Amniotic fluid embolism-apropos two consecutive cases

Amniotic fluid embolism (AFE) is a sporadic, unpredictable, and usual fatal obstetric complication. The paper deals with two cases of maternal deaths because of AFE verified by medicolegal autopsy. In both the cases, several known risk factors associated with AFE, such as increased maternal age (41 and 35 years), diabetes, augmented labor, and cesarean delivery, were identified. Clinical features were typical, including sudden onset of cardiovascular and respiratory symptoms. In the patient who survived longer, both clinical and autopsy signs of disseminated intravascular coagulopathy were present, while they were absent in the case where death occurred rapidly. This paper describes briefly the particular features to look for at autopsy and stresses the importance of histology examination and staining techniques.     

Identification and analysis of human remains recovered from wells from the 1991 War in Croatia

From 1996 to the present, the remains of 61 individuals killed during the 1991 War in Croatia were recovered from both dried out and functioning wells. Positive identification was established in 60.7% or 37/61 cases. Remains recovered from the same geographical region but from non-well settings were identified in 77.4% or 1256/1623 cases. The purpose of this paper is to report on the taphonomic, demographic and trauma characteristics of remains recovered from wells and identify factors responsible for the discrepancy in the identification ratios. The age and sex distributions in the well and non-well series were similar, as were the frequencies of recovered personal documents, jewelry and other artifacts. The taphonomic features of the remains were, however, significantly different. Preservation of remains was considerably better in non-well settings (1400/1623 or 86.3% compared to 40/61 or 65.5% in wells). Congruently, commingling of remains was more frequent in wells (26/61 or 42.6% compared to 77/1623 or 4.7% in non-well settings). In bodies recovered from non-well settings the preservation, state and commingling of the remains were strongly correlated with positive identification. None of these features were correlated with the identification of bodies from wells. Instead, identification of remains from wells was significantly affected by the presence or absence of water in the well. As both series have similar frequencies, and identical rankings of identification factors, the reason for the discrepancy in the identification ratios lies in the fact that by themselves, these factors were rarely sufficient for positive identification. In both series the majority of identifications (51.4% in the well, and 58.1% in the non-well series) were established through a combination of biological and non-biological features. The significantly lower identification ratio in the well series resulted from the difficult recovery conditions in wells with significant amounts of water, and the negative effect that water had on the preservation of clothing, personal artifacts and some dental features. Significant differences were also noted in the types and locations of perimortem traumas. There is a significantly higher frequency of entrance gunshot wounds to the back of the head, suggestive of execution style murders, in the well series.     

Population genetics of 15 AmpflSTR Identifiler loci in Macedonians and Macedonian Romani (Gypsy)

Allele frequencies of 15 AmpFlSTR Identifiler STR loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA) were analysed in a sample of 100 unrelated autochthonous Macedonian and 102 Macedonian Romani individuals, representing different ethnic groups residing within the same country of Former Yugoslav Republic of Macedonia. The interpopulation comparisons between Macedonians and Macedonian Romani with four south eastern European populations, Kosovo Albanians, Serbians from Vojvodina Province, western Romanians and northern Greeks were performed as well as comparison between Macedonian Romani and Assam population from Asia (India). Reported data point that Macedonian Romani, as an example of an endogamous population of Asian (Indian) origin, show significant allelic differences when compared to neighbouring south eastern European populations.     

Human Y-specific STR haplotypes in population of Serbia and Montenegro

Nine Y chromosome short tandem repeat (STR) loci (DYS19, DYS385, DYS389I, DYS389II, DYS390, DYS391, DYS392 and DYS393) were analyzed in group of 237 unrelated healthy males from population of Serbia and Montenegro in order to assess the frequencies of Y haplotypes. We observed 174 different haplotypes of which 146 (61.6%) were seen only once. Y-STR allelic frequencies in Serbia and Montenegro, in general, correspond to other European populations, except for the DYS19, DYS385 and DYS389II loci.     

Fatalities temporally associated with the ingestion of ibogaine

Ibogaine is a naturally occurring psychoactive plant alkaloid that is used globally in medical and nonmedical settings for opioid detoxification and other substance use indications. All available autopsy, toxicological, and investigative reports were systematically reviewed for the consecutive series of all known fatalities outside of West Central Africa temporally related to the use of ibogaine from 1990 through 2008. Nineteen individuals (15 men, four women between 24 and 54 years old) are known to have died within 1.5-76 h of taking ibogaine. The clinical and postmortem evidence did not suggest a characteristic syndrome of neurotoxicity. Advanced preexisting medical comorbidities, which were mainly cardiovascular, and/or one or more commonly abused substances explained or contributed to the death in 12 of the 14 cases for which adequate postmortem data were available. Other apparent risk factors include seizures associated with withdrawal from alcohol and benzodiazepines and the uninformed use of ethnopharmacological forms of ibogaine.     

Pontomedullary lacerations in falls from a height--a retrospective autopsy study

Brainstem pontomedullary laceration (PML) in falls from a height appears as isolated cases and usually in feet-first impacts with a ring fracture. The aim of this study was to determine the frequency of PML in falls from a height, as well as the frequency of concomitant head and neck injuries. Out of 261 cases, PML was present in 40. An impact to the chin, as well as a feet- or buttocks-first impact, most often led to PML owing to transmission of the impact force. Also, a lateral, frontal, or posterior head impact, with subsequent hinge fracture, as well as the frontoposterior hyperextension of the head associated with an upper spine fracture, could be possible mechanisms of PML in falls from a height. The jawbone and other facial bones act as shock absorbers, and their fracture diminishes energy transfer toward the skull and protects the brain and brainstem from injury.     

Pontomedullary lacerations in unhelmeted motorcyclists and bicyclists: a retrospective autopsy study

ABSTRACT: Pontomedullary lacerations (PMLs) have often been reported in car occupants and pedestrians, are less frequently described in motorcyclists, and are very rarely described in bicyclists. The aim of this study was to determine the frequency of brainstem PMLs among fatally injured motorcyclists and bicyclists as well as the frequency of concomitant cranial, facial, and cervical spine injuries in such cases. A possible underlying mechanism of PML in fatally injured motorcyclists and bicyclists might thus be established. Of 443 cases of fatally injured motorcyclists and bicyclists, a sample of 381 cases of fatally injured motorcyclists and bicyclists with head injury of Abbreviated Injury Scale score of 3 or greater was formed and further analyzed. This group was composed of 345 men and 36 women. The average age was 48.8 ± 20.8 years (range, 15-99 years). In the analyzed sample group, there were 158 motorcyclists and 223 bicyclists. Partial PMLs were present in 44 cases (12%) within the sample of 381 head injuries, which breaks down to 40 men and 4 women. In our study, the impact area on the head and the specific skull base fracture type were good predictors of either PML occurrence or absence (B = -2.036, Wald = 161.312, P < 0.01, for the whole model). Impact to the chin, with or without a skull base fracture, most often led to this fatal injury due to impact force transmission, either through jawbone or vertebral column. Also, lateral head impact, the most frequent in bicyclists, with subsequent hinge fracture, PML, and frontoposterior hyperextension of the head that is associated with upper spine fracture, could be possible mechanisms of brainstem injury in fatally injured motorcyclists or bicyclists. Our study showed that the jawbone, as well as other facial bones, could act as shock absorbers, and their fracture could diminish energy transfer toward the skull and protect the brain and brainstem from injury.     

Keeping the pieces together: comparison of mass grave excavation methodology

Mass graves are a complex and confusing mix of bodies, body parts, soils, artifacts, and other feature evidence. Forensic investigations of these complex crime scenes should attempt to maximize the collection of evidence, which includes the mortal remains, in their best possible condition as they were deposited within the graves. Two standard methods of mass grave excavation were examined with the aim of identifying the better approach. Two experienced teams using different methodologies excavated two separate but very comparable mass graves located in the same area. Single disarticulated skeletal elements not associated with a body at the time of removal from the grave were categorized and their counts analyzed to evaluate the efficiency of the differing excavation methodologies. The methodologies used were the 'pedestal' method, which focuses on the body mass, and the 'stratigraphic' method, in which the grave feature and contents are conjointly excavated. The first grave (Grave A), excavated using the 'pedestal' method, was observed to have a disproportionately larger amount of unassociated bones than did the second (Grave B), which used the 'stratigraphic' method. Chi-square (chi2) goodness-of-fit and contingency tests were performed on the total numbers of recorded elements and different categorical groups of bones, based on size and shape, in each grave. Results demonstrate that significantly greater numbers of unassociated elements resulted from the excavation of Grave A using the pedestal method, both in total number of disarticulated bones as well as within 'large' and 'medium' categories. Conversely 'small' skeletal elements were recovered at a higher rate in Grave B. The lower 'large' and 'medium' bone production rates from Grave B indicate that the stratigraphic method better maintained the provenience and articulation of remains than did Grave A, while the higher 'small' bone recovery rate may point to better recovery techniques of Grave B's excavation team.