The eyes of child abuse victims: autopsy findings.

The authors studied 77 pairs of eyes removed from children who had died of suspected child abuse. Forty-seven of the cases had retinal hemorrhages. Those showing retinal hemorrhages were younger children and had fewer other stigmata of child abuse. Hemorrhages are more likely to occur in cases where the child was shaken or swung than in those with severe direct head trauma. The authors recommend that examination of the eyes be included in the autopsies of all small children who died without an obvious cause of death. Experience in both processing and reading of ocular material is necessary for reliable results.     

Radiographic human identification using bones of the hand: a validation study

The 1993 Supreme Court case Daubert v. Merrell-Dow Pharmaceuticals, Inc. underscores the importance of validating forensic science techniques. This research examines the validity of using posterior-anterior radiographs of the hand to make positive identifications of unknown human remains. Furthermore, this study was constructed to satisfy the requirements of Daubert's guidelines of scientific validity by establishing a standard methodology for hand radiograph analysis, testing the technique, and noting rates of error. This validation study required twelve participant examiners from the forensic science community, working independently, to attempt to match 10 simulated postmortem radiographs of skeletonized hands to 40 simulated antemortem radiographs of fleshed cadaver hands. The overall accuracy rate of the twelve examiners was 95%, while their collective sensitivity and specificity were 95% and 92%, respectively. However, the accuracy of each examiner was related to the amount of radiological training and experience of the observer. Six Ph.D. forensic anthropologists and four experienced forensic anthropology graduate students correctly identified all the matches. Participant examiners noted bone morphology, trabecular patterns of the proximal and middle phalanges, and distinctive radiopaque and radiolucent features as the anatomical features that aided the identification process. The hand can be an important skeletal element for radiographic positive identification because it contains 27 individual bones for comparative analysis.     

Confusing injury findings in a suicidal gunshot fired to the chest from a carbine with a sawed-off barrel

The stellate bullet entrance wound is one of the facultative features of a contact shot. For the formation of a star-shaped wound two factors are of special importance: first, an extensive bony support underlying the skin in the entrance region, and second, a strong propellant charge of the cartridge fired. Contact shots to the precordial region usually do not cause stellate entrance wounds, even if high-powered rifle ammunition is used. In the reported case, an injury pattern was observed that was not in line with normal findings and seemed confusing at first. Following a suicidal gunshot to the chest from a sawed-off carbine 98a (cal. 8 x 57 Js), a 4.5 cm wide, gaping bullet entrance wound with radiating tears was found. Instead of the usual pocket, the anterior thoracic wall showed a fist-sized area of destruction with extensive undermining of the subcutis. Not far from the entrance hole, a rib fragment had become displaced retrogradely thus perforating the skin from the inside out. The unusual pattern of findings could be explained by the fact that the barrel had been sawed off: as a result of this manipulation, a considerable part of the propellant charge had been converted outside the barrel, i.e. in the initial section of the bullet path.     

Bacteria in lung tissue from an autopsy population of alcoholics

The retrieval of bacteria from the lungs postmortem was examined in a population of alcoholics who had a medico-legal autopsy performed. The results were compared with non-alcoholic controls. Pneumococci were found more frequently in alcoholics, but in general there were no major differences. Proteus mirabilis was detected in three out of five alcoholics with unascertainable cause of death. It is speculated whether this species may cause septicaemia in some alcoholics due to abnormal splanchnicus circulation.     

Radiographic demonstration of esophageal and tracheal fistulas at autopsy using a contrasting medium that vulcanizes at room temperature

Esophageal and tracheal fistulas, which occur in 0.05% of medicolegal autopsies, were demonstrated in three cases by a postmortem radiographic technique using silicone rubber/lead oxide as a contrasting medium that vulcanizes at room temperature. In one 83-year-old male, a tracheoesophageal fistula was detected, which had developed after surgical repair of an esophageal rupture caused by a flexible fiberoptic endoscope. In a second case, carcinoma of the esophagus in a 78-year-old male had eroded the trachea and arcus of the aorta creating a fatal tracheoesophagoaortic fistula. In a third case, 55-year-old female developed a tracheobrachicephalic artery fistula as a result of an infiltrating cystic adenocarcinoma of the trachea, resulting in a fatal hemorrhage into the trachea. The results of this study indicate that diagnostic radiologic methods using a vulcanized contrasting medium are useful in supplementing normal dissection in autopsy cases with suspected fistulas of the esophagus or trachea.     

Uncertainty of determining cause of death in a medicolegal material without autopsy. An autopsy study

In constrast to other studies, this investigation was made on cases of medicolegal deaths that would not normally be autopsied. 223 females and 322 males, whose deaths were found to be natural before as well as after autopsy, were studied. The cause of death was estimated by external medicolegal examination, and after autopsy.In 79 females and 109 males, i.e. 35% and 34% respectively, estimated cause of death was found to be different after the autopsy. This was mostly because ischaemic heart disease as a cause of death was overestimated at the external medicolegal examination. No constant relationship between differing causes of death and age group could be demonstrated. Underdiagnoses and overdiagnoses tended to outweigh each other. Pneumonia, pulmonary embolism, cor pulmonale and aortic stenosis were clearly underestimated before autopsy. In addition, a variety of diseases that were not even mentioned at the medicolegal examination was found (subarachnoid haemorrhage, uraemia, perforated and bleeding gastric ulcers, tuberculosis).The same unreliability in the estimated cause of death therefore exists among cases not normally autopsied as found in retrospective studies of cases where autopsy is performed under all circumstances at the request of the police.False information will thus be given to the mortality statistics among the approximately 5000 cases of medicolegal deaths not autopsied in Denmark per year, most of these being natural deaths. Besides, contagious and inherited diseases could be overlooked, relatives given false information and the value of scientific studies in causes of death diminished.The conclusion is that autopsy is still essential to ensure continuous control and correction of causes of death.     

The need for a complete dental autopsy of unidentified edentulous human remains

In December 2017, a decomposed unidentified body was found near the river Tronto in Teramo, Italy. The corpse was found without any identifying documents or specific personal belongings, except for a packet of cigarettes. The medical examiner determined a gastric perforation from the intake of hydrochloric acid to be the cause of death. A jar of muriatic acid found near the body led to suicide being considered the manner of death. The Penal Court in Teramo appointed two forensic odontologists to complete the postmortem assessment and collect dental data for personal identification. The corpse was found wearing a complete set of upper and lower dentures. The dental autopsy and 42 periapical X-ray images helped generate a biological profile of a man totally edentulous with upper and lower dentures, as well as an osteosynthesis with two plates and screws in the left ascending ramus of the mandible. In March 2018, the sister of a missing person reported the disappearance of her brother, and a presumptive identification was performed through visual recognition of the decomposed body. The sister confirmed the presence of two dentures and the location of the maxillo-facial surgery for the treatment of the fractured mandible. A complete dental autopsy was able to establish his identity without any DNA comparison needed. This case highlights the importance of performing a complete dental autopsy inclusive of dental radiographs, and its value in the identification of all unknown human remains even when totally edentulous.A complete dental autopsy should be performed in all cases of human identification.

Keypoints

• Despite a corpse being edentulous, a complete dental autopsy can still be useful.
• Dental radiographs, such as bitewings, periapical images, panoramic radiographs, and CT scans, are recommended in all identification autopsies.

     

Comparison of pulmonary autopsy findings of the rats drowned at surface and 50 ft depth

INTRODUCTION: When a body is recovered from the water after a fatal SCUBA diving accident, it is useful to know if the diver was under pressure or not when he/she took his/her last breath, in order to determine the cause and manner of the death. If the victim was under pressure, the air remained in the lungs of the diver will be equal to the environmental pressure. If the body comes to the surface, the air in the lung will expand according to the Boyle's Gas Law and give mechanical damage to the surrounding tissues, due to decreases in environmental pressure. We designed an experimental study to see the difference in pulmonary autopsy findings of the rats that drowned under normobaric and hyperbaric conditions. METHOD: Forty five male, 250-300 g, Sprague Downey adult rats were divided into three groups. Two groups of rats were drowned under normobaric conditions (Groups DS Group DSS) and the third group at 50 ft pressure (Group DD). The pulmonary autopsy findings of the groups were compared. In the light microscopy, the number of the microscopic fields (x10) containing at least one emphysematous area with longitudinal dimension greater than 300 micro m were compared among the groups. RESULTS: The gross examination revealed a prominent swelling of the lungs in all rats in the Group DD, in comparison to that of the Groups DS and DSS. The number of the microscopic fields, which included at least one emphysematous area with longitudinal dimension greater than 300 micro m out of 150 fields from each of the groups DS, DSS and DD, were 88, 101 and 115 respectively. The difference between the group DS and DD was found to be statistically significant. CONCLUSION: We conclude that in investigating the fatal diving accidents, pulmonary autopsy findings give valuable information whether the death occurred at the surface or at the depth.     

Dental characteristics of a large military population useful for identification

The number and complexity of dental restorations has decreased for younger Americans. Since the presence and extent of restorations are important data for forensic science identification purposes, the Computer-Assisted Postmortem Identification (CAPMI) system was used to assess the practical effect of the decreased selectivity expected as a result of improved dental health. Dental examination data from 7030 soldiers were recorded on optical mark read forms and entered into a database. The data were reorganized and analyzed to generate summary statistics about the incidence of each type of restoration (divided into 16 categories) for both anterior, posterior, upper, lower, and combined segments. Patients' ages ranged from 17 to 49 with a mean of 24 years 5 months. Sixty percent were from 18 to 25 years old. A characteristic is defined as any situation other than a virgin tooth; for example, extracted, missing, unerupted, or restored. The average subject had 7 dental characteristics with approximately 75% having 4 or more. Within the entire population, 9% had 32 unrestored teeth. 3.6% had only one characteristic. To test the selectivity and uniqueness of various combinations of dental characteristics, 363 simulations using the CAPMI system were made against the entire 7030 subject database. Sample records (33 per group) with 2, 3, 4, 5, 6, 7, 8, 9-11, 12-14, 15-18, and 19+ characteristics were chosen at random from the database and searches were made.(ABSTRACT TRUNCATED AT 250 WORDS)     

Genetic STRs variation in a large population from Tuscany (Italy)

Allele frequencies for 17 STRs, together with some parameters of forensic interest, were estimated in a sample of 835 unrelated individuals born in Tuscany, an Italian region. These data were compared with Italian, Chinese, Kosovo Albanian, Romanian and Tunisian populations, strongly represented in this area. No significant differences in single loci were detected, except for Chinese in comparison with all the other populations.     

The population of coloured fibres in human head hair.

In 2002 a population study of textile fibres in human hair was carried out using 26 volunteers in Cambridgeshire, UK. Over 12,000 fibres were recovered from a variety of hair lengths using low adhesive tape and classified according to colour, generic type and fibre length. The results of the study showed that the most common fibre colours were black/grey (48%), blue (29.1%) and red (12.7%), the least common being green, orange/brown and yellow which each accounted for less than 5% of the total. Natural fibres (mainly cotton) were predominant (72.3%) and man-made fibres were considerably less frequent. When colour and generic type were classified together, the most common combinations were black and blue cottons. The least common were the man-made fibre/colour combinations with the most frequent of these accounting for less than 7% of the sample. Fibre loads carried by long hair were found to be significantly less than that carried by short hair. The results of this study are in accordance with previous fibre population studies using other types of recipient surfaces and are likely to be influenced by factors such as seasonal and geographical variation.     

Difference between in vivo and postmortem distances between anterior chest and heart surface. A combined autopsy and in vivo computerized tomography study

The distance between anterior chest surface and intrapericardial surfaces of the heart and great blood vessels was measured on 37 cases (seven with acute fatal hemopericardium) at autopsy and on 24 live persons by computerized tomography. At autopsy, the apex of the heart was always closest to the skin surface except in cases with acute fatal hemopericardium, where the heart was displaced backwards by 10-40 mm. At computerized tomography, chest-heart distances were approximately 16 mm shorter than at autopsy. Changing the position of the patient from supine to prone decreased the distances by about 10 mm. The data presented demonstrate that the topography of the heart and great vessels is changing with the position of the body in vivo and that chest-heart distance tend to increase postmortem; therefore, the depth of a stab wound in the anterior surface of the heart as measured at autopsy should be regarded as a maximal estimate of the length of the stabbing weapon actually having penetrated the tissues.     

Managing incidental findings in human subjects research: analysis and recommendations.

No consensus yet exists on how to handle incidental findings (IFs) in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are findings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed.     

Determination of human immunodeficiency virus antibody status in forensic autopsy cases in Vancouver using a recombinant immunoblot assay

Sera from 207 forensic autopsy cases were tested for the presence of antibody to the human immunodeficiency virus (HIV) using a recombinant immunoblot assay (RIBA) technique developed by Chiron Corporation of Emeryville, California--the Chiron RIBA-HIV216 test system. Out of these cases, 172 autopsies were of individuals with no known risk factors for HIV infection, and of these, 169 had no detectable antibodies to HIV. In 2 cases, the serum reacted with p24 alone on the RIBA-HIV216 assay, but these results were not confirmed by further testing and are considered to be false positive reactions. In 1 case, the serum reacted only with gp41 on the RIBA-HIV216 test but was nonreactive with further testing. This result has been designated equivocal. Of the 35 cases at high risk of HIV infection, 4 had antibodies to HIV detected in postmortem serum samples. The sensitivity (100%) and specificity (98.5%) of the RIBA-HIV216 test system are high. However, the test appears to be more suitable for routine diagnosis of HIV infection than for rapid screening in the mortuary.     

Comparison between computed tomography (CT) and autopsy findings in cases of abdominal injury and disease

We report 10 autopsy cases involving fatal pathological changes in abdominal organs, for which findings of computed tomography (CT) on admission or after death were compared with autopsy findings. Two of the cases were death due to natural causes and eight were death due to traffic accidents. From the findings at autopsy, the causes of death were considered to be rupture of an aortic aneurysm in one case, gastrointestinal bleeding due to gastric cancer in one case, retroperitoneal bleeding in two cases, laceration of the liver in three cases, and traumatic rupture of the small intestine in three cases. CT findings revealed ascites or retroperitoneal bleeding in eight cases. However, in the cases of small-intestinal rupture, CT findings on admission revealed no free air. Therefore, ascites on CT should be regarded as a useful indicator of blunt abdominal trauma. Hepatic portal venous gas, known to be a post-mortem change, was significantly evident on post-mortem CT in cases of traumatic liver or intestinal injury, and was also seen in cases where the period between the accident and CT examination was long.     

Rupture of a giant splenic artery aneurysm. Report of an autopsy case.

We describe an autopsy case of a 61-year-old woman with von Recklinghausen's disease, who died suddenly following intraperitoneal hemorrhage due to the rupture of a giant splenic artery aneurysm. The aneurysm measured 16 x 13 x 5.5 cm--much larger than those in most previous reports. The pancreatic body, which was pressed by the aneurysm, was widely atrophic. In general, splenic artery aneurysms are more frequent in pregnant women or patients with portal hypertension. The pathogenesis of this aneurysm is presumed to be arterial dysplasia, focal arterial inflammation, or portal hypertension, unlike other aneurysms due to arteriosclerosis or syphilis. Since the patient had not been pregnant and had not had liver cirrhosis or arteriosclerosis, the pathogenic factor could not be determined in this case. The relationship between the genesis of the aneurysm and von Recklinghausen's disease was not clear either.     

Radiographic personal identification with characteristic features in the hip joint.

This case demonstrates a radiographic personal identification. A body was found but no positive results were obtained from the remains regarding the cause of death, the manner of death, or precise identification. At the autopsy, a characteristic radiographic deformity was found in the hip joints. After searching the registry of persons with congenital acetabular dysplasia and super-imposing the postmortem radiograph on the films of the registry, the identification was successful.