Category Archives: Forensic pathology

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

Postmortem CT compared to autopsy in children; concordance in a forensic setting

International Journal of Legal Medicine April 2014
The aim of this study is to assess the accuracy of postmortem CT (PMCT) in determining the cause of death in children who underwent a forensic autopsy because of a suspected nonnatural death.

Journal of Law and Medicine Vol 21 no 2 December 2013

Regulating the use of human bodily material [Editorial]

The articles in this special issue consider recent developments in the law regulating the use of human bodily material and the wider implications of those developments. For some time, the law has accepted that a person who has undertaken “work and skill” on excised bodily material may obtain at least a possessory right; but the person from whom the material came did not have such a right. Now, however, the law has recognised that people may have some legal rights regarding their own bodily material. What is the nature and source of those rights? Should they be expanded? If so, what legal principles are best to do that? The most frequent suggestion is the law of property but many other areas of law are also relevant: the law of contract; tort (bailment and consent); criminal law (e.g., forensic testing); gifts; custodianship and others. These regulatory options are outlined in this editorial and discussed by lawyers and other contributors in their articles in this special issue. There are also stimulating philosophical reflections on the nature of human bodily material.

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Relational bodies

This article argues that debates over the legal status of bodies reveal a much deeper  dispute over the nature of the self. In these discussions lawyers and ethicists have much to learn from a more profound understanding of the biological nature of the body. Far from being a static entity, the body is constantly recreating itself. It contains parts that are organisms in their own right. Bodies are dependent upon other bodies and the external environment for survival. The complex biological picture reflects a philosophical truth that
bodies are interdependent and “leaky”. We should not, therefore, expect a single legal regime, such as property, to capture the biological and ethical values that are at stake in relation to every part of the body. A more complex statutory regime is required to recognise the complexity of the interests in, and nature of, different body parts.

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Property or not property? The spectrum of approaches to regulating theuse of human bodily material

This article presents the case for taking a property approach in regulating the use of human  bodily material. It examines the current debates on the issue and outlines the various perspectives, ranging from the anti-property stance, through the spectrum of positions on modified and semi-proprietary approaches, through to the “full-blooded” property approach advocated by some commentators. It elucidates why those approaches that allow some proprietary aspects into regulation are to be preferred.

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“Shaken baby syndrome” and forensic pathology

Forensic Science, Medicine, and Pathology Colin Smith March 2014

Commentary:
The article by Byard [1] raises interesting points, and
highlights issues faced by the forensic pathologist, and I
will try to present a neuropathological perspective. An
infant, by definition aged up to 12 months, is presented to
the emergency services having suddenly collapsed. On
admission the child is hypotensive and bradycardic, and,
following resuscitation, investigations show bilateral thin
film subdural hemorrhage (SDH), bilateral retinal hemorrhage,
and ischemic encephalopathy. Life support is withdrawn
at some point later and the forensic pathological
investigations begin.

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New book in the library – Essentials of Autopsy Practice: Advances

Essentials of autopsy practice: advances, updates and emerging technologies (2014) / Rutty, Guy N. (ed)

This book covers new and exciting topics which have emerged in the area of autopsy recently, including the three different post-mortem CT-angiography systems currently available to practitioners in this field; a highly topical chapter on the role of genetic abnormalities in the handling of drugs within the body and how this can affect the interpretation of toxicological results in relation to how the drug may have caused or contributed to death; an update on the current classification and considerations related to deaths due to hanging; a review of injuries and fatalities caused by animals including post-mortem scavenging; an authoritative review of poisons and toxins from water and the life that inhabits it; and recent advances in knowledge in the use of entomology as an investigative tool as well as knowledge related to colonisation of cadavers by insects, animals and birds.

Essentials of Autopsy Practice: Advances, Updates and Emerging Technologies is a multi-subject book, aimed at different grades of practitioners, from different practice areas, covering topics that are currently discussed and anticipated to be discussed in the field of autopsy practice over the next few years.

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New book in the library collection – Essentials of Autopsy Practice: Innovations

Essentials of autopsy practice: innovations, updates, and advances in practice (2013) / Rutty, Guy N.

Essentials of Autopsy Practice: Innovations, Updates and Advances in Practice is the fifth volume in the Essentials in Autopsy Practice series, covering topics of current and future interest. Designed to keep all involved in the investigation of death abreast of changes within the field, this volume covers a wide range of topical areas which can be encountered around the world.

Essentials of Autopsy Practice: Innovations, Updates and Advances in Practice covers death by drowning; deaths from extreme temperature; the radioactive autopsy; chemical contamination and the autopsy; blast injuries; forensic odontology identification; and determination of the force used to cause an injury.

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Mutation models for DVI analysis

Forensic Science International: Genetics Volume 11, July 2014, Pages 85–95

In recent years, the use of DNA data for personal identification has become a crucial feature for forensic applications such as disaster victim identification (DVI). Computational methods to cope with these kinds of problems must be designed to handle large scale events with a high number of victims, obtaining likelihood ratios and posterior odds with respect to different identification hypotheses. Trying to minimize identification error rates (i.e., false negatives and false positives), a number of computational methods, based either on the choice between alternative mutation models or on the adoption of a different strategy, are proposed and evaluated. Using simulation of DNA profiles, our goal is to suggest which is the most appropriate way to address likelihood ratio computation in DVI cases, especially to be able to efficiently deal with complicating issues such as mutations or null alleles, considering that data about these latter are limited and fragmentary.

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Abdominal apoplexy: a stroke of misfortune

Podduturi, V., Guileyardo, J. M. (2014) Academic Forensic Pathology 4(1): 118-122

Idiopathic spontaneous intraperitoneal hemorrhage (ISIH), or abdominal apoplexy, is due to nontraumatic, small vessel rupture; excluded by definition is hemorrhage associated with aortic aneurysm, gynecologic conditions (including ruptured ectopic pregnancy), and bleeding tumors. As defined, this condition is rare and etiologically complex. We report
a case of ISIH associated with ruptured dissection of the gastroduodenal artery (GDA) which occurred following two paracentesis procedures for ascites due to cirrhosis. Severe acute inflammation of the vessel wall and resolving endocardial thrombosis suggest an infectious or “mycotic” etiology for this arterial dissection. Direct vascular injury during paracentesis was excluded as a cause of death. Small artery hemorrhage may be associated with aneurysmal rupture or other vasculopathies. Visceral small vessel aneurysms are rare, and GDA aneurysms are even less common. Although the regional vascular anatomy is complex and finding a bleeding point within a bloody field with no intravascular pressure may be impossible, careful dissection of the smaller vascular branches can be rewarding. Clinical management of ISIH is also challenging since findings may be nonspecific and limited to hemodynamic instability and atypical abdominal pain; however, immediate exploratory surgery is the treatment of choice, and the non-operative mortality approaches 100%.

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Rehydrating mummified hands: the Pima County experience

Hernandez, G. & Hess, G. L. (2014) Academic Forensic Pathology, 4(1): 114-117

A number of articles and technical notes describing various methods of softening or casting mummified fingers to obtain fingerprints have been published in the scientific literature over the last 50 years. The publications to date describe either single case reports or a small number of cases in which mummified fingers were rehydrated or casted using a
variety of techniques. From 2001–2012, we rehydrated approximately 425 pairs of mummified hands for fingerprint identification using a 3% sodium hydroxide (NaOH) solution. Disarticulated mummified hands are rehydrated in a 3% NaOH solution for 48-72 hours until the desired
level of suppleness is reached. Following rehydration, the hands are dried and fingerprinted. From 2011–2012, 76 pairs of mummified hands were rehydrated using this technique. Positive fingerprint identifications were made in 34 (45%) of the 76 cases after successful rehydration.

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The value of the pediatric skeletal examination in the autopsy of children

Love, J. C. [et al...] (2014) Academic Forensic Pathology, 4(1): 100-108

The pediatric skeletal examination (PSE) is an autopsy technique recommended for pediatric cases suspicious for nonaccidental injury. The technique requires the reflection of the musculature and periosteum of the ribs, clavicles, long bones, and scapulae, and inspection of the bone surfaces and chondro-osseous interfaces. The technique is time consuming, labor intensive and possibly disfiguring. Therefore, the value of the technique must be measured against the cost.
The present study was designed to evaluate the impact of the PSE on the sensitivity of the autopsy. A non-randomized retrospective review of 94 autopsy reports was done. The cause and manner of death for each case was classified as blunt force trauma and homicide. Half of the sample received a PSE during the autopsy and half did not. The number of rib and long bone fractures noted in the reports was significantly greater in the
group that received the PSE. The number of cranial, scapular and  clavicular fractures was not significantly different between the two groups. The PSE does not increase the visibility of the neurocranium; therefore, a difference in the number of cranial fractures was not expected. Scapular and clavicular fractures were rare in the study population. The  insignificant difference between the two groups may be a reflection of the rarity of the fracture as opposed to the sensitivity of the PSE. The results of the study indicate that the PSE increases the sensitivity of the pediatric autopsy with respect to long bone and rib fractures.

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Study of sudden gastrointestinal deaths: An autopsy study

Medicine, Science and the Law April 2014 vol. 54 no. 2 63-67

Sudden or unexpected deaths can occur from violence, poisoning, as well as from natural causes. In spite of gastrointestinal diseases being one of the important causes for sudden natural death, only limited studies have been conducted into the pattern of sudden deaths due to gastrointestinal causes. As a result, a 10-year (January 2001 to December 2010) retrospective study was conducted in the Department of Forensic Medicine, M.S. Ramaiah Medical College, Bangalore, South India. Data were collected from the post-mortem register maintained in the department and the relevant reports were reviewed. Descriptive statistics for qualitative type of data was summarized using frequency and percentage. A total of 7520 deaths were reported. This included a total of 291 sudden natural deaths, out of which 62 cases (21.3%) were due to gastrointestinal causes. Maximum number of cases (nine cases – 15.6%) occurred in the year 2009. Of the 62 cases, 87% were males and 13% were females. The age of the deceased ranged from seven to 78 years and maximum numbers of cases were in the age group of 30–39 years (25.8%). Out of 28 cases (45.1%) of cirrhosis, 19 died due to variceal bleeding and the rest due to hepatic failure. Perforations resulted in death in 29% of cases due to peritonitis.

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