A. Du Chesne

Post-mortem orthopantomography – an aid in screening for identification purposes

Abstract Ante-mortem orthopantomograms may be of great value in the identification of human remains. This x-ray technique provides an overall view of the teeth and jaws and thus of numerous individual structural characteristics within a short time. Standardised post-mortem orthopantomography has previously not been feasible in the forensic practice. The present study shows how orthopantomography can be applied to identification procedures. The reproduction of ante-mortem x-ray conditions is implemented here in the production of post-mortem x-rays, using a purpose-designed radiographic tripod. For the first time, account is taken not only of the size and structure but also of the nature of the soft tissue covering of exhibits. For post-mortem preparation of these radiographs, appropriate positioning aids, a spinal column substitute and a soft tissue filter were constructed. Individual macerated jaws as well as the complete cranium can now be positioned correctly in the upright orthopantomograph (OPG). The method presented expands the spectrum of forensic radiology for the individual case and in our opinion also offers a reliable aid for victim identification in the wake of mass disasters, aircraft crashes and terrorist attacks, where a large number of bodies have to be identified under great pressure.

Medico-legal aspects of postmortem pink teeth

SummaryWhile the phenomenon of pink teeth has been known since 1829, when it was first described by Bell, its application in forensic medicine has been limited. Recently, however, attention was again focused on pink teeth in legal cases. The medico-legal implication was the use of pink teeth as a possible means of evaluating the cause of death. Pink teeth can occur during life and postmortem. Except for very few and poorly documented exceptions, they develop earliest after 1 to 2 weeks postmortem. Their chemical analogy is seepage of hemoglobin or its derivates into the dentinal tubules. Prerequisites are hyperemia/congestion and erythrocyte extravasation of the pulp capillaries, furthermore autolysis and a humid milieu. Therefore, they are most often associated with water immersion. The intensity of characteristics varies between different cases and also between different teeth in an individual case. Since the ante-mortem prerequisites are non-specific and can be replaced by certain postmortem conditions, there exist until now no specific correlation to the cause of death. The phenomenon is very often seen in victims of drowning where the head usually lies in a head-down position. From this it can be assumed that pink teeth even if not identical to postmortem lividity can, at least to some extent, be considered as analogous. Since, there is no obvious connection between the occurrence of pink teeth and the cause of death, it may be concluded that pink teeth are not pathognomonic for a specific cause of death and this is therefore an unspecific phenomenon.ZusammenfassungDas zuerst 1829 von Bell beschriebene Pink Teeth-Phänomen hat seither wiederholt bei der Untersuchung von Tötungsdelikten eine Rolle gespielt. Die postmortale Pinkfärbung der Zähne ist in der Regel frühestens 1–2 Wochen nach dem Tod zu beobachten. Dem Phänomen liegt das Einsickern von Hämoglobin oder von Hämoglobinderivaten in die Dentinkanälchen zugrunde. Voraussetzungen sind Hyperämie bzw. Stauungszustände, eine Erythrozytenextravasation aus den Pulpakapillaren, ferner Autolyse und feuchtes Milieu. Das Phänomen ist daher meist bei Wasserleichen beobachtet worden. Die Intensität der Verfärbung variiert von Fall zu Fall und, innerhalb eines Falls unter Umständen von Zahn zu Zahn. Eine spezifische Assoziation des Phänomens mit bestimmten Todesursachen ist nicht nachweisbar. Postmortale Bedingungen spielen für die Entstehung der Pinkfärbung eine wesentliche Rolle. Nicht selten ist sie bei mit abhängendem Kopf treibenden Wasserleichen zu beobachten. Insofern ist Analogie zur postmortalen Hypostase naheliegend. Da das Phänomen in Verbindung mit ganz unterschiedlichen Todesursachen (Ertrinken, Verbrennen, CO-Intoxikation, Strangulation u.a.) beobachtet wurde, kann es keinesfalls als pathognomonisch für eine spezielle Todesursache angesehen werden.

Inflammation of the cardiac conduction system in a case of hyperthyroidism.

A 37-year-old female showed signs of hyperthyroidism 2 weeks before death after a partial thyroidectomy was carried out 15 years previously. An examination 3 days before death revealed a normal blood cell count, an increased level of thyroidal hormones, sinus tachycardia and a high blood pressure of 170/90 mm Hg. A hyperthyroidism was diagnosed and therapy with carbimazol (2 × 10 mg) was started but 2 days later fever and chill occurred and before death short phases of unconsciousness and dyspnoea. The autopsy findings showed an interstitial inflammation of the AV-node, the His-bundle and its branches which can correlate with typical ECG changes in hyperthyroidism.

MACROPHAGE SUBTYPE PATTERNS IN PROTRACTED ASPHYXIATION

The question was examined whether protracted asphyxiation is associated with a distinct macrophage subtype pattern in lung tissue. Immunohistochemical preparations of lung specimens were tested with the antibodies MRP8, MRP14, 27E10 and 25F9 in cases of protracted asphyxiation (n = 8) and in “control” groups (hanging:n = 6; peracute deaths:n = 9). MRP8 and MRP14 interstitial cell counts showed a doubling in protracted asphyxiation. Furthermore, clear increases of 27E10 and 25F9 cells (intravascular and interstitial) were found in protracted asphyxiation, both in the intravascular and interstitial compartments. At present the results look promising as to an additional diagnostic criterion for the differential diagnosis between acute and protracted asphyxiation.

Accidental injury: biomechanics and prevention, 2nd edn

One of the classical functions of forensic medicine is the reconstruction of events leading to injury. The main question to be answered is how the injuries were caused and this is dependent on both internal and external influencing factors. Internal factors are controlled by the characteristics of biological tissue even if this is only within the broad framework of biological variability. During events leading to injury the tissues are subjected to pressure. The character, degree and direction of this pressure are the external factors affecting the mechanism leading to injury. Clinical traumatology is not really concerned with this question, where diagnosis and treatment are the main concerns. Forensic pathologists, who are mostly concerned with the biomechanical characteristics of tissues and their behaviour under stress, are therefore mostly frustrated by the available literature on trauma. The editors Nahum and Melvin, have tried to fill this gap with the second edition of “Accidental injury: biomechanics and prevention”. In 22 chapters a total of 32 further authors from the USA present their opinions on general and specialised aspects of the biomechanics of injuries. As is customary, the dominant theme of the book revolves around traffic accidents. Generalised chapters are mostly concerned with the possibilities of biomechanical research, such as crash tests, dummies (anthropomorphic test devices) and mathematical passenger models. The effect of occupant restraint systems and the current important problem area of the biomechanics of airbag inflation-induced injury, are of course discussed. Other chapters on the biomechanics of injury to special tissues and body regions, such as bones, soft tissues, bony skull, brain, cervical vertebrae, thorax, abdomen, thoracic and lumbar vertebrae as well as the pelvis and limbs, are also a treasure trove for forensic pathologists. The maximum stress limits, which are often very difficult to find, are presented here and discussed in detail. The book closes with a chapter on the biomechanics of injury and prevention in children and vehicle interaction with pedestrians. The biomechanics of injury as a scientific entity is in a state of flux. It is obvious that “Accidental Injury” of Nahum and Melvin cannot be used to answer all questions. Astonishingly but praiseworthy is the fact that nonamerican references have also been cited in some of the chapters. This book deservedly belongs to the basic library of all forensic pathologists.

MANIPULATED RADIOGRAPHIC MATERIAL : CAPABILITY AND RISK FOR THE FORENSIC CONSULTANT?

Abstract As interest is being increasingly focused on the digital processing of radiographs for identification of the deceased, the benefits and risks of electronic image processing are presented. With digitization of all kinds of radiographic equipment being on the increase and image processing personal computers being readily accessible, increasing quantities of manipulated radiographic material are to be expected in the future. This potential risk is meanwhile highlighted from the legal aspect.

Does the Transferrin C2 Frequency Depend on Age

In a previous study Beckman and Beckman [Hum. Hered. 1986;36:254-255] reported a decrease in the Tf C2 frequency with age, from 0.173 in newborns to 0.099 in 70-year-old healthy individuals. The autho

The distinction between lacerations and cuts in ligaments and tendons

In contrast to skin wounds the characteristic forensic features of lesions of ligaments and tendons have rarely been investigated. However, in a suspected homicide the question became crucial whether an isolated discontinuity of the posterior atlanto-occipital membrane was caused by a rupture mechanism or by a cut. In order to re-evaluate the associated criteria experimental lesions were made in ligaments and tendons and examined histologically. From these experiments the following criteria could be established:Lacerations exhibit complete destruction of the tissue texture with microruptures and splitting of fibres in the adjacent region. Such wound edges have an irregular structure and fibres near the rupture site exhibit variable thicknesses due to traction.Incisions exhibit smooth wound edges with no disturbance of the tissue texture. The thickness of fibres near the rupture site is regular. These results were obtained by light microscopical examination and confirmed using electron microscopy. Under controlled experimental conditions the forces necessary to rupture tendons with a diameter of 1 mm varied between 50–70 Newton (N). In the suspected homicide, the lesion of the posterior atlanto-occipital membrane was examined visually and histologically and was compared with the experimentally established criteria. Based on these criteria the lesion could be identified as an incision which had probably been caused accidentally while severing the medulla during the first autopsy and was therefore not connected with the cause of death.

Forensic neuropathology and associated neurology Oehmichen M., Auer R.N., König H.G.

Springer When the forensic pathologist reaches the limits of his knowledge on neuropathology, he must seek advice from specialised neuropathologists. Under normal circumstances, this is adequate. And yet it does occur that professional cooperation is obstructed in cases where the forensic pathologist—with his limited neuropathological insight— meets head on with a neuropathologist, who in turn has a limited grasp of the specific and pragmatic forensic viewpoints. Mechanical, hypoxic and toxic injuries of the nervous system are major problems in forensic pathology, but the preferences neuropathologists have often lie in other areas of the specialty. In their book Forensic Neuropathology, Oehmichen, Auer and König cover the areas in this specialty where the gaps in the knowledge of both experts border on each other. The book is, therefore, a gap-filler in the best sense of the word—and a comparison with Unterharnscheidt’s “Traumatologie von Hirn und Rückenmark” (Traumatology of the brain and spinal column, volume 13 of Special Pathological Anatomy from Doerr and Seifert) seems obvious: but there is no comparison. Unterharnscheidt’s contribution is a treasure trove of historical casuistry in which everyone will find something valuable, if they but look long enough. When browsing through this voluminous book, it becomes apparent how difficult it must have been to maintain an orderly chest of jewels. Oehmichen, Auer and König have achieved this with their unyieldingly tight organisation, so that always, a corresponding section for each relevant question can quickly be located. The specialised field is systematically but also comprehensively treated within a scope of less than 700 pages. The illustrations are abundant and of high quality. The casuistry plays practically no role, in contrast to Unterharnscheidt’s books. There is no question that both books are an obligation and and an asset for any forensic pathologist’s library. The first 100 pages deal with the pillars of medico-legal practice (risks, responsibilities and liabilities) and important areas of general neuropathology (cytology of the CNS, cell and tissue reactions, methods in forensic neuropathology). One of the main chapters, comprising 150 pages, treats mechanical trauma of the brain and spinal cord. In accordance with the title, the subject also has clinical neurological aspects. Other important topics are the neuropathology of asphyxia and intoxication. Pediatric neuropathology is given its own chapter, with highly informative discussions of the forensic problems arising from shaken infant syndrome. Finally, there is a comprehensive list of the most common natural causes of sudden unexpected death (seizures and epilepsy, vascular diseases, inflammatory diseases, nutritional and metabolic insults, ageing and brain pathology). The authors have succeeded in producing an urgently needed and long-since-overdue presentation of a specialty in forensic pathology and neuropathology that confronts the forensic pathologist on a daily basis. Neuropathological, clinical neurological and forensic aspects, too, have been considered. The text is not too long but sufficiently comprehensive. It will be absolutely clear to the reader that this book should have been written long ago. Credit and recognition are due to Oehmichen, Auer and König that this has finally happened. Int J Legal Med (2007) 121:335 DOI 10.1007/s00414-007-0156-8

Review of “Forensic medicine of the lower extremity” by Rich, Dean, and Powers (HUMANA PRESS, 2005-11-03 ISBN: 1-588-29-269-X)

At first sight, it seems to be an unusual idea to write a book dealing with Forensic Medicine of the lower extremities as an isolated topic. Accordingly, the authors rhetorically ask “What makes the lower extremity different enough from other anatomic regions that it merits a separate text?” The authors conclude by stating that the lower extremity can provide a plethora of useful forensic information, starting from the identification and ending up with a wide array of biomechanical perspectives. Major chapters are Anthropological Analysis (Part I), Trauma Analysis, and Reconstruction (Part II). The anthropological chapter contains numerous formulas for the determination of gender, race, and stature from skeletal elements of the lower extremities. As a deficiency in the references, the European experts might miss the book by Leopold. Special emphasis has been placed on traumatological and biomechanical chapters including—as major themes— detailed discussions of findings in traffic accidents and child abuse. The illustrations are excellent, specifically in the chapter on the Radiology of the Lower Extremities. Part III of this study deals with the role of feet and footwear in medicolegal investigations. These chapters, apart from being really informative, contain amusing case reports. I assume that reading this book will both be a useful and a pleasurable experience for experts in medicolegal and criminal investigations. Are there questions that may be omitted in a book like this one? Let us bear in mind that this is merely a small (though by no means unimportant) section of the more general field of Forensic Medicine. Perhaps this would apply to the first chapters, which concentrate on the decomposition of Human Remains and the Skeletal Anatomy of the lower extremities. All in all the book is—if I may quote Kathleen Reich—“a major step forward, certainly in the radiological, traumatological, and biomechanical chapters.” It will greatly enhance day to day work for experts in this specific field of forensic medicine.