Category Archives: Forensic pathology

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

Characterization of five cases of suspected bathtub suicide

Legal Medicine Available online 13 July 2015

We reviewed five autopsy cases of suspected bathtub suicide. The immediate cause of death in all cases was determined to be drowning on the basis of macropathological findings such as frothy fluid in the airways or overinflation of the lungs as well as histological findings obtained at autopsy. We suspected that the manner of death in those cases was suicide based on comprehensive postmortem investigations of statements from witnesses, the presence of a farewell letter, the fact that clothes had been worn, additional means to ensure suicide, and results of drug tests, as well as autopsy findings. Cases of bathtub suicide should be investigated carefully to distinguish them from accidental or natural death.

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Neck Protection in suicidal hanging

Australian Journal of Forensic Sciences Published online: 02 Jul 2015

Padding, or protecting the neck while hanging, while not rare, may suggest autoerotic activity to less experienced pathologists. Three cases are reported, however, to illustrate two types of neck protection that may occur in suicidal hangings to show an alternative scenario. Case 1: a 38-year-old woman had a grey woollen scarf around her neck underneath a plaited ligature made from sheeting. Case 2: the 57-year-old male partner of Case 1 had a black and white scarf around his neck underneath a ligature made from a plaited sheet. Case 3: a 57-year-old woman had positioned the fingers from both hands beneath a ligature around her neck. The cause of death in each case was hanging, the manner suicide. These cases show that padding of the neck beneath ligatures may on occasion be a feature of suicidal hangings, and also that victims may insert their fingers between the ligature and the neck possibly to reduce the discomfort from ligature compression. Although any unusual features in hanging deaths should be fully investigated, protecting of the neck with padding or finger insertion under ligatures may occur in otherwise relatively straightforward cases of suicide.

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Study of palatal rugae pattern following orthodontic treatment

Australian Journal of Forensic Sciences Published online: 02 Jul 2015

Several studies have demonstrated that palatal rugae, found on the hard palate, behave similarly to fingerprints. In fact, these structures can aid the human identification process particularly when other processes such as dental examination, dactiloscopy and forensic genetics, cannot be used. However, much remains to be explained regarding palatoscopy, and doubts persist about palatal rugae stability following dental treatment. Hence, this study evaluates the stability of palatal rugae pattern after orthodontic treatment. Forty-six casts (24 females and 22 males) were analysed and photographed using standardised techniques. Palatal rugae patterns were measured and assessed using the classification described by Basauri and Martins dos Santos. Data analyses were performed using the software Statistical Package for Social Sciences (SPSS), 22.0. Descriptive analyses were performed and differences between cases were assessed using the Wilcoxon and the chi-square tests at a 5% significance level. There was no morphological change in any rugae for both sexes. However, in females, the first right rugae had significant differences in size before and after the treatment (p = 0.039), suggesting that, in females, palatal rugae morphology is a better marker that palatal rugae length.

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Potentially preventable infant and child deaths identified at autopsy; findings and implications

Forensic Science, Medicine, and Pathology June 2015

Purpose
The purpose of the study was to determine the proportion of pediatric deaths investigated by HM Coronial autopsy which were potentially preventable deaths due to treatable natural disease, and what implications such findings may have for health policies to reduce their occurrence.

Methods
A retrospective study of 1779 autopsies of individuals between 7 days and 14 years of age requested by HM Coroner, taking place in one specialist pediatric autopsy center, was undertaken. Cases were included if they involved a definite natural disease process in which appropriate recognition and treatment was likely to have affected their outcome. Strict criteria were used and cases were excluded where the individual had any longstanding condition which might have predisposed them to, or altered the recognition of, acute illness, or its response to therapy.

Results
Almost 8 % (134/1779) of the study group were potentially preventable deaths as a result of natural disease, the majority occurring in children younger than 2 years of age. Most individuals reported between 1 and 7 days of symptoms before their death, and the majority had sought medical advice during this period, including from general practitioners within working hours, and hospital emergency departments. Of those who had sought medical attention, around one-third had done so more than once (28 %, 15/53). Sepsis and pneumonia accounted for the majority of deaths (46 and 34 % respectively), with all infections (sepsis, pneumonia and meningitis) accounting for 110/134 (82 %).

Conclusion
Around 10 % of pediatric deaths referred to HM Coroner are potentially preventable, being the result of treatable natural acute illnesses. In many cases medical advice had been sought during the final illness. The results highlight how a review of autopsy data can identify significant findings with the potential to reduce mortality, and the importance of centralized investigation and reporting of pediatric deaths.

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Cyanide poisoning related deaths, a four-year experience and review of the literature

Australian Journal of Forensic Sciences  Published online: 03 Jun 2015

Cyanide has been used as a poison for thousands of years. Symptoms of cyanide poisoning begin quickly and death occurs within minutes. In this study, we review 52 cyanide poisoning cases in Tehran, Iran, over a four-year interval, from 30 December 2009 to 1 January 2014. Toxicological analysis and post-mortem findings are discussed. Colour test (Prussian Blue) was used for screening for cyanide with confirmation using the voltammetry method. The youngest decedent was a 2-month old girl. Men constituted 76.9% (40) of the total 52 victims. Peak age prevalence of cases was seen in age groups 21–40 years (32 cases, i.e. 61.5%). Methadone and opioid alkaloids were the most common drugs detected in biological samples in this study. A suicide attempt was the main cause of poisoning in 33 cases. The results showed that cyanide-poisoning-related deaths are among the most public health problems in Iran. Restricted access to cyanide and stricter buying and selling controls may reduce intentional self-poisoning with this dangerous substance.

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Prevalence of new psychoactive substances in Victorian fatally-injured drivers

Australian Journal of Forensic Sciences Published online: 16 Jun 2015

The presence of new psychoactive substances (NPS) in Victorian drivers was determined in the blood of 253 Victorian fatally-injured drivers covering a 2-year period, from 2012 to 2013. The validated LC-MS/MS methods was used to detect 56 synthetic cannabinoids and 32 synthetic cathinones. In only two of the drivers were cathinones detected; 4-methylenedioxypyrovalerone (MDPV) and α-pyrrolidinopentiophenone (α-PVP) in one driver and methylone in another. Synthetic cannabinoids were detected in four of the fatally-injured drivers, and comprised four different drugs: JWH-122, JWH-122-pentenyl derivative, CRA-13 and PB-22, all at quite low concentrations (less than 1 ng/mL). The prevalence of NPS was 2.4% compared with about 29% for the presence of all psychoactive drugs in this period.

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Case of the month – Academic Forensic Pathology

*Please click on the title link to request a copy of the article* (QH staff only)

Volume 5, number 2, June 2015.

Fatal hemoptysis due to undiagnosed pulmonary tuberculosis

Amnestic somnambulism and nocturnal eating disorder associated with zolpidem use as a contributing factor in accidental death

Cerebral toxoplasmosis presenting as a Medical Examiner case

Contact gunshot wound characteristics associated with muzzle modification