A 73-year-old man developed nausea, vomiting, and diarrhea 20-30 min after receiving a 1.0 mg intravenous dose of colchicine for the treatment of severe pain due to gouty arthritis in his physician's office. He was hospitalized 8 h later, and his condition deteriorated as he developed renal and respiratory failure. He subsequently died 10 h later, or a total of 18 h after he received the original 1 mg colchicine injection. The patient received a prescription for oral 0.6 mg colchicine tablets 8 days previously and consumed eight tablets during that period, an average of 0.6 mg/day (42 of 50 tablets remained at the time of death). Colchicine concentrations were measured by liquid chromatography-mass spectrometry in selected ion monitoring mode using positive ionization. Chromatography was performed using an Eclipse XDB C8 analytical column (30 mm x 2.1-mm i.d., 3-microm particle size) and a programmed mobile phase consisting of 50 mM pH 4 ammonium acetate buffer and acetonitrile. Colchicine concentrations were as follows: 50 microg/L in cardiac blood, 10 microg/L in vitreous humor, 575 microg/kg in liver, 12,000 microg/L in bile, and 4.4 microg in 60 g received gastric contents (estimated total gastric contents 100 g). The cause of death was ruled to be "acute colchicine toxicity" and the manner of death "accidental."
A records survey at the Office of the Chief Medical Examiner In Edmonton, Alberta from 1990 to 1997 reveals outdoor suicidal hangings to be a common occurrence, particularly In rural areas. These Isolated settings may result In delayed discovery and decomposed remains. Three case studies are presented Involving outdoor hangings with extended postmortem Intervals -5 weeks, 16 months and 10 years, respectively. The last case presented many of the diagnostic elements associated with autoerotlc asphyxia and the difficulties of differentiating this accidental manner of death from suicide after 10 years of decay and scene deterioration are discussed. RESUME Une etude des dossiers provenant du bureau du medecln leglste en chef d'Edmonton, Alberta, a revele qU'i1 y avalt eu beaucoup de suicides par pendalson durant la perlode de 1990a1997 et ce partlculierement dans les regions rurales. ces deces dans des endrolts Isoles ont Implique des decouvertes tardlves et des restes humalns decomposes. Trois enquetes de mort par pendalson en pleln air Impliquant des delaIs postmortem conslderables -5 semalnes, 16 mols et 10 ans-sont presentees. La dernlere enquete rapportee dans cet article semblalt demontrer des slgnes d'asphyxle auteerotlque alnsl que des dlfflcultes a dlfferencler une mort accldentelle d'un suicide apres 10 ans de decomposition.
Two unusual cases of suicidal overdose of acetaminophen (paracetamol) without the usual extensive centrilobular necrosis of the liver are reported. Both cases were subjected to comprehensive drug screening by immunoassay, and a combination of gas chromatography with mass spectrometry, nitrogen detection, and electron capture detection. Acetaminophen was detected in both cases. No other drugs were detected in case #1, and only a small amount of olanzapine (<0.1 mg/L) was detected in case #2. No anatomical cause of death was identified in either case. If untreated, the normal outcome of a large acetaminophen overdose would be massive hepatic necrosis with delayed death and low blood and tissue acetaminophen concentrations. In contrast, particularly high postmortem acetaminophen concentrations were measured in both our cases with little hepatic tissue damage. For case #1, femoral blood acetaminophen 1280 mg/L, vitreous 878 mg/L, and liver 729 mg/kg; in case #2, cardiac blood 1220 mg/L, vitreous 779 mg/L, liver 3260 mg/kg, and gastric 11,500 mg/500 g. Acetaminophen was measured using high performance liquid chromatography with UV detection (254 nm) using 3-hydroxyacetanilide as the internal standard. The very high concentrations of acetaminophen is these cases but relatively little hepatic damage suggests an alternative, possibly cardiac, mechanism of death.
The 3M™ Petrifilm™ Staph Express Count plate method was compared with AOAC Official Method 975.55 for the enumeration of Staphylococcus aureus in selected foods. Five foods—ice cream, raw milk, yogurt, whey powder, and cheese—were analyzed for S. aureus by 12 collaborating laboratories. For each food tested, the collaborators received 8 blind test samples consisting of a control sample, a low inoculation level, a medium inoculation level, and a medium inoculation level with background flora, each in duplicate. The mean log10 counts for the methods were comparable for all 5 foods. The repeatability and reproducibility variances of the 24 h Petrifilm Staph Express Count plate method were similar to those of the 72 h standard method.
Backed-up toilets lead to the discovery of a skeleton in the septic tank. Our challenges began with the excavation of this unconventional grave and progressed through recovery and examination of the skeleton, determination of the cause and manner of death, and ultimately, identification of the victim. Main aspects of the septic tank system are summarized, including functional theory, physical design and components, and general comments on use and maintenance. We discuss some basic principles applicable to the excavation and examination of any human skeletal remains, and offer a general approach to identification of the decedent.
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