Forensic Science
Head Motions While Riding Roller Coasters: Implications for Brain Injury
by Pfister, Bryan J.; Chickola, Larry; Smith, Douglas H.
[1 Dec 2009 at 12:00am]
The risk of traumatic brain injury (TBI) while riding roller coasters has received substantial attention. Case reports of TBI around the time of riding roller coasters have led many medical professionals to assert that the high gravitational forces (G-forces) induced by roller coasters pose a significant TBI risk. Head injury research, however, has shown that G-forces alone cannot predict TBI. Established head injury criterions and procedures were employed to compare the potential of TBI between daily activities and roller coaster riding. Three-dimensional head motions were measured during 3 different roller coaster rides, a pillow fight, and car crash simulations. Data was analyzed and compared with published data, using similar analyses of head motions. An 8.05 m/s car crash lead to the largest head injury criterion measure of 28.1 and head impact power of 3.41, over 6 times larger than the roller coaster rides of 4.1 and 0.36. Notably, the linear and rotational components of head acceleration during roller coaster rides were milder than those induced by many common activities. As such, there appears to be an extremely low risk of TBI due to the head motions induced by roller coaster rides.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Suicide by Ligature Strangulation: Three Case Reports
by Demirci, Serafettin; Dogan, Kamil Hakan; Erkol, Zerrin; Gunaydin, Gursel
[1 Dec 2009 at 12:00am]
Suicide by ligature strangulation, which gives the initial impression of a homicide, is very rare. In this article, 3 suicidal death cases caused by ligature strangulation in Konya between 2001 and 2006 are presented. The first victim was a 68-year-old man who suffered from depression and lived alone in a cottage house. He terminated his life by applying a tourniquet to his neck after leaving a suicide note. The second victim was a 70-year-old woman who was found dead on the floor of the living room in her house. After she cut the vessels in her wrist, she tied pantyhose with 3 knots around her neck. It was reported that she had been intermittently receiving treatment for bronchial asthma and depression for 20 years. The third victim was a 30-year-old woman who suffered from schizophrenia for 6 years. She tied a scarf around her neck with 3 knots and died in the hospital after 1 day due to "hypoxic brain syndrome." As a result of the death scene investigations, autopsies, and judicial inquiries, it was concluded that death was by suicide in all 3 cases. Because the use of the ligature strangulation method, and particularly the tourniquet method, in suicidal cases is extremely rare in the literature, our aim is to present and discuss these cases.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Death of a Child From Topical Diphenhydramine
by Turner, Jane Willman
[1 Dec 2009 at 12:00am]
Diphenhydramine is a drug readily available over the counter in the form of capsules, tablets, and syrup used for allergy relief. A topical form is sold as a cream without a prescription to alleviate itching. Diphenhydramine is a drug commonly found in postmortem toxicology reports. In rare instances, death is attributed to ingestion of lethal concentrations of the drug. Herein is a report of a toddler who died of lethal concentrations of diphenhydramine from topical application.
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Hemorrhagic Lividity of the Neck: Controlled Induction of Postmortem Hypostat...
by Pollanen, Michael S.; Perera, S D. Channa; Clutterbuck, David J.
[1 Dec 2009 at 12:00am]
Postmortem hypostasis (livor mortis or lividity) is classically defined as the intravascular pooling of blood in gravitationally dependent parts of the body after death. However, intense lividity can be associated with small hemorrhages in the skin, so-called postmortem hypostatic hemorrhages (Tardieu spots). Postmortem hypostatic hemorrhages seem to contradict the usual understanding of lividity, since hemorrhage is by definition an extravascular phenomenon. Substantive medicolegal difficulties can arise if such hemorrhagic lividity develops in the necks of bodies that have ventral lividity due to prone position at the death scene. To study this phenomenon, we have developed a model for the controlled formation of hypostatic hemorrhages in human cadavers. In this model, extensive hypostatic hemorrhages or hemorrhagic lividity could be reproducibly but not universally induced in the soft tissues of the anterior neck and strap muscles. Histologic examination revealed hemorrhage that was microscopically indistinguishable from the acute hemorrhages observed in contusions. In addition, some larger areas of interstitially extravasated blood showed "buffy coat"-sedimentation separation of neutrophils that closely mimicked acute inflammation, further confounding the correct diagnosis. This research implies that hypostatic hemorrhages form after the progressive development of increasing gravitational hydrostatic pressure in an autolysing venous plexus. Thus, this phenomenon can mimic soft tissue injury ("pseudo-bruising") and the internal injuries related to strangulation. Caution must be exercised when diagnosing strangulation in bodies with anterior neck lividity.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Parasailing Fatalities in Southwest Florida
by Wolf, Barbara C.; Harding, Brett E.
[1 Dec 2009 at 12:00am]
Parasailing is a recreational sport that is generally considered to be of little risk to the participants. Typically, the passenger launches from a motorboat with a specially designed winch that pulls him or her back to the boat at the end of the ride. The sport is not regulated at the federal, state, or county level. There have been few reports of injuries to parasailors. Additionally, there have been only 2 fatalities reported to the United States Coast Guard in a 10-year review. We report the details of these 2 deaths, those of a mother and daughter riding in a tandem parasail, which occurred on Fort Myers Beach in 2001, as well as an additional case of a parasailing fatality that occurred in southwest Florida in 1999. These cases illustrate the injuries seen in such fatalities and the hazards posed by adverse weather conditions and faulty equipment, as well as the impairment of passenger judgment by drugs and/or alcohol.
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Drug-Facilitated Sexual Assault Provoked by the Victim's Religious Beliefs: A...
by Maravelias, Constantine; Stefanidou, Maria; Dona, Artemis; Athanaselis, Sotiris; Spiliopoulou, Chara
[1 Dec 2009 at 12:00am]
The number of drug-facilitated sexual assault incidents has lately been increased all over the world leading law enforcement agencies and hospital doctors to constant alert. The drugs involved may be benzodiazepines, hypnotics, other sedatives, anesthetics, drugs of abuse or ethanol. The detection of these agents in biologic fluids is difficult, since most of them are shortly acting, and provoke victim's amnesia which in turn leads the victim to report the allegation late. An unusual case-study of a 35-year-old, married woman who was admitted to the hospital with dizziness and loss of memory for a period of 10 days is here reported. The toxicological analysis of the victim's blood and urine for unknown sedative drugs, achieved by GC-MS, revealed the presence of zolpidem (Stilnox), a nonbenzodiazepine hypnotic. Concentration of zolpidem in blood, 11 hours after the last supposedly intake, was 47 [mu]g/L. After family counseling at the hospital, the victim's husband confessed that he was replacing the contents of Losec capsules of his wife, with Stilnox tablets. This unjust act was committed by the husband in order for him to have sex with his wife, since she was not willing to participate in a sexual intercourse due to her religious restraints for a fasting period of 40 days. The aim of this article is 2-fold. First, to emphasize the fact that a sexual assault can take place not only between 2 strangers, but also within a happily married couple. Second, to remind doctors that any case of sexual assault must be examined toxicologically, for a better and thorough investigation.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Postmortem Findings After Anaphylactic Reactions to Drugs in Turkey
by Yilmaz, Riza; Yuksekbas, Ozlem; Erkol, Zerrin; Bulut, Erkut R.; Arslan, Murat N.
[1 Dec 2009 at 12:00am]
Aims: To determine the frequency of anaphylactic deaths at autopsies performed in Turkey between January 2001 and June 2006 and to review the circumstances of death and autopsy findings.
Methods: The Council of Forensic Medicine database in Istanbul was searched for anaphylactic deaths. Postmortem reports and medical records were reviewed to determine the circumstances of death. Data about basic demographics, medical history, drugs responsible for allergic reactions, and pathologic findings at autopsy were collected.
Results: A total of 36 anaphylactic deaths from drugs were identified for the study period. Death was due to antibiotics in 26 cases, analgesics in 7 cases, an intraoperative drug in 1 case, an H2 receptor in 1 case, and intravenous contrast medium in 1 case. Out of 36 cases, 19 were male and 17 female. They were aged between 1 and 74 years with the median age of 26.7 years. Death occurred within 1 hour of the onset of anaphylaxis in 27 cases. Findings at autopsy included nonspecific pulmonary edema and congestion, upper airway edema, cerebral hypoxia, and cutaneous edema. Serum tryptase levels were not measured in all cases.
Conclusion: Anaphylactic reaction is an uncommon cause of sudden death. In many cases, no specific macroscopic or microscopic findings were detected at autopsy. When serum tryptase levels cannot be determined, in the presence of typical clinical records, eye witness reports and autopsy findings can be useful diagnostic aids.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Black Powder Handgun Deaths Remain an Uncommon Event
by Hartwig, Sven; Tsokos, Michael; Byard, Roger W.
[1 Dec 2009 at 12:00am]
Although it was predicted that there would be an increase in the use of black powder guns due to their greater ease of procurement with less government control on sales, this does not seem to have been the general experience. To determine the rate of use of black powder handguns in shooting deaths in Berlin, Germany, review of the files of the Institute of Legal Medicine and Forensic Sciences, Charite-Universitatsmedizin Berlin was conducted over a 10-year period from 1997 to 2006. Out of total 85 gunshot deaths, there were only 3 where black powder handguns were used (3.5%). The cases involved 3 males aged 55, 62, and 63 years, respectively, all of whom had committed suicide with black powder percussion handguns, using 0.45, 0.56, and 0.36 caliber weapons. The source of the guns could not be determined. Wounds were characterized by excessive soot and propellant soiling and tattooing. The low number of fatalities involving black powder guns in a large forensic institution in Berlin, Germany, suggests that limiting access to such weapons would have little effect on total numbers of gunshot deaths. Simple loading mechanisms and reliability appear to be more important features influencing the choice of a handgun, rather than mere availability.
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Observations on Increased Accidental Asphyxia Deaths in Infancy While Cosleep...
by Li, Ling; Zhang, Yang; Zielke, Ron H.; Ping, Yan; Fowler, David R.
[1 Dec 2009 at 12:00am]
The Office of the Chief Medical Examiner (OCME) has recorded a significant increase of accidental asphyxia deaths in infancy associated with cosleeping in the state of Maryland in 2003. A total of 102 infants died suddenly and unexpectedly during 2003 in the state of Maryland. Of the 102 infants, 46 (45%) were found cosleeping. The frequency of cosleeping among these 102 infants was 28% (29/102) for black infants and 15% (15/102) for white infants. Ten of the 46 cosleeping infant deaths (20%) were determined to be the result of accidental asphyxia, and 28 cosleeping infant deaths (59%) were classified as "undetermined" because the possibility of asphyxia due to overlay while cosleeping could not be ruled out. Only 21 cases were determined to be Sudden Infant Death Syndrome (SIDS), which is consistent with the continuous decline of SIDS death in Maryland since 1994. The age of asphyxiated cosleeping infants ranged from 15 days to 9 months. Nine out of the 10 asphyxia deaths were black infants. The most common sleeping location of the asphyxia infants was on a couch/sofa, followed by an adult bed.
Crib availability was documented in all of the cosleeping cases. A majority (61%) of the cosleeping infants (28/46) had an available crib or bassinet at home and 9 out of 10 asphyxiated cosleeping infants had a crib at home at the time of the incident.
This report focuses on the detailed scene investigation findings of infant victims who died of asphyxia while cosleeping. The shift of diagnosis in sudden infant death investigation is also addressed.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Sudden Death due to Nontraumatic Diaphragmatic Hernia in an Adult
by DeAlwis, Kanthi; Mitsunaga, Erin M.
[1 Dec 2009 at 12:00am]
Sudden death in an adult due to an undiagnosed congenital diaphragmatic hernia (CDH) is a very rare occurrence. The majority of adults who experience discomfort related to their condition have experienced some kind of trauma prior to symptom manifestation; however, there can be the cases that are exceptions to a medical trend. In the following, we present a case of an adult female who died from an undiagnosed congenital diaphragmatic hernia without any prior traumatic event or significant medical history. In these situations, early diagnosis and rapid surgical intervention are necessary for successful treatment of affected individuals.
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Cardiac Contusion and Hemopericardium in the Absence of External Thoracic Tra...
by Gonin, Julie; de la Grandmaison, Geoffroy Lorin; Durigon, Michel; Paraire, François
[1 Dec 2009 at 12:00am]
The case of an unusual homicidal cardiac contusion is described. A previously healthy 24-year-old woman suddenly died after being kicked on the chest by her boyfriend. A forensic autopsy was performed showing no external sign of thoracic trauma. An hemopericardium and a cardiac contusion of the basal and posterior surface of the left ventricle were found to be the cause of the death. Death could be a direct consequence of the myocardial contusion through electrical instability or/and consequence of the hemopericardium because its volume and sudden apparition were sufficient to cause tamponade. Numerous associated recent skin contusions mainly located on the face were consistent with inflicted blunt force trauma, supporting homicide as a manner of death. This case report underlines the importance of a systematic complete autopsy in all cases of sudden death occurring in a young adults, to rule out a possible homicide. The present case also shows that myocardial injury must be ruled out in every living patient presenting blunt chest trauma even in the absence of external sign.
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Unexpected Intrauterine Fetal Death in Parvovirus B19 Fetal Infection
by Silingardi, Enrico; Santunione, Anna Laura; Rivasi, Francesco; Gasser, Bernard; Zago, Silvia; Garagnani, Lorella
[1 Dec 2009 at 12:00am]
Parvovirus B19 infection during pregnancy can be transmitted to the fetus through the placenta. The consequences for the health of the fetus are very variable and can be very serious. They include intrauterine fetal death (IUFD) and miscarriage, which can lead to medico-forensic questions. For the most part, cases of IUFD take place during the second trimester of gestation and present an anatomopathologic picture characteristic of fetal infection with hydrops, placental edema, serous effusion, and erythroblastosis with nuclear inclusions. Endocardial fibroelastosis, medullar and thymic hypoplasia, and hepatic hemosiderosis are frequently present. In the third trimester, the cases are less frequent, not accompanied by hydrops, and can depend more on placental compromise than on direct infection of the fetus. We present 5 cases of IUFD resulting from parvovirus B19 and we discuss the pathogenetic and anatomopathologic aspects and obstetric liability. In 4 cases, the IUFD took place suddenly, in the absence of symptoms, in women who had not previously shown any symptom of the viral infection. In one case, the patient was hospitalized following an ultrasound diagnosis of fetal hydrops and IUFD took place 5 days after admission. Of these cases 3 were verified in the second trimester and 2 in the third trimester. Only the cases of the second trimester and one of the 2 cases of the third trimester presented the characteristic aspects of fetal infection. The other case of third trimester was characterized by placental involvement.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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A Survey of Self-Mutilation From Forensic Medicine Viewpoint
by Taghaddosinejad, Fakhredin; Sheikhazadi, Ardeshir; Yaghmaei, Asadolah; Vakili, Vida; Saberi, Seyed Mehdi; Behnoush, Behnam
[1 Dec 2009 at 12:00am]
Objectives: Currently little research exists examining self-mutilation (SM) in samples of forensic referrals. The present study provides a comprehensive review on the frequency, etiology, and morphologic characteristics of self-inflicted injuries in a sample of outpatients' forensic referrals.
Methods: In a prospective cross-sectional study, during 3 years, we examined 9874 outpatients' forensic referrals and found 1248 SM cases in Ghouchan (an urban and suburban area of Iran).
Results: Based on forensic medical examinations, it was found that 12.6% of all outpatients' forensic referrals had engaged in SM behavior at sometime. Males had significantly higher rates of SM than females (76.9 vs. 23.1%, respectively). The mean age was found to be significantly lower in patients with SM (23.6 +/- 8.5) than patients without SM (40.0 +/- 10.5) (P < 0.001). Rate of being single and unemployed was higher in the SM group (58.2, 56.1%, respectively) than in the group without SM (19.1, 22.8%, respectively). Superficial cuts and scratches were found to be the most common type of SM (79.5%), followed by bruises (10.8%), burns (3.4%), deep cuts (3.2%), fractures (0.6%), and other miscellaneous injuries (2.5%). Upper extremities including forearms, wrists, and arms opposite the dominant hand were the most common areas of injury.
Conclusions: Nonsuicidal self-injury, the deliberate-direct destruction of body tissue without suicidal intent is a relatively common event in forensic referrals. It is very important to distinguish between this and other types from forensic point of view. Forensic practitioners must be expert and trained for this purpose.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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The Medical Examiner/Coroner's Guide for Contaminated Deceased Body Management
by Hanzlick, Randy; Nolte, Kurt; deJong, Joyce; The National Association of Medical Examiners Bioterrorism and Infectious Disease Committee
[1 Dec 2009 at 12:00am]
In the past few years, a number of publications and other resources have appeared concerning the management of mass fatality incidents. Some are geared toward the general management of incidents while others cover more specific topics such as decontamination procedures. Still others cover selected agents, including chemical, biologic, or radiologic ones. Few publications have been written specifically for medical examiners and coroners.
The Medical Examiner and Coroner's Guide for Contaminated Deceased Body Management is written specifically for the medical examiner or coroner who will be in charge of investigations of fatalities that result from terrorism or other events that result in contaminated remains. In some such cases, agents may be used that will require mitigation of environmental hazards and decontamination of human bodies. To that end, this Guide provides information and suggestions that may be useful in understanding the principles involved in decontamination procedures, recognizing that it may not be the medical examiner or coroner staff who actually conducts decontamination procedures.
The suggestions in this guide may differ slightly from those in other publications. However, those who have contributed to this guide believe that the recommendations are practical, workable, have a scientific basis, and do not differ much in substance when compared with other relevant publications.
The contents of this Guide may be reproduced for practical use but the Guide may not be sold and it may not be cited for advertisement purposes. Reference to specific commercial products is for informational purposes only and does not constitute endorsement of the product or company which produces the product.
The recommendations contained in this Guide are not mandated nor are they required by federal, state, or local law. Rather, the recommendations are intended to assist medical examiners and coroners for the purposes of planning and providing a set of reasonable practice guidelines for incident response.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Epidemiology of Intimate Partner Homicide-Suicide Events Among Women of Child...
by Krulewitch, Cara J.
[1 Dec 2009 at 12:00am]
Intimate partner homicide-suicide (IPH-IPS) among women during the childbearing years leaves irreversible outcomes that are devastating and have lasting repercussions for surviving children, families, and communities. An estimated one-third of all intimate partner homicides of women aged 15 to 50 end in suicide. The purpose of this study was to describe the temporal trends and characteristics of both victims of IPH-IPS. Data were collected using a retrospective, cross-sectional analysis of medical examiner records for women aged 10 to 50 in Maryland, during 1994-2003. Seventy-five IPH-IPS incidents were identified over the 10-year period. Of those, 94.7% were a female homicide followed by a male suicide. The average rate of IPH-IPS was 0.52 per 100,000 women aged 10 to 50. About half of the couples were within 5 years of the age of each other, married or separated and the same race. Eleven percent of the women were pregnant/1-year postpartum when they died. The findings presented represent a significant public health problem that has a unique pattern compared with other populations studied. Understanding this problem involves a more comprehensive assessment of both victims. There is a need for a national surveillance system that identifies IPH-IPS events and provides information on both victims that includes individual and relationship characteristics.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Delayed Homicides and the Proximate Cause
by Lin, Peter; Gill, James R.
[1 Dec 2009 at 12:00am]
Delayed homicides result from complications of remote injuries inflicted by "the hands of another." The investigation of delayed homicides may be a challenge due to a number of factors including: failure to report the death to the proper authorities, lack of ready and adequate documentation of the original injury and circumstances, and jurisdictional differences between the places of injury and death. The certification of these deaths also requires the demonstration of a pathophysiologic link between the remote injury and death. In sorting through these issues, it is helpful to rely upon the definition of the proximate cause of death.
Over a 2-year period in New York City, there were 1211 deaths certified as homicide of which 42 were due to injuries sustained greater than 1 year before death. The survival interval ranged from 1.3 to 43.2 years. The most common immediate causes of death were: infections (22), seizures (7), and intestinal obstructions/hernias (6). Common patterns of complications included infection following a gunshot wound of the spinal cord, seizure disorder due to blunt head trauma, and intestinal obstruction/hernia due to adhesions from an abdominal stab wound. Spinal cord injuries resulted in paraplegia in 14 instances and quadriplegia in 8. The mean survival interval for paraplegics was 20.3 years and 14.8 years for quadriplegics; infections were a frequent immediate cause of death in both groups, particularly infections due to chronic bladder catheterization.
The definition of proximate cause originated with civil law cases and was later applied to death certification as the proximate cause of death. The gradual extinction of the "year and a day rule" for the limitation of bringing homicide charges in delayed deaths may result in more of these deaths going to trial. Medical examiners/coroners must be able to explain the reasoning behind these death certifications and maintain consistent standards for the certification of all delayed deaths due to any injury (homicides, suicides, and accidents).
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Reconstruction of the Weapon in a Case of Homicidal Decapitation
by Turillazzi, Emanuela; Di Donato, Sabina; Fiore, Carmela; Fineschi, Vittorio
[1 Dec 2009 at 12:00am]
Decapitation as homicidal mode of death is relatively rare. In most cases of decapitation, the differentiation between the modes of death might be difficult to some extent, particularly in cases where essential investigative elements, like the decedent's head and the weapon, are unavailable. Our report concerns a case of homicide by decapitation without any further mutilation of the victim, where only the combination of autopsy results, histologic findings, and engineering technical reconstruction allowed us to identify with certainty the mode of death as vital decapitation. The technical reconstruction of the alleged weapon allowed the identification and the discovery of the hand saw used by the murderer to decapitate the victim.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Three Cases of Death Caused by Shots From Blank Cartridge
by Zdravkovic, Miodrag; Milic, Miroslav; Stojanovic, Miroslav; Kostov, Milos
[1 Dec 2009 at 12:00am]
The authors describe 3 cases of lethal injuries caused by 7.62 mm blank cartridge shots from military automatic rifle of domestic origin (AK 47, 7.62 mm). In 1 case, the cartridge was fired from a weapon that had been leaned on the head, with subsequent destruction of brain, and in other 2 cases, the weapon had been leaned on the chests, which led to destruction of heart parts. The injuries were caused by the action of striking wave of gunpowder explosion, the air blast type. The cases demonstrate that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall and the skull.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Subcutaneous Corn Oil Injections, Fat Embolization Syndrome, and Death
by Hain, John Randolph
[1 Dec 2009 at 12:00am]
An unlicensed practitioner performing subcutaneous injections of large volumes of corn oil caused the death of one of her clients and life-threatening neurologic complications of a second client from systemic fat embolism. Several additional clients also came forward to report other serious complications they had suffered from similar procedures. The clinicopathologic and investigative findings from these cases are described. In both instances of fat embolization, the diagnosis was overlooked by hospital staff because of insufficient or misleading clinical history. The local and systemic pathologic manifestations of corn oil injections in 1 victim who died several days later from multiple organ failure are described. The clinical history and course of another who survived after 8 days of hospitalization are also presented. Similarities with complications from other forms of cosmetic oil injections are discussed. Laboratory analyses applied to confirm the nature of the injected oil and the course of criminal prosecution are also described.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Death Due to Hemorrhagic Shock After Delayed Rupture of Spleen: A Rare Phenom...
by Kodikara, Sarathchandra
[1 Dec 2009 at 12:00am]
Delayed splenic rupture after blunt trauma is rare and contributes to a significant mortality rate. As this is accompanied by a period of clinical quiescence, a close clinical vigilance is required for early diagnosis and surgical intervention. A case report on death because of delayed rupture of healthy spleen after blunt trauma is presented. The pathophysiology of delayed rupture and importance of early detection are discussed. The case presented is the first known case of death due to delayed splenic rupture in Sri Lanka.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Iatrogenic Endocardial Injury Associated With Preexisting Atrial Abnormalities
by Jolley, Tracie M.; Guileyardo, Joseph M.
[1 Dec 2009 at 12:00am]
Considering the rising number of cardiac catheterization and pacemaker placement procedures being performed each year, it is likely that increasing numbers of deaths associated with complications from these procedures will require certification by the medical examiner. We report 2 cases of iatrogenic atrial injury related to pacemaker placement in which a preexisting cardiac abnormality increased the risk of such complications. One case was associated with an embryologic remnant known as Chiari's network, and the other case was associated with lipomatous hypertrophy of the interatrial septum. The identification of an anatomic abnormality, which results in a predisposition to iatrogenic injury may decrease the risk of costly or unnecessary litigation commonly associated with these deaths.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Erratum
[1 Jun 2009 at 12:00am]
No abstract available
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Excited Delirium, Restraints, and Unexpected Death: A Review of Pathogenesis
by Otahbachi, Mohammad; Cevik, Cihan; Bagdure, Satish; Nugent, Kenneth
[1 Jun 2010 at 12:00am]
Unexpected deaths periodically occur in individuals held in police custody. These decedents usually have had significant physical exertion associated with violent and/or bizarre behavior, have been restrained by the police, and often have drug intoxication. Autopsy material from these cases may not provide a satisfactory explanation for the cause of death, and these deaths are then attributed to the excited delirium syndrome. The pathogenesis of excited delirium deaths is likely multifactorial and includes positional asphyxia, hyperthermia, drug toxicity, and/or catecholamine-induced fatal arrhythmias. We suggest that these deaths are secondary to stress cardiomyopathy similar to the cardiomyopathy seen in older women following either mental or physical stress. This syndrome develops secondary to the toxic effects of high levels of catecholamines on either cardiac myocytes or on the coronary microvasculature. Patients with stress cardiomyopathy have unique ventricular morphology on echocardiograms and left ventricular angiography and have had normal coronary angiograms. People who die under unusual circumstances associated with high catecholamine levels have contraction bands in their myocardium. Consequently, the pathogenesis of the excited delirium syndrome could be evaluated by using echocardiograms in patients brought to the emergency centers, and by more careful assessment of the myocardium and coronary vessels at autopsy. Treatment should focus on prevention through the reduction of stress.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Histological and Immunohistochemical Study of Wischnewsky Spots in Fatal Hypo...
by Tsokos, Michael; Rothschild, Markus A.; Madea, Burkhard; Rie, Manfred; Sperhake, Jan P.
[1 Mar 2006 at 12:00am]
Wischnewsky spots in the gastric mucosa are considered an important finding for the diagnosis of hypothermia-related deaths. In the present prospective histological and immunohistochemical investigation, 14 cases of fatal hypothermia presenting Wischnewsky spots at autopsy were studied. Macromorphologically, the lesions, varying in diameter from 0.1 to 0.4 cm, had a blackish-brownish color and appeared partly lofty, especially on the apex of gastric folds. Histologically, no erosions or ulcers were observed in the gastric mucosa. In some cases, hemorrhages in conjunction with infarctions of the mucosa were observed in the mucosal glands. Those regions, however, did not represent the lesions visible as Wischnewsky spots at the macroscopical level. Immunohistochemical stains were done with a specific antibody against hemoglobin (Dako, Glostrup, Denmark). Wischnewsky spots expressed immunopositivity with antihemoglobin. Concerning the pathogenesis and underlying pathophysiologic mechanisms contributing to the development of Wischnewsky spots, we hypothesize that cooling of the body in the setting of cold ambient temperatures primarily leads to circumscribed hemorrhages of the gastric glands in vivo or in the agonal period, respectively. Subsequently, due to autolysis, erythrocytes are destroyed and hemoglobin is released. Following exposure to gastric acid, hemoglobin is hematinized, leading to the typical blackish-brownish appearance of Wischnewsky spots seen at gross examination. Wischnewsky spots are not equivalent to erosions in terms of histopathological diagnosis but rather represent epiphenomena generated in vivo or in the agonal period of fatal hypothermia.
(C) 2006 Lippincott Williams & Wilkins, Inc.
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Natural Death in the Forensic Setting: A Study and Approach to the Autopsy
by Christiansen, Lydia R.; Collins, Kim A.
[1 Mar 2007 at 12:00am]
Although unexpected natural deaths comprise a large proportion of the cases seen in the forensic setting, the investigation of these cases remains a unique challenge. Some cases are straightforward; however, others require special examination and dissections, as well as the use of special dissections and ancillary studies. For the forensic investigator to accurately assign a cause and manner of death, one must be aware of the differential diagnoses, common scenarios, and typical victim.
The authors reviewed all forensic cases referred to the Forensic Section of the Medical University of South Carolina over a 15-year period from January 1989-December 2003. The number of natural deaths occurring in adults (age 18 years and older) was 6932, compared with the overall number of 13,227 cases. The natural deaths were then analyzed as to autopsy findings, cause of death, cardiac versus noncardiac, age, race, and gender. Current techniques, special dissections, and ancillary studies that can assist in the classification of these deaths in the forensic setting are reviewed.
(C) 2007 Lippincott Williams & Wilkins, Inc.
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Survey of Sudden Death From Aneurysmal Subarachnoid Hemorrhage in Cadavers Re...
by Sheikhazadi, Ardeshir; Gharehdaghi, Jaber
[1 Dec 2009 at 12:00am]
Background and Aim: Some cases with aneurysmal subarachnoid hemorrhage (SAH) never reach the medical centre alive and they are not included in most studies of SAH. To explain the clinical profile of sudden death from aneurysmal SAH, we examined the epidemiology and clinicopathologic characteristics of patients with aneurysmal SAH who never reached medical attention or died within first 24 hours of the onset of first symptoms.
Materials and Methods: Using the autopsy records in Legal Medicine Organization of Tehran, we identified all cadavers who were diagnosed with aneurysmal SAH between 2001 and 2005.
Results: There were 85 women and 60 men with a mean age of 50 years. Twenty patients (14%) died without reaching medical care and 58 (40%) died within first 24 hours of the onset of first symptoms. The remnant had died after 24 hours to 28 days of hospitalization. In comparing patients with sudden death versus remnant, the main variables were the frequency of posterior circulation aneurysms that was found in 59% compared with 19.4% in those who had died after 24 hours, intraventricular hemorrhage 53.8% versus 19.4%, and pulmonary edema 92.3% versus 34.3% (P = 0.01).
Conclusion: In our population, the frequency of sudden death from aneurysmal SAH has not changed during the last 5 years. The typical clinical profile of sudden death in SAH includes intraventricular hemorrhage, pulmonary edema, and a ruptured posterior circulation aneurysm. Intracerebral hemorrhage is rarely connected to sudden death from aneurysmal SAH.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Deaths With Transdermal Fentanyl Patches
by Jumbelic, Mary I.
[1 Mar 2010 at 12:00am]
Fentanyl is a potent Schedule II narcotic analgesic recommended for use in the management of unremitting pain not controlled by morphine or other opiate/opioid drugs. The danger inherent to fentanyl is its potency (greater than 50-100 times that of morphine) and rapidity of action, causing respiratory depression within minutes of administration. Advisories have been issued on a state and national level to health care providers and through manufacturers' package inserts for patients. Still, as will be demonstrated in this case review, the use of only a single transdermal patch taken as prescribed for the first time can prove fatal. A drug that requires such extensive warnings-that if unheeded lead to death because of its narrow therapeutic/toxic window, should have strict criteria and limited outpatient use. Initial medical observation and documentation for determining tolerance might be required before issuing a prescription. There has been a rise in the popularity of this drug evidenced by increased deaths among drug abusers and more prescriptions written. In the year 2006, the Center for Forensic Sciences in Onondaga County had 8 cases where fentanyl was considered the cause of death, often with other drugs detected in therapeutic concentrations. This number was a marked increase from the 1 to 2 cases occurring annually from 2002 to 2005. All of these 2006 overdoses because of fentanyl involved the transdermal formulation. The investigative data, blood and liver fentanyl levels, and autopsy findings will be presented.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Homicide by Unspecified Means
by Matshes, Evan W.; Lew, Emma O.
[1 Jun 2010 at 12:00am]
The fundamental function of all North American systems of death investigation is to determine cause and manner of death. Modern teaching emphasizes the need to consider all investigative aspects including careful evaluation of the scene and circumstances, history, physical examination of the body, and ancillary laboratory studies, prior to death certification. This integrative approach to forensic pathology differs from an autopsy-focused practice whose function is to produce "anatomic" cause of death statements.
Some individuals die under suspicious circumstances and, despite thorough autopsy, have no anatomic cause of death. In Miami-Dade County, when the preponderance of evidence and investigative data suggest homicide despite the absence of an identifiable cause of death, "homicide by unspecified means" has been used as a summative cause of death statement. The records of the Miami-Dade County Medical Examiner Department were searched for this diagnosis, identifying 18 such cases between 1990 and 2004. The characteristics of these cases are discussed. Guidelines for the use of this diagnostic label are provided.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Forensic Kinesiology: Foundations of an Interdiscipline for Accident/Crime In...
by Pelham, Thomas W.; Holt, Laurence E.; Holt, Jason
[1 Jun 2010 at 12:00am]
Kinesiology is the study of human movement, and comprises several disciplines, each devoted to a specific aspect of human activity, each with its own set of principles and methods to assess and analyze movement. Forensic kinesiology is the application of kinesiological techniques to accident/crime investigation; specialists in this field can use various tools and procedures to measure, analyze, model, and determine the movement sequences involved in events under investigation. This article will highlight major subdisciplines of kinesiology most relevant to forensics, present the key assessment and analytical tools used by kinesiologists, and demonstrate how both the principles and the practices of kinesiology can be applied to accident/crime investigation.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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A New Digital Approach for Measuring Dentin Translucency in Forensic Age Esti...
by Acharya, Ashith B.
[1 Jun 2010 at 12:00am]
Assessment of age from the dentition constitutes an important step in constructing an identity profile of the decedent. Dentinal translucency is one of the morpho-histologic parameters considered best for dental age estimation, not only in terms of accuracy but also simplicity. By convention, translucency has been measured using calipers. Computer-based methods have been proposed for the same, although these required the use of custom-built software programs. The present study describes a method to measure translucency on sectioned teeth using commercially available computer hardware and software. Translucency measurements on 81 tooth sections were obtained using the digital method and compared with those obtained using a caliper. Correlation coefficients of translucency measurements to age were statistically significant for both methods (P < 0.001) and marginally higher for the digital approach (r = 0.49). Application of linear regression equations derived from both methods on an independent sample (n = 15) revealed better ability of the digital method to assess age-60% of age estimates were within +/-5 years of the actual age as against 40% for caliper-based method. The superior results using the digital method are attributed to refined measurements obtained under magnification and the "touch-free" approach of measuring translucency on digital images of thin tooth sections. Moreover, the computer hardware and software used in the present study are ubiquitous and easy to use. Considering these advantages, the report recommends the use of the digital method to assess translucency for age estimation.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Asphyxial Deaths: A Retrospective Study and Review of the Literature
by Azmak, Derya
[1 Jun 2006 at 12:00am]
An increasing death rate as a result of violence constitutes a large group in medicolegal autopsies. Specially, deaths due to asphyxia are one of the most important causes in violence deaths.
During the 21-year period from January 1984 to October 2004, there were 134 asphyxial deaths autopsied by the Department of Forensic Medicine, Trakya University, Edirne, Turkey. Asphyxial deaths comprise 15.7% of all forensic autopsies; 20.8% of the cases are aged between 30 and 39 years, and the average age was 41.9 years. Males constitute 79.8% of all the cases.
The most frequent method of asphyxiation death is hanging (56 cases, 41.8%), followed by drowning (30.5%) and carbon monoxide poisoning (8.2%). More violent methods, such as ligature or manual strangulations, constitute 2.9% and 2.3% of all asphyxial deaths, respectively. Although it was varying according to the methods of asphyxiation, suicide was found to be the manner of death in the majority of the cases.
(C) 2006 Lippincott Williams & Wilkins, Inc.
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The Earlobe Crease, Coronary Artery Disease, and Sudden Cardiac Death: An Aut...
by Edston, Erik
[1 Jun 2006 at 12:00am]
The majority of previous studies have demonstrated a correlation between diagonal earlobe creases (ELC) and coronary artery disease (CAD).
In this study of 520 forensic autopsy cases, the earlobes were studied and photographed before autopsy, and the existence of a diagonal ELC was noted in 55%. The cause of death, the degree of coronary atherosclerosis, aortosclerosis, and cerebrosclerosis, as well as heart, kidney, and spleen weights, were noted in each case. The body mass index (BMI), thickness of abdominal fat, baldness, and excessive hair in the meatus externa of the external ears were also assessed. Nonparametric methods were used in the statistical calculations.
It was found that ELC was strongly correlated with CAD in both men and women (P < 0.0001) but with sudden cardiac death (SCD) only in men (P < 0.04). The sensitivity of the ELC sign was 75% and the positive predictive value (ppv) was 68%. In individuals below 40 years, the ppv was as high as 80%. Using multiple logistic regression analysis, ELC was found to be the strongest independent risk factor for CAD and SCD apart from age and BMI (both genders), as well as baldness and hair in the meatus externa (in males).
It is concluded that in a patient population similar to that in the present study the ELC sign could be especially useful in screening for premature CAD in younger individuals.
(C) 2006 Lippincott Williams & Wilkins, Inc.
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Analysis of Discrepancies Between External Body Examination and Forensic Autopsy
by de la Grandmaison, Geoffroy Lorin; Fermanian, Christophe; Durigon, Michel
[1 Mar 2008 at 12:00am]
At present in France, most of the medico-legal investigations are restricted to death scene investigation, which means there is only an external body examination without subsequent autopsy. The aim of our study was to show the limits of death scene investigation by establishing the rate of discrepancies between the results of external body examination and forensic autopsy.
A retrospective study was carried out on 200 autopsy cases which were all preceded by death scene investigation and performed in 2002. For each case, age, sex, body weight, body state, place, and time of death were reported. The number of recent trauma lesions detectable at external body examination and at autopsy was studied. Conclusions about manner and cause of death between death scene investigation and autopsy were also studied. Discrepancy rate about interpretation of the lesions seen at external body examination and at autopsy was determined. Discrepancy between minor external trauma lesions and severe internal trauma lesions was also studied.
The mean age of the studied population was 42.4 years. Sex ratio was 2.2. External body examination was limited by body state in 32% of the cases. The mean number of recent external trauma lesions recorded at autopsy was significantly higher than those recorded during death scene investigation. Manner and causes of death were undetermined after death scene investigation in 54.5% and 49% of the cases, respectively. When the cases were determined by death scene investigation, discrepancy rate, respectively, was 5% and 9% of all cases (n = 200) for manner and causes of death.
Death scene investigation even carried out by a well-trained forensic physician is not reliable relative to cause and manner of death. Our study underlines the necessity in the future to perform more forensic autopsies in France, relying on the European harmonization of medico-legal autopsy rules.
(C) 2008 Lippincott Williams & Wilkins, Inc.
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Fatal Cardiac Arrhythmia After Repeated Exposure to 1,1-Difluoroethane (DFE)
by Avella, Joseph; Wilson, James C.; Lehrer, Michael
[1 Mar 2006 at 12:00am]
A 42-year-old man was found dead after repeated exposure to 1,1-difluoroethane (DFE, Freon 152a), a propellant found in CRC Duster, a product intended for the removal of dust and lint. Toxicologic analysis detected DFE in femoral blood 136.3 mg/L, brain 117.5 mg/kg, liver 87.6 mg/kg, lung 60.3 mg/kg, adipose 235.7 mg/kg, and vitreous fluid 25.1 mg/L. The cause of death was determined to be a fatal cardiac arrhythmia due to intoxication with 1,1-difluoroethane. After comparison to previously published cases involving DFE, we suggest that analysis of adipose tissue for DFE and similar compounds, along with blood and other tissues, may be useful in distinguishing between acute versus chronic exposure. Adipose may also be a valuable alternate specimen for detection in cases where loss or elimination from blood is likely to have occurred.
(C) 2006 Lippincott Williams & Wilkins, Inc.
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Vehicle-Assisted Suicide Resulting in Complete Decapitation
by Türk, Elisabeth E.; Tsokos, Michael
[1 Sep 2005 at 12:00am]
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.
(C) 2005 Lippincott Williams & Wilkins, Inc.
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Detection of Drugs of Forensic Importance in Postmortem Bone
by McGrath, Kelly K.; Jenkins, Amanda J.
[1 Mar 2009 at 12:00am]
There is a paucity of literature detailing the disposition of drugs in bone and bone marrow. Infrequently, in deaths involving skeletonized remains, fragmentation, decomposition, and exsanguination, traditional specimens may be unavailable for toxicological testing. This study examined the utility of bone for the detection of benzodiazepines, opiates, cocaine and metabolites, and basic drugs in 39 cases. Cases were identified on the basis of a positive blood result. After specimen preparation, samples were assayed by liquid-liquid or solid phase extraction with gas chromatographic and gas chromatographic mass spectrometric detection. The majority of decedents were white males with 28% of individuals between the ages of 41 to 50 years. The cause of death was drug intoxication in 22 cases. The most prevalent drugs detected in the blood males and females were opiates and bases. Morphine, codeine, and oxycodone were detected in bone, whereas 6-acetylmorphine and hydrocodone were absent. For alkaline extractable drugs, in only 57% of blood positive specimens, the corresponding bone was also positive. These included antidepressants and antihistamines. Diazepam and nordiazepam were detected in the bone of all blood positive cases. Bone concentrations were higher than blood levels. Benzoylecgonine was the most common cocaine analyte detected in bone. These data demonstrated that drugs may be detected in bone using current technologies and that in general concentrations were higher than those observed in corresponding blood specimens. A negative result in bone, however, should be interpreted with caution because multiple factors determine the deposition of a drug in this matrix.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Subacute Combined Degeneration Mimicking Traumatic Spinal Cord Injury
by Paul, Ian; Reichard, R Ross
[1 Mar 2009 at 12:00am]
Subacute combined degeneration (SCD) of the spinal cord is the most common neurologic manifestation of vitamin B12 (cobalamin) deficiency and is usually secondary to autoimmune gastritis, but may also be seen in malnutrition syndromes such as chronic alcoholism, strict vegetarianism, gastrectomy, and also in nitrous oxide abuse. Although traumatic spinal cord injury is routinely encountered in the medical examiner's office, medical causes of spinal cord abnormalities such as SCD should be considered in the appropriate clinical setting. We report a case of alcohol-associated SCD mimicking traumatic spinal cord injury.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Morphologic Analysis of Third-Molar Maturity by Digital Orthopantomographic A...
by Introna, Francesco; Santoro, Valeria; De Donno, Antonio; Belviso, Maura
[1 Mar 2008 at 12:00am]
Accurate timing of the eruption of first and permanent teeth is an important parameter in forensic odontology to establish the age of dead or live individuals. Determination of adulthood may determine, for example, whether an individual convicted of a crime is sentenced as an adult and incarcerated in a state penal institution or as a juvenile and sent to a juvenile camp. At present, there is a large immigrant population in Italy, and young foreign criminals sometimes have false passports bearing a later birth date, with the aim of evading punishment. In such circumstances, age determination is becoming a significant forensic issue.
Late in adolescence, after formation of the premolars and canines, only the third molars continue to develop. According to several studies, although the third molars are the most variable teeth in the dentition, they remain the most reliable biologic indicator available for estimation of age during the middle teens and early twenties.
In this study, the authors test the possibilities offered by orthopantomography executed by means of digital technology, with the aim of exploiting the advantages of the computerized digital technique compared with the conventional technique, to determine adult age on the basis of root development of the third molar.
Digital radiography is simple to use, quick, and effective, allowing superimposition and enlargement; the images can be electronically stored and transported. In comparison with traditional orthopantomography, the digital technique features greater diagnostic accuracy of some anatomic structures: upper and lower front teeth, root apexes, floor of the nasal fossa and maxillary sinus, nasal septum, mandibular condylus. Moreover, digital orthopantomography suffers less from artifacts.
The digital orthopantomographies of 83 Caucasian subjects (43 females and 40 males) aged between 16 and 22 years were analyzed in standard conditions, assessing the degree of maturation of the upper and lower third molars. A standardized computer procedure was used to acquire the x-ray images, recording 3 per plate: the overall orthopantomography and 2 enlargements of optical type of the left and right sides, to reveal the third molars while maintaining unaltered the image resolution.
For the analysis, the authors adopted Demirjian's staging system that classifies development of the third molar in 8 stages (A, B, C, D, E, F, G, H) on the basis of morphologic criteria. This has been statistically proved to feature notable precision and high predictive ability.
To assess any sex-related variations in mineralization speed, the series was subdivided by gender. The study demonstrated that such differences are more evident under the age of 18 years.
Overall, the observation of 245 third molars showed faster development of the upper than the lower third molars, a prevalence of stages D to G in the age range between 16 and 18 years, and a clear predominance of stage H in individuals over 18 years of age. Finally, an intermediate stage between G and H was demonstrated in subjects aged between 17 and 21 years.
(C) 2008 Lippincott Williams & Wilkins, Inc.
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The Prevalence of Drugs in Carbon Monoxide-Related Deaths: A Retrospective St...
by Przepyszny, Lisa M.; Jenkins, Amanda J.
[1 Sep 2007 at 12:00am]
The objective of this study was to review demographic characteristics and drugs detected in carbon monoxide (CO)-related deaths from cases received by the Office of the Cuyahoga County Coroner in Cleveland, Ohio, from 2000-2003. Postmortem reports were reviewed, and decedents for which CO was listed as the cause of death were included. The data were compiled into 3 groups according to the official coroner's verdict as to the manner of death: accident, suicide, and homicide. Included in this study were 122 cases: 84 (69%) accidental, 31 (25%) suicide, and 7 (6%) homicide.
Accident decedents were typically white males, aged 40-59 years, residing in Cleveland. Suicide decedents were also middle-aged, white males but residing in the suburbs. Homicide decedents under the age of 6 were characteristically black (N = 2), while decedents over the age of 39 were predominately white (N = 3). Carboxyhemoglobin (COHb) levels in suicide cases were higher than concentrations measured in accidental deaths. The highest percentage of suicide decedents (36%) had a COHb level >70% saturation, accident decedents (36%) between 50% and 69% saturation, and homicide decedents (71%) below 50% saturation.
Ethanol (N = 34) was detected in 28% of deaths, and therapeutic and/or abused drugs (N = 50) were detected in 41% of deaths. Illicit drugs were detected in 11% of cases (cocaine/metabolites; THC/metabolites), other drug positives were therapeutic medications. The most common drugs detected were antidepressants and antihistamines in suicides and pain medications and antihistamines in accidents.
(C) 2007 Lippincott Williams & Wilkins, Inc.
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Dead Bodies Found in Wells*
by Dogan, Kamil Hakan; Demirci, Serafettin; Erkol, Zerrin; Gulmen, Mete Korkut; Deniz, Idris
[26 Jul 2010 at 12:00am]
Corpses found in wells or lime pits must be identified and the cause and manner of death must be determined. There are several circumstances that may lead to the presence of corpses in wells. In this study, 3940 death examinations and autopsies, performed at the Konya Branch of Forensic Medicine Council (Turkey) between 2000 and 2007, were retrospectively investigated, and it was found that 18 (0.46%) of the bodies had been recovered from wells. The cases were evaluated in terms of their demographic features, manner of death (accidental, suicidal, or homicidal), autopsy findings, cause of death, and the characteristics of the wells in which they were found. The ages of the victims ranged from 4 to 74 years, and the average age was 40. 4 +/- 20.6 years. Of total, 16 cases were males and 2 were females. The manner of death was determined to be accidental in 10 of the cases, suicide in 6 of the cases, and homicide in the remaining 2 cases. In 7 of the cases, death had occurred as a result of drowning in water. A comprehensive scene investigation and autopsy must be performed for corpses recovered from wells and pits for both identification and determination of the cause and manner of death. Wells should be covered and kept closed at all times to reduce the number of accidental deaths resulting from falls into wells.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Homicide and Suicide in Yorkshire and the Humber: 1975-1992 and 1993-2007
by Gregory, Marilyn J.; Milroy, Christopher M.
[1 Mar 2010 at 12:00am]
Homicide-suicide (HS) events in Yorkshire and the Humber have been documented previously by Milroy in a study of the period 1975 to 1992 (Milroy, Med Sci Law. 1993;33:167-171; Milroy 1994; Milroy, Forensic Sci Int. 1995;71:117-122; Milroy, Med Sci Law. 1995;35:213-217; and Milroy, J Clin Forensic Med. 1998;5:61-64). Reported here is an update of that study covering HS events in the same region from 1993 to 2007. Data from cohort 1 (1975-1992) and cohort 2 (1993-2007) are presented and compared, where data are available, with the findings of 2 previous studies in England and Wales (Barraclough and Harris, Psychol Med. 2002;32:577-584; and West 1965). Homicide followed by suicide is often defined in the literature as homicide(s) followed by the suicide of the perpetrator within 1 week of the homicide(s) (Barraclough and Harris, Psychol Med. 2002;32:577-584; Campanelli and Gilson, Am J Forensic Med Pathol. 2002;23:248-251; and Hannah et al, 1998;19:275-283). All the cases reported here fall within this definition. Findings are consonant with international literature, and suggest that HS is most likely to be carried out by an older, white, married, or cohabiting working man, who kills his female partner and/or their children and then himself. There are indications that restricting access to significant methods of killing can reduce the incidence of HS.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Toxicologic Aspects of Deaths Due to Falls From Height
by Fanton, L; Bévalot, F; Schoendorff, P; Lalliard, S; Jdeed, K; Malicier, D
[1 Sep 2007 at 12:00am]
A prospective study of 161 victims of falls from height is reported. The aim was to determine the interest of systematic qualitative and quantitative toxicological analysis in such fatalities. The primary cause of death was suicide (84.5%), followed by accidents (7%) and homicide (1%). In the remaining 7.5%, cause of death was undetermined. In the suicides, there was evidence of psychotropic medicines in 57% of the observations, with a much higher proportion of benzodiazepines and antidepressants in women than in men. Quantitative toxicologic analysis showed overdosing on medication in 16 suicide victims, with toxic levels in 11 of these. Systematic qualitative and quantitative toxicologic analysis made a significant contribution to the diagnosis of suicide by revealing either an unknown psychiatric treatment or a toxic level.
(C) 2007 Lippincott Williams & Wilkins, Inc.
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Left Atrial Infarction: A Case Report and Review of the Literature
by Rose, Kelly L.; Collins, Kim A.
[1 Mar 2010 at 12:00am]
The majority of cardiac related deaths are due to ischemic heart disease, with the most common clinical scenario being severe coronary artery atherosclerosis resulting in left ventricular myocardial infarction. However, infarction of other cardiac chambers does occur, and often has specific clinical associations. We report a case of a 70-year-old man who suffered from left atrial infarction that resulted in a transmural rupture of his left atrium. The patient had a history of rheumatic heart disease, mitral valve stenosis, and severe atherosclerotic coronary artery disease. Four days before death, he underwent mitral valve replacement and left circumflex coronary artery bypass. Two days later, he developed atrial fibrillation. On the day of death, he had decreased mental status, questionable seizure activity, hematemesis, ventricular tachycardia, and eventually asystole. At autopsy, he had significant hemopericardium with a fibrinous pericarditis and bilateral hemothoraces (total blood volume: 1250 mL). A 0.1 to 0.2 cm left atrial transmural defect was identified. The prosthetic mitral valve was free of vegetations, and completely intact. Similarly, the left circumflex artery bypass graft was completely patent and unremarkable. Severe calcific atherosclerosis was of his native left circumflex and left main coronary arteries. Microscopic examination revealed acute myocardial infarction of the left atrium at the rupture site. The anatomy of atrial circulation as well as the pathology and consequences of atrial infarction are discussed.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Brain Germinoma in a Young Adult Man With Suspicion of Fatal Neglect
by Kibayashi, Kazuhiko; Sugita, Yasuo; Shojo, Hideki; Sumida, Tomomi
[1 Jun 2009 at 12:00am]
We report a forensic autopsy case of brain germinoma in a 26-year-old man who was severely wasted and initially suspected of fatal neglect. He had a history of nocturnal wandering and was confined by his parents. Neuropathological examination showed germinoma in the hypothalamus and neurohypophysis. The cause of death was certified as hypothalamo-hypophyseal insufficiency due to germinoma. Because hypothalamic lesions may dysregulate feeding behavior and sleeping rhythms, germinoma was considered the causative lesion of the anorexic wasting and nocturnal wandering. Confinement was a preventive measure of the patient's wandering. The findings in this case indicated that hypothalamic tumors should be recognized as a cause of wasting in autopsies suspected of fatal neglect.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Sudden Death Caused by Fibrovascular Esophageal Polyp: Case Report and Study ...
by Ramalho, Leandra N. Z.; Martin, Carmen C. S.; Zerbini, Talita
[1 Mar 2010 at 12:00am]
Benign tumors of the esophagus are rare but can lead be fatal when aspirated into the upper airway. Here, we describe a sudden death due to aspiration of a fibrovascular polyp supported by a review of 11 cases from the literature.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Fatalities Associated With Home-Made Pipe Bombs in Northern Ireland
by Lucas, James; Crane, Jack
[1 Jun 2008 at 12:00am]
Pipe bombs are crudely constructed improvized explosive devices which are easily made at home. They are increasingly used by terrorists and others, and may inflict serious injuries and cause death. Four fatalities have occurred in association with their use in Northern Ireland between 1998 and 2002. In 2 cases, death was due to penetrating shrapnel injuries to the chest causing laceration of the great vessels, and a third fatality occurred due to a bomb fragment penetrating the cranial cavity. A pipe bomb exploded close to the back of the head of a fourth victim and this was associated with a severe brain injury. The pathologist was able to determine the position of the victim in relation to the explosion by interpreting the pattern of injuries. It seems likely that 2 of the victims had been involved in the construction, transport, or use of the devices. A third victim was entirely innocent and had been in the process of removing a pipe bomb, which had been thrown through the window of her home, when it exploded. The fourth victim was a member of the security forces who had been struck by a bomb fragment, in the region of the right eye, during a period of sectarian unrest.
(C) 2008 Lippincott Williams & Wilkins, Inc.
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Is Daily Shaving of Axillary and Pubic Hair a Feature of Suicide in the Musli...
by Demirci, Serafettin; Dogan, Kamil Hakan; Erkol, Zerrin; Deniz, Idris
[1 Dec 2008 at 12:00am]
In the Islamic context, "fitrah" refers to humanity's innate disposition toward virtue and the ability to differentiate between right and wrong. A common quote regarding fitrah, from the Prophet is "The fitrah consists of 5 things: circumcision, trimming the moustache, cutting the nails, plucking the armpit hairs, and shaving the pubic hairs."
In this study, our aim was to determine the status of axillary and pubic shaving in medicolegal death cases that took place in the Konya Province of Turkey and to evaluate the relationship with the origin of suicide. Of 2850 medicolegal death cases, 206 (7.2%) were of suicidal origin. It was observed that the average age in the cases of suicidal origin was 36.76 +/- 17.72 years, and 146 of 206 cases (70.9%) were men. As a method of suicide, hanging was the chosen method in 100 cases (48.5%), whereas firearm injuries occurred in 54 cases (26.2%), and intoxication was involved in 37 cases (18.0%). Daily axillary and pubic shaving was observed in 26 of 2644 (1.0%) death cases that occurred with nonsuicidal reasons, but in 65 of 206 were (31.6%) suicidal cases. Because suicidal notes were present in 25 (12.1%) of all of the suicidal cases, the ratio of daily axillary and pubic shaving was significantly higher than that of the suicidal notes.
In investigating the cases of suicidal origin for medicolegal purposes, evidence showing that this action was committed by the victim, the presence of a suicide note at the death scene and, a history of a previous suicidal attempt, it was thought that the presence of daily axillary and pubic shaving on external examination of the victim's body, when of Muslim faith, could also be considered a feature of suicide.
(C) 2008 Lippincott Williams & Wilkins, Inc.
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Histological Diagnosis of Sickle Cell Trait: A Blinded Analysis
by Thogmartin, Jon R.; Wilson, Christopher I.; Palma, Noel A.; Ignacio, Susan S.; Pellan, William A.
[1 Mar 2009 at 12:00am]
Hemoglobin electrophoresis is the method most commonly used to diagnose sickle cell trait (SCT) at autopsy. However, in some cases, this accepted technique is unable to be used due to either insufficient sampling, sample degradation, or lack of forethought; histology samples and/or gross tissue are not subject to these sampling errors and are routinely taken during autopsies. In this study, we attempted to determine whether one can reliably diagnose SCT using histology only. Histology sections of commonly sampled tissues (primarily heart, lung, and liver) from 9 decedents with SCT, 3 decedents with hemoglobin SC disease, and 18 control cases were examined in a blinded fashion as single slides and then as slide sets. When evaluating slide sets, the reviewers were able to identify the cases with SCT (sensitivity = 95%, specificity = 100%). Such samples could be used to diagnose SCT even decades after the original death certification and long after samples necessary for other techniques have degraded or been discarded.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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