Peter Juel Thiis Knudsen

Role of forensic pathologists in mass disasters

The forensic pathologist has always had a central role in the identification of the dead in every day practice, in accidents, and in disasters involving hundreds or thousands of victims. This role has changed in recent years, as advances in forensic odontology, genetics and anthropology have improved the chances of identifying victims beyond recognition. According to the Interpol DVI Guide, fingerprints, dental examination and DNA are the primary identifiers, and this has given new emphasis to the role of the forensic pathologist as the leader of a multidisciplinary team of experts in a disaster situation, based on his or her qualifications and the experience gained from doing the same work in the everyday situation of an institute of forensic medicine.

Terminal ballistics of 7.62 mm NATO bullets: experiments in ordnance gelatin

Military rifle bullets are assumed to tumble 180° in the target and end up facing backwards, but intact. It has been claimed, however, that a German version of the 7.62 mm × 51 (7.62 mm NATO) bullet may fragment at ranges up to 100 m. A lack of strength in the jacket, causing it to break at the cannelure when hitting the target at high impact velocity, has been held responsible for this behaviour. The Danish Armed Forces use a 7.62 mm × 51 bullet, produced by Ammunitionsarsenalet (AMA), which is similar in design. Since the legality of this and similar bullets may be questioned in view of the Hague Declaration of 1899, we decided to supplement an investigation of actual fatal cases with an investigation using ordnance gelatin. In order to compare various makes of bullets on an equal basis, they were fired into ordnance gelatin at various ranges and, consequently with various impact velocities. Bullets manufactured by the US Government, Bofors (Sweden), Raufoss (Norway) and AMA were used. The AMA bullet M/75 used previously was found to fragment at ranges up to approx. 100 m, corresponding to impact velocities of approx. 715 m/sec, while all the other 3 types of bullets were intact at ranges down to 2.5 m, corresponding to impact velocities of approx. 810 m/sec. The final prototype of an AMA bullet to answer this criticism proved capable of withstanding fragmentation as well as the foreign makes previously tested. It will enter series production in late 1995.

Author's comment

1. Knudsen PJT (1988) The effect of the THV bullet in animal tissue. Z Rechtsmed 101 : 219227 2. Fackler ML (1987) Bullet performance misconceptions. Int Def Rev 3 : 369-370 3. Fackler ML (1988) Handgun bullet performance. Int Def Rev 5 : 555-557 4. Fackler ML (1987) Whats wrong with the wound ballistics literature, and why. Institute Report No. 239. Letterman Army Institute of Research, Presidio of San Francisco, CA 5. Fackler ML (1988) Wound ballistics: A review of common misconceptions. JAMA 259 : 2730-2736

The Danish Disaster Victim Identification effort in the Thai Tsunami: organisation and results

Following the December 2004 tsunami in Thailand experts from many countries, including Denmark, went to Thailand to help with identification work. The Interpol system for Disaster Victim Identification (DVI) was employed for the identification of the many casualties. This paper describes the work of the Danish teams in Thailand from the 30th December 2004 until the 6th June 2005. The investigation covers all Danes reported missing directly after the tsunami in Thailand on the 26th December 2004 and who were later found deceased, or, in one case, never recovered. The AM and PM forms were reviewed retrospectively and the relevant information compared. Forensic odontology alone was responsible for 70.3% of identifications, and in two more cases (5.4%) the identification was established using a combination of odontology and fingerprint information. Fingerprints were used to establish identity in 8 cases (21.6%). DNA-typing was only used in one identification, in combination with fingerprinting data. Only one Danish victim was not identified. This review of the 37 Danish cases confirms that odontological examination yielded the most identifications, fingerprint data much fewer, and DNA was only used to a small extent, due to organisational problems with the examination and because the initial samples were of inferior quality.

The effect of the THV bullet in animal tissue

SummaryThe Très Haute Vitesse (THV) bullet was introduced to meet the requirements of law enforcement officers, as an alternative to larger calibre fully jacketed bullets, since expanding or exploding bullets are not relevant in Europe. To examine the effect of the THV bullet in tissue, especially the size of the lesion and the degree of overpenetration, 11 recently killed pigs were shot with the weapons used by the Danish Police Force and a 9-mm pistol for reference. The ammunition was THV in the calibres 7.65 mm, 0.38, and 9 mm, using conventional fully jacketed bullets for comparison. The lesions were considerably larger when the THV bullet was used, the entry wound in particular, being roughly twice the diameter in the case of the THV bullet as compared to the fully jacketed bullet of similar calibre. Only one 7.65-mm THV bullet overpenetrated the target when fired against the thorax or abdomen of the pigs and then with only minimal residual energy. All fully jacketed 7.65-mm bullets, all 0.38 bullets, with the exception of one THV bullet, and all 9-mm bullets overpenetrated the target. The 7.65-mm THV bullet produced a lesion which in its extent resembled that of the fully jacketed 9-mm bullet, and should be a suitable alternative for the Danish Police Force.ZusammenfassungDas Très Haute Vitesse (THV) Geschoß wurde entwickelt, um die Forderungen der Polizei zu erfüllen. Es stellt eine Alternative zu Vollmantelgeschossen größeren Kalibers dar, da ein Geschoß, das sich verformt und explodiert, in Europa nicht gestattet ist. Um den Effekt des Geschosses im Gewebe zu untersuchen — insbesondere die Größe der Verletzungen und die Möglichkeit, das Ziel zu durchschießen — wurde auf 11 kurz vorher getötete Schweine mit den Waffen der Dänischen Polizei und mit einer 9-mm Referenz-Pistole geschossen. Die Geschosse waren THV vom Kaliber 7.65 mm, 0.38 und 9 mm. Vollmantelgeschosse wurden zum Vergleich benutzt. Die Verletzungen durch die THV-Geschosse waren erheblich größer, die Eintrittswunden waren ca. zweimal so groß im Durchmesser wie die Verletzungen mit den Vollmantelgeschossen von entsprechendem Kaliber. Nur ein 7.65 mm THV-Geschoß hat das Ziel durchschossen. Alle 0.38 Geschosse — abgesehen von einem THV — und alle 9 mm Geschosse hatten das Ziel durchschossen, ungeachtet des Geschoßtypes. Die Verletzungen des 7.65 mm Geschosses waren denen des 9 mm Vollmantelgeschosses ähnlich. Das 7.65 mm THV-Geschoß scheint deshalb eine brauchbare Alternative für die Dänische Polizei zu sein.

Neonatal High Bone Mass With First Mutation of the NF-κB Complex: Heterozygous De Novo Missense (p.Asp512Ser) RELA (Rela/p65)

Heritable disorders that feature high bone mass (HBM) are rare. The etiology is typically a mutation(s) within a gene that regulates the differentiation and function of osteoblasts (OBs) or osteoclasts (OCs). Nevertheless, the molecular basis is unknown for approximately one‐fifth of such entities. NF‐κB signaling is a key regulator of bone remodeling and acts by enhancing OC survival while impairing OB maturation and function. The NF‐κB transcription complex comprises five subunits. In mice, deletion of the p50 and p52 subunits together causes osteopetrosis (OPT). In humans, however, mutations within the genes that encode the NF‐κB complex, including the Rela/p65 subunit, have not been reported. We describe a neonate who died suddenly and unexpectedly and was found at postmortem to have HBM documented radiographically and by skeletal histopathology. Serum was not available for study. Radiographic changes resembled malignant OPT, but histopathological investigation showed morphologically normal OCs and evidence of intact bone resorption excluding OPT. Furthermore, mutation analysis was negative for eight genes associated with OPT or HBM. Instead, accelerated bone formation appeared to account for the HBM. Subsequently, trio‐based whole exome sequencing revealed a heterozygous de novo missense mutation (c.1534_1535delinsAG, p.Asp512Ser) in exon 11 of RELA encoding Rela/p65. The mutation was then verified using bidirectional Sanger sequencing. Lipopolysaccharide stimulation of patient fibroblasts elicited impaired NF‐κB responses compared with healthy control fibroblasts. Five unrelated patients with unexplained HBM did not show a RELA defect. Ours is apparently the first report of a mutation within the NF‐κB complex in humans. The missense change is associated with neonatal osteosclerosis from in utero increased OB function rather than failed OC action. These findings demonstrate the importance of the Rela/p65 subunit within the NF‐κB pathway for human skeletal homeostasis and represent a new genetic cause of HBM.

Neonatal High Bone Mass With First Mutation Of The NF-κB Complex

Heritable disorders that feature high bone mass (HBM) are rare. The etiology is typically a mutation(s) within a gene that regulates the differentiation and function of osteoblasts (OBs) or osteoclasts (OCs). Nevertheless, the molecular basis is unknown for approximately one‐fifth of such entities. NF‐κB signaling is a key regulator of bone remodeling and acts by enhancing OC survival while impairing OB maturation and function. The NF‐κB transcription complex comprises five subunits. In mice, deletion of the p50 and p52 subunits together causes osteopetrosis (OPT). In humans, however, mutations within the genes that encode the NF‐κB complex, including the Rela/p65 subunit, have not been reported. We describe a neonate who died suddenly and unexpectedly and was found at postmortem to have HBM documented radiographically and by skeletal histopathology. Serum was not available for study. Radiographic changes resembled malignant OPT, but histopathological investigation showed morphologically normal OCs and evidence of intact bone resorption excluding OPT. Furthermore, mutation analysis was negative for eight genes associated with OPT or HBM. Instead, accelerated bone formation appeared to account for the HBM. Subsequently, trio‐based whole exome sequencing revealed a heterozygous de novo missense mutation (c.1534_1535delinsAG, p.Asp512Ser) in exon 11 of RELA encoding Rela/p65. The mutation was then verified using bidirectional Sanger sequencing. Lipopolysaccharide stimulation of patient fibroblasts elicited impaired NF‐κB responses compared with healthy control fibroblasts. Five unrelated patients with unexplained HBM did not show a RELA defect. Ours is apparently the first report of a mutation within the NF‐κB complex in humans. The missense change is associated with neonatal osteosclerosis from in utero increased OB function rather than failed OC action. These findings demonstrate the importance of the Rela/p65 subunit within the NF‐κB pathway for human skeletal homeostasis and represent a new genetic cause of HBM.

Whiplash-Associated Disorders: Clinical and medico-legal guidelines on the methods of ascertainment

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.

Unusual accidental decapitation in a road traffic incident

Decapitation is an occurrence only rarely encountered in forensic medical practice. This fatality is generally most often described in pedestrians who have been run over by trains accidently or in cases of suicide, or alternatively in occupants of cars involved in high speed vehicle collisions. We report, for the first time, a case of a complete decapitation of a pedestrian as a consequence of a traffic accident. Due to a thorough medico-legal investigation of the body and the involved vehicle, we were able to reconstruct the unique dynamics of the accident and the mechanism of injury.

Forensic Case Reports Presenting Immersion Pulmonary Edema as a Differential Diagnosis in Fatal Diving Accidents

Immersion Pulmonary Edema (IPE) reduces the transport of gases over the respiratory membrane due to edema in the interstitium and respiratory zones. IPE has previously been described in both swimmers and divers, with a few known fatal cases. We have reviewed 42 SCUBA and snorkeling‐related drowning deaths, and through a thorough analysis of each case, including both diving physiology and forensic pathology, we present IPE as a differential diagnosis to drowning in four cases. Our findings propose that; absence of watery content in the stomach and conducting airways, and liquid filled lungs without hyperexpansion, may be compatible with IPE. We suggest that IPE should be considered in cases where witness testimony reveals; no obvious signs of aspiration and rapid respiratory deterioration despite continuous breathing through an appropriate air source. The diagnosis should be based on the overall impression, including both the autopsy findings and the circumstances regarding the accident.