Fournier Gangrene and Unexpected Death

Abstract: Fournier gangrene represents a rare but progressive perineal infection that may result in rapid death. A 70‐year‐old man with poorly controlled diabetes mellitus and alcohol abuse is reported who was found unexpectedly dead. He had last been contacted the night before his death. At autopsy, the most striking finding was deep necrotic ulceration of the scrotum with exposure of underlying deep muscles and testicles, with blood cultures positive for Escherichia coli. Death was, therefore, attributed to necrotic ulceration/gangrene of the perineum (Fournier gangrene) that was due to E. coli sepsis with underlying contributing factors of diabetes mellitus and alcoholism. In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. Fournier gangrene may be an extremely aggressive condition that can result in rapid death, as was demonstrated by the rapid progression in the reported case.     

Family Violence and Children’s Behavior Problems: Independent Contributions of Intimate Partner and Child-Directed Physical Aggression

Using data from a diverse sample of 581 families living in predominantly low-income, rural communities, the current study sought to investigate the longitudinal associations among father-perpetrated intimate partner violence (IPV) and child-directed physical aggression perpetrated by the mother. The unique contributions of each of these types of family violence on children’s behavioral problems at school entry were also examined. Results confirm bidirectional associations between father-perpetrated IPV and maternal physical aggression directed toward the child, and indicate that both types of physical aggression contribute to child behavior problems at school entry.     

England,Englishness and Brexit

In the 1975 referendum England provided the strongest support for European integration, with a much smaller margin for membership in Scotland and Northern Ireland. By 2015 the rank order of ‘national’ attitudes to European integration had reversed. Now, England is the UK's most eurosceptic nation and may vote ‘Leave’, while Scotland seems set to generate a clear margin for ‘Remain’. The UK as a whole is a Brexit marginal. To understand the campaign, we need to make sense of the dynamics of public attitudes in each nation. We take an ‘archaeological’ approach to a limited evidence‐base, to trace the development of attitudes to Europe in England since 1975. We find evidence of a link between English nationalism and euroscepticism. Whatever the result in 2016, contrasting outcomes in England and Scotland will exacerbate tensions in the UK's territorial constitution and could lead to the break‐up of Britain.     

Stalin. New Biography of a Dictator

Stalin. New Biography of a Dictator . By Oleg V. Khlevniuk. Translated by Nora Seligman Favorov (New Haven and London: Yale university Press, 2015), pp.xvi + 392. Notes. Photographs. Index. AU$64.00 (cloth), distributed by Footprint Books in Australia.     

Brain Fluid Content Related to Body Position and Postmortem Interval – An Animal Model

Adult male Sprague Dawley rats were euthanized and placed in a horizontal or vertical (head‐down) position at room temperature, after which brain fluid content was measured by a moisture analysis technique at variable time points. No significant difference in brain fluid content was observed between horizontal and vertical postmortem positions. A significant increase in brain fluid content was demonstrated 3, 6, and 24 h after death, with maximal fluid content observed at 24 h. Specifically, the brain fluid content of control animals was 77.79 ± 0.36%, increasing to 80.05 ± 0.22% at 24 h (p < 0.0001). This study has demonstrated no significant differences in brain fluid content related to postmortem position, suggesting that a head‐down position is not associated with increased brain fluid content or swelling. However, significant temporal increases in brain fluid content after death, most likely related to cerebral liquefaction, occur.     

An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel

De‐identified wound data from 197 homicidal gunshot postmortems were obtained between 2000 and 2008. Forensic ballistics data were only available for cases between 2004 and 2008. Males represent 91% of gunshot victims and were struck in the thorax/abdomen with an average of 2.3 bullets. The type of firearms involved were semi‐automatic pistols in the predominant caliber 9‐mm Luger and assault rifles in caliber 5.56 × 45 mm and caliber 7.62 × 39 mm Soviet, using full metal jacket bullets. The majority of shootings occurred at ranges of 1 m or greater. The most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back. The most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs were struck by most bullets that entered the thorax.     

Forensic Features of Lethal Late‐Presenting Diaphragmatic Hernias

Diaphragmatic defects are a relatively common and benign finding in adults which may be congenital or secondarily acquired. The case files at Forensic Sciences South Australia were reviewed over a 10‐year period from July 2005 to June 2015 for all adult (>17 years) cases in which diaphragmatic hernias were identified at postmortem examination that had either caused or contributed to death. Five cases were found: age range 49–90 years (average 67.2 years); male:female ratio 2:3. Herniated organs included the stomach (N = 3), small (N = 3) and large intestines (N = 2). Mechanisms of death involved lung compression with respiratory failure and/or mediastinal shift, and vascular compromise with gastric or intestinal infarction and/or perforation. Diaphragmatic hernias may not be identified until the time of autopsy and may be quite complex entities to evaluate due to a lack of clinical history and to difficulties in determining their origin and possible contributions to mechanisms of death.     

Pathological Features of Fatal Crocodile Attacks in Northern Australia, 2005–2014

Eleven deaths from crocodile attacks in the Northern Territory, Australia were reviewed. The male:female ratio was 8:3; age range—10–62 years, average 29.4 years. Four children were included (one boy and three girls, aged 10, 11, and two at 12 years), and there were seven aboriginal victims (64%). The attacks were witnessed in eight cases with the victims swimming in freshwater N = 5, standing on a river bank N = 1, fishing in fresh water N = 1, or diving in the sea N = 1. At autopsy, several distinct patterns of injury were observed ranging from complete traumatic disruption of the body with only incomplete remains for examination (N = 5), to crushing of the head with fractures of the skull (N = 4), crushing of the chest with fractures of the ribs and sternum (N = 2), and avulsion of limbs (N = 4). In one case, there was decapitation. Autopsy evaluations were complicated by decomposition and loss of body parts.