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PubMed2004

External injuries to the neck after free fall from great height.

Falls from great height are suicidal in most cases. Any antecedent trauma that would indicate an involvement of a third party should, however, be excluded in each case. Herein lies the difficulty in such cases since injuries prior to the fall which could be of criminal nature may be masked by the impact injuries. Injuries on unexposed parts of the body should always raise the suspicion of an involvement of a third party. This applies especially for neck injuries. By a retrospective analysis of 132 cases of falls from great height, the authors conclude, however, that neck injuries may occur after free fall from great height on a flat surface without antecedent trauma.

Accidental Falls↗
PubMed2004

Use of prostate specific antigen in the identification of semen in postmortem cases.

Over the past 20 years, the use of prostate specific antigen (PSA) as evidence of the presence of semen in forensic cases has been well established. In this study, we compared a commercially available immunoradiometric assay (IRMA) for the identification of PSA with the identification of spermatozoa in swabs obtained from the vagina of deceased females. There was agreement between the 2 methods in 67 of the 80 cases (84%), including 18 cases where both the PSA was positive and sperm were observed microscopically. The remaining cases had 1 positive result and 1 negative result. We concluded that although there was substantial agreement between the presence of sperm and a positive PSA, there were enough discrepancies between the 2 methods (16%) to justify the use of both methodologies, if possible, to make the determination of sexual activity prior to death.

Autopsy↗
PubMed2004

What is the incidence and significance of "dry-lungs" in bodies found in water?

BACKGROUND: Drowning without aspiration of liquid, generally attributed to death from asphyxia while submerged and in laryngospasm, has been reported to occur in approximately 10% to 15% of drowning victims. OBJECTIVES: The occurrence of "dry-drowning" recently has been questioned and the hypothesis developed that "dry-lungs" in bodies found dead in the water could conceal more natural deaths than previously recognized. METHODS: Based on 578 selected adult victims who presumably drowned, we analyzed the correlation between the cases with a low combined lung/pleura liquid weight (< 1000 g and < 750 g) and a wide set of individual, circumstantial, and postmortem (PM) variables, using multivariate logistic regression analysis. Victims with lung weight < 1000 g were screened for long-QT syndrome (LQTS) founder mutations in KCNQ1 and KCNH2 genes. RESULTS: Of the 578 victims, 120 (20.7%) had a lung weight of < 1000 g, and 22 of these (3.8%) of < 750 g. Multivariate analysis showed a significant correlation for women (P < 0.001), for women aged 65 years or older (P < 0.001), and for men with prolonged PM submersion time (P < 0.001). "Normal" lungs were found in only 8 (1.4%) victims. Low-weight (< 1000 g), overdistended lungs with no sign of liquid penetration were seen in 11 (1.9%). No LQTS founder mutations were detected. CONCLUSIONS: The actual incidence of death of persons found in water who have normal lungs or do not have penetration of liquid into their airways, based on our study, is much lower (below 2%) than currently assumed.

Adolescent↗
PubMed2004

A case study of the suicide of Luis Mendès France, in Bordeaux, in 1695.

After being condemned and imprisoned in Lisbon by the Portuguese Inquisition, Luis Mendes de Franca exiled himself in late 1683 to France, where his descendants adopted the family name Mendes France. In 1695, at the age of 55 years, Luis Mendes committed suicide in Bordeaux by a pistol shot that decapitated him. The inquest conducted at that time concluded that Luis Mendes was insane and thus not guilty of the crime of suicide. We hypothesize that he used a flint stone-type pistol loaded with an extraordinarily large quantity of black gunpowder. Using available information on historic firearms, ammunition, and powder, coupled with the preserved testimony of historic figures, we propose a reconstruction of this drama and a diagnostic approach to the psychiatric aspects of the suicide.

Famous Persons↗
PubMed2004

Unusual torture methods and mass murders applied by a terror organization.

This study aims at describing autopsy findings of 19 victims killed by various torture methods applied by a terror organization after they had been kidnapped by this organization, as well as the unusual and unique binding style applied during these killings. The present study also aims at describing the unusual killing method of binding for literature and discussing international descriptions of torture.

Adult↗
PubMed2004

Detergent: an alternative approach to traditional bone cleaning methods for forensic practice.

Osteological assessment of human remains forms an essential part of forensic work, especially during the examination of extensively decomposed, dismembered, or burnt bodies. Currently employed methods for removal of adherent soft tissue reflect practices often used by museum curators, notably insect consumption, enzymatic maceration, or boiling of the bones, with subsequent manual removal of material. This study was designed to assess the effectiveness of detergents for the purpose of soft-tissue removal from animal-derived specimens. The results indicate that such a means is comparable to enzymatic maceration but with fewer health and safety issues and greater advantages regarding transportation and availability of materials when an investigator is in a fieldwork scenario.

Adolescent↗
PubMed2005

Death due to Ehlers-Danlos syndrome type IV.

Ehlers-Danlos syndrome (EDS) represents a group of collagen connective tissue disorders characterized by joint laxity, easy bruising, and various skin manifestations. Persons with type IV EDS are at risk for gastrointestinal, uterine, and arterial rupture. Mutations in the COL3A1 gene that encodes for type III procollagen underlie the pathologic abnormalities. Forensic pathologists must be aware of this rare, autosomal-dominant connective tissue disorder. Postmortem diagnosis is possible but requires specialized testing (fibroblast culture and subsequent biochemical assays, with or without molecular studies). When the condition is diagnosed or suspected at autopsy, it is important for forensic pathologists to notify family members of this potentially lethal disorder. Three cases of type IV EDS diagnosed by forensic pathologists are presented, followed by a discussion of the disorder.

Adult↗
PubMed2005

Case analysis of brain-injured admittedly shaken infants: 54 cases, 1969-2001.

The English-language medical case literature was searched for cases of apparent or alleged child abuse between the years 1969 and 2001. Three-hundred and twenty-four cases that contained detailed individual case information were analyzed yielding 54 cases in which someone was recorded as having admitted, in some fashion, to have shaken the injured baby. Individual case findings were tabulated and analyzed with respect to shaking as being the cause for the injuries reported. For all 54 admittedly-shaken-infant cases, the provided details regarding the shaking incidents and other events are reported. Data in the case reports varied widely with respect to important details. Only 11 cases of admittedly shaken babies showed no sign of cranial impact (apparently free-shaken). This small number of cases does not permit valid statistical analysis or support for many of the commonly stated aspects of the so-called shaken baby syndrome.

Brain Injuries↗
PubMed2005

Investigation of cardiac troponins in postmortem subjects: comparing antemortem and postmortem levels.

The limitations of autopsy in the diagnosis of death due to ischemic heart disease are well known. In the living, a simple reliable biochemical assay for cardiac troponins is used in the diagnosis of acute myocardial ischemia. Several studies have investigated the use of biochemical assays for cardiac troponins in postmortem subjects as a means to distinguish between a cardiac and anoncardiac cause of death. All of these studies, however, rely upon assigning subjects to "cardiac" or "noncardiac" death on the basis of a postmortem examination. As postmortem examination does not always accurately distinguish between these two groups, this approach is intrinsically flawed. Our study compares antemortem and postmortem cardiac troponin levels in five subjects. The antemortem samples were retrieved from the hospital biochemistry laboratory after each subject's death. The postmortem samples for each subject were taken from different sites and at different times during the early postmortem period.Erratic results bearing little or no relation to the antemortem cardiac troponin level were obtained for all subjects. Four of the five subjects had raised antemortem troponin levels, although only one had a cardiac cause of death. From this, we conclude that postmortem blood is not a suitable substrate for standard biochemical assays of cardiac troponins, which are designed for use on serum taken from living patients. In addition, the results of our study support the view that elevated cardiac troponins are a marker of serious morbidity and are not specific for cardiac injury as the primary cause of morbidity or mortality.

Autopsy↗
PubMed2005

Cor triatriatum sinistrum: a rare congenital cardiac anomaly presenting in an adult with chronic atrial fibrillation.

Cor triatriatum is a rare congenital cardiac anomaly in which the left atrium is divided into proximal (dorsal or upper) and distal (ventral or lower) chambers by a fibromuscular septum. The upper chamber receives the pulmonary veins and the lower chamber contains the atrial appendage and the mitral valve. The 2 chambers communicate through a defect in the membrane. Cor triatriatum is often associated with other congenital cardiac anomalies. Most frequently, the upper chamber communicates with the right atrium through a patent foramen ovale or atrial septal defect, and the clinical symptoms simulate anomalous pulmonary venous return. Less commonly, the foramen ovale communicates with the distal chamber and the clinical features mimic mitral stenosis. When cor triatriatum is the only abnormality, the clinical findings are also similar to mitral stenosis with development of pulmonary hypertension and subsequent right ventricular hypertrophy and atrial enlargement. The diagnosis is usually made in infancy or childhood, and the lack of treatment results in death in 75% of patients. We report the case of a woman who presented much later in life. The patient was a 57-year-old female with a clinical history of chronic atrial fibrillation who presented to the emergency department because of a "funny sensation" in her chest, though she denied chest pain, nausea, vomiting, or diaphoresis. EKG revealed atrial fibrillation with a rapid ventricular response and a tachycardic rate of 157. She had a therapeutic level of digoxin, and cardiac enzymes were normal. The patient was admitted and placed on Cardizem drip. Serial EKGs remained normal and heart rate control was achieved. On hospital day 2, the patient became dyspneic and cyanotic. She went into cardiac arrest and died.Autopsy revealed cardiomegaly (610 g) with 4-chamber dilatation. A septum divided the left atrium into 2 chambers. The defect in the dividing membrane measured 1 cm in diameter. No other congenital defects were noted. The large size of the defect in the membrane likely accounted for the late onset of symptoms that allowed this patient to survive into adulthood without previous diagnosis or surgical intervention (which is usually required in childhood).

Atrial Fibrillation↗
PubMed2005

An autopsy case of imipramine poisoning.

We present a fatal imipramine poisoning. Quantitative analysis of imipramine and its metabolite, desipramine, was performed by high-performance liquid chromatography. The concentrations of imipramine and desipramine were 18.67 microg/mL and 6.21 microg/mL in heart blood and 6.90 microg/mL and 1.77 microg/mL in the femoral venous blood, respectively. We concluded that the cause of death was due to imipramine poisoning.

Antidepressive Agents, Tricyclic↗
PubMed2005

Gestational age discrepancies due to acquisition artifact in the forensic fetal osteology collection at the National Museum of Natural History, Smithsonian Institution, USA.

Previously, numerous techniques have been used to assess either lunar or gestational age from fetal remains, such as from the external dimensions of the fetus, presence or absence of external features and ossification centers. One of the largest fetal collections in the U.S. is assessed with regard to errors in its biologic profile (ancestry, sex and age), the nature of the collection process, the methods of collection and the subsequent considerations for usage. Hrdlicka recorded the age, ancestry, sex and external measurements on card catalogs in the early 1900s for future use. For the purpose of this pilot study, measurements on 38 suitable fetuses stored at NMNH were used to calculate lunar age and compare with the recorded age in the card catalog. The differences between the age assessments are as follows: 20 showed no difference, 11 were discrepant by one month, 6 varied by 2 months and 1 diverged by 5 months. The average difference between lunar ages is 0.74 months, reflecting a nearly three-week difference. The purpose of this paper is to demonstrate that such discrepancies exist and to confirm specimens with accurate ages, which can be marked for future research. Moreover, it is also the purpose of this paper to demonstrate that such bias artifact exists in museum collections, and that this artifact needs to be eliminated from the sample materials prior to study.

Age Determination by Skeleton↗
PubMed2005

LAP-banding obesity: a case of stomach perforation, peritonitis, and death.

We present a case of peritonitis and death due to the misplacement of a laparoscopic adjustable band inserted through, instead of around, the stomach. This represents the first case in the published literature where a LAP-BAND perforated the stomach, followed by peritonitis and death. The morbidly obese female patient with a history of hypertension and arthritis was 47 years old, 5 feet 6 inches tall, weighed 361 pounds, and had a body mass index of 58.3. She underwent a 2-hour, elective, LAP-band insertion operation to achieve weight loss; 27 hours after band insertion, following the conduction of all FDA-mandated Lap-Band postoperative protocol (including a radiologic Gastrogrografin swallow), the patient was discharged with "no evidence of esophageal stasis or obstruction." She remained out of hospital care and in her residence until she called for and was taken by an ambulance to an alternate, local hospital (57 hours after band insertion), when gastric perforation was confirmed via x-ray and CT scans. No open surgery was attempted to repair the damage, and cardiac arrest ensued 7 hours after admission to the second hospital. The patient was pronounced dead 64 hours after LAP-band insertion. This unique case is significant, given that there were no deaths of this kind reported in The LAP-BAND(R) Adjustable Gastric Banding System Summary of Safety and Effectiveness Data by the United States Center for Devices and Radiologic Health, of the Food and Drug Administration, or in searches of the published literature.

Female↗
PubMed2005

Vehicle-assisted suicide resulting in complete decapitation.

A rare case of vehicle-assisted suicide in a 43-year-old man is presented. The man had tied a rope between a fence and his neck and, while seated on the driver's seat, accelerated the vehicle, which resulted in complete decapitation. Earlier that day, the man had tried to bleed himself to death by bottling his own blood in his flat, thus defining the case as secondary complex suicide.

Adult↗
PubMed2005

Review of autopsy findings in judicial electrocutions.

Electrocution has been a means of execution since 1890, when it was introduced as a more humane method than hanging. Only 1 state today, Nebraska, uses it as the sole method of execution. Since the reinstatement of the death penalty in the state of Florida, 43 judicial electrocutions have taken place in the years 1983-1999. In 2000, the state of Florida passed legislation allowing lethal injection as an alternative to electrocution. Since that time, lethal injection has been used and judicial electrocution has virtually become obsolete. In this review of the 43 autopsies, the most common physical findings were an annular burn on the head due to the scalp electrode and a burn on the right calf due to the anklet, both due to electrical current flow. In 3 cases, unexpected events occurred during the electrocution. The autopsy findings in these 3 cases were similar to those found in previous electrocutions. This review presents an objective and factual description of changes due to one method of capital punishment.

Adult↗
PubMed2005

Identification of exhumed remains of fire tragedy victims using conventional methods and autosomal/Y-chromosomal short tandem repeat DNA profiling.

In a fire tragedy in Manila in December 1998, one of the worst tragic incidents which resulted in the reported death of 23 children, identity could not be established initially resulting in the burial of still unidentified bodies. Underscoring the importance of identifying each of the human remains, the bodies were exhumed 3 months after the tragedy. We describe here our work, which was the first national case handled by local laboratories wherein conventional and molecular-based techniques were successfully applied in forensic identification. The study reports analysis of DNA obtained from skeletal remains exposed to conditions of burning, burial, and exhumation. DNA typing methods using autosomal and Y-chromosomal short tandem repeat (Y-STR) markers reinforced postmortem examinations using conventional identification techniques. The strategy resulted in the identification of 18 out of the 21 human remains analyzed, overcoming challenges encountered due to the absence of established procedures for the recovery of mass disaster remains. There was incomplete antemortem information to match the postmortem data obtained from the remains of 3 female child victims. Two victims were readily identified due to the availability of antemortem tissues. In the absence of this biologic material, parentage testing was performed using reference blood samples collected from parents and relatives. Data on patrilineal lineage based on common Y-STR haplotypes augmented autosomal DNA typing, particularly in deficiency cases.

Autopsy↗
PubMed2005

Sudden death due to asphyxia by esophageal polyp: two case reports and review of asphyxial deaths.

Asphyxia, not an uncommon cause of sudden death, may result from numerous etiologies. Foreign-body aspiration and strangulation are 2 extrinsic causes. Airway obstruction may also be caused by laryngeal edema, asthma, infection, or anaphylaxis. Chronic causes of asphyxia include musculoskeletal diseases (eg, muscular dystrophy, amyotrophic lateral sclerosis), neurologic disorders (eg, myasthenia gravis, multiple sclerosis), respiratory disease (eg, emphysema, chronic bronchitis), or tumors. The manner of death in cases of asphyxiation may be natural, accidental, homicide, or suicide. For the death investigator, determining the cause and manner of death can often be quite challenging. We report here 2 cases of an esophageal fibrovascular polyp causing sudden asphyxial death, review of the literature, and discussion of other differential diagnoses in the case of asphyxial death.

Adult↗