Forensic science international
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Nitrous oxide is a popular inhalation anesthetic-analgesic agent. Its euphoric action and its availability have led to its abuse. ⋯ The deceased was a hospital worker who had access to the hospital supply of nitrous oxide. His death was due to hypoxemia and asphyxiation, secondary to nitrous oxide inhalation.
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Comment Letter Case Reports
Isolated basilar traumatic subarachnoid hemorrhage: an observer's 25 year re-evaluation of the pathogenetic possibilities.
This paper was inspired by Leadbeatter's recent review [1] on the subject, and consists primarily of a recapitulation of this author's observations in the 25 years since publication of his paper [2] describing three cases of traumatic basilar subarachnoid hemorrhage resulting from direct trauma to the upper lateral neck. Those observations include personal experience and case reports personally communicated or published. Leadbeatter's analysis makes the following three salient points to which the author considers a response to be appropriate: 1. ⋯ Accordingly, empirical factors have to be considered for a diagnosis in most cases. Four diagnostic criteria have been established for a firm conclusion of death due to traumatic basilar subarachnoid hemorrhage. 3. While over half of traumatic basilar subarachnoid hemorrhages involve a completely different site of trauma, and many indirect mechanisms of injury may come into play, the author still considers that in the commonly observed syndrome as described by him in 1971, direct trauma to the vertebral artery is the primary causative factor.
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For the last number of years, when ethical problems were discussed in Germany in public, the hippocratic oath was quoted as the valid norm for medical ethics. Although no physician swears this oath in Germany, it is necessary to know its contents, its origin and its role in the history of medicine. And it is necessary to ask some questions: What are the ethical claims of the hippocratic oath? Does it really originate from Hippocrates? How and why did the hippocratic oath become the 'Magna Carta' of behaviour for physicians? Do specific medical ethics exist over time? Do specific medical ethics exist in general? And if it exists, can it be normative ethics? A short survey of the multiple dependences of medical situations shows that ethics in medicine must undertake a new beginning. ⋯ It has to respect rules and declarations, but it has also to compare the benefits and risks. In the center of such ethics stands the responsibility of the physician. To assume this responsibility, the physician needs knowledge, the ability to make decisions and a conscience.
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The different concepts of brain death are subject to controversial debate. It is outlined that only the whole-brain concept, that is the irreversible loss of all functions of the entire brain, is consistent with the death of man. ⋯ It is shown that apnea testing must be accompanied by blood-gas analysis, as it may take 15 min for the PaCO2 to achieve the desired level of 8 kPa. The problem with CNS-depressing drugs and their metabolites interfering with the clinical diagnosis--e.g. sedatives, barbiturates, opioids--is described, and it is stressed that, in these cases, the cerebral panangiography (digital subtraction angiography with catheter tip in the aortic arch) is the gold standard for the final and definite proof of brain death.
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'Brain death' is defined pathophysiologically as intracranial circulatory arrest. The morphological features of brain death include cerebral edema, absence of reactive changes, and--after an interval of 15-36 h--the morphological hallmarks of respirator brain: edema, global softening of the brain, dusky discoloration of the gray matter, and often necrotic and sloughing tonsillar herniations. ⋯ These issues are elucidated and their bearing on forensic practice is illustrated by several real-life situations. Thus, neuropathological examination in the case of clinically diagnosed brain death is--without doubt--necessary in order to answer several questions often or regularly expected.