Identification of an alcoholic beverage in which methamphetamine was dissolved

A man was arrested for violating the Stimulant Control Law. Twelve small plastic containers each containing 1-3 ml of reddish purple alcoholic beverage in which methamphetamine had been dissolved, and a bottle of blueberry liquor of a similar colour, were found in his house. He admitted that the blueberry liquor belonged to him, but strongly insisted that he had been asked to keep the containers by another person and that he had no knowledge of their contents. The alcoholic beverage and the blueberry liquor were analyzed in order to test whether he had dissolved methamphetamine in the blueberry liquor. The aroma components found in the alcoholic beverage in each of the plastic containers were identical, but differed from those found in the blueberry liquor. Based on these results and further police investigations, the suspect's allegation was supported and he was not prosecuted.     

Sudden, unexpected death of a cannabis bodypacker, due to perforation of the rectum

A forty year old cannabis bodypacker was found dead in his flat in November 2000, two days after arriving back from a trip to Northern India. On his return he had complained to his family of feeling unwell, although he had refused to let them in or accept medical help. At post-mortem he was found to have 55 packages of cannabis resin in the large intestine, wrapped in cellophane. Subsequent search of the flat by the police revealed the presence of a further 133 similar packages in the fridge, suggesting that he had concealed 188 packages in total. The cause of death was given as peritonitis due to perforation of the distal large intestine caused by swallowing the packages.     

Autopsy findings of a patient with rapidly progressive massive ascites caused by alcoholic cirrhosis

A 54-year-old man, who lived alone, was hospitalized due to rapid deterioration of the general condition over a three-week period caused by alcoholic cirrhosis. One month after he left hospital, he was found dead in his house by his friend. Three days before he was found dead, he had met his friend and seemed to be in poor condition. Autopsy was conducted by a medical examiner to clarify the cause of death. Externally, signs of severe jaundice were apparent over the whole body, along with extensive abdominal swelling and edema of the extremities. Autopsy findings demonstrated that the abdominal cavity contained an amount of massive turbid and slight pale reddish brown ascites (23 l). There were no findings of severe peritoneal inflammation. The liver (650 g) was elastic hard and had a micro-nodular surface, which showed severe atrophy. Microscopic examination of the liver showed clear pseudolobule with severe fibrosis in the stroma. There were no significant changes in the heart or brain. The stomach was empty and only a slight amount of intestinal contents. There was no ethanol detected in the blood or urine. The direct cause of his death was circulatory dysfunction due to massive accumulation of the ascites. The reasons for the massive ascites accumulation over 20 l in this case were (1) that he had no serious complications other than ascites; and (2) he did not have any medical treatment just before his death.     

High-grade urothelial carcinoma of the prostate on FDG PET-CT

We report the PET-CT appearance of a high-grade prostatic urothelial carcinoma in a 68-year-old man with a long history of urothelial carcinoma. The patient was initially diagnosed with urothelial carcinoma in the left ureter, status postleft nephrourethrectomy. He was subsequently, 11 years later, diagnosed with low-grade urothelial carcinoma involving the bladder for which he received monthly Bacillus Calmette-Guerin treatment. Three months after the diagnosis of the bladder tumor, he was found to have biopsy-proven high-grade urothelial carcinoma of the prostate for which he was referred to have a PET-CT scan to evaluate for distant metastasis.     

Fatal intoxication with naftidrofuryl

A 52-year-old man was found dead in his bed. He had financial and psychosocial problems like separation from his wife and children or unemployment due to alcoholism. Under treatment of disulfiram he was presently abstinent from alcohol. As he had suffered from epileptic seizures and dizziness, he received valproic acid and the vasodilator naftidrofuryl, respectively. Autopsy showed no morphologic cause of death. Chemical analysis of blood revealed concentrations for valproic acid and disulfiram in the therapeutic and above the therapeutic range but far below the lethal level, respectively. No ethanol was found. However, the very high concentration of 7500 μg/L naftidrofuryl in whole blood was considered as cause of death, and the most probable manner of death seemed to be suicide. To our knowledge, this is the first reported case of a fatal poisoning with naftidrofuryl.     

Abnormal serotonin reuptake in an overtrained, insomnic and depressed team athlete

The purpose of this report is to study serotonin reuptake of the brain in a severely overtrained athlete by using single-photon emission computed tomography (SPECT). A 26-year-old team athlete increased his training volume (by 200 %) and intensity markedly in a new high-level team. After two months, he started to feel continuous fatigue. He had tinnitus in his left ear, he felt disturbing palpitation and had pollacisuria. After four months, he started to suffer from insomnia. He still continued to play for another three months, after which he was unable to play. He could only sleep for 3 to 4 hours per night. Only minor abnormalities could be found in extensive physical and laboratory examinations. The athlete had a severe overtraining state. In the brain SPECT scans, using the specific radioligand for serotonin transporter imaging ( (123)I labelled 2beta-carbomethoxy-3beta-[4-iodophenyl]-nortropane), low activity areas were detected in the midbrain, anterior gingulus, and left frontal and temporo-occipital lobes. In a psychiatric examination, the patient was found to have signs of major depression, which he hardly recognized himself. We conclude, that that the severe overtraining state could have been related to decreased serotonin reuptake in the brain and signs of major depression.     

Myxoedematous madness and grievous bodily harm

Psychosis is a rare but recognized complication of hypothyroidism (otherwise known as 'myxoedematous madness'). This is the report of a man charged with attempted murder who was found to be suffering from myxoedematous madness. The case illustrates several problems in the law relating to mental disorder and criminal responsibility. He was interviewed in the absence of an appropriate adult and this led to the inadmissibility of the police interviews. However, to have laid the basis for a defence of insanity the ideal evidence would have been what he told the investigating police officers about his state of mind at the material time, under caution and possibly with the assistance of an appropriate adult. As it was, although he was clearly mentally ill at the material time, the insanity defence was not open to him as he did not satisfy the MacNaughton Rules and his mental state did not fulfill the criteria for automatism. By the time he stood trial he was fully recovered from his psychosis and this faced the judge with a difficulty in sentencing him. The case is used to discuss proposed changes to the law concerning insanity.     

Fatal water intoxication in a schizophrenic patient--an autopsy case

We report a case of fatal water intoxication due to polydipsia. A 69-year-old schizophrenic male was found dead at his room of the hospital in which he had been admitted. Medico-legal autopsy was carried out to determine the cause of his death. The autopsy revealed no severe trauma leading him to the death. Internally, it was noticed that the stomach was vigorously expanded, including fluid contents. Intracardiac blood, being dark-red in color, seemed to be diluted. The both lungs ballooned aqueously, showing apparently edema. However, there was neither macroscopic nor histopathological lesion, being responsible for his death. Postmortem biochemical analyses revealed severe hyponatremia of 92 mEq/ml. In cases with short postmortem interval, serum sodium level almost similarly reflected antemortem level. According to his psychiatric doctor, he had been diagnosed as water intoxication due to polydipsia. Moreover, at 2 h before the discovery of his body, he had been found to drink much running water. It was concluded the cause of his death as fatal water intoxication.     

Blood or needle phobia as a defence under the Road Traffic Act 1988

A man was charged with driving over the prescribed alcohol limit. Both specimens of breath contained less than 50 micrograms of alcohol per 100 ml and he refused to submit to a blood test. His defence was that he had a phobia of blood and that he should have been allowed to claim to replace the breath specimens with a specimen of urine. Evidence that he had a phobia was accepted by the prosecution. A woman was arrested on suspicion of driving whilst unfit through drink or drugs. She was charged with refusing to provide a specimen of blood. It was her defence that she had a phobia of needles. Evidence that she had a phobia was not accepted by the prosecution. In both cases the court was asked to decide whether or not the forensic medical examiner had been seriously wrong in deciding that there was no medical reason for refusing a specimen of blood. The man was acquitted and the woman was found guilty. These cases are used to describe the law relating to blood or needle phobias and to suggest how such cases should be approached by the police and forensic medical examiners.     

Verbluten aus einer sehr ungewöhnlichen Rückenschnittverletzung

A case is reported in which a man was found dead in a pool of blood next to a scythe in his basement. There was a deep horizontal incision wound on the back as well as various blood trails around the body and on the stairs. Because of the anatomical localization of the injury and the blood trails, a homicide could not initially be excluded. The complete constellation indicated, however, that the man had fallen onto the scythe. From the position in which the body was found it could be deduced that the man had retained the capacity to act for a limited period of time after having sustained the severe injury. The forensic examination resulted in several explanations for his fall. On the one hand he was under the influence of alcohol (1.63‰ BAK), on the other hand he had suffered from various severe diseases.     

The “mystery” of the train station: The importance of a forensic approach to a rare case of survival after a train-pedestrian collision

In the early morning a 28-year-old man was found lying on the tracks of a railway station with head injuries and fractures of the cervical spine resulting in permanent quadriplegia. He was in a club about 1 km away until about 2 h earlier and did not have any recollection of what could have happened. Was he the victim of an assault, did he fall down or was he hit by a passing train? The solution to this “mystery” came from a forensic evaluation that included the forensic branches of pathology, chemistry, merceology and genetics as well as the scene evaluation. Through these different steps, the role of a railway collision in determining the injuries was ascertained and a possible dynamic was postulated. The presented case is an expression of the importance of the different forensic disciplines and the difficulties the forensic pathologist encounters when analysing such peculiar and rare cases.     

An unusual suicide with parenteral copper sulphate poisoning: a case report

A 22-year-old unmarried, male painter was found by neighbouring shopkeepers to be rolling on the ground inside his shop due to severe abdominal pain. The man had tried to commit suicide by intravenously injecting a solution of copper sulphate, used as an antifouling agent in paints. He was taken to the local hospital with severe epigastric pain, vomiting and diarrhoea. His condition worsened after three days and he was transferred to the All India Institute of Medical Sciences, New Delhi, but the victim died on his way to the hospital. His relatives and neighbours confirmed that he had recently been suffering from depression.     

William Penn and the peace of Europe

The Quaker William Penn proposed a European Union to ensure peace in the continent in 1693. Penn was unusual among Quakers in being of the landed upper classes. When converted, he became a leader of the Quakers and other Dissenters. He had the two related ideals of peace and religious toleration, and dreamed of realizing both ideals in the New World. A practical idealist, he took advantage of four factors: friends at Court made through his social position; King Charles II's gratitude for services rendered by his father, Admiral Sir William Penn; the King's desire to conciliate the City merchants, who were ready to invest in Penn's scheme; and above all the King's concern to get North America settled by British colonists. Penn received a charter to found Pennsylvania in 1681. In England he worked hard, especially in collaboration with James II, for toleration for the cruelly persecuted Quakers and other Dissenters. In Pennsylvania he was able to establish complete toleration and his fair and friendly treatment gave the colony 70 years of peaceful co-existence with the Indians. In his essay on the peace of Europe, he virtually invented collective security and with amazing foresight planned in detail something very like the present European Union.     

Fatal water intoxication during olanzapine treatment: A case report

A man in his twenties was diagnosed with schizophrenia in his late teens. The night before his death, his family reported he drank a large amount of water, vomited, collapsed, and snored loudly while sleeping, but they did not view the event seriously as he did it routinely. The following morning, he was found dead. Autopsy revealed hyponatremia by water intoxication as the cause of death. Water intoxication has various causes. In this case, 610 ng/mL olanzapine was detected in serum samples. Although this concentration is not as high as the fatal concentrations reported in past studies, it might have caused some adverse effects. Furthermore, the observation that excessive drinking behavior started after the dose of olanzapine was increased suggests a possibility that olanzapine aggravated water intoxication.     

Male genital mutilation: 'whodunnit'?

A 26-year-old man was brought to hospital having sustained amputation of his penis, scrotum and testes. Although he claimed that his 'master' did it, the 'master' denied the allegation. The police subsequently retrieved the two testes but the amputated penile shaft was never found. The remaining scrotum and short penile stump were repaired to enable him pass urine. The evidence of the patient was not corroborated. No motive for the amputation was established. The patient refused to appear in court as prosecution witness against the accused, his 'master'. Furthermore, although he has not withdrawn his accusation, he has paid friendly visits to the master subsequently. There is, therefore, the suspicion that the patient was himself responsible for the amputation. This patient will require long-term psychological, endocrinological and urological follow-up.     

"WITH NO EVIL INTENT": THE CRIMINAL PROSECUTION OF PHYSICIANS FOR MEDICAL NEGLIGENCE

If a person publicly practising as a physician, on being called upon to attend a sick woman, prescribes, with foolhardy presumption or gross recklessness, a course of treatment which causes her death, he may be found guilty of manslaughter, although he acted with her consent, and with no evil intent.     

Cases from the aerospace medicine residents' teaching file. Case #26. A fighter pilot with a single left frontal lobe infarction and probable mitral valve prolapse and supraventricular arrhythmias

A fighter pilot with a single left frontal lobe infarction and probable mitral valve prolapse and supraventricular arrhythmias is presented. He was found unfit for flying duties as a fighter pilot, but because of his experience and expertise he was restricted to flying with a qualified copilot in aircraft other than fighters, with regular aeromedical followup.     

Primary renal candidiasis: fungal mycetomas in the kidney

Fungal infections of the urinary tract have a predilection for drainage structures rather than for the renal parenchyma. Of the causal factors, diabetes mellitus, immunosupressed states, AIDS and prematurity are those most commonly encountered. The case of a young, diabetic man whose chief clinical presentation was dysuria is described. On further examination he was found to harbour fungal balls in the right kidney. Radiological manifestations of acute pyelonephritis were also present. Although primary renal candidiasis is often commensurate with systemic fungaemia, he displayed none of the clinical features of disseminate infection and, hence, was treated conservatively with oral antifungal agents. Fortuitously, spontaneous passage of fungal particulate matter in urine was later reported.     

一例战斗机飞行员硬膜外血肿清除术后随访12年并文献复习

目的 探讨外伤致飞行员硬膜外血肿的诊治方案、预后评估. 方法 结合1例男性战斗机飞行员的临床资料及复习文献,对硬脑膜外血肿的发生、诊治及预后进行综合分析. 结果 原歼-6飞行员,因车祸致头部外伤后昏迷,清醒后感头痛、头昏、恶心和呕吐.头颅CT提示:左颞顶部硬膜外血肿.保守治疗3 h病情加重.复查头颅CT示:左颞顶部硬膜外血肿明显增大.全麻下急诊行左颞顶部硬膜外血肿清除术,经综合治疗,临床治愈出院.出院诊断:重型闭合性颅脑损伤,左颞顶部硬脑膜外血肿,左颞顶骨骨折,头皮血肿.后因脑外伤综合征两次住院治疗.复查头颅CT无异常发现.1年半后停飞,转业到民航,2002年在民航开始参与飞行(副驾)空客及波音系列机型至今已6年,一切正常. 结论 根据外伤史、临床症状及头颅CT检查可明确诊断飞行员硬膜外血肿.及时而合理的治疗有利于病情恢复,并可恢复飞行.     

Elbow dislocation secondary to fall during police arrest

A case of total elbow dislocation with significant swelling and loss of distal pulses during police arrest is described. To date, this specific injury in relation to police arrest has not been described in the literature. Whilst attempting to remove the detainee from a public transport vehicle, the patient and the officers involved fell to the ground with his arm slightly flexed. He was handcuffed to the rear and taken to the police office. Whilst there, it was noted that his left elbow was swelling dramatically and he complained of pain. The detainee and officers attended the emergency room and he was found to have a total dislocation of the left elbow and vascular compromise of the limb. The elbow was promptly reduced with sedation and a post reduction angiogram demonstrated injury to the tissues surrounding the brachial artery.