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We report three cases of suicide in Scotland where barbecue charcoal was purposely burned in confined areas (an outbuilding, a car and a bedroom). External examination of the three cases revealed a distinctive 'cherry red' discolouration to the post-mortem lividity and blood and there were no marks or injuries to the bodies to give any cause for concern. Toxicological analysis of femoral blood samples revealed fatal levels of carbon monoxide (70%, 85% and 80% respectively). Considering the history, circumstances and external findings, a 'View and Grant' examination was conducted in all three cases and the cause of death was attributed to carbon monoxide poisoning due to inhalation of burning charcoal fumes. This particular method of suicide is not common in Europe and is more widely reported in the Far East.

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AIMS: To review the diagnostic value of using a thorough necropsy protocol for the investigation of sudden infant deaths, with particular emphasis on the value of routine ancillary laboratory investigations. METHODS: The necropsy and related records of all neonatal, infant, and young childhood deaths (under three years) referred for medicolegal investigation at Dundee from 1990 to early 1998 were reviewed retrospectively. Relevant positive and negative findings were abstracted from the police reports, hospital medical records, necropsy reports, and the results of routine bacteriological, virological, toxicological, and biochemical laboratory investigations. RESULTS: Within the study period, 63 deaths presented as apparent "cot deaths," nine as suspected homicides, nine as neonatal deaths, and 14 in some other manner. An adequate cause of death was identified on the basis of necropsy and laboratory investigations in 35% of the 63 apparent cot deaths, leaving 63% to be finally categorised as sudden infant death syndrome (SIDS). Ten (16%) of the apparent cot deaths were explained on the sole basis of unexpected positive microbiological findings, mostly pneumococcal or meningococcal meningitis and/or septicaemia. Petechial haemorrhages were identified at one or more intrathoracic site in 90% of SIDS and in 55% of explained cot deaths. CONCLUSIONS: Early and extensive laboratory investigations performed routinely in apparent cot deaths provide an unexpectedly high positive diagnostic yield. Routine early bacteriological culture of the CSF (by cisternal puncture) and blood before necropsy should be mandatory in the investigation of all sudden infant deaths.

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Death from air embolism during pregnancy has been reported following sexual activity, particularly vaginal insufflation. We report a death from air embolism in a non-pregnant woman during consensual penile intercourse, in a position with the pelvis elevated above heart level. Air is thought to have entered the veins via a vaginal laceration, which occurred during digital foreplay.

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AIMS: To gather data on blood alcohol concentrations in a forensic necropsy population and to analyse the information on trends that may predict where alcohol testing is going to prove cost-effective. METHODS: Alcohol assays were performed on blood, urine, and vitreous samples in 1620 consecutive medicolegal necropsy examinations. RESULTS: Alcohol was detected in only 7% of natural deaths from all causes and in four of 40 deaths categorised as unknown/obscure. Alcohol concentrations > or = 350 mg/100 ml were found in nine drug/alcohol abuse deaths (range 362-506 mg/100 ml), five accidental deaths (356-504 mg/100 ml), and one homicide victim (400 mg/100 ml). Those categorised as alcohol abusers were represented in all but one category of death (unknown/obscure deaths in males), showing that many true alcoholics die with their alcoholism rather than of it; 39% of males and 34% of females with histories of alcohol abuse had alcohol present in their blood at necropsy at concentrations > or = 50 mg/100 ml, v only 9% (male) and 6% (female) without such history. CONCLUSIONS: The study highlights the problems of elderly and "hidden" alcoholics and illustrates cases where routine assays would provide additional significant information. Routine alcohol testing is useful in all cases of suspected unnatural death but universal testing of forensic necropsies is not cost-effective.

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Calliphora vicina larvae reared on artificial foodstuffs spiked with human equivalent therapeutic (100 ng/g), toxic (300 ng/g), lethal (500 ng/g), and 10 x lethal (5,000 ng/g) concentrations of amitriptyline and nortriptyline, alone and in various combinations, were harvested at various stages of development and analysed for drug content by high-pressure liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS). Mean (range) larval amitriptyline concentrations (ng/g) in larvae reared on foodstuffs containing 100 ng/g, 500 ng/g, and 5,000 ng/g amitriptyline were 3.21 (<1-5.72), 21.3 (14.2-27.4), and 50.1 (38.8-64.3), respectively, on day 5; 6.62 (5.98-7.72), 22.5 (16.4-32.4), and 38 (22.8-50.9) on day 8; and 4.45 (3.45-5.93), 25.2 (18.6-38.4), and 26.2 (22.7-29.7) on day 11. Nortriptyline concentrations (ng/g) in larvae reared on foodstuffs containing 100 ng/g, 500 ng/g, and 5,000 ng/g nortriptyline were 6.86 (4.48-8.96), 14.1 (11.9-17.8), and 18.5 (16.7-20.6), respectively, on day 5; 8.32 (4.9-11.7), 12.9 (11.5-14.2), and 18.8 (11.5-23) on day 8; and 5.06 (3.27-7.25), 19.4 (17.8-22.4), and 26.6 (11.7-44.7) on day 11. Among 45 separate larval rearings fed on the same foodstuff, mean larval weight ranged from 24-96 mg and larval amitriptyline concentration from <1-148 ng/g. Biological variability in larval drug concentrations were greatest in larvae reared on high drug concentrations. Such variability makes quantitative extrapolation back to the drug concentration in foodstuff unreliable. Larval drug accumulation became unpredictable when larvae encounter more than one drug or different concentrations of a single drug. Drug concentrations measured were partly due to surface contamination with drug-rich putrefactive residue and they also depend partly on the analytical method used. Fly larvae are unreliable samples for quantitative toxicological analysis.

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We compared the post mortem diagnostic value of gamma-glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT), alcoholic liver disease (ALD), blood alcohol concentration (BAC), the presence of multiple bruises and poor hygiene of the feet as markers of chronic alcoholism (heavy continuous drinking) in 32 alcoholics with 32 age-sex matched controls drawn from a forensic autopsy population. Alcoholics and controls were selected on the basis of positive and negative medical history but controls were excluded if BAC exceeded 70 mg%. Femoral venous blood, urine and vitreous humour alcohol concentrations were determined by headspace gas chromatography (GC). BAC was positive in 19 alcoholics (mean 234 mg%, range 2-570 mg%) and six controls (mean 32 mg%, range 2-52 mg%). Serum GGT was measured by a kinetic photometric method, and CDT by both isoelectric focusing/laser densitometry and by a commercial radioimmunoassay kit (CDTect). Features of alcoholic liver disease were graded histologically using two weighted scoring systems. Eleven alcoholics tested positive for GGT, CDTq and ALD, nine were positive for two tests, five for one test and three were negative for all three tests. No controls were positive for all three tests but six were positive for two tests and nine for only one test; 17 were negative for all three tests. Using the normal clinical cut-off values GGT, CDTq and CDTect gave poor specificity which was improved at moderate cost to sensitivity by raising cut off values for each test. Comparison of receiver operating characteristic curves, likelihood ratios and post-test odds showed CDT to be the best individual test, followed by ALD and GGT. Quantitation of CDT by IEF/laser densitometry performed slightly better than MAEC/RIA by CDTect. CDT shows considerable promise as a post mortem marker of chronic alcoholism.

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Although raised urinary CA levels provide good supportive evidence of prolonged agonal stress in hypothermic deaths, the CA index is not, in our experience, of particular diagnostic significance.

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We compared the weights of the brain, heart, spleen, lungs, liver, and kidneys, uncorrected and corrected for body surface area (BSA) and body mass index (BMI), of 50 alcoholics with 50 forensic controls matched for sex, age, and body weight. With the exception of combined renal weight corrected for BSA and BMI, no significant differences were found in organ weights between the two groups. Glomerular diameter corrected for BSA was significantly greater in alcoholics than controls. It appears that nephromegaly and glomerulomegaly are both population markers for alcoholism. In alcoholics, there was no correlation between the microscopic degree of steatosis and glomerulomegaly. In controls, renal glomerular diameter was greater with increasing severity of hepatic steatosis, probably as a reflection of obesity.

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The death of a 23-year-old man by suicidal flecainide and alcohol poisoning is reported. Flecainide was identified by ultraviolet (UV) spectrophotometry and gas chromatography-mass spectrometry (GC-MS). Flecainide levels, quantitated by high performance liquid chromatography (HPLC) with UV detection were: femoral blood 7.3 mg/L, urine 117 mg/L, stomach contents 19 mg and liver 302 mg/kg. Ethanol levels in femoral blood, urine and vitreous humor were 107, 136 and 113 mg%, respectively. The importance of carefully considering all the available pathological and toxicological data, together with the past medical history and circumstances surrounding the death in poisoning cases is emphasized.

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Calliphora vicina larvae were fed on drug-laden muscle from three suicides involving amitriptyline, temazepam and a combination of trazodone and trimipramine; triplicate daily harvestings were analysed. The limit of detection for all four drugs was 0.01 micrograms drug/g larvae. Mean drug concentrations (microgram/g) in the initial muscle were:amitriptyline, 2.68; temazepam, 4.04; trazodone, 21.56; and trimipramine, 19.58. Larval rearings for days 4-8 (15 larval samples per drug) had mean and ranges of drug concentrations (microgram/g) of 0.10 (r, 0.02-0.24) for amitriptyline; 0.52 (r, 0.26-0.78) for temazepam; 0.13 (r, 0.05-0.32) for trazodone; and 0.28 (r, 0.10-0.59) for trimipramine. After day 8 there was a precipitous fall in larval drug concentrations associated with pupariation. At day 11 ranges of drug concentrations (microgram/g) were: amitriptyline, < 0.01-0.01; temazepam, 0.01-0.08; trazodone, < 0.01-0.01; and trimipramine, 0.04-0.04. Day 16 pupae had corresponding ranges (microgram/g) of < 0.01, 0.01-0.01, < 0.01 and < 0.01-0.02. Transfer to drug-free food at day 5 led to similar falls in drug concentrations (microgram/g) from day 5 to day 6: 0.08-0.03 for amitriptyline, 0.61-0.09 for temazepam, 0.13-0.01 for trazodone, and 0.30-0.02 for trimipramine. The results show considerable variation in larval drug concentrations, both at the same developmental stage and at different stages of the life cycle, under conditions which closely reflect case situations. In practice, the precipitous decrease in drug concentrations in non-feeding larvae and at pupariation make it desirable to sample only larvae actively feeding on a corpse.

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One adult and one childhood case of concealed homicide by strangulation are presented. Both cases were first recognised on formal neck dissection at necropsy. Neither showed any obvious external trauma to the neck or laryngeal fracture. External petechiae were absent in the child. The pattern of internal injuries in both cases suggested that the likely mechanism was strangulation. Particular care is required in busy routine medicolegal practice in order to detect deaths which are not immediately apparent as asphyxial.

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