International journal of legal medicine
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Shotguns are usually used to fire multiple pellets, but they are capable of firing single projectiles. Shotgun slug injuries are rare, severe, and fully comparable to those inflicted by high-velocity projectiles. A case of gunshot suicide of a 59-year-old man with a shotgun loaded with shotgun slugs is presented. ⋯ The man was able to reload and refire. The third shot was fired into the region of right temple; the last shot caused severe cerebrocranial gunshot injury and was fatal. The victim did not pull aside his clothing to expose his skin before shooting into the heart region.
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An 80-year-old woman was intubated with a spiral endotracheal tube via a tracheal stoma during an arytenoidectomy. After being connected to the ventilator, the victim quickly became cyanosed, showed a decrease in blood pressure, and fell into cardiopulmonary arrest. Despite continuous resuscitation, the victim died. ⋯ Tracheal perforation is a rare, but life-threatening complication following a tracheostomal intubation. The inappropriate use of a tracheal tube stylet, guiding catheter, dilating forceps, and oversize tracheal tube have been demonstrated to cause airway injuries. However, fatal incorrect intubation with a spiral endotracheal tube via a tracheal stoma that resulted in death has not been reported previously.
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Case Reports
Fatal and severe codeine intoxication in 3-year-old twins--interpretation of drug and metabolite concentrations.
This work presents two cases of codeine intoxication in 3-year-old monozygotic twin brothers while treated with a codeine slow-release formulation. One child had to be admitted to the hospital, whereas the other one died at home after aspiration of gastric content. The concentrations of codeine and major metabolites including morphine and corresponding glucuronide conjugates were measured by liquid chromatography-tandem mass spectrometry in serum, urine, cerebrospinal fluid, and brain tissue, respectively. ⋯ High concentrations of all substances were found in samples of both children. The pharmacokinetic estimate suggests an overdose of codeine, and the possible reasons for the high opiate concentrations are discussed. Furthermore, the postmortem distribution--during and after resuscitation--might play a major role in the interpretation of postmortem concentration levels.
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Case Reports
Forensic application of ESEM and XRF-EDS techniques to a fatal case of sodium phosphate enema intoxication.
Sodium phosphate enemas and laxatives are widely used for the treatment of constipation, even if a number of cases of significant toxicity due to alterations of the fluid and electrolyte equilibria (hypernatremia, hyperphosphatemia, and hypocalcemia) have been reported. We present the case of an 83-year-old man who died of fecal and chemical peritonitis secondary to an iatrogenic colon perforation (produced performing a Fleet enema through the patient's iliac colostomy) with peritoneal absorption of sodium phosphate. Environmental scanning electron microscopy coupled with an X-ray fluorescence energy dispersive spectrometry discovered multiple bright crystals formed of calcium, phosphorus, and oxygen in the brain, heart, lung, and kidney sections of the victim. The absence of these kinds of precipitates in two control samples chronically treated with Fleet enemas led us to assume that the deceased had adsorbed a great quantity of phosphorus ions from the peritoneal cavity with subsequent systemic dissemination and precipitation of calcium phosphate bindings.
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The authors report the case of a death which occurred during wild boar hunting. The scene details revealed that the victim and the beast were aligned in the visual shooting path and the victim had been struck by overpenetrating bullet shot by his friend on the neighbouring stand. The fatal entrance wound was on the victim's left chest. The authors emphasise the importance of the exhaustive forensic investigation, including autopsy of the beast, in cases like this, in order to distinguish accident from homicide.