Search

Establishing the manner of death is one of the most challenging tasks for forensic pathologists. We present the case of a 24-year-old woman found dead in the early morning on a flyover. The body was sitting on the ground with the back leaning against a wall. The neck was encircled by a white phone charger cable knotted to the staircase's handrail. The victim had argued with her boyfriend and tried to jump out of his car while coming home from a wedding party the night before. After that, she left home alone with her phone charger in her hand. Due to self-harm behaviors, the first hypothesis was suicide by hanging. However, the ligature crossed immediately beneath the thyroid cartilage and encircled the neck twice horizontally; the two ends of the cable overlapped, forming a cross-over point in the front-right of the neck. Then, the ligature passed obliquely through the nape, gradually disappearing, forming a gap in the mark. The mark was sharply defined, stiff, yellow, and parchment-like. The investigators performed a three-dimensional scene reconstruction using the Trimble X7 Laser Scanner and the PC-Crash Multibody System. Even though the geometry of the ligature mark in the present case raised doubts about the manner of death, the three-dimensional reconstruction confirmed that the hanging was feasible without any external intervention. [ABSTRACT FROM AUTHOR]

Two cases in a row demonstrate the importance of autopsy in the investigation of the cause of death, even when circumstantial information and preliminary examinations suggest potentially lethal pathology, such as sub-arachnoidal or intracranial haemorrhage, arteriovenous malformation (AVM) rupture, sudden cardiac death, aortic dissection, pulmonary embolism, intoxication, etc. These two cases show how every sudden death needs further investigation to figure out what the real cause is because there are so many fatal pathologies that can cause it. Indeed, the duodenal ulcer detected in these cases cannot be diagnosed without an autopsy. External examination only may be insufficient or too generic being able, if not followed by an autopsy, to direct towards incorrect causes of death. [ABSTRACT FROM AUTHOR]

The figure of the junior doctor is defined in different ways depending on age, educational path, and contract terms related to the conditions of the work contract. The issues related to this particular professional figure should be considered one of the greatest tests to which Health Systems have to respond. In this paper, these aspects are discussed together with practical advice that could be tailored to individual working situations in order to adequately address these issues. Cornerstones and common practices of clinical risk management which may be successfully applied in these contexts are also discussed. The application of Risk Management tools can both provide proactive solutions to reduce the risk of litigation, and create an environment based on trust and one in which junior doctors feel encouraged to signal adverse events and to learn from them. This could result in overall growth in the system, also from a cultural perspective, and better healthcare both for staff and patients. [ABSTRACT FROM AUTHOR]

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