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Biomedical subjects

John D Gilbert

Publications and source records attributed to John D Gilbert.

17 recordsLinked to original sources
PubMed2006

Death associated with volatile substance inhalation--histologic, scanning electron microscopic and energy dispersive X-ray spectral analyses of lung tissue.

The investigation of deaths due to the inhalation of volatile substances may be complicated by a lack of scene and autopsy findings. Mechanisms of death may not be determinable at autopsy, and there may be very few markers of inhalant abuse. A 21-year-old man is reported who died from the combined effects of methadone toxicity and toluene inhalation. Histological examination of the lungs revealed congestion and edema, as well as particles of blue, pigmented material within the interstitium and in macrophages. Scanning electron microscopy was undertaken, revealing that the particles contained granules that measured 0.15-0.2microm in diameter, within the range of mean particle sizes for inorganic paint pigments. Energy dispersive X-ray spectral analysis of the granules demonstrated a significant percentage of titanium (12%) confirming their origin from paint. Ancillary investigations such as electron microscopy and X-ray spectral analysis in cases of possible lethal volatile inhalation may prove useful adjuncts in determining the type of substance inhaled and in providing evidence of previous non-lethal episodes.

Administration, Inhalation↗
PubMed2006

Blood stain pattern interpretation in cases of fatal haemorrhage from ruptured varicose veins.

Blood stain patterns from wounds are determined in part by the nature of the injuries, but also by the types of vessels that have been traumatised. Characteristic spray from arterial injury usually results in a fine projected bloodstain pattern, often found at some distance from the victim. In contrast, venous bleeding tends to be under much lower pressure and less disseminated. However, blood projected from ruptured varicose veins of the lower limbs may also result in a similar pattern of projected, disseminated fine bloodstains. Two cases of lethal haemorrhage from lower leg varicosities are presented involving a 60-year-old woman and an 86-year-old woman. Scene examination in both cases revealed evidence of extensive haemorrhage, with patterns of finely clustered bloodstains on the floors and walls produced by high venous pressures and the small wounds of the acutely ulcerated varicose veins. These features of ulcerated lower leg varicosities simulate the situation that occurs following arterial trauma, where blood may be forced out of a vessel under high pressure through a narrow defect. The fine, dispersed pattern of bloodstains in these cases reflected more the circumstances of the haemorrhage, rather than the intrinsic nature of the vessel of origin. An awareness of this phenomenon may assist in death scene examination when there is extensive haemorrhage with apparent arterial blood spray. An acutely ulcerated lower leg varicosity, with blood spray either on the floor, or at a level that corresponds to the height of the vascular injury, may indicate that the cause of the blood pattern was a lesion with higher than normal pressure venous, and not arterial, haemorrhage.

Aged, 80 and over↗
PubMed2006

Temporal trends over the past two decades in asphyxial deaths in South Australia involving plastic bags or wrapping.

Asphyxial deaths utilising plastic bags or wrappings occurring over a 20-year period from March 1984 to February 2004 were reviewed at Forensic Science SA, Australia. A total of 45 cases were identified, with three occurring in infants and children (one accidental asphyxia; two homicides). Of the remaining 42 adults the male to female ratio was approximately 1:1 (23 and 19 cases, respectively), with all deaths attributed to suicide. The 42 adult cases represented 1.2% of the 3569 suicides autopsied at the centre over the time period of the study. The age ranges of the adult victims were 19-88 years (mean=47.1 years) for the males, and 32-89 years (mean=60.5 years) for the females. The adult female victims were significantly older than the males (p<0.001). A number of victims had histories of depression and had taken prescription medications. A significant difference was found in the temporal occurrence of the adult deaths, with six cases occurring between 1984 and 1989, nine between 1989 and 1994, 11 between 1994 and 1999, and 16 between 1999 and 2004 (p<0.001). Plastic bag asphyxial deaths were rare and in adults were due to suicide involving either older females or younger males. A significant increase in cases in South Australia in recent years was demonstrated, possibly related to publicity surrounding assisted suicides, and the ready availability of suicide manuals and information on suicide techniques from the internet.

Accidents↗
PubMed2006

Fatal electrocution in adults--a 30-year study.

A retrospective study was undertaken of all cases of death in adults (>16 years) due to electrocution which were autopsied at Forensic Science SA, Adelaide, Australia, over a 30-year period from 1973 to 2002. A total of 96 cases were identified with 87 males (91%) (mean age=41.6 years; range 17 to 86 years) and nine females (9%) (mean age=49.2 years; range 20 to 76 years). Deaths were due to accidents in 66 cases (69%; M:F = 63:3), suicides in 28 cases (29%; M:F=24:4) and homicides in two cases (2%). Both homicide victims were females, with females accounting for only 5% of the accidents and 14% of suicides. The number of accidental deaths increased until the early 1990s and then declined, whereas suicidal electrocutions were only found in the last 20 years of the study. Most deaths (N = 80; 83%) were due to low voltage circuits (<1000 volts), with deaths due to high voltages occurring in 15 cases (16%). One death was due to lightning (1%). While suicides were evenly distributed throughout the year, most accidental deaths occurred in late spring and summer (N = 42; 64%) with the lowest number of accidental deaths occurring in winter and early spring. This report demonstrates a significantly higher rate of electrocution deaths among males, with a summer predominance of accidental deaths, most likely due to increased outdoor activities in better weather. The reduction in cases over the last decade of the study may be a reflection of the success of workplace and domestic safety campaigns. Female electrocution suicides and electrocution homicides were rare events.

Accidents↗
PubMed2005

Café coronary syndrome-fatal choking on food: an autopsy approach.

To examine the characteristic features of fatal food asphyxia and to develop an autopsy approach to such cases a retrospective study of autopsy files was undertaken at Forensic Science SA (Adelaide, Australia) over a 10 year period from 1993 to 2002 for all cases of food asphyxia/café coronary syndrome. Forty-four cases were identified (M;F=21:23), with one infant (11 mths) and 43 adults (30-96 yrs; mean 68.9 yrs), with a preponderance of victims (57%) aged between 71 and 90 yrs. Deaths occurred in nursing homes (N=22) cases, at home (N=11) and in restaurants (N=4). Twenty-seven of the victims (61%) had histories of neurological or psychiatric disorders such as dementia (N=8), schizophrenia (N=6), Alzheimer disease (N=4), atherosclerotic cerebrovascular disease (N=4), mental impairment (N=2), multiple sclerosis (N=1), Parkinson disease (N=1) and obsessive-compulsive disorder (N=1). Twenty-seven cases (61%) were described as either edentulous or having significant numbers of teeth missing. Toxicological evaluation of blood revealed alcohol and a variety of psychotropic prescription medications in 19 cases. Sudden collapse during or shortly after a meal should always raise the possibility of café coronary and the autopsy examination should not only attempt to demonstrate airway occlusion by a bolus of food, but also to identify or exclude underlying neurological disease. Such cases may raise issues concerning adequacy of care and appropriateness of medication. The diagnosis of café coronary syndrome can only be made with confidence after the clinical history and circumstances of death have been clearly established, impacted material has been demonstrated in the airway at autopsy (or recorded by those attempting resuscitation), risk factors have been identified and other possible causes of death have been excluded.

Adult↗
PubMed2005

The pathological features and circumstances of death of lethal crush/traumatic asphyxia in adults--a 25-year study.

A 25-year retrospective study of cases of crush/traumatic asphyxia autopsied at Forensic Science SA, Adelaide, Australia from 1980 to 2004 was undertaken. A total of 79 cases of crush asphyxia was found consisting of 63 males (80%) and 16 females (20%). The age range of the males was 19-86 years (mean=41.8 years) and of the females was 19-75 years (mean=38.6 years). In 18 cases the exact circumstances of death were unclear, leaving 61 cases in which details of the fatal episode were available. Major categories included vehicle crashes (N=37), industrial accidents (N=9), farm accidents (N=6) and entrapment beneath vehicles (N=5). Forty of the 79 victims (51%) had only very minor bruises and abrasions; 28 (35%) had evidence of chest compression with rib and sternal fractures and large areas of soft tissue bruising of the chest; 7 cases (9%) had other significant injuries or findings that had contributed to death. All of these victims had signs of crush asphyxia in the form of intense purple congestion and swelling of the face and neck, and/or petechial hemorrhages of the skin of the face and/or conjunctivae. The pattern of pathological findings of crush asphyxia was not influenced by the presence or absence of concomitant serious or lethal injuries. In 4 cases (5%) where the circumstances of the lethal episode were those of crush asphyxia there were no characteristic pathological findings. This study has shown that a high percentage of crush asphyxias may be caused by vehicle accidents. It has also demonstrated that on occasion fatal crush asphyxia may have to be a diagnosis of exclusion, made only when there are characteristic death scene findings, and no evidence of lethal natural diseases or injuries at autopsy, with negative toxicological screening.

Adult↗
PubMed2004

Narcotic administration and stenosing lesions of the upper airway--a potentially lethal combination.

Two cases are reported where significant narrowing of the upper airway in association with narcotic administration resulted in respiratory compromise and death. Case 1: A 29-year-old woman with upper airway narrowing due to tonsillar enlargement from an Epstein-Barr infection was admitted to hospital, administered morphine and left in a room on her own with the door closed. She was found dead several hours later. At autopsy there was significant narrowing of the upper airway due to tonsillomegaly with a blood morphine level of 0.16 mg/L. Case 2: A 48-year-old woman with severe narrowing of her glottic inlet from recurrent squamous cell carcinoma and an intravenous drug taking history was found dead at her home. At autopsy there was evidence of recent and remote intravenous drug administration with marked narrowing of the glottis due to a recurrent tumor with a blood morphine level of 0.48 mg/L. In both cases, death was due to the effects of severe upper airway narrowing in combination with the respiratory depressant actions of morphine. Additional exacerbating factors may have included muscle weakness, drowsiness and reduced clearance of airway secretions from the effects of morphine. Narcotic administration in individuals with compromised upper airways should be undertaken extremely circumspectly and hospital protocols should ensure constant surveillance if this has been undertaken. Individuals who self administer narcotics should also be made aware of the dangers if there is coincidental upper airway narrowing. Toxicological evaluation in fatal cases of upper airway narrowing/stenosis may be extremely useful in revealing compounding factors such as opiate administration.

Adult↗
PubMed2004

Changing patterns of female suicide: 1986-2000.

A study was undertaken of the rates and methods of female suicide observed at the Forensic Science Centre in South Australia over a 15 year period from 1986 to 2000. A total of 609 cases of female suicide were found (age range= 13-88 yrs; mean= 44 yrs), with 249 drug overdoses, 114 hangings, 100 deaths due to carbon monoxide (CO) toxicity, 40 drownings, 35 firearm deaths and 71 miscellaneous deaths (including deaths due to self-immolation, jumping from heights and incised wounds). The most common age range was 26-50 yrs in all categories except for drowning where victims tended to be older. While overall suicide rates in females remained unchanged, with no changes in the rates at different ages, significant increases in hanging and CO deaths occurred over all age groups (p < 0.05), with significant falls in drug overdose deaths in the 10-25 year age group (p < 0.01), and significant overall falls in suicides due to gunshot wounds (p < 0.05). No changes were observed in female suicides due to drowning. This study has demonstrated, therefore, that although no changes in overall suicide rates for females occurred, there have been alterations in the types of methods being used. Although drug related deaths remained the largest category, hanging deaths, which were once uncommon in females, have increased markedly.

Adolescent↗
PubMed2004

Characteristic features of deaths due to decapitation.

Deaths due to decapitation are rare in civilian populations. A study in South Australia over 17 years from January 1986 to December 2002 revealed 20 cases (age range, 14 to 72 years; average, 30.7 years; male to female ratio, 15:5). There were 13 suicides consisting of 11 train-related deaths (age range, 14 to 72 years; average, 31.3 years; male to female ratio, 10:1), 1 hanging death, and 1 death using a ligature and a motor vehicle. Five cases related to motor vehicle crashes (age range, 19 to 46 years; average, 30.2 years; male to female ratio, 1:4) and 2 were associated with industrial trauma. Suicidal decapitation accounted for <1% of total suicides and showed a striking male predominance, with the favored method involving trains.

Accidents, Occupational↗
PubMed2003

Cetacean café coronary.

The carcass of a young adult male Indian Ocean Bottlenose dolphin (Tursiops cf aduncus) was found floating in an estuary near Adelaide, South Australia. An autopsy revealed that death had been caused by obstruction of the upper aerodigestive tract by a 660 mm Cobbler Carpetshark (Sutorectus tentaculatus). Similar airway obstruction in humans while feeding has been termed café coronary syndrome. Although death may have merely resulted from over-enthusiastic feeding, the possibility of neurological impairment was considered, and limited toxicological analyses of tissues was undertaken. No increase in organochlorine pesticides was found, however the possibility of heavy metal poisoning was not excluded. Formal neuropathology was unable to be undertaken. When sudden death in other mammal species mimics cases that are found in humans, similar underlying mechanisms may be present.

Journal Article↗
PubMed2003

Traumatic subarachnoid hemorrhage and extracranial vertebral artery injury: a case report and review of the literature.

The case is presented of a 19-year-old man who was assaulted and died shortly afterward from a large traumatic basal subarachnoid hemorrhage (TBSAH) that arose from rupture of the left vertebral artery, proximal to the point at which the artery penetrated the dura. The literature regarding TBSAH and vertebral artery rupture is reviewed, and a number of points are highlighted: patients with TBSAH may remain conscious for a period of hours after injury, subcutaneous or muscular bruising may be contralateral to the ruptured vessel, fractures of the transverse processes of the cervical vertebrae and significant pathology of the vertebral artery are not typically associated with TBSAH, and rupture of the vertebral artery may be intracranial, junctional, or extracranial.

Adult↗
PubMed2003

Unusual facial markings and lethal mechanisms in a series of gasoline inhalation deaths.

A review of deaths associated with hydrocarbon toxicity from gasoline sniffing in South Australia throughout a 10 year period from July 1987 to June 2002 revealed 4 cases. The victims were all Aboriginal people from remote inland communities. Each death had occurred while the victim was lying in bed sniffing gasoline from a can held to the face. Once unconsciousness had occurred, the mouth and nose had been pressed firmly against the can by the weight of the head. In each case, the effects of gasoline toxicity had been exacerbated by hypoxia and hypercapnia from rebreathing into the container once a tight seal had been established between the face and the can. The circular impressions left by the can edges on the faces of each of the victims provided an autopsy marker that assisted in clarifying the details of the fatal episodes. Discouraging solitary gasoline sniffing in bed may reduce the death rate in communities where this behavior is practiced.

Administration, Inhalation↗
PubMed2002

Clinicopathologic features of fatal self-inflicted incised and stab wounds: a 20-year study.

The files of the Forensic Science Center in Adelaide, South Australia, were examined for all cases listed as suicide in which death had been caused by the use of a sharp instrument during the 20-year period from January 1981 to December 2000. Fifty-one cases were identified, consisting of 35 men and 16 women. The age range was 23 to 83 years (mean 49 years) representing 1.6% of total suicides (51/3182). Fatal injuries included incised wounds to the arms in 51.4% of men (n = 18/35) compared with 87.5% of women (n = 14/16), incised and stab wounds to the neck in 40% of men (n = 14/35) and 25% of women (n = 4/16), and stab wounds to the chest or abdomen in 28.6% of men (n = 10/35) and 12.5% of women (n = 2/16). In 8 cases, multiple sites were involved. The use of sharp instruments in suicide was favored by older, rather than younger, individuals, with a tendency for women to incise their wrists. Hesitation marks were present in 23 cases (54%) and scarring of the wrists from previous suicide attempts in 5 cases. Although this study demonstrated a higher number of men than women committing suicide by using sharp objects, this method of suicide remains uncommon.

Abdominal Injuries↗
PubMed2002

Gasoline exposure in motor vehicle accident fatalities.

Three cases are described in which deaths after motor vehicle accidents occurred as a result of positional asphyxia associated with exposure to gasoline. The deceased individuals were aged 16, 34, and 35 years, respectively (M:F = 1:2) and had all been in the back seat of motor vehicles involved in rollover accidents that had resulted in spilling of gasoline with contamination of the cabins. Major components of gasoline were detected in blood and tissues by headspace gas chromatography. Postmortem toxicologic investigations of such cases, which include analyses for volatile hydrocarbons, may therefore produce additional significant information.

Accidents, Traffic↗
PubMed2002

Diagnostic problems associated with cadaveric trauma from animal activity.

Analysis of a series of deaths between 1986 and 2001 resulting from natural disease, accidents, suicides, and homicide, where postmortem animal activity had traumatized bodies, was undertaken at the Forensic Science Center in Adelaide to demonstrate the range of lesions that may occur and problems in interpretation that result. Tissue damage had been caused by a variety of animals, including fly larvae, ants, birds, dogs, rodents, sea lice, and sharks. Postmortem animal activity had disguised injuries, modified wounds, and created the appearances of inflicted injury. Problems with identification occurred after postmortem facial trauma, and loss of organ parenchyma had interfered with, or precluded, the precise determination of the manner of death in some cases. Specific kinds of tissue and organ damage may occur after death, necessitating careful assessment of lesions in a search for characteristic features of animal activity. The pattern of lesions may enable identification of the particular species of animal involved.

Adolescent↗
PubMed2002

Cervical fracture, decapitation, and vehicle-assisted suicide.

Two cases of vehicle-assisted suicides are described in males aged 33 and 24 years, respectively. In both cases the victims had tied ropes between stationary objects and their necks and then attempted to drive their vehicles away. The speed with which the vehicles were driven resulted in forces great enough to cause fracture--dislocation of the cervical spine in Case 1 and virtual decapitation in Case 2. Although inadvertent alteration of the death scene in Case 1, with removal of the rope, complicated the initial assessment, the extent of soft tissue and bony injuries was such that ligature strangulation appeared unlikely.

Adult↗