Abstract
In this third edition, Knight's Forensic Pathology continues to be the definitive international postgraduate textbook for forensic pathologists, covering all aspects of the medico-legal autopsy, including the cause and time of death, interpretation of wounds and every other facet of the investigation of a fatality. The emphasis is on the practical application of knowledge and research findings, and the new edition continues the often praised traditions of clarity and succinct presentation. This book will be an essential text for all pathologists in training, and remains a standard text to those in practice.
... Extrinsic environmental factors, such as aridity, circulation of air, and climate, are commonly seen as having a strong impact on soft tissue desiccation [10,19,[21][22][23]. An enclosed and ventilated space could favor desiccation [24]. Another effect of enclosed places is the partial or complete preclusion of insects [25]. ...
... Aufderheide [21] has argued that if skin is pressed tightly against another part of the body or against tight clothes, this can prevent water evaporation. It is suggested that desiccation is more likely to occur in smaller bodies, with a higher ratio of skin to underlying tissue and less body fat [24,26], though there are conflicting views on this [22]. Prominent body parts or parts with more skin in relation to the amount of underlying tissue, e.g., fingers and outer ears, are more prone to desiccation [19,20]. ...
... Emaciation is also thought to favor desiccation [1]. The development of mummification is considered to take weeks, if not months, and once mummification is reached, the body can be preserved in that state for an extended period of time [10,19,24]. Soft tissue preservation may interfere with the estimation of PMI and an experimental study has shown further development of desiccation and tissue changes after a PMI of 9 years, suggesting that this is an ongoing process [27]. ...
The objective of this study was to evaluate the presence of mummification in an indoor setting, with an emphasis on the forensic perspective. A dataset of 102 forensic autopsy cases was assessed for distribution of desiccation of skin and soft tissue (i.e., sub-cutaneous fat and musculature) and for moist decompositional (i.e., putrefactive) changes. Further, possible correlation with the post-mortem interval (PMI) was evaluated, as well as the effects of clothing coverage of the body. The results indicated that yellow to orange parchment-like desiccated skin was found at significantly shorter PMIs than reddish brown to black leathery desiccated skin, even when soft tissue desiccation was included in the comparative analysis. Clothing appeared to have a significant decelerating effect on the extent of desiccation on the legs, but findings in regard to whole body or torso/arms were inconclusive. A large variation in PMIs was evident as regards fully desiccated skin (PMI 18-217 days), indicating difficulties in PMI estimation due to a variable repressive effect on the decompositional process per se in an indoor setting. For the specific case in forensic practice, no definite conclusion can be drawn from the observed desiccation changes to the PMI. One way forward might be creating a systematic and standardized method for describing different desiccation types, as well as other cooccurring decompositional changes and how they relate to the PMI, as a foundation for a future quantification model.
... The World Health Organization definition is of death within 24 h from the onset of symptoms, but this is much too long for many clinicians and pathologists, some will only accept death within 1 h from the onset of illness. 16 We have to also bear in mind that a death may appear sudden and unexpected to an outsider but may not necessarily been so from the point of the pathological disease process. The deceased may have been symptomless and utterly unaware of his chronic disease, or he may have had symptoms but interpreted them as harmless. ...
... The septum occasionally ruptures, and the consequent left-right shunt, while the patient survives, provides a classical diagnostic sign for the stethoscopes of clinicians. 16 The rupture does not take place in the early stages of a new infarct, but after a day or two when necrotic softening is well established. The blood usually tracks through tortuous channels between muscle bundles rather than bursting a direct fistula from ventricle to pericardial sac. ...
Key Clinical Message
Ventricular myocardial rupture is a rare complication of myocardial infarction. It occurs within hours to weeks after an infarction. Mortality is high. Antemortem diagnosis is a challenge in low‐resource settings, leading to potential misdiagnosis.
Abstract
Left ventricular myocardial rupture is a potentially fatal yet common complication in acute myocardial infarction patients. Rupture can occur as early as hours after an infarction. However, rupture may also occur later in the first week in the setting of myocardial necrosis and neutrophilic infiltration. Patients may survive several days to weeks before rupture occurs, and cardiac tamponade may present subacutely with a slow or repetitive clinical course. Sudden death can be attributed to ventricular rupture, more commonly during this time frame. Myocardial rupture can also occur as a result of trauma, infections, or cancer. Mortality is exceedingly high if surgical intervention is delayed. In most patients, myocardial rupture manifests as a catastrophic event within days of a first, small, uncomplicated acute myocardial infarction. Acute onset of shortness of breath, chest pain, shock, diaphoresis, unexplained emesis, cool and clammy skin, and syncope may herald the onset of ventricular septal rupture after acute myocardial infarction. Sudden death from myocardial rupture during acute myocardial infarction in patients with no apparent previous symptoms of myocardial ischemia represents a challenge for medical examiners, law enforcement officers, and society as a whole. An autopsy is critical for establishing the cause of death. We present the case of a 54‐year‐old male whose body was found beside the road after a trivial quarrel a day before. Further medical information about the deceased was not available. The preliminary cause of death was presumed to be traumatic. No evidence of trauma was seen during the autopsy. Massive pericardial blood collection compressing the heart and concealed left ventricular myocardial rupture were noted. Histopathological examination of the heart demonstrated myocardial infarction with a tear associated with bleeding that was contained in the pericardial sac. We ruled cardiac tamponade as the cause of death due to an infarcted myocardial rupture. Antemortem diagnosis of myocardial rupture can be challenging in low‐resource settings, leading to potential misdiagnosis and negative impacts such as community conflicts.
... [3,5,6] Thus, rapid evaluation and treatment of gunshot wounds, especially in case of serious injuries, within the golden hour is of vital importance. [7,8] Cite this article as: Meral O, Sağlam C, Güllüpınar B, Aktürk ÖE, Beden S, Parlak İ. Investigation of firearm injury cases presented to training and research hospital's emergency service . Ulus Travma Acil Cerrahi Derg 2020;26:74-79. ...
... Injuries from firearms are increasing in our country and in the world and also form an important part of all injuries. [8,9] Thus, attention has been drawn to the necessity of strict measures for the control of firearms, as well as to increase public awareness using media and other social networks. [1] After forensic medicine evaluation was made, it was concluded that 48 patients (22.5%) suffered a life-threatening injury, 33 patients' injuries (15.5%) were mild enough to be treated by simple medical intervention, and the remaining 132 cases (62%) were found not to have life-threatening injury but also not to be mild enough to be treated by simple medical intervention. ...
Background:
Firearm injuries are criminal events that may cause severe morbidity and mortality and concerned with Emergency Medicine and Forensic Medicine. The present study aims to evaluate the wound characteristics of the cases who presented to emergency services due to firearm injuries.
Methods:
In this study, 213 patients who were 18 years of age or older who applied to the Sağlık Bilimleri University Bozyaka Training and Research Hospital Emergency Service with gunshot injury were included.
Results:
Of the 213 cases examined, 182 (85.4%) were male. The ages of the cases ranged from 18 to 78 years, and the mean age was found as 33.2±12.6. The most common months were April (n=28, 13.2%) and May (n=25, 11.6%). The findings showed that 194 (91.1%) of 213 patients were discharged after completing the treatment in the hospital, and 19 patients (8.9%) died despite all interventions.
Conclusion:
Our study presents an important cross-section of the gunshot injury patterns and their consequences in Turkey, but it contains regional data. In this regard, multicentre and multidisciplinary studies covering the country, in general, are considered to be a significant contribution to the literature.
... Carbon soot can be detected with the naked eye 2 or 3 days after inhalation of smoke 4 . The presence of more than a smoker ' s level of 5 % saturation of the blood with carboxy haemoglobin means that breathing occurred after the fire began 5 . Reddening of the edges of the burns may point to an ante-mortem aetiology, but this is not conclusive 6 . ...
... [2] The black eye is usually caused by a direct impact on the eye socket, which may or may not be associated with injuries on the skin on the upper cheek, eyebrow, nose or other parts of the face. [3] Another cause of black eye following trauma is the gravitational seepage of blood beneath the scalp from an injury on or above the eyebrow. A third cause of the black eye following trauma, which is usually bilateral, is due to the percolation of blood into the orbit from a fracture of the anterior cranial fossa of the skull. ...
... In sudden death the immediate cause is almost to be found in the cardiovascular system even though topographically the lesion is not in the heart or great vessels. Ischemic heart disease is the most common cause of death in western countries, but the term has been employed loosely rather inaccurately as it encompasses a number of diseases namely coronary atherosclerosis, hypertensive heart disease, aortic valve disease, anomalies of coronary circulation and other coronary artery disease like polyarteritis (52). All these cases have different pathological manifestations which are indistinguishable from each other when examined by naked eye. ...
Diagnosis of Sudden cardiac death (SCD) is challenging for forensic experts. In the current scenario, genetic analysis is rapidly gaining interest in forensic science. Previous studies are not only limited to using protein markers. In this regard, analysis of mRNA is also a key feature. Analysing mRNA offers insight into the diseases and mechanisms leading to death. It can also be used for forensic diagnostic purposes. This review article takes the help of this methodology to discuss about those mRNA species that can aid in the process of sudden cardiac death (SCD) diagnosis. These are mRNA encoding Heat Shock Protein (HSP), mRNA encoding Hemoglobin A1/2 & B, mRNA encoding Pyruvate Dehydrogenase (PDK4), mRNAs encoding Connexin 43 (Cx43) & Zonula occludens-1 (ZO1), mRNA encoding TNNI3, MYL3, TGFB1, MMP9, VEGFA and mRNA expressing Brain Natriuretic Peptide (BNP).Owing to the difficulty of diagnosing SCD, molecular markers are often developed that can aid in the process. Nowadays, mRNA is showing promising usefulness to supplement the process.
... 3 Several death signs of medical interest may be retrieved from deceased bodies to support inferences about the cause of death. 4 Profuse froth from the nostrils, broken horns of the thyroid cartilage and sloped suspension peak marks are examples of cadaveric signs that may be found in victims of asphyxia by drowning, manual strangulation and suicidal hanging, respectively. 5 While on one hand, several cadaveric signs may be detected by pathologists during the medical autopsy, a restricted number of signs are a vailable and useful when it comes to the participation of Forensic Dentistry in the search for the cause of death. ...
Background:
In contemporary forensic practice, Medicine and Dentistry combine forces to improve the search for the cause of death and human identification. The pink tooth phenomenon (PTP) is a cadaveric sign that allegedly manifests more often in victims of asphyxia. However, the scientific literature is scarce and controversial on this aspect.
Objective:
This study aimed at screening victims of mechanical asphyxia in order to search for post-mortem pink teeth.
Material and methods:
Retrospectively, autopsy reports from a local medico-legal institute in South Brazil were revisited in the search for victims of death by asphyxia. Autopsy reports of twenty one victims aged between 6 and 67 years (mean age: 40.6 years ±19.20; median: 37 years) were found and analyzed.
Results:
The different modalities of asphyxia included drowning (n=7; 33.33%), strangulation (n=1; 4.76%) and hanging (n=13; 61.91%). A single case of PTP was detected (4.76%) - a 26-year-old male victim of hanging.
Conclusion:
This study illustrates and highlights the unspecific aspect of the PTP. In practice, forensic experts must avoid interpretations of this phenomenon as conclusive evidence of the cause of death, such as asphyxia by drowning, strangulation or hanging.
... Wound has been defined as a disruption of the continuity of a tissue structure due to application of mechanical force (Saukko Pekka 2004). ...
Abstract Background Regarding postmortem estimation, the evaluation of early histological and miRNA molecular changes have been of great concerns among forensic scientists due to uncertainty of known conventional methods. The histological and miRNA molecular changes in incisional wound remain poorly described. Purpose This evaluation presents a histo-molecular approach that could be used to estimate the early post mortem interval in incisional wound. Methods The histological and miRNA (205 and 21) changes were evaluated in 18 female albino rats with incisional wound at three interval times: 0, 24, and 48 h after infliction. Results The wound margin showed progressive morphological changes with increasing postmortem interval. Inflammatory phase had appeared immediately after infliction. After this period, degenerative changes began. mRNA-205 and 21 expressions, detected via real-time PCR, were increased significantly to reach their higher levels at 24 h after wound infliction, then they were significantly diminished with increasing postmortem interval. Conclusions Our results suggest that histological and miRNA-205 and miRNA-21 changes, occurred at perimortal incisional wound, could be helpful in forensic work regarding postmortem estimation.
... The phenomenon of knowingly and intentionally injuring oneself (self-infliction) is reported in forensic medicine textbooks. [1][2][3][4] But the phenomenon of agreeing to get injured by someone else (self-suffered) though well-recognized in legal practice is yet to be reported in forensic textbooks. Victims of such injuries are seen to be mis-presenting before the clinicians with fake stories of assault and are a headache to the clinician as well as for the investigator. ...
Introduction: Violent crimes using sharp objects are a common problem in Indonesia because sharp weapons can be easily accessed. When evaluating sharp-force injuries, the correct interpretation of the morphology of individual wounds, as well as the overall pattern of findings, is of paramount importance in the reconstruction aspect of the crime. Any knowledge of the occurrence and distribution of sharp force injuries in knife attack victims and perpetrators can help to verify statements or expose defensive lies. Case: We present, a patient from another hospital came to the emergency room at Doctor Soetomo Hospital with a stab wound to the right chest. The 35-year-old male victim, with the initials SPJ, admitted that he was stabbed by his brother. The victim's vital signs were stable when examined. On the right chest, an open wound with flat edges and sharp and blunt angles was found, measuring three centimeters long and five centimeters wide. The victim underwent radiological and laboratory examinations, installed water-sealed drainage, and was administered anti-pain and antibiotics. Discussion: The qualification for this patient's wound based on the Indonesian Criminal Code and the scoring carried out is a moderate wound. Conclusions: Based on the law and the scoring carried out by the author, the wounds on the patient's body are injuries resulting from a criminal act and are included in the category of moderate abuse, which means that the injuries that occurred to the victim did not cause death or cause permanent disability but caused temporary obstacles in carrying out work.
Background
There is a global increase in the number of deaths caused by violent neck asphyxia, which includes both suicides and homicides. This research presents autopsy-based findings and analytical demographic data that are pertinent to significant medicolegal cases.
Methods
A retrospective examination of 113 autopsy reports of non-accidental violent neck asphyxia reported to the forensic pathology department of Al-Balqa Governorate in Jordan within the period from January 2010 to March 2023. Age, gender, and autopsy results were documented, along with medicolegal records that included toxicology reports. Conversely, information on the manner of death was derived from police inquest records. For the purpose of this research, all the cases of throttling and ligature strangulation have been determined to be homicidal, and all cases of hanging were classified as suicide.
Results
Males were predominant in hanging (72%), while females were predominant in ligature strangulation (82%). The mean age group in hanging was 21-35 years (51%), while the range for throttling was 36-50 years, and that in strangulation was 2-20 years. Most hanging and throttling cases showed typical external neck findings. Seventy-two percent of hanging cases (n = 68) did not exhibit any internal neck findings, while all throttling cases yielded positive results. Both hanging and strangulation by ligature cases exhibited an absence of thyroid cartilage fracture (83%). Eighty-nine cases (95%) of hanging did not exhibit any injuries to the rest of the body. However, all cases of throttling and ligature strangulation had an almost positive external body injury. In all cases of throttling and ligature strangulation, ocular petechial hemorrhage was present, whereas one-third of the hanging cases had it.
Conclusion
The forensic doctor must observe the pattern of ligature marks and other signs of physical assault found on the neck, meticulously examine the rest of the body, rule out other causes of death, and cooperate with the legal authorities regarding the collection of the history and death scene findings to accurately determine the manner and mechanism of death in cases of violent neck asphyxia.
Although identifying antemortem pathological thrombi in autopsies is vital in assessing the cause of death, distinguishing them from simple blood clot masses only based on macroscopic appearance is sometimes challenging. This study examined the utility of increased methemoglobin concentrations in identifying antemortem pathological thrombi. From 49 autopsy cases, 98 blood clot samples were collected from the arterial （aorta） or venous （vena cava and proximal pulmonary artery） circulation. The samples were divided into a pathological thrombus group and a simple coagulation group based on macroscopic appearances. Methemoglobin concentrations （MetHb） were determined using a spectrophotometer, while the cutoff value was calculated by plotting the receiver operating characteristic curve. MetHb levels were significantly higher in the pathological thrombus group than in the simple coagulation group in arterial and venous samples （arterial: 15.1％ vs. 6.3％, venous: 15.2％ vs. 5.9％, respectively; p＜0.05）. The cutoff value was 11.1％ （area under the curve ［AUC］ 0.85） in arterial samples and 16.7％ （AUC 0.75） in venous samples. We also analyzed corrected values by subtracting MetHb values of the reference blood. This corrected value was also significantly higher in the thrombus group than the simple coagulation group in both arterial and venous samples （arterial: 10.1％ vs. 1.5％, venous: 10.1％ vs. 1.3％, respectively; p＜0.05）. The cutoff values were 4.6％ （AUC 0.87） in arterial samples and 3.7％ （AUC 0.73） in venous samples. The MetHb concentration in blood clot masses of autopsied bodies can help differentiate between antemortem pathological thrombi and simple postmortem coagulation masses.
Background:
Carbon monoxide (CO) poisoning rate has stayed the same around the globe over the last quarter of a decade. However, the number of people who die compared to the number of people who get poisoned, and the mortality rate has declined dramatically.
Objective:
The aim of this study was to evaluate the severity of the CO poisoning problem in Jordan and compare it to other countries and to search for any related factors that could affect the death rate.
Methods:
A retrospective study was conducted in the Forensic Medicine Teaching Centre, Irbid, Jordan for a 10-years period (2009 -2018). 5,725 autopsy reports were assessed, and only 71 CO-related death cases were selected and analyzed based on the following risk factors: age, gender, year and month of death, nationality, address, the settings that the cases occurred in, carboxyhemoglobin saturation (COHb%) and the presence of alcohol and drugs in blood.
Results:
The rate of deaths due to CO poisoning showed a general decline over the reviewed years. Most victims were males (70.4%). And although the death rate showed an increase with age, the age group between 20-year-old and 39-year-old accounted for 38% of all cases. Most cases happened in the winter months, December, January, and February. 87.1% of the cases occurred at home settings. The average COHb% was 68%±13% and ranged from 12%-83%.
Conclusion:
Although the incidence is decreasing with time, CO is still a threat that must be dealt with. As all cases in our study were accidental cases and good preventive measures, such as good CO detectors and good air flow in the places that hold devices that could generate CO, and proper education to the public, especially in the colder regions of the country, could prove useful in decreasing the incidence of CO deaths further.
Decomposition, or the process by which a corpse turns into a skeleton due to the destruction of the soft tissue, is very complicated. Humankind has used various methods to inhibit and delay decomposition changes over centuries. It includes mummification, embalming, and preservation of the body under low temperatures. In this report, we present a criminal case involving the conservation of the body using a paste made from clarified butter and turmeric powder, with the body simultaneously kept in an air-conditioned
room. The body acquired a stiff, leathery appearance consistent with mummification. The subjacent layers of the muscles had a soft consistency and specified adipocere changes. Adipocere changes were present in most internal organs. This case report involves a certified hospital death with no disagreement over the after-death interval or the cause of death during the postmortem examination. The postmortem changes resulted from a unique method of body preservation: a combination of lower temperature (by air conditioner) and the application of clarified butter mixed with turmeric powder.
Rust stains are marks left by firearms in case of prolonged contact with the cutaneous surfaces. These peculiar signs along with other well-documented findings can guide the medical examiner in the determination of the manner of death, especially in case of firearm suicide. This paper presents the case of a 33-year-old male soldier who committed suicide by using a short-barreled weapon, whose trigger remained in contact with the first finger of his right hand, leading to the formation of a rust stain that perfectly reproduced its design. The forensic examination of the scene, the external cadaveric inspection, and the autopsy are described. For the evaluation of the histological findings typical of rust spots, the authors decided to replicate the phenomenon in an experimental setting using porcine skin. In order to provide an exhaustive overview on the formation and the features of rust stains, a review of the forensic literature concerning this rare mark was performed.
En este trabajo se presenta, desde una perspectiva tafonómica, el estudio de cinco casos forenses de cadáveres humanos
consumidos por carnívoros, hallados al aire libre en la provincia de Mendoza (Argentina). Para ello se describe la preservación ósea diferencial, la
desarticulación, meteorización, marcas y fracturas producidas por los carnívoros y sus implicaciones en la reconstrucción del perfil
osteobiográfico, evaluación de la causa de muerte e identificación. Además, se comparan los intervalos postmortem establecidos por los
estudios entomológicos con el estimado a partir del grado de desarticulación. Finalmente, se discute la importancia de la participación de personal especializado en el lugar del hecho para una recuperación de la evidencia en estos escenarios tan complejos originados por procesos de dispersión, desarticulación y fragmentación como consecuencia del carroñeo.
This study aimed to investigate the usefulness of the thyroid-related hormones as markers of acute systemic hypoxia/ischemia to identify deaths caused by asphyxiation due to neck compression in human autopsy cases. The following deaths from pathophysiological conditions were examined: mechanical asphyxia and acute/subacute blunt head injury; acute/subacute non-head blunt injury; sharp instrument injury as the hemorrhagic shock condition; drowning as alveolar injury; burn; and death due to cardiac dysfunction. Blood samples were collected from the left and right cardiac chambers and iliac veins, and serum triiodothyronine (T3), thyroxine (T4), thyroglobulin (Tg), and thyroid-stimulating hormone (TSH) levels were measured using electrochemiluminescence immunoassays. Two types of thyroid cell lines were used to confirm independent thyroid function under the condition of hypoxia (3% O2). The human thyroid carcinoma cell line (HOTHC) cell line derived from human anaplastic thyroid carcinoma and the UD-PTC (sample of the second resection papillary thyroid carcinoma) cell line derived from human thyroid papillary adenoma, which forms Tg retention follicles, were used to examine the secretion levels of T3, T4, and Tg hormones. The results showed a strong correlation between T3 and T4 levels in all blood sampling sites, while the TSH and Tg levels were not correlated with the other markers. Serum T3 and T4 levels were higher in cases of mechanical asphyxia and acute/subacute blunt head injury, representing hypoxic and ischemic conditions of the brain as compared to those in other causes of death. In the thyroid gland cell line, T4, T3, and Tg levels were stimulated after exposure to hypoxia for 10–30 min. These findings suggest that systemic advanced hypoxia/ischemia may cause a rapid and TSH-independent release of T3 and T4 thyroid hormones in autopsy cases. These findings demonstrate that increased thyroid-related hormone (T3 and T4) levels in the pathophysiological field may indicate systemic hypoxia/ischemia.
Shot range, the muzzle-target distance, is a crucial parameter for forensic reconstruction of deaths by firearms. In a large number of cases, especially suicides, the forensic pathologist is confronted with contact or near-contact shots, where muzzle gases play an additional role. This study was conducted to systematically investigate the influence of muzzle gases on the temporary cavity (TC). A total of 72 shots were fired using full metal-jacketed bullets in four forensically relevant calibres from 10-, 5-, 3-, 2- and 1-cm distance and in close contact. Target model was the so-called reference cube (10% gelatine at 4 °C) with 12-cm edge length. The TC was recorded using high-speed video (HSV). Cross-sectional analysis was performed by cutting the blocks to 1-cm slices, which were evaluated by applying the polygon method. The TC of shots from 10 and 5 cm distance had a tubular form. This aspect changed depending on the cartridge with decreasing distance (≤ 3 cm) into a pear-like form, which was typical for contact shots. The cumulated heights of the TC increased with decreasing distance below 3 cm. Contact shots approximately doubled the extension of the TC compared with exclusive energy transfer. Whereas HSV documented an increasingly asymmetric profile with ballooning at the entry side, cross-sectional analysis of cracks in gelatine resulted in convex graphs with only slight asymmetry for contact shots. Additional damage in gelatine was detected for 3-cm distance or less in calibre .357 Magnum and ≤ 2 cm for .32 auto, .38 special and 9mm Luger. The increasing influence of muzzle gas pressure is detectable with decreasing shot range below 3 cm.
Although the arcus corneae (AC) has long been used as an age indicator for forensic purposes, its diagnostic value has not been evaluated. To evaluate the AC as a predictor of chronological age, the author has studied the correlation of AC with respect to age of the deceased. A cross-sectional study was conducted of 342 Thai corpses at the Maharat Nakhon Ratchasima Hospital, Thailand. AC was graded into three levels: no AC, incomplete ring, and complete ring. One-way analysis of variance, chi-square test, binomial logistic regression, sensitivity, specificity, predictive values, and likelihood ratios were used for analysis. The Cohen’s kappa was used to determine the intraobserver and interobserver reliability. The prevalence of AC and the probability of complete AC were significant higher in corpses aged 60 years and above than in those under 60 years. Consequently, this study confirmed that the prevalence of AC was significantly correlated with the age of Thai individuals. If the complete AC is used as an indicator of age of 60 years and above, complete AC has high sensitivity (92.56%) but low specificity (72.85%), low positive predictive value (65.12%), but high negative predictive value (94.71%). For diagnostic value, the presence of AC can be used for age screening but not for absolute confirmation. The absence of AC indicates young age, incomplete AC indicates middle age, and complete AC indicates old age. The high intraobserver and interobserver reliability provides assurance of the value of AC as a means to estimate personal age.
Purpose:
Fatal trauma on the neck occurs frequent in forensic cases and often results in fractures of the hyoid-larynx complex. The aim of the present study is to provide an overview of fractures in the hyoid-larynx complex that occur due to fatal trauma on the neck and can be observed by radiological evaluation.
Methods:
Radiological images from a forensic radiological database created in -BLINDED- were used for analysis. Hyoid-larynx complexes were explanted in 284 individuals who accordingly to the forensic pathologist allegedly died from fatal trauma on the neck. These explants were imaged with conventional X-rays in eight directions and a CT scan. Radiological images were analyzed for fractures, dislocations, joints, and anatomical variations by a trained analyst and a radiologist.
Results:
In 281/284 cases, the hyoid bone and, in 252/284 cases, the thyroid cartilage could be assessed. In 56 victims (20%), the hyoid bone was fractured, 55 times in the greater horn, 1 fracture in the body. The calcified superior horn of the thyroid showed a fracture in 101 victims (40%). The calcified cricoid cartilage was fractured in one case. Multiple fractures were found in 31/284 cases (11%). Joints between the greater horn and body of the hyoid were present in 74%.
Conclusion:
Trauma on the neck leads most frequently to fractures of the superior horn of the thyroid cartilage and second most to fractures in the greater horn of the hyoid bone. (Forensic) radiologists should be aware of uncommon fracture locations, anatomical variations, and dislocations in the hyoid-larynx complex.
Forensic anthropologists are frequently faced with the challenge of individualizing and sorting commingled remains in a variety of scenarios. A number of protocols have been proposed to standardize the methodological approach to individuating commingled remains, some of which are focused on pair-matching. A recent study by Karell et al. (2016) proposed a virtual method for pair-matching humeri using a semi-automatic procedure that gave encouraging results. With regards to the phalanges, there are only a handful of studies focusing on identifying and siding phalanges, as well as exploring their directional and functional asymmetry. Yet, they are still as important as every other bone when sorting commingled human remains in various situations, such as archaeological common burials and mass graves, commingled decomposed remains resulting from atrocities, accidents or natural disasters. This study investigates a new method for pair-matching, a common individualization technique, using digital three-dimensional models of bone: mesh-to-mesh value comparison (MVC) as proposed by Karell et al. (2016). The MVC method digitally compares the entire three-dimensional geometry of two bones using an iterative closest point (ICP) algorithm to produce a single value as a proxy for their similarity. The method is automated with the use of Viewbox software 4.1 beta for a simultaneous comparison of all possible pairs. For this study, 515 phalanges from 24 individuals of mixed ancestry were digitized using CT scans and the 3D modeling program AMIRA 5.3.3. The models were also hollowed (internal information of compact and trabecular bone removed) to test the method with simulated surface scan models. The subsequent data—over 73,000 comparisons—were assessed using sensitivity and specificity rates via ROC analysis to indicate how well the automated version of MVC pair-matched phalanges. The best bone in terms of pair-matching was the proximal phalanx of Digit 3 with 87.5% sensitivity and 92.4% specificity rates at a threshold value of 0.488 for the unhollowed bones. The specificity drops slightly (91.1%) when the hollowed models are compared. To compare the performance of the method in all phalanges, the specificity was set to 95%—allowing for a 5% acceptable error—and the adjusted sensitivity was compared. The highest sensitivity, namely 68.8%, was noted for Digit 2 proximal phalanx for both unhollowed and hollowed models. Thus far, our preliminary results indicate that the MVC method performs well when pair-matching phalanges, though it is less accurate than pair-matching other types of bones. The introduction of 95% specificity threshold allows for rejecting pairs in great confidence, which could, for instance, significantly reduce the number of DNA comparisons required for the remaining possible matches. In addition, the similar results obtained from hollowed and unhollowed models indicate that the internal information included in the unhollowed models adds little to the identification of true pairs. This means that if a CT scan is not available, the method could be applied to surface models produced by light and laser scanners as well. While additional work needs to be done to verify these preliminary results, this research has the potential to expand the repertoire of individualization methods.
The carotid body and carotid sinus are localized in the area of the carotid bifurcation and respond to pressure fluctuations in the arterial blood vessel system. In case of irritation or stimulation, nervous impulses can reflexively increase ventilation or slow down heart rate and blood pressure, respectively. External stimulation of the carotid sinus by neck compression with subsequent bradycardia or asystole, especially in pre-existing heart disease, is discussed controversially in the literature. Histological examination of tissue of the carotid bifurcation, particularly regarding haemorrhage as an indication of tissue trauma, should be carried out as a simple and easy routine diagnostic test. Carotid bifurcations were examined histologically in 20 cases of violence against the neck and an additional 82 cases of a control group without neck trauma and variable causes of death. Haemorrhage around the carotid bifurcation was found in one case of violence against the neck. This suggested direct trauma to the tissue of the carotid bifurcation, but evidence of lethal cardiac reflex was not found in any case.
Purpose
Cumyl-PEGACLONE was the first synthetic cannabinoid (SC) with a γ-carbolinone core structure detected in forensic casework and, since then, it has dominated the German SC-market. Here the first four cases of death involving its fluorinated analog, 5F-Cumyl-PEGACLONE, a recently emerged γ-carbolinone derived SC, are reported.
Methods
Complete postmortem examinations were performed. Postmortem samples were screened by immunoassay, gas chromatography mass spectrometry (GC–MS) or liquid chromatography tandem mass spectrometry. For quantification of SCs, the standard addition method was employed. Herbal blends were analyzed by GC–MS. In each case of death, the Toxicological Significance Score (TSS) was assigned to the compound.
Results
5F-Cumyl-PEGACLONE was identified at concentrations ranging 0.09–0.45 ng/mL in postmortem femoral blood. In case 1, signs of hypothermia and kidney bleedings were noted. Despite a possible tolerance due to long term SC use, a TSS of 3 was assigned. In case 2, an acute heroin intoxication occurred and a contributory role (TSS = 1) of 5F-Cumyl-PEGACLONE was suggested. In case 3, a prisoner was found dead. GC–MS analysis of herbal blends, retrieved in his cell together with paraphernalia, confirmed the presence of 5F-Cumyl-PEGACLONE and a causative role was deemed probable (TSS = 2). In case 4, the aspiration of gastric content due to a SC-induced coma was observed (TSS = 3).
Conclusions
5F-Cumyl-PEGACLONE is an emerging and extremely potent SC which raises serious public health concerns. A comprehensive analysis of circumstantial, clinical, and postmortem findings, as well as an in-depth toxicological analysis is necessary for a valid interpretation and for the assessment of the toxicological significance.
Stature estimation methods for Danish adult population have generally relied on Trotter and Gleser’s and Boldsen’s regression equations that are based on the skeletal remains of recent war dead American Whites, Terry Skeletal Collection, and Danish archaeological medieval skeletal materials, respectively. These equations are probably not suitable for stature estimation in contemporary Danish forensic cases. Furthermore, because postmortem computed tomography (PMCT) is now routinely performed at Danish forensic departments, equations based on PMCT, rather than measurements of defleshed bones, are needed. The aim of this study was to develop new equations for adult stature estimation based on PMCT femoral measurement. Maximum femoral length was measured on the PMCT images of 78 individuals (41 males and 37 females) aged 23–45 years. The measurement accuracy was tested on dry bones, and all the measurements were included in the inter‐ and intra‐observer analyses. Both analyses results demonstrated the reliability of the method and data. Comparison between the living stature of the individuals and the estimates based on the equations by Trotter and Gleser and Boldsen demonstrated the unreliability of the previous equations to some extent. New regression equations were then developed and validated on a different sample of 18 Danish forensic cases. Comparisons of all the equations indicated that both the sets of previous equations underestimated the stature in the new validation dataset. The new equations developed in this study provide a reliable alternative for stature estimation in modern Danish forensic cases.
The purpose of this study was to assess the value of magnetic resonance imaging (MRI) in addition to computed tomography (CT) in gunshot wound cases with bullets or pellets lodged inside the head. In this context, the potential heating and movement of the lodged bullets were additionally investigated using animal models. Eleven forensic cases of penetrating gunshot wounds underwent CT and MRI. The data of each imaging modality were reviewed according to the following relevant characteristics: bony lesion at the entrance, intracranial bone fragments, intracranial metal fragments, gunshot residues, the wound channel and the severity of metal artifacts. Four-point Likert scales were used for the assessment. The heating of projectiles and their magnetic field interactions with the static magnetic field were assessed using animal models. MRI presented major advantages in cases with transversal trajectories and non-ferromagnetic bullets compared to CT. In general, MRI enabled a clear visualization of the wound channel and gunshot-related soft tissue injuries. An image fusion of CT and MRI datasets demonstrated the individual strengths of both modalities. Radio frequency (RF)-induced heating due to bullets lodged inside the brain tissue was invalidated. The likelihood of ferromagnetic projectile migration inside brain tissue is low. MRI of decedents with a bullet lodged inside their heads is viable and provides a valuable supplement to CT. The in situ, noninvasive depiction of the wound channel and gunshot-related soft tissue injuries on MRI can contribute to the knowledge of wound ballistics.
Background:
Time of death estimation in humans for the benefit of forensic medicine has been successfully approached by Henssge, who modelled body cooling based on measurements of Marshall and Hoare. Thereby, body and ambient temperatures are measured at the death scene to estimate a time of death based on a number of assumptions, such as initial body temperature and stable ambient temperature. While so far, practical use of the method resorted to paper print outs or copies of a nomogram using a ruler, increasingly, users are interested in computer or mobile device applications. We developed a computational solution that has been available online as a web accessible PHP program since 2005. From that, we have received numerous requests not so much to detail our code but to explain how to efficiently approximate the solution to the Henssge equation.
Methods:
To solve Henssge's double exponential equation that models physical cooling of a body, it is sufficient to determine a difference term of the equation that will be close to zero for the correct time of death using a discrete set of all sensible possible solutions given that the modelled time frame has practical upper limits. Best post-mortem interval approximation yields minimal difference between equation terms RESULTS: The solution is approximated by solving the equation term difference for a discrete set of all possible time of death intervals that are sensibly found, and by then determining the particular time of death where equation term difference is minimal.
Conclusions:
The advantage of a computational model over the nomogram is that the user is also able to model hypothermia and hyperthermia. While mathematically impossible to solve in a straightforward way, solutions to the Henssge equation can be approximated computationally.
Venous air embolism (VAE) is a rare cause of death for which special procedures are needed for autopsy diagnosis. The current one of choice was devised by Richter in 1905 to prevent introduction of gas into the right heart while opening the thorax. We could find no published data demonstrating that that this occurs during standard autopsy technique. Two scenarios were investigated. In the first, the study group included cases using the traditional method to open the thoracic cage; in the control group, Richter’s method was used. Gas was collected under water and measured in a calibrated tube. The second scenario involved cases in which an intracardiac catheter was present at autopsy. In these, 50 mL of air was injected prior to chest opening and the amount of intracardiac air was measured. The first (non-injected) study and control groups consisted of 28 and 26 cases, respectively. Gas was identified in 3 cases (10%) in the study group and 2 cases (7%) in the control group. In the ten injected cases, there was a significant difference in the amount of the gas recovered (10 mL in the standard cases and 30 mL in the Richter group). No significant artifactual gas entrapment occurs in the right heart using the standard autopsy technique. However, it is possible that this technique may cause loss of intracardiac gas and if there is a clinical suspicion of VAE, Richter’s technique should be used.
The establishment of postmortem interval is one of the most important aspects of forensic expertise. Microbes may provide a novel way to estimate the postmortem intervals in order to avoid many of these limitations. The oral cavity harbors one of the most diverse microbiomes that play a key role in the decomposition of corpses. In this study, the oral bacterial community showed obvious changes in relative abundance during the process of mice decomposition. Meanwhile, at different taxonomic levels, specific bacteria were found to be significantly correlated with the postmortem interval. Linear regression models between relative abundance and the postmortem interval were constructed. Among these species, Gamma-proteobacteria and Proteus were the best ones that can be used to infer the postmortem interval, especially late postmortem interval. Therefore, we suggest that succession of oral microbial community can be developed as a forensic tool for estimating the postmortem interval.
Objective
To elucidate postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging findings suggesting massive fat embolism.
Materials and methods
Consecutive forensic cases with PMCT and PMMR scans of subjects prior to autopsy were assessed. For PMCT, 16- or 64-row multidetector CT scans were used; for PMMR, a 1.5 T system was used. MRI sequences of the chest area included T2- and T1-weighted fast spin-echo imaging, T2*-weighted imaging, T1-weighted 3-dimensional gradient-echo imaging with or without a fat-suppression pulse, short tau inversion recovery, and in-phase/opposed-phase imaging. At autopsy, forensic pathologists checked for pulmonary fat embolism with fat staining; Falzi’s grading system was used for classification.
Results
Of 31 subjects, four were excluded because fat staining for histopathological examination of the lung tissue could not be performed. In three of the remaining 27 subjects, histology revealed massive fat embolism (Falzi grade III) and the cause of death was considered to be associated with fat embolism. CT detected a “fat-fluid level” in the right heart or intraluminal fat in the pulmonary arterial branches in two subjects. MRI detected these findings more clearly in both subjects. In one subject, CT and MRI were both negative. There were no positive findings in the 24 subjects that were fat embolism–negative by histology.
Discussion and conclusion
In some subjects, a massive fat embolism can be suggested by postmortem imaging with a “fat-fluid level” in the right heart or intraluminal fat in the pulmonary arterial branches. PMMR potentially suggests fat embolism more clearly than PMCT.
Purpose
This paper presents a proposed guideline for the use of post-mortem computed tomography (PMCT) during forensic dental identification. Currently, whole-body PMCT is widely used prior to autopsies for the diagnosis of fractures, organ changes, hemorrhages, and for the localization of foreign bodies, but it may also facilitate the odontological identification process in single cases and in cases involving multiple fatalities. Several studies have described the use of PMCT in forensic odontological work, but we have not found any comprehensive set of guidelines on how to perform a forensic odontological examination using PMCT. The aim was to develop guidelines for creating post-mortem dental charts during forensic odontological identification examinations using the standard functions of PMCT.
Methods
A proposed guideline was developed from 15 selected cases examined at the Section of Forensic Pathology, Department of Forensic Medicine at the University of Copenhagen in Denmark from October 2011 to May 2012. Using the functionalities and three-dimensional (3D) reconstructions of OsiriX DICOM-viewer software (Pixmeo Sarl, Bernex, Geneva, Switzerland) we adjusted the contrast and brightness settings and developed a proposed guideline for creating PMCT-based dental charts. A four-step guideline was produced.
Conclusion
In our casework, we are currently using the guidelines proposed herein. The use of PMCT has allowed us to target our clinical examinations, greatly improving their efficiency. Furthermore, PMCT allows the storage of data for later documentation and research. Further research is needed to validate the proposed guideline.
Auroraceratops rugosus from the Lower Cretaceous Zhonggou Formation, Gansu Province, China is characterized by exquisite external preservation of articulated, often ventrolaterally curled remains found in discrete locations several to hundreds of meters apart. This has prompted a hypothesis that the remains are the result of recurring die-offs and rapid burial in burrows. To test this, rare earth element (REE) concentrations were measured from Auroraceratops bones and surrounding red-bed mudstones via inductively coupled plasma mass spectrometry. Petrographic analysis was conducted to understand the preservation of the bones and surrounding rock. Results suggest early postmortem deterioration of the bone by bacteria and/or fungal hyphae (Wedl type I tunneling and mineralized remains) and mineralization of hyphae in acidic/reducing conditions. This is supported by Ce-enriched, filamentous ferromanganese oxide coatings on the external and internal bone cavities. Deterioration/dissolution of the bone must have ceased for a period of time, and we suggest that desiccation of the carcasses halted the deterioration of bone. A second mineralization phase occurred as remains came into contact with vadose water, as evident by precipitation of micritic calcite, recrystallization of filamentous apatite in the bone matrix, and bone REE patterns indicating equilibration with alkaline/oxidized fluids. Despite poor histologic preservation, the well-articulated, curled-up positioning of the remains, and similarity to remains from the Upper Cretaceous Nemegt Formation of Mongolia, suggests that the Auroraceratops beds are the result of death in burrows in a seasonally arid environment. The similar taphonomic mode to remains from Nemegt may represent a common preservation mode for faunas from extensional basin deposits.
SUPPLEMENTAL DATA—Supplemental materials are available for this article for free at www.tandfonline.com/UJVP
Citation for this article: Suarez, C. A., E. M. Morschhauser, M. B. Suarez, H. You, D. Li, and P. Dodson. 2019. Rare earth element geochemistry of bone beds from the Lower Cretaceous Zhonggou Formation of Gansu Province, China; pp. 22–35 in Hailu You, Peter Dodson, and Eric Morschhauser (eds.), Auroraceratops rugosus (Ornithischia, Ceratopsia) from the Early Cretaceous of northwestern Gansu Province, China. Society of Vertebrate Paleontology Memoir 18. Journal of Vertebrate Paleontology 38(Supplement). DOI: 10.1080/02724634.2017.1400441.
Joining forensic traditional autopsy and CT-MR postmortem virtual approach may assist forensic experts in adequate reconstruction of cause, manner, and way of death, significantly to find evidence of found wound/fracture and relative interpretation. Evaluation of criminal burning is often a difficult challenge in the view of misinterpretation of wound/fracture victims and usually poor case history of this criminal offense. In this scenario, a strong collaboration between imaging and classical forensic techniques is helpful.
The Global status report on road safety published by the World Health Organization (WHO) in 2015 estimating information from 180 countries indicates that worldwide the total number of road traffic deaths has plateaued at 1.25 million per year. This report, the third Global status report on road safety, shows that low- and middle-income countries are more affected with a mortality rate of 90% of global road traffic deaths.
In cases of inflicted injury, the process of examining the patient for external injuries and documenting the findings is important for forensic assessment, including estimating or determining the type of weapon used and the circumstances of the violence. However, external examination is obviously limited in assessing internal injury. Here, we report the cases of two patients who survived stab wounds, where the findings of contrast-enhanced computed tomography (CT) performed for clinical diagnosis in the hospital were useful for forensic injury evaluation. In both cases, contrast-enhanced CT clearly displayed the injuries to the parenchymal organs and enabled the estimation of the direction and depth of the stab wounds by depicting the track and base of the wounds on acquired images. With the addition of the findings from examination of the external wound, the stab wounds in both victims were consistent with injury caused by the suspected weapon. Recently, imaging modalities including CT have become useful supplemental tools for precise forensic evaluation. Imaging findings obtained from these modalities could especially provide useful information for forensic assessment in clinical forensic medicine because examination of internal injury in the living body cannot generally be performed. Research on the precise diagnostic value of this method is required to utilize this method adequately in clinical forensic medicine.
The diagnosis of drowning is one of the most difficult in forensic medicine. The aim of this study was to analyze pulmonary tissue reactions in death by drowning. In particular, we focused on the immunohistochemical expression of P-selectin, SP-A, HSP70, AQP-5, and fibronectin to investigate our expression in drowning and to understand whether there are differences between saltwater drowning (SWD) and freshwater drowning (FWD), which may indicate a different pathophysiology. We retrospectively investigated 10 cases of SWD (Mediterranean Sea) from the Institute of Legal Medicine of Genoa (Italy), and 10 cases of FWD (Lake of Geneva) from the University Center of Legal Medicine of Geneva (Switzerland). As control group, we examined 10 cases of death by acute external bleeding, characterized by minimal respiratory distress. As compared with controls, in SWD cases, the results showed a decrease of SP-A expression with membrane patterns. Furthermore, we observed a greater SP-A expression with granular pattern in drowning cases without statistically significant difference between SWD and FWD. For the markers AQP-5, HSP70, fibronectin, and P-selectin, no statistically significant differences were found between SWD, FWD, and controls.
Zur Todeszeitdiagnostik im frühen postmortalen Intervall wird die sog. Komplexmethode angewandt, die sowohl temperaturbasierte als auch nichttemperaturbasierte Faktoren berücksichtigt. Die nichttemperaturbasierten Komponenten der Komplexmethode und ihre Zeitgrenzen wurden im Wesentlichen aus empirischen Daten älterer Literaturquellen abgeleitet; neuere systematische Studien fehlten bislang. Die vorgestellten Untersuchungen über die Auslösbarkeit mehrerer nichttemperaturbasierter Faktoren führten zur Verifizierung (idiomuskuläre Kontraktion und Wegdrückbarkeit von Leichenflecken) sowie zur Falsifizierung (Neubildung der Leichenstarre, pharmakologische Beeinflussbarkeit der Pupillomotorik) bisher mitgeteilter forensisch relevanter Post-Mortem-Zeitgrenzen. Sie tragen damit zur erhöhten Sicherheit der forensischen Beurteilung bei.
Positional or postural asphyxia occurs when a particular body position interferes with adequate respiratory movements for a lengthy period of time. Death is usually accidental and associated with alcohol or drug intoxication, disability, or restraint. We report on the case of a 42-year-old man found unresponsive while working on farmland. The upper part of his body (head and upper limbs) was trapped in the highest and largest opening of the atomizer of a high-volume sprayer tank while his legs were hanging down. Bruises and abrasions were found on both suprascapular regions. Tramline bruises encircled the body between the abdominal and thoracic regions in line with the morphology of the tank’s opening where the body was found. Cyanosis and petechial hemorrhages were found on his face, conjunctives, neck, and superior chest; the lungs were edematous. Toxicological analyses of body fluids were negative. The cause of death was postural asphyxia, and the manner of death was certified as a fatal accident at work. Work-related postural asphyxia has rarely been described in the literature. Scene investigation, autopsy, and toxicological analyses play a key role in the reconstruction of the dynamics involved in occupational events, in turn allowing the identification of any legal responsibilities of the worker or the employer.
For the medicolegal evaluation of victims of survived strangulation, a neck-magnetic resonance imaging (MRI) can be performed for assessing lesions in the inner soft tissues (fat, muscles or lymph nodes, for example). In our institute, such MRI examinations have been performed for a test period of 4 years with the aim of evaluating the use of this tool by forensic pathologists and identifying medicolegal indicators for the performance of neck-MRI in surviving victims of strangulation. We retrospectively reviewed medicolegal reports from all victims examined during the test period. We extracted objective lesions (e.g. petechiae, bruising and abrasions) and reported clinical symptoms (e.g. vision disorder, dysphasia) from the reports. These findings were compared to those reported from the neck-MRI. In total, 112 victims were clinically examined after suspected strangulation. Eleven of these victims underwent an MRI examination of the neck. Eighty-four of the victims presented objective lesions during the clinical examination, with eight showing signs of both petechiae and bruising. Neck-MRI was performed in four of these eight victims and three of them showed lesions visible in MRI. Of 76 victims with bruising as the only objective finding, 66 victims described clinical symptoms. Of those 66 victims, seven were examined by MRI and two demonstrated lesions in MRI. When MRI was performed, relevant findings were detected in 45% of the cases. This leads to the suspicion that many more findings could have been detected in the other victims, if an MRI had been performed in those cases. Our results lead us to the conclusion that an MRI examination of victims of suspected strangulation is useful, and strict indications for its application should be established.
Chop or slash wounds are produced by sharp-edged tools such as an axe, or a machete. This paper presents a case of a violent death of a 57 year-old-man. Autopsy revealed deformation of the right side of the head. A total of 23 slash, stab and cut wounds as well as contused lacerations were identified on the scalp as well as the face and the neck. In addition, superficial abrasions and bruises were identified on the skin. The immediate cause of death was due to extensive brain contusion following fragmentation of the neurocranium. The injuries resulting in the death of the victim were sustained during an assault on the head with an axe, which was used both as a slashing tool and a blunt instrument.
This represents one of several sections of "A Bibliography Related to Crime Scene Interpretation with Emphases in Geotaphonomic and Forensic Archaeological Field Techniques, Nineteenth Edition" (The complete bibliography is also included at ResearchGate.net.). This is the most recent edition of a bibliography containing resources for multiple areas of crime scene, and particularly outdoor crime scene, investigations. It replaces the prior edition and contains approximately 10,000 additional citations. As an ongoing project, additional references, as encountered, will be added to future editions.
This bibliography would not be complete without the inclusion of references to the general topics of crime scene and criminal investigation. Just as the compiler emphasizes the need for law enforcement to understand the training and practices of specialists he might call to a crime scene, it is important for the non-law enforcement practitioner, or civilian expert, to understand the training to which an investigator is exposed. The non-forensic expert consulted by law enforcement must remember that crime scene processing includes procedures for avoiding cross-contamination and insuring proper chain of custody. A premise of Melissa Connor's Forensic Methods, (2007), is this introduction of criminal investigators and non-law enforcement to each other's viewpoints. The formally trained archaeologist and criminalist will find in common, goals of systematically documenting, collecting, and interpreting physical evidence for the purpose of understanding factors which affected the depositional history of that evidence, and ultimately elucidating human behavior in a very precise way. For both disciplines the comprehensive documentation of the physical evidence in its contextual setting is paramount. the greatest handicap for the academic forensic specialist is coping with the paradox of being pressured to process crime scenes as efficiently as possible. Research projects involving relatively trivial subject matter are often afforded more time than scenes which literally involve circumstances of life and death. The researcher may find the sections on Excavation and Recovery Strategies; Planning, Reconnaissance and Mapping Techniques; and Mass Fatality and Human Rights Investigations cross referenced here or compatible with citations found below.
(2935 citations)
Purpose
Pulmonary fat embolism (PFE) is a relevant diagnosis playing a role as a sign of vitality or a cause of death. Its severity is assessed according to histological grading systems like that of Falzi. The aim of this study was to determine the utility of unenhanced postmortem computed tomography (PMCT) for PFE diagnosis based on the detection of fat layers.
Methods
Consecutive cases with PMCT and autopsy were studied retrospectively. The case group consisted of cases with positive PFE, and the control group included cases with negative PFE. Three observers independently assessed PMCT data for fat layers in the pulmonary trunk and the right and left pulmonary artery. For cases with fat layers, autopsy protocols were assessed for the cause of death, relation to trauma, and undertaken resuscitation measures.
Results
Eight hundred thirty cases were included: 366 PFE positive cases (144 of Falzi grade 1, 63 of 1.5, 99 of 2, 28 of 2.5, and 32 of 3) and 464 PFE negative cases. Interrater reliabilities varied between substantial and almost perfect, and discrepancies were solved according to majority. Eighteen cases showed fat layers on PMCT (2 controls—traumatic instantaneous deaths—, 16 PFE positive cases). PMCT showed low sensitivity but high specificity for PFE diagnosis. The layers were located at the same position in the pulmonary trunk directly adjacent to the pulmonary valve distal to the right ventricle.
Conclusion
Fat layer on PMCT is a rare finding but relates to PFE diagnosis, especially of severe histological grade. It is to be expected in a typical position within the pulmonary trunk.
Literature on electrocution in Italy is limited. The authors have focused their attention on the use of scanning electron microscope/energy-dispersive X-ray analysis in order to evaluate the current mark even on paraffin-embedded samples. A total of 24,104 autopsies were performed at the Section of Legal Medicine of Milan (1993–2017); all cases of death caused by electrocution (low and high voltage) were selected. We assessed a regular histological examination, a toxicological examination and detected metallisation with energy-dispersive X-ray spectroscopy analysis on paraffin-embedded tissues of typical current marks. We collected 27 high-voltage fatalities and five cases of low-voltage suicide electrocution; the technique revealed itself as sensitive. In all cases, microscopic examination highlighted the typical signs of electric current and thermal damage but the histochemical specific stainings for copper and iron gave negative results. Scanning electron microscope/energy-dispersive X-ray analysis, assessed on these same samples, even when paraffin-embedded, however, enabled us to detect these elements and differentiate between the various metal residues involved in the electrocution process. Based on their experience, authors advise the use of scanning electron microscope/energy-dispersive X-ray analysis on electrocution deaths to provide information for forensic diagnosis.
Background:
Seat belt marks are seen frequently on occupants after motor vehicle accidents. Over the years, the clinical significance of these marks has changed as restraint systems have evolved. With modern restraint systems, signs of a compromised occupant-restraint relationship are an important and easily identified bedside finding.
Objectives:
We sought to learn to recognize seat belt marks that demonstrate an abnormal occupant-restraint system relationship and to cultivate an understanding of significant soft tissue biomechanical loading associated with marks caused by a compromised occupant-restraint relationship.
Discussion:
A review of case studies from the literature combined with forensic work demonstrate a strong correlation between significant injury and improper seatbelt use. When evidence of a compromised occupant-restraint relationship exists, incorporating computed tomography angiography and observation may be clinically indicated.
Conclusion:
The recognition of seat belt marks made by a compromised occupant-restraint relationship is an important finding that allows risk stratification of the patient at the bedside. Further investigation with a prospective trial at a trauma center is warranted.
Different sampling techniques can impact on post mortem tryptase levels. A previous study demonstrated significantly lower femoral post mortem total tryptase levels in samples collected via transcutaneous aspiration compared with directly sampling during internal examination. However, an outlier with high tryptase level was noted in one transcutaneous aspiration sample. This 6-month prospective study compared total post mortem tryptase levels between 21 paired aspirated venous and arterial femoral blood samples, and 19 paired aspirated and cutdown femoral venous blood samples in non-anaphylactic deaths only. No statistical differences were demonstrated between the different sampling methods. However, four outlier cases with higher tryptase levels in aspirated arterial and femoral cutdown samples compared with aspirated venous femoral samples were noted. The reasons for the outliers may be due to the bloods collected from these two methods being contaminated by central arterial and venous blood with high tryptase levels respectively. None of the aspirated venous femoral post mortem tryptase levels were above recognized post mortem tryptase cutoff to diagnose anaphylaxis. This study recommends aspirating blood samples from a clamped femoral/external iliac vein for post mortem tryptase analysis should be defined as the gold standard. Further study using the recommended sampling method on post mortem tryptase levels in non-anaphylactic and anaphylactic cases is warranted.
John F. Kennedy once said that he was a Berliner (1). Following in his footsteps, albeit less exalted in my case, I would like the record to state that I am a chemist. Despite various peregrinations in my career, I am at heart a chemist. Yet, I also lay claim to be a forensic archaeologist. While some may wonder why I did not pursue the well-established discipline of forensic chemistry, or even toxicology, a topic for another time, the thrust of this discussion is to determine what my background and training has meant to my study of forensic archaeology.
The concept of spontaneous combustion has huge appeal as an historical fiction but it has no scientific background. However, in some deaths involving fire, a body can burn away virtually completely with minimal thermal destruction to the neighboring environment. We report an extraordinary case of the self-immolation of an elderly woman who set herself on fire with suicidal intentions. The unusual appearance and location of the body closely resembled the phenomenon of so-called spontaneous human combustion because the upper parts of the body were almost totally destroyed by fire, while the legs and surrounding structures remained almost untouched by flames. The results of all investigations proved that the woman set fire to her body using a box of matches and accelerants (concentrated ethanol and a solid firelighter). Near-total combustion of her body subsequently occurred during the postmortem period. The development of alleged spontaneous human combustion requires the following: ignition (external heat source), fuel (molten human fat), a wick (e.g. charred and porous clothing, bedding, or ground), time, and an optimal microclimate for gradual burning.
Several articles have described the use of postmortem computed tomography (CT) and postmortem magnetic resonance imaging (MRI) in forensic medicine. Although access to CT scanners and, particularly, access to MRI scanners, is still limited for several institutes, both modalities are being applied with increasing frequency in the forensic setting. Certainly, postmortem imaging can provide crucial information prior to autopsy, and this method has even been considered a replacement to autopsy in selected cases by some forensic institutes. However, the role of postmortem imaging has to be assessed individually according to various injury categories and causes of death. Therefore, this systematic review focuses on the role of postmortem CT and MRI in cases of hanging and ligature and manual strangulation. We assessed the most common and relevant findings on CT and MRI in cases of strangulation and compared the detectability of these findings among CT, MRI and autopsy. According to the available literature, mainly fractures of the hyoid bone or thyroid cartilage were investigated using postmortem CT. Compared to autopsy, CT demonstrated equivalent results concerning the detection of these fractures. A currently described “gas bubble sign” may even facilitate the detection of laryngeal fractures on CT. Regarding the detection of hemorrhages in the soft tissue of the neck, postmortem MRI is more suitable for the detection of this “vital sign” in strangulation. Compared to autopsy, postmortem MRI is almost equally accurate for the detection of hemorrhages in the neck. Another “vital sign”, gas within the soft tissue in hanging, which is hardly detectable by conventional autopsy, can be clearly depicted by CT and MRI. The number of cases of manual and ligature strangulation that were investigated by means of postmortem CT and MRI is much smaller than the number of cases of hanging that were investigated by CT and MRI. Likewise, judicial hanging and the hangman’s fracture on postmortem imaging were described in only a few cases. Based on the results of this systematic review, we discuss the additional value of CT and MRI in fatal strangulation compared to autopsy, and we reflect on where the literature is currently lacking.
A year after the Department of Health issued guidelines on post exposure prophylaxis (PEP) for health care workers exposed to HIV, we conducted a telephone survey of occupational health nurses and junior doctors in London teaching hospitals, to assess implementation of the guidelines and awareness among junior doctors of local policies. The management and administration of PEP for HIV differed considerably between hospitals. Many junior doctors did not know what to do in the event of a needlestick injury. Both the implementation of and the briefing of staff about current management policies need to improve.
The growth of the hepatic weight was correlated to fetal parameters of maturity (gestational age, crown-rump length and weight) in 70 human fetuses ranging from 14 to 39 weeks post-conception using the allometric method. The growth of the hepatic weight presents moderate positive allometry relative to age and C-R length, and isometry relative to fetal weight. The coefficiens of correlation are very high (p less than 0.001, Table 1). This study presents growth curves of the hepatic weight useful in medical branches such as anatomy, forensic medicine, fetopathology, medical imagery, onstetrics and pediatrics.