International journal of legal medicine
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As a rapid-acting dissociative anesthetic, ketamine has been used in drug-facilitated crimes. The aim of this study is to investigate the disposition of ketamine and its main metabolite norketamine in hair after a single dose of ketamine. Four healthy volunteers were recruited into the study. ⋯ Except for the first week, the ratio of ketamine to norketamine in most of segments (87.5%) was greater than 1. All the cotton swab samples collected at 24 and 48 h were positive. The results from cotton swabs and the concentrations of ketamine and norketamine in hair segments collected at different times showed that some of ketamine and norketamine incorporated into hair originated from sweat and sebum on the scalp of the subjects.
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Cardiomyopathies and channelopathies are major causes of sudden cardiac death. The genetic study of these diseases is difficult because of their heterogenic nature not only in their genetic traits but also in their phenotypic expression. The purpose of the present study is the analysis of a wide spectrum of previously known genetic mutations in key genes related to hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), and Brugada syndrome (BrS) development. ⋯ Three different mutations were found in six of the 19 LQTS patients, representing three families and two different mutations were found among six patients with previous syncope. Genetic analysis in sudden cardiac death cases could help to elucidate the cause of death, but it also can help in the prevention of future deaths in families at risk. The study presented here shows the importance and relevance of genetic screening in patients with signs of cardiac hypertrophy and in family cases with more than one relative affected.
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Suicidal shots fired simultaneously to the head from two handguns are rare. The authors report about a recent case in which a Smith & Wesson cal. 9 mm pistol and a Smith & Wesson cal. .357 Magnum revolver were used. ⋯ An upside-down muzzle imprint in the left temporal region and recoil injuries of a mandibular incisor, and the lower lip indicated that both the pistol and the revolver had been held in an inverted manner at the time of discharge. Blood stains (backspatter) and gunshot residues were present on both firing hands, whereas forward spatter originating from the exit wounds was deposited on the wall behind the suicide's head.
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Case Reports
Assault-induced Takotsubo cardiomyopathy associated with persisting anterograde amnesia and myopathy.
Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction, electrocardiographic changes, and minimal release of myocardial enzymes that mimic acute myocardial infarction in patients without coronary artery disease. Takotsubo cardiomyopathy is frequently triggered by emotional or physical stress and occurs primarily in post-menopausal women. The pathomechanism of Takotsubo cardiomyopathy is, so far, unknown. ⋯ Follow-up after 8 weeks showed a regression of electrocardiographic and echocardiographic abnormalities; the amnesia for the assault, however, remained unchanged. This case shows that Takotsubo cardiomyopathy may be triggered by emotional stress induced during an assault. Assault-induced stress may not only induce Takotsubo cardiomyopathy but also amnesia for some of the events that occurred during the act.
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Up to 22 % of all child maltreatment cases involve non-accidental burns or scalds. In the time period of 2000 until 2007, 20 children with non-accidental burns and scalds in conjunction with other mechanisms of injury were examined at children's hospitals in Hamburg and at the Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, by experts in forensic medicine. The fact that these children presented with additional injuries due to blunt and sharp force and sometimes had signs of neglect emphasize the urgent need for a multidisciplinary cooperation between pediatricians and forensic medical experts to ensure the early identification and prevention of child maltreatment. A new approach for Germany, enforcing mandatory child well-being examinations is discussed.