Michael Graham

Chlorocarbons in adipose tissue from a Missouri population

Abstract Specimens of abdominal wall adipose tissue from 35 individuals who died in St. Louis, MO, were analyzed by an isomer-specific GC/MS technique for 2, 3, 7, 8-substituted tetra- through octachlorodibenzodioxins and tetra- and pentachlorodibenzofurans. Detectable amounts of all compounds were found in all specimens; quantification could be carried out on seven of them. Concentrations correlate positively with age; acceptable linear correlations were found between the tetra- and pentachlorodibenzodioxin and pentachlorodibenzofuran concentrations and age. The pattern of concentrations found is consistent with airborne particulates being the ultimate source of these compounds.

Phencyclidine and violent deaths in St. Louis, Missouri: a survey of medical examiners' cases from 1977 through 1986

A survey of 104 deaths involving phencyclidine (PCP) occurring from 1981 through 1986 in metropolitan St. Louis, Missouri, is presented. Four black males (22-33 yr) died from fatal PCP intoxication. PCP was detected in an additional 100 deaths: 81 homicides, 13 suicides, and 6 accidental deaths. Seventy-five of these deaths were homicides of Black males (mean age 27 years) typically dying from gunshot wounds, 64 cases. In 50% of deaths where PCP was detected, other drugs were co-administered: ethanol (35%) and cocaine (20%) being the most common mixtures. A dramatic continuous increase in PCP abuse from 1984 through 1986 was demonstrated by drug abuse indicator data: treatment admissions, emergency room episodes, police exhibits, and driving under the influence of PCP arrests. Increased abuse of PCP in St. Louis has been associated with increased medical emergencies and violence against persons.

Unexpected Deaths Due to Colloid Cysts of the Third Ventricle

Colloid cysts of the third ventricle are rare central nervous system tumors that are a recognized cause of unexpected death in young, otherwise healthy adults and children. We report three adults and one child who died from colloid cysts of the third ventricle. Our report illustrates the difficulties of diagnosing these tumors premortem.

Double pituitary glands with partial duplication of facial and fore brain structures with hydrocephalus

A female term infant was born with multiple bony and facial abnormalities involving the mandible, palate, tongue, nasopharynx, vertebrae, ribs and brain. Death occurred at 1 week and a rare combination of forebrain anomalies, were found in a big head, with complete agenesis of the corpus callosum with duplication of the infundibulum, pituitary, anterior third ventricle and aqueduct. The CAT scan was diagnostic of agenesis of corpus callosum. Incomplete twinning or incompetent neural induction with genetic and epigenetic factors have been suggested as possible mechanisms responsible for this rare malformation.

Sudden Death in Hemodialysis Patients

Hemodialysis patients may die suddenly and unexpectedly from a number of causes. These may be divided into those deaths due directly to and occurring during hemodialysis, those deaths occurring while the patient is not undergoing dialysis, and those deaths that may occur at any time. The first group includes brain herniation, air embolism, acute hemorrhage as a result of machine malfunction or fistula rupture, electrocution, cardiac arrhythmia caused by hypokalemia, complications of subclavian intravenous catheter insertion, third-degree heart block as a result of triglyceride emulsion, and disseminated intravascular coagulation (DIC) or hyperkalemia caused by overheated dialysate. The second group includes deaths due to pericardial tamponade because of effusion and suicidal causes of death (exsanguination, electrolyte imbalance as a result of excessive intake of salt, fluid, or potassium) as well as more conventional methods of suicide. The last category includes people dying of arteriosclerotic cardiovascular disease, hypertensive cardiovascular disease, and internal hemorrhage. Investigation of these deaths, including pertinent historical, laboratory, and autopsy data and investigation of dialysis equipment, is discussed.

An unsuspected arsenic poisoning murder disclosed by forensic autopsy

An unsuspected case of homicidal arsenic poisoning, clinically thought to be a primary hematopoietic disorder, was uncovered by an expanded toxicologic screen which is performed in all medical examiners cases in which the decedent displays gastrointestinal symptoms prior to death. Arsenic concentrations were: blood, 7.2 mg/liter; liver, 15 mg/kg; and kidney, 6 mg/kg.

A Case of Suicide Involving the Concomitant Intravenous Injection of Barbital and Oral Ingestion of Arsenic

A case of suicide involving the intravenous injection of barbital and the oral ingestion of arsenic trioxide is reported. The pathologic and toxicologic findings are discussed.

Unexpected death as a result of infective endocarditis.

Thirteen cases of infective endocarditis (IE) diagnosed for the first time at autopsy or, in those patients with a previous diagnosis of IE, not thought to be active at the time of death, are presented. Of the six patients who died within 24 h of the onset of symptoms, two died of obstruction of a valve orifice, two died of sepsis, one died of sepsis and alcoholic cardiomyopathy, and one died of a coronary artery embolus. Of the five patients with symptoms lasting more than 24 h, three died of sepsis and congestive heart failure. One died from sepsis alone and one died from congestive heart failure (CHF). In two patients whose duration of symptoms is unknown, one died of sepsis and CHF, and in the other the mechanism of death is unknown. Predisposing factors present in 11 of 13 patients included alcoholism (three), intravenous (IV) drug abuse (three), prosthetic valves (three), aortic stenosis (two), past rheumatic fever (one), and nonstenotic congenitally bicuspid valves (two). The reasons for no antemortem diagnosis were a missed or incorrect clinical diagnosis in three patients seen by a physician shortly before death, no signs or symptoms or found dead (four), non-specific signs and symptoms (three), refusal of medical treatment (one), and a solitary lifestyle (one); there was insufficient information about one patient. Individuals with needle tracks, generalized petechiae. Oslers nodes, splinter hemorrhages, intravenous catheters, pacemaker wires, and infected aortic-valve (A-V) shunts are at risk of IE. Blood and the vegetations should be cultured. The attending physician should be notified of the diagnosis in such cases.

Investigation of Deaths Temporally Associated with Law Enforcement Apprehension

The investigation of a death that occurs in custody requires a careful and methodical approach since concerns of police or institutional misconduct may be raised. The medicolegal official charged with the investigation and ultimate certification of death bears heavy responsibility to the decedents family, the public, law enforcement and other institutions. A wide variety of causes of death and manners of death are seen in these deaths. This paper reviews causes, mechanisms, manners, findings, and evaluation of persons who have died in temporal relation to legal apprehension.

The stability of electrically induced ventricular fibrillation

The first recorded heart rhythm for cardiac arrest patients can either be ventricular fibrillation (VF) which is treatable with a defibrillator, or asystole or pulseless electrical activity (PEA) which are not. The time course for the deterioration of VF to either asystole or PEA is not well understood. Knowing the time course of this deterioration may allow for improvements in emergency service delivery. In addition, this may improve the diagnosis of possible electrocutions from various electrical sources including utility power, electric fences, or electronic control devices (ECDs) such as a TASER® ECD. We induced VF in 6 ventilated swine by electrically maintaining rapid cardiac capture, with resulting hypotension, for 90 seconds. No circulatory assistance was provided. They were then monitored for 40 minutes via an electrode in the right ventricle. Only 2 swine remained in VF; 3 progressed to asystole; 1 progressed to PEA. These results were used in a logistic regression model. The results are then compared to published animal and human data. The median time for the deterioration of electrically induced VF in the swine was 35 minutes. At 24 minutes VF was still maintained in all of the animals. We conclude that electrically induced VF is long-lived - even in the absence of chest compressions.