Kris Sperry

Radiographic Identification by Mastoid Sinus and Arterial Pattern

A skull and some incomplete postcranial remains were discovered in two searches over a two-month period near Santa Fe, New Mexico. The discoveries could be demonstrated to be from the same person, and the remains were shown to be consistent with a specific missing person on the basis of anthropological analysis. Further work led to a positive identification on multiple grounds, including agreement of the details of the mastoid sinus and endocranial arterial patterns observed radiographically. These features may be useful for establishing positive identification from skeletal remains when antemortem radiographic studies for comparison are limited to lateral cranial vault studies.

Toward a population-based assessment of death due to pulmonary embolism in New Mexico

During a 5-year period (1981 through 1985), 586 of 46,512 (1.26%) deaths in New Mexico had pulmonary embolism (PE) listed on the death certificate. The frequency of death due to PE was mentioned more frequently in the autopsied than in the non-autopsied component of the study (2.4% v 1.1%). This observation, together with published data on the accuracy of clinical diagnostics among persons dying with autopsy-documented PE, suggests that the frequency of death due to this disease is considerably higher than previously thought. Among autopsied persons who died of PE, risk factors and associated diseases are not appreciably different for those who die in or out of the hospital. Important associations with respect to persons dying of PE include male gender, advanced age, serious medical or surgical disease, immobilization, and trauma.

Suicide by intravenous injection of cocaine. A report of three cases.

Death as a consequence of cocaine abuse is continuing to increase in all parts of the United States. Cocaine use may cause the development of psychosis, with subsequent expression of suicidal ideations, and potentially even successful suicide. Cocaine dependence may also cause depression in the individual who is unable to control his or her craving for the drug, and suicide may be perceived as the only solution to a desperate problem. Despite the dramatic escalation of cocaine abuse and the potential toxicity of this drug, there have been no reports within the United States of cocaine being used as the agent to accomplish a suicide. Herewith are reported three cases in which depression and desperation over cocaine dependence were the motivations for successful suicide, which was accomplished through the intravenous injection of cocaine to the point of death. True cocaine suicide is probably only identified through the presence of objective scene information that unequivocally proves suicidal intent, such as notes or letters which contain information to this effect. A careful search of the scene of death in cocaine fatalities is mandatory, and diligent application of routine scene investigation principles may reveal that suicide through the use of cocaine is more widespread than first appearances would suggest.

Myocardial infarction in pregnancy.

Myocardial infarction occurring during pregnancy or the puerperium is a rare condition, occurring in about 1 per 10,000 deliveries, and carries a mortality of approximately 30%. As a consequence of its rarity, symptoms of impending infarction may be easily mistaken by physicians for much more common and innocuous conditions, especially those (such as gastroesophageal reflux) typically associated with pregnancy. Two cases of infarction in pregnant women are presented, with a discussion of risk factors which may predispose towards development of coronary artery disease or thrombosis in this population. Other, more uncommon, causes of myocardial infarction during pregnancy are also addressed.

Suicidal Contact Gunshot Wounds to the Head with .38 Special Glaser Safety Slug Ammunition

Glaser Safety Slug TM ammunition is a uniquely designed, essentially prefragmented ammunition. Tests performed by the U.S. Justice Department demonstrated that the ammunition possesses high kinetic energy, high relative incapacitation index (RII) and poses a very low risk to bystanders because of its total loss of kinetic energy in the target. Despite having been manufactured since 1974, no deaths from this ammunition have been previously reported. The authors herein describe the first three reported human deaths.

The Use of Hydrogen Peroxide to Visualize Tattoos Obscured by Decomposition and Mummification

Tattoos are distinctive, potentially important acquired identifying features that last for the life of the bearer, and persist into the postmortem period. However, the accumulation of decompositional pigments in the skin and subcutaneum will obscure tattoo designs. By treating the area with 3% hydrogen peroxide, the dark red-black decomposition products are temporarily removed, allowing underlying tattoos to be located, and photographed for identification purposes.

Terminal ballistic characteristics of Hydra-Shok ammunition: a description of three cases

The Hydra-Shok bullet is characterized by a hollow-point construction, with a distinctive central post in the base of the hollow. These features allow such missiles to be easily identified during the course of an autopsy examination of a gunshot victim. Higher velocity loadings of the Hydra-Shok may fragment along the wound path, occasionally forming a ring-like fragment that suggests this ammunition, but this feature cannot be considered unique. Although radiographic examination is helpful in bullet localization, the characteristic central post may be identified by X-ray only if sufficient expansion results in its exposure. Three cases of shooting deaths involving Hydra-Shok bullets are presented and discussed; in each case, the entrance wounds were indistinguishable from entrances associated with conventional ammunition, and in no instance did the missiles exit from the body (including head, chest, and abdominal wounds). Familiarity with relatively unusual ammunition types such as the Hydra-Shok allows for quick identification by the pathologist at the time of autopsy.

Unexpected death as a result of infective endocarditis.

Thirteen cases of infective endocarditis (IE) diagnosed for the first time at autopsy or, in those patients with a previous diagnosis of IE, not thought to be active at the time of death, are presented. Of the six patients who died within 24 h of the onset of symptoms, two died of obstruction of a valve orifice, two died of sepsis, one died of sepsis and alcoholic cardiomyopathy, and one died of a coronary artery embolus. Of the five patients with symptoms lasting more than 24 h, three died of sepsis and congestive heart failure. One died from sepsis alone and one died from congestive heart failure (CHF). In two patients whose duration of symptoms is unknown, one died of sepsis and CHF, and in the other the mechanism of death is unknown. Predisposing factors present in 11 of 13 patients included alcoholism (three), intravenous (IV) drug abuse (three), prosthetic valves (three), aortic stenosis (two), past rheumatic fever (one), and nonstenotic congenitally bicuspid valves (two). The reasons for no antemortem diagnosis were a missed or incorrect clinical diagnosis in three patients seen by a physician shortly before death, no signs or symptoms or found dead (four), non-specific signs and symptoms (three), refusal of medical treatment (one), and a solitary lifestyle (one); there was insufficient information about one patient. Individuals with needle tracks, generalized petechiae. Oslers nodes, splinter hemorrhages, intravenous catheters, pacemaker wires, and infected aortic-valve (A-V) shunts are at risk of IE. Blood and the vegetations should be cultured. The attending physician should be notified of the diagnosis in such cases.

An unusual, deep lingual hemorrhage as a consequence of ligature strangulation

During the course of the daily practice of forensic pathology, little or no attention is generally devoted to the tongue (if it is even removed at all during the autopsy examination) except in a handful of relatively well-defined situations. In some other instances, such as injuries involving the neck and laryngopharyngeal organs, the tongue may be removed, but examined in only a cursory manner, since the serious pathology which caused or contributed to death is most often located in adjacent structures. While the postmortem examination was being carried out on a victim of ligature strangulation who exhibited relatively sparse external and laryngeal findings of significance, a unique and apparently heretofore undescribed patterned hemorrhage was discovered within the deep musculature of the tongue, having an appearance and contour identical to that of the curved edge of the subjacent hyoid bone. In difficult cases where strangulation is suspected as well as other potentially medicolegal problems with trauma involving the neck organs, a detailed inspection of the tongue through an easily accomplished dissection technique may provide invaluable information as to the mechanism of injury.

Fatal Intoxication by Tocainide

A 26-year-old woman committed suicide by ingestion of a large quantity of tocainide, a recently developed oral antiarrhythmic agent with chemical similarities to lidocaine. Blood and bodily fluid analysis by thin-layer chromatography, high pressure liquid chromatography, and mass spectroscopy confirmed the presence of tocainide, with a serum level of 68 mg/L, nearly 7 times the upper recommended therapeutic level for this drug. Tocainide was also detected at significant levels in vitreous fluid and bile. Although the mechanism of death from tocainide intoxication in animal studies is related to central nervous system toxicity, the presentation of ventricular tachyarrhythmias with coma in this patient suggests that tocainide at high levels may have primary myocardiotoxicity in humans.