Histological and immunohistochemical study of Wischnewsky spots in fatal hypothermia

Wischnewsky spots in the gastric mucosa are considered an important finding for the diagnosis of hypothermia-related deaths. In the present prospective histological and immunohistochemical investigation, 14 cases of fatal hypothermia presenting Wischnewsky spots at autopsy were studied. Macromorphologically, the lesions, varying in diameter from 0.1 to 0.4 cm, had a blackish-brownish color and appeared partly lofty, especially on the apex of gastric folds. Histologically, no erosions or ulcers were observed in the gastric mucosa. In some cases, hemorrhages in conjunction with infarctions of the mucosa were observed in the mucosal glands. Those regions, however, did not represent the lesions visible as Wischnewsky spots at the macroscopical level. Immunohistochemical stains were done with a specific antibody against hemoglobin (Dako, Glostrup, Denmark). Wischnewsky spots expressed immunopositivity with antihemoglobin. Concerning the pathogenesis and underlying pathophysiologic mechanisms contributing to the development of Wischnewsky spots, we hypothesize that cooling of the body in the setting of cold ambient temperatures primarily leads to circumscribed hemorrhages of the gastric glands in vivo or in the agonal period, respectively. Subsequently, due to autolysis, erythrocytes are destroyed and hemoglobin is released. Following exposure to gastric acid, hemoglobin is hematinized, leading to the typical blackish-brownish appearance of Wischnewsky spots seen at gross examination. Wischnewsky spots are not equivalent to erosions in terms of histopathological diagnosis but rather represent epiphenomena generated in vivo or in the agonal period of fatal hypothermia.     

Fatal intoxication with amisulpride and presentation of organ distribution

Amisulpride is a substituted benzamide used as an atypical antipsychotic drug. It antagonizes dopamine D2 and D3 receptor-mediated effects with greater affinity for the limbic system suggesting better neurological tolerance than classical neuroleptics. However, occasionally amisulpride intoxications associated with seizures, comatose conditions and agitation, hyperthermia, tachycardia, prolongation of the QT interval and extrapyramidal features have been described. A 27-year-old female with a medical history of psychosis and amisulpride therapy was found dead at home. By means of high performance liquid chromatography coupled with mass spectrometry (LC/MS) an amisulpride concentration of 13.4 mg/l was found in the peripheral blood. A lower concentration in the brain and an extremely high concentration in bile can be explained by the polarity and hydrophobic character of the substance. After macroscopic and histological exclusion of other causes of death the results of the toxicological analysis were consistent with the assumption of a fatal amisulpride overdose.     

Violence or nonviolence: which do we choose?

A large mass of research on violence now exists, yet the utilitarian value of this vast amount of scientific endeavor may be rated as low, comparing it to the levels of violence at all levels abounding in the world today. The author calls for centralizing funding and work on violence at the national level in the United States, perhaps forming a separate National Institute for Violence. In addition to focusing on violence, nonviolence must be studied with more vigor for scientific work in this area to increase in utilitarian value.     

Medicolegal aspects of witnessed suicide due to gunshot to the head. Part 1: Circumstances and psychopathology

In the USA the frequency of witnessed suicide, i.e. suicide committed in the presence of at least one further individual, is reported to range between 5 and 15%. As up to now no detailed analysis of this special issue has been given in the medicolegal literature, this article presents and discusses a number of cases including 8 males and 1 female (age 19-58 years, mean 41.2 years) who had all committed suicide by inflicting a gunshot to the head. In 3 cases post-mortem blood alcohol concentrations of 1.73, 1.88 and 2.23 g/kg respectively were observed. Toxicological tests produced negative results. 5 cases had a medical history of psychiatric disorder with endogenous depression in 3, chronic alcohol abuse and drug abuse with concomitant psychosis in one case each. As far as the motives were known, domestic arguments were of prevailing importance. With one exception the suicides were committed at home. In 6 cases one witness was present, in 2 cases 2 individuals and in one case 22 persons witnessed the suicide. The reported cases are discussed in comparison with the psychiatric-psychological classification according to McDowell et al. with the aim to provide a solid and comprehensive medicolegal method to distinguish between homicide and suicide. Furthermore aspects of psychiatric sequelae and psychological support of the witnesses, which are also of importance for the forensic pathologist called to the scene, are discussed.     

A path model of risk factors for intimate partner violence among couples in the United States

The present study was designed to identify the impact of drinking problems, impulsivity, and a history of childhood physical abuse on both male-to-female (MFIPV) and female-to-male intimate partner violence (FMIPV). The data were collected in 1995 from a representative national sample of couples living in the contiguous 48 states. Using a multistage probability sampling design, face-to-face interviews were conducted in respondent' homes, privately with each member of 1, 635 couples. A complex path model building on earlier work was tested for African American, Hispanic, and White couples separately. Multiple-group path analysis demonstrated that impulsivity, alcohol problems, and childhood physical abuse were differentially associated with reports of MFIPV and FMIPV as a function of ethnicity. This study suggests that a history of being physically harmed by parental figures during childhood, impulsivity, and drinking problems are all risk factors for intimate partner violence in the general household population in the United States.     

Deep incisional neck injuries caused by an electric knife

Electric knives, due to the double blades swinging in opposite directions, have a high injury potential. Tissues such as skin can be cut smoothly without cutting motion and with only little pressure. Authors report on the case of a woman of 47 years who cut herself deeply on both sides of her neck with an electric knife, slightly carving a notch into the larynx and a cervical vertebra and opening large blood vessels. With respect to the extent of injuries the capacity to act had to be questioned. However, considering the absence of venous air embolism and the peculiarity of the tool it had to be assumed that the capacity to act lasted for a short time.     

Conceiling the cadaver in masonry and cement

Encasing with concrete and/or bricks are relatively rare forms of hiding or disposing of a body; criminologically, cases of this kind are often treated as "matters involving a missing person" at first. The article describes the circumstances and findings of 2 cases in which bodies were encased with concrete. Under the aspects of reconstruction it is of importance that bodies may be preserved quite well in concrete, which allows not only identification of the victim but also determination of the cause of death even after a prolonged post-mortem interval, the more so as occasionally tools used for committing the offense are also encased together with the body.     

Reexamining the Relationship Between Fiscal Stress and Outsourcing

The determinants of outsourcing in local government are widely studied from a variety of frameworks. One concept consistently used to explain local government outsourcing is fiscal condition, with many noting that outsourcing is more likely when a local government’s fiscal condition declines into fiscal stress. Despite the ubiquity of this expectation in the outsourcing literature, several articles reviewed suggest that the findings for this relationship remain uncertain. As a result, the research presented in this article sought to examine and extend what is known about the relationship between fiscal stress and outsourcing in U.S. municipalities. The research includes previous measures of fiscal stress and adds new measures. In addition, it tries to overcome the limited theoretical testing of the relationship between fiscal stress and outsourcing by examining both direct and indirect effects of fiscal stress on outsourcing. It finds that municipalities in the United States that are experiencing fiscal stress are more likely to engage in outsourcing, particularly municipalities that are experiencing fiscal stress and have a positive evaluation of the external market to provide services.     

Postmortem distribution of sertraline and desmethylsertraline in a fatality

Sertraline (CAS 79617-96-2) is a relatively safe medication for patients suffering from depression. Data reporting the postmortal distribution of sertraline and desmethylsertraline remain rare as well as reports of risks of side effects following ingestion of the drug. In a case of a young woman found dead in her flat sertraline and desmethylsertraline were identified and quantified in body fluids and tissues by gas chromatography/mass spectrometry and high performance liquid chromatography with diode array detection after alkaline extraction. Sertraline and its desmethyl metabolite were found in the peripheral blood in levels of 0.15 mg/l and 0.20 mg/l, concentrations in liver and bile were markedly higher. By exclusion of other reasons for death a lethal sertraline intoxication was decided. Sertraline is suggested to possess a low inherent toxicity, however, a risk of side-effects which may occur in single cases even under moderate dosages should be considered.     

Satanism and suicide in adolescence--2 case reports

Death cases--suicides as well as homicides--within the context of satanism are meanwhile becoming routine casework for forensic pathologists. Therefore the investigators should be aware of satanic signs and items associated with the occult to identify a satanic background. Based on two suicides of young persons, satanic signs helpful for classification are pointed out.