Smartphone Image Acquisition During Postmortem Monocular Indirect Ophthalmoscopy

The medical usefulness of smartphones continues to evolve as third‐party applications exploit and expand on the smartphones’ interface and capabilities. This technical report describes smartphone still‐image capture techniques and video‐sequence recording capabilities during postmortem monocular indirect ophthalmoscopy. Using these devices and techniques, practitioners can create photographic documentation of fundal findings, clinically and at autopsy, without the expense of a retinal camera. Smartphone image acquisition of fundal abnormalities can promote ophthalmological telemedicine—especially in regions or countries with limited resources—and facilitate prompt, accurate, and unbiased documentation of retinal hemorrhages in infants and young children.     

Dural hemorrhage of the tentorium on postmortem cranial computed tomographic scans in children

We analyzed four children with increased density of the tentorium on postmortem computed tomographic (CT) scans that suggested traumatic subarachnoid hemorrhage; but in which followup autopsy demonstrated an absence of subarachnoid hemorrhage. All cases had neither head injuries nor distinct intracranial abnormalities. Histological examinations showed extensive hemorrhage within the tentorium. These findings indicate that increased density of the tentorium on postmortem CT scan reflects 'dural hemorrhage' that may occur in children without intracranial abnormalities. Pediatricians and forensic pathologists should be aware of this phenomenon when using postmortem preautopsy CT scanning for diagnosis of child abuse.     

Postmortem monocular indirect ophthalmoscopy

Postmortem monocular indirect ophthalmoscopy permits examination of the posterior fundus and peripheral retina even if there is less than perfect anterior segment media such as postmortem corneal clouding. Light directed through the decedent's pupil from a bright focal light source illuminates the fundus and reflected light from the retina is then projected out of the eye. An aspheric condensing lens positioned in front of the eye focuses the retinal image at the focal plane of the lens. The real inverted, laterally reversed image comprises a wide field of view permitting evaluation of the decedent's fundus for retinal hemorrhages and other lesions.     

Hemorrhagic Retinopathy and Optic Nerve Sheath Hemorrhage Associated With Fatal Subarachnoid Hemorrhage from a Ruptured Intracranial Aneurysm Due to Segmental Fibromuscular Dysplasia

Fibromuscular dysplasia is an idiopathic, nonatheromatous, and noninflammatory arterial disease that most commonly affects the renal and carotid arteries. We report a child with subarachnoid and ocular hemorrhage associated with an aneurysm due to fibromuscular dysplasia. Computed tomography following a witnessed collapse revealed diffuse subarachnoid hemorrhage and severe cerebral edema. An autopsy confirmed the radiographic findings and detected bilateral retinal hemorrhages, optic nerve sheath hemorrhages, and a ruptured saccular aneurysm due to focal fibromuscular dysplasia involving the intracranial right vertebral artery. This case documents a fatal subarachnoid hemorrhage in a child with an intracranial saccular aneurysm caused by fibromuscular dysplasia. The associated retinal hemorrhages are easily detected by postmortem monocular indirect ophthalmoscopy.     

The forensic entomologist in the context of the forensic pathologist's role.

An adequate death investigation requires the combined efforts and cooperation of experts in different disciplines: crime scene technicians, death investigators, forensic pathologists, anthropologists, entomologists, other medical and non-medical professionals. These front-line experts play a crucial role in every death investigation process. The forensic pathologist normally has the legal authority to take charge of the dead body at a death scene and his primary functions are the exterior and interior examination of the cadaver by analyzing the extent of antemortem injuries and the postmortem changes and the recovery of physical evidence. He is responsible for determining how, when and why of any death which is the result of violence, suspicious or unexplained circumstances or a death which is sudden or unattended, defending and explaining the reasons for making these diagnoses in a courtroom. The forensic entomologist can provide invaluable aid in death cases where human remains are colonized by insects and in the overall investigation. His principal role is to identify the arthropods associated with such cases and to analyze entomological data for interpreting insect evidence. He is responsible for determining the period of insect activity according to all the variables affecting insect invasion of remains and their development. The major goal of medico-criminal entomology is to contribute to the determination of the time, cause, manner and place of the investigated death (especially on badly decomposed corpses or skeletonized human remains) with the support of all the elements which can be inferred from the study of insects found on the cadaver or nearby. The application of techniques devised recently in forensic entomology can allow experts in the field to collect strong entomological evidence and provide useful information not only in a death investigation including movement or storage of the remains following death, time of dismemberment, postmortem artifacts on the body but also at the scene, and even more in child neglect, sexual molestation and identification of suspects. As the role of the forensic entomologist at the death scene, at the autopsy and in the laboratory is defined and well known, this paper focuses on the difficulties that could arise if forensic pathologists and entomologists are uncertain about the procedures that they have to follow, do not realize the value of objective findings or fail to evaluate them. Although every forensic case presents a slightly different set of circumstances and has to be tackled individually, the forensic pathologist should work with the forensic entomologist from the visual observations of the cadaver on the scene, through the collection of arthropods and temperature data at the death scene and at the autopsy, up to the final report with the interpretation of entomological and other biological evidence.     

IgE死后生化学检测的研究现状及应用展望

过敏性休克导致死亡的案例在法医学实践中常有发生,然而由于缺少特异的病理形态学指征,导致过敏性休克死亡的法医学鉴定面临一定的困难。IgE作为介导I型超敏反应的关键介质,其死后生化学检测对过敏性休克死亡案例的法医学鉴定具有辅助作用。但在实际应用中,血液等检材常受溶血等死后变化因素影响,尤其我国尸体保存以冷冻为主,溶血程度更加严重,对IgE等生化学指标的检测造成极大干扰。本文就目前IgE死后生化学检测的研究现状、生物学检材的选取及检测方法进行综述,并对现实应用中所面临的问题进行探讨。     

法医毒物动力学

本文作者针对法医毒理学的任务、发展趋势和面临的挑战，提出将法医毒物动力学列为法医毒理学新的分支学科，并阐述了法医毒物动力学的概念、研究目的和任务、研究对象、研究内容、研究方法、研究方向及亟待解决的问题。内容涉及毒物动力学、死后分布、动态分布、死后再分布、死后弥散、毒物分解动力学、毒物死后产生情况等。法医毒物动力学研究将解决中毒法医学鉴定中的许多问题，如尸体或活体中毒当时机体内毒物浓度的推断、死后腐败产生毒物与生前服毒的区别、生前服毒与死后染毒的鉴别、毒物进入机体时间、途径和方式的确定。     

The forensic or medicolegal autopsy. Friend or foe?

The major issue in questioning the performance of general pathologists doing medicolegal or forensic autopsies is that they are very often without a firm basis for performing this task. With minimal training in medical school and minimal exposure during their residency, practicing general pathologists, although expected or even forced to do these cases, may face criticism after their performance in a case. The necessity for teaching forensic medicine and pathology in medical schools is obvious, and the necessity of there being more forensic pathology exposure in residency training programs in the United States and overseas is also obvious. Medical educators are responsible for all phases of medicine being taught to medical undergraduates and graduates and must be pressured to support the practice of all kinds of medicine in American communities, including legal or forensic medicine, in those cases in which questions arise that lead to the performance of postmortem examination.     

Pig-mentation: postmortem iris color change in the eyes of Sus scrofa

Experienced forensic pathologists and examiners may be familiar with the phenomenon of postmortem iris color change; however, only Knight, Simpson's forensic medicine, Arnold, London, 1997; Ref. 1 and Saukko and Knight, Knight's forensic pathology, 3rd ed., Arnold, London, 2004; Ref. 2 have referred to it in the literature, and to date, there have been no published scientific research studies on this taphonomic artifact. A controlled experiment was conducted of postmortem changes to isolated Sus scrofa eyes. The eyes (n = 137) were separated into three groups and each sample was observed for 3-day postmortem at a different temperature. In addition, a Sus scrofa head was obtained to observe postmortem changes of eyes in situ. All isolated blue eyes in the experiment, at room temperature and higher, changed to brown/black within 48 h. The in situ blue eye, at room temperature, turned brown/black within 72 h. If iris color consistently changes postmortem in humans, then this taphonomic artifact must be incorporated into victim identification protocol, including disaster victim identification software, and autopsy reports to prevent inaccurate victim identification and inappropriate exclusion from the identification process.     

Death due to Ehlers-Danlos syndrome type IV

Ehlers-Danlos syndrome (EDS) represents a group of collagen connective tissue disorders characterized by joint laxity, easy bruising, and various skin manifestations. Persons with type IV EDS are at risk for gastrointestinal, uterine, and arterial rupture. Mutations in the COL3A1 gene that encodes for type III procollagen underlie the pathologic abnormalities. Forensic pathologists must be aware of this rare, autosomal-dominant connective tissue disorder. Postmortem diagnosis is possible but requires specialized testing (fibroblast culture and subsequent biochemical assays, with or without molecular studies). When the condition is diagnosed or suspected at autopsy, it is important for forensic pathologists to notify family members of this potentially lethal disorder. Three cases of type IV EDS diagnosed by forensic pathologists are presented, followed by a discussion of the disorder.     

The Value of Outsourcing Selected Cases in a Medical Examiner Population: A 10‐Year Experience

Due to increasing caseloads and inadequate staffing, the burden on Coroner/Medical Examiner Offices to comply with recommended autopsy limits for forensic pathologists (FPs) has been difficult. Since 2006, pathologists at the University of Alabama at Birmingham have performed select autopsies for the Alabama Department of Forensic Sciences. Each case was reviewed by a state FP and scene investigator to determine appropriateness for referral. All referred cases received full postmortem examination including microscopic examination and collection of toxicological samples, and toxicology was ordered by the referring FP as appropriate. The final cause and manner of death were determined by the referring state FP after review of all findings. A majority of the 421 cases were ruled accidental deaths (233), most due to drug toxicity. Of the 178 natural deaths, 118 were attributed to cardiovascular disease. Outsourcing select forensic cases can be educational and an effective tool to manage workflow without compromising quality.     

A Pilot Study Comparing Postmortem and Antemortem CT for the Identification of Unknowns: Could a Forensic Pathologist Do It?

Forensic pathologists are commonly tasked with identifying human remains. Although DNA analysis remains the gold standard in identification, time and cost make it particularly prohibitive. Radiological examination, more specifically analog imaging, is more cost-effective and has been widely used in the medical examiner setting as a means of identification. In the United States, CT imaging is a fairly new imaging modality in the forensic setting, but in more recent years, offices are acquiring CT scans or collaborating with local hospitals to utilize the technology. To broaden the spectrum of potential identifying characteristics, we collected 20 cases with antemortem and postmortem CT images. The results were qualitatively assessed by a forensic pathologist and a nonmedically trained intern, and all cases were correctly identified. This study demonstrates that identification of human remains using visual comparison could be performed with ease by a forensic pathologist with limited CT experience.     

Virtopsy: postmortem imaging of the human heart in situ using MSCT and MRI

The rapid further development of computed tomography (CT) and magnetic resonance imaging (MRI) induced the idea to use these techniques for postmortem documentation of forensic findings. Until now, only a few institutes of forensic medicine have acquired experience in postmortem cross-sectional imaging. Protocols, image interpretation and visualization have to be adapted to the postmortem conditions. Especially, postmortem alterations, such as putrefaction and livores, different temperature of the corpse and the loss of the circulation are a challenge for the imaging process and interpretation. Advantages of postmortem imaging are the higher exposure and resolution available in CT when there is no concern for biologic effects of ionizing radiation, and the lack of cardiac motion artifacts during scanning. CT and MRI may become useful tools for postmortem documentation in forensic medicine. In Bern, 80 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy until the month of August 2003. Here, we describe the imaging appearance of postmortem alterations--internal livores, putrefaction, postmortem clotting--and distinguish them from the forensic findings of the heart, such as calcification, endocarditis, myocardial infarction, myocardial scarring, injury and other morphological alterations.     

A Characterization of Sources of Isopropanol Detected on Postmortem Toxicologic Analysis

Abstract: Isopropanol is an important chemical to forensic pathologists in that intoxication can result in death yet presence does not necessarily indicate intoxication. Several reports have been published, which indicate that isopropanol can be created endogenously in certain situations including diabetes mellitus, starvation, dehydration, and chronic ethanol use; however, a large‐scale analysis addressing all of the possible causes of postmortem isopropanol detection has not been performed. A retrospective review of all cases examined at the Bexar County Medical Examiner’s Office between 1993 and 2008 in which isopropanol was detected in routine alcohol screening was undertaken. The cases were categorized by the source of the isopropanol, and the concentrations of isopropanol and acetone were analyzed. Analysis revealed isopropanol concentrations to be low (<100 mg/dL) in cases of antemortem and postmortem creation and in postmortem contamination and high (>100 mg/dL) in cases of antemortem exposure. These results are consistent with other published reports.     

The use of quantitative light-induced fluorescence (QLF) to identify composite restorations in forensic examinations

There has been a large increase in the number of tooth colored restorations "white fillings" placed in recent years. An increased demand from the public for more aesthetic dental restorations causes a potential problem for forensic dentists who may find the fillings difficult to identify and hence include in postmortem odontograms. This has implications for the accuracy of dental identifications, particularly in situations where limited time is available for postmortem identification, e.g., mass casualty incidents. A new method for the detection of composite restorations is presented. Quantitative Light-induced Fluorescence (QLF) is a technique currently employed to detect small changes in enamel mineral content. An experiment was conducted to determine if the technique would afford a greater degree of contrast between composite and enamel and thus enable the accuracy of composite identification in enamel. Twenty-four previously extracted human premolars were gently cleaned with pumice and wet-and-dry paper. Twelve were subsequently randomly selected and restored on their buccal surfaces with Spectrum (a composite) following manufacturer's instructions. No attempt was made to color match the teeth and all were filled with shade B3. Twelve teeth were left unrestored. QLF and normal white light images were taken of both restored and non-restored surfaces with teeth wet and then dried. Ten forensic dentists were asked on two separate occasions (one month between each attempt) to indicate whether or not they thought the surface was: a) restored or b) unrestored. Results indicate that forensic dentists detected a significantly higher proportion (p<0.005) of filled surfaces with QLF.     

Actin、Dm、Mb和Fn诊断急性心肌梗死的研究

目的探讨Actin、Dm、Fn和Mb在诊断急性心肌梗死中是否具有实际应用价值。方法选取已确诊的30例尸检心脏标本,分为急性心肌梗死组、冠状动脉粥样硬化组及正常心肌组。在心脏左前壁取材,连续切片,分别作HE染色,Actin、Dm、Fn和Mb免疫组化SP法染色,采用图像分析技术客观测量及比较各组标本染色强度。结果在急性心肌梗死组和冠状动脉粥样硬化组中,Actin、Dm和Mb在心肌细胞中表达均明显缺失,而Fn明显表达;而且在这两组间此4项指标表达效果无统计学差异。在正常心肌组中,Actin、Dm和Mb在心肌细胞中表达均无缺失,而Fn不表达。结论Actin、Dm、Fn和Mb对心肌细胞的缺血缺氧十分敏感,能反映明确的心肌坏死,但对坏死发生的机制缺乏特异性,因此用于诊断急性心肌梗死时需慎重。     

Application of ultrasonography to postmortem examination. Diagnosis of pericardial tamponade

In postmortem examination, it is difficult to diagnose pericardial tamponade in a dead body from the findings of conventional external examination alone. However, ultrasonography is a common diagnostic tool for pericardial tamponade in clinical practice. We studied the postmortem diagnosis of pericardial tamponade at external examination level by applying an ultrasonographic device. The ultrasonographic findings were compared with the conventional autopsy findings. Among 455 cases of forensic autopsy in Hamburg and Tokyo conducted within 5 days after death, we successfully diagnosed 11 cases of pericardial tamponade by ultrasound imaging prior to autopsy, and failed to diagnose pericardial tamponade in only two cases. In addition, 79 cases of external examination conducted at the Tokyo Medicinal Examiner's Office were also examined with ultrasonography, and we diagnosed three cases of pericardial tamponade and five cases of pericardial effusion. The differences in ultrasonographic findings between tamponade and effusion were relatively clear. Although autopsy provides definitive evidence for the cause of death, sometimes autopsy cannot be performed due to some social factors. In such cases, conventional external examination alone cannot establish a cause of death by pericardial tamponade, and application of diagnostic imaging technique will be helpful. While CT and/or MRI may provide more detailed information than ultrasound imaging, these techniques require special equipment, room and specialist, and most of all involves high cost, which is perhaps the most important consideration in the present atmosphere of medical cost containment. On the other hand, the ultrasonographic devices we use are compact, and can be used directly at the scene of death. Postmortem application of ultrasonography may be a valuable adjunct in the work of medical examiners and forensic pathologists.     

Sexual abuse and death of an elderly lady by "fisting"

We describe the death of an elderly lady which resulted from the insertion of the hand and forearm into the rectum. The practice of "fisting" is a form of sexual activity confined primarily to the homosexual community. We report this death to alert forensic pathologists to this unusual practice, which can be fatal.     

Anterior thoracic wall trauma in elderly homicide victims. The "CPR defense"

During the course of medicolegal postmortem examinations, forensic pathologists often encounter the sequelae of cardiopulmonary resuscitation (CPR) that was administered by medical and paramedical personnel. A wide variety of CPR-related injuries have been described since the institution nearly 30 years ago of this now common-place emergency technique. The forensic pathologist must be aware of both typical and unusual CPR-related trauma patterns in order to differentiate between injury produced during emergency therapy procedures and injury sustained through other mechanisms (for example, during an assault or an accident). This article describes two recent separate and unrelated incidents in which an elderly woman was murdered. In each instance, bony injuries of the anterior thoracic wall structures were identified during the autopsy. Defense attorneys in each case attempted to use these injuries as proof that their accused clients had performed external cardiac massage on their victims, thus indicating that the homicides had not been intentional, and that the perpetrators showed remorse. These cases are presented, with a discussion of the typical features of CPR-related thoracic wall trauma as compared with willfully inflicted injury.     

Studies of dentition abnormalities in children of the Republic of Armenia for the purpose of personality identification

This paper reports the results of investigations carried out to elucidate the frequency and the structure of various forms of abnormalities of dentition among the children of the preschool and school age in the Republic of Armenia. These data may be of help for the forensic medical personality identification especially for the expertise of unrecognized corpses. Moreover, these data provide an indirect picture of the prevalence of abnormalities of dentition among the adult population of the country. Specifically they may sometimes be used to identify the ethnic and/or racial background of a person.