Intracranial stab injuries: case report and case study

Non-missile penetrating brain injuries are rare events in western countries. We report a case with lethal stab injury of the brain and identification of the weapon used in the assault by digital superimposition on CT scans taken at admission of the victim to a hospital. Furthermore, all cases with knife stab wounds of the skull between 1971 and 2000 were analyzed and compared with literature reports. Results of this study show that there is no region preference despite of differences in bone thickness, that stab wounds of the brain are almost invariably associated with multiple stab wounds to the trunk and that the wound tract may correspond to the dimensions of the blade allowing the identification of the weapon by digital image analysis.     

Path of bullet and injuries determined by radiography

Radiography is commonly used to find bullet pathways in forensic pathology. In the case presented here, a man had sustained multiple gunshot wounds and one bullet could not be traced. A radiograph was used to find the bullet and showed an interesting bullet pathway. By observing the bullet pathway on a radiograph, sometimes we can surmise the victim's body posture at the time of an incident.     

Criminal and suicidal death with bolt gunshot weapons. An experimental and case contribution

Authors report on two cases of homicide and another case of suicide, all committed with captive-bolt livestock-stunners. The investigation of skull caps revealed roundish holes at the entry sites which were beveled-out in a paraboloid-like manner on the inner aspect. These defects were reproducible in test shots with various strengths of ammunition and different materials as targets.     

Atypical "body packing syndrome"--a case report

A case of ingested cocaine is reported in which death must be classified as body packer syndrome although both the temporal relationship and the number of packets were atypical. The deceased, a consumer of hard drugs who smuggled for his own use, was found in his flat. He was resuscitated and survived for another four days in hospital. Only four intact drug packages were found in the upper gastro-intestinal tract. The concentrations of cocaine in blood and organs were relatively low but in a potentially lethal range. The case is presented, and its particularities as well as the option of induced vomiting as a way of preventing the fatal outcome are discussed.     

Popliteal artery bullet embolism in a case of homicide: a case report and review of the tangible literature

Bullet embolism is a well known but a relatively rare phenomenon in common medicolegal autopsy practice. We present a homicide case of a bullet embolism to the left popliteal artery with interesting trajectory of projectile through the chest wall and right heart ventricle into the aortic lumen. Since in our presented case obvious homicidal manner of death was in question, discovery of bullet was an obligatory part of investigation in order to positively identify the responsible firearm. Detection of the missile transported through the circulation requires very thorough autopsy examination, especially if X-ray equipment is not available. As in all other cases in which initial bullet trajectory is changed in the body, the very important part of the medicolegal autopsy in cases accompanied with missile embolism, is to determine direction of the first part of the bullet's trajectory, because this indicates the position of the axis of the weapon barrel in the moment of firing (if there was no external ricochet), taking into consideration the posture of the victim and the location of the shooting person in the same moment. A review of the tangible literature is given.     

Traffic accident vs homicide: The contribution of DNA analysis to clarify this mystery. A case report

A marriage procession was going through the road when the vehicle met with a fatal accident and the wife of the driver died. The autopsy revealed lesions according with fatal traffic accident. But, a second autopsy revealed that there were injuries, but it was not reported in the first autopsy protocol. We analyze several autosomal STRs to typify some evidences collected inside the vehicle of traffic accident which were stained by the blood of the woman mortal victim. The results of the analysis of DNA suggested that the victim bled inside the vehicle and died and then, she was placed on the pavement and her husband simulated an accident.     

The poisoned pen. A case report

In a case of suicide by overdose of a sedative and hypnotic and a tranquilizer the author analyses the deterioration in writing ability in the time frame recorded by the victim.     

Multiple homicides as a result of chloroform poisoning: case report and experimental study.

Two cases (involving five murder victims) of multiple homicide by inhalational chloroform intoxication are reported. In the discussion of the findings the valence of toxicological analyses is underlined with regard to the possibility of forcible external suffocation due to occlusion of the respiratory orifices by means of a chloroform-soaked soft covering. In addition storage experiments were performed at +4, +20 and -20 degrees C with cadaver blood mixed with chloroform. The optimal solution for avoiding volatile losses was stored in glass tubes with ground glass stoppers. In cases of unclear death in which involvement of volatile substances is suspected it is, therefore, advisable to preserve an additional blood sample at -20 degrees C in glass tubes that are only opened for the analysis of volatile substances.     

Diagnosis of electrical skin injuries. A review and a description of a case.

This paper presents a brief review of the results of research in the area of electrical skin injuries. It also includes a case report of a 5-year-old girl noted on her admission to the hospital to have injuries to the skin of her chest and left arm. Histological examinations demonstrated that the skin lesions were segmental and showed necrosis and inflammation. Deposits of calcium salts distinctly located to collagen fibers were observed below the regenerated epidermis at the periphery of two skin lesions of the chest wall, in the lower part of dermis at the periphery of a skin lesion of the left arm, and within connective tissue adjacent to elastic arteries and peripheral nerves from the thoracic cavity. The pattern of calcification localized to collagen fibers and situated both superficially and deeply in the skin in a zone of viable tissue close to necrotic tissue is characteristic of electrically induced lesions. Although there have been reports of deposition of calcium salts on collagen fibers after application of calcium salts in high concentration at the skin surface, the collagen calcification in the pattern observed in this patient is probably diagnostic of electrical injury.     

A death due to ethchlorvynol abuse. A case report

A fatal case of ethchlorvynol abuse is reported with blood and tissue determinations.     

Bullet embolism with radiologic documentation. A case report

A case of bullet embolism is reported wherein a handgun missile, fired during a "shoot-out," perforated (among other structures) the anterior and posterior walls of the thoracic aorta, rebounded into the aortic lumen, and was transported to the left femoral artery where it came to rest. Roentgenographic study was instrumental in promptly locating the errant bullet whose recovery established the identity of the responsible firearm. The implications of bullet embolism of the arterial, venous, and paradoxical types for the forensic pathologist and the clinician are discussed briefly.     

Chronic extradural haemorrhage. A case report and brief literature review

A case of chronic extradural haemorrhage with a presumed time interval of 5-6 weeks between injury and diagnosis at postmortem examination is presented. The literature relating to this entity has been reviewed, and relevant features commented upon, including time intervals, age, sex, location, clinical features, pathological findings, associated skull fractures, mechanisms involved, and the source of the bleeding.     

Left atrial myxoma. A case report of unusual complication

Atrial myxoma may present in unusual fashion and must be considered in the differential diagnosis of several conditions. A 17-year-old, white male presented with central nervous system symptoms, and the diagnosis was established postmortem. A brief discussion of tumor characteristics and diagnostic methods is made.     

Cognitive biases in the peer review of bullet and cartridge case comparison casework: A field study

ObjectiveForensic judgments and their peer review are often the result of human assessment and are thus subjective and prone to bias. This study examined whether bias affects forensic peer review.HypothesesWe hypothesized that the probability of disagreement between two forensic examiners about the proposed conclusion would be higher with “blind” peer review (reviewer saw only the first examiner’s comparison photos) than with “non-blind” peer review (reviewer also saw the first examiner’s interpretation and proposed conclusion). We also hypothesized that examiners with a higher perceived professional status would have a larger effect on the reported conclusion than examiners with a lower status.MethodWe acquired data during a non-blind and a blind peer review procedure in a naturalistic, covert study with eight examiners (3–26 years of experience). We acquired 97 conclusions of bullet and cartridge case comparisons in the blind and 471 in the non-blind peer review procedure.ResultsThe odds of disagreement between examiners about the evidential strength of a comparison were approximately five times larger (95%-CI [3.06, 8.50]) in the blind than in the non-blind procedure, with disagreement about 42.3% and 12.5% of the proposed conclusions, respectively. Also, the odds that their proposed conclusion was reported as the final conclusion were approximately 2.5 higher for the higher-status examiners than for lower-status examiners.ConclusionsOur results support both the hypothesis that bias occurs during non-blind forensic peer review and the hypothesis that higher-status examiners determine the outcome of a discussion more than lower-status examiners. We conclude that blind peer review may reduce the probability of bias and that status effects have an impact on the peer reviewing process.     

Suicide by xylene ingestion. A case report and review of literature

A 27-year-old male committed suicide by ingestion of a large quantity of xylene. The presence of xylene in the tissues of the victim was confirmed by chromatographic and spectrometric techniques. High levels of xylene were detected in blood (11 mg/dl), gastric contents (880 mg/dl), and duodenal contents (3,300 mg/dl). Histological examination of the lungs showed severe congestion and acute pulmonary edema. Review of the relevant literature is presented.     

Testing for alpha-chloralose by headspace-GC/MS. A case report.

A case is presented involving an acute fatality resulting from self-administered alpha-chloralose, a rodenticide. A 18-year-old man was found dead at home, with several stains of vomit on the carpet. An empty box of three bags of 5 g 100% alpha-chloralose (Corbeaux nuisibles, Rh?ne Poulenc) was found near the body. The compound was identified and quantified by headspace gas chromatography coupled to mass spectrometry. Alpha-chloralose was converted by concentrated sulphuric acid into chloral, a volatile compound, that was, after chromatography on a HP5-MS capillary column, identified by the following ions, m/z 82, 111 and 148. Peripheral blood concentration was 175.7 mg/l. Alpha-chloralose was quantified in several tissues, indicating kidney sequestration. No other drugs, including ethanol, were detected.     

A case of external beveling with an entrance gunshot wound to the skull made by a small caliber rifle bullet.

The external beveling caused by an entrance gunshot wound to the skull has not been completely explained, but the mechanism is probably a combination of several factors including the angle of shot, twisting force of a rotating bullet, blow-back effect, velocity, shape and size of the bullet, outspread of the kinetic energy from the bullet, and resistance of the skull.     

Factitious disorder comorbid with bipolar I disorder. A case report

We describe a case of factitious disorder with physical and psychological symptoms comorbid with bipolar I disorder in a 37-year-old woman. Since the onset of bipolar disorder, which occurred at the age of 31, she increasingly complained of physical symptoms, compulsively seeking medical and surgical interventions. She has been hospitalised several times and her Munchausen-type factitious disorder recently appeared to be developing into Munchausen by proxy, involving her 11-year-old daughter. The patient adhered poorly to stabilising and antipsychotic drug treatment and did not improve through the years. We here analyse her mood phases, which were always associated with changes in the quality of factitious symptoms, according to whether the disorder was in its depressive phase (somatic complaints and suicidal ideation prevail), or in its manic or mixed phase (medical intervention-seeking and manipulation of clinicians to obtain surgical interventions). We also briefly discuss some important forensic issues to consider in similar cases, mainly stemming from the psychotic aspects of these two co-occurring disorders. Clinicians should be aware of some patients' ability to produce signs and symptoms of physical and/or psychological illness and consult psychiatrists before giving consent to invasive diagnostic procedures or surgery.