Pink teeth in a series of bodies recovered from a single shipwreck

Pink teeth have most often been observed in victims of drowning but have also been reported in subjects who died suddenly and unnaturally. There is general agreement that there is no obvious connection between the occurrence of pink teeth and the cause of death, but the condition of the surroundings (especially humidity) must certainly play an important role in the development of the pink-tooth phenomenon. The frequency and distribution of postmortem pink coloration of the teeth have been studied among a representative sample of 52 cadavers. All the bodies were victims of a single shipwreck that occurred on March 13, 1997, in the middle of the Otranto Canal (Mediterranean Sea). The bodies were recovered from the seawater after approximately 7 months. A distinct pink coloration of the teeth was found in only 18 cadavers (13 females and 5 males) of ages ranging between 13 and 60 years. The phenomenon was more pronounced in younger individuals due to age-related changes of the root canal, less penetrable by the pigment responsible for the postmortem pink staining. By histochemical methods and autofluorescence, hemoglobin and its derivatives have been identified as the most likely pigments responsible for this postmortem process that can be considered analogous to postmortem lividity. These data are consistent with previous reports on pink teeth, indicating that the diffusion of the blood in the pulp into the dentinal tubules causes the red discoloration of the teeth. Based on the results, the pigmentation is more prominent on the teeth with single roots rather than in the posterior teeth with multiple roots.     

Spontaneous Clostridium infection--often a post-mortem diagnosis

Infections with Clostridium species occur very seldom but then often as a lethal disease. They are mainly associated with trauma, surgery and malignancies, but can also occur with dermal and intestinal infections, burns and septic abortion. The development of gas gangrene is insidious and progression is very rapid. So it may stay unrealized until death and is often diagnosed only at autopsy.     

Superimposition of ante- and post-mortem photographs of tattoos as a means of identification--a case report

With the rising number of tattooed people tattoos have become increasingly important for the identification of unknown corpses. Tattoos can be helpful in both phases of the identification process, either by providing clues to the identity of an unknown person or body or as a means of verifying a postulated identity. In the presented case, an ante-mortem photograph of a tattoo was available although it was of poor quality. The respective skin region of the body was photographed from the same angle as the tattoo on the ante-mortem photograph. When superimposing the two photos, the tattoos were found to match and the identity of the body could be verified.     

A study of ethyl glucuronide in post-mortem blood as a marker of ante-mortem ingestion of alcohol

The possibility of post-mortem production of ethanol makes correct interpretation of ethanol detection in forensic autopsy samples difficult. Even though the levels of ethanol formed post-mortem are generally low, this may be highly relevant in cases where intake of alcohol was forbidden, for instance for pilots, professional drivers and countries with low legal alcohol limits for driving. Different criteria are used to determine whether a finding of ethanol is of exogenous origin, but there is no marker for alcohol ingestion that has been studied in detail. In this study, we wanted to evaluate the sensitivity and specificity of ethyl glucuronide (EtG), a direct minor metabolite of ethanol, measured in blood, as a marker of ante-mortem alcohol ingestion. Forensic autopsy cases were divided into groups with and without ante-mortem alcohol ingestion, according to strict inclusion criteria. In 93 cases with information on ante-mortem alcohol ingestion, EtG was detected in blood in all cases, even when levels of ethanol were low. In another 53 cases where there were no indications of ante-mortem alcohol intake, EtG could not be detected in blood in a single case, also in 11 cases in which ethanol was detected and considered to be most probably formed post-mortem. In conclusion, blood EtG determination seems to be a reliable marker of ante-mortem ingestion of alcohol, and it could be considered in forensic autopsy cases when post-mortem formation of ethanol is questioned.     

An apparently jawless cadaver: a case of post-mortem slippage

Passer-by witnesses reported a human cadaver in woodland associated with an agricultural college to police in Northern Ireland. The cadaver comprised reasonably preserved feet, legs and pelvis, with poorly preserved arms and torso, lying with the torso down-slope abutting a fallen tree. A search of the area around the torso, and for some 20m around, failed to find the cranium and mandible. The mandible was found, embedded inside the chest cavity. The cranium was found some 30m away. The victim was later identified as a 24-year old drug addict who had absconded from a local hospital. Mapping of the area led us to speculate that he had tripped and fallen down-slope: other reasons for the body location were also considered. After death, the cadaver had further slipped down-slope forcing the mandible into the chest cavity: slippage of human remains is well-known in forensic and archaeological literature but not well documented. Knowledge of this process of cadaver 'slip' may save wasted police resources in future similar environments where the mandible, and possible other nearby bones appear missing yet are inside the body.     

Glycated hemoglobin: a useful post-mortem reference marker in determining diabetes

Glycated hemoglobin (HbA(1c)) has been demonstrated to be a useful marker for long-term glucose control in diabetes. This parameter characterizes each non-enzymatic fixation of glucose on hemoglobin. It is a useful test in addition to periodic glycemia controls since it reflects the mean glycemia of the past 60 days. We studied the conservation of HbA(1c) at 4 degrees C as a function of time with different anti-coagulants and preservatives (3, 6 months, 1 year). A total of 106 tests were performed using the high performance liquid chromatography (HPLC) method dedicated to the semi-automatic analysis of HbA(1c) (Bio-Rad) and we applied the method in forensic cases. Conservation at 4 degrees C was good for as long as 3 months in blood samples collected with fluoride and 6 months in samples collected in a dry or in a heparinized tube. In non-diabetic subjects, HbA(1c) reference values obtained from forensic samples were identical to those of living controls (3.5-6.25% of total hemoglobin). All positive HbA(1c) results were confirmed by a medical evaluation. This method was successfully applied to five forensic cases. In cases of increased acetonemia, acetone or isopropanol are easily measured. However, in some unexplained post-mortem circumstances, increased HbA(1c) permits to differentiate alcoholic or starvation ketoacidosis from the diabetic cases. Glycated hemoglobin should, therefore, be considered the forensic marker of choice in the post-mortem diagnosis of a diabetic disorder and demonstrates its usefulness in post-mortem validation.     

Olanzapine-induced hyperglycemic ketoacidosis and corresponding acetone concentrations post-mortem: a forensic interpretation

Olanzapine has been shown to cause or have a contributory role in the development of hyperglycemia and diabetes mellitus. Without careful monitoring for the development of these conditions and control of the resulting adverse effects, patients receiving olanzapine may be at risk of developing fatal ketoacidosis. A review of post-mortem toxicological reports has revealed an increase in the incidence of post-mortem findings of acetone in decedents who were taking olanzapine over the past decade. A review of the current literature and a comprehensive review of case histories and toxicological findings were conducted at the Centre of Forensic Sciences (Toronto, Ontario). Olanzapine concentrations ranging from <62.5 to 858 ng/mL and acetone concentrations as high as 95 mg/dL were detected concurrently. Due to the unstable nature of olanzapine, in several instances quantitation was not possible despite elevated responses during qualitative screening procedures. Five cases suggesting olanzapine-induced ketoacidosis were identified based on the case history and toxicological findings. These data have been compiled and examined with respect to acetone concentrations following olanzapine use and the forensic relevance of post-mortem olanzapine and acetone concentrations are discussed.     

Comparison of ethyl glucuronide in hair with phosphatidylethanol in whole blood as post-mortem markers of alcohol abuse

Ethyl glucuronide (EtG) is a direct metabolite of ethanol and has been used as a marker of alcohol abuse in both urine and hair. This study investigated the value of EtG testing in post-mortem hair for diagnostic improvement of alcohol abuse in forensic medicine. Material from 70 consecutive medico-legal autopsies was collected in accordance with the recommendations on ethics by the Swedish National Board of Forensic Medicine. A method for determination of EtG in hair samples was developed using ultra performance liquid chromatography/electrospray tandem mass spectrometry (UPLC/ESI-MS/MS; LOQ, 2.5 pg/mg). The result of the EtG analysis was compared with the findings of phosphatidylethanol (PEth) in femoral whole blood, as measured by high performance liquid chromatography with an evaporative light-scattering detector (HPLC-ELSD; LOQ, 0.22 micromol/l). Evaluation of liver histology and anamnestic evidence of alcohol abuse of the deceased were taken in consideration for the interpretation. Measurable levels of EtG were present in 49 of the 70 autopsy cases whereas PEth was present in 36. Thirty-nine cases had EtG levels above the cutoff limit (> or = 30 pg/mg) compared with 29 for PEth (> or = 0.7 micromol/l). Fifteen cases had EtG as exclusive indicator for alcohol abuse compared with four cases for PEth. These findings suggest that measurements of EtG in hair may provide improved diagnostic information on alcohol abuse, due to a long retrospective time-window for detection and stability of EtG in hair in the decaying cadaver. However, an EtG level below the cutoff does not completely exclude previous alcohol abuse.     

Lingual markings of anterior teeth as seen in human bite marks

A review of the available literature does not reveal a plausible explanation as to why the incisal edges of maxillary anterior teeth do not always mark clearly. Generally, the mandibular incisal edges do mark with some consistency. This paper demonstrates through test bites on skin that the answer lies in the position of the mandible.     

Alterations in human bones and teeth as a result of restricted sun exposure and contact with corrosive agents

Skeletal remains were discovered in an unused cistern near the Omaha, Nebraska airport and were positively identified through comparison of antemortem and postmortem dental radiographs. Although nearly nine years had elapsed between death and discovery, the bones and teeth revealed evidence of the application of a corrosive substance at or about the time of death, as well as an unusual restricted response to sun exposure, that contributed to the prosecution and murder conviction of a member of Hell's Angels in the Omaha area.     

C-reactive protein (CRP), a comparison of pre- and post-mortem blood levels.

During autopsy of 26 inpatients with elevated CRP levels (14-536 mg/l) blood was taken from the femoral vessels and analysed for the content of CRP. The post-mortem CRP values were compared with the results of CRP analysis performed within the last 24h before death. This showed that the post-mortem values of CRP in average were reduced with 35% compared to the ante-mortem values. The decrease in CRP levels was not significantly influenced by the time interval from death until blood was drawn for analysis, at least up to 6 days. When blood taken from healthy individuals killed in accidents was analysed, no elevated CRP values were observed, indicating that there is negligible risk for false positive results. It is also shown that frozen blood can be used for CRP analysis if an immunometric kit assay based on whole blood is applied. The results demonstrate that an elevated level of CRP in post-mortem blood is a good marker for an ongoing inflammatory process prior to death. CRP analysis may therefore be a helpful tool in post-mortem examinations, especially in non-hospitalised individuals without medical records.     

Evaluation of post-mortem estimated dental age versus real age: a retrospective 21-year survey

The aim of the study was to evaluate the reliability of methods used for forensic dental age estimation. We analysed all cases over the last 21 years (1984-2004) of unidentified bodies that were examined for identification purposes (including age assessment), and of which secure identification was subsequently achieved. In total, the study included 51 cases and 7 different methods had been used for dental age estimation, with the Bang/Ramm and the Gustafson/Johanson methods being the most frequently applied. The age estimates had usually been recorded as 10-year intervals. Factual ages at death were in the range of 6-76 years, with the largest concentration of cases being in the age interval of 25-55 years (34 cases). There was good agreement between estimated age interval and factual age at death in 37/51 (72%) of the cases. In eight cases the factual age at death deviated up to +/-5 years from the estimated age, and in six cases by more than 6 years. The average difference between factual age at death and estimated age was 4.5 years. The four subadults in the material were all correctly estimated within an age range of +/-3 years. Our study showed that forensic odontological age estimates are reliable. However, the implementation of the specific methods may need to be adjusted concerning age ranges. In the future we recommend to register anamnestic information and the different steps in the methods used. Clinical evaluation should contain more details about attrition, colour, number and presumed age of the restorations and periodontal status.     

Dating human skeletal remains: investigating the viability of measuring the equilibrium between 210Po and 210Pb as a means of estimating the post-mortem interval

Estimating the post-mortem interval in skeletal remains is a notoriously difficult task; forensic pathologists often rely heavily upon experience in recognising morphological appearances. Previous techniques have involved measuring physical or chemical changes within the hydroxyapatite matrix, radiocarbon dating and 90Sr dating, though no individual test has been advocated. Within this paper it is proposed that measuring the equilibrium between two naturally occurring radio-isotopes, 210Po and 210Pb, and comparison with post-mortem examination samples would produce a new method of dating human skeletal remains. Possible limitations exist, notably the effect of diagenesis, time limitations and relative cost, though this technique could provide a relatively accurate means of determining the post-mortem interval. It is therefore proposed that a large study be undertaken to provide a calibration scale against which bones uncovered can be dated.     

Width as an alternative measurement to length for post-mortem interval estimations using Calliphora augur (Diptera: Calliphoridae) larvae

The length of fly larvae collected from corpses is often used to help provide an entomological estimate of time since death. However, 'head-curling' by larvae can affect the accuracy of length measurements. To investigate a possible resolution to this problem, larvae of Calliphora augur were grown on sheep's liver at two constant temperatures (20 and 25 degrees C). Replicate samples were collected at set time intervals until pupation. Body length and width were measured for individual larvae and examined as predictors of age. It was found that body width, as measured at the junction of the fifth and sixth abdominal segments, is comparable with body length for age prediction of maggots of C. augur grown at these temperatures. Furthermore, conversion of width to length can be done with 95% accuracy from a simple linear model.     

Putrefaction and wound dehiscence: a potentially confusing postmortem phenomenon

The decomposed body of a 49-year-old man was found at his home address. At autopsy, 3 incised wounds of the lower abdomen and groins were identified, raising the possibility of some form of inflicted injury. Further dissection revealed that the wounds were healing surgical incisions that had been forced open by putrefactive tissue breakdown, swelling, and gas formation. Death was due to ischemic heart disease. Putrefaction is a common problem encountered in forensic practice that may result in considerable distortion and modification of tissues. Unusual skin lesions caused by the disruption and dehiscence of healing surgical wounds may be created by decomposition. This possibility should be considered when symmetrical, cleanly incised wounds are identified.     

High cyanide level in a homicide victim burned after death: evidence of post-mortem diffusion.

Elevated levels of carbon monoxide and cyanide serve as evidence of intravital burning in fire victims. Hydrogen cyanide is released by combustion of nitrogen-containing organic material such as plastics and wool. We present a case of a man who died of haemopneumothorax caused by a stab wound. According to several eye witnesses the body was wrapped in a plastic sheet and burned 2 days after death with the aid of gasoline. No coal pigment was observed in the mucosa of the upper airways at autopsy. The blood sample taken from the pulmonary vessels 6 days after death disclosed a level of blood carboxyhaemoglobin of 4% and of blood cyanide of 10 mg/l. The low carboxy-haemoglobin level was consistent with the smoking habits of the victim. The thoracic cavity had been opened by burning of the intercostal soft tissue. This allowed hydrogen cyanide gas to enter the thoracic cavity and diffuse into the blood probably causing the high blood-cyanide level.     

An estimation of the post-mortem interval in human skeletal remains: a radionuclide and trace element approach

Estimation of the post-mortem interval remains a contentious issue, with forensic pathologists often relying upon the recognition of morphological changes.A radionuclide approach has often been suggested in the literature, although limitations have prevented its application, most notably those of diagenesis. Within this pilot study, we show for the first time that there is a correlation between certain radionuclide content and time since death.A larger study is proposed to confirm these findings and possibly provide a calibration against which bones uncovered can be dated.