Suicidal chloroquine poisoning: report of two cases.
Two cases of suicidal chloroquine poisoning are presented. The autopsy, toxicological findings and strategies for preventing self-destruction by this method are discussed.
Adult↗
Biomedical subjects
A Busuttil
Publications and source records attributed to A Busuttil.
Two undiagnosed cases of intussusception.
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Appendicitis↗
A five year review of fatal self-ingested overdoses involving amitriptyline in Edinburgh 1983-'87.
One hundred and twelve cases of fatal self-ingested overdoses were investigated in the Forensic Medicine Unit of the Department of Pathology of the University of Edinburgh in the period 1983-'87 (inclusive). Of these, 24 cases involved amitriptyline as either the sole agent or in combination with another drug, the most common of which was ethanol. The mean age of the latter group was 43 years with a marked female preponderance. The social history was documented with six out of the 24 cases living alone and five out of the 24 cases divorced. The number previously referred for psychiatric treatment and the number of cases where over 100 tablets of the drug had been prescribed at any one time (where known) was recorded: eight out of 24 cases. The fact that amitriptyline was by far the commonest of the tricyclic antidepressants to be encountered in a fatal overdose situation raises the important question of the prescribing of amitriptyline as a first line therapy in mental depression.
Adolescent↗
Deaths from substance overdose in the Lothian and Borders region of Scotland (1983-1991).
1. A retrospective analysis of 352 consecutive cases of fatal substance overdose that occurred in the Lothian and Borders region of Scotland (LBRS) between 1983 and 1992 (inclusive) is presented. All these cases were subjected to a full forensic autopsy with histological and toxicological studies. 2. The overall male:female ratio is 1.2:1. Males significantly predominate (1.9:1) in the 21-30 year age group, but females significantly predominate (0.7-0.9:1) above the age of 50 years (P < 0.001). A significant progressive alteration in the sex ratio is noted: from 0.7:1 in 1988 to 2.4:1 in 1992 (P < 0.001). 3. Analgesics account for 43.2% of all overdose deaths with narcotic analgesics representing 32.4%. Dextropropoxyphene is the commonest (38.2%) narcotic analgesic and fatal overdoses on it have been increasing since 1989; methadone deaths also showed an increase. Death from heroin overdose fell sharply in 1985. 4. Antidepressants account for 20.2% of deaths (tricyclics representing 19.3%): Amitriptyline is the commonest (75.0%) tricyclic and its use, particularly by female suicides, has been increasing since 1989. Barbiturate poisoning has declined considerably since 1986. 5. Temazepam comprises 65.4% of all benzodiazepines overdose deaths; two-thirds of fatal benzodiazepine abuse involve males. 6. This study once more emphasises that physicians, and especially general practitioners, must prescribe cautiously for their patients. Control through legislation of the sale of non-narcotic analgesics is worth serious consideration.
Acetaminophen↗
Suicidal inhalation of vehicular exhaust in the Lothian and Borders region of Scotland.
1. A 6-year retrospective study of the features of 79 consecutive completed suicides from exhaust fume inhalation (SEFI) in the Lothian and Borders region of Scotland was conducted. Full forensic autopsies with histological and toxicological studies were carried out. 2. The mean incidence is 2.0/100,000 population (M = 3.7; F = 0.4; P <> 0.001); increasing since 1990. The age peak is in the 35-44 years age group (especially among males) and a significant (P < 0.001) proportion reside in rural areas. 3. SEFI is significantly (P < 0.05) higher during spring and summer; outdoor locations are prevalent during summer. 4. Most (75.6%) of the victims were in current employment. Psychiatric illness (30.7%), problems in marriage or relationships (28.2%) and financial difficulties (16.7%) were the major associated socio-medical factors. 5. The mean carboxyhaemoglobin (COHb) saturation was 74 +/- 11.2%; fatal COHb saturation levels were still detectable in severely decomposed bodies. The blood alcohol concentration (BAC) in 37 of the victims ranged from 14-397 mg dl-1. No significant correlation exists between COHb saturation and the victim's age or BAC. 6. Attempts to reduce the incidence of SEFI must be directed principally to dealing with associated sociomedical problems. The reduction of the potential of vehicles to produce carbon monoxide and of directing exhaust fumes into the interior of the vehicle are important secondary preventative measures.
Adolescent↗
Brief report: fulminating fat embolism syndrome caused by paradoxical embolism through a patent foramen ovale.
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Aged↗
The potential role of bacterial toxins in sudden infant death syndrome (SIDS).
Toxigenic bacteria have been implicated in some cases of Sudden Infant Death Syndrome (SIDS). Although there is not much evidence that Clostridia spp. are associated with SIDS in Britain, strains of Staphylococcus aureus producing pyrogenic toxins have been isolated from significant numbers of these infants at autopsy The pyrogenic toxins, produced by some strains of group A Streptococcus pyogenes as well as staphylococci, are powerful "superantigens" that have significant physiological effects including induction of fever > 38 degrees C. In this article, interactions between genetic and environmental factors that might enhance colonization of epithelial surfaces by toxigenic staphylococci are analyzed: infant's expression of Lewis(a) antigen which acts as a receptor for some microorganisms; viral infections; the effect of mother's smoking on susceptibility to respiratory infection. Based on epidemiological findings and laboratory investigations, a hypothesis is proposed to explain how bacteria producing pyrogenic toxins might contribute to some cot deaths.
Bacterial Infections↗
Sudden death in HIV-infected drug users. Presumptive overdose in an HIV-positive narcotic addict.
We report the case of an HIV-positive drug user who was found dead in a room in which were discovered tablets of dihydrocodeine and amitriptyline. There had been past episodes of drug overdose which was suspected of being the cause of death on this occasion. However toxicology analysis did not support this diagnosis and necropsy revealed a severe desquamative interstitial pneumonitis and HIV encephalitis. The need to investigate thoroughly the cause of sudden death in all HIV-positive drug users is emphasised.
Adult↗
Assessment of Lewis blood group antigens and secretor status in autopsy specimens.
The ability of enzyme linked immunosorbent assays (ELISA) to detect Lewis and H antigens in secretions obtained from 280 autopsies was assessed. The ELISA results were compared with those for matched blood specimens examined by agglutination of erythrocytes by monoclonal anti-Lewis(a) and anti-Lewis(b) antibodies. There was good agreement between the results for the two tests and the ELISAs could be used to determine secretor status of the subject. While determination of ABO group with monoclonal anti-A and anti-B was possible even with lysed blood, the results for Lewis typing by erythrocyte agglutination were poor if the sample was lysed or partially lysed. Detection of the antigens by ELISA was as efficient among elderly subjects as among younger ones and both H and Lewis antigens could be detected on erythrocytes and in secretions up to 127 h after death.
Adolescent↗
Human immunodeficiency virus and the brain: investigation of virus load and neuropathologic changes in pre-AIDS subjects.
Brain tissue was examined for evidence of human immunodeficiency virus (HIV) infection in 23 intravenous drug users who died suddenly some years after seroconversion but while still in presymptomatic stages of infection. None showed giant cell encephalitis, but 14 showed T cell lymphocytic leptomeningitis and 3 showed other significant neuropathologic features. Quantitative polymerase chain reaction for HIV was applied to 13 of the 23 with negative results in 6 and very low positive results in the other 7, a finding consistent with contamination by residual infected blood in the brain tissue. This contrasted with findings in AIDS-infected tissue, in which substantial amounts of provirus were found. It is concluded that significant infection in brain tissue does not occur in presymptomatic stages of HIV infection and that invasion of the central nervous system may be delayed until the transition to symptomatic AIDS.
Acquired Immunodeficiency Syndrome↗
Recreational abdominal suspension: a fatal practice. A case report.
A 12-year-old girl fatally suspended herself accidentally from a tree branch with a circumferential webbing tape tied round the midtrunk area. This occurred as part of a recreational practice whereby the body, tied in this fashion, could be made to swing in a pendulumlike horizontal plane. She was found dead in this position, hanging transversely one foot above the ground. A complete autopsy showed a tram-line circumferential parchmented bruise of the midtrunk area and bruising of the intercostal muscles and diaphragm with occasional petechiae. The mechanism through which death resulted in this case is believed to have involved a progressive tightening and compression of the primary respiratory muscles, resulting in eventual failure of the respiratory effort.
Asphyxia↗
Medicolegal practice in Pakistan. A view from within.
Two generations have passed since Pakistan changed constitutionally from being under the rule of the British monarchy to becoming an independent Islamic-based democratic republic. Its medicolegal system, including the administration of justice, the academic basis of its medical and scientific expertise, and the practical investigation of crime, is thus a conglomerate of the English legal system and traditionally orientated and religiously based addenda that were successfully grafted onto the preexisting codes. With increasing urbanization, the greater availability of education, and specialization, further changes are likely that will mirror ongoing developments and activities in medicolegal practice worldwide. An overview of the Pakistani medicolegal system as it now exists is presented here to enable a better understanding of the changes that are gradually occurring and that need to continue.
Criminal Law↗
Immunocytochemical detection of the microsomal glucose-6-phosphatase in human brain astrocytes.
Using an antibody raised against the catalytic subunit of glucose-6-phosphatase, this enzyme was immunolocalized in many astrocytes in 20 normal human brains. Double immunofluorescence studies showed co-localization of glial fibrillary acidic protein (GFAP) with glucose-6-phosphatase in astrocytes. However, not all GFAP-positive cells were also glucose-6-phosphatase positive, indicating that some astrocytes do not contain demonstrable expression of this enzyme. Reactive astrocytes in a variety of abnormal brains were strongly glucose-6-phosphatase positive, but neoplastic astrocytes were often only weakly positive. Expression of the enzyme could not be demonstrated in radial glia, neurons or oligodendroglia. Astrocytes normally contain glycogen and the demonstration that some astrocytes also contain glucose-6-phosphatase indicates that they are competent for both glycogenolysis and gluconeogenesis, which may be critical for neuronal welfare.
Adult↗
Condylomata acuminata in pre-pubertal children.
The medico-legal significance of anogenital warts as a marker of sexual abuse in children is unclear. This review article presents three case reports and discusses the possible modes of transmission of papilloma virus in children. Although genital warts can indicate sexual abuse, non-sexual transmission may also occur.
Child↗
Trichomonas vaginalis infection in pre-pubertal girls.
This short paper discusses the implications of Trichomonas vaginalis infection of the genital tract in children with respect to suspected child abuse. Two case reports are described to illustrate the problems that can arise in the investigation of such cases T. vaginalis is usually transmitted sexually but the potential for non-sexual transmission does exist.
Adolescent↗
Impaling-type head injury in a road traffic incident.
A fatal impaling-type head injury is described in a young man, sustained when he crashed his car while intoxicated, his head being transfixed by a broken wooden fence post. This shattered the facial bones and damaged the brain stem. Other published instances of impaling head injuries are discussed.
Accidents, Traffic↗