Trials and tribulations of using beta-amyloid precursor protein immunohistochemistry to evaluate traumatic brain injury in adults

Axonal pathology is increasingly identified by beta-amyloid precursor protein (betaAPP) immunohistochemistry in the brains of patients who may or may not have a history of trauma. The presence of betaAPP-IR(+) has been variously interpreted as either that diffuse traumatic axonal injury (TAI) is indeed a universal finding in cases of fatal traumatic brain injury (TBI) or there are other causes of betaAPP-IR(+) axons which under certain circumstances may be sufficient to mimic TBI and therefore make the medico-legal interpretation of certain cases very difficult. To address some of the uncertainties we have undertaken a detailed analysis of the amount and distribution of betaAPP immunohistochemistry in 63 cases of fatal TBI, 17 cases of patients dying after cardiac arrest, 12 cases dying in association with status epilepticus, 3 cases of carbon monoxide (CO) poisoning, 13 cases of hypoglycaemia and in 60 controls. Three patterns of betaAPP-IR(+) were identified. First, diffuse multi-focal, second, corresponding to the outline of an infarct or haematoma, and thirdly a mixture of the two. The first pattern was seen in cases of the lesser grades of TAI, CO poisoning, and hypoglycaemia, the second pattern in cases in which there was evidence of raised intracranial pressure and the third in cases of severe TAI. It is concluded that the proper interpretation of cases requires the examination of a sufficient number of blocks ( [Formula: see text] ), processing using standardised protocols including betaAPP immunohistochemistry and in some cases the mapping of any IR(+) on anatomical line diagrams. betaAPP carried out on a small number of randomly taken blocks is likely to lead to misinterpretation of the clinico-pathological correlations and possibly to a miscarriage of justice.     

Accidental insulin overdose

Exogenous insulin has been used for many years to treat diabetes mellitus. Due to the complex nature of insulin therapy, there have been numerous accidental overdoses by these patients. Unfortunately, in other instances, insulin has been used as an agent for suicide and homicide in diabetics as well as nondiabetics. Presented here is a fatal case of accidental insulin overdose in a nondiabetic. Following the case presentation, we review insulin pharmacology and the methods of diagnosing insulin overdose postmortem. In any case of insulin overdose, a comprehensive scene investigation to document the amount and type of insulin used, along with information revealing the source of the insulin is critical. In addition, a complete autopsy, including appropriate laboratory studies, is needed to make a diagnosis in these cases. Proper attention should be given to collection and storage of blood samples, as these specimens often yield the strongest evidence of insulin overdose.     

Neurovisualization methods in diagnostics of consequences in light craniocerebral trauma

The purpose of the case study was to elucidate the frequency rate of pathological changes as registered by computer tomography (CT) and magnetic-resonance tomography (MRT) of the head in patients with chronic cerebral blood-circulation deficiency (CBD), functional disorders and vegetative nervous pathologies in presence (in their medical histories) of closed-type cranial trauma concomitant with concussion of the brain (CB) or without such trauma. A comparative analysis revealed a minor prevalence in the number of pathological changes in patients with CBD concomitant with CB. As for other nosological forms, the quantities of changes, expressed in percent, were virtually identical. A conclusion was made on the need to examine the patients of the discussed category by neurovisualization in the acute and remote periods of trauma.     

The role of retroperitoneal hematomas in thanatogenesis of pelvic trauma

A brief statistical analysis of the pelvic hematomas' evolution in traumas with various localizations is presented in the article. The current published data were made use of to describe the state-of-art for the time being. Finally, problems related with the forensic-medical aspects of the issue are defined, and methods to cope with them are appropriately suggested.     

The identification of antigens of systems AB0, GM,and haptoglobin (HP) phenotypes in mixed bloodstains of human and domestic goose

The traditional methods of investigations according to systems AB0, Gm and Hp were used to define the serological specificity of home gooses' blood. The experimental examinations' results related with mixed bloodstains of man and home gooses are described. A possibility is demonstrated to identify the blood group factors of man in bloodstains with admixture of home-goose blood.     

Diagnostics of the skeletal massiveness and human somatotype using hand bones

The skeleton massiveness (SM) and the somatotype of human constitution were determined on the basis of osteometry of bones of carpal and metacarpal bones (MB) and of phalanxes. Seventy male and 13 female skeletons from the collection of the chair for anthropology, Moscow State University, were investigated. Described are the results of examinations of 8 carpal bones made according to 3 signs (length, width, and height), and of 5 metacarpal bones made according to 4 signs (length, base and head width, and base height); investigation findings of finger phalanxes (in full) are also presented. Methods of current multidimensional statistics were used within the case study, i.e. related with the key components--for SM specification and the discriminative analysis--for constitution specification. The SM determination accuracy according to type A was 40%, according to type B--80%, according to type C--37.5% and according to type D--52.9%. The classification accuracy of constitutions by carpal bones was 50.0%, by MB--46.4%, and by MB plus finger phalanxes--48.1%. It is pointed out that it was for the first time that the elaborated quantitative criteria of osteometry of hand bones could be used in the expertise practice for the purpose of personality identification by osseous remains.     

A method for exposing the intraosseous portion of the carotid arteries and its application to forensic case work

A method that allows extraction of the intraosseous portion of the carotid arteries is presented, along with four cases to illustrate its application to forensic case work. The method described permits a cosmetically acceptable reconstruction.