Immunohistochemical detection of early myocardial damage in two sudden deaths due to intentional butane inhalation. Two case reports with review of literature.

Abstract	The abuse of household and other commercially available products containing volatile organic solvents is underrecognized. Not infrequently intentional butane inhalation results in high morbidity and mortality. A fatal outcome of butane abuse can be caused by asphyxia, cardiac arrhythmia or trauma. The reported number of cases in which death was the consequence of pure butane inhalation is limited, and in most cases a mixture of propellants was involved. This report covers two cases of sudden death due to the sniffing of a cigarette lighter refill containing butane. Autopsy was followed by toxicological, pathohistological and immunohistochemical analysis. Butane gas was confirmed in samples of blood, urine, brain and lungs by the gas chromatography method - "headspace" technique. Histology showed almost identical changes in the lungs and heart in both cases. The morphology of heart damage on standard H/E stains was of special interest because it displayed all the characteristics of chronic and acute myocardial hypoxia found in the absence of atherosclerotic heart disease. In order to confirm early cardiac death caused by asphyxia due to butane inhalation a panel of immunohistochemical agents was used: Myoglobin, Desmin, Fibronectin, Fibrinogen and CC9.
Authors	Irena Novosel, Zdravko Kovačić, Stjepan Gusić, Lovorka Batelja, Marina Nestić, Sven Seiwerth, Josip Skavić
Journal	Journal of forensic and legal medicine (J Forensic Leg Med) Vol. 18 Issue 3 Pg. 125-31 (Apr 2011) ISSN: 1878-7487 [Electronic] England
PMID	21420651 (Publication Type: Case Reports, Journal Article, Review)
Copyright	Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Chemical References	Butanes butane
Topics	Adolescent Adult Brain Chemistry Brain Edema (pathology) Butanes (adverse effects, analysis) Chromatography, Gas Death, Sudden (etiology) Forensic Pathology Forensic Toxicology Humans Hypoxia (pathology) Immunohistochemistry Inhalant Abuse Lung (chemistry, pathology) Male Myocardium (pathology) Necrosis Pulmonary Edema (pathology) Staining and Labeling

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