An unusual case of suicide by broken glass pierced through the buttocks: a case report

Suicidal stabbing to the back and buttocks is very unusual due to the limited accessibility of that region to the victim's hand. The following case report describes a 38-year-old man, known for depression and suicidal ideation, who was found deceased in his home after tearing his right internal iliac artery by stabbing himself through the buttock with a piece of glass from a broken beer bottle. The literature on suicidal stabbing, particularly focusing on the type of weapon and localisation of wounds, is reviewed.     

Socio-cultural aspect of sexual practices and sexual offences - an Indian scenario

Ignorance of the law of the land is no defence. Furthermore, it is a legal dictum that one should not be held criminally liable unless possessing a guilty mind. But during trials of some sexual offences in India it is often observed that the accused did not know that he had committed an offence because the crime in question was a part of his socio-cultural milieu. India is a vast country with great socio-cultural diversity and many different ethnic groups, each with its own distinct cultures. However, the entire Indian culture is religion based and finds its root from the ancient Holy Scriptures. The sexual culture of Indian society stems from the Kama Sutra of Vatsyayana, an epic on sex. This text is considered holy and is accepted culturally, even though many practices contained therein are offences under modern law. Child marriages and arranged marriages are an integral part of Indian society and in some tribes, even prostitution is socially sanctioned. However, all of these are also against the law. Many of the conflicts observed between the sexual practices that are accepted in Indian culture but not by the law can be explained on the basis that the Indian legal system is borrowed from that of the British.     

Exercise in a hot environment: comparison of two different fluid intake patterns

AIM: Extensive research has been undertaken in the area of exercise and hydration. Most work has focused on prehydration. Less is known about different fluid intake patterns during exercise and its effect in thermoregulatory variables in hot environments. This study attempted to determine if ingesting fluid either in a single bolus or intermittently during exercise had different results in thermoregulatory parameters and thirst in a hot environment. METHODS: Six moderately trained men and women (n=6, 5 male, 1 female; mean+/-SD: age 28.5+/-2.5 y; weight 74.4+/-3.3 kg, VO2max 45.9+/-3.7 ml.kg.min-1) completed 2 exercise sessions in a randomized, counterbalanced order. Treatment 1 (bolus) consisted of 60 minutes of bicycling at 50% of VO2max in a climatic chamber (dry bulb temperature, 35 degrees C, 45% relative humidity). Subjects consumed 1 000 ml of plain cool (22 degrees C) water immediately before exercise. During treatment 2 (intermittent) the same environmental conditions were present, but subjects consumed 250 ml of water immediately before exercise. During the bicycle ride, subjects consumed 250 ml of cool water at minutes 15, 30, and 45 of exercise for a total trial volume of 1,000 ml. Tympanic ear temperatures, heart rates, rating of perceived exertion (RPE), and thirst scale data were collected immediately before exercise and at minutes 10, 20, 30, 40, 50, and 60 of exercise. RESULTS: No statistical differences were noted in temperature between treatments (P>0.05). Lower heart rates and thirst scores were noted for the bolus treatment at various time points (P<0.05). Little differences were noted between treatments for RPE during exercise. CONCLUSIONS: These results suggest that consumption of water in a single bolus is more beneficial for some aspects of thermoregulatory control and delaying thirst during exercise in the heat. Additional mechanistic studies with larger sample sizes are warranted.     

Do youth sports prevent pediatric obesity? A systematic review and commentary

Sport is a promising setting for obesity prevention among youth, but little is known about whether it prevents obesity. We reviewed research comparing sport participants with nonparticipants on weight status, physical activity, and diet. Among 19 studies, we found no clear pattern of association between body weight and sport participation. Among 17 studies, we found that sport participants are more physically active than those who do not participate. We found seven studies that compared the diet of sport participants with non-participants. These studies reported that youth involved in sport were more likely to consume fruits, vegetables, and milk, and also more likely to eat fast food and drink sugar-sweetened beverages and consume more calories overall. It is unclear from these results whether sports programs, as currently offered, protect youth from becoming overweight or obese. Additional research may foster understanding about how sport, and youth sport settings, can help promote energy balance and healthy body weight.     

Elimination of scalp blood flow by headband during dynamic brain scintigraphy.

The effect of the application of a headband during brain scintigraphy was investigated in 11 healthy volunteers. In each person, extracranial recording of a bolus of 99mTc-pertechnetate injected intravenously was done on two occasions during a scintillation camera. On one occasion a narrow sphygmomanometer cuff encircling the head from brow to occiput and inflated to 300 mmHg was applied during measurements; another time, the procedure was identical except for the headband. A comparison between counting rates under the derived time-activity curves showed significantly lower values on headband application (p less than 0.01). Static scintigrams consisting of the first 300,000 counts recorded after bolus release with and without headband application show a clear delineation of the headband position with prevention of "halo" appearance about the cranial cavity. It has thus been possible by simple means to reduce the irrelevant radionuclide distribution which, especially during dynamic investigations of cerebral circulation, constitutes a source of error.     

Death after excessive propofol abuse

Abuse of the anaesthetic agent propofol (2,6-diisopropylphenol) is rare, but we report a case of a 26-year-old male nurse in which the autopsy showed unspecific signs of intoxication and criminological evidence pointed towards propofol abuse and/or overdose. Intravenously administered propofol is a fast and short-acting narcotic agent, therefore it seemed questionable whether the deceased would have been able to self-administer a lethal overdose before losing consciousness. The blood and brain concentrations corresponded to those found 1–2 min after bolus administration of a narcotic standard dose of 2.5 mg propofol/kg body weight. Extremely high propofol concentrations were found in the urine indicating excessive abuse before death. However, due to the short half-life of propofol, the cumulative effects of repeated injections should not be relevant for toxicity, since this would result in a blood level increase of only 1–2 μg/ml. Furthermore, the detection and quantitation of propofol in three different hair segments indicated chronic propofol abuse by the deceased. The results of the investigation suggest that death was not caused by a propofol overdose but by respiratory depression resulting from overly rapid injection. Received: 1 July 1999 / Accepted: 25 November 1999     

Acute water intoxication during military urine drug screening

Random mandatory urine drug screening is a routine practice in the military. The pressure to produce a urine specimen creates a temptation to consume large volumes of water, putting those individuals at risk of acute water intoxication. This occurs when the amount of water consumed exceeds the kidney's ability to excrete it, resulting in hyponatremia owing to excess amount of water compared to serum solutes. The acute drop in serum osmolality leads to cerebral edema, causing headaches, confusion, seizures, and death. There has been increasing awareness of the danger of overhydration among performance athletes, but dangers in other groups can be underappreciated. We present the case of a 37-year-old male Air Force officer who developed acute water intoxication during urine drug screening. Our case demonstrates the need for a clear Air Force policy for mandatory drug testing to minimize the risk of developing this potentially fatal condition.     

腹部CT增强检查新技术的应用

腹部CT增强检查对显示腹部实质脏器和血管病变至关重要。多层螺旋CT的发展为腹部实质脏器及血管获得最佳增强效果提供了可能,也对传统的增强扫描方法提出了挑战。小剂量团注试验法和自动跟踪触发技术是两种新的增强扫描技术,可以使腹部增强获得更佳增强效果;不同注射流率、双筒高压注射器及生理盐水的应用进一步提高了对比剂的利用率。     

The plica mediana dorsalis of the dura mater and its relation to lumbar peridurography (Canalography)

Summary Lewit and Sereghy (1975) have expressed some doubts about the existence of the dorsal plica mediana and its relation to the median translucency regularly seen on peridurographic pictures made in the PA projection. The present paper reports the demonstration of the dorsal plica mediana in fresh anatomical preparations under conditions lowering the intradural pressure, and the relation of the plica to the peridurographical median translucency, shown on the basis of the injection into the lumbar peridural space of a gelatine solution containing India ink.Respectfully dedicated to Professor J. R. von Ronnen on the occasion of his sixty-fifth birthday.     

Combined chemotherapy and radiotherapy: cyclophosphamide

Compared to the other chemotherapeutic preparations discussed today, cyclophosphamide in combination with radiotherapy is a relatively unproblematic substance. Despite the great number of experimental and clinical data, the evaluation does not prove an advantage of the combined therapy with cyclophosphamide and irradiation as against radiotherapy alone in local tumor treatment. This should give occasion to further experimental investigations in adequate models. On the other hand, the practice of combined treatment with irradiation and preparations containing cyclophosphamide should be reconsidered for those cases where local control of a tumor is the principal therapeutic aim.     

Light microscopy can reveal the consumption of a mixture of psychotropic plant and fungal material in suspicious death

Light microscopical examination of plant and fungal remains in the post mortem gut may be capable of demonstrating the ingestion of unexpected natural psychotropic materials. This is demonstrated here in a case in which a 'shaman' was accused of causing the death of a young man. The deceased had participated in a ceremony which involved the drinking of ayahuasca in order to induce a psychotropic experience. Ayahuasca is an infusion of Banisteriopsis caapi (ayahuasca vine), which produces a monoamine oxidase inhibitor, and one or more additional tropical plants, generally Psychotria viridis (chacruna) which produces dimethyltryptamine (DMT). The monoamine oxidase inhibitor prevents DMT from being broken down in the gut, so enabling its passage into the bloodstream and across the blood/brain barrier. Toxicological tests for DMT demonstrated the presence of this compound in the body. The deceased was reported to be in the habit of using Psilocybe semilanceata (liberty cap). This fungus (popularly called magic mushroom) contains psilocybin which is hydrolysed in the gut to psilocin; this compound mimics a serotonin uptake inhibitor, and also invokes psychotropic experiences. Microscopical examination established that the ileum and colon contained spores of Psilocybe and, in addition, pollen of Cannabis sativa and seeds of Papaver cf. somniferum (opium poppy). Both the plant species yield psychotropic substances. Palynological and mycological analysis of containers from the deceased person's dwelling also yielded abundant trace evidence of pertinent pollen and spores. The police had requested analysis for DMT but there was no screening for other psychotropic substances. Investigators were surprised that a mixture of hallucinogenic materials had been consumed by the deceased. The charge was modified from manslaughter to possession of a ‘Class A’ drug as the deceased had been consuming psychotropic substances not administered by the 'shaman'. Where death involving drugs from plants or fungi is suspected, microscopical examination of samples from the gut can provide a rapid and effective method for assessing, in a temporal context, the presence of ingested materials that may not have been previously suspected. The example presented here also demonstrates the need for caution in interpreting toxicological results where screening for unusual compounds has been limited.     

The influence of a calorie supplement on the consumption of the meal, ready-to-eat in a cold environment

There is a dichotomy between calories issued to soldiers in their daily field rations and the amounts actually consumed. Soldiers frequently consume insufficient calories to maintain body weight. A supplemental pack (740 kcal) was developed, to increase field calorie consumption, and tested with the old and new versions of the Meal, Ready-to-Eat on a 10-day field study in Alaska. Initial and final measurements included body weights, heights, blood, and urine parameters. Daily measurements included the collection of urine samples and completion of a dietary intake log. Energy intakes of the supplemented groups were 4%-11% higher (p less than 0.05) although the calorie intakes were still below the recommended 4,500 kcal/day for cold weather operations. Mean body weight loss ranged from 3.0 lb (1.7%) to 4.8 lb (2.8%). Two groups of the four groups became hypohydrated by day 3, due to low water intake, and only improved after direct intervention to increase drinking. Water and food intakes were strongly correlated (p less than 0.05). Results confirm the success of the supplemental pack as a means of increasing food intake and underscore the importance of water discipline in a cold environment.     

Intramural hematoma of the esophagus after endoscopic sclerotherapy. X-ray computed tomographic aspect and course

A case of intramural oesophageal hematoma following endoscopic sclerotherapy is reported. CT showed a spontaneous hyperdense masse without enhancement after intravenous bolus of contrast material which confirmed the diagnosis; it permitted to eliminate another abnormality (e.g. perforation) and to survey the evolution (complete recovery without treatment in about four weeks).     

Renal hydatid cyst. Contribution of radiology apropos of a case

Hydatid disease, an infestation of gastrointestinal origin, is essentially localized in the two principal filters of the body, the liver and the lung (80% of localizations); 20% correspond to a random distribution (brain, bones, kidneys, etc.). The observation of a new case of rare renal infestation (1 to 5% of all hydatid cysts) constitutes an occasion to review the role of various radiological investigations in this disease. Computed tomography has a role in the diagnosis which is complementary to that of plan abdominal x-rays and ultrasonography. Intravenous pyelography may be performed subsequently. It has an essential role in the systematic investigation of other localizations.     

Hart-Devlin revisited: law, morality and consent in parenthood

The debate about law and morality is not new but changing social structures and advances in science, medicine and technology have impacted the decisions courts have to make. Within the fast-changing societies of the 21st century, is judicial decision-making cognisant of these advances and how do the judiciary currently reconcile difficult emergent issues concerning law, science and morality? The dilemma of decision-making regarding frozen embryos, the gametes of deceased donors and the issue of consent is analysed by reference to recent case law and the problem of decision-making in relation to the newly possible.     

1. Positron Emission Tomography of Thoracic Malignancies. Reduction of Myocardial Fluorodeoxyglucose Uptake Artifacts With a Carbohydrate Restricted Diet

Purpose: To reduce the artifact caused by cardiac uptake of F-18 fluorodeoxyglucose (FDG); we investigated the change in myocardial FDG uptake after placing a group of patients on a carbohydrate-restricted diet.Methods: Case control study involving 130 whole body FDG PET scans. 73 scans were of patients on carbohydrate-restriction; the remaining 57 were without dietary restrictions. Dietary intake for the last meal prior to scanning was recorded for both groups. Coronal and axial images were assessed and scored based on myocardial FDG uptake the presence of associated image artifacts.Results: Of the 73 patients on the diet, 50 did not consume carbohydrates, while of the 57 patients without dietary restriction, 13 did not consume carbohydrates. Of the 67 patients from both groups who consumed carbohydrates prior to their PET scan, 17 (25.4%) had a clinically significant image artifact versus only 6 (9.5%) of the 63 patients who did not consume carbohydrates (P = 0.018) in their meals prior to scanning. The odds ratio was calculated to be 3.23 (confidence interval 1.09-10.00), indicating that the risk a clinically significant image artifact will occur is 3.23 times higher for patients who consume carbohydrates in their last meal prior to scanning.Conclusion: A substantial reduction in the prevalence of myocardial FDG uptake image artifacts among patients who did not consume carbohydrates was observed. A carbohydrate dietary restriction prior to scanning may play a significant role in increasing lesion detectability and in preventing false negative scans when imaging for thoracic neoplasm.     

Medico-legal significance of the identification of offending snake in a fatal snake bite: A case report

A 19 year old male was admitted to a tertiary care centre in Sri Lanka, with a history of snake bite while sleeping at night. A killed specimen of a snake was brought with the patient. It had been identified as a non-venomous snake by the doctor and handed over to relatives, with a comment to that effect. Patient had no clinical or laboratory evidence of envenoming on admission.Patient developed bilateral ptosis six hours after alleged snake bite, soon followed by respiratory paralysis and was treated with Indian polyvalent anti-venom serum. After 12 h of the bite, patient had developed hypotension that did not respond to ionotropes. Despite intensive management, patient had become deeply comatose and deceased 46 h following the snake bite. Autopsy revealed features suggestive of disseminated intravascular coagulation.Since an allegation of medical negligence too had been levelled by the relations of the patient against the clinical staff, the buried specimen of the snake was recovered by police, on a judicial order, a week later. It was found to be almost completely disintegrated and only the scales and bones were remaining. According to the scale characters, the reconstructed specimen was identified as Indian krait (Bungarus caeruleus).Authentication of snake is important in investigating a death due to snake bite, especially when the snake was initially claimed to be a non-venomous snake. This case suggests the usefulness of forensic identification of species of the snake in investigating suspected snake bite cases.     

An autopsy case of salt poisoning from drinking a large quantity of shoyu (Japanese soy sauce)

We report herein a suicide case of salt poisoning from drinking a large quantity of shoyu (Japanese soy sauce). The deceased was a 60-year-old housewife who was found dead in her bedroom by her husband. An empty 1,000 ml bottle of shoyu, which had been purchased on the day before death, was discovered in the kitchen. Macroscopically, the alimentary tract contained a yellowish-brown liquid-like material with the strong smell of shoyu, and slight lung and brain edema were noted. The 1,000 ml bottle of shoyu contained approximately 160 g of salt. Therefore, the cause of death was determined to have been salt poisoning from drinking a large quantity of shoyu.     

Rapid MR imaging of a vascular challenge to focal ischemia in cat brain

Deoxygenated blood was effectively used as a magnetic resonance (MR) susceptibility contrast agent to distinguish perfused and nonperfused (ischemic) regions in a focal ischemia model in cat brain at 2 T. Modulation of cerebral blood oxygenation levels in response to apnea was followed in real time with T2*-weighted (gradient-recalled) echo-planar MR imaging. Signal loss in the T2*-weighted images occurred only in perfused tissues as blood became globally deoxygenated. These data complemented information from diffusion-weighted and contrast agent bolus–-tracking images. In addition, observation of the signal recovery behavior on reventilation in both normal and ischemic brain offered potentially useful information about the state of the cerebral autoregulatory mechanism.     

Three subsequent infanticides covered up as SIDS

Within a period of 9 years a young woman lost 3 daughters during infancy and each time death was attributed to the sudden infant death syndrome. The children had different fathers and died at the ages of 11 weeks, 7 weeks and 2 weeks, respectively. A fourth daughter survived and lives separated from the mother together with her father and is healthy. At autopsy the last of the three deceased infants did not reveal any pre-existing pathological organ findings, except for acute pulmonary emphysema and extensive intra-alveolar bleeding. As a consequence the strong suspicion of mechanical suffocation arose. Subsequent police investigations produced incriminating clues that the first two children had also been suffocated. On confrontation with the autopsy findings and investigation results, the woman confessed that she herself had killed the first two infants by pressing a cushion on their faces. In the case of the third death the baby had been smothered by the childs father who in agreement with the mother put a plastic film on mouth and nostrils.Dedicated to Prof. Dr. Dr. h.c. B. Brinkmann on the occasion of his 65th birthday.