Cardiac Injuries Caused by Blunt Trauma: An Autopsy Based Assessment of the Injury Pattern

Abstract:  Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common, particularly as a result of rapid deceleration in high-speed vehicular accidents, over the past 2–3 decades. The high mortality rate of cardiac injuries and possible late onset complications make blunt cardiac injuries an important challenging point for legal medicine. One hundred and ninety cases with blunt cardiac injuries in a period of 3 years were analyzed retrospectively in terms of patterns of cardiac injury, survival times, and demographic profiles of the cases in this study.     

Head injuries of Roman gladiators

Gladiator remains from a recently unearthed cemetery in ancient Ephesus (Turkey) offer a unique opportunity for proving common theories involving the weaponry and techniques of gladiator fighting based on the evidence supplied by cranial bones. This mass grave is the first of its kind to undergo a thorough osteological and forensic examination.A minimum number of individuals (MNI) analyses revealed that at least 68 individuals. All individuals found turned out to have been males aged between 20 and 30 years, except for one female associated with a female slave gravestone, and one male aged 45–55 years, had been buried in this area of the cemetery. The male mean body height was 168 cm (S.D. = 5 cm), which lies inside the normal range of height for Roman populations at those times.Eleven (16% of MNI) individuals exhibit a total of 16 well-healed antemortal cranial traumata. Five of the 11 individuals showed multiple trauma. Ten (15% of MNI) individuals exhibited a total of 10 perimortal cranial traumata. This is a surprisingly high frequency of deadly head injuries, taking into account that most of the gladiator types wore helmets. A possible explanation could be the frequently reported deathblow technique used by the hammer-carrying death god “Dis Pater”.The gladiator weaponry is well known through historical sources. At least one injury per known type of offensive weapon could be identified, as well as evidence for the most popular, the gladiator trident, which was found to be represented by one perimortem and two antemortem injuries. Overall the reportedly very strict nature of combat rules for gladiator fights could be confirmed by the absence of multiple perimortal traumatized individuals, showing a lack of the excessive violence commonly observed on medieval battle ground victims.This graveyard gives the opportunity to confirm historical aspects and to check the reliability of forensic methods for identification of antemortem, perimortem, or postmortem bone lesions. Typical examples for these kinds of lesions and injuries are presented. The colour of the margins of the traumata proved to be the most distinguishing feature for postmortal lesions.     

Head injuries of Roman gladiators

Gladiator remains from a recently unearthed cemetery in ancient Ephesus (Turkey) offer a unique opportunity for proving common theories involving the weaponry and techniques of gladiator fighting based on the evidence supplied by cranial bones. This mass grave is the first of its kind to undergo a thorough osteological and forensic examination. A minimum number of individuals (MNI) analyses revealed that at least 68 individuals. All individuals found turned out to have been males aged between 20 and 30 years, except for one female associated with a female slave gravestone, and one male aged 45-55 years, had been buried in this area of the cemetery. The male mean body height was 168 cm (S.D.=5 cm), which lies inside the normal range of height for Roman populations at those times. Eleven (16% of MNI) individuals exhibit a total of 16 well-healed antemortal cranial traumata. Five of the 11 individuals showed multiple trauma. Ten (15% of MNI) individuals exhibited a total of 10 perimortal cranial traumata. This is a surprisingly high frequency of deadly head injuries, taking into account that most of the gladiator types wore helmets. A possible explanation could be the frequently reported deathblow technique used by the hammer-carrying death god "Dis Pater". The gladiator weaponry is well known through historical sources. At least one injury per known type of offensive weapon could be identified, as well as evidence for the most popular, the gladiator trident, which was found to be represented by one perimortem and two antemortem injuries. Overall the reportedly very strict nature of combat rules for gladiator fights could be confirmed by the absence of multiple perimortal traumatized individuals, showing a lack of the excessive violence commonly observed on medieval battle ground victims. This graveyard gives the opportunity to confirm historical aspects and to check the reliability of forensic methods for identification of antemortem, perimortem, or postmortem bone lesions. Typical examples for these kinds of lesions and injuries are presented. The colour of the margins of the traumata proved to be the most distinguishing feature for postmortal lesions.     

Modification Methods of Blank Pistols in Turkey in 2006

Abstract:  This study describes the modification methods of blank cartridge firing pistols in Turkey. We have examined cases submitted to the Aydın Regional Criminal Laboratory of Turkey in 2006. In total, 95 modified pistols and 300 modified cartridges were examined. The blank cartridge firing pistols are guns which look similar to "real" pistols, however, there are blockages in their barrel in order to prevent the discharge of a bullet. However, as a result of simple modifications, these pistols can be easily converted into "real" firearms. Studied modification methods are removing the obstruction from the barrel, removing the partial obstruction from the barrel, sleeving a smaller diameter tube into the original barrel, using a replacement barrel, and rifling the original barrel. Special cartridges for these modified pistols are also produced. These modified pistols and cartridges were evaluated in respect of the converting methods.     

Signs of injury in bone findings--analysis and evaluation

Recent bone finds examined under forensic aspects as well as historic skeletons (mainly dating from the Middle Ages) with a known history as to the cause of death and the place where they were found were studied to develop basic criteria for the assessment of the cause and time of origin of bony defects. With regard to the time of origin it was found that the closer an injury occurs before or after death, the harder it is to distinguish from a perimortal injury. A schematic pattern was worked out for the kind of origin classifying the injuries as to "type of force", "mechanism", "weapon/object" and "effect to the bone", which helps in the forensic assessment of the causes of injuries found on bones.     

Weapon Usage in Attempted and Completed Parricides in Nineteenth-Century America: An Archival Exploration of the Physical Strength Hypothesis

Abstract:  The "physical strength hypothesis" (PSH) predicts that where there is the greatest discrepancy in size and strength between offenders and victims, the former will use superior weaponry (e.g., firearms) to overcome structural imbalances against the latter. Using archival data from the New York Times and the Chicago Tribune , 1851–1899, this paper examines the weapons used in attempted and completed parricides in nineteenth-century America. Findings indicate that parricide offenders used firearms most frequently against their fathers while intimate contact methods were used against mothers. When gun usage was combined with level of intent in male offender patricides, where the greatest discrepancy in strength was expected, results indicate that spontaneous gun usage outnumbered premeditated gun usage, thus challenging the assumptions of the PSH. The data suggest that cultural factors such as methods of dispute resolution, weapon carrying, and alcohol consumption may be important factors in understanding parricides.     

Firearm suicide committed using an unusual combination of tandem missiles: a bullet, a nail, and a screw

An interesting case of firearm suicide carried out using an unusual type of handmade weapon and a peculiar combination of tandem missiles is presented. A nail and a screw were placed in the rifle barrel ahead of a bullet, and all 3 were simultaneously discharged. The inflicted injury began with 1 common channel, which later split in 2 separate channels, both directed backwards and upwards; one was caused by the screw, ending in the epistropheal body, and the other, caused by the bullet and the nail, penetrated into the cranial cavity, where it bifurcated in 2 branches, one from the bullet, ending in the cerebellar tissue, and the other from the nail, penetrated through the brain stem. The established site of the entrance suicidal wound, the appearance of the weapon, and the unusual missiles are discussed with regard to the available references dealing with different types of nail injuries to the head.     

Suicidal shot in the mouth with an unmodified blank cartridge pistol

In the medicolegal literature reports of suicides with weapons designed for self-defence, especially gas pistols, are rare. We report on a suicide of a 54-year-old woman who fired a fatal shot in her mouth with an unmanipulated blank cartridge pistol, make R?hm RG 8, calibre 8 mm. The autopsy findings (lips and mucosa of the buccal vestibule without injuries, but extensive lesions of the tongue and the middle and rear third of the smooth palate) suggest that the shot was fired - as observed by a witness - with the barrel of the weapon inside the oral cavity. Both macroscopic inspection and histological investigations excluded the possibility that death was caused by an injury of the brain, in particular the brain stem. The immediate cause of death was deep aspiration of chyme with concurrent aspiration of blood.     

Rare and Severe Maxillofacial Injury Due to Tear Gas Capsules: Report of Three Cases

Tear gases are used by police or armed forces for control of riots or social events or by the general population for private self‐defense. These agents are used widely throughout the world, but some harmful effects have reported. In addition, despite well‐defined chemical side effects documented in the literature, data are insufficient regarding mechanical injury due to tear gas capsules. We report three cases of severe maxillofacial injury in patients who had these capsules fired from tear gas guns directly to their faces. The capsules penetrated the patients' faces, causing potentially fatal injuries. To our knowledge, reports of this kind of injury related to tear gas capsules are very rare in the literature. In conclusion, tear gas guns may be very dangerous in terms of human health and they may cause severe injuries, especially when they are not used according to strict guidelines.     

创伤的AIS评分与损伤程度评定对比分析的研究

ＡＩＳ评分法是国际医学临床上公认的创伤严重度评价方法之一。作者收集了本室５４６例伤害案件，分别给予损伤程度评定及ＡＩＳ评分，设为损伤程度组和ＡＩＳ组。两组比较，经Ｘ２检验，Ｐ＜０．００１；经Ｓｐｅａｒｍａｎ等级相关检验ｒｓ＝０，９４０，Ｐ＜０．００１，均有高度显著性，反映两组之间有密切关系而且损伤程度组的程度变化与ＡＩＳ组分级变化有关系。提示：轻伤、重伤可以参照ＡＩＳ严重度分级、编码，由此为轻、重伤分级、标准的计算机化及国际间的交流提供新方法。     

Unusual wound morphology after textile penetration by the automatic rifle (StG) 58. A case report

Technical characteristics of the used fire-arm and ammunition, the firing range and the shot through garments of the victim are essential factors, that exercise an influence on the appearance of gunshot injuries. An exemplary case-report shall emphasize the importance of these factors. It deals with a suicidal double-shot fired from an automatic rifle by a young soldier. The wounds were localized in the left chest region and the adjacent skin was blackened by soot in a remarkable geometrical pattern, although an ammunition with a smokeless charge has been used. By means of comparative shots we have good reasons to suppose this phenomenon to be caused by rests of gun powder and pressure of the explosion gas leaved in the barrel after the first shot. The second projectile pushed out this explosion gas to the skin that had been uncovered in a star-shaped way by the first shot.     

Suicide with a walking cane gun: weapon, injury picture and psychopathology]

In Germany firearms camouflaged as items of daily use are forbidden. While reports on ball-point pen-guns have repeatedly been published in literature, the use of a walking-stick gun is a rarity. The report deals with the suicide of a 31-year-old schizophrenic man who inflicted a shotgun injury to his head with typical morphological characteristics. The weapon used was a normal-looking walking stick with a barrel, cal. .410. Under forensic and criminological aspects the significance of a walking-stick gun is comparable to that of ball-point pen-guns. Both weapons can be carried and used inconspicuously, but from a walking-stick gun also ammunition of larger calibres with a higher potential of injury can be fired.     

Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old Boy

Abstract:  Sickle cell disease (SCD) and sickle cell trait (SCT) can be associated with sudden unexpected death in the pediatric population, usually due to pulmonary complications occurring within the acute chest syndrome (ACS). Musculoskeletal complications can occur and are classically limited to bone infarcts. The occurrence of bone pathology centered upon the epiphyseal growth plate in SCD/SCT is extremely rare, and multiple such injuries in a single patient have not been previously reported. Herein, we describe a case of sudden unexpected death in a 5-year-old child with undiagnosed SCT due to the ACS, with widespread epiphyseal and periosteal bone lesions mimicking multiple inflicted injuries at autopsy. This case highlights the importance of clinicopathological correlation and is the first to describe SCT pathology as a mimic of nonaccidental injury.     

A Case of Extreme Sexual Self-Mutilation

Abstract:  We report on a case of extreme sexual self-mutilation in which the subject inflicted severe trauma to his genitalia and then falsely reported a sexual assault. The 30-year-old white male did not report the incident for 10 days and then checked into a hospital. The hospital called the Westminster Police Department after the subject reported that he was the victim of a sexual assault in our city. This case is unusual in that the subject's initial behavior and story did not indicate deception. It was not until the subject's computer was searched that investigators determined that the injuries were self-inflicted. Without this critical information the case might still remain open as a sexual assault. This case is reported to broaden our understanding of this behavior and inform investigators of the potential for this type of self-inflicted injury.     

Homemade battery-operated multi-barreled muzzle-loading gun

In a recent shootout by a terrorist group against a law enforcement agency, some unusual firearms were seized. On examination, these firearms were found to be homemade, battery-operated, multi-barreled muzzle-loading guns, analogous to a repeater. Reference to battery-operated firearms is rather scanty in the literature. Hence, the unique design features, electrical circuit, and the operation system of these unusual guns are described.     

Hepatic glycogen staining. Applications in injury survival time and child abuse

Hepatic glycogen stores have long been known to decrease with starvation, trauma, acute stress, and shock. In this study, hepatic tissue was examined in 122 decedents ranging in age from 1 to 88 years who died of a variety of causes. Hepatic tissue was stained for glycogen/carbohydrates using the Best's carmine and/or period acid-Schiff (PAS)-alcian blue methods in 121 cases. The liver samples were evaluated for amount of staining, staining around hepatic injuries (if present), and presence of histologic abnormalities. Prominence of staining was decreased with increasing survival times after injury (P=.0001) and increasing postmortem interval. Staining along the edges of hepatic injuries was decreased in antemortem injuries but not in postmortem-induced injuries (P<.0001). If used in conjunction with circumstantial and autopsy information, hepatic glycogen/carbohydrate staining using the Best's carmine and PAS-alcian blue methods could greatly aid in the determination of injury survival times and the vital nature of questionable injuries in child deaths and other cases.     

Recognition of Skeletal Fractures in Infants: An Autopsy Technique

Abstract:  Complete recognition and documentation of injury pattern is crucial in the diagnosis of child abuse. Skeletal fractures regarded as highly specific to nonaccidental injury in infants include posterior rib, scapular, metaphyseal, and spinous process fractures. These injuries are often occult, especially when acute, to standard radiologic and autopsy procedures. The presented autopsy technique requires incising and reflecting skeletal muscles to expose the bones and costal osseous joints in situ , increasing the opportunity to recognize skeletal injury. Fractured or atypical appearing bones are removed and processed for complete evaluation. The bones are processed by macerating the soft tissue in a water soap bath at an elevated temperature. To aid in reconstruction of the decedent, long bones are replaced with wooden dowels and the chest cavity is packed with the organ bag. The technique is invasive and recommended for cases in which the pathologist has reasonable suspicion of acute or remote trauma.     

Forensic Epidemiologic and Biomechanical Analysis of a Pelvic Cavity Blowout Injury Associated with Ejection from a Personal Watercraft (Jet‐Ski)

Jet‐propelled personal watercraft (PWC) or jet‐skis have become increasingly popular. The means of propulsion of PWC, which is a jet of water forced out of small nozzle at the rear of the craft, combined with a high risk of falling off of the seat and into close proximity with the water jet stream, raise the potential for a unique type of injury mechanism. The most serious injuries associated with PWC falls are those that occur when the perineum passes in close proximity to the jet nozzle and the high‐pressure water stream enters the vaginal or rectal orifice. We describe the forensic investigation into a case of an anovaginal “blowout” injury in a passenger who was ejected from the rear seat position of a PWC and subsequently suffered life‐threatening injuries to the pelvic organs. The investigation included a biomechanical analysis of the injury mechanism, a summary of prior published reports of internal pelvic injuries resulting from PWC falls as well as other water sports and activities, and a comparison of the severity of the injuries resulting from differing mechanisms using the New Injury Severity Score (NISS). The mean (±standard deviation [SD]) NISS values for reported PWC injuries [not including the NISS of 38 in this case study] were 11.2 (±9.5), while the mean value for reported water‐skiing falls was half that of the PWC group at 5.6 (±5.2). It was concluded that the analyzed injuries were unique to a PWC ejection versus other previously described non‐PWC‐associated water sport injuries. It is recommended that PWC manufacturers help consumers understand the potential risks to passengers with highly visible warnings and reduce injury risk with revised seat design, and/or passenger seat “deadman” switches.     

Enhancing the Visibility of Injuries with Narrow‐Banded Beams of Light within the Visible Light Spectrum

The use of narrow‐banded visible light sources in improving the visibility of injuries has been hardly investigated, and studies examining the extent of this improvement are lacking. In this study, narrow‐banded beams of light within the visible light spectrum were used to explore their ability in improving the visibility of external injuries. The beams of light were induced by four crime‐lites^® providing narrow‐banded beams of light between 400 and 550 nm. The visibility of the injuries was assessed through specific long‐pass filters supplied with the set of crime‐lites^®. Forty‐three percent of the examined injuries improved in visibility by using the narrow‐banded visible light. In addition, injuries were visualized that were not visible or just barely visible to the naked eye. The improvements in visibility were particularly marked with the use of crime‐lites^® “violet” and “blue” covering the spectrum between 400–430 and 430–470 nm. The simple noninvasive method showed a great potential contribution in injury examination.