Cadaver mix-up--an avoidable problem?

Depending on local conditions it may happen from time to time that no officer involved in the previous investigation is present during the forensic autopsy. In this case, the post mortem examiner often has to rely solely on written documentation concerning the identity of the deceased. The authors report a case where the body had already been mixed up with another body by the undertaker prior to the inspection by the police. In spite of clear distinguishing characteristics in the written documentation, this led to the wrong body being autopsied. For the post mortem examiner, the only safe way to identify a body seems to be the presence of persons who had known the deceased or of police officers as acknowledging witnesses. If these conditions are not given, other means of safe information on the identity are called for, for example a "police body card" similar to an evidence card.     

Comparison of the clinical and post mortem diagnoses of the causes of death

The fast moving progress in medical technology causes someone to ask if the progress is not only in diagnostic abilities but also in diagnostic precision. Despite the improved quality of diagnostic technology, the frequency of misdiagnosis has not decreased appreciably. The goal of autopsy is not only to uncover clinicians mistakes or judge them but rather to instruct clinicians to learn by their own mistakes.We reviewed the autopsy records from the Archive of the Institute of Forensic Medicine in Ljubljana of 1792 deceased persons in 1997 and 1998 and compared the clinical and post mortem diagnoses. We eliminated from study all autopsies performed on deceased persons not admitted to the Clinical Medical Centre. From the remaining 911 autopsy reports we compared the post mortem diagnoses with the clinical diagnoses. We classified findings into five groups according to the level of agreement between the clinical and the post mortem diagnoses. Group 1 included cases of complete agreement between clinical and post mortem diagnoses. Group 2 cases of disagreement about the basic illness, group 3 cases of partial disagreement about the direct causes of death, group 4 cases of total disagreement between the clinical diagnosis and the post mortem, named, also misdiagnosis and group 5 clinical diagnosis which could not be calssified.The diagnoses were in total agreement in 49.30% of cases, in partial agreement (disagreement about direct causes of death) in 20.68% and in disagreement about the basic illness in 6.87%. The diagnoses were in total disagreement in 9.87%. 13.30% of cases were not possible to classify owing to incomplete death certificates or reports of the causes of death.     

Pharmacogenetics in medico-legal context

Medico-legal autopsy is the primary method in determining the cause and manner of death when the death is suspected to be unnatural. In some of these autopsies, the death remains ambiguous, even after a complete autopsy including histological investigation and toxicological screenings. In cases where there are no morphological abnormalities, medico-legal genetics may offer additional means to provide knowledge of possible genetic mutations, which may have initiated the process or predisposed the individual to stress risk conditions leading to death. One class of ambiguous deaths consists of drug-related deaths where the interpretation of the toxicological results are not clear. In such situations post mortem genotyping and the analysis of metabolite rations may provide an insight to the findings. A few cases demonstrating the potential strength of pharmacogenetics in medico-legal context has been published. However, there is a paramount need for serious scientific studies before the field of post mortem pharmacogenetics can be utilized in routine medico-legal analyses casework and brought routinely into courtroom.     

The speed of post mortem change to the human skeleton and its taphonomic significance

The aim of this study was to assess the potential speed of post mortem alteration to skeletal microstructure by examining human material drawn from differing environmental contexts and time periods. The material was taken from terrestrial, intertidal and lacustrine contexts and extended over a range of 3 months to 83 years post mortem. The examination was conducted using backscattered electron imaging which provided information on microstructure and relative density. The results from this study have significantly brought forward the time of known onset for post mortem alteration for 3 morphological types of microstructural change, the earliest of which was 3 months post mortem. The contribution of the depositing environment was also shown to influence significantly the microstructural/ morphological type of post mortem alteration. It is hypothesized that microstructural changes to bone could occur within days of death as a result of endogenous bacterial migration to the skeleton. Further studies are required to establish definitively the earliest moment that such change can occur prior to skeletonisation.     

Palatal rugae as an individualising marker: reliability for forensic odontology and personal identification

Personal identification is based on the comparison between ante mortem and post mortem data which can be considered unique for each individual: palatal rugae represent a useful element for such a comparison, thanks to their apparent low variability with time and unique patterns. Literature however is scarce.This pilot study aims at assessing the reliability of palatal rugae in time and at developing an identification method based on their comparison. Two casts from the upper dental arch of 39 subjects were obtained in different periods of time; at their first cast, 85.2% of patients were less than 16 years old. The second cast was performed after a period of time which varied between 4 and 65 months later than the first cast. The first cast can be taken to simulate ante mortem information, the second post mortem information. Every cast was then digitised with a scanner. In the digital images the palatal rugae were highlighted by using Adobe® Photoshop® 7.0 software; each image was coded and a comparison between “simulated” ante mortem and post mortem data was performed. In all cases ante mortem and post mortem data from the same individual were correctly matched.The study seems to indicate that this technique is highly reliable and user friendly, even on subadults, where growth processes seem not to affect the specific morphology of palatal rugae.     

Collection of post mortem data: DVI protocols and quality assurance

In many countries forensic odontologists are members of the Disaster Victim Identification (DVI) team. As part of their post mortem (PM) tasks work on the incident site may include securing and preserving the dental material and evidence before transport to the mortuary. In the autopsy room the main aim is to register the PM dental status. Photographs and radiographs are essential documentations in addition to a conventional registration of the dental status. Abbreviations in the registration may be used if agreed with the ante mortem (AM) team. Dental age estimation may be an aid in the sorting process and especially in victims without previous dental treatment. Interpol has a form set as part of their DVI manual. Forensic odontologists working in pairs and checking each other will act as quality assurance (QA) as suggested by International Organization for Forensic Odonto-Stomatology (IOFOS). Direct entry into the computer program as part of the registration in the autopsy room may save time and manpower.     

Investigations to determine the time of death, late post mortem, by means of electrophoresis of inner organs (author's transl)

In CAF-electrophoresis, extracts of cardiac muscle and of kidney tissue, after storage at 4 degrees C, show a roughly linear increase of the equivalent to the Albumin fraction. This increase depends on the time elapsed and is explained by the relatively high stability of this fraction compared to organ proteins, which appear in the globulin region. Thus, a sort of internal standard exists and can be used as a parameter for the determination of the post mortem period. Hepatic tissue is less suitable for this kind of investigations as the relation of the post mortem period and the values of the relative concentration of the fraction do not show the linearity found in cardiac muscle and kidney tissue. Splenic tissue shows no distinct trend and the findings are of little value. The present investigations were arranged in such a way that taking the order of magnitude for the equivalent of the Albumin fraction as a guideline led to a determination of the maximum post mortem period, i.e., the maximum period of time the body lay after the hour of death. The tables of this paper show the figures for the individual organs.     

Fatal Waterhouse-Friderichsen syndrome due to Ewingella americana infection

A fatal case of Waterhouse-Friderichsen syndrome resulting from infection in a previously healthy 74-year-old woman is reported. The patient died suddenly within 14 hours after presentation. The diagnosis of Waterhouse-Friderichsen syndrome as the cause of death was established post mortem based on autopsy findings, microscopic examination, measurement of serum procalcitonin concentration (113 ng/ml), and outcome of postmortem bacteriologic cultures that grew in heart and spleen blood samples. Since the introduction of as a new group in the family in 1983, more recent case studies have established its clinical significance and pathogenic potential to cause severe, life-threatening bacteremia and sepsis. is a rare pathogen that should be added to the list of unusual bacteria causing Waterhouse-Friderichsen syndrome.     

Simulation of homicide to hide child's suicide

A case of pretending a homicide to conceal a child suicide is reported in which characteristic findings of the postmortem examination and conclusions from the analysis of forensic autopsy series provided substantial support for the police investigation. In the late night hours of a spring day the police authorities were informed that a 10-year-old girl had been found dead on a playground near its parents' house. As injuries of the neck were recognized by the police officers a homicide investigation was initiated. The post mortem examination showed a furrow symmetrically slanting from the front to the nape of the neck, discrete punctate haemorrhages of the skin of the face and numerous 'tram-line' bruises of the back, buttocks and extremities. These findings indicated as cause and manner of death suicidal hanging following corporal punishment. Confronted with these conclusions the mother immediately made a corresponding confession.     

Haptoglobin typing of human bloodstains using a specific DNA probe

The stability of DNA in human bloodstains and various post mortem tissues has been investigated. High molecular weight (HMW) DNA was usually recovered from dried bloodstains, even those up to a few years old, but very rapid degradation was found to occur post mortem in the liver, pancreas, spleen and kidney. Other tissues such as the heart, thyroid and skeletal muscle were found to give a reasonable yield of HMW DNA during the first few days after death. The feasibility of using DNA extracted from forensic bloodstain specimens for the detection of DNA polymorphisms was explored using a human haptoglobin (Hp) alpha chain specific probe. Using HindIII and XbaI digests the Hp genotypes Hp2, Hp1F and Hp1S were distinguished by Southern blot analysis in DNA prepared from 1 cm2 bloodstains up to 15-18 months old.     

Aspiration of gastric contents in hanging with typical position of the strangulation cord and free suspension]

Among 193 cases of hanging from the years 1978 to 1991 examined in the institute of Forensic Medicine of the Freie Universit?t Berlin 8 cases with an aspiration of stomach contents had been reported. Herefrom 3 cases were hanging in a "typical" position (suspension point at the back of the head, free suspension of the hanging body) and did not undergo resuscitation. By free suspension of the hanging body the observed massive aspiration of gastric contents only can be explained by an at least partly open connecting passage between the laryngeal entry and the entrance of the oesophagus. The post mortem flowing in of stomach contents as well as a post mortem gastro-oesophageal peristalsis seem not to be able for explicating the findings. Differences in important parameters (e.g. gastric contents, alcoholization) to the cases of hanging without aspiration were not found. Even by free suspension of the body, running noose and point of suspension in the back of the neck sometimes the connection between larynx and oesophagus may stay open, especially when by emesis a high pressure is produced by the stomach.     

Determination of phenol and o-cresol by GC/MS in a fatal poisoning case

A fatality due to the ingestion of solution containing phenol and o-cresol is described. The pathological findings were typical of acute substantial poisoning. Blood, urine and stomach content were obtained during post mortem examinations. Phenol and o-cresol were identified using GC/MS. The extractions from autopsy materials were obtained as follows: by gel permeation with cyclohexane/dichloromethane from stomach content, by solid phase extraction (SPE) from urine and by deproteinization with acetonitrile from blood. The phenol and o-cresol concentrations in the samples were found, respectively, as follows: 115.0 and 5.0 microg/g in the stomach contents, 58.3 and 1.9 microg/ml in the blood, 3.3 and 20.5 microg/ml in the urine. Distributions of phenol in fatal poisonings have been reported, but, usually, colorimetry was used as the analytical method and it cannot exclude the interference of other phenolic compounds.     

Post-mortem changes in skeletal muscle protease and creatine phosphokinase activity — A possible marker for determination of time of death

The pattern of change in activity of two enzymes in rat skeletal muscle during body storage after death has been determined. Myofibrillar protease activity was found to increase linearly with time of storage post mortem at room temperature but not at 4 °C. In contrast, creatine phosphokinase activity declines linearly with time, and again storage at 4 °C prevented the change in enzyme activity. Starvation of animals for 5 days or forced exercise prior to death did not markedly alter the rate of change in activity of the two enzymes, although creatine phosphokinase specific activity at time of death was higher in the starved and exercised rats as compared to control animals. A plot of the logarithm of protease/creatine phosphokinase specific activities ratio versus time post mortem yields a linear curve at room temperature. These observations offer a potential method for estimating time of death.     

The tissue survival problem in using current methods of morphological study]

Time course of ultrastructural changes and RNA production in human brain and myocardial cells during the period between clinical and biological death is studied. Changes in the cytoplasm of brain neurons develop 4 hours after death, and 8 h post mortem the destructive changes in the cytoplasm and nuclei progress. During the period of 4-13 h post mortem the endotheliocyte nuclei are capable of producing RNA. Active production of RNA is on-going in the myocyte nuclei 4 h after death; the synthetic activity decreases by 8 h and by 13 h the synthetic activity in autopsy material is over.     

Dermal lesions after post mortem petrol-exposure

The effect of post mortem contact of the skin with petrol was investigated in 18 corpses with exposure times between 10 min and 24 h. The earliest onset of skin changes was observed within 2 h of exposure. They consisted of swelling and wrinkling with detachment of the upper layers of the skin (positive Nikolski's sign). Histologically the lesions appeared as non-vital acantholyses located in the prickle-cell layer with formation of intra-epidermal bullae. An influence of age and sex could be excluded, the earlier onset of lesions at 22 degrees C than at 4 degrees C was not statistically significant. These findings prove that post mortem petrol exposure may lead to dermal lesions.     

New horizons in forensic radiology: the 60-second digital autopsy-full-body examination of a gunshot victim by multislice computed tomography

The goal of this study was the full-body documentation of a gunshot wound victim with multislice helical computed tomography for subsequent comparison with the findings of the standard forensic autopsy. Complete volume data of the head, neck, and trunk were acquired by use of two acquisitions of less than 1 minute of total scanning time. Subsequent two-dimensional multiplanar reformations and three-dimensional shaded surface display reconstructions helped document the gunshot-created skull fractures and brain injuries, including the wound track, and the intracerebral bone fragments. Computed tomography also demonstrated intracardiac air embolism and pulmonary aspiration of blood resulting from bullet wound-related trauma. The "digital autopsy," even when postprocessing time was added, was more rapid than the classic forensic autopsy and, based on the nondestructive approach, offered certain advantages in comparison with the forensic autopsy.     

Identification of unknown human remains by comparison of antemortem and postmortem radiographs

The identification of unknown human remains by comparison of ante mortem and post mortem radiographs has found wide acceptance in recent years. This report documents two recent cases in Hong Kong in which unequivocal positive identifications were achieved by comparison of radiographs. In both cases, comparison of radiographs was the only available means of establishment of personal identity. The first case involved the identification of a very badly burned body of a 22-year-old male by the matching of the ante mortem and post mortem radiographic images of the cranial base (in particular the sella turcica), hard palate, paranasal air sinuses, mastoid air cells, the lambdoid suture, and the upper molar teeth as revealed on comparable lateral skull films. The second was the identification of a deliberately mutilated torso of a 28-year-old female by comparison of the radiographic images of the lumbar spine, pelvis, and head of the femur as revealed on plain abdominal films taken before and after death. While evidence of injury or surgery did not figure in either of the identifications, the presence of a mild scoliosis and the absence of the twelfth ribs aided identification in the latter case. Emphasis is placed in this account on the value of radiographic comparison as a means of identification because it draws upon the matching of intricate and highly individual patterns of external and internal bony anatomy that are stable over long periods of time. In cases where ante mortem radiographs and photographs are available, establishment of personal identity by comparison of radiographs is deemed preferable to identification by photographic superimposition because radiographic comparison permits the matching of a potentially larger number of unique anatomical features and is less time consuming and technically exacting.     

死后组织DNA变化与死亡时间关系的研究

为调查死后组织DNA含量变化与死亡时间的关系,本文采用流式细胞仪对死后0～96小时(0～96hourpostmortem,hpm)大鼠的骨骼肌、脾、肾细胞DNA含量进行分析,结果表明,各组织显示了随死后间隔时间延长,含碎片DNA细胞增多,含完整DNA细胞减少的趋势;DNA降解系列组方图分析结果表明,脾组织降解速度明显快于肾和骨骼肌组织;骨骼肌在制成单细胞悬液过程中的人为损伤,可造成DNA提前降解.     

Homicide by asphyxia--yes or no? On the use of muscle histology

In two cases of death autopsy revealed large hemorrhages in the muscles of the neck, which lead to the conclusion of a murder by strangulation, e.g. with a soft tool. Histologic examination of the injured muscles didn't show any sign of vital reaction, which means, that they had developed post mortem. There was no reason for further suspicion of a violent crime. Later it became obvious, that neck lesions resulted from inadequate recovery and transport of the corpses. "Vital" type of muscular alteration is characterized by segmental or disk-like fragmentation of muscle fibres, loss of sarcoplasmatic cross-striation and appearance of pathologic longitudinal fibrillar structures. These signs are missing in case of a postmortal injury, whereas the cross striation is intact. The slides should be stained with PTAH. With these two cases we would like to demonstrate the importance of histologic examination of injured muscles, when question for intravital or postmortal injury rises.     

Deaths among narcotic addicts in Denmark in 1978 and 1979

Objective measurements were carried out to study the evolution of rigor mortis on rats at various temperatures.Our experiments showed that:(1) at 6 °C rigor mortis reaches full development between 48 and 60 hours post mortem, and is resolved at 168 hours post mortem; (2) at 24 °C rigor mortis reaches full development at 5 hours post mortem, and is resolved at 16 hours post mortem; (3) at 37 °C rigor mortis reaches full development at 3 hours post mortem, and is resolved at 6 hours post mortem; (4) the intensity of rigor mortis grows with increase in temperature (difference between values obtained at 24 °C and 37 °C); and (5) at 6 °C a “cold rigidity” was found, in addition to and independent of rigor mortis.