Fatal accidental inhalation of brake cleaner aerosols.

Brake cleaner liquid is commonly used for cleaning of engines and motor parts. The commercially available products usually contain mainly volatile organic compounds. As a consequence brake cleaner evaporates fast and almost completely from the cleaned surface. This case report presents a fatal accidental inhalation of brake cleaner liquid aerosols due to the attempted cleaning of a boat engine. A 16year old boy was found lifeless in the engine compartment of a boat engine. In close proximity to the body, the police found cleanings wipes soaked with brake cleaner as well as a pump spray bottle filled with brake cleaner. Essentially the autopsy revealed a cerebral oedema with encephalomalacia, no coagulated blood as well as increased blood and tissue fluid content of the lung. Toxicological analysis revealed brake cleaner fluid in the lung, gastric content and heart blood.

Comparative lipidomic analysis of synovial fluid in human and canine osteoarthritis.

OBJECTIVE: The lipid profile of synovial fluid (SF) is related to the health status of joints. The early stages of human osteoarthritis (OA) are poorly understood, which larger animals are expected to be able to model closely. This study examined whether the canine groove model of OA represents early OA in humans based on the changes in the lipid species profile in SF. Furthermore, the SF lipidomes of humans and dogs were compared to determine how closely canine lipid species profiles reflect the human lipidome. METHODS: Lipids were extracted from cell- and cellular debris-free knee SF from nine donors with healthy joints, 17 patients with early and 13 patients with late osteoarthritic changes, and nine dogs with knee OA and healthy contralateral joints. Lipid species were quantified by electrospray ionization tandem mass spectrometry (ESI-MS/MS). RESULTS: Compared with control canine SF most lipid species were elevated in canine OA SF. Moreover, the lipid species profiles in the canine OA model resembled early OA profiles in humans. The SF lipidomes between dog and human were generally similar, with differences in certain lipid species in the phosphatidylcholine (PC), lysophosphatidylcholine (LPC) and sphingomyelin (SM) classes. CONCLUSIONS: Our lipidomic analysis demonstrates that SF in the canine OA model closely mimics the early osteoarthritic changes that occur in humans. Further, the canine SF lipidome often reflects normal human lipid metabolism.

The role of histopathology in forensic practice: an overview.

The role of forensic histopathology in routine practice is to establish the cause of death in particular cases. This is achieved on the basis of microscopic analysis of representative cell and tissue samples taken from the major internal organs and from abnormal findings made at autopsy. A prerequisite of this is adherence to the quality standards set out for conventional histological/cytological staining and enzyme histochemical and immunohistochemical methods. The interpretation of histological findings is performed by taking into account macroscopic autopsy findings and information on previous history. Histological analysis may prompt postmortem biochemical and chemical-toxicological investigations. The results of histological analysis need to be classified by experts in the context of the available information and the need to withstand the scrutiny of other experts.

Widespread pulmonary granulomatosis following long time intravenous drug abuse--a case report.

Foreign body granulomas in the lungs following acute singular or long time intravenous drug abuse are frequent findings during microscopic investigation of the lungs. Most cases present single granulomas. Cases with multiple foreign body granulomas, already palpable during autopsy and leading to pulmonary granulomatosis with multiple granulomas are less frequent. We report the case of a 32-year old man, dying suddenly and unexpectedly after a well-known history of drug abuse for more than a decade. The granulomas are caused by foreign particle embolization immediately after intravenous injection of not only the drug itself but also of adulterants, e.g. cotton fibers, potato starch or microcrystalline cellulose. At the end, a reduction in the size of the pulmonary bed had occurred followed by pulmonary hypertension. For the first time, lung dust in such a case was characterised by energy dispersive X-ray (EDX).

Cardiomyopathies--misdiagnosed as Sudden Infant Death Syndrome (SIDS).

Cardiomyopathies are an important and heterogenous group of diseases. With the identification of several new disease entities over the past decade, advances in diagnosis and precise causation, some disease definitions have become outdated. The past decade has witnessed a rapid evolution of molecular genetics in cardiology, e.g. myocardial diseases (Hypertrophic cardiomyopathy-HCM, Arrhythmogenic right ventricular cardiomyopathy-ARVCM) and channelopathies (Long QT syndrome-LQTS, Brugada syndrome-BrS, Catecholaminergic Polymorphic Ventricular Tachycardia-CPVT and Short QT syndrome-SQTS) as diseases predisposing to potentially lethal ventricular tachyarrhythmias. Beside the detection of mutations in several genes, histological and immunohistochemical findings can point to a cardiomyopathy as underlying disease. Therefore, previous microscopical investigations of different parts of the myocardium can help to select those cases of suspected Sudden Infant Death Syndrome (SIDS), where a search for genetic mutations can lead to a diagnosis explaining the sudden and unexpected death.

Lethal enterovirus-induced myocarditis and pancreatitis in a 4-month-old boy.

After inconspicuous pregnancy and birth, a 16-year-old mother presented her male baby 5 days later with severe diarrhoea and vomiting. During the following weeks, the child temporarily showed hypotension, hypothermia and increased body temperature, bradyarrythmia with apnoea, continuing diarrhoea, sometimes vomiting and developed signs of pancreatic insufficiency. Due to increasing loss of weight and obviously severe dystrophia, parenteral nutrition had to be initiated. All clinical investigations revealed no underlying disease. Numerous biopsies, mainly from the gastrointestinal tract were taken, but no relevant pathological findings were disclosed. The baby was found lifeless by his mother, 4 months after birth. According to the death certificate, the physicians regarded the lethal outcome as a case of sudden infant death syndrome (SIDS). Histological and immunohistochemical investigations of organ samples revealed signs of myocarditis, pancreatitis and focal pneumonia. Molecularpathological techniques were used to detect enterovirus RNA from tissue samples from the myocardium, liver and pancreas. Enteroviral myocarditis with concomitant pancreatitis was determined as cause of death.

Two simultaneous suicidal gunshots to the head with robbed police guns.

The suicidal infliction of two gunshot wounds to the head represents a critical issue for medicolegal investigation. In principle, simultaneous infliction with two firearms or third parties' involvement, i.e. two consecutive gunshots, have to be considered. We report for the first time on a case of suicidal infliction of two simultaneous gunshots to the head (oral, temporal) with Action 4 expanding ammunition. A male had robbed two service guns and committed suicide thereafter under the influence of high-dose alcohol and cocaine. Interestingly, Action 4 ammunition had been used, leading to an uncommon gunshot wound morphology and extensive backspatter. At the scene, these findings caused confusion; moreover, the number of gunshot wounds was unclear, until autopsy revealed two gunshot wounds to the head, which had obviously been inflicted simultaneously. Expanding ammunition like QD-PEP and Action 4, used by several German federal state police forces, can cause an atypical gunshot wound morphology, most probably due to its peculiar deformation behaviour. Investigators should be careful when interpreting gunshot wound morphology at the scene after usage of such expanding ammunition. With regard to reconstruction in cases of two gunshot wounds to the head and two guns at the scene, two simultaneous gunshots should be taken into consideration.

Spinal epidural haematoma after blunt trauma to the neck and hyperflection of the cervical spine.

Spinal epidural haematomas (sEDH) can be regarded as rare events, in principle a spontaneous and a traumatic aetiology can be distinguished. Spontaneous spinal epidural haematomas can arise, e.g. from vascular malformations, coagulopathies, etc. On the other hand, traumatic sEDH are related to, e.g. spinal trauma or intraoperative vascular injuries. With regard to clinical significance, spinal epidural haematomas accompanied by transient mild neurological symptoms up to lethal outcomes have been observed. We report on a 53-year-old male alcoholic who was found in the kitchen of his asylum in a grotesquely fixed body position, with his head and cervical spine in a maximum anteflected position. A general practitioner had ruled for a non-natural manner of death due to "broken neck" and alcohol intoxication, therefore, the prosecution authorities called for a medicolegal autopsy. At autopsy, paravertebral soft tissue haemorrhage in between the shoulder blades was disclosed. Furthermore, a spinal epidural haematoma, extending from the foramen magnum down to the middle portion of the thoracic spine was found. No fractures of vertebrae nor lesions of spine ligaments or bleedings of intervertebral discs were found. Blood alcohol concentration was determined 1.92 g/l and urine alcohol concentration was 1.76 g/l. Further morphological findings were cerebral oedema and cardiac hypertrophy; the urinary bladder was found filled to bursting. Neuropathological investigations confirmed the presence of the spinal epidural haematoma and assigned lethal significance to this finding. There were no histological signs of axonal injury. Reconstruction revealed that when sitting on a chair in a drunk condition, the individual's upper part of the body had fallen backwards in the corner and subsequently got stuck with maximum anteflection of the head and cervical spine, causing rupture of vessels and spinal epidural haematoma. Acute respiratory failure caused by impairment of the phrenic nerve following spinal epidural haematoma with potential synergism of alcohol intoxication was ascertained as the cause of death.