Delaware's first serial killer.

The violent murder of Shirley Ellis on November 29, 1987, marked the beginning of the strange and terrible tale of Steven Bryan Pennell's reign as the state of Delaware's first convicted serial killer. Three more bodies followed the first victim, and all had been brutally beaten and sadistically tortured. The body of a fifth woman has never been found. State and county police collaborated with the FBI to identify and hunt down their suspect, forming a task force of over 100 officers and spending about one million dollars. Through their knowledge and experience with other serial killers, the FBI was able to make an amazingly accurate psychological profile of Delaware's serial killer. After months of around-the-clock surveillance, Steven Pennell was arrested on November 29, 1988, one year to the day after the first victim was found. Pennell was found guilty in the deaths of the first two victims on November 29, 1989, and plead no contest to the murder of two others on October 30, 1991. Still maintaining his innocence, he asked for the death penalty so that he could spare his family further agony. Steven Pennell was executed by lethal injection on March 15, 1992.

Spontaneous splenic rupture and infectious mononucleosis in a forensic setting.

In this report we present two fatal cases of spontaneous splenic rupture. The prodromal symptoms, clinical presentations, autopsy findings and histologic findings are discussed, pertinent literature reviewed and the implication for the forensic pathologist stressed.

Three unusual cases of multiple suicidal gunshot wounds to the head.

We describe three unusual cases of suicide involving multiple gunshot wounds, in which all of the victims suffered gunshot wounds to the head, yet none was rendered immediately incapacitated. Injuries were confined to the same area in two of the cases and were located in different areas in the other case. Two of the cases initially appeared to be homicides rather than suicides.

Propane-associated autoerotic fatalities.

We describe 3 unusual autoerotic fatalities in which propane gas was used to induce hypoxia. To our knowledge, these are the first cases of their kind to be reported and described in depth, although brief references to similar cases have appeared. The case histories of 3 white males, aged 22, 42, and 62 years, are described with emphasis on the scene and circumstances and the identification of propane from autopsy materials. In one case, unusual paraphilia and multiple foreign bodies in the rectum were noted. These 3 cases illustrate an unusual form of autoerotic practice in which hypoxia is induced by propane inhalation, unlike the usual neck compression that has been previously described in depth. The importance of scene reconstruction and an awareness of this phenomenon is stressed.

Traumatic seromuscular rupture of intestine: the acute and chronic forms.

BACKGROUND: Traumatic seromuscular rupture of intestine in the acute form is recognized by surgeons and pathologists and has received mention in the medical literature. The authors encountered two cases of this lesion presenting in the chronic form, in one case initially going unrecognized, both in battered children. To our knowledge, the chronic form of the injury has not been previously described in the literature. Three lesions in the acute stage were used to analyze the evolutionary stages of the chronic presentation. METHODS: The two chronic cases are described, together with gross and microscopic photographs. Three acute lesions are also described, with illustrations, two in battered children and one in a pedestrian/vehicle fatality. RESULTS: The three acute cases illustrate the pathogenesis and gradation of the injury that, in the absence of surgical therapy, will develop into the chronic lesion. The two chronic case descriptions illustrate the gross and microscopic pathology and the pathognomonic features. CONCLUSION: Seromuscular rupture of the intestine, when left untreated, develops in time into a lesion that may appear cryptogenic to the surgeon or the pathologist. This paper defines that lesion and its pathogenesis.

Cocaine babies: the scourge of the '90s.

Six cases of cocaine-related deaths of infants have covered the spectrum of potentially devastating effects. They include an intrauterine death of a 35-week-old fetus following acute maternal cocaine abuse; anoxic encephalopathy at birth with 3 months' vegetative survival from a similar episode; traumatic compression asphyxia in a 4-month-old; infectious cardiomyopathy with heart failure in a twin at age 21 months following maternal cocaine abuse at birth; malnutrition and dehydration in a 7-week-old during continuing cocaine abuse by the parents; and a teenage sibling's cocaine lacing of a baby milk bottle ingested by his 6-week-old brother. All the cases had positive toxicological screening for cocaine or metabolites or both in the mother at delivery or in the infant at birth, or both. There were no instances of sudden infant death syndrome (SIDS, or "crib death"). Pathologic and toxicologic, as well as birth, developmental, and social data are presented. An integrated medical, public health, law enforcement, and educational policy to prevent or at least ameliorate these tragic cases, now approaching epidemic proportions, has yet to be developed. A careful obstetrical history and examination of the mother, indication on the birth certificate of maternal drug abuse, and notification of health authorities (by birth certificate checking, among other ways) may send an early warning message to providers for intercession. Active ingestion/injection and passive inhalation by older children and teenagers require more intensive monitoring and aggressive interaction by pediatricians, social workers, school authorities, and employers.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytologic diagnosis of a chordoma without physaliforous cells.

Fine-needle aspiration cytology of a presacral chordoma without the classic physaliforous cells is reported. The potential for the misdiagnosis of these lesions when these cells are absent is discussed. The pertinent literature related to this case is reviewed.

Effects of functionally-distinct T-cell subsets on the maturation of null cells in man.

We have found that the 'null' cell population (negative for surface immunoglobulin and for E-rosette formation) includes cells which can develop surface immunoglobulin and secrete immunoglobulin in culture. The apparent 'maturation' of these null cells to immunoglobulin-secreting B cells was enhanced by T cells and may require T cells. T-cell subsets shown previously to have a helper effect on immunoglobulin secretion by peripheral blood B cells accelerated this maturation process, whereas subsets without helper effects on peripheral blood B cells did not.

Direct evidence for loss of human suppressor cells during active autoimmune disease.

These studies indicate that a regulatory subset of lymphocytes is missing in patients with juvenile rheumatoid arthritis but these patients have antibodies in their serum that react with normal T cells. This regulatory subset of T cells is, however, present in patients whose serum shows little or no reactivity with normal T cells. In addition, patients who are deficient in this regulatory subset of lymphocytes significantly higher numbers of cells secreting Ig as measured by a hemolytic plaque assay. The significance of these observations is twofold: first, they represent a positive relationship among the loss of regulation overproduction of immunoglobulin, and the presence of anti-T cell antibodies and second and perhaps of equal importance, is the indication that serum from patients with autoimmune diseases may give us a readily available reagent with which to dissect further functionally distinct subsets of normal T cells in man.

T-cell regulation of human peripheral blood B-cells responsiveness.

We have investigated the influence of human T cells on the synthesis and secretion of immunoglobulin by peripheral blood B cells. The plaque-forming assay used, which identified the number of B cells secreting Ig, is a short-term assay which requires no exogenous stimulation. We have shown that the B-cell population alone contains fewer secreting cells than the total lymphocyte population, and that T cells are required to achieve maximal plaque-forming cell levels. Cycloheximide treatment of cells at concentrations known to inhibit protein synthesis does not affect the cooperative potential of these cells. Additionally, this cooperation effect is markedly better among autologous mixtures of Ig- and Ig+ cells, than among mixtures obtained from randomly selected individuals.