Pekka J. Karhunen

The polymerase chain reaction and post-mortem forensic identity testing: Application of amplified D1S80 and HLA-DQα loci to the identification of fire victims

The application of DNA typing methods after amplification by the polymerase chain reaction (PCR) of DNA derived from body tissues from charred fire victims was investigated. A total of 26 different tissue specimens from ten extensively burned individuals were analyzed. The samples included femoral muscle, psoas muscle, bone marrow and blood. The post-mortem period varied from 38 to 183 h. After amplifying the DNA by PCR from the various tissues, the D1S80 locus was analyzed with a high resolution polyacrylamide gel electrophoresis technique followed by silver staining and the alleles of the HLA-DQ alpha locus were detected by using a reverse dot blot format. All samples could be typed for both loci and the genotypes were consistent in the various tissues from each individual. A parentage test was performed in two cases and Mendelian inheritance of the alleles for both loci was observed.

Neurosurgical vascular complications associated with aneurysm clips evaluated by postmortem angiography

Neurosurgical vascular complications were evaluated by postmortem angiography in a consecutive prospective series of 63 patients in Helsinki who suffered a fatal outcome following neurosurgery for ruptured intracranial aneurysm. Operative vascular complications were revealed in 28 (44%) of the cases. Massive intraoperative bleeding resulting from rupture of the aneurysm or adjacent major artery during dissection or clip application complicated the operation in 16 (25%) patients. Clip-induced obstruction of cerebral arteries was detected by angiography in seven cases (11%). In six of the patients an adjacent cerebral vessel was accidentally clipped. In one case a kinking of the clip had caused obstruction of the right anterior cerebellar artery with resulting frontal infarct. A combination of rupture of the internal carotid artery and accidental ligation of the left posterior cerebellar artery occurring simultaneously during the clipping of a ruptured basilar aneurysm was detected in one patient (2%). Other types of complication were revealed in four cases (6%): detachment of clip with re-bleeding; clipping of an uninvolved aneurysm instead of the ruptured one; displacement of the clip beneath the ruptured aneurysm. Operations on ruptured basilar artery aneurysm were significantly (P less than 0.01) more prone to complications. The results indicate that operative vascular complications play a significant role in the mortality of aneurysm patients. Post-mortem angiographic technique with contrast medium that vulcanizes at room temperature is particularly suitable for demonstration of the haemodynamic significance of clip-induced cerebrovascular accidental occlusions, and is the only method at autopsy to reveal an occlusion caused by a kinking of a properly placed aneurysm clip.

Arteriovenous malformation of the brain: Imaging by postmortem angiography

Arteriovenous malformation (AVM) of the brain, detected in 0.06% of medicolegal autopsies in Helsinki, was imaged in four cases by postmortem angiography using contrast medium which vulcanised at room temperature. Postmortem angiography visualized the location, extent and type of the malformation as well as its feeding vessels. Angiography was also useful in differentiating between AVM and cerebral artery aneurysm as a cause of haemorrhage and in identifying vascular complications following neurosurgical resection of malformations.

Alcohol screening with the Alcoscan test strip in forensic praxis

The Alcoscan test strip was applied as an assay for the screening of alcohol in vitreous humor and urine samples in autopsy cases and in saliva from drunken drivers. The method gives instant and reliable semi-quantitative information on the presence of alcohol and is valuable when considering the necessity of chemical sampling especially during autopsy.

High cyanide level in a homicide victim burned after death: Evidence of post-mortem diffusion

Elevated levels of carbon monoxide and cyanide serve as evidence of intravital burning in fire victims. Hydrogen cyanide is released by combustion of nitrogen-containing organic material such as plastics and wool. We present a case of a man who died of haemopneumothorax caused by a stab wound. According to several eye witnesses the body was wrapped in a plastic sheet and burned 2 days after death with the aid of gasoline. No coal pigment was observed in the mucosa of the upper airways at autopsy. The blood sample taken from the pulmonary vessels 6 days after death disclosed a level of blood carboxyhaemoglobin of 4% and of blood cyanide of 10 mg/l. The low carboxy-haemoglobin level was consistent with the smoking habits of the victim. The thoracic cavity had been opened by burning of the intercostal soft tissue. This allowed hydrogen cyanide gas to enter the thoracic cavity and diffuse into the blood probably causing the high blood-cyanide level.

Blood alcohol in sudden and unexpected deaths

Blood alcohol concentration was determined in 1672 sudden and unexpected natural and non-natural out-of-hospital deaths. The material covered all medicolegal autopsies in the province of Uusimaa which has a population of approximately 1.1 million inhabitants. In general, the prevalence of cases with alcohol in the blood at the time of death was high but varied considerably according to sex, age, and the cause and manner of death. The blood alcohol result was positive in 36% of the male and in 15% of the female material. In 59% of the alcohol-positive male and in 54% of the alcohol-positive female cases the actual concentrations were at least 1.5%. Acute use of alcohol was regarded as a significant condition contributing to death in 23% of the whole male and in 8% of the whole female material. These gross results and the details presented indicate that the acute use of excess alcohol is a factor contributing to non-natural but also to sudden and unexpected natural deaths to an extent that is not generally known. The results also emphasize that simple blood alcohol determination should be a routine procedure in the autopsy praxis of all sudden and unexpected natural and non-natural out-of-hospital deaths.

Benign bile duct tumours, non-parasitic liver cysts and liver damage in males.

Pathogenetic associations between benign hepatic tumours and liver damage were studied in an autopsy series of 91 males with high incidence of alcoholism. Information on the consumption of alcohol was obtained by interviewing a family member or a close friend of the deceased. The reported use of alcohol correlated well with the increase of fatty and fibrotic changes and with the occurrence of liver cirrhosis, alcoholic hepatitis or pancreatitis. Benign bile duct tumours (bile duct adenomas and von Meyenburgs complexes) (n = 26) were associated with the occurrence of bridging (P less than 0.0005) and periportal (P less than 0.025) fibrosis of the liver and, independently from these, with chronic pancreatitis (P less than 0.05) and with non-parasitic liver cysts (n = 14) (P less than 0.01). The weight of the liver was greater (P less than 0.01) in males with focal nodular hyperplasia (n = 3). Cavernous hemangioma (n = 19) occurred independently of the parameters studied. None of the tumours showed significant correlation to liver cirrhosis, alcoholic hepatitis, fatty liver or diseases of the gallbladder. The results are in line with observations on the reactive nature and connections to fibropolycystic liver disease of benign bile duct tumours in laboratory animals and in man. Their presence in human liver specimens should be taken into account as a sign of liver damage, in this study related to heavy use of alcohol or to chronic inflammation of the pancreas.

Diagnostic postmortem angiography of fatal splenic artery haemorrhage

SummaryThe site of fatal haemorrhage from the splenic artery, caused in one case by a ruptured aneurysm and in another case by an intracystic haemorrhage of a postoperative pancreatic pseudocyst, was revealed by postmortem angiography. Radiopaque silicone rubber vulcanizing at room temperature was used as contrast medium. In the latter case, the dissection was seriously hampered by tight postoperative intestinal adhesions following four abdominal operations to control bleeding into the gastrointestinal tract. The results indicate the usefulness of postmortem angiography with contrast medium vulcanizing at room temperature for postmortem diagnosis of rare causes of gastrointestinal haemorrhage.ZusammenfassungDie Quelle der tödlichen Blutung der Arteria lienalis, die in einem Fall durch die Ruptur eines Aneurysma und im anderen Fall durch die Verblutung in die Pseudozyste des Pankreas nach der Operation veranlaßt war, wurde mit Hilfe der Angiographie bei der Leichenöffnung dargestellt. Bleioxid in Siliconkautschuk Vergußmasse (Wacker-Chemie GmbH.) wurde als Kontrastmittel bei Zimmertemperatur angewandt. Im zweiten Fall war die Dissektion wegen der festen Adhäsionen nach vier Magenoperationen, die man wegen der Blutungen ausgeführt hatte, sehr schwierig.Die Ergebnisse weisen darauf hin, daß bei der Obduktion die Verwendung dieser angiographischen Methode, mit bei Zimmertemperatur vulkanisierbarem Material, gut geeignet ist für den Nachweis von seltenen und mit anderen Methoden nur schwierig darstellbaren Blutungsquellen in die Bauchhöhle oder den Magendarmkanal.

Peripheral Zonal Hepatic Necrosis Caused by Accidental Ingestion of Methyl Ethyl Ketone Peroxide

Fatal massive peripheral zonal hepatic necrosis developed in a 47-year-old man who accidentally ingested a solution of methyl ethyl ketone peroxide (MEKP) in dimethyl phtalate. Such solutions contain about 10% active oxygen. The clinical course was characterized by temporary cardiac arrest, abdominal burns, severe metabolic acidosis, rapid hepatic failure, rhabdomyolysis and respiratory insufficiency. A fatal outcome resulted 4 d afterwards from hepatic coma associated with blood coagulation disorders. Microscopical examination revealed massive periportal hepatic necrosis accompanied by atypical pseudoductular proliferation. The proliferating cells were probably of bile duct origin and exhibited atypia and mitoses. The pathogenetic mechanism may involve lipid peroxidation caused by free oxygen radicals derived from MEKP.

Surveillance of Human Immunodeficiency Virus (HIV) Antibodies in Medicolegal Autopsies in Finland—Monitoring Early Changes in HIV-Seropositivity Among Risk Groups and Average Population

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.