Cosimo Di Nunno

Anomalies and alterations of the hyoid-larynx complex in forensic radiographic studies

The authors illustrate the anatomic interest of the hyoid-larynx complex in the differential diagnosis of traumatic lesions, purely anatomic anomalies, and lesions resulting from natural causes. Forty larynges from corpses undergoing autopsy at the Institute of Legal Medicine of the University of Trieste were studied during the period May 1996 to May 2001. The larynges were excised and examined through radiographic magnification with dedicated mammographic equipment. Triticeous cartilages were evidenced in 12 (30%), they were bilateral in 7 (17.5%) and monolateral in 5 (12.5%). These cartilages were more frequent in men (8 out of 26; 31%) than in women, 4 out of 14 (28.5%). Total fusion of the body of the hyoid bone with the greater horns was revealed in 10 (25%), partial fusion in 4 (10%), and evident articular rima between the body and the greater horns of the hyoid bone in 14 (35%). The lesser horns of the hyoid bone were symmetrical in 29 (72.5%), asymmetric in 11 (27.5), absent in 1 (2.5%). While confirming the validity of the radiographic method used, we conclude that great care should be taken when diagnosing traumatic lesions of the hyoid-larynx complex. This diagnosis is often difficult to establish owing to the considerable frequency of anatomic anomalies of the complex.

Self-strangulation: an uncommon but not unprecedented suicide method.

The authors report two cases of self-strangulation in which the investigators had initially suspected homicide but eventually deemed the cases to be suicide. Self-strangulation may be mistaken for homicide because it is widely believed to be impossible to carry out this act without assistance. An accurate medicolegal evaluation of the circumstances, a thorough postmortem examination, and methodical inspection of the site are extremely important in such cases. It is equally important to examine the knot or other means used to exert pressure on the neck and to document its position. Finally, to gain a full understanding of these unusual cases, close collaboration between the two different fields, investigative and medicolegal, is essential.

DNA identification of sperm cells collected and sorted by flow cytometry.

In cases of rape, obtaining enough biologic material for DNA identification of the attacker is often difficult because the methods for distinguishing and separating sperm cells from vaginal cells are not sufficiently efficacious. This article describes a new, innovative method for spermatic DNA extraction from the vaginal washing fluid by means of flow cytometry. The high specificity and sensitivity of the flow-cytometric sorting method provides enough sperm cells for DNA typing. The ease of execution of this method, involving vaginal washing with physiologic solution and flow-cytometric reading of the fresh sample, substantially increases its cost-benefit ratio.

What is the best sample for determining the early postmortem period by on-the-spot flow cytometry analysis?

The level of degradation of DNA as a means for determining the time of death has been proposed as a valid adjunct to the classic thanatochronologic methods. The twofold aim of this work was to determine which organ might reveal both a correlation between the percentage of degradation of the DNA and the time lapse since death, and would be easiest to sample and yield the most reproducible results even in technically unfavorable situations such as on-the-spot investigations at the scene of death. A comparison of the spleen, blood, and liver showed that hepatic tissue best meets these specific needs because it shows a virtually linear correlation between the time elapsed since death and the level of degradation of the DNA, and it can easily be sampled at the scene of death by use of a common biopsy needle.

Suicide with a butcher's bolt.

The captive bolt pistol is an atypical firearm exclusively produced and used for butchery of breeding animals, but in some rare cases, it has been used as a lethal weapon for committing suicide by butchers, breeders and other people who have access to such weapons during their professional activities. This study describes the suicide committed by a butcher in the province of Udine (N. Italy) in 2001 who shot himself with his own captive bolt pistol that produced in the right temporal region a circular wound and a bone lesion of the temporal squama with a groove involving the frontal lobe; he died five days later of the fatal consequences of the meningo-encephalic lesions. The medico-legal issues implicated in this case, seen in the light of the data reported in the international literature, illustrate the difficulties faced when diagnosing these types of lesions, bearing in mind their rarity and peculiar nature, and introduce elements of differential diagnosis regarding lesions produced by similar weapons that lead to ascertainment of the event as accidental, suicidal, or homicidal.

DNA extraction: an anthropologic aspect of bone remains from sixth- to seventh-century ad bone remains.

In the archeological site of the early Christian Episcopal complex of Saint Peter, in Canosa di Puglia (Bari, Italy), during the operations of archaeological excavations, tombs were discovered. They were dated between the sixth and seventh centuries ad with carbon 14 methodology. Five skeletons were found in the 5 tombs: 28A: male individual, 43 years old. The height was 170 cm; the biomass was 65.7 kg. The analysis of the bones indicated several noteworthy pathologies, such as a number of hypoplasia lines of the enamel, the presence of Schmorl hernias on the first 2 lumbar vertebrae, and the outcome of subacromial impingement syndrome. 28E was a male individual, with a biologic age of death of between 44 and 60 years. The height was 177 cm. He had a posttraumatic fracture callus of the medial third of the clavicle, with an oblique fracture rima. 29B was a female individual, 44–49 years old. The height was 158.8 cm; the biomass was 64.8 kg. There was Wells bursitis on the ischial tuberosity on both sides. 29E was a male individual, 45–50 years old. The height was 169.47 cm; the biomass was 70.8 kg. The third and the fourth vertebrae showed Baastrup syndrome (compression of the vertebral spine). There were radiologic signs of deformity on the higher edge of the acetabula and results of frequent sprains of the ankles. 31A was a male individual, 47–54 years old. The height was 178.65 cm; the biomass was 81 kg. The vertebral index showed a heavy overloading in the thoracic lumbar region. There were bony formations under the periosteum on both on the higher and medium facets of the first metatarsus and on the higher and lateral facets of the fifth metatarsus on both sides. As the topography indicates, these small ossifications coincided with the contact points between the back of the foot and parts of the upper shoe. From the osseous remains, in particular from the teeth (central incisors), the DNA was extracted and typed to identify potential family ties among all the subjects. The extraction technique used came from the DNA Promega technique, partially modified by the authors. Stay times of the sample in the extraction buffer were increased and were increased the polymerase chain reaction (PCR) cycles.

A case of suicide using a home-modified gun.

The problem of the possibility of modifying blank cartridge dummy firearms to make them fire a real bullet has long been known, but the phenomenon has been constantly on the increase in the recent years. In Italy, there are no restrictions on the purchase of an inoffensive weapon. However, few modifications are frequently enough to transform the inoffensive weapon into a harmful one: a procedure is often undertaken to avoid the mandatory control and registration of firearms. We describe a case of suicide of a man in Trieste, Italy, in 2002, with a blank cartridge dummy pistol that had been modified to fire homemade bullets.

Aorto-oesophageal fistula and intestinal infarction secondary to volvulus following ingestion of foreign bodies in a schizophrenic patient.

We present a case of death caused by voluntary ingestion of non-organic foreign bodies observed at the Institute of Legal Medicine of the University of Trieste. The victim was a young schizophrenic patient whose death, at first giving rise to suspicions of murder by another psychiatric patient, was found to be caused by an uncommon chronic permanence of foreign bodies at different locations of the digestive tract which suddenly evolved into a series of simultaneous lethal complications as yet never described. The case also raised the issue of possible responsibilities of the subjects healthcare providers.

Unusual neck lesion in a pedestrian caused by a road accident

The authors describe a road accident that occurred in the Trieste region of Italy in 1998, wherein a pedestrian experienced a mortal injury. During the on-site examination, the forensic officer in charge noticed, in addition to dispersed abrasions, bruises, and fractures, an unusual position of the head with a highly unusual motility of the cervical rachis and, above all, an apparent whitish fibrous elastic cord, 7–8 cm long, which came out of the mouth. The cord was found to be a segment of the spinal cord, expelled and driven into the mouth cavity by the impact. This represents an interesting case because of the specific dynamics of the accident and the type of lesion involved. This kind of spinal cord injury, in particular, is infrequent among pedestrians involved in road accidents in comparison with other road casualties.