Antonio De Donno

Positional asphyxia: reflection on 2 cases.

Abstract.Positional asphyxia, a fatal condition arising because of the adoption of particular body positions, causing mechanical interference with pulmonary ventilation, can occur in various circumstances that are likely to come under the observation of the specialist in legal medicine (work, car accidents, torture, kidnapping, etc.). It is difficult to diagnose the cause of death in such cases because they generally present with an aspecific anatomopathologic picture.In some situations, positional asphyxia can be hard to distinguish from asphyxia because of chest compression. The main difference is in the way the event occurred: whether the particular position causing the asphyxia had been adopted by choice or by compulsion or necessity when an extrinsic mechanical action would result in traumatic asphyxia.The diagnosis of positional asphyxia is essentially based on 3 criteria: the body position must obstruct normal gas exchange, it must be impossible to move to another position, and other causes of natural or violent death must be excluded.To illustrate the main physiopathologic and diagnostic causes of positional asphyxia, the authors report 2 cases taken from the records of events that came under the observation of the Medico-Legal Sector of Bari University Hospital throughout the last 10 years.

The bodies of two missing children in an enclosed underground environment

Two young children, respectively 11 and 13 years old, originally from a small town of Southern Italy, were missing on 5 June 2006 (06:30 p.m.). Soon after their disappearance, the search for the missing children began. Broadcasters promptly transmitted a description of the missing children, pushing the entire community to assist in the search and safe recovery of the children. However, every effort was in vain, and the search went on for more than 1 year. During the missing-child search, the investigators collected enough evidence against the father, who was arrested 17 months after the childrens disappearance. He was indicted for kidnapping, homicide and concealment of the two bodies. He never confessed to the crimes and claimed to be innocent. Three months after the conviction, a fireman found the two corpses in a subterranean, dry cistern next to a well over 20 m deep. The bodies were well preserved, almost mummified, with only few body-parts skeletonised. Based on dental records, they were identified as those of the two children, who had gone missing 1.5 years before. Signs of a very low insect activity were present, reasonably consistent with a rapid skin dehydration. The autopsy showed no signs of defence injuries or ligature consistent with strangulation or captivation, except for fractures of the axial skeleton at a number of points consistent with a fall from a low-medium height. The body of the elder brother presented major injuries with signs of recent haemorrhages and gut content analysis consistent with the last meal, which provided enough evidence to ascertain a very short survival time. The younger child showed minor injuries, signs of old haemorrhages and gastric- and intestine-emptying time consistent with a longer survival time of approximately 3-4 days, spent alone in the dark and cold cistern. A long post-mortem interval (PMI) of approximately 20 months was estimated, mainly from the pattern of insect succession. Based on such physical evidence, on 4 March 2008, 4 months after conviction and 40 days after the recovery of the two bodies, the father was finally released from prison and exonerated from previous indictment of homicide.

Forensic age estimation of living individuals: A retrospective analysis

In recent years, skeletal age determination has become increasingly important in criminal investigations for determining the age of living individuals. To increase diagnostic accuracy, a physical examination, an X-ray examination of the left hand, as well as a dental examination including the determination of the dental status and an X-ray of the dentition should always be performed. In this work, the authors analyze a sample of 52 illegal immigrants who came under their observation in the period from May 1989 to September 2007. A statistical analysis of the results of dental and skeletal age estimations was performed as well as an analysis between the reported and assessed ages. The results showed a significant difference between reported age and assessed biological age (p<0.001); however, no statistical difference was shown between skeletal and assessed dental age (p=0.431).

Applicability of Greulich and Pyle and Demirijan aging methods to a sample of Italian population

Age estimation in forensics is essential in cases involving both living and dead subjects. For living subjects, age estimation may be used to establish an individuals status as a minor in cases involving adoption, criminal responsibility, child pornography, and those seeking asylum. Criteria for age estimation in the living have recently been put forth by The Study Group on Forensic Age Diagnostics. The group has proposed guidelines with a three-step procedure: a physical examination and anthropometrical analysis; dental analysis by orthopantomogram (OPG); and X-ray study of the left hand and wrist. The board of FASE highlighted advantages and limits of each method, and suggested practical solutions concerning the age estimation process for adults and subadults. The aim of this study was to verify the applicability of the Greulich and Pyle, and Demirjian techniques on a sample group of Italians, whose ages were known, in determining the skeletal and dental age, in addition to evaluating the reliability of these techniques. 535 subjects between the ages of 7 and 15years were examined, each one undergoing both an orthopantomography (OPG) and radiography of the left wrist and hand. The data obtained underwent statistical analysis. The analyses have shown that a correlation exists between skeletal and dental age, and real age. Age estimation carried out using the Greulich and Pyle method has shown itself to be especially accurate on the Italian sample, particularly in the age ranges of 7-9years and 10.4-11.5years. The Greulich and Pyle method has shown itself to be reliable for the sample analyzed notwithstanding the ethnic differences between the original sample of reference and those analyzed in this study. Application of the Demirjian technique resulted in an overestimation of dental age. This difference is shown to be more highly significant in the higher age ranges. The combination of the Greulich and Pyle, and Demirjian methods have revealed a difference regarding real age, which turns out to be more modest in the younger age ranges and more significant in older subjects.

Pink Teeth in a Series of Bodies Recovered From a Single Shipwreck

Pink teeth have most often been observed in victims of drowning but have also been reported in subjects who died suddenly and unnaturally. There is general agreement that there is no obvious connection between the occurrence of pink teeth and the cause of death, but the condition of the surroundings (especially humidity) must certainly play an important role in the development of the pink-tooth phenomenon. The frequency and distribution of postmortem pink coloration of the teeth have been studied among a representative sample of 52 cadavers. All the bodies were victims of a single shipwreck that occurred on March 13, 1997, in the middle of the Otranto Canal (Mediterranean Sea). The bodies were recovered from the seawater after approximately 7 months. A distinct pink coloration of the teeth was found in only 18 cadavers (13 females and 5 males) of ages ranging between 13 and 60 years. The phenomenon was more pronounced in younger individuals due to age-related changes of the root canal, less penetrable by the pigment responsible for the postmortem pink staining. By histochemical methods and autofluorescence, hemoglobin and its derivatives have been identified as the most likely pigments responsible for this postmortem process that can be considered analogous to postmortem lividity. These data are consistent with previous reports on pink teeth, indicating that the diffusion of the blood in the pulp into the dentinal tubules causes the red discoloration of the teeth. Based on the results, the pigmentation is more prominent on the teeth with single roots rather than in the posterior teeth with multiple roots.

Suicide by Self-Administration of a Drug Mixture (Propofol, Midazolam, and Zolpidem) in an Anesthesiologist: The First Case Report in Italy*

The authors report an unusual case of suicide of an anesthesiologist, in which the suicide manner and means depend upon the victims occupation. This is the first case report published in Italy of a death involving propofol and other drugs. The anesthesiologist was found dead with an empty drip still inserted in the hand and another one near his body. Forensic and toxicological findings suggested that the cause of death was a respiratory depression due to a self‐administration of a rapidly infused lethal drug mixture. Analytical drug quantification was performed by gas chromatography‐mass spectrometry. Blood analysis revealed: zolpidem (0.86 μg/mL), propofol (0.30 μg/mL), midazolam (0.08 μg/mL), thiopental (0.03 μg/mL), and amitriptyline (0.07 μg/mL). Adipose tissue and hair analysis suggested a previous and repeated use of these drugs verifying the fact that in Italy recreational abuse of anesthetic and sedative agents in health care practitioners is becoming an increasing problem.

Morphologic analysis of third-molar maturity by digital orthopantomographic assessment.

Accurate timing of the eruption of first and permanent teeth is an important parameter in forensic odontology to establish the age of dead or live individuals. Determination of adulthood may determine, for example, whether an individual convicted of a crime is sentenced as an adult and incarcerated in a state penal institution or as a juvenile and sent to a juvenile camp. At present, there is a large immigrant population in Italy, and young foreign criminals sometimes have false passports bearing a later birth date, with the aim of evading punishment. In such circumstances, age determination is becoming a significant forensic issue. Late in adolescence, after formation of the premolars and canines, only the third molars continue to develop. According to several studies, although the third molars are the most variable teeth in the dentition, they remain the most reliable biologic indicator available for estimation of age during the middle teens and early twenties. In this study, the authors test the possibilities offered by orthopantomography executed by means of digital technology, with the aim of exploiting the advantages of the computerized digital technique compared with the conventional technique, to determine adult age on the basis of root development of the third molar. Digital radiography is simple to use, quick, and effective, allowing superimposition and enlargement; the images can be electronically stored and transported. In comparison with traditional orthopantomography, the digital technique features greater diagnostic accuracy of some anatomic structures: upper and lower front teeth, root apexes, floor of the nasal fossa and maxillary sinus, nasal septum, mandibular condylus. Moreover, digital orthopantomography suffers less from artifacts. The digital orthopantomographies of 83 Caucasian subjects (43 females and 40 males) aged between 16 and 22 years were analyzed in standard conditions, assessing the degree of maturation of the upper and lower third molars. A standardized computer procedure was used to acquire the x-ray images, recording 3 per plate: the overall orthopantomography and 2 enlargements of optical type of the left and right sides, to reveal the third molars while maintaining unaltered the image resolution. For the analysis, the authors adopted Demirjians staging system that classifies development of the third molar in 8 stages (A, B, C, D, E, F, G, H) on the basis of morphologic criteria. This has been statistically proved to feature notable precision and high predictive ability. To assess any sex-related variations in mineralization speed, the series was subdivided by gender. The study demonstrated that such differences are more evident under the age of 18 years. Overall, the observation of 245 third molars showed faster development of the upper than the lower third molars, a prevalence of stages D to G in the age range between 16 and 18 years, and a clear predominance of stage H in individuals over 18 years of age. Finally, an intermediate stage between G and H was demonstrated in subjects aged between 17 and 21 years.

Age assessment using the Greulich and Pyle method on a heterogeneous sample of 300 Italian healthy and pathologic subjects

The exponential growth of the illegal immigration phenomenon, the requests for asylum, and the increasing number of migrant settlements on Italian territory have strong repercussions on the legal system. One important aspect of this problem is age assessment. In the case of living individuals, identification may be focused on ascertaining their age, more directly if they can attest their age but are not registered (foreigners who claim to be minors or under 14 years of age). These have entered our country as illegal immigrants and have an interest in declaring a younger age (as a minor or under 14) rather than their true age because they can obtain the benefits specifically provided by Italian law for such categories. Since the most frequently used method in age assessment is the Greulich and Pyle Atlas, the objective of this study was to evaluate the consistency and accuracy of the method on a sample of Italian teenagers, in order to ascertain whether or not the Atlas is suitable for the purpose, especially in the critical threshold between 14 and 18 years of age. A total of 300 radiographs of the left wrist and hand of individuals between 10 and 20 years of age were obtained from the outpatient Pediatric Radiology Department of the Papa Giovanni XXIII Hospital in Bari. The results showed that the Greulich and Pyle Atlas, used on the Italian population, provide a good match with the chronological age, showing no statistically significant differences. The Greulich and Pyle Atlas is usable on the Italian population since there were no significant differences in skeletal age determination with this method as compared to the chronological age; however, one must allow for a possible standard deviation equal to more or less 13 months.

Personal Identification by Morphometric Analyses of Intra‐Oral Radiographs of Unrestored Teeth*

Abstract:  The aim of this study was to work out a biometric method for personal identification by comparing simulated antemortem and postmortem digital radiographs of unrestored teeth. Intra‐oral radiographs of the inferior right first molar, without restorations, were acquired at two different times in 70 subjects using a standardized technique followed by a morphometric analysis. The program automatically supplied values of the absolute distances, relative distances, shape factors, moments, perimeter values, and the areas of the triangles, which were obtained by joining key reference points. The values for the homologous samples were compared with the heterologous samples. Statistical analysis was then carried out, resulting in a section point value of 0.9992. Higher correlation coefficients indicate positive identification, with less than 2% risk of false positives, and approximately 3% of false negatives. We have also tested the method on dental records from 30 patients in order to demonstrate the specificity and sensitivity of the system.

Extraction of DNA from bones in cases where expectations for success are low.

AbstractTo resolve cases involving unidentified cadavers, the study of polymorphic DNA markers of old bones is an invaluable but often challenging tool used in forensic genetics. Some of the difficulties encountered involve the limited quantity of endogenous DNA, its subsequent degradation (a result of elapsed time, environmental conditions, and the microorganisms that develop during the postmortem phase), and the coextraction of substances that inhibit amplification reactions. For these reasons, it is necessary to direct research toward the development of new extraction techniques with the goal of obtaining adequate quantities of high-quality DNA.The aim of this study was to improve the collection of extracted DNA compared with the amount of DNA obtained with the NucleoSpin DNA Trace Kit (Macherey Nagel) protocol for the extraction of genomic DNA from human bones. A modified version of the standard protocol is presented.The modified method for the extraction of genomic DNA, followed by amplification reaction, allowed for identification of 4 cadavers and typification of 1 cadaver. The study carried out involved unidentified cadavers, or their remains, discovered after a long period from time of death.