Survived stab to the heart in a schizophrenic man

Schizophrenia is associated with a significant risk of suicide. According to recent research, 10-15 % of all schizophrenic patients die by suicide. It is not uncommon that the victims show sharp force injuries, so that the forensic pathologist first has to differentiate between self-infliction and involvement of another person. The authors' case report presents a 68-year-old schizophrenic patient who committed suicide by jumping out of a window of his apartment located on the second floor after inflicting multiple stab wounds to his thoracic region. At autopsy, an older stab wound to the apex of the heart was detected. In the criminal investigation, a suicide attempt made 13 days before could be ascertained. As the patient did not want to be taken to a hospital at that time, the injury had never been examined or documented. Since there was no evidence suggesting homicide, the older stab to the heart was interpreted as a tentative injury.     

Optical 3D surface digitizing in forensic medicine: 3D documentation of skin and bone injuries

Photography process reduces a three-dimensional (3D) wound to a two-dimensional level. If there is a need for a high-resolution 3D dataset of an object, it needs to be three-dimensionally scanned. No-contact optical 3D digitizing surface scanners can be used as a powerful tool for wound and injury-causing instrument analysis in trauma cases. The 3D skin wound and a bone injury documentation using the optical scanner Advanced TOpometric Sensor (ATOS II, GOM International, Switzerland) will be demonstrated using two illustrative cases. Using this 3D optical digitizing method the wounds (the virtual 3D computer model of the skin and the bone injuries) and the virtual 3D model of the injury-causing tool are graphically documented in 3D in real-life size and shape and can be rotated in the CAD program on the computer screen. In addition, the virtual 3D models of the bone injuries and tool can now be compared in a 3D CAD program against one another in virtual space, to see if there are matching areas. Further steps in forensic medicine will be a full 3D surface documentation of the human body and all the forensic relevant injuries using optical 3D scanners.     

'Morphological imprint': determination of the injury-causing weapon from the wound morphology using forensic 3D/CAD-supported photogrammetry

Forensic three-dimensional/computer aided design (CAD)-supported photogrammetry (FPHG) plays an important role in the field of the documentation of forensic relevant injuries; particularly so when a detailed, 3D reconstruction is necessary. This is demonstrated in the case of a patterned blunt injury to the face of a victim, which injury was subsequently proven by FPHG to have been caused by a blow from the muzzle of a soft air gun.The objects to be evaluated had to be series photographed in order to be evaluated virtually on the computer. These photo series were then analyzed with the RolleiMetric system. This system measures and calculates the spatial location of distinctive points on the objects' surfaces, and creates 3D data models of the objects. In a 3D/CAD program, the "virtual 3D model of the injury" is then compared against the "virtual 3D model of the possible injury-causing instrument".The validation of FPHG, as shown by the 3D match between certain characteristics of the muzzle form and the facial injury, demonstrates how this 3D method can be used for patterned wound documentation and analysis.     

Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings

Because the use of radiology in modern forensic medicine has been, until today, mostly restricted to conventional X-rays, which reduces a 3D body to a 2D projection, a detailed 3D documentation of a gunshot's wound ballistic effects was not possible. The aim of our study was to evaluate whether the progress in imaging techniques over the last years has made it possible to establish an observer-independent and reproducible forensic assessment using multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) technologies for the documentation and analysis of gunshot wounds. The bodies of eight gunshot victims were scanned by MSCT and by MRI; the data of these imaging techniques were post-processed on a workstation, interpreted and subsequently correlated with the findings of classical autopsy. With the spiral CT and MRI examinations and the subsequent 2D multi-planar reformation (MPR) and 3D shaded surface display (SSD) reconstruction, the entire gunshot-created complex skull fractures and brain injuries (such as wound channels and deeply-driven bone splinters) could be documented in complete and graphic detail. CT and MRI also documented vital reaction to the gunshot by demonstrating air emboli in the heart and blood vessels and the classic pattern of blood aspiration to the lung. Gunshot residues deposited within and under the skin were visible. In conclusion, we think that the radiological methods of MSCT and MRI have the potential to become a routine "virtual autopsy" tool in the future. Bullets and relevant histological samples from specific sites then might be won in image-guided minimally invasive fashion via percutaneous biopsy. The rapid application of developing radiological methods may lead to new horizons in forensic documentation and intravital as well as postmortem examination.     

Homicide by unusual‐edged weapons: Forensic considerations of two cases

Homicide by stab wound is common worldwide. However, the use of unusual edged weapons is rarely reported in the forensic literature. Here, we report two cases of homicide involving a Japanese sword, or katana, and a sickle. Both of these weapons can create either stab or incised wounds with some particularities. In our cases, characteristics of the external wounds, internal injuries, and the depth of penetration raised the possibility of an unusual weapon. Meticulous forensic examination of these injuries (morphological characteristics, depth of penetration, trajectories, and cut marks in the bone) may allow the forensic expert to determine the type of weapon used.     

多层螺旋CT与三维重建技术在法医损伤学中的应用

影像学技术发展迅速．已经成为临床诊断、治疗不可或缺的有效工具。利用MSCT与三维重建技术进行虚拟解剖,因为具有非破坏性、可显示特殊部位损伤形态、分析快速且便捷、便于证据保存和出示等特点在法医学尸体解剖中日益凸显优势．在法医损伤学研究及实践鉴定过程中具有较高的应用价值。文章综述了利用MSCT与三维重建技术在锐器伤、钝器伤、高坠伤、交通伤等实践领域的研究成果,并通过实践检案中遇到的典型案例,探讨多层螺旋CT与三维重建技术在法医学损伤鉴定中的应用价值。     

Haptics in forensics: The possibilities and advantages in using the haptic device for reconstruction approaches in forensic science

Non-invasive documentation methods such as surface scanning and radiological imaging are gaining in importance in the forensic field. These three-dimensional technologies provide digital 3D data, which are processed and handled in the computer. However, the sense of touch gets lost using the virtual approach. The haptic device enables the use of the sense of touch to handle and feel digital 3D data. The multifunctional application of a haptic device for forensic approaches is evaluated and illustrated in three different cases: the representation of bone fractures of the lower extremities, by traffic accidents, in a non-invasive manner; the comparison of bone injuries with the presumed injury-inflicting instrument; and in a gunshot case, the identification of the gun by the muzzle imprint, and the reconstruction of the holding position of the gun.The 3D models of the bones are generated from the Computed Tomography (CT) images. The 3D models of the exterior injuries, the injury-inflicting tools and the bone injuries, where a higher resolution is necessary, are created by the optical surface scan.The haptic device is used in combination with the software FreeForm Modelling Plus™ for touching the surface of the 3D models to feel the minute injuries and the surface of tools, to reposition displaced bone parts and to compare an injury-causing instrument with an injury.The repositioning of 3D models in a reconstruction is easier, faster and more precisely executed by means of using the sense of touch and with the user-friendly movement in the 3D space. For representation purposes, the fracture lines of bones are coloured. This work demonstrates that the haptic device is a suitable and efficient application in forensic science. The haptic device offers a new way in the handling of digital data in the virtual 3D space.     

Determining the Effectiveness of Noncontact Three-Dimensional Surface Scanning for the Assessment of Open Injuries

Noncontact three-dimensional (3D) surface scanning methods are used within forensic medicine to record traumas and other related findings. A structured light scanning technique is one of these methods and the most suitable for the forensic field. An assessment of the efficiency of different structured light scanners with forensic injuries is essential to validate this technique for wound documentation. The purpose of this study was to evaluate the capability of the HP structured light scanner Pro S3 for digitizing open injuries having complicated areas and depths. Fifteen simulated injuries on mannequins were scanned and assessed. Comparisons between 3D and direct wound measurements were made. The results showed that the technique was able to create detailed 3D results of the extensive injuries. Statistical significance tests revealed no difference between the two measurement methods. Because the scanner is applicable for routine work, it should be considered to confirm the same results on real cadavers and actual wounds.     

Virtopsy: postmortem imaging of the human heart in situ using MSCT and MRI

The rapid further development of computed tomography (CT) and magnetic resonance imaging (MRI) induced the idea to use these techniques for postmortem documentation of forensic findings. Until now, only a few institutes of forensic medicine have acquired experience in postmortem cross-sectional imaging. Protocols, image interpretation and visualization have to be adapted to the postmortem conditions. Especially, postmortem alterations, such as putrefaction and livores, different temperature of the corpse and the loss of the circulation are a challenge for the imaging process and interpretation. Advantages of postmortem imaging are the higher exposure and resolution available in CT when there is no concern for biologic effects of ionizing radiation, and the lack of cardiac motion artifacts during scanning. CT and MRI may become useful tools for postmortem documentation in forensic medicine. In Bern, 80 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy until the month of August 2003. Here, we describe the imaging appearance of postmortem alterations--internal livores, putrefaction, postmortem clotting--and distinguish them from the forensic findings of the heart, such as calcification, endocarditis, myocardial infarction, myocardial scarring, injury and other morphological alterations.     

The Cane Sword

This report provides an overview of the injuries caused by a unique blade‐type weapon known as a cane sword. The cane sword usually consists of a blade that is stored in a cylindrical “cane” that can be released at the handle to reveal the hidden blade within. The victim of the case was found to have a stab wound in the left mid‐back that caused perforation of both the lower and upper lobes of the left lung, resulting in a left hemothorax. Upon autopsy, it was concluded that the patient died from injuries caused by the stab wound to the back. Given the shape of the wound and the fact that the weapon itself was found at the site of the homicide, the weapon that caused the injury was believed to be a cane sword. This case will inform forensic pathologists, law‐enforcement officers, emergency medical personnel, and physicians about rare weapon, the cane sword.     

Case report of accidental stab wound to the heart

A 33 year-old Polish field-worker was found by his colleagues kneeling in front of his trailer, with a bloody stab wound in the heart region. In spite of prompt surgical intervention, the man died from his injury a few hours later. Upon examination of the dead man's trailer a blood-smeared vegetable-knife was found in the sink, and on the floor, a pullover with a slit-like cut. On the wall hung a jacket on a hook with a cut in the inner surface of the left breast pocket but not in the outside layer. The examination of the clothes, the autopsy and a reconstruction of the sequence of events led to the following conclusion: The knife had been placed into the breast pocket of the jacket with the tip facing downwards. As the man put down a sack of potatoes, the knife hooked into a pre-existing gap in the sack and was driven into the chest cavity by the pressure weight of the heavy sack.     

共聚焦激光扫描显微镜在法医病理学中的应用

共聚焦激光扫描显微镜(confocal laser scanning microscope,CLSM)是一种新兴的显微图像检测技术,能够进行光学切片和对检材进行三维重构,并且能够获得较之普通光学显微镜更高的空间分辨率.CLSM作为一种精密的观察工具,在法医病理学的显微图像检测中具有重要价值.本文综述了CLSM在心源性猝死、枪弹创分析以及神经系统损伤分析等相关领域的研究成果,探讨其在法医病理学研究以及法医检案中的应用价值.     

3D surface and body documentation in forensic medicine: 3-D/CAD Photogrammetry merged with 3D radiological scanning

A main goal of forensic medicine is to document and to translate medical findings to a language and/or visualization that is readable and understandable for judicial persons and for medical laymen. Therefore, in addition to classical methods, scientific cutting-edge technologies can and should be used. Through the use of the Forensic, 3-D/CAD-supported Photogrammetric method the documentation of so-called "morphologic fingerprints" has been realized. Forensic, 3-D/CAD-supported Photogrammetry creates morphologic data models of the injury and of the suspected injury-causing instrument allowing the evaluation of a match between the injury and the instrument. In addition to the photogrammetric body surface registration, the radiological documentation provided by a volume scan (i.e., spiral, multi-detector CT, or MRI) registers the sub-surface injury, which is not visible to Photogrammetry. The new, combined method of merging Photogrammetry and Radiology data sets creates the potential to perform many kinds of reconstructions and postprocessing of (patterned) injuries in the realm of forensic medical case work. Using this merging method of colored photogrammetric surface and gray-scale radiological internal documentation, a great step towards a new kind of reality-based, high-tech wound documentation and visualization in forensic medicine is made. The combination of the methods of 3D/CAD Photogrammetry and Radiology has the advantage of being observer-independent, non-subjective, non-invasive, digitally storable over years or decades and even transferable over the web for second opinion.     

玻璃刺创形态学特点的初步研究

目的研究玻璃刺创的形态学特点。方法分别用3个厚度为0．31cm带尖状突起的啤酒瓶残端及3块厚度为0．29cm有尖的普通窗玻璃碎片按设定的不同方向刺击带皮猪肉组织,重复此过程3次,形成198例创口,观察、编号、拍照、测量各创口。结果198例创口的整体形态可分为5种类型,即“工”型、“”型、“”型、“上”型与“一”型,各型在不同刺击方向的分布上存在差异,其中前4种为主要类型,共约占总数的93％,其共同点为在损伤的中部出现了一段与损伤整体走向垂直的创口,啤酒瓶残端所致垂直创口的长度为0．31±0．Olcm（x±s）,窗玻璃碎片所致垂直创口的长度为0．29±0．Olcm（x±s）。结论损伤中部有与损伤整体走向垂直的短创口是玻璃刺创中易出现的一种形态学特点,垂直创的长度与致伤玻璃的厚度具有一致性。     

家兔死后心血氧化还原电位值变化与死亡时间的关系

目的研究在不同温度条件下家兔死后心血氧化还原电位(oxidation reduction potential,ORP)值变化与死亡时间(postmortem interval,PMI)的关系。方法随机将48只家兔分为6组,以空气栓塞法处死后,取家兔右心室血液分别置于10、15、20、25、30和35℃温度下的水浴中,自取血即刻(0h)至死后132h内,每4 h用PB-21型电化学分析仪测定样本的ORP值。应用SPSS 17.0软件建立曲线回归方程,再应用MATLAB7.10.0软件建立曲面方程和三维曲面图。结果不同温度条件下家兔心血ORP值变化与PMI具有高度相关性,温度高时,ORP值上升明显,温度低时,ORP值上升缓慢,并获得拟合的曲面方程以及三维曲面图。结论拟合的ORP值与PMI的曲面方程及三维曲面图可进行温度变化条件下的PMI推断。     

大鼠 Fn剪接异型体分布及皮肤损伤后表达研究

目的研究成年大鼠、新生幼鼠纤维连接蛋白剪接异型体 EⅢ A、 EⅢ B体内分布及皮肤切创、挫伤后表达情况 , 以期为法医学损伤经历时间研究探索新指标及选择阳性对照 . 方法组织匀浆后抽提总 RNA, 逆转录聚合酶链反应 ( RT- PCR) 技术扩增目标条带 . 结果 (1)正常皮肤 EⅢ A+ 、 EⅢ B+ 不表达 , 伤后 18h EⅢ A+ 位点高丰度表达 , EⅢ B+ 位点变化不明显 , 两种致伤方式表达结果差别不大 ; (2)成年大鼠各器官分布情况依次为脑、心、肝 . 结论 EⅢ A+ 可作为皮肤损伤研究的敏感指标 .     

Practical application of the Injury Severity Score (ISS) in expert forensic testimony

The retrospective analysis of the autopsy records of 50 homicides showed that the Injury Severity Score (ISS), a numerical scoring system initially developed to quantify the severity of injuries sustained in road traffic accidents, can also be useful for objectively describing and ranking the overall severity of trauma with regard to forensic issues. The present case report illustrates to what extent the ISS can help to assess the contribution of each assailant in homicides committed by several perpetrators. In the case presented the court was convinced that one perpetrator had inflicted four deep stab wounds to the victim's face (each with bony lesions), 2 stabs to the chest piercing the right lower pulmonary lobe and causing a haemothorax of 200 ml, an abdominal stab wound without involvement of a parenchymatous organ as well as multiple defence wounds of the arms. Thereafter, a second perpetrator was thought to have inflicted several heavy blows with a full water bottle causing severe contusions on the right side of the forehead, the chin, the left side of the face and a spider's web fracture of the frontal bone. Using the ISS an injury severity score of 24 was assigned to the first complex of injuries and a score of 10 to the second complex. The forensic conclusions with regard to prognosis and lethal outcome are discussed.     

Secondary combined suicide viewed by the wife]

A 47-year-old man was found dead at the bottom of a wall outward the door of the cellar of his house. Preliminary physical examination at the scene of the death revealed a laceration of the scalp, an incised wound in front of the neck and several stab wounds in the left chest penetrating through the clothing. Questioned by the police his wife told that her husband who suffered from severe depression had inflicted the incised and the stab wounds himself, had made an unsuccessful attempt at self-strangulation and had finally jumped down from the wall beside the stairs declining to the cellar of their house. As the circumstances of the scenario were suspicious and as the pattern of injuries arose doubts concerning self-infliction homicide was taken into consideration as well. Autopsy showed additional hesitation marks adjacent to the left end of the incised wound in front of the neck. The stab wounds of the chest were restricted to the region of the heart and displayed only minimal penetration of the chest-wall, findings characteristic of self-infliction. As a consequence the manner of death could be determined as prolonged suicide, and exact reconstruction was possible with the help of the wife's testimony.