Analysis of blunt trauma injuries: vertical deceleration versus horizontal deceleration injuries

There are several similarities found in blunt trauma injuries to humans sustained as a result of vertical deceleration (falling) and those sustained as a result of deceleration in a horizontal plane (automobile accidents). However, examination of the patterns of traumatic skeletal injuries can distinguish those injuries associated with falling from heights from those associated with automobile accidents. While there is considerable variation within each type of blunt trauma injury dependent on the angle at which one falls or is struck, there are several characteristic skeletal features associated with each type of trauma. In this study we review both the current literature and human skeletal remains from the University of New Mexico's Documented Collection known to have been subjected to blunt trauma. This collection is used to characterize and differentiate the pattern of skeletal injuries to various parts of the body for each type of trauma. These assessments are applied to investigate the traumatic skeletal lesions observed in a forensic case where the manner of death is unknown. Analyses suggest two possible scenarios that would explain the death of the individual investigated, with death most likely related to a vehicular-pedestrian accident.     

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.     

Some medicolegally important aspects of symphyseal injuries due to trauma

A total of 58 cases of fatal trauma (forensic autopsies) were investigated for lesions of the pelvic girdle, the pubic symphysis, and for injuries distant from the pelvis. Traumata of the pubic symphysis were present in 30% (n = 17) of the cases. The symphyses were examined by x-ray and macroscopically related to the main violence (Abbreviated Injury Scale [AIS]). A correlation between the latter and the severity of the resulting injuries could be deducted. Characteristic patterns of symphyseal injuries included small hemorrhages, partial and complete ruptures, and also ruptures of the ligamentary insertions, which have not yet been described. The kind and severity of these lesions related to the intensity/direction of the violence are demonstrated and discussed.     

Resuscitation injuries complicating the interpretation of premortem trauma and natural disease in children

Minor soft tissues injuries are common in both adults and children who have had cardiopulmonary resuscitation (CPR). Potentially life-threatening injuries are rare. The pre-arrest history in a resuscitated adult often assists the pathologist to interpret autopsy findings. In contrast, an infant or child may not have a reliable history. In this situation, it may be difficult if not impossible to distinguish resuscitation injuries from pre-existing accidental or inflicted trauma. I describe two children who had significant autopsy-documented injuries initially attributed to abuse. The State filed murder charges against the caretaker in each case. However, further history and review of the medical records suggested that resuscitation rather than pre-arrest trauma caused almost all of the injuries. The State dismissed the charges in the first case. A jury returned a "not guilty" verdict in the second. It is essential to consider the entire history and not just autopsy findings when performing a death investigation.     

Fatal trauma to the neck: immunohistochemical study of local injuries

As fatal trauma to the neck is often associated with short survival times, proof of vitality may often be difficult using standard histochemical techniques. Soft tissue neck injuries resulting from strangulation by ligature or manual strangulation were examined immunohistochemically using antibodies to myoglobin, fibronectin, C5b-9 and MRP14, and compared to controls consisting of accidental soft tissue neck injuries as well as undamaged neck soft tissue. Although survival times in the study and control groups were unknown and certainly some individual variation may be expected in the time course of normal wound development, both the study and control groups demonstrated similar time courses in the immunohistochemical detection of antigen. Myoglobin was always found in those samples in which only one antigen was shown to be involved in an injury-specific pattern; myoglobin and fibronectin were found in samples with dual antigen involvement. Samples involving three antigens always included C5b-9 in addition to myoglobin and fibronectin. The single positive MRP14 sample in the study and control groups was simultaneously positive for the other markers used. Myoglobin, fibronectin, C5b-9 and MRP14 are therefore suitable for immunohistochemical detection of vital reactions and estimation of temporal relationships in the early posttraumatic period after neck trauma.     

Morphology of fractures of long tubular bones in children upon trauma due to solid blunt objects

Morphologic features of diaphyseal fractures of lond tubular bones in different age groups in childhood were studied experimentally on biodummy using direct stereomicroscopy (MBC-9). Blow effect was induced by solid blunt objects at the middle diaphyseal parts at a right angle. A series of specific morphologic features which help to diagnose the specific bone tissue lesions in different fracture zones as well as in different age periods was obtained. Experimental data were confirmed by expert observations which proves the possibility of using these specific morphologic features of diaphyseal fractures of long tubular bones in childhood for medicolegal purposes.     

The forensic medical characteristics of the injuries to the spleen in blunt trauma of the abdomen

Analysis of 220 sectional cases with blunt spleen trauma is given in this article. Trauma circumstances, morphologic features of spleen injuries depending on the kind of blunt trauma, mechanism of their formation were studied.     

The morphological characteristics of the brain injuries in acceleration trauma depending on the conditions of its occurrence

The series of 175 cases of cranio-cerebral trauma (acceleration trauma by mechanism of its formation) was studied. Morphology of percussion and anti-percussion cerebral lesions was shown to depend on conditions of trauma formation and other factors including presence or lack of cranial bone fractures, cerebral vascular pathology, nature of trauma (isolated or combined) etc.     

Ultrastructure of acute ammonia toxicity in the human lung

A tanker truck carrying anhydrous ammonia (NH3) fell off a freeway, releasing a dense cloud of NH3 gas, killing several people. The driver was dead upon impact. To our knowledge, pulmonary NH3 toxicity in humans has not been studied previously by electron microscopy (EM). Therefore, in two cases, the paraffin-embedded tissue blocks of lung were deparaffinized and reembedded in plastic for 1-mu sections and EM examination. The lung tissue of a third case, the truck driver, was similarly processed as a control. Light-microscopic pulmonary findings in the acute NH3 deaths included denudation of the tracheobronchial epithelium, edema of the lamina propria, and marked alveolar edema, congestion, and hemorrhage. In contrast, in the truck driver's lungs, the bronchial epithelium was intact, and there was no gross odor of NH3. Massive pulmonary hemorrhages in his lungs were attributed to trauma rather than NH3 inhalation. EM examination of the lungs of the truck driver showed no discernible toxic alterations in either the capillary endothelial cells or the Type I or II alveolar epithelial cells, and alveolar and capillary basement membranes were intact. In contrast, EM study of the lungs from two individuals dying acutely of NH3 inhalation showed marked swelling and imbitional edema of Type I alveolar epithelial cells; however, alveolar basement membranes and capillary endothelial cells appeared as usual. These electron-microscopic findings demonstrate the Type I epithelial cell to be the target cell of acute alveolar wall injury in NH3 inhalation.     

Posttraumatic acute cholecystitis. Relationship to the initial trauma

Posttraumatic acute cholecystitis is an often unrecognized and potentially fatal complication seen among patients hospitalized for trauma, and differs in etiology from cholecystitis which develops de novo. The cause, although not yet clearly defined, is believed to be related to bile stasis, ischemia, bacterial infection, sepsis, the activation of factor XII, and the Shwarzman reaction. A case is described in which a 53-year-old man with pelvic fractures developed acute acalculous cholecystitis and died of multiple organ failure 3 weeks following cholecystectomy. The histopathological findings are also reported; these are most likely attributed to the Shwarzman reaction or the activation of the factor XII pathways. There has been a tendency to regard posttraumatic acute acalculous cholecystitis as induced by trauma, and calculous as mere coincidence. We believe, however, that it is not calculous but histopathological findings that determine whether acute cholecystitis following trauma was more than coincidence or just mere coincidence. Although progress in clinical care has improved the chances of survival of severely traumatized patients, posttraumatic acute cholecystitis has been increasing in frequency. We cannot be careful enough in judging the relationship of this fatal complication to the initial trauma.     

The forensic medical expertise of acute local radiation trauma]

Informative diagnostical criteria of medicolegal evaluation and prognosis of corporal lesion gravity in case of acute local radiation trauma as well as algorithm of medicolegal diagnostical process concerning these lesions with reference to external radiation exposure, kind of injuring factor, differential-diagnostical signs of acute local radiation trauma are suggested. They make it possible to formulate medicolegal diagnosis and can form the basis for developing diagnostical programmes.     

机械性窒息死亡案例中的舌骨骨折研究近况

一、概况 用手扼压颈部,用带子勒颈或直接用钝器压迫颈部均可致机械性窒息性死亡.除了1993年Gonzales发表过此类论文及研究过此类与法律有关的死亡方式外,在法医病理学或人类学中很少有涉及此类的论著.尽管诸多尸体现象可以确证机械性窒息死亡的诊断,但舌骨骨折在法医学实践中却有非常重要的意义.     

机械性窒息死亡案例中的舌骨骨折研究近况

一、概况用手扼压颈部 ,用带子勒颈或直接用钝器压迫颈部均可致机械性窒息性死亡。除了 1 993年Ｇｏｎｚａｌｅｓ发表过此类论文及研究过此类与法律有关的死亡方式外 ,在法医病理学或人类学中很少有涉及此类的论著。尽管诸多尸体现象可以确证机械性窒息死亡的诊断 ,但舌骨骨折在法医学实践中却有非常重要的意义。二、舌骨骨折在机械性窒息案例中的情况舌骨呈Ｕ形 ,位于颈前喉上方 ,在颈部肌群和舌之间起重要连接作用。舌骨前端向后突出连结茎突 ,随着年龄的增长 ,茎突骨化。舌骨被分成几部分。后面的部分形成舌骨大角 ,与舌骨体相连续 ,舌骨…     

Forensic medical assessment of acute blood loss in combination with craniocerebral trauma and alcohol intoxication

Forensic medical findings have been analysed retrospectively for 242 deceased of acute blood loss: 186 (76.8%) corpses were male and 56 (23.2%) corpses were female. It was found that in acute blood loss (ABL) duration of the terminal period (TP) depended on its combination with craniocerebral trauma (CCT) or alcohol intoxication (AI). A short TP (several minutes) was observed in ABL patients with CCT (39.6%), a long-term TP--in ABL associated with AI (20-60 min, 40.4% cases; several hours, 56.3%; over 24 hours, 54.5%). Slow TP occurred primarily in mild AI (TP for several hours 55.6%, over 24 hours--83.3% cases). In severe AI the number of cases with a short TP exceeded the number of cases with a long TP (over 24 hours) by 53.7%.     

Expert criteria of the degree of severity of the chemical trauma in acute poisonings by organophosphate insecticides

The article deals with quantitative assessment of severity of chemical trauma (according to life-threatening characteristics) in case of acute peroral poisoning with OPI (carbophos and chlorophos). Standard diagrams were plotted which help to assess the life threatening values of the given compounds depending on the initial blood poison level or recorded decrease in enzyme cholinesterase activity. Basic opportunity to assess severity of body lesions in case of poisoning with OPI according to character of specific clinical signs was evidenced.