Chemical burn from alkaline batteries--a case report.

A 2-year-old male was found to have a third degree (full thickness) burn on his rear right thigh. The father discovered the burn at a physician's office where the child was being treated for an ear infection. The physician notified authorities of suspected physical child abuse.     

Virtopsy--fatal motor vehicle accident with head injury

A man wearing no protective helmet was struck by a motor vehicle while riding a bicycle. He was loaded on his left side, and the impact point of his head was his occiput on the car roof girder. He was immediately transported to the general hospital, where he passed away. Postmortem examination using multi-slice computed tomography (MSCT) revealed an extensively comminuted fracture of the posterior part and the base of the skull. Observed were deep direct and contrecoup brain bruises, with the independent fractures of the roof of the both orbits. Massive subdural and subarachnoidal hemorrhage with cerebral edema and shifting of the mid-line towards left side were also detected. MSCT and autopsy results were compared and the body injuries were correlated to vehicle damages. In conclusion, postmortem imaging is a good forensic visualization tool with great potential for documentation and examination of body injuries and pathology.     

Burn injuries caused by a hair-dryer--an unusual case of child abuse

About 1.4-26% burn injuries in children appear to be abusive in origin. A 2.5-year-old girl was referred to our institute because of suspected child abuse. Clinical examination and later interrogation of the mother revealed non-recent deep second degree burn injuries on both gluteal regions, caused by the partner of the mother by pressing a hand-held hair-dryer against the skin. The authors present the findings of this unusual method of child abuse.     

Burn disasters in shooting range areas

Shooting range injuries are generally caused by ballistic accidents, and so far no burn disaster has been reported. In this article we reported a disaster caused by a gunpowder explosion in an indoor shooting range area in Istanbul, Turkey. Fourteen injured people were evacuated from the scene. Our burn center accepted 7 of them. Of the 7 injured people, 2 who were accepted by our burn center, and 3 people who were admitted by another center died. It is clearly identified how this mechanism of injury differs from that of usual burn injuries, due to both the high temperature generated, and the combination of hot and toxic gases produced by the explosion. We described the features of burn injury, and possible reasons of burn disasters.     

Charred body: virtual autopsy with multi-slice computed tomography and magnetic resonance imaging

The correct examination of a charred body is a forensic challenge. Examination, interpretation, and conclusion in respect to identification, vital reactions, toxicological analysis, and determining cause and manner of death are all more difficult than without burns. To evaluate what can be seen in the case of a charred body, we made an examination with the new radiological modalities of cross-section techniques, via multi-slice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI), prior to performing the classical forensic autopsy. In a charred body case of a single motor vehicle/fixed object collision with a post crash fire, the radiological methods of MSCT and MRI made it possible to document the injuries caused by burn as well as the forensic relevant vital reactions (air embolism and blood aspiration). In conclusion, we think postmortem imaging is a good forensic visualization tool with a great potential for the forensic documentation and examination of charred bodies.     

少量矿物油燃烧所致烧伤特点

目的观察少量矿物油燃烧所致烧伤的特点,探讨其形成机制。方法介绍3例法医实际尸检案例所见烧伤,并将其特点与法医病理学文献所载烧伤特点比较。结果少量矿物油燃烧所致烧伤,一般仅限于皮肤的角质表皮层,或者真皮浅层;主要是Ⅰ度红斑烧伤;烟熏征象突出;毛发被烧程度不重,有的仅见一片发梢被烧卷的痕迹;局部烧伤与非烧伤部位之间界限分明;衣物上的烧痕,有时仅限于局部表层纤维。结论少量矿物油燃烧所致烧伤与通常所见到的有机物燃烧所形成的烧伤不同,其形成与少量矿物油燃烧时高温作用的持续时间短,产生较多烟雾有关。     

Searching for Kin Amidst Tragedy—Disaster Victim Identification Operations for US Bangla Flight 211

The nature of air disasters includes factors that exacerbate challenges in the identification process. Of the 49 deceased in the US Bangla air crash in Kathmandu, Nepal, four were intact, 11 presented with burn injuries, another 11 presented with partial charring, and 23 were completely charred. Personal belongings were useful in the identification phases for all types of victims. Fingerprints were obtainable and useful in intact victims and victims with less severe burn injuries; medical and surgical information was useful in bodies with burn injuries; finally, dental findings were useful in cases of extensive charring. Other useful methods in the process included marks of identification, physical features, and exclusion. In certain resource‐limited settings, especially in closed population disasters, where scientific identification (DNA, dental records, etc.) is not currently available, personal belongings, clothing, and physical findings analyzed by an identification team using a structured organization may be cautiously used as the primary means of identification.     

Bruise Documentation,Race and Barriers to Seeking Legal Relief for Intimate Partner Violence Survivors: a Retrospective Qualitative Study

Documentation of physical injuries from intimate partner violence (IPV) is critically important when a victim seeks legal help. Bruising, a common IPV injury, is often less visible on victims of color. This retrospective qualitative study is focused on IPV survivors’ and service providers’ experiences with the complex interrelationship between IPV injury, bruise documentation, race and legal assistance. Focus group results with a racially diverse group of female IPV survivors and legal service providers indicate that all victims struggle with documenting their bruises, but for women of color, even documentation of visible bruising underrepresents the severity of their IPV injuries. Further, there are a number of social, logistic, and systemic barriers to injury documentation that may make legal relief for IPV difficult for all women, but particularly more difficult for women of color. Proposed solutions to address the gap include, improved documentation techniques, and greater education for legal service providers. Implications for the field of family violence generally and potential future research directions are also discussed.     

Vital animal predation of the genital region caused by a mongrel dog

A 79-year-old man, who was in a helpless situation due to cardiac decompensation, suffered dog bite injuries on the left thigh and in the genital region while still alive. Two extensive soft-tissue defects with contused and bruised wound edges were surrounded by multiple slit-like skin lesions. The outer genitals were almost completely missing. Because of surgical emergency treatment, molecular biological investigations were no longer possible. Therefore, the cause of the bite injuries had to be determined solely on the basis of the documented morphology of the wounds.     

Determination of questionable suicide as a homicide by studies of criminal stains

In a woman found dead with cuts on both arms in a domestic sauna plastered with blood were assumed next to a bleed to death. The question self-infliction or by a third party of arm injuries could not be decided. By investigation of blood traces only could be clarified the cause of death. The husband had strangled his wife and inflicted several cuts on both arms with a razor blade to simulate suicide. Afterwards, he also inflicted several cuts on himself with a razor blade with the intention of suicide. He survived these injuries.     

Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration

Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high‐detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.     

Unusual blunt force wound patterns due to a hexagonal steel bar

Pathologists routinely examine victims with blunt force traumatic injuries. Many of these victims exhibit injury patterns that can help identify the weapon used in the assault. Proper documentation that accurately portrays the injury pattern and allows for comparison with recovered weapons is therefore essential. Our office investigated a homicide with unusual blunt force injuries. This article presents the procedure that we followed to identify the weapon.     

Nonterrorist suicidal deaths involving explosives

Suicidal deaths involving explosives unconnected to terrorism are rare. The investigation of deaths from explosive devices requires a multidisciplinary collaborative effort, as demonstrated in this study. Reported are 2 cases of nonterrorist suicidal explosive-related deaths with massive craniocerebral destruction. The first case involves a 20-year-old man who was discovered in the basement apartment of his father's home seconds after an explosion. At the scene investigators recovered illegal improvised power-technique explosive devices, specifically M-100s, together with the victim's handwritten suicide note. The victim exhibited extensive craniofacial injuries, which medicolegal officials attributed to the decedent's intentionally placing one of these devices in his mouth. The second case involves a 46-year-old man who was found by his wife at his home. In the victim's facial wound, investigators recovered portions of a detonator blasting cap attached to electrical lead wires extending to his right hand. A suicide note was discovered at the scene. The appropriate collection of physical evidence at the scene of the explosion and a detailed examination of the victim's history is as important as documentation of injury patterns and recovery of trace evidence at autopsy. A basic understanding of the variety of explosive devices is also necessary. This investigatory approach greatly enhances the medicolegal death investigator's ability to reconstruct the fatal event as a means of separating accidental and homicidal explosive-related deaths from this uncommon form of suicide.     

Homicide with postmortem opening of the thoracic and abdominal cavity--morphological, criminological and forensic-psychiatric aspects

During a walk a man found the partially unclothed body of a 16-year-old girl in a field near a village in South Baden. The body showed numerous injuries caused by sharp force. Several stab wounds were discernible on the neck, the chest, the genital region, the back and the right thigh. Postmortem, the anterior wall of the trunk had been severed with one long cut reaching from the mons pubis to the jugular fossa. The injuries and the scene suggested homicide with a sexual motive. Already on the next day a male suspect was ascertained. Blood traces of the victim could be demonstrated on his car. The man confessed the homicide, but did not describe the course of events in detail. He denied a sexual motive for the homicide. The psychiatric examination did not furnish any clues to internal, neurological or psychiatric disorders. The perpetrator did not claim intoxication for the time of the offence, which might have been relevant for the question of criminal responsibility. Psychodiagnostically, it was found that he had a narcissistic personality structure with a pronounced lack of self-esteem, deficits in affect processing and control as well as anxiety and aggression problems. The man was sentenced to life imprisonment for murder.     

A Holistic Multi-Scale Approach to Using 3D Scanning Technology in Accident Reconstruction

Three-dimensional scanning and documentation methods are becoming increasingly employed by law enforcement personnel for crime scene and accident scene recording. Three-dimensional documentation of the victim's body in such cases is also increasingly used as the field of forensic radiology and imaging is expanding rapidly. These scanning technologies enable a more complete and detailed documentation than standard autopsy. This was used to examine a fatal pedestrian-vehicle collision where the pedestrian was killed by a van while crossing the road. Two competing scenarios were considered for the vehicle speed calculation: the pedestrian being projected forward by the impact or the pedestrian being carried on the vehicle's bonnet. In order to assist with this, the impact area of the accident vehicle was scanned using laser surface scanning, the victim was scanned using postmortem CT and micro-CT and the data sets were combined to virtually match features of the vehicle to injuries on the victim. Micro-CT revealed additional injuries not previously detected, lending support to the pedestrian-carry theory.     

Fatal exsanguination following complete transection of femoral vessels due to angle grinder injury in an industrial accident

Angle grinders are one of the most dangerous and frequently used tools in industrial settings. Angle grinder injuries range from superficial cuts to deep penetrating injuries with underlying fracture-dislocation and vascular trauma. The injuries caused by angle grinders mostly involve the head, face, or upper limbs, while the lower limb is an unusual site. The high-speed rotating disc of the angle grinders does not respect anatomical boundaries or structures; therefore, the injuries caused may be disfiguring, permanently incapacitating, or even fatal. We report a fatal case of an angle grinder injury to the lower limb. The victim sustained a sharp cut over the left thigh while woodworking in an industrial setup. The rotating disc of an angle grinder had transected the skin, subcutaneous fat and muscles, and both the femoral vessels of the left side, which led to fatal exsanguination within 10 min of the incident.     

Saddle Pulmonary Embolism with Paradoxical Coronary Artery Embolism through a Patent Foramen Ovale

A 35‐year‐old male patient was found in cardiac arrest in his vehicle, with no apparent injuries after a minor motor vehicle collision. The decedent was found to have a saddle pulmonary embolus with a thromboembolus impacted across a patent foramen ovale and a paradoxical embolism in the circumflex coronary artery, as well as significant clotting in the deep veins of both lower extremities. There were no risk factors in his history to explain the deep venous thrombosis; family history suggested the possibility of an unrecognized clotting disorder.     

Biomechanical conditions of developing injuries sustained from falling from a height

Evaluation of the height from which human fell from his/her tissue and organ injuries is discussed. The authors of available publications paid the principal attention to estimation of the height from which the victim fell without consideration for the kinetic energy of the body, which depends not only on the height from which the victim fell, but on his/her body weight as well. Primary external and primary internal injuries are distinguished, which are determined by the area of contusion during landing; secondary contact injuries which form during inertial movement of the body after the first contusion, and injuries due to negative acceleration during contusion when landing (so-called signs of total body concussion) are also distinguished. The totality of all listed injuries helps estimate the total kinetic energy at the moment of contusion and determine the height of falling, with due consideration for anthropometric characteristics of the victim.     

Children with burn injuries--assessment of trauma, neglect, violence and abuse

Burns are an important cause of injury to young children, being the third most frequent cause of injury resulting in death behind motor vehicle accidents and drowning. Burn injuries account for the greatest length of stay of all hospital admissions for injuries and costs associated with care are substantial. The majority of burn injuries in children are scald injuries resulting from hot liquids, occurring most commonly in children aged 0-4 years. Other types of burns include electrical, chemical and intentional injury. Mechanisms of injury are often unique to children and involve exploratory behavior without the requisite comprehension of the dangers in their environment. Assessment of the burnt child includes airway, breathing and circulation stabilization, followed by assessment of the extent of the burn and head to toe examination. The standard rule of 9s for estimating total body surface area (TBSA) of the burn is inaccurate for the pediatric population and modifications include utilizing the Lund and Browder chart, or the child's palm to represent 1% TBSA. Further monitoring may include cardiac assessment, indwelling catheter insertion and evaluation of inhalation injury with or without intubation depending on the context of the injury. Risk factors and features of intentional injury should be known and sought and vital clues can be found in the history, physical examination and common patterns of presentation. Contemporary burn management is underscored by several decades of advancing medical and surgical care however, common to all injuries, it is in the area of prevention that the greatest potential to reduce the burden of these devastating occurrences exists.