Category Archives: Forensic pathology

Journal articles relating to forensic pathology including coronial autopsies and Disaster victim identification.

Cardiac fibroma presenting as sudden unexpected death in an adolescent

Forensic Science, Medicine, and Pathology July 2014

The deceased was a previously healthy 16-year-old female who had no significant past medical history, was not on any regular medications and had no known preceding symptoms. Her family described her as “bookish” (as opposed to “sporty”), but it is unknown whether this was the result of poor exercise tolerance or simply personal preference. On the evening of her death, she was seen by her mother who reported she appeared normal. Ten minutes later her mother heard a “thud” coming from her daughter’s bedroom. On investigation she was found collapsed on the floor and not breathing. Emergency services were called and cardiopulmonary resuscitation (CPR) commenced. On arrival paramedics noted her to be in ventricular fibrillation (VF). CPR efforts were continued, including defibrillation and endotracheal intubation, however she did not regain a pulse and was declared dead approximately 1 h post-collapse.

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Endogenous gamma-hydroxybutyric acid (GHB) concentrations in post-mortem specimens and further recommendation for interpretative cut-offs

International Journal of Legal Medicine   August 2014;  DOI:  10.1007/s00414-014-1051-8

When interpreting gamma-hydroxybutyric acid (GHB) concentrations in post-mortem specimens, a possible increase in GHB concentrations because of post-mortem generation must be considered. In this study, endogenous GHB concentrations in post-mortem biological fluids were investigated. Additionally, we review post-mortem GHB concentrations already published in the literature. Heart and peripheral blood samples, cerebrospinal fluid, urine, and vitreous humor were collected from 64 autopsies in subjects where the cause of death excluded GHB exposure. Sample analysis was carried out either on the day of autopsy or later after immediate freezing and storage at −20 °C. GHB concentrations in venous blood samples (n = 61) were <0.6–28.7 mg/L (mean 11.9 mg/L; median 10.6 mg/L), <0.6–65.3 mg/L (mean 15.2 mg/L; median 12.8 mg/L) in heart blood (n = 56), <0.6–25.1 mg/L (mean 6.0 mg/L; median 3.8 mg/L) in urine (n = 50), <0.6–39.0 mg/L (mean 9.6 mg/L; median 7.5 mg/L), in vitreous humor (n = 54), and <0.6–24.0 mg/L (mean 4.2 mg/L; median 3.2 mg/L) in cerebrospinal fluid (n  = 52). There was no significant difference between GHB concentrations in cases where there were signs of beginning putrefaction at the time of autopsy (n = 9) and cases without obvious signs of putrefaction. In one case with advanced putrefaction, the GHB concentration in venous blood was 32.7 mg/L. In conclusion, for post-mortem venous blood, urine, and cerebrospinal fluid, an interpretative cut-off of 30 mg/L for GHB concentrations is suggested in cases where GHB analysis is conducted on the day of sample collection at autopsy or if samples have been stored at −20 °C immediately after collection.

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The concept of ‘intent’ within Australian coronial data: factors affecting the National Coronial Information System’s classification of mortality attributable to intentional self-harm

Health Information Management Journal  28 July 2014; DOI: 10.12826/18333575.2014.0007.Dodds

Within Australia all unexpected deaths are investigated by the Coroners Court; specifically, the coroner investigates the identity of the deceased and the cause and circumstances of death. This ‘unexpected death’ category inevitably includes cases of self-harm and suicide. Concerns regarding the accurate reporting of national suicide statistics resulted in a review of the coding process undertaken by the Australian Bureau of Statistics (ABS), which produces the national statistics, and a formal Commonwealth Government Senate Inquiry in 2009. This article reflects data and opinions collected prior to the Senate Inquiry or the adjustment of the ABS coding processes, and explores the role of the Coroner in determining the intent of the deceased person and the role the National Coronial Information System (NCIS) 1 database plays in the provision of this information. At the Case Notification and Case Closure stages of the coronial process, administrative coders abstract from the coronial file the ‘intent’ of the deceased and enter the data into relevant administrative systems (which upload to the NCIS). The relevant intent code in the NCIS is ‘Intentional Self-Harm’, which incorporates deliberate actions of self-harm and suicide. A mixed-method study was employed to investigate anecdotal reports of a problematic coronial coding process surrounding this category of cases. A sample of Australian coroners (n=16), and of the national population of NCIS coders (n=36), were surveyed using separate instruments, and an unobtrusive case review of sampled NCIS cases (n=127) reflecting nine key mechanisms-of-death, was undertaken. Each Australian state and territory has its own Coroners Act, none of which provides legislative direction regarding the determination of intent by the coroner. Neither the coroner-respondents nor the coders favoured a standard proforma to record ‘intent’. In order to inform their classificatory decision-making regarding the deceased’s ‘intent’, the coders need to abstract extensively from the entire case file, scrutinising documentary materials from different investigators. They rely primarily on the police report at Case Notification and the coroner’s finding at Case Completion. Coders do not generally perceive the classification of ‘intent’ to be problematic; however, despite NCIS-provided coder (technical) support materials, there exist inconsistent coder work practices and, sometimes, absent documentary evidence reflecting lack of information for ascertainment and interpretation by the coroner, investigators, and forensic experts on the ‘intent’ of the deceased. The gap between what a coroner is legally required to document regarding ‘intent’ and what society needs to know for statistical and preventive purposes, seems problematic to bridge.

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Three rounds as “tandem bullets”: unusual findings in a case of a suicidal gunshot to the head

Forensic Science, Medicine, and Pathology August 2014; DOI: 10.1007/s12024-014-9591-2

We report an unusual case of suicide in which three 7.65 caliber projectiles were found in the single gunshot wound to the head of a 53-year-old man. Based on data collected at the death scene, CT scan, autopsy findings, and ballistics analysis, the events were reconstructed as follows: two 7.65 mm rounds had already been fired from the 9 mm Makarov pistol the subject was using but, being a smaller caliber, the cartridges had slipped forward and lodged within the barrel. When a third 7.65 mm cartridge was chambered and the gun fired for the third time, the nose of the last bullet hit the lodged bullets and all three rounds were propelled out of the muzzle in tandem as a single shot. Ballistic investigations confirmed that the kinetic energy of the three tandem bullets would have been sufficient to perforate the skull. In cases of gunshot wounds where the manner of death is unclear, a number of well-described circumstantial parameters, such as an atypical anatomical location of the gunshot, unusual firearm, or ammunition, as well as ambiguous autopsy findings, can raise doubts about the manner of death. In very rare cases, despite a single entrance wound, two or more bullets are recovered from the body, fired by the same weapon at the same time (the so-called “tandem bullet” phenomenon). Injuries by “tandem bullets” have crucial implications in gunshot deaths because of the mismatch between the number of entrance and exit wounds and the number of bullets found in or near the body.

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Traumatic Rupture of Deep Neck Structures in Hanging: Two Case Reports

Am. J. Forensic Med. Pathol.  28 July 2014;  DOI: 10.1097/PAF.0000000000000114

Injuries to the neck structures are various in case of hanging. Soft tissue lesions generally consist in sternocleidomastoid and subhyoid muscle hemorrhages. Traumatic ruptures of deep neck structures are rare. We report 2 cases of partial and complete ruptures of sternocleidomastoid muscles after suicidal hanging. Both were typical and complete hanging. In 1 case, muscle laceration was associated with common carotid rupture on the same side. Hemorrhage at the rupture site was only found at the microscopic level. Such injuries may result from the ligature’s compression and depend on duration of suspension. Heavy body weight, rigid rope material, and fall after a jump may promote their occurrence.

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Why quad bike safety is a wicked problem: an exploratory study of attitudes, perceptions, and occupational use of quad bikes in Northern Queensland, Australia

Journal of Agricultural Safety and Health. 20(1): 33-50, 2014  (doi: 10.13031/jash.20.10380)

Quad bike safety represents the quintessential wicked problem. To address this wicked problem, this research explores the use of quad bikes in the northwestern region of outback Queensland, Australia, concentrating efforts on the pastoral industry. Focus groups and interviews were conducted with pastoralists, farmers, retailers, repairers, healthcare professionals, and regulators. The discussions revealed the diverse activities currently undertaken in the region’s pastoral enterprises while riding a quad bike, and that attitudes toward the purchase and use of quad bikes vary and may be influenced by retailers. Perceptions of risk and safety in the use of quad bikes in occupational settings also varied. The findings from this study provide insight into the decisions of local pastoralists and agriculturalists to use quad bikes in their workplaces, and attitudes toward safety and injury prevention relating to quad bike use in these industries in northwestern outback Queensland. This study is the first step toward understanding quad bike use in this region, with the goal of reducing injury and death, and will be used in policy and legislation development regarding the use and safety of quad bikes in Australia.

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Feasibility of liver weight estimation by postmortem computed tomography images: An autopsy study

Pathology International Volume 64 Issue 7 pages 315–324; July 2014;  DOI: 10.1111/pin.12174

Although organ weight gives pathologists information about the pathogenesis of diseases at autopsy, the knowledge is rarely helpful in postmortem virtual autopsy by computed tomography (CT). To investigate the feasibility of liver weight estimation based on liver volume estimated from three-dimensional CT images and the specific gravity of liver, thirty cadavers who died in the University of Fukui Hospital and whose family members agreed to postmortem CT and autopsy were prospectively enrolled. Mean specific gravity of liver was 1.054 ± 0.009 g/mL (95% confidence interval: 1.0507–1.0573 g/mL). The specific gravity was positively correlated to Hounsfield unit (HU) values of less than 40 (cases with moderate to severe fatty deposition) and remained stable between 1.05 to 1.065 g/mL for HU values greater than 40 (cases with mild or no fatty change). The liver weight estimated by our formula corresponded well to the actual liver weight, and the correlation coefficient was 0.96 (P < 1 × 10−13). The estimated liver weight calculated from estimated liver volume and the specific gravity of 1.055 g/mL was highly accurate, whereas the specific gravity should be reduced by 2%–3% in patients with an HU value less than 40 due to fatty deposition

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