Body packing: the value of modern imaging procedures in the detection of intracorporeal transport media

The necessity of rapid objective appraisal of the suspicion of intracorporeal drug smuggling (body-packing) by effective methods of investigation in the course of the first criminal investigation department measures raises the questions of suitable and admissible methods. The proportion of undetected crimes in intracorporeal narcotic smuggling must be rated as very high according to the data of the Federal Criminal Investigation Department. In the present paper, the suitability of various imaging techniques for drug detection are reported in terms of their risk, practicability and costs. For this purpose, the value of digital radiography, two-spectra radiography and X-ray computer tomography as compared to conventional X-ray investigations is examined in human experiments. A reality-oriented narcotics dummy (glucose pressed hard in preservative) was developed and administered to nine volunteers per os with a variable initial alimentary situation. Four radiograms were taken at fixed times up to 12 hours after administration with each imaging technique. The highest rate of detection was attained with computer tomography. In contrast to the other methods, more than 90% of the body packs could be identified here. Nevertheless, an application in criminal investigation practice cannot be recommended owing to various disadvantages. The recovery rate of the remaining methods is between 20% and 25%.     

Death of a twin--infanticide or intrauterine fetal death?

The authors report an intrauterine death in a twin pregnancy. Due to external circumstances, infanticide was initially suspected. Forensic examination of fetus and placenta, however, revealed a placental cause for the death of the twin. The macerated fetus, which had been retained for at least one week, was expelled, apparently unnoticed, shortly before the live birth of the hypotrophic second twin. The question of the possibility of unnoticed fetus expulsion was discussed.     

Determination of sex with a discriminant analysis of new pelvic bone measurements: Part II

The pelves of 100 white skeletons were measured on both sides for the following: (1) length from the superiormost aspect of the pubic symphysis to the nearest rim of the acetabulum (PS-A), (2) length from the highest point of the pubic tubercle to the nearest rim of the acetabulum (PT-A), (3) acetabular diameter (AD), (4) the vertical distance from the anterior aspect of the ischial tuberosity to the farthest rim of the acetabulum (IT-A), and (5) greatest femur head diameter. From these, three indices were derived: AD/PS-A (acetabulum/pubis index), AD/PT-A (acetabular diameter/pubic tubercle-acetabular rim index), and IT-A/PS-A (ischium-acetabulum height/pubic symphysis-acetabular rim index). The left AD/PS-A ratio and left IT-A height proved statistically to be of greatest discriminating value. Using these two variables, a discriminant function was derived which correctly separated 98% of our sample. The acetabulum/pubis ratio alone correctly assigned 95%. With either the discriminant function analysis of two variables or the acetabulum/pubis index as a single predictor, 97% of our sample of known sex was correctly identified if all specimens that fell within a doubtful or overlapping range of values were sorted by femur head diameter.     

Involuntary administration of medication in the community: the judicial opportunity

In a state in which patient refusal of antipsychotic medication in all nonemergency situations must be respected, lawyers and psychiatrists in western Massachusetts have employed probate court decisions as involuntary outpatient treatment orders. The legal, administrative, and clinical issues in sustaining court-ordered outpatient treatment are discussed by focusing on case examples demonstrating some successes, some challenges, and some failures. Judicially sanctioned involuntary outpatient treatment presents an alternative model to statutorily based outpatient commitment.     

Sudden natural death at the wheel--a particular problem of the elderly?

Thirty-nine autopsy cases of sudden natural death at the wheel were analysed with special respect to the questions if this is a peculiar problem of the elderly and if there are particular pathological features in the elderly. The ages ranged from 33 through 83 years and the median age was 56.4 years. 97% of the deaths were attributable to cardiovascular diseases, about 90% to coronary heart disease. People older than 60 years of age tended to exhibit severe chronical arterio-sclerotic changes of the coronary arteries, especially multiple calcified stenoses and myocardial scars, but there was a low percentage of recent thrombotic occlusion of a coronary artery.     

Atypical "body packing syndrome"--a case report

A case of ingested cocaine is reported in which death must be classified as body packer syndrome although both the temporal relationship and the number of packets were atypical. The deceased, a consumer of hard drugs who smuggled for his own use, was found in his flat. He was resuscitated and survived for another four days in hospital. Only four intact drug packages were found in the upper gastro-intestinal tract. The concentrations of cocaine in blood and organs were relatively low but in a potentially lethal range. The case is presented, and its particularities as well as the option of induced vomiting as a way of preventing the fatal outcome are discussed.     

Interdisciplinary cooperation of forensic sciences--results of a simulation exercise

In a workshop held on the occasion of the foundation of the INFW, the Interdisciplinary Network of Forensic Sciences (www.infw.org), 14 scientists from 10 fields of expertise were allotted to 3 teams. Each team had to independently solve the same fictitious forensic case. In this, several corpses or skeletons in varying degrees of decomposition were found in the remains of an old bunker during a large building project. After a set time limit of 45 minutes, the approaches to the task were noted on individual flipcharts by each team. A comparison of the solutions suggested by the three very heterogeneously composed teams revealed a high degree of similarity. However, particularly the "exotic" disciplines developed surprising approaches. The experiment was an interesting and instructive experience for all participants and underscores the necessity of interdisciplinary cooperation in solving complex forensic questions.     

Fatal bromethalin poisoning

Bromethalin is a neurotoxin found in some rodenticides. A delusional 21-year-old male presented to a hospital with altered mental status the day after ingesting a bromethalin-based rodenticide. He died 7 days after his self-reported exposure to c. 17 mg bromethalin (equivalent to 0.33 mg bromethalin/kg). His clinicopathologic course was characterized by altered mental status, obtundation, increased cerebrospinal fluid pressure, cerebral edema, death, and diffuse histologic vacuolization of the white matter in the central nervous system seen on microscopic examination at autopsy. The presence of a demethylated form of bromethalin in the patient's liver and brain was confirmed by gas chromatography with mass spectrometry. Clinical signs and lesions observed in this patient are similar to those seen in animals poisoned with bromethalin. This case illustrates the potential for bromethalin ingestion to result in fatal human poisoning.