Osteological case study to narrow the timing of postmortem trauma to a skull

In the course of an exhumation performed 5.5 years after death, several bone fragments were uncovered during the excavation of the clay-rich soil. Amongst others, there was a large piece of the frontal neurocranium. In addition, a so-called coffin stain was discernible. The exhumed coffin was intact. The forensic autopsy revealed a complete corpse with distinct adipocere formation. Consultation with the cemetery administration allowed the conclusion that the additional bone fragments were from the first use of the grave approximately 100 years ago. The heavily soil-encrusted skull fragment bore clear signs of a half sharp force, that could immediately be classified as postmortem. The pattern of injury pointed to an excavator as the cause. However, the question arose whether the postmortem trauma occurred 5.5 years ago during the excavation of the grave or during the current exhumation. First the skull fragment was dried. However, it was then impossible to remove the clay-rich soil without damaging the bone. The fragment was therefore carefully washed and dried again. The cut and fracture areas then showed distinctly lighter surfaces than the rest of the bone, which pointed to the exhumation as the time of origin. For comparison, fresh injuries were inflicted with a hatchet. These distinctly showed even lighter surfaces, so that the time of origin could be assumed to have been during the excavation of the grave 5.5 years ago.     

The role of trauma in postmortem blood alcohol determination

In postmortem cases, a blood sample is frequently obtained by transthoracic (TT) puncture. The purpose of this study was to determine if, in traumatic death, blood samples collected by TT provided a valid sample for blood alcohol analysis. A retrospective study (1980–1986) was conducted to evaluate possible contamination of blood by GI alcohol in traumatic death cases. Out of 6000 cases reviewed, 19 cses with BACs >500 mg/dl were found and 8 of these cases involved traumatic death with GI laceration and/or transection. The results of this study support the hypothesis that blood samples from the 8 cases had been contaminated, resulting in a falsely elevated BAC. A transthoracic study (1987–1989) was conducted under controlled conditions, where blood alcohol content of TT blood samples was compared with samples collected from the intact heart chamber. Seven out of 28 cases of traumatic injury revealed trauma to the GI tract. The results showed that when GI traumatic injury occurs and unabsorbed ethanol is present in the stomach, contamination of TT blood samples occurs and artificially elevated BACs are obtained. It is recommended that, in cases of traumatic injury, heart blood samples from the intact heart chamber, as well as samples of additional biological fluids, be collected to rule out the possibility of contamination and to ensure that the BAC used for forensic interpretation is accurate.     

Pseudo-subarachnoid hemorrhage of the head diagnosed by computerized axial tomography: a postmortem study of ten medical examiner cases

In this report, we describe ten cases of pseudo-subarachnoid hemorrhage on computer axial tomography (CT) scan of the head. A pseudo-subarachnoid hemorrhage is a false positive finding by CT of the head in which the scan is interpreted as being positive for a subarachnoid hemorrhage not substantiated by subsequent neuropathologic findings. This study is a retrospective review of postmortem cases brought into the Office of the Chief Medical Examiner for the State of Maryland over a three-year period (from 1997 to 2000). We compared the clinician's impression of the CT scan with the postmortem neuropathology. The clinical diagnosis of subarachnoid hemorrhage was based on misinterpretation of non-contrast CT scans of the head. In six of the ten cases, the reading was performed by a radiologist and in four cases by nonradiologist physicians (emergency room physician, neurologist, or neurosurgeon). All the patients survived between a few hours to a few days after being admitted to the hospital. For most of the cases (80%), the neuropathology showed hypoxic/ischemic encephalopathy. The most common cause of death (four out of ten cases) was narcotic intoxication. This report is submitted so that clinicians and pathologist become more familiar with this entity.     

高位视路损伤与管内段间接视神经损伤的比较

目的 探讨高位视路损伤的法医学鉴定问题。方法 搜集11例头部外伤致高位视路损伤的案例资料,与随机选取的20例管内段间接视神经损伤的案例资料进行比较,并就相关临床检查所见、电视野及闪光VEP特征进行分析。结果 与视神经损伤相比,高位视路损伤的临床常规检查,除视功能障碍的主诉外瞳孔对光反射及眼底均无阳性所见;电视野检查表现为双眼同向性偏盲,管内段视神经损伤表现为单眼视野缺损。在11例高位视路损伤者中,8例为枕叶皮层损伤,闪光VEP表现为双眼P1波潜伏期轻度延长,波幅基本正常;3例为皮层下损伤,表现为P1波潜伏期明显延长,波幅明显降低。视神经损伤闪光VEP表现为伤眼PI波潜伏期明显延长,波幅明显降低,甚至无波诱出。结论双眼视野同向性偏盲是高位视路损伤的特征性改变,高位视路损伤闪光VEP的异常率较低,但一旦双眼闪光VEP异常可以支持高位视路损伤的诊断,鉴定时应同时结合头颅CT及脑电图结果综合分析,加以确认高位视路损伤的存在。     

超生反应阶段人骨骼肌对电刺激反应的形态学研究

利用人骨骼肌在死亡早期阶段能对电刺激产生兴奋和收缩的特点，以加大刺激强度为手段，对18例死亡早期阶段（1小时25分至6小时40分）具有超生反应能力的尸检骨骼肌和17例稍晚阶段（10～60小时）不具有超生反应能力的尸检骨骼肌，进行了电刺激损伤的系列形态学对比研究。结果表明，死亡早期阶段的肢体骨骼肌，经电刺激后，能产生整个肌肉或局部肌肉的收缩；在电极周围以及电路中的肌纤维形成大片的极具特点的收缩带、条带状嗜酸性变、高度变形的节段状和盘片状崩解等改变；稍晚期阶段受刺激的肌纤维则未见上述改变。探讨形态学改变的形成机理及意义，为研究死亡早期阶段的电损伤提供形态学基础。     

Structure of the hypothalamic nuclei in a severe craniocerebral trauma

Large- and small-cell hypothalamic nuclei from 30 males who died of craniocerebral trauma were studied. Number of neurons at different stages of neurosecretory process was calculated in the large cell nuclei (supraoptic and paraventricular nuclei). Mean volume of neuron karyon (MVNK) was estimated in all the nuclei as a neuron function index. It was found that the proportion of neurons at different stages of the neurosecretory cycle is changed in large cell nuclei. This points to impaired synthesis of neurosecretion. Significantly increased MVNK of the neurons of paraventricular, arcuate and posterior nuclei was detected. The above evidence demonstrates activation of humoral hypothalamic regulation of the endocrine and immune systems.     

甲拌磷在大鼠体内的死后分布研究

目的建立甲拌磷灌胃染毒致死的大鼠动物模型,建立生物检材中甲拌磷的气相色谱和气相色谱质谱联用检测方法 ,观察甲拌磷在3种剂量染毒大鼠体内的死后分布特点。方法大鼠2LD50、4LD50或8LD50甲拌磷灌胃染毒,死后立即解剖,采集心、肝、脾、肺、肾、脑、肌肉、睾丸、心血和胃组织,GC/MS、GC/FPD法定性定量检测各组织和心血中甲拌磷。结果大鼠2LD50、4LD50和8LD50甲拌磷染毒后31±3min、19±4min和11±6min死亡。气相色谱和气相色谱质谱联用法均可检到甲拌磷。染毒死亡大鼠体内甲拌磷的含量由高到低顺序依次为：2LD50组：胃组织〉肝〉脾〉肾〉肺〉脑〉睾丸〉肌肉〉心〉心血。4LD50组：胃组织〉肝〉肺〉脾〉肾〉睾丸〉肌肉〉脑〉心〉心血。8LD50组：胃组织〉肝〉肾〉脾〉肺〉心〉肌肉〉睾丸〉心血〉脑。结论甲拌磷在大鼠体内死后分布不均匀。胃组织中含量最高,其次是肝、脾、肺和肾,脑、肌肉和睾丸含量最低。甲拌磷的灌胃染毒致死动物模型、气相色谱和气相色谱质谱联用方法及死后分布规律可应用于甲拌磷中毒死亡案件的法医学鉴定和法医毒物动力学研究。     

重型颅脑损伤患者P300与智商的相关性

目的研究重型颅脑损伤患者认知功能的改变以及事件相关电位(event-related potential,ERP)中的P300成分与智商的关系。方法对40例重型颅脑损伤患者进行听觉P300检查并用中国修订韦氏成人智力全量表测定智商,另外用40例正常成年人作为对照组也进行P300的检查。结果病例组P300潜伏期较正常组明显延长(P<0.01),病例组P300的潜伏期与操作智商和总智商之间呈显著负相关(r=-0.335、-0.344,均P<0.05)。结论ERP是测定重型颅脑损伤患者认知功能变化的一项客观指标。     

Significance of the recent extraction to the postmortem dental identification: a case study

This case report illustrates the significance of the partially healed extraction site to the postmortem dental identification process. It presents the remains of two individuals with documented extractions--one, 6 1/2 months prior to death, the second, only three weeks prior to death. These photographs, compiled with others, can be used as a guideline for the forensic scientist who seldom has the opportunity to study skeletonized remains.     

The clinico-morphological basis for a diagnosis of diffuse axonal brain damage in head trauma

The most typical neurologic signs and variants of computer-tomographic cerebral picture in diffuse axonal lesion of the brain are presented. Dynamics of pathomorphologic changes depending on duration of posttraumatic periods is detected.     

死后尸体CT在法医学鉴定中的应用价值初探

目的 对不同类型案件中的死者进行死后尸体CT扫描和常规尸体解剖,探索PMCT在法医学鉴定中的应用价值.方法 对7例因不同原因死亡的个体进行全身PMCT扫描,随后进行系统的尸体解剖,通过比较两种方法检测的结果,分析PMCT与传统尸体解剖在不同类型案件中应用的优点和不足.结果 在7个案例中,尸体上总共检出67处阳性发现.其...     

大鼠创伤性脑损伤后Bcl-2及Fas-L的表达

目的 观察大鼠创伤性脑损伤后,脑组织中Bcl-2及Fas-L不同时间的表达变化,探讨其与脑损伤经过时间的关系。方法 自由落体法制作大鼠脑创伤模型,在伤后不同时间处死动物并取材后,进行Bcl-2、Fas-L免疫组织化学(SP法)和HE染色观察;图像处理大鼠脑挫伤后不同时间Bcl-2及Fas-L免疫反应阳性细胞并进行统计学分析。结果 染色阳性细胞主要分布在挫伤灶的周围。Bcl-2在伤后30min即有阳性表达,后逐渐加深;至伤后4h达高峰,然后随时间延长,阳性细胞染色强度逐渐减弱。脑挫伤后30min,损伤灶的周围即出现Fas-L阳性表达,随后呈缓慢增长;从伤后4h,Fas-L阳性反应的程度及数量逐渐显著增加。结论 脑挫伤后Bcl-2和Fas-L的表达在伤后不同时间,呈现一定的规律性变化。     

A study of drug detection in a postmortem pediatric population

At The Office of the Cuyahoga County Coroner (CCCO), Cleveland, Ohio, it is customary to perform an autopsy and conduct toxicological testing on decedents less than 19 years of age. This study provides a retrospective evaluation of drugs detected in a pediatric postmortem population between the years 1998 and 2002 (n = 730). Demographic information, cause and manner of death, and toxicological results were examined. Blacks comprised 54% of cases, males 59%, and 48% were less than one year of age or stillborn. Forty-two percent of deaths were ruled natural, 27% accident, 13% undetermined, 5% suicide, and 2% homicide. Of the 640 cases subjected to comprehensive testing, 38% of the cases were positive for at least one compound. Resuscitative/treatment drugs were detected most frequently (56% of positive results), followed by illicit drugs (26%), ethanol (11%), carbon monoxide (8%), and antihistamines (6%). Eighty-seven cases contained more than one drug. The deaths of 47 individuals were drug related (6%). In this population, it is recommended that illicit drugs and ethanol are targeted for testing, especially when limited specimens are available for analysis.     

The mechanism of facial injury

Medicolegal experts are often asked to explain how, why and when facial injuries occurred. This can only be done satisfactorily if they are considered carefully and if all of the associated features are taken into account. One aspect of the topic which has received scant attention in medical and dental texts is Biodynamics, a brief analysis of the principal features of which is reproduced in this paper.     

SPECT在脑损伤中的诊断价值

单光子发射ＣＴ扫描(ＳｉｎｇｌｅＰｈｏｔｏｎＥｍｉｓｓｉｏｎＴｏｍｏｇｒａｐｈ,ＳＰＥＣＴ)是将注入体内的放射性核素在所要诊断的器官上的浓度积聚进行扫描并显示其立体分布的图像。1960年,Ｋｕｈｌ和Ｅｄｗａｒｄｓ首先开始使用ＳＰＥＣＴ,到了90年代,ＳＰＥＣＴ有了很大的发展。目前的ＳＰＥＣＴ可以进行脑和身体任何部位的断层显像,是临床上常用的一种辅助检查手段。一、ＳＰＥＣＴ脑显像原理与技术从70年代以来,ＣＴ和ＭＲＩ已成为诊断脑外伤的主要手段,其价值也得到相应的肯定。但是,这些扫描方法只能显示外伤所致的解剖结构的变…     

SPECT在脑损伤中的诊断价值

单光子发射CT扫描(Single Photon Emission Tomograph,SPECT)是将注入体内的放射性核素在所要诊断的器官上的浓度积聚进行扫描并显示其立体分布的图像.1960年,Kuhl和Edwards首先开始使用SPECT,到了90年代,SPECT有了很大的发展.目前的SPECT可以进行脑和身体任何部位的断层显像,是临床上常用的一种辅助检查手段.     

Experimental study of postmortem change under field conditions: effects of freezing, thawing, and mechanical injury

Understanding the processes of postmortem change in biologic systems is important to the forensic sciences. Previous experimental studies of postmortem change in animals under field conditions made use of animal carcasses that had been incidentally exposed to the effects of freezing and thawing or mechanical damage, or both, and were limited to gross observations. The current study was designed to document intrinsic processes of postmortem change, and the effects of freezing-thawing and mechanical injury, under controlled conditions in the field, using histologic and microbiologic techniques, as well as gross observation. Insect and microbiologic succession sequences, and patterns of decomposition and disarticulation, were observable over time. Previously frozen-thawed animals showed predominantly decay (aerobic decomposition) in the field, while freshly killed animals showed predominantly putrefaction (anaerobic decomposition). Previously frozen animals showed the same sequence, but accelerated rates, of disarticulation. Mechanically injured tissues showed accelerated rates of decomposition. These findings have implications for the interpretation of results of previous studies, as well as the interpretation of human and animal remains subjected to freezing and thawing.     

Determination of postmortem interval by arthropod succession: a case study from the Hawaiian Islands

A postmortem interval of 34 to 36 days was established for remains recovered on the island of Oahu, Hawaii, based on interpretations of patterns of arthropod succession on the remains. This interval was primarily based on the presence of adult specimens of Philonthus longicornis (family Staphylinidae), mature larvae of Piophila casei (family Piophilidae), and empty puparial cases of Chrysomya rufifacies (family Calliphoridae). Species and developmental stages of two additional Coleoptera species and three additional Diptera species were also present, which was consistent with the estimated interval, although not definitive.