Death by self-inflicted asphyxia with helium – First case reports from Norway and review of the literature

ABSTRACT An increasing number of asphyxia suicides by inhalation of inert gases have been reported from different parts of the world over the last decade. So far this phenomenon has not been described in our country. This article presents the first two case reports from Norway of presumed suicide by asphyxiation due to helium inhalation from a closed plastic bag over the head. In both cases a forensic autopsy, which included comprehensive toxicological analysis, was requested and performed. In the two cases death was attributed to asphyxia due to helium inhalation, and suffocation due to a plastic bag over the head and aspiration of gastric contents, respectively. Toxicological analysis revealed no findings contributing to the deaths. The absence of toxicological and autopsy findings to determine the cause of death in such cases may represent challenges of clinical and forensic significance. In contrast to the promotion of this method by euthanasia interest groups for the terminally ill reported suicides by helium asphyxiation primarily involve relatively young individuals suffering from psychiatric and/or substance use disorders, and not from terminal illness.

Screening of Danish traffic cases for synthetic cannabinoids in whole blood by LC-MS/MS

ABSTRACT A target screening method for the detection of 13 synthetic cannabinoids in whole blood was developed and validated. Samples underwent automated solid-phase extraction, and sample extracts were analyzed by liquid chromatography-positive electrospray ionization-tandem mass spectrometry using two transitions in multiple reaction monitoring mode. The limit of detection was between 0.1-2.5 ng/mL for the compounds except HU-210, and extraction recovery ranged from 59 to 78%. The method was used to screen 393 Danish traffic cases from 2012, where the driver was suspected of driving under the influence of drugs. No synthetic cannabinoids were identified in these samples. Additionally, the method was applied to a clinical intoxication case, and the synthetic cannabinoid AM- 2201 was identified in serum. We conclude that the prevalence of driving under the influence of synthetic cannabinoids in Denmark is likely to be low, and that synthetic cannabinoids are most likely to be encountered in the clinical setting.

Finger lengths and behavior: Is the 2D:4D index of interest in forensic medicine?

ABSTRACT The relationship between the second and the fourth digit in the human hand, the 2D:4D index, is considered a putative marker of exposure to prenatal testosterone. Much research has been done in the attempt to associate the 2D:4D index and physical characteristics as well as cognitive skills and behavioral patterns. It has been suggested that these characteristics and behavioral patterns may be linked to high levels of testosterone. The basis for considering the 2D:4D index a marker of prenatal exposure to testosterone, and the influence of prenatal and circulating testosterone on behavior are reviewed. Furthermore, it is discussed whether forensic medicine may benefit from identification of a marker of behavioral predispositions. It seems that it is not possible to derive any valid information on predispositions from finger length ratio, however the field of 2D:4D research might benefit from forensic studies.

Inhalation injury and burn trauma: an experimental investigation of oxidative stress and histopathology

ABSTRACT Smoke inhalation injury is associated with high incidence of pulmonary complications as it represents a major cause of mortality after major burn injury. Burn is associated with release of inflammatory mediators which ultimately cause local and distant pathophysiological effects. The present study investigated the effect of smoke inhalation or\and burn injury on the antioxidants status in the lungs in a rat model to simulate an inhalation injury as might be encountered by firefighters and burn victims. Seventy five rats were equally randomized to five groups: Sham group, smoke inhalation injury group, burn group, sham burn group, and smoke burn group. At the end of the exposure protocol rats were killed by cervical decapitation and the lungs were removed completely and processed for histopathological and biochemical analysis by measuring lung antioxidant enzyme activities: Malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPs) level, as an index of lipid peroxidation. Grossly, results showed that rats´lungs in the smoke inhalation group and the smoke burn group showed multiple hemorrhagic spots. Light microscopic examination showed localized and diffuse alveolar hemorrhage. Two rats in the burn group had evidence of pneumonia and lung abscesses. Biochemically, results showed that both smoke inhalation and burn injury significantly elevated lung MDA and glutathione peroxidase levels when compared with controls. The combined smoke and burn group resulted in a more significant rise in both antioxidant levels indicating a higher level of lipid peroxidation. SOD level was significantly lowered on exposure to both conditions when compared to control. SOD level was significantly lower in the combined injury group when compared to either smoke or burn alone. In conclusion; the above data provide evidence that inhalation injury with and without burn decrease tissue antioxidant capacity and increase tissue peroxidative injury.

Forensic anthropology and human identification

ABSTRACT This is the full summary paper of a thesis to be defended at the University of Copenhagen, May 31st, 2013

Forensic Medicine – seen through the eyes of a social anthropologist

ABSTRACT For the average Dane death has become part of daily life. The media paints a picture of numerous violent acts, but even though we come across it on a daily basis certain aspects of death, e.g. working with the dead, are still seen as taboos. This article is based on my internship at the Institute of Forensic Medicine in Odense in February 2011 where I participated in the daily routines, and therefore had the opportunity to see how the employees relate to death and the dead. The section “A Room of Impurities” deals with the symbolical impurity of the autopsy rooms at the Institute, since death, according to the anthropologist Mary Douglas, is a taboo and therefore something symbolically impure. In the section “Subjects or Objects?” another aspect of working with the dead is presented. The employees at the Institute have an ability to see the dead as both subjects and objects and to switch between these. The dead body as an object can equally be seen as something impure. The last section “A Part of Human Life” compares the taboo surrounding the Institute of Forensic Medicine with the view upon death in Tibet, and concludes on the manuscript.

Fatal bupivacaine overdose through intrathecally positioned epidural catheter

ABSTRACT We describe a fatality due to an intrathecally positioned epidural catheter and an infusion rate of bupivacaine set 10 times higher than planned. The undetected misplacement, despite safety routines, is discussed along with the toxicological findings and new information on the intrathecal distribution of bupivacaine. From a clinical point of view, the human factor, in combination with an indistinct decimal point on the pump, was considered as the reason for the unfortunate overdose. In continuous epidural infusion of local anesthetics, the importance of guidelines and informed staff in managing complications of epidural lumbar infusion as well as careful monitoring of the vital functions is essential. Guidelines are also vital during the procedure of insertion of epidural catheters. When using combined spinal and epidural anaesthesia, we believe that an epidural catheter should be inserted, and its position tested, prior to spinal anesthesia. The case also illustrates the need of innovative investigation techniques to confirm the suspicion of unusual manifestations of inadvertent drug effects. Segmental analysis, together with analyses in a control case, enabled us to elucidate the high and varying tissue concentrations in the central nervous system.

Accidents are caused, they do not happen

ABSTRACT The head, being the most vulnerable part of human body, is the most commonly injured body part in accidents, especially those involving road traffic. In an unusual case, the deceased succumbed to internal injuries of the brain that resulted from the neck being constricted with the loose end of a dupatta. The woman was pillion riding a motorbike when the loose end of the dupatta got entangled in the rear wheel of the motorbike. As a result, her neck was constricted by the dupatta and wentunnoticed. This paper comments on the safety of wearing the traditional style dressing of Indian women while riding on two wheeled vehicles. Additionally, this paper suggests it be mandatory to wear helmets for all pillion riders in order to prevent such mishaps in future.

Visualisation of contrast-filled stab wounds in various tissue types with computed tomography

ABSTRACT Background: Stab wounds are common in homicide cases. Post-mortem multislice computed tomography (PMCT) has proved to be a useful tool in forensic examinations of victims of sharp force trauma, but due the limited resolution of soft tissues, the radiological depiction of a stab channel is difficult. In this study, we have tried to obtain information about the shape of a knife blade by CT scanning contrast-filled experimentally inflicted stab wounds in various types of pig tissue. Methodology: The tissue samples were mounted on floral foam (oasis) with wooden sticks. Two contrast media were used: one was unmodified and easy flowing, and one was made more viscous with polyethylene glycol. Stab channels in ballistic soap were used for comparison. India ink-filled stab channels were investigated histologically to determine the pattern of leakage. Principal findings: We found that the shape of the stab wounds on the CT images from lung and muscle tissue did not correspond well to the shape of the inflicting knife. There was a better correspondence in the images obtained from liver, spleen and kidney. The viscous contrast medium was less likely than the thin (easy flowing) contrast medium to spill into to structures outside the stab channel, but some spillage was observed for both types of contrast medium. Air bubbles were only observed in the viscous contrast medium. Conclusion: Radiological evaluation of a contrast-filled stab wound in isolated tissue blocks did not permit the positive identification of the inflicting weapon, but it was, in tissue blocks from liver, spleen and kidney, possible to obtain a rough idea of the shape of the inflicting knife and to differentiate a knife from a screwdriver.