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PubMedDate not supplied

The medical and scientific evidence in alleged tubocurarine poisonings. A review of the so-called Dr. X case.

The problem of proving the presence or absence of a poison in a buried cadaver is the central theme of this presentation. Certain general questions are posed which may serve to guide those seeking to determine the cause of death in buried cadavers and allegedly due to a poison. Medicolegal and scientific evidence is presented from the court records of five deaths which were alleged homicides due to intravenous tubocurarine. As to the medical evidence: The prosecution claimed absence of adequate medical causes but full congruence with intravenous tubocurarine as the cause of death. The defense claimed and presented its evidence, including history, clinical picture, gross and microscopic pathological findings--for the deaths having occurred from competent natural causes in all but one case. In that one case the cause was undetermined. In two of the four cases evidence was presented for the mechanism of death and why they died at the time that they did. As to the forensic toxicological evidence: The prosecution claimed qualitative identification but with no particular quantitative detection or identification limits of tubocurarine in the remains based on results of combinations of HPLC followed by RIA and of some selected ion direct inlet mass spectrometry. The defense corroborated--along with a quantitative estimate--the presence of a substantial concentration of tubocurarine in the liver specimen of one case. However the chain of custody of this particular specimen was compromised for a period of several days between post-exhumation autopsy and submission to the prosecution toxicologists. With respect to all the other specimens examined by the defense, direct inlet mass spectrometry failed to show ions which are critical for establishing the identity of tubocurarine. The defense also presented results of experiments which showed that the tissues of the cases in question destroyed tubocurarine at such a rate that no reasonably conceivable administered amount could have survived the 10 years of burial of these cases. In each of the five cases exhumation and re-autopsy would have been found to be neither justified nor even indicated had an objective examination of the available record been made and supplemented by a similarly objective review of the literature and the simple stability experiments used by the defense. After an 8-month trial, the jury brought in a not guilty verdict on all counts after less than 2 h of deliberations.

Adult↗
PubMed1988

Determination of paraquat from formalin-fixed tissue.

In this paper, a sulfuric acid digestion method and a clean-up technique by using cation exchange resin followed by XAD-2 resin has been developed for the determination of paraquat from formalin-fixed tissue at the submicrograms per gram level. Formalin-fixed tissue is dissolved by hot sulfuric acid, then paraquat is isolated and purified with cation exchange chromatography. The eluted paraquat forms an ion-pair with sodium dodecyl sulfate, it is then adsorbed on XAD-2 resin. Paraquat is eluted, extracted and reduced with solvent mixtures, NaCl solution and dithionite reagent, respectively. The calibration graphs of zero-order and second-derivative spectroscopy are linear in the range of 0.01-5.0 mg/kg. The relative standard deviation was less than 5% and the detection limit was 0.02 mg/kg based on 0.5-g samples. The sensitivity of the proposed method could be increased by using larger sample sizes. The method was precise and gave a quantitative recovery of paraquat spiked into formalin-fixed liver homogenates (78%). The proposed method has been satisfactorily applied to the determination of paraquat in the formalin-fixed tissues of suspected poisoned cases. It has been shown to be of great value in the field of forensic toxicology especially when formalin-fixed tissue only is available.

Adult↗
PubMed1990

The stability of several compounds in formalin fixed tissues and formalin-blood solutions.

Buffered formalin solutions were added to spiked blood samples containing diazepam, phenytoin, carbon monoxide and cyanide to give formalin-whole blood solutions of 5 and 8%. Sections of liver positive for desipramine, phenobarbital and phenytoin were placed in separate 5 and 8% formalin-water solutions. The formalin-blood solutions were monitored daily for 30 days, while the fixed liver and formalin-water samples were analyzed once a week for 4 weeks. In the formalin-blood solutions losses were found for diazepam and phenytoin over the 30-day period of at least 41% and 33%, respectively. Cyanide detection was not possible immediately after the addition of formalin and the presence of carboxyhemoglobin was difficult to detect after 1 week. In the liver, losses of phenobarbital and desipramine were greater than 60% while phenytoin showed little change. This study has revealed that the drugs examined at toxic concentrations can be detected, with variable recoveries, for up to 30 days after fixation with formalin. However, quantitative analysis for cyanide and carboxyhemoglobin may be significantly impaired in the presence of formaldehyde.

Carbon Monoxide↗
PubMed1993

The study of tricyclic antidepressants in formalin-fixed human liver and formalin solutions.

The stability of amitriptyline, nortriptyline, desipramine and imipramine in formalin-fixed human liver tissue and formalin solutions was investigated. The levels of the tricyclic and its primary demethylated metabolite in the frozen liver were determined and compared with levels obtained in the formalin-fixed liver and formalin solutions in which the liver was stored. It was obvious that some methylation of the secondary amine, nortriptyline, to the corresponding tertiary amine, amitriptyline, and of desipramine to imipramine took place in the formalin environment. Nortriptyline was not detected in most cases, suggesting that it may degrade more rapidly than desipramine. There was no consistent ratio between the concentration of the drug in the frozen liver tissue versus formalin-preserved tissue or versus formalin solution. The methylation rates of the secondary amines could not be quantitated. Storage of the liver tissue in formalin at room temperature resulted in leaching of the drugs into the formalin solution. The drugs tested may be detected for up to 22 months in the formalin-fixed liver and in the formalin medium.

Amitriptyline↗
PubMed2007

Ultrasonographic confirmation of intraosseous needle placement in an adult unembalmed cadaver model.

STUDY OBJECTIVE: Intraosseous access is widely used in pediatric and adult resuscitations when vascular access cannot be promptly established. Confirmation of intraosseous needle placement has traditionally relied on the ability to aspirate blood or marrow or infuse crystalloid easily. This study's aim is to determine the value of bedside ultrasonography as a means of confirming intraosseous needle placement by visualizing the flow of crystalloid within the intraosseous space. METHODS: A controlled trial was conducted in which intraosseous access was obtained in the bilateral distal tibia of 4 freshly frozen, unembalmed cadavers. In 8 legs, an intraosseous needle (15-gauge Jamshidi) was inserted 1 fingerbreadth superior to the medial malleolus and flushed with 10 mL of crystalloid. Measurements included whether crystalloid was observed to flow by gravity into the drip reservoir of the intravenous tubing and whether color flow was visualized within the intraosseous space of the tibia with a 5- to 10-MHz linear transducer in color power Doppler mode, positioned just cephalad to the intraosseous needle. Intraosseous needles were then intentionally placed into the subcutaneous space just posterior to the distal tibia, and these measurements were repeated. Two blinded observers reviewed ultrasonographic video recordings and rated the presence or absence of color flow within the intraosseous space. RESULTS: Intraosseous color flow on ultrasonography correctly identified all placements, but flow into the drip reservoir was incorrect for one of the intraosseous lines (P=1.0 versus ultrasonography) and 6 of the subcutaneous lines (P=0.31 versus ultrasonography). There was perfect interobserver agreement (kappa=1) during video review. CONCLUSION: In freshly frozen cadavers, ultrasonographic visualization of flow within the intraosseous space may be a reliable method of confirming intraosseous placement. The observation of flow into the drip reservoir appears to be an unreliable indicator of intraosseous placement in fresh frozen cadavers.

Adult↗
PubMed1997

Identification of phenolic acids and inositols in balms and tissues from an Egyptian mummy.

A number of samples taken from an Egyptian mummy (ca. 100 B.C.) from the Guimet Museum in Lyon have been analyzed by GC-MS. Derivatives of aromatic acids (hydroxyhydrocinnamic, vanillic, protocatechuic and gallic acids) and inositols (non-methylated and mono-O-methyl) have been found among the constituents of extracts prepared by methanolysis and trimethylsilylation. From the reported electron impact mass spectra, ion sets where proposed for a sensitive and selective profiling of these selected compounds by mass fragmentometry. The source of gallic acid and inositol was found to be a vegetable tannin, an ingredient which was not previously known to be used for mummification in ancient Egypt. The nature and abundance ratios of the detected inositols also appeared to be a promising criterion to further investigate the botanical source of the tannin employed.

Adult↗
PubMed1996

Techniques for human temporal bone removal: information for the scientific community.

Human temporal bones provide an irreplaceable resource for study of the pathology and pathophysiology of disorders of hearing, balance, taste, and facial nerve function. Additional specimens are needed to study disorders for which there are few human specimens; to increase the number of specimens for a given disorder to understand the natural variability and expression of the disease entity; to evaluate the accuracy of otologic diagnoses and the efficacy of otologic treatment modalities; to apply newly available scientific methods, including immunohistochemistry and molecular biologic or molecular genetic techniques; and to teach the anatomy of the human ear and modern otologic surgical techniques. This article provides information for the scientific community concerning techniques for temporal bone and auditory brain stem removal, including intracranial and extracranial approaches and methods to minimize postmortem autolysis and cosmetic defects. Close collaboration between physicians and funeral directors will maximize the yield and utility of these valuable specimens for scientific inquiry and training.

Brain Stem↗
PubMed1999

A chemical and physicochemical study of an Egyptian mummy 'Iset Iri Hetes' from the Ptolemaic period III-I B.C.

Chemical and physicochemical examinations of the fragments of an Egyptian mummy dated between the 3rd and 1st century B.C. were performed. The chemical examinations indicated the presence of resin in the skull and in the fragments of bandages wrapped around the mummy. An analysis of the infrared spectra of the fragments indicated a type of resin originating from the Copal group. Physicochemical investigations showed that main chemical elements such as Ca, Mg, Na, K, P and trace chemical elements such as Fe, Zn, Cu, and Pb occurred in bone fragments in proportions typical for people living today. In tooth fragments, values were similar to normal except for K, P, and Zn, which were lower, and Pb, which was absent. In the fingernails, most elements were found in much higher concentrations except for Cu and Pb, which were lower. The results of the study in terms of their implications on mummification are discussed.

Bone and Bones↗
PubMed1975

Temporal bone studies: findings with undecalcified sections in a 2,600-year-old Egyptian mummy.

Roentgenologic studies by polytomography of the temporal bones of a 2,600-year-old Egyptian mummy (PUM-II) revealed an increase in radiographic density throughout the left temporal bone. The superior portions of the petrous bones were removed with an electric saw for study by undecalcified techniques. For histological control, a similar specimen was removed from a cadaver immediately after autopsy. Light microscopy of sections showed excellent preservation of the Haversian systems. The vascular channels were clearly seen, and they were similar in appearance to those of the fresh specimen. The lacunae contained osteocytes with good preservation of the nucleus. Osteoid seams were identified and the osteon activity was described for the first time in an Egyptian mummy. There was a low turnover type of bone, but there was no evidence of metabolic bone disease. We postulate that the increased radiological density of the left temporal bone was due to a greater amount of resin infiltration in this bone as compared to the right. It appeared that the resin acted as a fixative preserving the bone cells and related elements.

Cell Nucleus↗