Fatal Penetrating Injuries Sustained by High-pressure Water Jet Unit

The high-pressure water jet unit is a generator of frequent burst of water jets. The water jet reaches very high speeds and is able to cause wounds similar to those of high-velocity projectiles. In the presented case, unusual fatal injuries sustained by water jet are presented. Operating with the unit, an untrained worker accidentally activated a high-pressure water jet unit, and the extremely high pressure of water liberated the jet unit from his hand and whirled it around him. A jet stream of water ran across his body and caused fatal penetrating injuries in the femoral region. The edges of the wound were mainly sharp with contusion rings on the skin beyond the edges. Exploring the inside of the canals during the autopsy, the left femoral artery and vein were found to be completely transected. The resemblance to a firearm entry wound and the severity of the internal injury make it a noteworthy entity.     

A Fatal Case of CO2 Intoxication in a Fermentation Tank

Carbon dioxide (CO₂) is an odorless constituent of air. Higher concentrations can be detected in geothermal and automotive emissions, fermentation, and sublimation of dry ice. An unskilled worker entered a fermentation tank to clean it, which had not been done for about 5 months allowing for high concentrations of CO₂ to build up. A second worker entered the tank to rescue the first one. Shortly after both were found the first worker was rescued directly whereas the tank had to be rotated to pull the second worker out. Cardiopulmonary resuscitation was successful only for the first worker. Medico‐legal autopsy showed bruises, hematoma, myocardial hemorrhage, and edema of the lungs. The right lung was vacuum degassed in an argon atmosphere and quadrupole‐mass‐spectrometry showed an elevated CO₂ content in lung gases. Thus, CO₂ intoxication/asphyxia in a vitiated atmosphere due to fermentation of wine mash was established as the cause of death.     

An autopsy case of Klinefelter's syndrome suspected and its DNA analysis

We experienced an autopsy case, small testes and tall stature, which suggested Klinefelter's syndrome. DNA analysis was performed to confirm the genetic abnormality. Case History: A 28-year-old man who was single and lived with his parents. He suddenly lost his consciousness in a sitting room and died. Autopsy findings: He was 176 cm in height and 57 kg in weight. The post-mortem hypostasis was red-purple on his back, and rigor mortis was strong in each joint of the whole body. The heart weighted 340 g, in which dark red fluidal blood (300 ml) without coagulation was contained. The testes were smaller than normal adult male (left and right testes with epididymides weighted 8.1 g and 6.0 g, respectively). As a results of pathological examination, clumped Leydig cells, sclerotic and hyalined tubules were observed. Some germ cells with spermatozoid were also present. DNA Analysis: Generally, Klinefelter's syndrome is determined by karyotype analysis and/or the detection of sex chromatin. However, in this case, karyotype analysis and the detection of sex chromatin could not be demonstrated, because the blood which was collected in the autopsy became too old. Therefore, we tried sex determination and STR analysis (HPRT, HUMARA and DXS 1470) using DNA extracted from stored blood materials. Consequently, in the sex determination, no different situation was found in the X- and Y-specific bands from normal male's and as results of STR analyses, we could not corroborate the Klinefelter's syndrome.     

Homicidal asphyxia by pepper aspiration

As punishment for lying, the foster mother of a five-year-old white male poured pepper into his throat. He immediately became dyspneic, then apneic, and was pronounced dead about 1 h later. At autopsy, the main stem and several smaller bronchi were occluded with pepper. Mechanisms of asphyxia by pepper include mechanical obstruction of the tracheobronchial tree and mucosal edema caused by the irritant effect of volatile oils in pepper. This rare circumstance represents the second reported fatal case of pepper aspiration and the third reported case overall.     

"I am flying to the stars"--suicide by aircraft in Germany

In 2006, 67 persons were killed in aircraft accidents in Germany and involving German aircrafts abroad. In spite of extensive investigation of each aircraft accident, there are no reliable data as to the number of suicides by aircraft. We report on a 50-year-old man who committed suicide by willfully crashing his Beech "Sierra" aircraft minutes after take off from an airport close to the town of Rendsburg, Germany. Before killing himself, the intoxicated pilot had sent an SMS announcing his suicide plans to a friend. The findings of the medico-legal investigation and the results of a review of aircraft accident reports by the German Federal Bureau of Aircraft Accidents Investigation (BFU) regarding suicidal plane crashes are presented.     

The Role of Forensic Botany in Solving a Case: Scientific Evidence on the Falsification of a Crime Scene

Forensic botany can provide useful information for pathologists, particularly on crime scene investigation. We report the case of a man who arrived at the hospital and died shortly afterward. The body showed widespread electrical lesions. The statements of his brother and wife about the incident aroused a large amount of suspicion in the investigators. A crime scene investigation was carried out, along with a botanical morphological survey on small vegetations found on the corpse. An autopsy was also performed. Botanical analysis showed some samples of Xanthium spinosum, thus leading to the discovery of the falsification of the crime scene although the location of the true crime scene remained a mystery. The botanical analysis, along with circumstantial data and autopsy findings, led to the discovery of the real crime scene and became crucial as part of the legal evidence regarding the falsity of the statements made to investigators.     

Acute poisoning involving the pyrrolidinophenone-type designer drug 4'-methyl-alpha-pyrrolidinohexanophenone (MPHP)

A 36-year-old woman consulted the medical emergency unit of a private health center for abdominal pain and gastroenteritis of 5 days duration. Acute right pyelonephritis was diagnosed. Five hours after admission she became unconscious in a state of clinical shock. She was transferred to an intensive care unit but resuscitation attempts were unsuccessful and she died 3 h later. Three days after death, she was buried in the family vault. Five days after the burial, her husband lodged a complaint with the public prosecutor because he had not received a clear explanation from the physicians concerning the cause of his wife's death. After analysis of the medical records of the deceased by two forensic pathologists, a medicolegal autopsy was ordered by the public prosecutor. The corpse was exhumed and autopsy performed 9 days after death. Massive hemoperitoneum was diagnosed with a macroscopically ruptured subcapsular hematoma. Pathological study confirmed acute right pyelonephritis and demonstrated the precise cause of the hemorrhage: rupture of the hepatic artery at the hilar part, following infectious arteritis which was probably secondary to the acute pyelonephritis. To the best of our knowledge, this is the first published report of such a case.     

A suicide decision as a motive for murder--an airplane as the murder weapon

It is supposed that some fatal aviation accidents of "cause unknown" especially of light and private airplanes are possibly intended by a suicidal act. However it is difficult to prove this suggestion. A case of a light aircraft accident is reported in which the medicolegal autopsy and the police investigation revealed, unexpected, a simultaneous homicide and suicide caused by a stabbing attack on the pilot. This paper stresses the importance of autopsies of the victims in aircraft accident investigation and discuss the medicolegal and psychopathological aspects of the case.     

A rare suicidal case of a ten-year-old child stabbing himself in the throat

A rare case is reported of a ten-year-old boy who committed suicide by stabbing himself in the throat with a pointed knife. Possibility of an accidental injury was excluded by the autopsy findings; suspicion of a homicide by his father was cleared through the deposition of his sister. The reason of suicide was attributed directly to his father's severe scolding and indirectly to his mother's death two years before.     

Intracoronary Thrombus Formation Following Carbon Monoxide Poisoning

Thromboembolic events in the context of carbon monoxide (CO) exposure have been well described in the literature. Six cases of clinically significant coronary thrombosis following CO exposure were previously reported. However, factors affecting the development of coronary thrombus in CO exposure are poorly understood, and the significance of this finding in a forensic context is not clear. This article discusses a case of coronary thrombosis found at autopsy following a death in which CO poisoning was suspected. A 67‐year‐old man was found dead in his garage with four vehicles with their ignition in the “on” position and their tanks empty. At autopsy, severe coronary atherosclerosis and an acute nonocclusive coronary thrombus were found. Given the dissimilarities among cases and the presence of CO exposure, it was suggested that the coronary artery thrombosis is likely due to the inherent prothrombotic mechanism of CO, the only common denominator in all the cases.     

Homicide of a supervisor simulating an occupational accident]

An unusual case of homicide is reported. A driver of an excavator killed his foreman by using the scoops of his machine and tried to feign an industrial accident. The man was convicted by the autopsy findings because his testimony could not explain the severe injuries.     

Panhypopituitarism in a young drug abuser

An intoxicated young man returned home from a drinking party and collapsed and died in his mother's presence. Three weeks earlier, he had been released from prison, having served a sentence for possession and sale of "street drugs". At the time of his release, he and his friends had gathered together for a celebration at which drugs were used. At the autopsy table, there was initial evidence of an intrasellar hemorrhage of recent onset with ablation of the adenohypophysis. At first the prosectors considered the case to be one of drug-induced pituitary "apoplexy". However, there was subsequent autopsy evidence of chronic panhypopituitarism. The intrasellar lesion proved to be a Rathke-cleft cyst of dysontogenetic origin, probably unrelated to drug abuse. This case is presented as an example of the increasing complexities encountered by the forensic pathologist in a world of increasing numbers of available toxic substances.     

Fatal aviation accidents in Lower Saxony from 1979 to 1996

So far no national or regional studies have been published in Germany regarding the number of fatal aviation accidents and results of autopsy findings. Therefore, we evaluated all fatal aviation accidents occurring in Lower Saxony from 1979 to 1996. A total of 96 aviation accidents occurred in this period involving 73 aeroplanes. The crashes resulted in the death of 154 people ranging in age from 19 to 68 years. The greatest number of victims in a single crash of an aircraft was (n=7). Other types of fatal accidents were crashes of aircraft and helicopter while on the ground (n=5), hot-air balloons (n=2), parachutes (n=10), hang glider accidents (n=5) and the striking of a bystander by a model airplane. Autopsies were performed on 68 of the 154 victims (44.2%), including 39 of the 73 pilots (53.4%). Some of the autopsies yielded findings relevant to the cause of the accident: gunshot wounds, the presence of alcohol or drugs in blood and preexisting diseases. Our findings emphasize the need for autopsy on all aviation accident victims, especially pilots, as this is the only reliable method to uncover all factors contributing to an accident.     

Human being eaten by his own dogs: Genetic confirmation through analysis of bones recovered in a dog's stomach content

A part of a decomposed human body from an individual was found at his home, together with the decomposed bodies of his 3 dogs. The disappearance of half of the human body was hardly explained. Hypothetically the dogs, starving, could have eaten their owner after his death. All the bodies were recovered for autopsy.Small bone fragments were recovered in one dog's stomach and identified as human by anthropological analysis. DNA was extracted and cytochrome b gene analysis was made in order to determine their origin, confirmed as human.Genetic identification allowed achieving an eight mini-STR profile with MiniFiler (Applied Biosystems) identical to the bone material collected at the victim's autopsy, confirmed that the dogs had effectively eaten their owner.The results showed that it is possible to obtain nuclear DNA in samples subjected to gastric acids and the combination of different techniques allowed us to determine, in each step, the most convenient workflow for the remains identification.     

Accidental non-commercial aircraft fatalities: the 7-year Metro-Dade County experience from 1977-1983

A study of accidental non-commercial aircraft fatalities was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, FL, U.S.A., between the years 1977 through 1983. A total of 57 cases were collected and analyzed as to the age of the victim, the race and sex of the victim, the cause of death, the blood alcohol content at autopsy, the drugs detected at autopsy, the type of aircraft, the occupant role, the risk factor responsible for the crash, the time of the fatality, and the nature of usage of the aircraft. Essentially, these 57 cases comprised 1.2% of the non-vehicular accidental fatalities during the period. The age of distribution is relatively evenly distributed from age 16 to 65 years with white males predominating. Multiple injuries were the most common cause of death although conflagration injuries (e.g., smoke inhalation, burns) were frequent. The victims were sober and free of drugs in the majority of cases. Most fatalities occurred in a single engine plane with the victim, the pilot, flying for private reasons in the afternoon or evening hours. The most common identifiable risk factor was human error (e.g., judgement), rather than mechanical or plane failure.     

Avulsion of the distal tibial shaft in aircraft crashes: a pathological feature of extreme decelerative injury

A pilot and his passenger were killed on impact with the ground when their light aircraft crashed. Both deaths were caused by extensive injuries involving severe craniocerebral, skeletal, soft tissue, and organ trauma. In both victims, the legs were shortened, with stripping of muscle and soft tissues from the shafts of the lower limb long bones. In addition, fragments of distal tibial shaft had been forced through the soles of the victims' shoes. This sign indicated a fall from height and showed that the direction of the decelerative forces had been along the axis of the legs and that the force of impact was severe enough to cause fracturing of the lower limb bones, with subsequent extrusion of bone fragments downwards through the shoes. When present, this observation represents another feature at autopsy that can add to the understanding of the circumstances of a fatal air crash and the position of the victims immediately prior to impact.     

John Paul Jones: An Overlooked Autopsy Finding that May Explain His Terminal Illness

A finding in the autopsy of John Paul Jones, the American Revolutionary War naval hero, may explain his terminal illness. During his last 2 years, he had a persistent productive cough and dyspnea. Ten days before death, he developed rapidly progressive dependent edema and ascites. He died in France in 1792. His body, preserved in alcohol in a lead coffin, was, in 1905, removed to the United States. Glomerulonephritis was noted on an autopsy, performed in France, but there was no comment then or since about ventricular wall thickness being the same in both ventricles at 5–6 mm. Hypertrophy and dilatation with biventricular failure followed by tissue shrinkage during 113 years in alcohol could have resulted in these ventricular wall findings. Systemic hypertension and left ventricular failure are consistent with his respiratory symptoms complicated perhaps by pulmonary emboli, right ventricular failure with tricuspid regurgitation, peripheral congestion, and jaundice.     

Fall from height--surprising autopsy diagnosis in primarily unclear initial situations

External post-mortem examination and first police assessments are often not consistent with subsequent autopsy results. This is all the more surprising the more serious the injuries found at autopsy are. Such discrepancies result especially from an absence of gross external injuries, as demonstrated by four examples. A 42-year-old, externally uninjured male was found at night time in a helpless condition in the street and died in spite of resuscitation. Autopsy showed severe polytrauma with traumatic brain injury and lesions of the thoracic and abdominal organs. A jump from the third floor was identified as the cause. At dawn, a twenty-year-old male was found dead on the grounds of the adjacent house. Because of the blood-covered head the police assumed a traumatic head injury by strike impact. The external examination revealed only abrasions on the forehead and to a minor extent on the back. At autopsy a midfacial fracture, a trauma of the thorax and abdomen and fractures of the spine and pelvis were detected. Afterwards investigations showed that the man, intoxicated by alcohol, had fallen from the flat roof of a multistoried house. A 77-year-old man was found unconscious on his terrace at day time; a cerebral seizure was assumed. He was transferred to emergency care where he died. The corpse was externally inconspicuous. Autopsy revealed serious traumatic injuries of the brain, thorax, abdomen and pelvis, which could be explained by a fall from the balcony. A 47-year-old homeless person without any external injuries was found dead in a barn. An alcohol intoxication was assumed. At autopsy severe injuries of the brain and cervical spine were found which were the result of a fall from a height of 5 m. Conclusion: On the basis of an external post-mortem examination alone gross blunt force trauma cannot be reliably excluded.     

Fatal chest injury from a shotgun slug: homicide, accident or suicide?

A 78-year-old hunter was found dead beside his raised hide with a gunshot wound to his chest. In the present case, the reconstruction of the shooting event revealed an accident. Disregarding all safety rules, the hunter had placed his superposed rifle-shotgun on the chair and pulled the barrels of the cocked gun towards his body. One of the triggers interlocked with the button of a camping chair's cushion and a shot was fired. Furthermore the morphology of wounds from shotgun slugs is discussed on the basis of the autopsy findngs.     

Sudden death owing to right atrial hemangioma

Primary cardiac tumors are rare, with an autopsy incidence of 0.03%. Seventy-nine percent to 85% of primary cardiac tumors are benign, and of the benign tumors, cardiac hemangiomas account for 5-10% of cases. Most cardiac hemangiomas are asymptomatic and are discovered incidentally at autopsy, or by echocardiography, computerized tomography, or magnetic resonance imaging. We report a case of sudden death owing to cardiac hemangioma in a 22-year-old woman who collapsed while shopping and became unresponsive. The autopsy revealed a hemorrhagic mass on the surface of the right atrium which was infiltrating and replacing the wall of the right atrium; histopathological examination confirmed the tumor was a cavernous hemangioma. Fewer than 20 cases of right atrial cavernous hemangiomas have been reported in English literature, emphasizing the rarity of our case.