Search

Following the death of a woman with blunt force chest trauma, the question was asked how common was the finding at autopsy of a flail chest in decedents after failed cardiopulmonary resuscitation. It was suggested in court that this was an uncommon occurrence. To address this issue, autopsy cases in adults (>18 years) with rib fractures attributable to cardiopulmonary resuscitation were taken from the files of Forensic Science SA over a 7-year period from 2008 to 2014. Flail chest injuries were defined as those arising from fractures at two sites in at least three consecutive ribs. From 236 cases with rib fractures attributed to resuscitation, a total of 43 flail chest injuries were found in 35 cases (14.8%). The majority occurred in the 60-79-year-old age group. These data suggest that flail chest injuries are a more common sequelae of cardiopulmonary resuscitation than has been previously appreciated in autopsy cases, particularly in the elderly.

Careful examination of the skin and soft tissues is a routine part of the forensic autopsy to identify and characterise traumatic lesions. Three cases are reported where benign vascular lesions presented as bruises. In case 1, a 44-year-old man with a history of epilepsy was found dead on the floor. Dissection of the neck revealed a haemorrhagic area 15 mm × 1.5 mm, deep to the left thyrohyoid muscle. In case 2, an 87-year-old man was found dead with a plastic bag over his head attached to an opened cylinder of nitrogen gas. On the mucosal surface of his upper lip, there was an apparent 5 mm blue/purple bruise. In case 3, examination of the back of a 16-month-old girl revealed an apparent 15 mm bruise. Histological examination of all three lesions revealed benign vascular lesions. In the absence of microscopy, these lesions would have been considered traumatic in origin, raising the possibility of inflicted trauma.

Sudden cardiac death among children and young adults is a devastating event. We performed a prospective, population-based, clinical and genetic study of sudden cardiac death among children and young adults.We prospectively collected clinical, demographic, and autopsy information on all cases of sudden cardiac death among children and young adults 1 to 35 years of age in Australia and New Zealand from 2010 through 2012. In cases that had no cause identified after a comprehensive autopsy that included toxicologic and histologic studies (unexplained sudden cardiac death), at least 59 cardiac genes were analyzed for a clinically relevant cardiac gene mutation.A total of 490 cases of sudden cardiac death were identified. The annual incidence was 1.3 cases per 100,000 persons 1 to 35 years of age; 72% of the cases involved boys or young men. Persons 31 to 35 years of age had the highest incidence of sudden cardiac death (3.2 cases per 100,000 persons per year), and persons 16 to 20 years of age had the highest incidence of unexplained sudden cardiac death (0.8 cases per 100,000 persons per year). The most common explained causes of sudden cardiac death were coronary artery disease (24% of cases) and inherited cardiomyopathies (16% of cases). Unexplained sudden cardiac death (40% of cases) was the predominant finding among persons in all age groups, except for those 31 to 35 years of age, for whom coronary artery disease was the most common finding. Younger age and death at night were independently associated with unexplained sudden cardiac death as compared with explained sudden cardiac death. A clinically relevant cardiac gene mutation was identified in 31 of 113 cases (27%) of unexplained sudden cardiac death in which genetic testing was performed. During follow-up, a clinical diagnosis of an inherited cardiovascular disease was identified in 13% of the families in which an unexplained sudden cardiac death occurred.The addition of genetic testing to autopsy investigation substantially increased the identification of a possible cause of sudden cardiac death among children and young adults. (Funded by the National Health and Medical Research Council of Australia and others.).

Animals may be responsible for an array of potentially lethal injuries. Blunt force injuries characteristically involve larger animals such as cattle or horses that may kick, crush, or trample a victim causing head and facial injuries. Farm workers in particular are at high risk of lethal injuries involving the head and torso. Significant blunt trauma may be found in vehicle occupants after collisions with large animals such as camels or moose. Rarely, zookeepers may be crushed by particularly massive animals such as elephants. Sharp force injuries usually involve carnivore bites, most often from dogs with a "hole and tear" pattern of wounding. Injuries from animals such as alligators and sharks may have a significant component of crushing. Incised wounds may result in death from exsanguination and air embolism. On occasion, blunt or sharp trauma from animal activity may be confused with postmortem damage or with inflicted injury from an assault.

In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids.

Case reportA 47-year-old man with a history of alcoholic liver diseasewas found dead at his home address on the floor, lying facedown. He had been unwell for 2 months prior to death andhad complained of abdominal pain. He also had a diagnosisof prolonged QT interval.At autopsy there was no evidence of liver failurealthough the liver was fatty and fibrotic. There was acongenital anomaly of the coronary arteries with the cir-cumflex coronary artery arising from the right sinus ofValsalva with significant narrowing of the ostium. Therewas no evidence of trauma and toxicological screening ofblood was unremarkable. Biochemical analysis of vitreoushumor revealed elevated sodium (144 mmol/L) and creat-inine (217 lmol/L) levels in keeping with terminal dehy-dration and renal failure, with a normal b-hydroxy butyrate(thus excluding alcoholic ketoacidosis).Althoughthebrainappearedexternallyunremarkablewithnovermal atrophy of the cerebellum, sectioning of the mammillarybodiesdemonstratedsymmetricalhemorrhagehighlysuggestiveof Wernicke encephalopathy (Figs. 1, 2). Focal hemorrhagicareas were also noted within the walls of the third ventricle.Microscopically the mammillary bodies displayedrecent microhemorrhages and prominent microvascularproliferation with endothelial swelling typical of Wernickeencephalopathy (Fig. 3). The mammillothalamic tracts andthe walls of third ventricle also contained microhemor-rhages. There was patchy microvacuolation of the neuropilwith unremarkable neurons, fibrous astrocytes, and occa-sional perivascular macrophages containing hemosiderin,indicative of more chronic disease. Mild extravasation oferythrocytes and prominent congested vessels were notedwithin medullary dorsal motor vagal nuclei.Death was attributed to natural causes, most likelyinvolving a combination of cardiac and alcohol-relateddisease. The striking finding was of clinically unsuspectedWernicke encephalopathy.DiscussionWernicke encephalopathy is a neurological disorderresulting from thiamine (vitamin B-1) deficiency [1].Although in Western countries it occurs predominantly inalcoholics, related to poor dietary intake and impairedutilization, it can also be caused by a variety of otherconditions that interfere with normal thiamine metabolism.These include starvation, bariatric surgery, hyperemesisgravidarum, human immunodeficiency virus/acquiredimmunodeficiency syndrome (HIV/AIDS), and in infantsgiven thiamine-deficient formulas [1, 2].The clinical prevalence of Wernicke encephalopathy isuncertain as autopsy studies indicate that the condition islikely under-diagnosed during life [3]. Delay in diagnosismay result from nonspecific symptoms that resembleintoxication. The symptoms, severity, and the regions ofthe brain that are affected are also variable due to a

Epidemiologic and experimental data support the notion that Ljungan virus (LV), endemic in some rodent populations in Sweden, Denmark, and the United States, can cause morbidity and mortality in animals and humans. LV infection can cause type I diabetes mellitus, myocarditis, and encephalitis in bank voles and experimental mice, and lemmings. Mouse dams infected with LV experience high rates of stillbirth that may persist across generations, and their fetuses may develop cranial, brain, and limb malformations. In humans, epidemiologic and serologic data suggest that LV infection correlates with intrauterine fetal death, malformations, placental inflammation, myocarditis, encephalitis, and Guillain-Barré syndrome. The proposed role of LV infection in SIDS is unconvincing. Further research is necessary to clarify the role of LV infection in animal and human disease.

The identification of tattoos often provides important forensic information when investigating criminal activity. Tattoos may be used by police intelligence as a source of identification of known criminals. Tattoos may be effaced by laser surgery so that they can no longer been seen by visual inspection of the skin. However, remnants of pigment persist within the dermis. This paper describes a novel technique using infrared photography that can demonstrate the presence of tattoos that have been ablated by lasers. The method provides adequate detail of the tattoo's characteristics to aid in forensic identification. A literature search did not reveal any known methods of detecting latent residue inks after removal or detecting alteration of a pre-existing tattoo.

The cause of sudden death in young people remains unknown in up to 50% of postmortem cases. Mutations in the ion channel genes are known to cause primary arrhythmogenic disorders such as long QT and Brugada syndromes, which can present with sudden cardiac death and a negative autopsy. In this study, 59 sudden unexplained deaths occurring in Australians aged ≤35 years with a negative autopsy, from 1994–2002, were studied. Genomic DNA was extracted from paraffin-embedded tissues. Genetic analysis of the KCNQ1 and SCN5A genes was performed using denaturing high-performance liquid chromatography and direct DNA sequencing. Nine DNA sequence variants were identified in the KCNQ1 gene and 9 sequence variants were identified in the SCN5A gene. In total, 23 out of 59 cases were found to have at least one DNA variant in KCNQ1 or SCN5A , of which one, H558R in the SCN5A gene, caused an amino acid substitution. None of the DNA variants were determined to be disease causing as they were also identified in control populations. In conclusion, no disease-causing mutations were found in the KCNQ1 or SCN5A genes in this cohort. A more selective screening approach, including only individuals with a clinical or family history of arrhythmogenic disorders, may yield greater success in identifying disease-causing mutations in cohorts of young individuals who have died suddenly.

Hyperspectral (chemical) imaging collects spectroscopic data in a two-dimensional spatial format. The potential application for the determination of the age of bruises is demonstrated and compared to reflectance probe spectrophotometry as well as photography. Blood was deposited on white cotton cloth or injected subcutaneously into pig skin to simulate a ‘fresh bruise’. A mixture of blood and bile was used to simulate ‘old’ bruises. On the cloth background all the photographic methods clearly separated the two groups of samples (i.e. ‘blood only’ from ‘blood plus bile’). However, on the pig skin the two groups could be separated by one of the photographic methods only. Separation of blood from blood and bile mixtures was obtained on the cloth and skin backgrounds using spectrophotometry and hyperspectral imaging. In a test using serial dilutions of blood and bile mixtures, the hyperspectral system performed slightly better than the spectrophotometer. The former also had the advantage of imaging a wider area and providing spatial data. Hyperspectral (chemical) imaging and spectrophotometry are superior to photography for the detection of bilirubin on a background of skin (due to the presence of yellow chromophores); this technology combined with mathematical analysis of the spectral data warrants further investigation.

Background and Objective Bruises are currently evaluated by visual inspection, and little is known about the first phase after injury. The temporal development of fresh injuries must be accurately described to be able to age bruises in a reliable manner. Color changes in a bruise caused by hemoglobin breakdown products will depend on the severity of the trauma, and thus on the local immune response in the skin. It is therefore important to relate the nature of the impact to the temporal tissue responses. Materials and Methods Controlled injuries were inflicted on anesthetized domestic pigs. Trauma was induced either by a pendulum device, or by paintballs released using pressurized air. The speed of the projectiles was recorded using a high speed camera. Biopsies and reflection spectra (400–850 nm) were collected from normal and bruised skin. The experiments were approved by the national animal research authority. Results The temporal development of the injury was found to depend strongly on the weight and speed of the object. Low speed, blunt objects did not cause persistent skin changes. However, deep muscular bleeding could be found in most cases. High speed, light weight objects caused a rapidly developing bruise. These bruises were fully developed within 15–20 minutes. No deep muscular hemorrhages were observed in those cases. White blood cells (neutrophilic granulocytes) could be found in biopsies from high speed injuries. The amount of white blood cells depended on the time between injury and collection of the biopsies. Conclusion Further investigations utilizing a larger range of object weight and velocities are required to be able to fully classify minor traumatic injuries. Preliminary results indicate that this can be achieved by controlled experiments using a porcine model. Reflectance spectroscopy was found to be a useful tool to study immediate skin reactions to the trauma. Lasers Surg. Med. © 2007 Wiley-Liss, Inc.

It might be expected that follow-up telephone communication with next of kin relating to coronial autopsies would be distressing, particularly when made months or even years after the death. However, our experience has indicated that this is not the case in the majority of calls.

Bruises are common injuries that can have medicolegal significance. There are those that maintain it is not possible to estimate the age of bruises. However, appreciation of the biological processes related to the resolution of a bruise suggests that these may provide information regarding the age of a bruise. Potential methods for determining the age of bruises-visual observation, colorimetry, spectrophotometry and histology-are reviewed. The observation of yellow (not orange or brown) indicates a bruise is not recent, but the abilities of visual observation are limited by the physiology of the human eye. Analysis of spectrophotometric data may provide more useful and objective information. Histological examination may be appropriate only in the postmortem situation. The lack of published information limits this as a tool for estimating the age of bruises. It is not known how the wide range of factors that can influence bruise formation and resolution could affect estimation of bruise age.

This study reviews firearm-related deaths (homicidal, suicidal and accidental) from 1994 to 2003 in the Western Sidney area, Australia, serviced by the Westmead Department of Forensic Medicine, in order to document the features of the cases and to assess the effect of the introduction of the NSW Firearms Act in 1996. There were 211 fatalities involving firearms (1.8% of all of the Coroner’s cases for the period); firearm deaths were classified as homicide (75), suicide (134) or accidental (2). There was a clear peak of homicide deaths by firearm in the 20–29 age group, whereas the suicide peak was broad, spanning the ages 20–69 years. More suicides occurred at home than homicides and a higher proportion of suicides were by rifle than homicides, which favoured hand guns. Entry wounds in suicides mostly involved the head, with the chest being the commonest entry site in homicides. The only statistically significant trend was for an increase in the number of firearm-related suicides in males, comparing the number of deaths pre- and post-firearm law introduction. The study includes reports of two suicides by unusual weapons: a home-made pipe gun and a spear gun.

The aim of this study was to identify volatile-free products that would be suitable for stabilizing incinerated dental remains at the scene of an incident, and that would not compromise any postmortem examination.The anterior mandibles of sheep were incinerated, sprayed unilaterally with stabilizing agents, vibrated for 30 s, and assessed. The effect of the stabilizing solutions on radiographic examination was also recorded. Tests for volatility and the effect on human mandibles were also conducted.A flour/water mixture of one part flour to two parts water, and a paste mixture of one part Clag™ glue to one part water both produced significant stabilization results. The flour mixture left an opaque layer on the samples that it was applied to, which still allowed dental examination, but the glue paste mixture resulted in a clearer layer. Both solutions allowed radiographic examination and were free of volatiles.Diluted Clag™ paste, when sprayed on to incinerated remains, assists in their stabilization for transportation. When Clag™ paste is unavailable a mixture of two parts water to one part plain flour could be utilized for stabilization.

An audit was performed to determine the effectiveness of histological sampling of forensic post-mortem cases based on a review of three years' data, which comprised 638 adult autopsy cases. During the study period organs and tissues that appeared macroscopically normal and abnormal were extensively sampled. Histology was regarded as in some way contributory (providing, altering or confirming a cause of death) 53% of the time. The use of histology provided the cause of death in 49 (24%) of the 203 cases not given a cause of death after the completion of the macroscopic examination. When an interim cause of death had been supplied following the completion of the gross examination it was changed in 4.8% of cases, but there were no changes of the manner of death. The majority of the histological diagnoses or discrepancies involved the lungs and the heart. All diagnoses relevant to determining the cause of death would have been made if samples had been taken only from the left ventricle, right ventricle, coronary arteries, lungs, kidneys and brain with any tissue or organ that appeared abnormal macroscopically. A macroscopically identified abnormality that appeared to have been responsible for death was not sampled in 20 cases; consequently, more attention will be paid to sampling macroscopically abnormal tissues. As a result of this audit histology sampling practice has been revised and will be re-audited in the future.

Early expression of p53 protein in thermal burns of guinea pig skin has been reported. This study sought to determine if expression occurred in thermal burns of human skin and if immunohistochemical demonstration of p53 protein could be utilised to distinguish ante-mortem from post-mortem injuries as well as indicating the age of a lesion in the living subject. Biopsy samples were obtained from live patients and post-mortem examinations. Immunohistochemistry was used to demonstrate the presence of p53 protein. Staining was assessed by field counting of epithelial cell nuclei. In live subjects there was a tendency for early (six hour to five day) expression, with peak levels occurring around one to two days. Late samples (13 to 23 days) demonstrated minimal or no expression. In contrast, burn wounds from post-mortem examination demonstrated greater staining for p53 protein in the late (28 to 77 day) samples than in the early ones. It appears that expression of p53 protein may assist in the ageing of ante-mortem, but not post-mortem, burn wounds. This implies that results obtained from live subjects may not be applicable to post-mortem material and that any putative method for determining the age of a wound should be tested in both situations.

Aims: To develop a non-invasive method to demonstrate the presence of haemoglobin and its degradation products in bruises in live human subjects for the purposes of objectively assisting in the determination of the age of a bruise. Methods: The cuvette holder unit of a Cary 100 Bio UV-Visible Spectrophotometer was replaced with the manufacture’s fibre optic cable and optical reflectance probe. The probe was placed on the skin surface. The absorption spectrum from 780 to 380 nm was collected and transformed into the first derivative. Calculation of the first derivative permits absorption attributed to haemoglobin degradation (primarily to bilirubin, but also haemosiderin) to be separated from absorption by haemoglobin. First derivative and colorimetry values, expressed as CIEL*a*b data, were derived from scans of 50 bruises. Results: The fibre optic cable and probe allowed the spectrophotometer to collect reproducible absorption spectra of bruises in the skin of living subjects. A bruise at three days has greater negative first derivative values at 480 and 490 nm than does a fresh bruise, indicating the local degradation of haemoglobin. Correlation between the first derivative and the CIEL*a*b “b” values in a series of bruises indicates that the yellow colour in a bruise is proportional to the amount of local haemoglobin breakdown. Conclusion: The ability to demonstrate the presence of haemoglobin and measure its degradation in bruises in living human subjects by a non-invasive method has not been described previously, and may be of use in the objective ageing of bruises for forensic purposes.

A retrospective study was carried out on 100 randomly selected medico-legal autopsies of victims who had committed suicide by hanging. All cases had undergone full police and coronial investigation. Complete external and internal examinations had been carried out including routine histological examination of organs. The age range of victims was 15-94 years (average, 41.7 years) with a male-to-female ratio of 7:1. External and internal injuries were consistent with the reported events. Diagnoses based purely on histology included hepatic steatosis (n = 16), asthma (n = 3), lymphocytic thyroiditis (n = 2), and pulmonary and cardiac sarcoidosis (n = 1). A large cell carcinoma of the lung and a rectal adenocarcinoma were confirmed. Histological evaluation was, however, of limited usefulness in contributing to the medico-legal evaluation of cases, with careful scene, external and internal examinations providing the most relevant information. The results of histological examination of tissues were all incidental to the cause, mechanism, and manner of death. Language: en

The forensic investigation of a deceased person retrieved following a fire includes measuring carboxyhemoglobin. A carboxyhemoglobin saturation above 10% is considered indicative of respiration during a fire, implying the person had been alive. This relies on the assumption that carbon monoxide will not diffuse into blood used for toxicological analysis. This project investigated the potential for carbon monoxide to passively diffuse into a body and if carboxyhemoglobin levels could become elevated post-mortem. Stillborn piglets with intact skin were exposed to carbon monoxide. Carboxyhemoglobin formed in the hypostasis of the skin, but carboxyhemoglobin levels in blood from the heart and chest cavities were not significantly elevated. However, defects in the skin over body cavities (producing breaches to replicate cases with stab wounds or heat damage) resulted in cavity blood carboxyhemoglobin levels above 10%. A review of fire death cases in South Australia 2000-2015 was performed to determine the origin of the blood samples used for toxicological analysis and the incidence of cases with breaches of body cavities. This revealed a small number of cases in which blood from the cavities had been analyzed when cavity breaches were present. Thus, there is a potential for significant elevation of carboxyhemoglobin saturation post-mortem in forensic casework involving bodies retrieved from fires.

Pseudoaneurysm formation may be a late complication of vascular grafting. A case of sudden death in an 83-year-old woman with a previous aortobifemoral bypass graft is reported that was due to spontaneous hemorrhage from a pseudoaneurysm of the graft site that had eroded through the overlying skin and subcutaneous tissues. Pseudoaneuryms do not have to be of a particularly large size for rupture to occur. Social isolation and age-related cognitive impairment may delay treatment in older individuals resulting in a lethal outcome. The elderly are also more vulnerable to serious morbidity and death under these circumstances owing to significant underlying cardiovascular and respiratory disease and/or anticoagulant medication. Rarer conditions that may cause pseudoaneurysms include tumors and vasculidites. The possibility of an infectious contribution to the pseudoaneurysm should be considered and microbiological sampling undertaken.

Purpose Incinerated human remains may require dental comparison to establish identity. The remains are often fragile and minor forces can damage teeth and facial bones, disrupting anatomical relationships, and impairing the ability to compare with antemortem records. This study evaluated the ability of a commercially available gloss spray to stabilize teeth in incinerated remains. Methods Lower anterior teeth of scavenged sheep mandibles were incinerated in a furnace at a temperature of 500 °C for 35 min. Before a series of vibration tests, the left side of each sample was treated with the spray, with the right side acting as a control. Results Significant retention of dental data was achieved utilizing the spray in comparison to the non-stabilized sides. Conclusion This study showed that a commercial clear gloss spray did not affect the ability to document or perform radiographic assessment of restorations, and statistically improved the stability and anatomical relationships of incinerated dental remains in scavenged sheep mandibles. Commercial products, such as the one tested in this study, are readily available and could be deployed at a mass disaster situation. However, the spray should not be used if there is any suspicion that accelerants might be involved at the scene.

Case reportA 55-year-old male with a medical history of cerebrovas-cular accident, coronary artery bypass grafting, type IIdiabetes mellitus, and infection of the leg (following cor-onary bypass grafting), collapsed after sexual intercourse.Resuscitation was unsuccessful.At autopsy, a healed vertical thoracotomy scar extend-ing to the xiphisternum, associated with underlying denseperi- and epicardial fibrous adhesions was found. Patentcoronary artery bypass grafts were connected to the leftanterior and posterior descending coronary arteries, withthe distal native vessels demonstrating marked atheroscle-rosis with significant stenosis. Myocardial fibrosis with fullthickness scarring of the left ventricular free wall wasconfirmed microscopically, with no evidence of acuteischemic myocardial damage. An area of previous ischemicinjury was identified in the right basal ganglia of the brain.There were no injuries; toxicology and biochemistry testswere unremarkable. No other underlying organic illnesseswere present which could have caused or contributed todeath. Death was therefore attributed to ischemic heartdisease.Also noted at autopsy were multiple rib fractures and alaceration of the liver, the results of attempts at resuscita-tion. Specifically, there were recent fractures (withoutintercostal muscle/soft tissue hemorrhage) of the second toseventh ribs on the left, and the second to ninth ribs on theright, in the mid-clavicular lines. Within the abdomen therewas a 3 cm long vertical laceration of the anterior surfaceof the left lobe of the liver in the midline, which extendedto a depth of approximately 1 cm (Fig. 1). There wassubcapsular bruising surrounding the tear but no intra-abdominal bleeding. Histological examination of samplesfrom the region of the laceration revealed no inflammatoryreaction.Of note, the liver laceration had been caused by a3.5 cm bony spur that projected downwards from thexiphisternum (Fig. 2). The bony spicule measuredapproximately 0.3 cm in diameter and ended in a terminalnodule 0.5 cm in diameter (Fig. 3). The bone spur hadarisen from heterotopic ossification within an area of densefibrous scar tissue associated with the previous coronaryartery bypass surgery. This calcified extension had causedthe tear in the liver when resuscitation was performed.Radiography confirmed the bony nature of the tissue(Fig. 4) and that it was not an extension of the wire suturethat had been used to close the sternum after cardiacsurgery.DiscussionHeterotopic ossification refers to the phenomenon of boneformation within extraskeletal soft tissues or organs. It canfollow trauma, surgery or burns, as well as being found incertain genetic disorders [1, 2]. It may also arise in bothbenign and malignant tumors, the latter caused by possiblestromal fibroblast metaplasia [3]. Heterotopic ossificationhas to be distinguished from extraskeletal or metastaticosteosarcoma as the pathogenesis and prognosis areentirely different [4, 5].

The aim of this study was to ascertain whether apoptotic counts have prognostic significance in colorectal cancer and if such counts are related to the expression of proteins implicated in cell cycle regulation. Material from a cohort of patients aged 45 years or less with colorectal carcinoma was re-examined to determine apoptotic and mitotic counts by light microscopy, in addition to assessing p53, c-myc, and bcl-2 protein status by immunohistochemistry. The apoptotic index in the 74 patients who were alive or who had died of colorectal carcinoma ranged from 1.2 per cent to 12.3 per cent and exhibited independent prognostic significance, with high counts predicting better survival (P = 0.02). Mitotic counts were not related to survival, despite a close correlation with apoptosis (r = 0.85). Tumours regarded as not staining with the CM1 antibody for p53 protein demonstrated higher apoptotic counts, compared with those that stained (medians 5.2 and 4.0 per cent, respectively; P = 0.03), but p53 expression was found not to be related to survival. The 68 tumours which stained for c-myc appeared to exhibit higher mitotic counts than those that did not. bcl-2 was detected in only four tumours. The latter two proteins exhibited no apparent relationship to the apoptotic index or survival. Although these results indicate a potential role for apoptotic counting in prognostic prediction in colorectal tumours, this is an uncommon group of patients who exhibited some atypical features. The likelihood of a proportion of cases arising within hereditary non-polyposis colorectal cancer syndrome may limit the application of the findings to a more general population with cancer of the colon and rectum. Further work is required, including critical measurement of reproducibility and assessment of the relative impact of this parameter compared with 'traditional' prognostic markers.

Summary Aims Biochemical analysis of glucose and ketones in the vitreous humour obtained at post-mortem examination is representative of the levels in the blood prior to death. Elevated levels can be indicative of conditions including diabetic ketoacidosis, which can be a cause for unexpected death. A rapid screening test for such conditions can be performed during the autopsy through urinalysis using test strips (urine ‘dipstick’ testing). The aim of this study was to assess the utility of urinalysis testing for post-mortem detection of derangements of glucose and ketone levels. Methods The results of vitreous biochemical analysis and urinalysis were collated from 188 forensic autopsy cases. Results A vitreous glucose result of above 10mmol/L was regarded as high. When this was compared to urinalysis results it was found that any urinalysis result above negative had a sensitivity of 0.83 and a specificity of 0.93. A vitreous ketone level of above 5 mmol/L was regarded as significantly elevated; a urinalysis result above negative had a sensitivity of 1, but a specificity of 0.12. Conclusions Urinalysis (‘dipstick’ testing) for glucose has a good sensitivity and specificity for high vitreous glucose levels, which are regarded as indicative of pathological hyperglycaemia during life. It was found that urine testing for ketones either has an excellent sensitivity with low specificity or a poor sensitivity with a good specificity; however, this finding has to be viewed in the context of uncertainty of the biochemical level of significant ketosis.

A 44 year old male was found collapsed on his bedroom floor. Investigators at the scene reported a laceration to the back of his head that they believed occurred during the collapse due to an impact on a bedside cabinet. He had a history of epilepsy, which was presumed to be the cause of his collapse. At postmortem examination the body was observed to be that of a male weighing 92 kg and measuring 169 cm in length. His appearance was consistent with his stated age and he seemed well nourished. Assessment of his scalp for the reported laceration revealed an area posteriorly which had a scarred appearance with widely separated, coarse hair follicles 0.3–0.5 cm in diameter, from which multiple hairs protruded (Figs. 1, 2). The area appeared congested and hemorrhagic, consistent with bruising, but there was no laceration or breach of the skin. From the findings of the postmortem examination, which included neuropathological examination of the fixed brain and toxicological analysis, death was attributed to epilepsy. A section of the skin of the scalp was taken for examination to assess the nature of the abnormality and to histologically assess the age of the contusion, to determine any relationship to the cause of death. Under the microscope the skin lesion displayed hemorrhage into the tissue. There was scarring of the dermis with an inflammatory infiltrate comprising predominantly lymphocytes and plasma cells. Sporadically, within the dermis there were abnormal hair structures comprising several coalesced follicles (Fig. 3). These features are consistent with folliculitis decalvans.

Biochemical analysis of the vitreous humor from the eye is an accepted accessory test for post-mortem investigation of cause of death. Modern biochemical analyzers allow testing of a range of analytes from a sample. However, it is not clear which analytes should be requested in order to prevent unnecessary testing (and expense). The means and standard deviation of the values obtained from analysis of the vitreous humor for sodium, potassium, chloride, osmolality, glucose, ketones (β-hydroxybutyrate), creatinine, urea, calcium, lactate, and ammonia were calculated from which the contribution of each analyte was reviewed in the context of post-mortem findings and final cause of death. For sodium 32 cases were regarded as high (more than one standard deviation above the mean), from which 9 contributed to post-mortem diagnosis [drowning (4), heat related death (2), diabetic hyperglycemia (2), and dehydration (1)], but 25 low values (greater than one standard deviation below the mean) made no contribution. For chloride 29 high values contributed to 4 cases--3 drowning and 1 heat-related, but these were all previously identified by a high sodium level. There were 29 high and 35 low potassium values, none of which contributed to determining the final cause of death. Of 22 high values of creatinine, 12 contributed to a diagnosis of renal failure. From 32 high values of urea, 18 contributed to 16 cases of renal failure (2 associated with diabetic hyperglycemia), 1 heat-related death, and one case with dehydration. Osmolarity contributed to 12 cases (5 heat-related, 4 diabetes, 2 renal failure, and 1 dehydration) from 36 high values. There was no contribution from 32 high values and 19 low values of calcium and there was no contribution from 4 high and 2 low values of ammonia. There were 11 high values of glucose, which contributed to the diagnosis of 6 cases of diabetic hyperglycemia and 21 high ketone levels contributed to 8 cases: 4 diabetic ketosis, 3 hypothermia, 3 ketosis of unknown cause, and 2 alcohol related deaths. A high lactate was identified in 25 cases, which contributed to 1 case with a diagnosis of metformin toxicity (1), but none of the 22 low lactate values contributed. The results of this audit have been used to reduce vitreous biochemistry test requests for sodium, osmolality, glucose, ketones, urea, and creatinine in most cases. Critical appraisal of each part of the post-mortem process should be undertaken to provide evidence to justify any investigative methods used in an autopsy.

Whole blood was withdrawn by tail vessel puncture from anesthetized adult male Sprague–Dawley rats and 0.1 ml was re-injected subcutaneously at each of two sites on their abdominal wall. In addition, two adjacent sites were injected with 0.1 ml of sterile saline, and two more sites were only punctured using an injecting needle. In the second part of the study anesthetized adult male Sprague–Dawley rats had two sites on the abdominal wall pinched using a small pair of forceps, two adjacent sites received an injection of 0.1 ml of whole blood obtained by tail vessel puncture, and two more sites were both pinched and injected with 0.1 ml of whole blood. At intervals of 3, 6, 12 h, 1, 2, 3, 5, and 7 days the animals were euthanized and the skin of the abdomen was processed for histological assessment. Hemosiderin staining in tissues from the first part of the study was assessed qualitatively by scoring sections as 0, 1, 2, or 3 (representing no staining, mild staining, moderate staining, and intense staining) and semi quantitatively using a Nanozoomer Digital Pathology Scanner (NDP Scan U10074-01, Hamamatsu Photonics K.K., Japan). No inflammatory reaction was observed at the sites subjected to needle puncture only. At the sites of saline injection a mild reaction occurred. At the sites where the blood had been injected an intense inflammatory cell response occurred centrally, but not toward the periphery where blood had tracked. In the second experiment the most intense inflammation was also observed in the sites where there had been a pinch and injection of blood. Again, this was maximal centrally with reduced inflammation peripherally. Perls’ staining of hemosiderin was comparable in both models, with iron first observed at day 1 at the region of the injection site. At the sites of injection only, and the sites of injection plus pinch, blood had spread laterally. Hemosiderin staining appeared first and more intensely at the site of injection/trauma. The intensity of the inflammatory response in this animal model of bruising was, therefore, directly related to the proximity to the site of trauma; the appearance and intensity of hemosiderin staining was also influenced by the location within the bruises. This study has shown that histological changes that may be utilized to date bruises may be significantly influenced by the site of the biopsy.

The purpose of this study was to investigate if magnetic resonance imaging (MRI) could be used to image the presence of hemosiderin in bruises and if there was the potential for this technique to be applied as a non-invasive method to estimate the age of bruises. To achieve this aim an animal model to produce lesions resembling bruises was created by injecting blood obtained from the tail vein subcutaneously into an area of the abdominal wall. The animals were euthanized at 3, 6, 12 h, 1, 2, 3, 5, and 7 days post injection and the skin of the abdominal wall was excised for MRI scanning and histological examination. The injected blood appeared as hypointense (dark) areas on the T2* MRI at 3 and 6 h. The image of the injected areas became indistinct at 12 h and continued to be indistinct at 1 and 2 days, although there appeared to be transitioning from hypointensity to hyperintensity (light). The magnetic resonance image appeared to better correspond to the histological appearance at 3 and 5 days, with the “bruise” appearing hyperintense (white); however, some hypointense (darker) areas at 3 day possibly corresponded to the development of hemosiderin. At 7 day the injected blood had been converted to hemosiderin with possible correlation between areas of blue staining in Perls’ stained histologic sections and areas of extreme hypointensity in the T2* magnetic resonance image. This study has shown that a series of changes occur on MRI of bruises in an animal model that may relate to histological changes. Although variability in the intensity of the MRI signal and considerable soft tissue artifact currently make interpretations difficult, this may be a technique worth pursuing in the non-invasive evaluation of bruises.

Decedents who are severely decomposed, skeletonized or incinerated present challenges for identification. Cochlear implants aid hearing and bear unique serial numbers that can be used to assist with identification of bodies that are not visually identifiable. The purpose of this paper was to highlight companies that have or had manufactured cochlear type implants and demonstrate the appearance of the implants to assist crime scene investigators, pathologists, anthropologists and odontologists. Investigation of cochlear implants was conducted on the internet and companies were contacted for information regarding their implants. The functional appearance of a cochlear implant is explained, brands of implants are tabulated and pre and post-incineration images are presented. The prevalence of cochlear implants is predicted to increase, thus they are likely to become relevant to the identification process. Company brand and serial markings can be retrieved from post-incineration implants making them a valuable aid in identification when other identifiers that may be present are not useful because they are heat-sensitive.

Objectives: To determine the causes of sudden cardiac death in people aged 35 years or younger. Design and setting: A review of all autopsies performed between 1 January 1994 and 31 December 2002 at a major Sydney forensic medicine department serving an area with over 2 million people. Main outcome measures: Incidence of various types of cardiac disease causing sudden death in those aged 35 years; proportion of deaths in which no cause was found at autopsy. Results: There were 10 199 autopsies performed during the study period. Of these, 2986 (29.2%) deaths occurred in people aged 35 years; 193 were classified as sudden cardiac deaths. The cause of sudden death in this group was not established in 60 (31%), and was presumed to be due to primary arrhythmogenic disorders. Coronary artery disease occurred in 46 (24%), hypertrophic cardiomyopathy/ unexplained left ventricular hypertrophy in 29 (15%), and myocarditis in 23 (12%). Conclusions: Unexplained deaths, presumed to result from sudden primary arrhythmogenic causes, occur in young Australians with structurally normal hearts. That underlying disease-causing genetic defects may be involved has clinical

Exhaust gases which have been subjected to catalytic conversion are non-hazardous when mixed with air. However, death can occur if the effluent is permitted to collect in a confined space, as exemplified by the passenger compartment of a domestic motor vehicle. This report describes the changes in the atmosphere of a car following the diversion of catalytically converted fumes into its interior. An irrespirable atmosphere will result from the accumulation of carbon dioxide with displacement of oxygen, but only after a protracted interval.

Turner's syndrome, the most common sex chromosome disorder of females, is caused by complete or partial loss of one X chromosome and is associated with a wide range of internal and external manifestations and increased mortality rates (three to nine times the background population). While individuals with Turner's syndrome may survive for many decades, premature and unexpected deaths can occur that bring decedents to the attention of forensic examiners. Causes of death in Turner's syndrome are often linked to underlying cardiovascular conditions such as aortic dissection, congenital cardiovascular disease, ischemic heart, and cerebrovascular disease, but deaths due to noncardiac causes also occur with increased frequency. The latter include epilepsy, diabetes mellitus, chronic renal disease, pneumonia, chronic liver disease, and malignancy. Thus, the autopsy evaluation of these cases requires careful examination of all major organ systems, with the consideration of confirmatory cytogenetic testing.

It has been suggested that the weather may promote some types of death; this study sought to determine if types of death in the region around Adelaide, South Australia, occur in non-random clusters and in relationship to the weather. A Poisson model was used to determine if the occurrence of types of death were random. An exploratory analysis was performed for each death type to see if there was a relationship to weather variables using data supplied by the Bureau of Meteorology. Cases examined at Forensic Science South Australia from 1 January 2008 to 31 December 2009 were reviewed. It was ascertained that cardiovascular deaths were distributed non-randomly; there was statistical evidence to suggest that deaths from ischemic heart disease, pulmonary embolus and drug toxicity had non-random occurrence. Maximum temperatures and increases in temperatures correlated with deaths from natural causes, cardiovascular disease, ischemic heart disease and pulmonary thromboembolus; lower hours of sunlight were statistically significant for deaths due to pulmonary thromboembolus. The distribution pattern of deaths resulting from motor vehicle collision did not fit the Poisson (random) model with variation through the week also being present. Non-random clusters of deaths do occur and weather events, such as increase in temperature, are associated with some types of death. However, analysis indicates that the weather is not responsible for all clustering. With regards to motor vehicle collision deaths temporal variation may be related to social factors, such as holiday periods. Further investigation may assist with health resource planning.

Post-mortem hypostasis develops due to passive settling of the blood under the effect of gravity after death. Due to consumption of oxygen in the tissues by residual cellular activity after the circulation has stopped, lividity is composed of deoxygenated blood. It has been previously shown that cooling of a body causes lividity to oxygenate, changing from a dark red/blue to a pink/red color, due to hemoglobin’s increased affinity for oxygen at low temperature. This study has confirmed that this occurs by passive diffusion through the skin, but that this can only occur within a limited time frame. The reasons for this process and its potential forensic application require further investigation.

Spectrophotometry has been investigated as a means to estimate the age of bruises as experiments have indicated that it can be used to detect the presence of degradation products of hemoglobin (bilirubin and hemosiderin). However, there is no data relating spectrophotometric observations to histological findings in bruises of human skin. A small number of bruises in human cadavers were studied by spectrophotometry. The average first derivative value at 490 nm was more negative in bruises with stainable iron (hemosiderin) than in those without, confirming that spectrophotometry observations can indicate the presence of degradation products of hemoglobin in the skin. This confirms spectrophotometry may be a useful tool for estimating the age of bruises.