Suicide is a complex phenomenon associated with psychological, biological, and social factors, claiming approximately 30,000 lives each year in the United States. We retrospectively reviewed all cases referred to the Medical Examiners' Office/Forensic Pathology Section at the Medical University of South Carolina from January 1988 to December 1997. The cases of suicide totaled 678. All of the cases were analyzed as to age/race/sex, method of suicide, time of year, and toxicological results. Files were also reviewed to determine if the victim left behind a suicide note. The ages ranged from 12 to 94 years; males comprised 79.5% of the victims, and whites 78.3%. The male to female and white to black ratios were both 3.9:1. The most common methods were gunshot wounds, accounting for 64.6% of the cases. No correlation existed with time of year, and the number of cases was not increased around major holidays. The group of victims 65 years and older and the pediatric group under the age of 18 were also examined separately.

The survival of spermatozoa and the persistence of prostatic acid phosphatase has been an area of interest for investigators of sexual assault. However, not much documentation exists concerning the examination of a deceased individual with regard to the postmortem interval and presence of such evidence. The authors reviewed cases referred to the medical examiner's office during a 10-year period. During this time, 199 cases were both autopsied and examined for sexual assault. In particular, these examinations included procurement of swabs for Papanicolaou staining of smears and for quantitation of prostatic acid phosphatase. Most of the victims were female, although a few were male. In the majority of cases, the swabs for smears and prostatic acid phosphatase were taken from oral, vaginal, and anorectal areas in females and oral and anorectal areas in males. The smears all were stained with the routine Papanicolaou stain, and intact spermatozoa and spermatozoan heads were sought. The prostatic acid phosphatase was analyzed by the microparticle enzyme immunoassay method and reported as ng/ml. A level of greater than 100 ng/ml was considered positive. The cases were analyzed with respect to postmortem interval; presence or absence of intact spermatozoa or spermatozoan heads; presence of an elevated prostatic acid phosphatase; body location of the specimen; the time of year; location of the victim; and physical injury (anogenital) of sexual assault. The authors hope that by examining the laboratory evidence of sexual assault, a correlation can be drawn between the presence or absence of such evidence and the aforementioned variables.

Anaphylactic reactions involve contact with an antigen that evokes an immune reaction that is harmful. This type of reaction is a rapidly developing immunologic reaction termed a type I hypersensitivity reaction. The antigen complexes with an IgE antibody that is bound to mast cells and basophils in a previously sensitized individual. Upon re-exposure, vasoactive and spasmogenic substances are released that act on vessels and smooth muscle. The reaction can be local or systemic and may be fatal. The authors report the death of a 19-year-old white male who had a history of "multiple allergies," including pets, molds, and penicillin. One morning, he and his friends made pancakes with a packaged mix that had been opened and in the cabinet for approximately 2 years. The friends stopped eating the pancakes because they said that they tasted like "rubbing alcohol." The decedent continued to eat the pancakes and suddenly became short of breath. He was taken to a nearby clinic, where he became unresponsive and died. At autopsy, laryngeal edema and hyperinflated lungs with mucous plugging were identified. Microscopically, edema and numerous degranulating mast cells were identified in the larynx. The smaller airways contained mucus, and findings of chronic asthma were noted. Serum tryptase was elevated at 14.0 ng/ml. The pancake mix was analyzed and found to contain a total mold count of 700/g of mix as follows: Penicillium, Fusarium, Mucor, and Aspergillus. Witness statements indicate that the decedent ate two pancakes; thus he consumed an approximate mold count of 21,000. The decedent had a history of allergies to molds and penicillin, and thus was allergic to the molds in the pancake mix. The authors present this unusual case of anaphylaxis and a review of the literature.

A N ELDERLY WHITE woman died in the care of a male friend who was her caretaker for the past year. She was found in her bed, unresponsive, and the police were notified. Upon arrival, the police found her in the bed on top of dirty, soiled linens. Fecal material and areas of urine staining were present, each in excess of what would be expected from agonal defecation and urination. Her physician refused to sign the death certificate because he had not seen her in 2 years, and previously she had been doing well. He could not think of a clear cause of death since her medical history was significant only for senile dementia and osteoporosis during the past 4 years. The male friend was considered the next of kin, and he desperately wanted to complete the paperwork for burial and insurance purposes. The physician agreed to sign the death certificate if a complete autopsy was performed. The body was taken from the home to the autopsy room. AUTOPSY FINDINGSAt autopsy, the decedent was noted to be cachectic, with dried fecal material between her buttocks. She appeared dehydrated, with tenting of the skin and sunken eyes. Decubitus ulcers were present over the sacral and inferior buttocks regions. The ulcers extended through the skin, subcutaneous soft tissue, and skeletal muscle down to the bone. The femoral head could be visualized on the right side. The surrounding tissue was friable and necrotic, and necrosis and inflammation were confirmed by microscopic examination. A yellow-tan exudate was present within the ulcers and was cultured by the pathologists. Blood was also drawn for culture. Both the blood culture and wound exudate culture were positive for Pseudomonas aeruginosa. Vitreous was drawn for analysis of electrolytes and the results showed dehydration with an increase in sodium, chloride, and urea nitrogen levels. Other findings included cerebral atrophy with remote ischemic changes microscopically.The cause of death statement was prepared as follows: COMMENTEach year approximately 10% of adults 65 years and older are abused, and 4% experience moderate to severe abuse.

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