Legal Medicine最新文献

Primary head injury is often followed by secondary brain damage. However, the association between injury circumstances and the prevalence of secondary injuries remains unclear. We report the prevalence and association of secondary brain injuries with the circumstances in which a head injury was sustained. The sample comprised 76 neuropathologically examined medico-legal autopsy cases with an acute primary head injury. Neuropathology reports were analysed to determine the prevalence of various secondary injuries, i.e., hypoxic-ischaemic neuronal injury, brain oedema, and vascular axonal injury (VAI). The prevalences were compared between cases from three distinct injury circumstances, i.e., fall, assault, and strangulation. The sample had a median age of 49 years (interquartile range 27–73) and 71.1% were identified as male. As for distinct injury circumstances, the sample comprised 14 fall cases, 21 assault victims, and 6 strangulation victims. The prevalence of hypoxic-ischaemic neuronal injury was highest in strangulations (100.0%), followed by assaults (81.0%) and falls (64.3%); of specific brain regions, statistically significant differences between the three case groups were found in frontal and parietal cortex (p ≤ 0.018) and the hippocampus (p = 0.005). Brain oedema was present in approximately half of assault (47.6%) and strangulation cases (50.0%), contrastingly to the lower prevalence in falls (7.1%; p = 0.024). The prevalence of VAI appeared higher among assault (23.8%) and strangulation cases (16.7%) compared to falls (7.1%), but the differences were not statistically significant. We conclude that hypoxic-ischaemic neuronal injury and brain oedema were more prevalent among assault and strangulation cases compared to falls.

Aggression, understood as intentional actions aimed at causing harm, remains in a direct relation with the phenomenon of interpersonal violence, especially its physical form. Creating an objective marker of aggression would be an important tool for preventing, protecting the victims and maintaining control over suspects. There have been attempts to link aggression with shifts in hormone levels, including those that can be measured in saliva, especially testosterone and cortisol. The systematic review aimed to assess changes in salivary hormone levels among perpetrators of violence, with particular emphasis on physical violence, as parameters pointing to perpetrators of violence. Following the inclusion and exclusion criteria, 22 studies were included. Most of the papers included in the analysis came from the USA and Europe. Studies typically included adults as well as children, while focusing mainly on men. Among the hormones, salivary testosterone levels were the ones analyzed most frequently. On the basis of the included studies, a meta-analysis was conducted on the relationship between aggressive behavior and the levels of concentration of testosterone and cortisol measured in saliva. Regardless of gender, individuals exhibiting aggressive behavior were proved to have significantly higher testosterone levels and lower cortisol concentrations in saliva measurements. The obtained results indicate the feasibility of using the examined parameters for initial detection of perpetrators of aggression-related violence. However, further research is necessary to more precisely determine the relationship between aggressive behavior and hormonal changes in order to determine the feasibility of using these parameters as an objective marker for early identification of perpetrators.

Forensic practitioners need contemporary anthropological data for the identification of human remains. The clavicle possesses a high degree of variability in its anatomical, biomechanical, and morphological features that are sex-dependent albeit population specific. The aim of this study was to develop sex estimation models for Malaysian individuals using post-mortem computed tomographic images of the clavicle. Sample comprised scans of 2.0 mm resolution of 405 individuals (209 male; 196 female) aged between 19 to 88 years. These scans were reconstructed and visualized using Infinitt. Six clavicular measurements (i.e. maximum length, C1; midshaft circumference, C2; midshaft maximum diameter, C3; midshaft minimum diameter, C4; maximum breadth of the sternal end, C5; and maximum breadth of the acromial articular surface, C6) were obtained from these images. Data were analyzed using descriptive statistics and discriminant function analysis. Measurements taken from the images were highly precise (ICC = 0.770–0.999). There is a significant difference between all parameters and sex (p < 0.001), however none for age and ethnic group. A multivariate sex estimation model was developed: Sex = (C1*0.86) + (C2*0.236) + (C3*-0.145) + (C5*- 0.074) − 17.618; with an accuracy rate of 89.1 % and sex bias of −3.2 %. Lower accuracy rates were obtained for single variable models (61.5–83.2 %). The resultant sex discriminant models can be used for estimating sex based on the clavicle in our local forensic practice.

The process of personal identification differs according to the state of preservation of the corpse, becoming more complicated when dealing with remains altered by taphonomic variables. Since 2015, the staff of the Laboratory of Forensic Anthropology and Odontology (LABANOF) of the University of Milan has been engaged in recovering the skeletons of 36 unknown people from the cemeteries of the city of Milan, to redraw their biological profiles and give them back the possibility of being identified. Of the 36 starting skeletons, 7 have been identified and therefore are not the object of this study, 25 individuals were previously subjected to an autopsy examination and 4 skeletons were studied for the first time in the present work. The post-mortem data of all the individuals who had previously undergone autopsy and had not yet been identified (n = 25) have been retrieved from the archives of the Institute of Forensic Medicine in Milan and allowed for a comparison with those obtained from the new anthropological study of each exhumed skeleton. The authors aim to present the three most interesting cases to better highlight the results that emerged from the comparison. The autopsy information alone lacked important details. In all cases, the anthropological examination proved to be capable of detailing the biological profile of the unknowns even after a long period of inhumation (even more than 20 years). The limitations of instrumental investigations in achieving the goal single-handedly and the importance of recovering the unknown skeletons from cemeteries for identification purposes are discussed.

One of the most important tasks in forensic anthropology is the construction of the biological profile, classically defined as a set of four basic biological descriptors: biological sex, age-at-death, ancestry, and stature. Yet, our empirical and technological abilities in reconstructing the life experiences and health from skeletal remains far exceed these four parameters and forensic anthropology could benefit from further descriptors in the search for an identity. In this paper, we propose the inclusion of two other investigations to forensic anthropology practice to implement the already known biological profile: the interpretation of bone disease and lesions, and forensic toxicology on unconventional biological matrices. These analyses can provide information regarding health, habits, and disease burden, and by implementing them in our practice of forensic anthropology, they have the potential to improve the biological profile. We also propose a new term that can include not only the classical biological profile but also further descriptors, namely, the “biocultural profile”.

Non-fatal strangulation poses a significant concern in clinical forensic medicine. Indeed, surviving victims often present a diverse array of signs and symptoms. In rare instances, acute pathological events that manifest with symptoms similar to those secondary to neck compression (e.g., stroke with subsequent neurological symptoms, etc.) can lead to loss of consciousness, inadvertently resulting in strangulation. Therefore, in this context, forensic investigation plays a crucial role in interpreting the signs and symptoms presented by the victim and determining whether they are the cause or consequence of neck compression. This report presents a case of a middle-aged previously healthy woman who was found by her husband on the bathroom floor and then brought to the medical attention exhibiting signs of neck compression in combination with neurological symptoms. Since a previous episode of domestic violence involving the husband has been recorded in the hospital database, a medico-legal investigation was initiated at the behest of the prosecutor. The integration of all clinical, radiological, forensic pathological findings and circumstantial data allowed the exclusion of homicidal strangulation by ligature perpetrated by the husband, as well as suicidal hanging; instead, it classified the case as an accidental hanging, with a stroke being the underlying cause of the accident. The case provides valuable insights into the complexity of interpreting injuries associated with neck compression and emphasizes the need for comprehensive investigative approach in such cases.

It is reported that immunostaining of Myoglobin (Mb) is useful for forensic diagnosis. In this study, we investigated the condition of fixation of striated muscle in 10 % neutral-buffered formalin to obtain appropriate stationarity of Mb in immunostaining. Firstly, criteria for staining intensity and definition of the stainability of examined were determined for sheep muscle tissue. Sheep myocardial tissue was fixed using 10 % neutral-buffered formalin under the 21 different conditions based on combinations of the following: three ratios of volume of formalin (mL) to weight of myocardium (g) (RFM) of 1, 4 or 9, 7 durations of fixation (DF) of 0.5, 3 or 6 h, and 1, 2, 5 or 7 days. Secondly, detection of Mb diffused form skeletal muscle from autopsy cases into formalin during fixation were confirmed by ELISA. Finally, the evaluation of stainability of Mb of striated muscle in routine autopsy examinations was confirmed using sheep staining intensity standards. From this experimental investigation, it has been demonstrated that the most suitable formalin fixation condition for using Mb staining in forensic diagnosis is RFM4 with a fixation time of at least DF 3 h up to 1 day. It was evident that staining intensity decreases with fixation durations exceeding 2 days, irrespective of the RFM. Thus, the fixation time was deemed the most influential factor affecting the staining properties of Mb staining in skeletal muscle tissue. When conducting Mb staining using striated muscle as an evaluation sample, particular attention should be paid to the fixation time.

The postmortem diagnosis of diffuse traumatic axonal injury (dTAI) relies on β-amyloid precursor protein (β-APP) immunohistochemistry. Most reports of factors associating with dTAI are decades old. We compared background characteristics and neuropathology findings of today’s Finnish medico-legal autopsy cases with and without β-APP-positive dTAI (dTAI+ and dTAI–, respectively). The cases had suffered a head injury prior to death and underwent a full neuropathological examination including β-APP stain. Background and circumstantial data as well as neuropathology findings were collected from police documents, medical records, and autopsy and neuropathology reports. Prevalence ratios were calculated for each factor to facilitate comparisons between the dTAI+ and dTAI– groups. The dataset comprised 57 cases (66.7% males), with 17 classified as dTAI+ and 40 as dTAI–. Based on prevalence ratios, the factors that had at least two-fold prevalence among dTAI+ cases compared to dTAI– cases were: an unknown injury mechanism; concurrent epidural or subdural haemorrhage; and an accidental manner of death. In contrast, the factors that had at least two-fold prevalence among dTAI– cases compared to dTAI+ cases were: a short postinjury survival (<30 min); concurrent intracerebral/ventricular haemorrhage or contusion; vermal atrophy; and a natural or homicidal manner of death. This study revealed differences in circumstantial features and neuropathology findings between dTAI+ and dTAI– cases in today’s medico-legal autopsy material. Data on typical case profiles may help estimate the prior probability of dTAI not only in medico-legal autopsies but also among living patients with head injuries.

In forensic medicine, hypothermia is a frequently encountered cause of death, and this characteristic provides public health information to prevent similar deaths in the future. Previous studies revealed regional differences in hypothermia occurrence (indoors or outdoors). However, to our knowledge, no recent studies in Japan have directly compared the characteristics of indoor- and outdoor-onset cases based on forensic autopsy reports. Hence, this study aimed to determine the characteristics and risks of unexpected hypothermia-related death. It included 218 cases from the Chiba Prefecture, Japan, wherein forensic autopsies were performed and hypothermia was diagnosed; these cases were categorized into indoor- and outdoor-onset cases, and their characteristics were examined. The results showed no significant differences between the two groups in relation to the age of onset or residential environment (i.e., the presence or absence of cohabitants). The outdoor-onset group tended to have a higher incidence of dementia. Regarding the causes of hypothermia, the indoor group had more internal causes (p < 0.0001), whereas the outdoor group had more primary and external causes (p < 0.0001 and p = 0.0029, respectively). The indoor group was more undressed than the outdoor group. Atypical antipsychotic components were predominantly detected in the blood in the outdoor group (p = 0.0077). The body mass index tended to be lower in the indoor group than in the outdoor group. Broadening public awareness of the present study findings may aid in developing preventative strategies for hypothermia based on the location of onset.

Introduction

Fetal umbilical cord hematoma has a low incidence but high mortality, and its cause during delivery is often unclear. We report an autopsy case in which it was concluded that umbilical cord hematoma resulted from fetal movements during childbirth.

Case presentation and autopsy findings

A 27-year-old primigravida at 39 + 2 weeks gestation with normal antenatal visits suffered a fetal heart rate decrease during active labor. Bedside ultrasound revealed fetal death in utero 22 min later. Forensic pathologists found that the umbilical vessels were torn and bleeding on almost the same plane, and the hematoma compressed both umbilical arteries, which is the cause of fetal stillness in utero. A total of 32 cases were reported, including 6 umbilical cord ruptures and 26 umbilical cord hematomas. The cause of hematoma was unknown in 77 % of cases, while dysplasia was present in 56.25 % of umbilical cords.

Discussion

This case indicates that fetal movements may cause umbilical cord vessel injury, particularly when oxytocin is used to induce labor. When fetal heart sounds decrease for no apparent reason, the possibility of cord injury should be considered, and cesarean delivery should be performed as soon as possible. Therefore, rigorous fetal heart tracing during active delivery is necessary.