Accidental carbon dioxide poisoning due to dry ice during a funeral wake: An autopsy case.

We report the autopsy case of a male in his 60 s diagnosed with carbon dioxide (CO2) poisoning caused by dry ice for cooling in a coffin during a funeral wake. He was last seen alive, clinging to his family member's body with his head inside the coffin. The autopsy and histological findings did not indicate a specific cause of death. To confirm the concentrations of CO2 and oxygen (O2) in the coffin, an experiment was conducted to reconstruct the scene. Based on the experimental results, 9 h after placing dry ice, the CO2 concentration at the estimated closest point to his head was 24%, a lethal level for CO2 poisoning. Contrastingly, although the concentration of O2 had fallen, it never reached a lethal concentration at any of the determination points during the experiment, thereby ruling out asphyxia as a cause of death. Based on our findings, we concluded that the cause of his death was CO2 poisoning. Forensic pathologists tend to overlook CO2 poisoning unless suspected, as it does not exhibit specific autopsy findings. For the diagnosis of CO2 poisoning, it is essential to collect detailed information about the deceased and the scene of death. The toxicity of CO2 itself is not well known, although dry ice is widely available to the public. In order to make its risk well known, it is necessary to inform people about the dangers of using dry ice.

Suicide by Gaseous Displacement of Atmospheric Oxygen With Carbon Dioxide From Dry Ice Sublimation.

ABSTRACT: Deaths from gaseous substances can occur from exposure to toxic gases or from accumulation of nontoxic gases that displace oxygen. We present a 38-year-old man with no known medical history, who was found deceased in a small bathroom with blankets and towels shoved under the door from the inside.At autopsy, the decedent was found to be in a moderate state of decomposition. There was mild pulmonary congestion, with no other significant findings. Standard postmortem toxicology on femoral blood was noncontributory.A search of the decedent's cell phone revealed statements and internet searches regarding carbon dioxide (CO 2 ) and asphyxia using dry ice. A journal entry also outlined a suicide plan using large amounts of dry ice, which was enacted by placing a laundry basket of dry ice into a bathtub containing water. Based on the investigation, the cause of death was determined to be asphyxia from displacement of oxygen with CO 2 .Dry ice sublimates into gaseous CO 2 , which quickly accumulates, with concentrations of 10% or more, rapidly becoming life-threatening. There are no pathognomonic autopsy findings seen in CO 2 -related asphyxia. In these circumstances, scene investigation is the most important factor in determining cause of death.

Full-thickness wounds resulting from 'do-it-yourself' cryolipolysis: a case study.

This report reviews the case of a 55-year-old woman who suffered frostbite while attempting a 'do-it-yourself' version of cryolipolysis without the guidance of a medical professional. Cryolipolysis is a well-understood process through which the careful application of below-freezing temperatures is used to induce adipose cell death while sparing the skin, reducing body fat. This patient used dry ice in lieu of professional medical equipment, resulting in 4% total body surface area full- and partial-thickness wounds to her abdomen. Ultimately, the more superficial wounds healed with xenograft and a silver-impregnated dressing. The superior, deeper wound was excised and primarily closed with a fleur-de-lis panniculectomy. Her hospital course and recovery were uneventful. This case illustrates how online information of dubious quality can put the uneducated patient at risk of injury. Health-care professionals should be aware of the questionable resources available online, and should help patients become more discerning consumers of online information. Strategies to prevent such injury should be developed on a national scale.

Sarcomatoid carcinoma arising in the congenital pigmented nevus after treatment with carbon dioxide snow freezing method.

We report a case of sarcomatoid carcinoma of the skin in a 63-year-old man who was treated with the carbon dioxide snow freezing method for a huge congenital pigmented nevus that extended from the right upper extremity to the right trunk during childhood. He had an exophytic red tumor on the nevus in the right upper extremity that grew slowly for 4 years and rapidly recently. Histological and immunohistochemical studies revealed both epithelial and mesenchymal malignancy in the same tumor. The epithelial component was composed of basaloid cells forming multiple nests with peripheral palisading, positive for keratins and BerEP4, implying basal cell carcinoma. The mesenchymal component was composed of spindle-shaped cells negative for keratins and positive for vimentin, suggesting sarcoma. This is, to our knowledge, the first report of sarcomatoid carcinoma arising in the primary pigmented nevus that had been treated by the carbon dioxide snow freezing method.

Suicide by carbon dioxide.

Suicides by self-poisoning are common in all parts of the world. Among these intoxications, gases are rarely used, especially carbon dioxide (CO2). Very few cases of self-inflicted and deliberate carbon dioxide poisonings have been reported. This paper presents two uncommon suicides by carbon dioxide intoxication. In one case, a 53-year-old man tightly sealed a small bathroom and locked himself in it likely with dry ice. Warning notices were tagged to the door. In another case, a 48-year-old man working in a restaurant committed suicide by closing himself in a walk-in refrigerator and opening the stored carbon dioxide containers intended for the beverage dispensing equipment. The limited possibilities of proving lethal CO2 intoxications post-mortem necessitate a close cooperation of the involved parties during investigation. Only the synopsis of all findings permits a sound assessment regarding the manner and cause of death.

Fatality in a wine vat.

Intoxication with carbon dioxide (CO2), a nonexplosive, colorless, and odorless gas does not cause any clinical symptoms or signs, with the occasional exception of sudation. Carbon dioxide is principally used in the food industry (70% of CO2 production), in particular to preserve foods and to carbonate beverages. Most fatalities resulting from CO2 intoxication are accidental and occur either in closed spaces or when dry ice is used in the food industry. In this case report, a 42-year-old male winemaker engineer was found dead, his head inside a wine vat that had been filled with grapes on the previous day and supplemented with dry ice to improve the taste of wine.

Oral frostbite due to dry ice.

OBJECTIVES: Dry ice is a commercially available cryogen that is used worldwide. It may cause frostbite if misused. However, frostbite of the oral cavity due to dry ice has not been previously reported. Here, we describe the first case of dry ice-induced frostbite of the oral cavity. METHODS: We present a case of oral frostbite due to dry ice and subsequent swelling of the submandibular area and lower lip. We discuss the clinical features of oral frostbite due to volatile substance abuse. RESULTS: Oral frostbite not only may result in the impairment of the affected mucosae directly, but also may adversely affect the tissues in the vicinity of the oral cavity floor indirectly. Oral frostbite may cause edema of the upper airway tract. In case of severe pharyngolaryngeal edema, either tracheal intubation or tracheostomy is necessary. Steroids and antibiotics may be effective in preventing the development of pharyngolaryngeal edema. CONCLUSIONS: It is important to bear in mind that volatile substance abuse may possibly induce unusual events. In particular, special attention should be paid to delayed unusual events.

A pharmacodynamic investigation into the efficacy of osteoprotegerin during aseptic inflammation.

BACKGROUND: Osteoprotegerin (OPG), as an osteoclast antagonist, limits mineralised tissue resorption under physiological conditions. Previous work investigating OPG in a rat periodontal ligament (PDL) ankylosis model found no inhibitory effect on osteoclasts when OPG was administered at a dosage of 2.5mg/kg. AIMS: The object of this study was to determine whether dosages higher than 2.5 mg/kg of OPG were required to limit osteoclastic activity in an aseptic inflammatory model in rats. MATERIALS AND METHODS: Dry ice was applied for 15 minutes to the upper right first molar crown of eighteen, 8-week-old, male Sprague-Dawley rats. Three groups of 3 were injected with OPG at dosages of 2.5, 5.0 and 7.5 mg/kg of body weight immediately following the thermal insult. After 7 days, the rats were sacrificed and each maxilla processed for histological examination and stained for osteoclastic activity using tartrate-resistant acid phosphatase (TRAP). Osteoclast population numbers were estimated via light microscopy and results were analysed using a comparative mixed model statistical analysis. RESULTS: Results showed OPG inhibited osteoclastic activity in a dose-dependent manner. From 2.5 mg/kg to 7.5 mg/kg, osteoclast populations were linearly reduced by 39.78% (p < 0.05). OPG did not appear to affect the inflammatory process and had varied efficacy in different regions of individual teeth. CONCLUSION: Although osteoclastic activity reduced, it was not completely eliminated, perhaps because dosages were still inadequate, or additional factors might influence OPG and osteoclast activation in the aseptic inflammatory model.

Frostbite injury of the foot from portable fire extinguisher.

Frostbite burns are uncommon and their etiologies are varied. We present a case of sudden frostbite burn of the left foot caused by carbon dioxide. The circumstances of this injury and preventive measures are discussed.

[Suicide case of carbon dioxide poisoning using dry ice].

We had a suicide case suspected to result in death from carbon dioxide poisoning by dry ice in the car. A clay cooking stove with charcoal was in the car, but the charcoal had no burning sign. CO hemoglobin saturation degree of the suicide victim's blood was 0%. Moreover, there were signs that 50 kg of dry ice was brought in the car. To clarify the cause of death, reproducibility testing was carried out by using a car under the same conditions. CO2 concentration in it increased to 22% and O2 concentration decreased to 16% within 20 minutes. From these observations, his death was considered to be caused by hypoxia and CO2 narcosis. CO2 in the suicide victim's blood was higher than those in the blood of healthy persons, and the same range was visible in the blood of fire victims. These data might support above supposition concerned with the cause of death. Blood analysis will be helpful in clearing the cause of death by CO2 poisoning.

A carbon dioxide fatality from dry ice.

This report documents a rare case of carbon dioxide intoxication in a young healthy male. The deceased hid in a small plastic container, size 1.5 x 1 x 1 m, and within 5 min he was located suffering convulsions and was reported as dead within minutes. Scene investigation revealed dry ice in the container. Autopsy findings were unremarkable. The probable cause of the convulsions was carbon dioxide intoxication due to both the dry ice sublimation and the small confined space in which he was hiding. This report emphasizes the significance of scene investigation in establishing the cause of the death.

Asphyxiation due to dry ice in a walk-in freezer.

BACKGROUND: Exposure to a high concentration of environmental carbon dioxide (CO2) can result in poisoning through direct toxicity and by displacing atmospheric oxygen (O2). Dry ice undergoes sublimation to a gaseous state at -78.5 degrees C (-109.3 degrees F), which is heavier than air and can accumulate in dependent areas. CASE REPORT: We report the case of a 59-year-old man found in cardiac arrest shortly after entering a recently repaired walk-in freezer that contained dry ice. First responders and bystanders did not recognize the proximate hazardous environment but were fortunately uninjured. A careful Emergency Department history coupled with rapid case investigation by the Medical Examiner's Office led to the determination of the cause of death and the elimination of the ongoing hazard. CONCLUSION: This case illustrates the lethal consequences of improper storage of dry ice and the need to consider toxic environmental exposure as a cause of sudden cardiac arrest.

Arpp/Ankrd2, a member of the muscle ankyrin repeat proteins (MARPs), translocates from the I-band to the nucleus after muscle injury.

Ankyrin-repeat protein with a PEST motif and a proline-rich region (Arpp), also designated as Ankrd2, is a member of the muscle ankyrin repeat proteins (MARPs), which have been proposed to be involved in muscle stress response pathways. Arpp/Ankrd2 is localized mainly in the I-band of striated muscle. However, it has recently been reported that Arpp/Ankrd2 can interact with nuclear proteins, such as premyelocytic leukemia protein (PML), p53 and YB-1 in vitro. In this study, to determine whether nuclear accumulation of Arpp/Ankrd2 actually occurs, we performed an immunohistochemical investigation of gastrocnemius muscles that had been injured by injection of cardiotoxin or contact with dry ice. We found that Arpp/Ankrd2 accumulated in the nuclei of myofibers located adjacent to severely damaged myofibers after muscle injury. Double-labeled immunohistochemistry revealed that Arpp/Ankrd2 accumulated in the nuclei of sarcomere-damaged myofibers. Furthermore, we found that Arpp/Ankrd2 tended to be localized in euchromatin where genes are transcriptionally activated. Based on these findings, we suggest that Arpp/Ankrd2 may translocate from the I-band to the nucleus in response to muscle damage and may participate in the regulation of gene expression.