Sudden death due to delayed rupture of hepatic subcapsular hematoma following blunt abdominal trauma

Blunt abdominal trauma can cause sudden, unexpected death due to injuries to internal organs. Rupture of a hepatic subcapsular hematoma is a relatively rare cause of sudden death following minor blunt abdominal trauma. Death may be delayed several days to weeks. The autopsy is an invaluable diagnostic tool that can be utilized to uncover sudden deaths due to abdominal trauma. The case of an alcoholic who died of a ruptured hepatic subcapsular hematoma is presented. The death investigation revealed that the victim had sustained blunt abdominal trauma during a fall a few days prior to death.     

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.     

Computer analysis of erythrocyte catalase activity in diagnosis of mild brain trauma and concussion

A complex investigation of catalase activity in erythrocytes was conducted basing on the results of computer quantitative morphometry of histochemical examination of blood samples from persons with mild craniocerebral trauma. It was found that erythrocytic catalase activity correlates with severity of brain trauma. A novel technique of objective histochemical diagnosis of trauma is described. It provides objective grounds for expert conclusions. Differential features of erythrocytic shape were defined in a small series of micropreparations vs the rest blood samples.     

Patterns of trauma in conflict victims from Timor Leste

Understanding population-level trauma patterns has implications for the recognition of war crimes and crimes against humanity. Trauma data were abstracted from autopsy and anthropology reports for 105 victims from the 1999 conflict in Timor Leste. A significant number of individuals displayed no evidence of injury. No trauma was found in 25% of the sample, while a further 5% had only minor, nonlethal wounds. Where trauma was evident, sharp force injuries were most common (35%), followed by gunshot (20%) and blunt force (13.33%). Timorese frequencies of trauma differ significantly from percentages found in prior reports of mass killings from Cambodia, Bosnia, Croatia, and Afghanistan but closely resemble reported trauma patterns in Rwanda. Decomposition and percentage of body recovered were shown to have a significant impact on the presence/absence of trauma. Complete, fleshed remains were 10.4 times more likely than skeletal remains to have evidence of major or lethal trauma.     

Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids

The relative toxicity of ephedra-containing dietary supplements is disputed. In order to ascertain the magnitude of the problem, we reviewed all autopsies in our Medical Examiner's jurisdiction, from 1994 to 2001, where ephedrine or any its isomers (E+) were detected. Toxicology testing results were tabulated and anatomic findings in E+ cases were compared to those in a control group of drug-free trauma victims. Of 127 E+ cases identified, 33 were due to trauma. Decedents were mostly male (80.3%) and mostly Caucasian (59%). Blood ephedrine concentrations were <0.49 mg/l in 50% of the cases, range 0.07-11.73 mg/l in trauma victims, and 0.02-12.35 mg/l in non-trauma cases. Norephedrine (NE) was present in the blood of 22.8% (mean of 1.81 mg/l, S.D.=3.14 mg/l) and in the urine of 36.2% (mean of 15.6 mg/l, S.D.=21.50mg/l). Pseudoephedrine (PE) was present in the blood of 6.3% (8/127). More than 88% (113/127) of the decedents also tested positive for other drugs, the most common being cocaine (or its metabolites) and morphine. The most frequent pathologic diagnoses were hepatic steatosis (27/127) and nephrosclerosis (22/127). Left ventricular hypertrophy was common, and coronary artery disease (CAD) detected in nearly one third of the cases. The most common findings in E+ deaths are those generally associated with chronic stimulant abuse, and abuse of other drugs was common in those with CAD. There were no cases of heat stroke or rhabdomyolysis. In most cases, norephedrine was not detected, suggesting it plays no role in ephedrine toxicity.     

Neurovisualization methods in diagnostics of consequences in light craniocerebral trauma

The purpose of the case study was to elucidate the frequency rate of pathological changes as registered by computer tomography (CT) and magnetic-resonance tomography (MRT) of the head in patients with chronic cerebral blood-circulation deficiency (CBD), functional disorders and vegetative nervous pathologies in presence (in their medical histories) of closed-type cranial trauma concomitant with concussion of the brain (CB) or without such trauma. A comparative analysis revealed a minor prevalence in the number of pathological changes in patients with CBD concomitant with CB. As for other nosological forms, the quantities of changes, expressed in percent, were virtually identical. A conclusion was made on the need to examine the patients of the discussed category by neurovisualization in the acute and remote periods of trauma.     

Aminopeptidase and cathepsin A activity in vitreous humor in relation to causes of death

Brain autolysis happens rapidly, especially when environmental temperatures are high, and poses serious limitations for evaluating damage using morphologic methods. In the present study we have measured total proteins, cathepsin A and aminopeptidase activity in the vitreous humor in relation to cause of death and survival time. We have studied vitreous humor samples from 106 cadavers autopsied in the I.A.F. of Granada. The samples were classified according to causes of death as follows: myocardial infarction; hanging; other mechanical asphyxias; multiple trauma; craniocerebral trauma; other violent death; pulmonary functions; and other natural deaths. Total protein was measured by Lowry's method, and cathepsin A and aminopeptidase activity by the Bowen and Davison (1973) and Greenberg (1962) methods, respectively. Results are expressed in IU/l and in mIU/mg of protein. We found higher values of aminopeptidase and cathepsin A activity in groups with severe brain damage (craniocerebral trauma, multiple trauma, etc.) and lower values in groups of natural deaths. We believe, therefore, that aminopeptidase activity in vitreous humor may be a useful parameter for evaluating brain damage.     

Biochemical indices in establishment of the time and cause of intracranial hemorrhages

The contents of glucose, glycogen, creatinine and urea were examined in 240 samples of cadaveric blood; the same examinations were made for 240 samples of the myocardium, as well as of muscles of the skeleton and liver in craniocerebral trauma and acutely impaired cerebral circulation. A statistically reliable dependence of the contents of glucose and glycogen on a trauma extent was defined.     

X-ray changes in the region of long-bone fractures in early post-traumatic period

Described are the results of computer-based X-ray interpretation of images of long-bone fractures made immediately after trauma. The difference between roentgenograms made on the day of trauma and on the next day is demonstrated. A new soft, which was used by the author for X-ray interpretations, is depicted.     

Laceration of the stomach by blunt trauma in a child: a case of child abuse

A case of perforation of the stomach following blunt abdominal trauma is described in a two-year-old boy. The abdominal trauma was the result of a blow to the abdomen by the stepfather. The child had ingested a large meal in the hour preceding the injury. The child died from peritonitis and shock 12 h following the injury. The literature on gastric perforation by blunt trauma is reviewed. Injuries to the stomach from nonpenetrating trauma are quite rare and are most often related to vehicular accidents. Gastric injury in a child presenting with a history of a minor home or play injury should arouse suspicion of more significant and perhaps intentional trauma.     

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.     

Children Who Have Been Traumatized: One Court's Response

A court that is trauma‐informed can assist with the process of identifying children in need of trauma‐focused services and can provide education and direction to families frustrated by prior treatment failures. The unique role of the juvenile court judge as a community convener offers an opportunity to increase community awareness about the impact of trauma, and to promote the adoption of evidence‐based treatment for trauma victims. This article outlines the way that increased trauma awareness and trauma screening within a family court system mobilized the development of effective resources for children and families affected by trauma.     

Post-mortem finding of a non-fatal left heart ventricle perforation by a pleural drain. A case report

A 76-year-old male with a previous history of heart arrhythmia and decompensation was treated for a complicated thoraco-abdominal trauma. Accidentally, a pleural drain was inserted in his heart through the ventricular septum, perforating the left ventricle, the drain tip being buried in its posterior wall. This injury was not recognized until autopsy. The patient died 7 days after insertion of the drain of lung emboli, which were related to his primary trauma and not to the heart perforation.     

Vicarious trauma: a comparison of clinicians who treat survivors of sexual abuse and sexual offenders

This study compared vicarious trauma in a random sample of male and female clinicians who treat survivors (n=95) and those who treat offenders (n=252). A national survey was conducted with members of the Association for the Treatment of Sexual Abusers (ATSA) and the American Professional Society on the Abuse of Children (APSAC). These data were used to test the relative contribution of variables theorized to contribute to two vicarious trauma effects (avoidance and intrusions) using the Impact of Event Scale. The sample reported high levels of avoidance and intrusions. Variables associated with vicarious trauma differed based on client population served. Sequential regression analyses were used to examine theoretically derived variables. Implications for practice and further research are discussed.     

A case of aortic dissection caused by blunt chest trauma

A 74-year-old woman was struck by a car travelling at about 50 km/h. On arrival at hospital, a CT scan showed dissection of the ascending and descending aorta. She collapsed and died suddenly 8h later. At autopsy, there was massive bleeding into the left pleural cavity, ruptures of the pericardium and right ventricle, and a type A thoracic aortic dissection. The cause of death was haemorrhagic shock due to rupture of the pericardium and delayed rupture of the right ventricle following trauma to the chest. The thoracic aortic dissection was not the direct cause of death although histological examination did reveal that it occurred in the accident. Traumatic aortic dissection is rare although traumatic aortic rupture is a major cause of death after blunt chest trauma. This paper discusses the mechanisms, and factors involved in aortic dissection caused by blunt trauma.     

An Analysis of Advertisements: A Lens for Viewing the Social Exclusion of Women in Police Imagery

This study examines whether there are differential relationships among trauma exposure, familial risk and protective factors, substance abuse, and posttraumatic stress disorder (PTSD) among incarcerated and non-incarcerated women. A case-control method was used to match 100 incarcerated women with 100 women in the general population. Incarcerated women had a significantly higher risk of trauma exposure as compared with controls, with odds ranging from 1.7 to 3.7. When group was controlled, exposure to sexual or physical trauma significantly increased the odds of PTSD (odds ratio = 5.0; p < .05), as did substance use in response to traumatic distress (odds ratio = 8.9; p < .001). Family-related characteristics did not appear to moderate this relationship. The findings suggest that incarcerated women are at high risk for PTSD given their high rates of trauma exposure and apparent lack of appropriate coping mechanisms; the results support the use of trauma-specific interventions for this population.     

Mast cell tryptase and hemolysis after trauma

BACKGROUND: We have previously found increased mast cell tryptase in accidental deaths due to trauma, indicating that mast cell degranulation had occurred. The present study was designed to confirm the previous observation and to determine if tryptase release after trauma is acute or delayed. Furthermore, the importance of hemolysis and direct trauma to the mast cells was investigated. MATERIALS AND METHODS: Mast cell tryptase was measured in post-mortem blood from the femoral vein in 27 cases of death from trauma and in 27 control cases by means of a commercially available immunoassay. The trauma cases were further classified into groups with single versus multiple trauma, and groups with short survival time (i.e. death at the scene of the accident) versus longer survival time (death in hospital). In five multi-trauma deaths, blood was sampled locally from the sites of crush injury. RESULTS: The mean value of tryptase in femoral vein blood was 35.6+/-34.6 microg/l in the entire trauma group and 14.7+/-6.5 microg/l in the controls (P<0.005). In bloody liquid sampled from crush injuries, tryptase was substantially elevated in all cases, with a mean of 227+/-146 microg/l. In cases with short survival time, tryptase was significantly higher than in those who died after several hours or days in hospital (P<0.001). No statistically significant difference was seen between multi- and single-trauma cases. A correlation between hemolysis in the samples and elevated tryptase was found only in the trauma cases (P<0.05), but experimentally induced hemolysis in vitro was not found to influence the measurements. CONCLUSION: Mast cell tryptase becomes elevated in trauma deaths and this seems to be ascribable either to direct mechanical injury to tissue mast cells and/or to cell lysis. In patients initially surviving severe injuries, the effects of massive release of histamine and other mast cell mediators might be of importance for treatment strategies and prognosis.     

Scanning electron microscopic analysis of skin resolution as an aid in identifying trauma in forensic investigations

The forensic investigator is frequently confronted with cases that present with wounds and blunt force trauma. Presently, the forensic investigator depends upon previous experience and further investigative deduction of the crime scene to analyze these injuries. Although not readily apparent to the naked eye, many skin tissue injuries can be visualized with scanning electron microscopy (SEM). This study was designed to establish skin trauma resolution using SEM in various skin preparations. Tissue trauma was induced on leather, preserved skin, fresh skin, and living skin using dies of varying thread size. Calibrated pressure forces in pounds per square inch (psi) were applied and impressions made using vinyl polysiloxane. Positive replicas of the tissues were prepared for SEM using isocyanate resin. After sputter coating the cast with 35 nm of gold-palladium, electron micrographs were generated using a Jeol JSM-5310LV scanning electron microscope. To establish resolution, thread widths of 52, 104, and 208 threads per inch (tpi) and trauma forces of 150, 200, and 250 psi were used to produce the impressions. Microgrooves that were identified on the die threads were analyzed. The optimum pressure for resolution studies was 150 psi using the 52 tpi die on the leather sample (4.67 +/- 0.88 microm, p = 0.046 and 0.025, respectively, by ANOVA). The resolution was compared to that of leather using preserved, fresh, and living skin. The resolution in preserved and fresh skin was less than for leather (9.00 +/- 1.73 and 10.5 +/- 4.5 versus 4.67 +/- 0.88 microm, p = 0.09 and p = 0.20, respectively). Living skin resolution was 3 microm at 52 tpi and 100 psi. Various implements of blunt force trauma were also examined using the leather sample. Time after trauma resolution was examined at 0 (3 microm), 5 (6 microm), 10 (8 microm), and 20 (9 microm) min in living tissue. A comparison between the microgrooves on the die replicas and the tissue trauma impressions revealed striking agreement for both linearity and resolution. Analysis of the microgrooves suggests that discrete morphological characteristics are seen in skin tissue traumas. This method could expand the tools available for the forensic investigation of blunt force trauma.     

Patterns of Trauma Induced by Motorboat and Ferry Propellers as Illustrated by Three Known Cases from Rhode Island*

Abstract: Understanding patterns of trauma is important to determining cause and manner of death. A thorough evaluation of taphonomy, trauma, and bone fracture mechanisms is necessary to reconstruct the circumstances of the death. This study examines the skeletal trauma caused by boat propeller strikes in terms of wound characteristics and location based on three cases from Rhode Island. These case studies review the traumatic characteristics caused by propeller injuries and highlight the anatomic regions most likely to sustain skeletal trauma. With this information, investigators may be able to identify propeller trauma even in severely decomposed remains. The discussion of boat propeller trauma also raises issues regarding how forensic anthropologists and forensic pathologists classify trauma (specifically blunt force vs. sharp) and highlights semantic issues arising in trauma classification. The study also discusses why these propeller cases should be classified as blunt trauma rather than sharp or chop/hack trauma. Ultimately, the authors urge consistency and communication between pathologist and forensic anthropologists performing trauma analyses.