The pathology and medicolegal aspects of sexual activity

The pathology of injury and its complications related to sexual activities has changed remarkably when compared with that of the past, which usually involved assaults or murders of female victims of varying ages, with moderate to serve beatings that may have accidentally resulted in the victim's death. Serial murderers, serial rapists, and molesters of both boys and girls have become much more prevalent in the last two decades in the United States. Unorthodox sexual behavior, such as "fisting," has increased in frequency, as has sexual violence related to cults, such as satanism. All of these present many challenges to medicolegal investigators. This report describes general and specific pathological sexual activities and injuries, some characteristics and methods of the perpetrators, and some specific cases as examples.     

Death during percutaneous insertion of an intraaortic balloon pump

Intraaortic balloon counterpulsation is currently the most widely used mechanical technique for temporary support of the circulation. We report a rare fatal case of perforation of the right common iliac artery during percutaneous insertion of an IABP.     

The narrow spinal canal - medicolegal aspects (author's transl)]

The constitutional anomayl of a narrow spinal canal was found in a neuroradiological department in 31 cases. The cervical stenosis can be defined in the following way: Inside diameter of cervical canal (anterior-posterior) in relation to diameter of vertebral body. In normal cases the quotient is over 1 - in pathological narrowing under 1. Clinical symptoms mainly appear from 45th year onwards, when reactive-degenerative changes increase the space problem. In wiplash injuries or other adequate cervical trauma 7 cases were seen and described with acute incomplete tetraplegia or/and multilocular lesions of cervical roots, resulting from cervical stenosis combined with degenerative changes in 6 patients. Myelography revealed multilocular deformities of the spinal subarachnoidal space in the abnormal narrow cervical canal. The referred cases were not complicated with forensic aspects. The prognosis quod sanationem was poor. A chronic cervical myelopathy results. Pretraumatic clinical alterations of cervical roots and/or the myelon in the referred cases were absent, existing in other patients. Predominantly men and hard working people with narrow cervical canal became ill. Early symptoms were pain in extremities. Dysesthesia and loss of sensation combined with signs of pyramidal lesion occured later. Defects in nerve roots sometimes overlayed the myelon symptoms. Unspecific CSF-Alterations were common. The EMG showed abnormalities in cases of root involvement. Operative treatment was tried to remove the reactive processes, but could not alter the constitutional anomaly. The resulting immobilisation of myelon and nerve roots involves in the case of trauma a direct mechanical lesion and secondary vascular complications via Arteria vertebralis, spinalis anterior and radicularis, namely in patients with degenerative alterations of the cervical spine, these including a further narrowing behind the constitutional anomaly. Our experience seems to recommend that more attention should be paid a cervical narrow spinal canal in medicolegal implications.     

An unusual penetrating head wound by a yard broom and its medicolegal aspects

A fatal case of a homicidal penetrating head injury by a blunt object (yard broom) is described. A piece of wood penetrated the skull and remained in the intracranial cavity resulting in infection. The need of careful examination of the head injury is emphasized.     

The medical examiner and AIDS. Death certification, safety procedures, and future medicolegal issues

The current worldwide epidemic of AIDS will have profound consequences not only for the delivery of health care, but also for forensic pathologists and investigators. AIDS continues to spread in definable risk groups, and deaths within some of these groups may fall under the jurisdiction of the medical examiner. We outline an approach to handling AIDS deaths based upon case definition, diagnosis by available information and procedures, and proper infection control. We also discuss medicolegal issues surrounding deaths due to AIDS.     

Postmortem serotonin (5-HT) concentrations in the cerebrospinal fluid of medicolegal cases

In a medicolegal study the postmortem serotonin (5-HT) cerebrospinal fluid (CSF) concentrations were determined in routine autopsies using a high performance liquid chromatographic procedure with electrochemical detection. There was no correlation between 5-HT concentrations and age, sex or blood alcohol concentration using a postmortem delay < or = 3 days. In suicides the suboccipital CSF concentrations were significantly decreased compared to the levels measured in the control group (8.55+/-5.99 ng/ml versus 20.15+/-13.56 ng/ml). Additionally, a decrease of 5-HT was found in the suboccipital CSF of opiate fatalities (15.56+/-13.52 ng/ml). The results support the hypothesis that decreased 5-HT concentrations in the CSF are characteristic in suicides. However, due to a rather broad overlapping of values between suicides and controls the results failed to define a possible cut-off level in the 5-HT CSF concentration to distinguish between a suicidal and a non-suicidal incident.     

Immunologic characterization of human seminal leucine aminopeptidase (LAP) and its medicolegal use

A new method for identification of seminal stains is described, based on the immunologic demonstration of leucine aminopeptidase (LAP), which is extremely abundant in human semen and specific for the prostate as well as semen. An antiserum against human seminal plasma was obtained by repeated immunization of rabbits with seminal plasma and Freund's adjuvant. Ouchterlony's double immunodiffusion test and Culliford's precipitin electrophoresis were performed to demonstrate specific proteins of seminal plasma. LAP activity was visualized with L-leucyl-beta-naphthylamide as substrate and with Fast Garnet GBC as coupler. The immunologic analysis of LAP produced two precipitin lines with enzyme activity. One was observed in kidney, jejunum, pancreas, prostate, as well as in semen, and was completely absorbed with kidney homogenates. The other was found only in semen and the prostate and was not absorbed with kidney homogenates. When the anti-seminal plasma serum absorbed with the kidney was used, the semen-specific LAP could be demonstrated by precipitin electrophoresis only in seminal stains stored for up to 2 months, whereas it was not demonstrated in stains from other human body fluids. By means of precipitin electrophoresis the detection of the semen-specific LAP was possible at semen dilutions of up to 1:32. The method described here greatly enhances the value of semen identification and is quite recommendable for the examination of stains in medico-legal practice.     

Sudden infant death syndrome (SIDS): a burgeoning medicolegal problem.

This Article presents a summary analysis of the administrative and statutory bases for the documented, prevalent mismanagement of Suddern Infant Death Syndrome (SIDS) cases by a majority of local death investigation agencies in the United States. Herein, Alan P. Cleveland, J.D. advances the theory that the unsatisfactory handling of cases of SIDS by the medicolegal community is the inevitable outgrowth of state laws that expressly require investigative agencies to approach a sudden, unexplained death from the direction of determining first whether or not a criminal act has occurred. In so doing, most statutorily mandated autopsy procedures are socially counterproductive since, in ignoring an acute medical need for supportive family counselling, they often constitute an insuperable obstacle to the effective management of SIDS as a public health problem. The author recommends that a requisite first step in implementing an SIDS management program at the state level is to insulate surviving family members form criminal investigative procedures by appropriate amendment of state laws governing local death investigation systems.     

How some medicolegal aspects of the Zeebrugge Ferry disaster apply to the investigation of mass disasters.

The capsizing of a British Channel ferry as it left Zeebrugge, Belgium's harbor, on the 6th of March, 1987, resulted in an all-out effort by Belgian and British authorities to identify the victims as well as to determine the medicolegal ramifications. This report describes the investigation and the lessons learned from it.     

Death caused by sharp injury. Criminologic and criminalistic aspects

From 3497 obductions during the ten years between 1979 and 1988 100 homicides and 18 suicides were caused by sharp trauma. Homicide by sharp trauma is the most frequent method for killing. These 100 homicides were analysed in relation to the age and nationality of victims and perpetrators, place of action, number and localisation of wounds, cause of death. The main results are discussed, particularly those which vary from the results of other authors.     

海子之死的证据学谜区（上）

20年来,伴随着海子诗歌的巨大成功和广泛社会影响,海子逝世的原因也引起社会日益广泛的关注和推测。本文提出了关于海子死亡问题的证据学谜区、广义破案和证明。并对关于海子案件的纷繁杂乱的证据材料之筐、证据系统完型谜区、海子死亡原因的可能性空间、死亡安排、证据理论的难题与困境等问题进行了初步探索。     

海子之死的证据学谜区（下）

20年来,伴随着海子诗歌的巨大成功和广泛社会影响,海子逝世的原因也引起社会日益广泛的关注和推测。本文提出了关于海子死亡问题的证据学谜区、广义破案和证明。并对关于海子案件的纷繁杂乱的证据材料之筐、证据系统完型谜区、海子死亡原因的可能性空间、死亡安排、证据理论的难题与困境等问题进行了初步探索。     

Death in the neonatal period and infancy. History of medicine and forensic criminal aspects

From antiquity up to the present time the history of medicine contains innumerable examples of the different attitude of human beings in dealing with the death of children. This is paradigmatically described for the death of neonates and infants, with special consideration of the sudden infant death syndrome (SIDS) and selected forensic-criminalistic aspects. Against the historical background of forensic postmortem examination and forensic paidopathology the development of the autopsy is also outlined.     

Death related to coronary artery fistula after rupture of an aneurysm to the coronary sinus.

Large coronary fistulas are considered to cause myocardial ischemia due to diversion of the coronary blood flow. In this case the authors report the reverse effect--the spontaneous closure of a large fistulation between the left circumflex artery and the coronary sinus evoked angina pectoris in a middle aged man, who died several years later. Postmortem examination revealed a coronary aneurysm that had ruptured and dissected into the coronary sinus and finally thrombosed. The origin of the aneurysm could be congenital but perhaps also represents a healed stage of Kawasaki disease.     

Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery

Treatment for individuals suffering from migraines and pain due to an inflammation or impingement of a nerve range from noninvasive methods such as massage, physical therapy, and medications to invasive methods such as epidural steroid injections and surgery. Each method of treatment has an associated level of risk. While minor to moderate complications from such procedures do occur, deaths are very rare. We report the first cited case of a death associated with the pain management procedure called nerve root block, also referred to as a transforaminal epidural steroid injection. We present the medical history and autopsy findings of a 44-year-old white female who died of massive cerebral edema secondary to the dissection of the left vertebral artery and subsequent thrombosis due to the perforation of that artery by a 25-gauge spinal needle during a C-7 nerve root block.     

Death Caused by Toxic Epidermal Necrolysis (Lyell Syndrome)

Abstract: Toxic epidermal necrolysis (TEN) is characterized by fever, scalded appearance of the skin, and epidermolysis associated to blister formation and exfoliation, and it is caused by hypersensitivity reaction to a drug. The authors report two cases of death as a result of TEN; both referred to old aged women treated with a polytherapy including allopurinol. Both patients displayed erythematous skin lesions similar to scald burns and epidermolysis at the face, chest, and abdomen and died shortly after hospitalization. Autopsy findings and histological examinations revealed epidermal necrolysis and confirmed the clinical diagnosis. A strict time‐correlation between allopurinol administration and symptoms was evidenced. Because of its iatrogenic origin, TEN often arises suspicions of medical liability; however, because of its unpredictable nature, the occurrence of this syndrome cannot be ascribed to the medical staff whose main task is the rapid diagnosis and the correct management.     

Death by peroral ingestion of soluble glass (sodium silicate)

The intake of 0.51 of water glass (sodium metasilicate; colloid pH 12.5) led to death within 1-1.5 h. Autopsy revealed alkali burns of the stomach mucosa. The stomach contained a small amount of liquid with a pH of 11.5. Histologically, numerous bronchioles and alveoles were filled with amorphous material. This material was chemically proved to be condensed water glass. The obstruction of large parts of the lungs by water glass led to an inhibition of alveolar gas diffusion, which may have been the cause of death. The transformation of the water glass from liquid to solid occurred in the lungs by means of the carbonic acid of expiration air. This was made possible because the pH of water glass had been changed by gastric secretions from 12.5 to 11.5. Water glass starts to solidify around pH 11.4-11.3.     

Analytical aspects of volatile substance abuse (VSA)

Through a case report, the authors illustrate the volatile substance abuse (VSA) toxicological investigation difficulties mainly due to evaporation of the compounds from postmortem samples and to the lack of reference data for interpretation. A 17-year-old man, student in a chemistry institute, was found dead with a plastic bag placed over his head. Several chemical substances were found in his belongings. Autopsy findings included serious pulmonary lesions and hemorrhagic digestive ulcerations. A large screening of drugs and toxic compounds and selective analyses for several classes of drugs of abuse were carried out in the autopsy samples. In particular, a headspace (HS), -gas chromatography/-mass spectrometry (GC/MS) technique was used to screen for volatile substances and metabolites in the biological samples and for residues of volatile substances on the surface of the plastic bag and in the chemicals found on the scene. The main analytical finding was the presence of alkanes (heptane, methyl-2-pentane, methyl-3-hexane, methylcyclohexane) in the gastric content. The literature data, VSA practices, long time-delay between death and autopsy, preservation conditions of the biological samples before analysis, and in-lab experiments on evaporation of volatile substances were considered to interpret this result. The present fatality was attributed to VSA with a gasoline-based stain remover like "eau écarlate," associated with a hypoxic recreation practice using a plastic bag.