occupational Safety and Prevention Research Center at the University of Parma, via Gramsci 14, 43100 Parma, Italy (b) Laboratory of Industrial Toxicology, Dept. of Clinical Medicine, Nephrology and Health Sciences, University of Parma, via Gramsci 14, 43100 Parma, Italy (c) Section of Legal Medicine (DiMIMP), Department of Internal Medicine and Public Medicine, University of Bari, Policlinico Piazza G. Cesare 11, 70124 Bari, Italy Article History: Received 3 June 2009; Revised 15 December 2009; Accepted 18 December 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.09.019 Byline: Biagio Solarino (a)(b), Benno RieAelmann (c), Claas T. Buschmann (a), Michael Tsokos (a) Keywords: Tramadol; Nicotine; Multiple transdermal patches; Forensic toxicology Abstract: A fatal case of multidrug poisoning by tramadol and nicotine is reported. Tramadol is a centrally acting analgesic used in the treatment of moderate to severe acute or chronic pain. Nicotine, a lipid-soluble alkaloid, is one of the most readily available drugs in modern society. A 46-year-old man was found dead in his bed, and a suicide note was discovered near the body. He had 25 transdermal nicotine patches attached to his thorax and abdomen. Two half emptied bottles were found on the bedside table; the toxicological examination revealed that they contained tobacco and nicotine as well as other drugs such as diphenhydramine. At autopsy, areas of fresh and old myocardial infarction as well as diffuse pulmonary congestion and edema were present. The tramadol concentration was 6.6[mu]g/mL in femoral venous blood, while levels of nicotine and its primary metabolite cotinine were determined to be 0.6 and 2.0[mu]g/mL in femoral venous blood. Based on these results, we determined the cause of death to be cardiorespiratory failure induced by the additive effects of tramadol and nicotine shortly after consumption. Author Affiliation: (a) Institute of Legal Medicine and Forensic Sciences, University Medical Centre Charite, University of Berlin, Turmstr. 21, Building L, 10559 Berlin, Germany (b) Section of Legal Medicine, Department of Internal Medicine and Public Medicine, University of Bari, P.zza Giulio Cesare 11, 70124 Bari, Italy (c) Governmental Institute of Legal Medicine and Forensic Sciences, University Medical Centre Charite, Turmstr. 21, 10559 Berlin, Germany Article History: Received 26 May 2009; Revised 15 September 2009; Accepted 21 September 2009