Markil Gregersen

Iatrogenic fractures of the hyoid bone and the thyroid cartilage. A case report

A case of fracture of the hyoid bone and the thyroid cartilage is reported as a complication to resuscitation. This gave rise to many forensic as well as police investigations and stresses the importance of detailed information at medicolegal autopsies as regards the resuscitation carried out.

Degenerative and traumatic changes in the lower cervical spine facet joints

Objective: The aim of this study was to examine anatomical variables of the lower cervical spine facet joints with regard to age, gender, and exposure to trauma. Methods: The lower four cervical spine segments (C4–C7 included) were obtained from 40 subjects during autopsy: 12 females and 28 males (median age 35 years, range 20–49). Through an available 636 unique facets (318 joints), 1830 randomly obtained observation lines were defined. Each of these lines resembled a 3‐mm‐thick parasaggital slice through a facet from which 10‐µm‐thick histological sections were produced and evaluated microscopically. Inter‐ and intraobserver agreement was tested on four randomly selected facets from each subject. Results: Significant age‐, gender‐, and trauma‐related changes in the bone, cartilage, and soft tissues were observed, including subchondral sclerosis, fibrillation and splitting of cartilage, and cartilage length differences. Females were less affected by changes in the cartilage than males. Two synovial folds were present in all but one joint. Moderate interobserver and good intraobserver agreement were achieved. Conclusions: This study provides knowledge of the anatomy of the cervical spine facet joints. The findings support existing knowledge that males are more commonly affected by degenerative changes than females and that these changes are common from a young age. Histomorphometry confirms the presence of synovial folds in all of the facet joints. Following spinal trauma, pathological lesions may be produced in the facet joints and/or accentuate already existing pathology. The information provided in this study may have relevance for patients with neck pain.

Pathoanatomy of the lower cervical spine facet joints in motor vehicle crash fatalities

Non-lethal injuries to the cervical spine facet joints have previously been described in decedents from motor vehicle crashes and in clinical settings these joints have been identified as potential culprits in chronic neck pain syndromes. The aim of this study was to conduct a detailed examination of the lower cervical spine facet joints in a forensic cohort of motor vehicle crash victims and controls using comparable data from medicolegal autopsy, stereomicroscopy and histological evaluations. Injuries to the cervical spine facet joints were common in the trauma cases and included facet fractures, haemarthrosis, and disruption and bleeding in the synovial folds. The injuries could not be reliably verified on stereomicroscopic evaluation, and routine autopsy procedures did not reveal any of the injuries to the facet joints. Despite the presence of these pathoanatomical lesions in road traffic crash fatalities their prevalence and potential clinical implications in survivors from motor vehicle crashes is unknown.

Chlamydia and sudden infant death syndrome. A study of 166 SIDS and 30 control cases.

SummaryChlamydia inclusions could be demonstrated by an immunofluorescence assay in formalin-fixed lung sections in 32 of 166 cases (19.4%) of Sudden Infant Death Syndrome (SIDS) and in the lungs of only 1 of 30 infants with a known cause of death (3.3%). The difference is statistically significant (P = 0.04).Chlamydia trachomatis is an agent of pneumonia in 1–4 month-old infants who have acquired the disease from an infected cervix during birth, but other chlamydia species are also capable of causing pneumonia. The lung sections of the 32 chlamydia positive SIDS cases did not show typical histological signs of pneumonia. Even though chlamydia inclusions were detected in the lungs of 32 SIDS cases a causal relation between chlamydia infection and SIDS could not be demonstrated.ZusammenfassungChlamydia-Einschlüsse konnten mit Hilfe eines Immunfluoreszenz-Ansatzes in formalinfixierten Lungenschnitten in 32 von 166 Fällen (19,4%) des Syndroms des plötzlichen Kindstodes und in lediglich einem von 30 Fällen von Kindern mit bekannter Todesursache (3,3%) festgestellt werden. Der Unterschied ist statistisch significant (P - 0,04). Chlamydia trachomatis ist ein Erzeuger von Pneumonien bei 1–4 Monate alten Kindern, die die Erkrankung während der Geburt aufgrund einer infizierten Cervix acquiriert haben, aber andere Chlamydia-Arten sind auch imstande, eine Pneumonic zu verursachen. Die Lungenschnitte von 32 Chlamydia-positiven SIDS-Fällen zeigten keine typischen histologischen Zeichen der Pneumonie. Obwohl jedoch Chlamydia-Einschlüsse in den Lungen von 32 SIDS-Fällen gefunden wurden, konnte eine kausale Beziehung zwischen Chlamydia-Infektion und SIDS nicht nachgewiesen werden.

Imaging Occult Lesions in the Cervical Spine Facet Joints

Discrete injuries in the lower cervical spine facet joints have been reported in studies of motor vehicle crash victims. We conducted a detailed investigation of these joints from 20 motor vehicle crash fatalities and 22 decedents due to nontraumatic causes, using conventional radiology, computed tomography, and magnetic resonance imaging to examine whether the diagnostic imaging procedures could identify injuries in the facet joints. The diagnostic imaging procedures identified facet joint fractures in 4 of the 19 trauma cases with computed tomography having the highest sensitivity and obtaining good correlation with findings from the microscopical evaluation. No diagnostic imaging procedure could reliably evaluate the integrity of the synovial folds or the joint spaces for bleeding despite microscopical evidence of such findings in these structures in a large proportion of the motor vehicle crash fatalities. This study emphasizes the need for scientific evidence of validity and reliability of advanced diagnostic imaging procedures in forensic settings, in particular, with regard to occult soft tissue lesions, and cautions uncritical use of negative results from these procedures until such evidence has been produced.

Fatal poisonings in Jutland (Denmark) during the 1980s

SummaryDuring the period 1980 through 1989 a total of 1029 cases of fatal poisoning (638 men and 391 women) were examined at the Department of Forensic Medicine, Aarhus University, Denmark. In 68% of the cases death had been caused by drugs, whereas acute alcohol poisoning and carbon monoxide accounted for 15% and 14% of the cases, respectively. Alcohol was detected in more than half of the 1029 fatal poisoning cases, and in 42% of all cases the blood alcohol concentration was above 0.8 g/kg. In 57% of the cases death was categorized as accidental, only in 31% of the cases as suicide. Accidental deaths were especially predominant amongst drug and/or alcohol abusers. Propoxyphene was the drug found to have caused most fatal poisonings during the decade (30% of the drug-related deaths). Most of the propoxyphene-related deaths occurred during the early and mid-eighties. Barbiturate poisonings were quite frequent during the first half of the eighties. However, the number of deaths caused by barbiturates decreased significantly after 1986, when most barbiturates were withdrawn from the market. The number of deaths caused by narcotics and analgesics increased during the survey period, while no specific tendency was observed concerning antidepressants.ZusammenfassungWährend des Zeitraums 1980 bis 1989 wurden insgesamt 1029 Fälle tödlicher Vergiftungen (638 Männer und 391 Frauen) in der Abteilung für Forensische Medizin der Universität Aarhus, Dänemark, untersucht. In 68% der Fälle war der Tod durch Medikamente verursacht, während Alkoholvergiftung und Kohlenmonoxid für 15% bzw. 14% der Fälle standen. Alkohol wurde in mehr als der Hälfte aller 1029 tödlichen Vergiftungsfällen gefunden und in 42% aller Fälle war die Blutalkoholkonzentration höher als 0.8 g/kg. In 57% der Fälle war der Tod als Unfalltod kategorisiert, in nur 31% der Fälle als Suizid. Unfalltodesfälle waren besonders herausragend bei Personen mit Drogen und/oder Alkoholmißbrauch. Propoxyphen war die Droge, welche die meisten tödlichen Vergiftungen während des Jahrzehnts verursacht hatte (30% der medikamentenbezogenen Todesfälle). Die meisten der Propoxyphen-bezogenen Todesfälle ereigneten sich in den frühen und mittleren 80er Jahren. Barbiturat-Vergiftungen waren ziemlich häufig während der ersten Hälfte der 80er Jahre. Jedoch nahm die Zahl der Todesfälle durch Barbiturate signifikant nach 1986 ab, als die meisten Barbiturate vom Markt genommen wurden. Die Zahl der Todesfälle durch Narkotika und Analgetika nahm während des Übersichtszeitraums zu, während mit Antidepressive keine spezifische Tendenz beobachtet wurde.

Esophageal injury in fatal rear-impact collisions

Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma.

Fatal poisoning with intravenously injected methadone and no fresh injection marks found.

SummaryDrugs addicts are commonly brought to casualty wards where they often pose a diagnostic problem. They are typically brought in unconscious with no signs of disease or trauma. The suspicion of poisoning arises by the finding of fresh injection marks. This paper describes a case in which a young male drug addict was dead on arrival in hospital without recognizable recent injection marks but with some old wounds or necroses in both groins. The autopsy and toxicological analyses revealed that death was caused by an overdose of methadone and that the necroses in the groins were fistulas facilitating administration of the drugs directly into larger veins.ZusammenfassungDrogenabhängige werden im allgemeinen auf Unfallstationen verbracht, wo sie häufig diagnostische Probleme verursachen. Typischerweise sind sie bewußtlos und haben keine Zeichen von Erkrankung oder Trauma. Der Verdacht einer Vergiftung entsteht durch die Auffindung frischer Injektionsmarken. In dieser Veröffentlichung wird ein Fall beschrieben, in welchem ein junger Drogenabhängiger bei der Ankunft im Krankenhaus bereits tot war, ohne erkennbare frische Injektionsmarken, áber mit einigen alten Wunden oder Nekrosen in beiden Leistenbeugen. Die Obduktion und die toxikologischen Analysen deckten auf, daß der Tod durch eine Überdosis von Methadon verursacht war und daß die Nekrosen in den Leistenbeugen Fisteln waren, welche die direkte Applikation der Drogen in größere Venen ermöglichten.

Examination and identification of a Danish 17th-century nobleman, Laurids Ebbesen

Skeletal remains from a crypt in Aarhus Cathedral, where an 87-year-old Danish nobleman, Laurids Ebbesen, was thought to have been buried in 1696 were examined by a multidisciplinary team of investigators. Examination of clothing revealed a burial cap, indicating that he had been a nobleman. Using transition analysis of various bones, the age was estimated at around 82 years (95% confidence interval: 70–92 years). The gender was male. The cranium showed an old, healed fracture in the left temporal region and there was arthritic damage of the vertebral column. In the chapel there were four statues of Laurids Ebbesen (and his three wives). Superimoposition of photographs of Ebbesen’s head from the figures onto X-ray and computed tomography images of the skull confirmed that the cranium and the skeleton could have been that of Laurids Ebbesen. Thus, the involvement of a number of disciplines resulted in accurate dating of the burial; determination of the age, gender, an social status of the deceased individual; exclusion of other possible individuals; and comparison of the skull with an image of the deceased.

Atrial fibrillation resulting from cardiac trauma

SummaryReports in the literature concerning isolated traumatic lesions of the conductive system of the heart following blunt injury to the thorax are rare.A 69-year-old woman who was a front-seat passenger developed disturbances of conduction with atrial fibrillation after blunt injury to the thorax. She died 7 days later. Autopsy and subsequent histological investigation of the conductive system of the heart showed isolated contusion in the right atrium close to the atrio-ventricular node.ZusammenfassungIsolierte traumatische Läsionen des Leitungssystemes des Herzens durch stumpfe Traumen werden in der Literatur selten beschrieben.Eine 69jährige Beifahrerin entwickelte nach einem stumpfen Thorax-trauma Leitungsstörungen und Vorhofflimmern und starb eine Woche später. Die Sektion und histologische Untersuchungen des Leitungssystems des Herzens zeigten isolierte Kontusionen des rechten Atriums dicht beim Atrioventrikularknoten.