Pigmentation of articular surfaces of bones as an identification factor: a unique case report

One of the classic problems of forensic pathology, the identification of a skeletal remains, involves techniques and expertise that span a number of disciplines. This forensic endeavor offers a more challenging and creative exercise because identification with medical and legal certainty often requires thinking beyond routine workups. Identification workups are creative in developing features that are unique as presented by an individual decedent. In this case report, a rare pathologic condition, ochronosis, has helped in the accurate identification of an individual from a systematic skeletal remains examination.     

A thousand tales of dead men: the forensic anthropology cases of William R. Maples, Ph.D.

This paper examines the nearly 1000 forensic anthropology case reports authored by the late William R. Maples during his 28 year career at the University of Florida, Gainesville. The types of case files reviewed include C.A. Pound Human Identification Laboratory reports; 999, US ARMY-CILHI reviews; 226, and historical or prominent persons. Although Dr. Maples performed private casework, these files were not available for examination. A demographic profile for the C.A. Pound Human Identification Laboratory sample is presented.     

Use of radiographic atlases in a mass fatality

In May and June of 1996, a forensic anthropology team from the C.A. Pound Human Identification Laboratory at the University of Florida identified 9 of 10 juveniles from the crash of ValuJet 592. The team relied primarily on a radiographic atlas developed and used by clinical practitioners to determine skeletal age. Postmortem radiographs of the juvenile victims were compared with radiographic standards to determine skeletal age. Skeletal age was then compared to a passenger list indicating the sex, weight, height, and chronological age of each individual. Tentative identifications based on the atlas method were organized into an exclusion matrix. Final identifications were based on this assessment in conjunction with other anthropological data such as appearance and fusion of ossification centers and estimation of stature.     

Positional asphyxiation in adults. A series of 30 cases from the Dade and Broward County Florida Medical Examiner Offices from 1982 to 1990.

Over a 9-year period, 30 cases of positional (or postural) asphyxia were identified in the Dade and Broward County (Florida) Medical Examiner Offices. The victims had an average age of 50.6 years with no significant sex or racial differences as compared with the general medical examiner population. Chronic alcoholism or acute alcohol intoxication was a significant risk factor in 75% of cases and these had an average postmortem ethanol concentration of 0.24 g%. Signs of mechanical asphyxiation (petechiae and/or combined lung weights greater than 900 g) were present in 93% of cases. Victims were commonly (43%) found in a restrictive position producing hyperflexion of the head and neck. Two deaths involved restraint vests ("poseys") in elderly, demented, wheel-chair-confined victims. Scene photographs of the undisturbed decedent are extremely helpful in confirming a suspicion of postional asphyxia.     

Sharp-force trauma analysis and the forensic anthropologist: techniques advocated by William R. Maples, Ph.D.

Forensic anthropological tenets supported by William R. Maples, Ph.D. provide the bases for a case study from the C.A. Pound Human Identification Laboratory. Using a multidisciplinary team that included police investigators, pathologists, odontologists, entomologists, and anthropologists, a biological profile and trauma analysis was constructed. Our analysis determined that the decedent was a middle-aged Hispanic male, approximately 5'6"-5'7" in stature, who had died a minimum of three months before the discovery of his remains. Gross and microscopic analysis revealed 11 areas of sharp trauma to the skull and cervical vertebrae. To aid with analysis of the trauma, nonhuman trauma exemplars were created using a Tiger rear flail mower of the make known to have been used at the scene where the remains were recovered. This use of nonhuman trauma exemplars proved to be essential in the effort to exclude the rear flail mower as the possible trauma agent.     

Importance and Approach to Manner of Death Opinions in Opioid-Related Deaths

The majority of opioid-related deaths are accidental. However, the number of opioid-related suicidal deaths is likely under recognized. Presented here is a case of suicide by heroin overdose. The manner of death would have likely been deemed accidental if not for critical information shared by the decedent’s family during follow-up telephone interviews between the forensic pathologist and the decedent’s family, which included text messages that were sent by the decedent just before his death that were not known at the time of the initial medicolegal death scene investigation. This case highlights that when a forensic pathologist establishes an engaged relationship with the decedent’s family, the information elucidated can prove to be invaluable in reaching an informed opinion about the manner of death. For overdose cases, identifying an accurate manner of death allows the design of public health efforts that adequately address the health risks in the community. For aid in the determination of the manner of death for overdose cases, we propose a five-step checklist that may assist forensic pathologists and medicolegal death investigators when approaching similar cases.     

Validation of chest X-ray comparisons for unknown decedent identification

Comparing skeletal structures between antemortem and postmortem chest radiographs is widely used by forensic specialists from many disciplines to positively identify unknown decedents. However, validity assessments of this method have been fairly limited. This study had three objectives: 1) to quantify the reliability of ante- and postmortem chest radiograph comparison for decedent identification; 2) to identify useful radiologic features supporting decedent identification; and 3) to recognize sources of error in decedent identification related to use of comparative radiographs. A forensic pathologist, a forensic anthropologist, and two radiologists participated in the study. Our results showed that chest radiograph comparisons proved reliable, if basic decedent information was provided, and antemortem and postmortem radiographs were adequately positioned and exposed. A "morphological approach" using normal anatomical structures for comparison may provide the most efficient method for accurate identification.     

Undiagnosed, untreated acute promyelocytic leukemia presenting as a suspicious sudden death

Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia frequently associated with clotting abnormalities and severe hemorrhagic diathesis. The disease is associated with a high incidence of early fatal hemorrhage. We report the sudden death of a 40-year-old male without significant medical history in which foul play had been initially suspected. A thorough postmortem investigation performed on the decedent lead to the diagnosis of APL. Cause of death was a cerebellar hematoma. Underlying APL should be considered in the differential diagnosis when unexplained bleeding is encountered in a decedent. This case emphasizes the value of routinely collecting bone marrow during an autopsy to enable accurate testing and diagnosis.     

The timing of histologic changes in liver lacerations

Microscopic examination was performed on 55 cases of traumatic liver lacerations incurred from fatal motor vehicle accidents. None of the deaths was due to the liver injury. In 38 of 55 cases, the decedent was pronounced dead at the scene. Microscopic examination of the liver lacerations in these 38 cases revealed no histologic changes related to the trauma. In 17 of 55 cases, the decedent was transported to the emergency room (ER) with a "survival time" (from Emergency Medical Service arrival to the time of pronouncement) of 15 minutes to 7 hours and 10 minutes. Nine of these 17 had vital signs at the scene. Five of the 17 had neutrophilic infiltration and hepatocyte necrosis at the site of the laceration. Four of these had vitals signs at the scene. Survival time of the 5 patients with a vital reaction at their liver injury ranged from 51 minutes to 7 hours and 10 minutes.     

Suicide by jumping from buildings

A study of 82 suicides during 1982-1986 that were committed by jumping from buildings was performed using the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, U.S.A. The analysis involved the age, race, and sex of the victim along with the results of toxicologic studies and the cause of death. Additionally, the decedent's place of residence, location of the suicide, height of the building, and the reason for the suicide were investigated. Whether or not a note was left by the decedent was also ascertained. The suicidal "jumper" most commonly was a white man who was greater than 60 years of age who died from the resultant multiple injuries. The victim commonly was sober and drug free at the time of the incident. In approximately two-thirds of the cases, the location of the suicide was the victim's residence, which frequently was an apartment or condominium-type dwelling that was seven floors or higher from the ground. The victim often had experienced depression prior to the incident and did not usually leave a suicide note. This article compares the Dade County cases with others that have been studied and discusses the reasons why jumping from a building may have been chosen as the suicidal mechanism.     

Fatal intoxication from 3,4-methylenedioxyamphetamine

The symptoms of MDA intoxication exhibited by the decedent prior to death closely mimic those of acute amphetamine poisoning: profuse sweating, violent and irrational behavior, and stereotypically compulsive behavior. Therefore, if amphetamines are not detected in specimens from a person displaying classic symptoms of amphetamine poisoning, hallucinogenic amphetamine derivatives may be considered. In the case described, a divided dose of 850 mg of MDA ingested within 2 h and 15 min was sufficient to cause the death of a 24-year-old male, 4 h after the final dose. While the methaqualone may have contributed to the demise of the decedent, the authors think that the MDA itself was sufficient to cause death. Results of limited recovery studies of MDA extraction from blood and elution from TLC plates supported the observations of Cimbura [13]. Approximately 85% of MDA is extracted by the method described and its elution from TLC plates is quantitative. This case points out once again the dangers of false advertising in the illicit market. The decedent, himself a dealer in the illicit drug market, and all present at the party believed the ingested white powder to be a mixture of morphine, LSD, and amphetamine, hence MDA. They were totally unfamiliar with 3,4-methylenedioxyamphetamine, MDA.     

Fatal fall of an aircraft stowaway: a demonstration of the importance of death scene investigation

Scene investigation is of paramount importance in forensic pathology. Many medical and coroner systems wisely and routinely evaluate the scene in homicides but do not routinely investigate traffic fatality scenes. This case originally was thought to be a pedestrian-automobile event, but, due to proper and prompt scene investigation, it was determined that the decedent was actually a wheel-well stowaway who fell from a commercial aircraft.     

Death during theft from electric utilities

Utilities that supply power are subject to theft of service and theft of hardware used to provide service. Individuals who try to steal from a power utility risk electrocution. We conducted a retrospective study of all individuals examined by the Jefferson County Coroner Medical Examiner Office from January 1981 through December 2001 and found that 8 individuals died trying to steal from a power utility. All decedents were men, with an average age of 33 years. Seven decedents were stealing copper, and 1 was stealing electricity. Only 1 decedent survived long enough to be admitted to a hospital. Five decedents were intoxicated, 3 with ethanol, 1 with cocaine, and 1 with both cocaine and ethanol. Seven decedents sustained electrical burns in keeping with the high voltage to which they were subjected. The unburned decedent died of laceration of the aorta at its origin from the heart, an injury sustained when the decedent fell from the power pole. All 8 decedents attempted their theft during daylight. Items found in the decedent's pockets, the presence of a ladder nearby, or the presence of electrical tools around the body may help to establish the attempted act of theft.     

The postmortem fate of Pat Gregory: a disinterred Native American

In late June 1990, the Mono County Sheriffs Department in Bridgeport, CA contacted the Physical Anthropology Human Identification Laboratory (PAHIL) at California State University, Chico to seek assistance in the identification of a recently discovered skull. To assist with possible identification, the cranium received a classic physical anthropological/morphological analysis to suggest the decedent's sex, age at death, ancestral affiliation, and uniqueness. It was concluded the cranium was that of an older male, and someone with mixed ancestry, probably Native American/White. Suggested uniquenesses were an eroded and greasy texture, with adhering white sand, evidence of healed antemortem nasal fractures, and a bifid left occipital condyle. The cranium was confiscated from a man suspected of vandalizing a Native American cemetery just south of the community of Lee Vining. The cemetery was established in the mid-1800's by local Native American tribes. Although ownership of the land was disputed by the US Forest Service (the Inyo National Forest), and the Los Angeles Department of Water and Power (LADWP), county authorities claimed that because the incident involved the desecration of a cemetery and human remains, it was a legal issue, and therefore, the Sheriff's Department had jurisdiction over the case if not the land. The suspect pled guilty to the possession of Native American remains but claimed not to have desecrated a grave. Over the next year and a half, members of the Native American community representing various tribes sought the return of the cranium, while also seeking assurance that it belonged to the vandalized grave. While county, US Forest Service, and LADWP officials continued to argue over whom had jurisdiction of the remains the superior court judge ordered the county to pay for any analysis necessary to determine if the cranium belonged to the decedent in question. This report addresses the conclusions of that analysis and the disposition of the case. Furthermore, the report addresses the forensic value to Native Americans of the continued study of a wide variety of human skeletal remains.     

Recovery of a mummified pregnant woman from a 55-gallon drum more than 30 years after her death

The body of a 28-year-old near-term pregnant woman was found in a 55-gallon steel drum in a crawl space under a house more than 30 years after her disappearance and death. At autopsy the body was remarkably well preserved and mummified, as was that of a male fetus. The decedent had 10 scalp lacerations and multiple comminuted depressed skull fractures and had died as a result of blunt force head trauma.     

Investigation of Postmortem Absorption and Redistribution After the Application of a Fentanyl Patch

Fentanyl deaths have increased with availability of transdermal patches. Interpretation of postmortem fentanyl levels may be complicated by postmortem redistribution and absorption of fentanyl from a patch. We applied an unused 100‐μg/h fentanyl patch onto the lower abdomen of a decedent with no premortem fentanyl exposure. Ocular fluid, blood, and urine were collected prior to placement, and the decedent was refrigerated for 23 h. Prior to the autopsy, urine, subcutaneous tissue under the patch, and samples from the same anatomic sites were obtained. We observed no fentanyl in any postpatch placement samples (LOD: 0.1 ng/mL for blood and vitreous fluid, 1.0 ng/mL urine, 2.0 ng/g for tissues). Although we observed no postmortem absorption of fentanyl, this was only a single case; therefore, we recommend that patches be removed after receipt of a cadaver before initiation of an autopsy, with the location of removed patch documented.     

论继承权丧失制度——以我国《继承法》第7条的修改为中心

继承权丧失制度是"任何人不得于其不法行为中获利原则"的体现,是对继承人不法或不道德行为的一种民事制裁。既不能纵容继承人的不法或不道德行为,也不能对继承人过于严苛,同时应充分尊重被继承人的意思。建议增加"以欺诈或胁迫手段迫使、妨害被继承人订立、变更或撤销遗嘱的"作为相对丧失继承权的法定事由。同时,若继承人遗弃被继承人或虐待被继承人情节严重的,由当然相对丧失继承权改为须经被继承人表示丧失继承权。     

Fatalities by ingestion of propylene glycol

Propylene glycol (PG), a widely used solvent and lubricant, is thought to have low toxicity when ingested. Three cases were identified where PG, either alone or in combination with other chemical agents, contributed to death. The decedent in whom PG was the sole agent was a 32-year-old schizophrenic man with cardiomegaly and renal impairment. The blood PG concentration was 4410 mg/L at least 9.5 h following ingestion.     

An unusual case of anaphylaxis. Mold in pancake mix

Anaphylactic reactions involve contact with an antigen that evokes an immune reaction that is harmful. This type of reaction is a rapidly developing immunologic reaction termed a type I hypersensitivity reaction. The antigen complexes with an IgE antibody that is bound to mast cells and basophils in a previously sensitized individual. Upon re-exposure, vasoactive and spasmogenic substances are released that act on vessels and smooth muscle. The reaction can be local or systemic and may be fatal. The authors report the death of a 19-year-old white male who had a history of "multiple allergies," including pets, molds, and penicillin. One morning, he and his friends made pancakes with a packaged mix that had been opened and in the cabinet for approximately 2 years. The friends stopped eating the pancakes because they said that they tasted like "rubbing alcohol." The decedent continued to eat the pancakes and suddenly became short of breath. He was taken to a nearby clinic, where he became unresponsive and died. At autopsy, laryngeal edema and hyperinflated lungs with mucous plugging were identified. Microscopically, edema and numerous degranulating mast cells were identified in the larynx. The smaller airways contained mucus, and findings of chronic asthma were noted. Serum tryptase was elevated at 14.0 ng/ml. The pancake mix was analyzed and found to contain a total mold count of 700/g of mix as follows: Penicillium, Fusarium, Mucor, and Aspergillus. Witness statements indicate that the decedent ate two pancakes; thus he consumed an approximate mold count of 21,000. The decedent had a history of allergies to molds and penicillin, and thus was allergic to the molds in the pancake mix. The authors present this unusual case of anaphylaxis and a review of the literature.     

A case of Ludwig angina: a case report and review of the literature

Ludwig angina is a rapidly progressing submaxillary, submandibular, and sublingual necrotizing cellulitis of the floor of the mouth that can have lethal consequences due to airway obstruction. Various aerobic and anaerobic microorganisms, and less often fungi, have been implicated to cause Ludwig angina, including oral flora such as streptococci and staphylococci. Early recognition and the use of parenteral antibiotics can prevent mortality and morbidity. We report a case of a 25-year-old white man who was admitted to the hospital by his dentist after being diagnosed with Ludwig angina secondary to periodontal abscesses involving teeth #17 and #32. Although antibiotics were administered, while in the hospital, the decedent had difficulty swallowing and was drooling. He suddenly began to have seizure-like activity thought to be anoxic myoclonus. The decedent was aggressively resuscitated and taken to the operating room for neck exploration and a tracheostomy. Neck exploration revealed severe necrotizing acute inflammation of the deep soft tissues and musculature of the neck. He remained on life support for 7 days until he was declared brain dead. Ludwig angina is a progressive cellulitis that often results in death by asphyxia. Ludwig angina can be complicated by subsequent deep neck infection. The underlying etiologies and common scenarios are examined, and significant autopsy findings and dissecting procedures are discussed. The pathophysiology of Ludwig angina is studied with a review of the current literature.