Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as “caput medusae.” Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.     

3D forensic facial approximation: Implementation protocol in a forensic activity

The primary objective of this paper is to report on the successful implementation of forensic facial approximation in a real case in the forensic context. A three‐dimensional (3D) facial approximation protocol of the skull was performed with free software, applying techniques in a virtual environment that have already been consolidated in the literature. The skull was scanned with the photogrammetry technique, the digital replica was imported in the Blender software (Blender Foundation, Amsterdam) and individualized model sketches of the face were traced with the MakeHuman software (MakeHuman Org) according to the anthropological profile of the victim. The face created was imported in Blender, where it was adapted, modeled, and sculpted on the 3D skull and its soft tissue markers, using an American open‐source application of the technique in the digital environment. The face created in a virtual environment was recognized and legal identification procedures were started, resulting in the more agile delivery of the disappeared body to its next of kin. It is therefore concluded that facial approximation may not be a primary method of human identification, but it can be satisfactorily applied in the forensic field as an individual recognition resource. It has great value in narrowing the search, reducing the number of alleged victims, and leading to identification tests, therefore significantly reducing the number of genetic DNA (deoxyribonucleic acid) tests—which are considered costly for the State or Federation—and consequently reducing the waiting time before delivery of the body to its family.     

Primary intimal sarcoma of the pulmonary artery misdiagnosed as pulmonary thromboembolism: A case confirmed at medicolegal autopsy

Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54‐year‐old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.     

Intentional overdose of glargine insulin: Determination of the parent compound in postmortem blood by LC-HRMS

Insulin glargine is a long-acting insulin analog that is converted after enzymatic cleavage of the arginine pair of the β-chain into its main metabolite M1 (21^A-Gly-insulin), which is responsible for the hypoglycemic activity. In all the overdose cases described in the literature, only M1 concentrations have been reported, whereas insulin glargine was always absent or below the limit of quantitation. In this study, we present a case of suicide of a young nurse by injection of insulin glargine in which the parent molecule was found at a toxic concentration in blood. The determination and the discrimination of insulin glargine from human insulin and other synthetic analogs in the blood specimen were performed by liquid chromatography coupled to high-resolution mass spectrometry (Waters XEVO G2-XS QToF) and extraction after precipitation in the presence of bovine insulin (internal standard), with a mixture of acetonitrile/methanol +1% formic acid followed by purification on solid phase extraction cartridges C18. Glargine insulin tested highly positive in the blood with a concentration of 1.06 mg/L. Due to the difficulty in obtaining a M1 pure standard, the metabolite could not be dosed. This unique presence of the parent molecule, reported for the first time, can be explained by inter-individual variability in the rate of conversion to metabolite. Intravenous injection versus subcutaneous injection can also explain the presence of insulin glargine. Finally, the dose injected may have been so high that saturation of the proteolytic enzymes responsible for conversion to M1 should have occurred.     

Radiodense bullet wipe around osseous entrance gunshot wounds

“Bullet wipe” is the material deposited by a bullet on any surface with which it comes into contact after it is fired and may contain debris from the gun barrel, including particles of primer and metal fragments from previously fired bullets. X‐ray analysis is a non‐destructive method by which traces of metallic elements can be visually detected. The analysis of osseous defects for radiodense bullet wipe (RBW) assists in determining the presence or absence of perforating gunshot wounds, especially in fragmented, skeletonized remains. The aim of our current study was to determine the frequency of RBW around entrance firearms injuries that perforated bone. We prospectively analyzed entrance gunshot wounds for RBW over a three‐year period using digital X‐ray analysis (n = 59). We retrospectively reviewed the corresponding autopsy reports to determine the frequency of RBW by biologic sex, reported ancestry, age‐at‐death, location of wound, manner of death, range of fire, bullet caliber, and presence of bullet jacket. Data were analyzed by Fisher's exact test or Chi‐square test with significance levels accepted at p < 0.05. RBW was present in 66% (n = 39) of examined cases. Decedent characteristics did not significantly alter RBW distribution, including biologic sex (p = 0.75), reported ancestry (p = 0.49), and age‐at‐death (p = 0.43). Additionally, the location of the osseous entrance gunshot wound, manner of death, range of fire, and cartridge caliber did not affect RBW detection. All cases involving non‐jacketed rounds (n = 5) showed RBW (p = 0.30). To our knowledge, this study is the first to report the frequency of RBW detection from osseous entrance gunshot wounds.     

“Rose is a rose is a rose is a rose” – what about code and law?

Law and information technology are interlinked. Since Lessig's “code is law” the discussions address the viability of law in technology markets. But recently, the direction of view has changed by way of conversion; in the context of smart contracts, the notion “law is code” became prevalent. The contribution looks into the interdependencies between law and code and pleads for a new functional understanding of law.     

The influence of paternal substance abuse and difficult temperament in fathers and sons on sons' disengagement from family to deviant peers

This study was undertaken to examine the relative contribution of paternal history of substance abuse and difficult temperament in fathers and sons on a panel of individual, family, and interpersonal risk factors shown to be associated with deviant peer affiliations among boys. Deviant peer affiliations among boys have been associated with development of a conduct disorder and early age substance use. In a sample of sons of substance abusing fathers (n =56) and normal fathers (n=94), a structural equation path analysis revealed that the conjoint influence of paternal history of substance abuse and difficult temperament in fathers and sons influenced family and interpersonal processes that, in turn, influenced the developmental trajectory of the child toward deviant peer affiliations. The full model (F=74.49, p<.001, Stability Index=0.70) explained 50% of the variance on sons' Peer Delinquency Scale scores. Implications for primary prevention are discussed.Supported by the Center for Education and Drug Abuse Research (CEDAR), Pittsburgh, PA. Funded by the National Institute on Drug Abuse (No. DA 05605) and ROIs DA08540 and AA09985 to the first author. CEDAR is a consortium between St. Francis Medical Center and the University of Pittsburgh.Received Ph.D. from University of Pittsburgh. Research interests include temperament, parent-child relationships, peer affiliations, and drug and alcohol abuse.Received Ph.D. from University of Oklahoma. Research interests include etiology and vulnerability to substance abuse.Received Ph.D. from Queens University. Research interests include the etiology of conduct disorder.Received Ph.D. from University of Pittsburgh. Research interests include social environment risk factors for substance abuse.Received Ph.D. from Penn State University. Research interests include temperament and substance abuse.     

THE POLITICS OF MICROECONOMIC REFORM: STRUCTURING A GENERAL MODEL1

Abstract: This paper examines the current endeavours to render the Australian economy more economically efficient. While the case for microeconomic reform is clear in economic theory, Australian public policy analysts are less sanguine about the possibilities for its long-term success. This paper seeks to develop the parameters of a simple general model to explain both why microeconomic reform proposals are dominant today on the Australian policy agenda and, more importantly, what the conditions are for their success or failure. This general model provides a framework that will allow further elaboration in case studies of particular episodes of microeconomic reform.
The paper concludes pessimistically; micro-economic reform has been subsumed into the normal political agenda contests of Australian party politics. The pressures of such "politics" inclines Australian reforming towards incrementalism, rather than the Simon-style rationalism implicit from micro-economics. This mode of policy implementation will inhibit microeconomic reform in the longer term.