Matteo Polacco

Death due to railway-related suicidal decapitation: a case report

In Italy, railway-related deaths give rise to extensive inquiries because it is mandatory for the public prosecutor to investigate the circumstances of death. For the railway embankment, normal traffic rules are not valid and the guilt of the engine driver usually cannot be proven. Consequently, these cases are very often declared as suicides without adequate evidence. Furthermore, there is a potential risk of confusion with homicide, body dismemberment or mutilation. Our medico-legal institutes are increasingly engaged with expert opinions on questions of accident, suicide or homicide because they lead to complications in the fields of insurance, criminal and civil law.

Foreign object ingestion in complex suicide: A case report and review of the literature

Foreign body ingestion frequently occurs accidentally in the paediatric population as well as intentionally in prisoners to achieve hospitalisation, but is relatively uncommon in forensic cases and extremely rare as a method of inducing death in complex suicide. The reasons for this infrequency are many, not least the slowness of action and the lack of effectiveness in terms of lethality, regardless of the object used. In this article, we show an unplanned complex suicide carried out by ingestion of four plastic knives before hanging. Other complex suicides involving foreign body ingestion reported in the forensic literature are reviewed.

Myocardial bridging and sudden cardiac death: Is the actual classification exhaustive?

Myocardial bridging (MB) is a congenital coronary anomaly charac-terizedbythepresenceofabandofcardiacmuscleoverlyingasegmentof a coronary artery along its normal course in the epicardial adiposetissue [1]. The tract of the coronary artery that penetrates within themyocardium and lies beneath the muscle is called “tunnelled artery”and the presence of the MB allows dividing the vessel in three sectors:proximal, underneath and distal to the bridge [2–4]. The incidenceranges from 1.5 to 16% when assessed by angiography [4] and up to80% in some autopsy series [3,5].(SeeFig. 1.)The left anterior descending coronary (LAD) is the most frequentlyaffected vessel (70% in an autopsy series) and in some cases heartscontain more than one bridge, affecting the same vessel or differentcoronaries [1,2,4,5]. Particularly, MBs are most commonly localized inthe middle segment of the LAD [3]. MBs were also detected above acoronary vein, albeit they appear to have no clinical relevance [3].The bridge of myocardial fibers passing over the tunneled segmentcan cause narrowing of the artery during each systolic contraction.However,coronaryflowismaximalduringdiastolicphaseofthecardiaccycle and not systole. Therefore, it appeared unlikely that this systolicphenomenon could by itself result in myocardial ischemia andmyocardial bridges have long been considered as a normal anatomicalvariant without any hemodynamic or physiological relevance [6].This hypothesis was disproved by ultrasound evaluations demon-strating that during early diastole, the period of highest coronaryblood flow,theMBisresponsibleforthedelayedrelaxation,thusreduc-ing the distal coronary pressure [2,4,6]. This mechanism represents themain functional consequence of this coronary anomaly.Recently,MBshave beenclassified inbenignorpathologicalaccord-ingto the intra-myocardiallength and depth.This anomaly is thereforeconsideredpathologicalwhenthetunneledsegmentis20–30 mmlongand 2–3 mm deep [5].Pathological myocardial bridges may, in some cases, lead to is-chemia, infarction, malignant ventricular arrhythmias, and suddencardiac deaths [1,5,7,8]. Ischemic damage has been reported inshorter bridges [5], demonstrating that benign bridges can be clini-cally significant.Themechanismforischemiaiscomplexandisrelatedtothedelayedrelaxationintheearly diastole. Infact, after releasingthesystolicocclu-sion due to MB, diastolic flow increased proportionally with the dura-tion of vessel occlusion, albeit the increase in diastolic flow is not fullycompensatory. As a result, the main diastolic flow and the coronaryflow reserve are both reduced [3,6]. The likelihood of ischemia alsoincreases if MBs are located more proximally in the vessel and thetunneled segment tends to be longer and/or deeper [3].Stresses or exercises produce a rise in sympathetic drive thus facili-tating ischemia through tachycardia and increased contractility. In fact,the positive chronotropic effect leads to an increase of the systolic–diastolictimeratioandtoadecreaseofdiastolicflow,whilethepositiveinotropic effect further aggravates systolic and diastolic compression[3]. Finally, during tachycardia diastole shortens more than systole.We hereby discuss four cases of MB with heterogeneous anatomiccharacteristics and clinical presentation, summarized in Table 1.According to the actual classification based on the intra-myocardiallength and depth, the first and the second case should be consideredbenign, while the third and the fourth a pathological variant.In particular, thefirst case presented a MB over the LAD at 3 cmfrom its origin which was 18 mm long and 3 mm deep. Nonethelessthe clinical and autopticalfinding respectively of fever and divertic-ulitis could be considered the stressors capable of producing anincrease in heart rhythm. In other meanings, they represented thetrigger of sudden death in presence of a benign MB. In fact, neither

Fatal blunt injuries possibly resulting from sexual abuse of a calf: a case report

We report a case of a calf-related fatality on a farm. The victim was a 60-year-old man who was possibly attempting to sexually approach the animal from behind when he was struck by it, sustaining fatal blunt injuries, mostly to the thorax. This case is reported because of its rarity and because of the particular circumstances of death. Fatal trauma associated with bovines is rare on the whole, and when it does occur it is usually caused by kicking or pushing during regular agricultural activity. Although the cause of death in our case could be determined, the circumstances and the manner of death remain speculative to some degree.

Visualization of myocardial infarction by post-mortem single-organ coronary computed tomography: a feasibility study

IntroductionPost-mortem imaging is increasingly used in forensic field in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. The aim of this study was to investigate the role of post-mortem multidetector coronary artery computed tomography in cases of sudden death in adults.Materials and methodsWe have enrolled 11 cases, all of whom were negative for macroscopic extra-cardiac lethal findings after standard autopsy procedure. Later, from the same individuals, isolated single-organ post-mortem computed tomography coronarography (PMCTA), using an iodinated non-ionic contrast medium, was achieved. After computed tomography examination, all the isolated hearths were carried to the forensic pathologist, and a conventional histology assessment was performed on them.ResultsIn 7 out of 11 of cadavers, a final diagnosis of myocardial infarction was made after a complete autopsy and histology procedures. Isolated hearts underwent PMCTA scanning and was confirmed in 6/11 cases, with the autopsy findings showing the presence and the localization of occlusions or severe stenoses and the extension of the myocardial hypoxic area by the extravasation of contrast medium as well.ConclusionIsolated single-organ PMCTA could be considered a valid and useful tool in addition to traditional autopsy investigation (macroscopic sections and histology) in identifying the cause of death by recognizing the presence and degree of coronary artery disease and myocardial infarction area visualization.

Decapitation Due to Car Accident

The occurrence of complete decapitation as a consequence of car accident is an extremely rare event. This fatality is generally seen in pedestrians run over by trains and also in motorcyclists who impact against the tailboard of trucks. Moreover, complete transection of pedestrians and occupants of cars has been described in road accidents especially in case of vehicles traveling at a high speed. We present a case of decapitation with complete degloving injury of the neck in a patient involved in a traffic accident, and we briefly discuss the possible mechanisms producing this injury.

Child abuse followed by fatal systemic Pseudomonas aeruginosa infection

Child abuse has become an increasingly serious diagnostic challenge for physicians. The clinical manifestations include malnutrition and sometimes infection. In fact, stress in children has been reported to increase corticosteroid levels. As a consequence, the thymus begins an involution process, producing a severe impairment in cellular and humoral immunity. Here, we report the case of a 7-year-old child who suffered a prolonged history of abuse and died from a systemic Pseudomonas aeruginosa infection. An initial local chronic infection propagated to the pelvic lymph nodes in an immunologically weak body and evolved into abscesses/phlegmons of the pelvic tissue, sepsis, acute respiratory distress syndrome, multiple organ failure and finally, death. Abused children have to be considered as potentially immunologically impaired patients; therefore, it is very important to screen them for opportunistic infections. Moreover, a history of unusual or recurring infections may indicate abuse, especially neglect or malnutrition. In these cases, further investigations should be conducted to determine if a protective service case should be opened. Thus, there is a need for multidisciplinary cooperation to ensure the early identification and prevention of child abuse.

Virtual autopsy with multidetector computed tomography of three cases of charred bodies.

Herein, we report a comparison of multidetector computed tomography (MDCT) and autopsy in the evaluation of three cases of charred human bodies. Interestingly, MDCT identified several findings useful for forensic purposes, including traumatic injuries not related to the fire, relevant vital reaction signs and detection of foreign bodies. Our results, in addition to data gathered in previous studies, indicate that MDCT is an excellent tool for imaging in postmortem investigations and that it has great potential for the forensic documentation and examination of charred bodies.

The death of Adolf Hitler--forensic aspects.

The death of Adolf Hitler is one of the unsolved mysteries of the twentieth century. Numerous historians and journalists have attempted to piece together the details, but despite the interest in the forensic literature regarding the identification of the body, there has not been much scientific debate about the alleged cause of death--cyanide poisoning, gunshot injury, or both. The available literature concerning Hitlers cause of death is incomplete because the toxicological analysis has not been performed and because the skull bone fragment with a gunshot wound possibly from Hitlers corpse has not been properly examined. This has given basis for various theories, which are reviewed. We believe that mtDNA analysis of the skull fragments and of Hitlers jaw, now filed in Moscow, and samples from maternal relatives of Hitler are crucial linking the skull fragment with the gunshot wound to Hitler.

Virtual autopsy in hanging

AbstractThe aim of the study was to compare postmortem computed tomographic (CT) imaging findings from a case of hanging with the autopsy findings. The CT showed a good match with autopsy findings especially for bone, soft tissue, and spinal injuries. The CT images of the injuries of the neck obtained by CT scan clearly showed the ligature mark, the hemorrhagic suffusion in the soft tissue (thickening of derma) and in the muscles (sternocleidomastoid) of the neck. Furthermore, CT 3-dimensional reconstruction showed brain edema, fracture of the left posterior horn of the hyoid bone, and a grade 1 retrolisthesis of C5 on C6. This last finding was not detected by autopsy because of the anterior approach that is frequently used in necropsy technique. Nevertheless, the CT virtual autopsy did not show vascular findings (like Amussat mark) because a barium mixture was not injected in the body.