Fatalities Due to Indigenous and Exotic Species in Florida

Florida's climate is suitable for many potentially hazardous animals, including both indigenous and exotic species, which are frequently kept as in zoos or as pets. This has resulted in many unforeseen fatal encounters between animals and the ever expanding human population. While the literature and knowledge pool for more common types of deaths referred to medical examiner/coroner's offices is abundant, the appreciation of wildlife and exotic pet‐related deaths is far less widespread. We report seven animal attack‐related deaths that occurred in Florida. The inflicted injuries included blunt and sharp force injuries, asphyxia, drowning, and envenomation. The underlying cause of death, however, was always a result of the human/animal interaction and in many cases related to human error and failure to appreciate the potentially dangerous behavior of nondomesticated species. These cases illustrate the varied circumstances and pathophysiologies associated with deaths due to indigenous and exotic species and the importance of the multidisciplinary approach in the medicolegal investigation of these cases.     

Applications of Social Network Media in Medicolegal Death Investigation

With the increased popularity of online social networking services (SNS) such as Facebook, LinkedIn, Twitter, and Google+, we propose that a wealth of new resources is available for medicolegal death investigation. Recognizing this potential, we identified cases in which social media had been useful in the past in our office and asked our investigative staff to consider using social media in current cases. These cases provided illustrative examples for this primer regarding how information from SNS was used in death investigations in our office. Information gleaned from online social media aided in establishing preliminary identification of a decedent, locating next‐of‐kin, investigating the circumstances of death as relevant to the manner of death, corroborating eyewitness accounts, and providing information relevant to time of death. Potential pitfalls were identified, such as shared accounts or online impostors. SNS proved useful to the medicolegal death investigator and medical examiner, so long as their limitations were recognized.     

Quantifying Macrophages and Hemosiderin in Pediatric Dura Mater,

Determining the age of a subdural hematoma at autopsy is of great interest for medicolegal purposes. The appearance of pigment‐laden macrophages is often referenced as evidence that the subdural hematoma is 3–4 days old. However, understanding the significance of macrophages and hemosiderin requires understanding the histology of infant dura. Samples of grossly unremarkable dura taken from 17 pediatric autopsies were identified and histologically confirmed to lack subdural neomembrane. CD68 immunostaining and Prussian blue staining was performed. The CD68‐positive cells per high‐power field were quantified, and the presence of iron‐containing cells was recorded. CD68‐positive cells were present in all cases, even in the dural border layer. Iron‐containing cells were identified in 59% of cases, and in the dural border layer in 29%. Therefore, CD68‐positive and iron‐containing cells can be present in pediatric dura without neomembrane or macroscopic subdural hemorrhage, and this requires consideration when estimating the age of a subdural hematoma.     

DNA in the Criminal Justice System: The DNA Success Story in Perspective,

Current figures on the efficiency of DNA as an investigative tool in criminal investigations only tell part of the story. To get the DNA success story in the right perspective, we examined all forensic reports from serious (N = 116) and high‐volume crime cases (N = 2791) over the year 2011 from one police region in the Netherlands. These data show that 38% of analyzed serious crime traces (N = 384) and 17% of analyzed high‐volume crime traces (N = 386) did not result in a DNA profile. Turnaround times (from crime scene to DNA report) were 66 days for traces from serious crimes and 44 days for traces from high‐volume crimes. Suspects were truly identified through a match with the Offender DNA database of the Netherlands in 3% of the serious crime cases and in 1% of the high‐volume crime cases. These data are important for both the forensic laboratory and the professionals in the criminal justice system to further optimize forensic DNA testing as an investigative tool.     

Concentrations of Opiates and Psychotropic Agents in Polydrug Overdoses: A Surprising Correlation Between Morphine and Antidepressants

Abstract: The relationship between postmortem concentrations of morphine and co‐detected psychoactive drugs in fatal overdoses is examined. Morphine and other drugs were detected in 161 medicolegal autopsy cases. Subsets of these morphine‐positive cases based on drug class were established, including opioids, antidepressants, ethanol, benzodiazepines, and “other.” Each subset was split into high or low concentration groups based on median drug concentrations. Morphine concentrations of the [high] and [low] groups were compared, with no significant difference in morphine concentration identified in the opioid, ethanol, or benzodiazepine subsets. The “other” drug class was too heterogeneous for statistical assessment. Morphine concentrations did show a significant direct relationship (p = 0.01) with antidepressants, namely increased concentrations of antidepressant drugs are associated with an increased concentration of morphine. This trend probably remains even after excluding cocaine‐positive cases. The unsuspected finding that postmortem concentrations of antidepressants positively correlate with morphine levels may be important in the treatment of depression in drug addicts.     

Bacterial Translocation and Sample Contamination in Postmortem Microbiological Analyses

The diagnostic value of postmortem bacteriology has been discussed controversially for decades. In the study herein, contamination during sampling procedures and postmortem translocation were investigated to interpret postmortem microbiology results. One hundred medicolegal autopsy cases in total were included. Radiology, histology, bacteriology, and biochemistry were performed in all cases. Based on all investigation findings, 4 groups of cases were identified: death unrelated to infection, true infections, false positive (contamination during sampling procedures, postmortem translocation and mixed situations), and undetermined. The results of this study indicate that postmortem bacteriology provides useful data supporting infection‐related deaths, especially when potentially significant observations are accompanied by consistent autopsy, histology, and biochemistry. Result interpretation requires careful evaluation of number and type of isolated microorganisms.     

Foreigners Dying in Istanbul

Abstract:  The study included 411 deaths selected from 14,647 medicolegal deaths autopsied in the Morgue Department of Forensic Medicine Institute Directorate, affiliated with the Ministry of Justice, between 1998 and 2002. Data were collected from court documents, coroner's investigation reports, and autopsy reports. The parameters of age, gender, nationality and origin, cause and place of death in foreigners dying in Istanbul were evaluated in the study. Out of 14,647 medicolegal deaths, 3.5% were foreigners from 34 different nationalities. The nationality with the highest rate of foreigner deaths (34%) was Romanian. Out of 411 deaths, 74.3% were male and 25.7% were female. Of all cases, 64.4% were tourists visiting Istanbul and 35.6% had a job in Istanbul. Of 146 foreigners employed in Istanbul, 94.5% did not have a work permit, while only 5.5% had a work permit.     

Relationship Between Self‐Injurious Behaviors and Levels of Aggression in Children and Adolescents Who Were Subject to Medicolegal Examination,

Aggression, which is defined as a behavior causing harm or pain, is a behavioral pattern typically expected in children and adolescents who are involved in criminal activities. The aim of this study was to examine the relationship between aggression and self‐injurious behavior (SIB) in children and adolescents. The study was performed in 295 cases which were sent for medicolegal examination. The mean age of the subjects was 14.27 ± 1.05 years (age range 10–18 years). The aggression levels of the subjects were determined using the Aggression Questionnaire (AQ), which is an updated form of the Buss‐Durkee Hostility Inventory. The mean total AQ score of the subjects with and without SIB was 78.04 ± 21.0 and 62.75 ± 18.05, respectively (p < 0.01). There were significant statistical differences between the two groups with respect to their subscale scores (p < 0.01). It was concluded that the levels of aggression increased in children and adolescents who were involved in criminal activities when the SIBs increased.     

Finding of Hyperostosis Frontalis Interna During the Autopsy Procedure: Forensic Issues

Hyperostosis frontalis interna is a common phenomenon, which may have been overrated in its significance in the past, and may, currently be underrated in its significance. We present three cases of hyperostosis frontalis interna found during medicolegal autopsies and discuss their forensic considerations. The patients were all middle‐aged women with metabolic and endocrine manifestations and psychiatric ailments; thickening of the inner table of the frontal bone of the skull was found during each autopsy. We describe the relationship between hyperostosis frontalis interna, metabolic manifestations, and neuropsychiatric symptoms as part of Morgagni‐Stewart‐Morel syndrome. There is still considerable disagreement in the scientific community as to whether this syndrome is a clinical entity. Nonetheless, awareness of Morgagni‐Stewart‐Morel syndrome can be of help in understanding the circumstances surrounding death. In some other cases, hyperostosis frontalis interna could be used by forensic pathologists as criteria for sexing and aging a skeleton.     

Association for Methodology and Documentation in Psychiatry Profiles Predict Later Risk for Criminal Behavior and Violent Crimes in Former Inpatients with Affective Disorder*

Abstract: Few studies have investigated criminal and violent behavior in patients with affective disorders. We reviewed the national crime register for records of criminal offenses committed by 1561 patients with affective disorders and studied the predictive value of certain psychopathological symptoms assessed with the Association for Methodology and Documentation in Psychiatry (AMDP) system concerning future criminal behavior. Sixty‐five (4.2%) patients had been convicted in the 7–12 years after discharge (307 cases). Patients with the AMDP syndrome mania had a significantly higher risk for later criminal behavior. The combination with the hostility syndrome further increased the risk. These findings are in line with previous data indicating a higher risk for later criminal behavior in patients with a manic/bipolar disorder compared to depressive disorder. As previously demonstrated in another sample of schizophrenic patients, the AMDP syndromes mania (and hostility) is associated with a higher risk of later criminal behavior.     

高效液相色谱-蒸发光散射法分析人和动物油脂种属

目的采用反相高效液相色谱-蒸发光散射方法分析人和动物油脂种属。方法采集人体和7种动物(猪、牛、羊、鸡、鸭、鹅、鱼)油脂,丙酮溶解后直接进样分析,色谱柱为C18反相柱,流动相为二氯甲烷-乙腈(30∶70 V/V),流速1.0mL/min,蒸发光散射检测器进行检测。结果采用本文方法检测POSt、MMP、StPSt、OPO 4种甘油三酯组分分离效果良好;用于油脂分析,其主要组分高级脂肪酸三甘酯均得到了有效分离,色谱峰的保留时间和相对峰面积比的重现性好;与动物油脂比较,人体油脂具有独特的色谱特征;动物之间色谱特征也有差异。结论采用本文高效液相色谱-蒸发光散射法检测油脂,可根据人体油脂与动物油脂色谱特征的差异为油脂种属鉴定提供依据。     

Implications of Genital Mutilation at Autopsy

Given the potential significance of mutilation of the external genitalia in medicolegal fatalities, a review of the literature was undertaken to identify subcategories. Such mutilations may have been sustained sometime before death, around the time of death, or after death. The most common type of ante mortem genital mutilations involves cultural practices such as male circumcision. Less common male mutilations such as subincisions are tribally based. Female genital mutilation is found particularly in African, Middle Eastern, or Asian populations. Self‐inflicted genital injuries are most common in males and may be related to attempts at suicide, or to self‐harming practices. The latter have a strong association with psychiatric illnesses. Postmortem injuries may arise from animal predation or deliberate mutilation of a corpse. The latter may be associated with ante mortem genital injuries in sadistic homicides. The range of possible causes of genital mutilations in forensic cases necessitates extremely careful evaluation.     

Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series,

Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner’s office that occurred during 2016. Autopsies were performed or supervised by board-certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re-evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head–neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and analyzed with McNemar’s test. We included 60 males and 20 females (median age 31 years, range 3–73). Based on PMCT, 56 (79.1%) cases had injuries relevant to the cause of death in a single body region (24 head–neck region, 32 thoracoabdominal region). Out of these 56 cases, 9 had a missed major diagnosis by PMCT outside that region, including 6 extremity injuries visible during standard external examination. Yet all had evident lethal firearm injury. We showed that PMCT identifies major firearm injuries in homicide victims and excludes injuries related to the cause of death in other regions when a single body region is injured. Although PMCT has a known limited sensitivity for soft tissue and vascular pathology, it can be combined with external examination to potentially reduce or focus dissections in some of these cases depending on the circumstances and medicolegal needs.     

A Silver‐Stain Modification of Standard Histological Slide Preparation for Use in Anthropology Analyses

The traditional histology method typically employed by forensic anthropologists involves plastic embedding of undecalcified bone. The embedded sample is then cut by a diamond blade saw and ground to the required thickness of ~50–100 microns using a grinder. There are several limitations to this method: Cement lines may be blurred; depth‐of‐field artifacts may result from viewing thick sections; and medicolegal offices with limited budgets may not be able to invest in additional equipment or training for this method. A silver nitrate stain modification of the standard histology preparation technique of decalcified bone is presented. The benefits of this technique are that: Cement lines are viewed clearly; no depth‐of‐field artifacts are present; and because this is a modification of the standard technique used by histology laboratories typically employed by medicolegal offices, no additional equipment or training is required.     

A Study of Fatal and Nonfatal Hangings

Approximately 50% of all suicides performed worldwide are strangulations. This article presents options for the medicolegal examination of hanging. The pathogenetic mechanisms and clinical pictures of victims are discussed. Examples of the process of diagnosis and expert conclusions are given. This article is intended for physicians and forensic pathologists. The literature focusing on asphyxia by strangulation is reviewed. Data from Vilnius Hospitals and the State Forensic Medicine Service concerning strangulations performed between 2012 and 2014 are analyzed and include the findings of 5650 autopsies (36% asphyxia) and 4 survived victims. The predominant symptoms were neurological, cardiovascular, and respiratory symptoms. After asphyxia, patients should consult by a psychiatrist, ophthalmologist, gastroenterologist, and endocrinologist. A ligature mark was the most observable sign of asphyxia by neck strangulation. Only complications in the poststrangulation period were treated. Mechanical asphyxia must be identified as the main injury in the clinical diagnosis and encoded as ICD‐10.     

105例凶杀案责任能力评定分析

目的探讨鉴定医生评定凶杀案例责任能力时的主要依据及影响因素。方法对总计105例凶杀案的精神病司法鉴定案例进行回顾性分析。结果无责任能力者41例(39.0%);限定责任能力者28例(26.7%);完全责任能力者36例(34.3%);与刑事责任能力的评定密切相关的因素有:凶杀行为是否由精神病理因素引起(Gamma=0.906,P=0.000),临床诊断是否为重性精神病(Gamma=0.761,P=0.000),被害人是否为家人亲属(Gamma=0.412,P=0.000)。结论从技术层面看,鉴定医生评价责任能力考虑的三个主要方面按重要性依次是:凶杀行为是否由精神病理因素引起,被鉴定人是否患有重性精神病,被害对象是否为家人亲属。     

A Forensic and Medical Evaluation of Dog Bites in a Province of Western Turkey

The aim was to evaluate the demographic data of dog‐bite cases organized from criminal and forensic reports. This study evaluated 328 cases admitted to the Director of Forensic Medicine, Eskisehir, as a result of dog bites between January 1, 2006 and December 31, 2010. It was found that those in the age‐group of 0–18 were most frequently exposed to dog bites (48.5%). Injuries to the lower extremity, upper extremity, and chest/abdomen/back were more frequent in men (72.6%, 76.4%, and 66.1%, respectively), while injuries to the head/neck/face were more frequent in women (52.3%) (p < 0.01). While most of those wounded in the upper extremity, the head/neck/face, and the chest/abdomen/back were in the child age‐group, most of those wounded in the lower extremity were in the adult age‐group (p < 0.001). Teaching children, in particular, how to behave around dogs would be useful in reducing the incidence of bite.     

Amniotic fluid embolism-apropos two consecutive cases

Amniotic fluid embolism (AFE) is a sporadic, unpredictable, and usual fatal obstetric complication. The paper deals with two cases of maternal deaths because of AFE verified by medicolegal autopsy. In both the cases, several known risk factors associated with AFE, such as increased maternal age (41 and 35 years), diabetes, augmented labor, and cesarean delivery, were identified. Clinical features were typical, including sudden onset of cardiovascular and respiratory symptoms. In the patient who survived longer, both clinical and autopsy signs of disseminated intravascular coagulopathy were present, while they were absent in the case where death occurred rapidly. This paper describes briefly the particular features to look for at autopsy and stresses the importance of histology examination and staining techniques.