Journal of Clinical Forensic Medicine

Aims & Scope/Editorial Board

2006-08-01

Philip S.L. Beh — 2006-08-01

This special issue of the journal is a collection of some of the papers presented at the 17th International Association of Forensic Sciences (IAFS) in August 2005 in Hong Kong.

The development and practice of forensic podiatry

Wesley Vernon — 2006-08-01

Abstract: Forensic podiatry a small, but potentially useful specialty using clinical podiatric knowledge for the purpose of person identification. The practice of forensic podiatry began in the early 1970s in Canada and the UK, although supportive research commenced later in the 1990s. Techniques of forensic podiatry include identification from podiatry records, the human footprint, footwear, and the analysis of gait forms captured on Closed Circuit Television Cameras. The most valuable techniques relate to the comparison of the foot impressions inside shoes. Tools to describe, measure and compare foot impressions with footwear wear marks have been developed through research with potential for further development. The role of forensic podiatrists is of particular value when dealing with variable factors relating to the functioning and the shod foot. Case studies demonstrate the approach of podiatrists, in footwear identification, when comparing exemplar with questioned foot impressions. Forensic podiatry practice should be approached cautiously and it is essential for podiatrists undertaking this type of work to understand the context within which the process of person identification takes place.

Review of initiatives adopted for effective documentation of torture in a developing country

Clifford Perera — 2006-08-01

Abstract: Effective documentation of torture is the key to successful interrogation and redress of torture victims. However the facilities available for such documentation to the forensic practitioners in less resourced countries are far from satisfactory. The emphasis on accurate and detailed documentation of examination findings of torture victims is currently necessary in Sri Lanka as the courts are relying heavily on medical reports for interrogation. In a situation where most of the torture victims are examined by unskilled medical officers who are not full time forensic practitioners, deficiencies of various degrees are commonly observed pertaining to depth of examination and documentation of examination findings. Therefore it was attempted in 2004, to introduce uniformity to existing documentation procedures by implementing Istanbul Protocol on island wide basis. However it was revealed that the adoption of the Istanbul Protocol could not be done as a whole in a short period due to variable degree of compliance from medical officers and further it need to be modified according to domestic requirements. The documentation of torture is a distinct multistage and multidisciplinary process. Therefore unless and untill a cohesive collaboration is established between all disciplines concerned, a positive development on documentation process cannot be anticipated.

Analysis of 265 autopsies of sudden death in children

Shaoying Lin — 2006-08-01

Abstract: Objective: To investigate the causes of death and characteristics of sudden death in children and to offer scientific bases for prevention and cure, and medicolegal expertise of sudden death in children.Material: A retrospective study was carried out on the 265 cases of sudden death in children under 14 years old from 1960 to 2003 in three key hospitals of Haikou city, Hainan Province, China.Result: Of the 265 cases, 164 were male and 101 were female (1.6:1). Most of them were babies aged 1 month–1 year (37.0%). The three most common causes of sudden death in children were diseases such as lobular pneumonia, aspiration pneumonia and viral pneumonia.Conclusion: Most of the reported cases of sudden death in children were babies aged 1 month∼<1 year and males were much more than females in the ratio of 1.6:1. The main diseases causing sudden death were the diseases of the respiratory system, especially pneumonia.

Wrongful convictions, lessons learned: The Canadian experience

Jeffrey R. Manishen — 2006-08-01

Abstract: Following the wrongful conviction of a man for the sexual assault and murder of a child, the Province of Ontario commissioned a public inquiry to prevent future miscarriages of justice. The implementation of several recommendations regarding forensic laboratory procedure and the presentation of expert evidence has proven to be beneficial to the Canadian criminal justice system.

Victims of sexual offences: Medicolegal examinations in emergency settings

Jorge Costa Santos, Anabela Neves, Marlene Rodrigues, Paula Ferrão — 2006-08-01

Abstract: The aim of the study was to present some data concerning the examinations of victims of sexual offences in emergency settings conducted by medicolegal examiners of the Lisbon Department of the National Institute of Legal Medicine (NILM) over a two-year period (2002–2003).The study was based on 352 alleged victims of sexual offences referred by investigating police authorities and physicians working at hospital emergency rooms. Examination records were reviewed and data collected according to the extended medicolegal protocol adopted by NILM, which includes sociodemographic variables, and medical and laboratory findings.The results show that examinations in emergency settings represented about 43% of the total examinations of victims of sexual offences, 44% of them being performed at hospital emergency rooms. Victims’ ages ranged from a minimum of 93 days to a maximum of 86 years. The mean age was 17.5 years. Females represented about 92% with a large over-representation of those aged from 0 to 19 years (61% of the total). Victims were mainly girls of school age (36%) or under 6 years old (25%). Offenders were male, referred to mainly, as acquaintances/neighbours (32%), friends (24%) or cohabiting family members (20%), a large majority belonging to the victim’s social or family circle (85%). Of the examinations requested as “urgent cases” only 61% were reported as having occurred within 72h prior to the examination. Traumatic lesions on the whole body were found in only 28% of the cases, while findings on the genitalia and/or the anus were present in 31%. Medical and laboratory findings were in accordance with some sort of sexual offence in 34% of the cases.Our findings show the great heterogeneity of the victims, with a high proportion of children as well as the interplay between examination requests in emergency settings and the need to define more accurate criteria and proceedings for legal authorities and physicians who are usually the first line of intervention before specialists in legal medicine.

Agricultural and horticultural pesticides fatal poisoning; The Jordanian experience 1999–2002

2006-08-01

Abstract: A prospective autopsy study addressing fatal poisoning with agricultural and horticultural pesticides was undertaken in Jordan over a 4 year period. A total number of 140 deaths occurred during 1999–2002. The mean fatality rate was 0.68 case per 100,000 population and the age range was 2–55 years; mean 28.3 years with male to female ratio 1.03. The largest number of cases occurred in those 20–29 years (n=69, 49.3%) followed by the age group 30–39 years (n=34, 24.3%) and 40–49 years (n=17, 12.1%). Less than 3.0% of the total fatal poisoning was noticed in both children younger than 9 years of age and those in the age group 50–59 years, with no fatal poisoning in adults at the age 60 years and above. At least 64.3% of all pesticide fatalities were due to suicide with male: female ratio (1.37:1). Accidental and homicide poisoning resulted in 24.3% and 7.9% of the total fatalities, respectively; however, only five cases 3.6% of fatal poisoning were due to unknown pesticides. The main pesticide used was carbamates with 110 cases 78.6% followed by organophosphorus 23 cases 16.4%. The study showed that the present legislation on pesticides availability in Jordan failed to reduce the number of fatal pesticides poisoning since the number of fatal pesticides poisoning was increased from 25.3 to 35 cases per year over a 20 years period. Enforcement of a new legislation addressing the availability of agricultural and horticultural pesticides for self-harm, especially carbamates and organophosphorus, is the most important strategy in the long term to prevent fatal pesticides poisoning in Jordan.

Drugged driving in Hungary 2000–2004

T. Varga, K. Mágori, Zs. Hideg, G. Somogyi — 2006-08-01

Abstract: The authors analyzed the biological samples available in criminal cases that were started because of illicit and prescribed drug-impaired driving between 2000 and 2004. The result of the on-the-spot clinical test is not informative and cannot be evaluated as it is mainly affected by the simultaneous presence of alcohol. Licit or illicit drugs in the urine could be detected in 378 people out of 623 people (60.7%), whereas in 59 cases (9.5%) there was some substance present in the blood. The occurrence multiple drugs was high (36.8%). The joint use of alcohol and drugs has increased in the past few years.

Successive explosions in Mumbai the economic center of India

R. Krishnamurthy, B.B. Daundkar, M.K. Malve — 2006-08-01

Abstract: Terrorist activities in India are increasing day by day with sophistication in modus operandi. Mumbai the economic center of India was attacked by a series of bomb blasts at twelve different places within a span of an hour on 12th March 1993. The main explosive used was RDX [Krishnamurthy R, Malve MK, Shinde BM. J Indian Acad Forensic Sci 1996;35(1& 2):46–61.]. After about 10 years, terrorist activity of late has again erupted taking a toll on innocent lives, with the use of explosives causing death and destruction. On 2.12.02 a public bus at Ghatkopar was blown up by an improvised explosive device (IED) with two casualties. On 27.1.03 the public vegetable market at Vileparle was targeted causing heavy damage and panic among common people. On 13.3.03 a fully packed local train compartment at Mulund railway station was blown up by an improved explosive device and the casualties ranged up to 10. In most of the explosions the explosives used were RDX, NC-NG, etc. The blasts that occurred at the Zaveri bazaar and the gateway of India on 25/8/03 showed the presence of big craters at the blast site and on analysis the presence of RDX and petroleum oil.

Forensic and criminologic aspects of murder in North-West (Epirus) Greece

Theodore Vougiouklakis, Christina Tsiligianni — 2006-08-01

Abstract: Little information is presenting in Greek literature regarding forensic and criminological aspects of homicide in North-West Greece. Autopsy reports and the prosecution authorities’ files were respectively analyzed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment in order to comprehensively characterize relevant forensic and criminologic aspects. In the 8-year period from January 1998 to May 2005, 26 homicide cases were autopsied in the Department of Forensic Medicine and Toxicology, University of Ioannina, Greece. Twenty-nine homicide victims (18 males, 11 females; mean age 47 years) and 26 offenders were involved – 20 single, 4 multiple-offenders and 2 were not known (24 males, 2 females; mean age 35 years). The most common method used for homicide was gunshot trauma (41.4%). Head injuries and multiple trauma were the most common cause of fatal injuries. Most homicides took place outside in a deserted area or close to agricultural side (n=12). Fifty percent (n=13) of all cases the offender and the victim were known to each other (acquaintances). Twenty-three cases were categorized as “single” homicides and 3 as “multiple” and the victims were classified; 20 as murder–physical injury with fatal outcome, 2 homicide–suicide, 1 infanticide, 4 matricide, and 2 as patricide.

Fatal poisoning in the region of Epirus, Greece, during the period 1998–2004

Theodore Vougiouklakis, Vassiliki A. Boumba, Antigony Mitselou — 2006-08-01

Abstract: The aim of this study was to assess the characteristics of acute poisoning deaths in the deprived region of Epirus, north-west Greece, as they were recorded among the autopsies performed at the Department of Forensic Medicine and Toxicology, Medical School, University of Ioannina, Greece.A retrospective study of the forensic records and the toxicological data of all autopsies performed over the period 1998–2004 revealed that 46 cases (2.9%) out of the 1582 total autopsies performed were attributed to acute fatal poisoning. The age range was from 16 to 94 years (mean±SD=46.20±22.13). Substances of abuse were implicated in 22 cases (47.8%), pesticides in 9 cases (19.6%), gases in eight cases (17.4%), corrosives in 4 cases (8.7%), and prescription drugs in 3 cases (6.5%). There were 35 males (76.1%) and 11 females (23.9%) and the age range was 16–94 years (mean±SD=39.26±19.00) and 16–93 years (mean±SD=63.36±23.46) for males and females, respectively. Fourteen out of the 46 fatal poisonings were suicide (30.4%), 30 (69.6%) were accident, and 2 were uncertain cases. Pesticides were the most common poisons used for suicide purposes (64.3% of suicides). Drugs of abuse were implicated in the majority of accidental poisoning deaths (73.3%) and were recorded mainly for males (95.5%). The selected cases were classified according to ICD-9 codes.

Occupational accidents and forensic medicine in Turkey

Haluk İnce, Nurhan İnce, Bedia Ayhan Ozyildirim — 2006-08-01

Abstract: In Turkey, evaluation of the ratio of loss of working capacity is made according to various laws and regulations. These laws and regulations use different standards in computing the above-mentioned ratio depending on the professional status of the worker, whether he or she is a member of SSK (Social Security Institution) or ES (The Retirement Pension Institution) system.The aim of this study is to point out at the differences and deficiencies in computing the degree of disability and at the need to bring common standards to these computations. This prospective descriptive research is based on the cases of occupational accidents and occupational diseases brought to the 3rd specialized branch of the Institution of Forensic Medicine (which is the highest ruling instance concerning the decision on this field). Of the 164 accident cases included in this research, 95.1% are males, and 4.9% females. According to distribution by age of the cases, the modal group is respectively (30–39) years for men and (12–19) years for women. 43.8% of the injuries were localized at the hand or wrist.No meaningful statistical relationship could be found between the level of qualification of the workers (skilled–unskilled) and the proportion of those suffering from total disability. For the cases included in the categories 3, 4 and 5 is the ES system; the ratio of disability was similar to those computed according to the SSK system. In conclusion, we would like to insist on the need for our country to amend our laws and regulations according to changing and prevailing conditions and sex differentials and to bring homogeneous standards for all workers.

Homicide in Tours (Indre-et-Loire, France): A four-year review

2006-08-01

Abstract: This retrospective study examined homicides in two French departments located in the West of France (Indre-et-Loire and Loir-et-Cher) for a four-year period from 2000 to 2003. During this period 63 homicidal deaths were investigated at the Institute of Forensic Science of Tours (Indre-et-Loire). There were 45 male and 18 female victims with an average homicide rate of 1.55 per 100,000 persons. The mean age of the victims was 42 years-old. Forty-five assailants were identified; their mean age was 38 years-old. The most common method of homicide was the use of firearms (40% of the cases), followed by blunt-force injury (36%) and sharp-force injury (16%). 51% of the victims knew their assailant, a family member in 26% of the cases. Spousal homicides occurred in 16% of the cases. Dyadic death occurred in six cases. A review of the literature compares these findings to other populations.

Sudden death in a patient with idiopathic scoliosis

Fumiko Satoh, Masaki Q. Fujita, Yoshihisa Seto, Akio Tsuboi, Sanae Takeichi — 2006-08-01

Abstract: We report an autopsy case of sudden death in a 36-year-old craftsman with idiopathic scoliosis. The doctor identified his scoliosis at the age of thirteen, and he was under medical care for three years until he stopped consulting the doctor. He collapsed while walking at the station and was sent to an emergency room in cardiopulmonary arrest state, where he was declared dead in spite of more than an hour of CPR. Numbers of petechiae were seen on the bilateral palpebral conjunctivae and the lips were cyanotic. There were no particular injuries except for small abrasions observed on the face. The back showed right rib hump owing to midthoracic scoliosis (with 73° of Cobb’s angle) and right hemithorax was deformed showing an appearance of pectus excavatum in the front. The volume of the right thoracic cavity was significantly decreased. In the right lung, there was extensive stromal fibrosis, leaving almost no normal alveolar structures, and medial hypertrophy of pulmonary arteriolar walls. Hypertrophy of the right heart ventricle due to these pulmonary changes and the congestion of other organs suggested that the cause of death in this case was cor pulmonale due to pulmonary hypertension. This was a rare case of fatal outcome of advanced idiopathic scoliosis without medical care in spite of early detection through mass screening.

Homicide followed by freezing and burning: Usefulness of measuring SCHAD (short-chain 3-hydroxyacyl-CoA dehydrogenase) activity

L. Fanton, H. Yappo-Ette, C. Vianey-Saban, D. Malicier — 2006-08-01

Abstract: An observation of homicide in which the victim was frozen then burned, was reported. This confirmed the usefulness of measuring SCHAD (short-chain 3-hydroxyacyl-CoA dehydrogenase) activity in the freezing of a human corpse despite unusual circumstances.

The Pathology of the heart conduction system in congenital heart block

2006-08-01

Abstract: The incidence of congenital complete heart block is estimated in 1 of 2500 – 20,000 births. Many cases are isolated (found in an otherwise normal heart) and the pathology of the heart conduction system is variable.We report a 51-year-old man with the diagnosis of complete heart block, with a permanent pacemaker. No family history of rhythm disturbances was available. The patient presented and endocarditis after replacement of the pacemaker battery. The prognosis was poor and the patient died three months later. Autopsy examination showed signs of shock, of septic origin. The heart was hypertrophic (450g) and the left ventricle thickened. Histopathological examination of the heart conduction system showed that the sinus and atrioventricular nodes were normal, but the His bundle was interrupted and replaced by fibrous tissue. No inflammatory signs were present.Loss of conducting fibres and their replacement by fibrous tissue is the most common pathological process in complete heart block. In this case His bundle was mostly affected, different to Lev’s disease where the process is more distal (branching atrioventricular bundle) and to Lenegre’s disease, which shows a diffuse damage in the conducting system.

Delayed deaths after vascular traumatism: Two cases

Anny Sauvageau, Jean-Sébastien Trépanier, Stéphanie Racette — 2006-08-01

Abstract: During expert testimony in court, forensic pathologists are often asked to estimate the length of survival following fatal injuries. Though it is impossible to be precise, fatal vascular trauma survival times are generally considered short. We here report two unusual cases of delayed deaths, one following homicidal stabbing of the heart and the other by suicidal cutting of the neck. In those two cases, investigation clearly provided evidence of prolonged survival: slightly more than 2h for the first case and about 8h for the second. Relevant literature is revised and physiopathological hypotheses are discussed.

Fatal asphyxia by a thyroglossal duct cyst in an adult

Anny Sauvageau, Émilie P. Belley-Côté, Stéphanie Racette — 2006-08-01

Abstract: Thyroglossal duct cysts arise from remnants of embryonic thyroglossal duct that connects the foramen cecum at the base of the tongue to the thyroid gland. The remnants enlarge secondary to secretions from the epithelial lining. Usually, thyroglossal cysts present as non-tender masses. However, they may also become infected, produce fistulas or give hoarseness and dysphagia. Rarely, especially if the mass is located at the base of the tongue, airway obstruction and dyspnea can ensue. This unusual presentation has been mainly seen in very young children and has caused death in about half of these cases. Nevertheless, in the adult population, very few cases of airway obstruction by thyroglossal duct cysts have been reported, only one being fatal. We present the case of a 55-year-old man who died from fatal asphyxia caused by a thyroglossal cyst.

Spontaneous oesophageal perforation

R. Clément, C. Bresson, O. Rodat — 2006-08-01

Abstract: An autopsy was performed on a young adult, who apparently died during his sleep. Mediastinitis was established and empyema was also found in left pleural cavity. The oesophagus examination showed a tear in left side. The lesion occurred in the distal oesophagus and showed the leak communicating freely with the left pleural space. Oesophageal perforation was the source of empyema, resulted from barotrauma to the lower oesophagus during the effort of vomiting. Death caused by septic shock. Boerhaave syndrome is a serious and rapidly fatal spontaneous oesophagus rupture. Forceful ejection of gastric contents in an unrelaxed oesophagus against a closed glottis is the mechanism described. The tear thus produced is vertical. The case report discusses the historical, statistical, pathophysiological, diagnostic and therapeutic aspects of Boerhaave syndrome. The syndrome is a cause of sudden death, which be known by forensic pathologists.

Macrophage activation syndrome: An autopsy case of sudden death

R. Clement, H. Jouan, F. Le Gall, O. Rodat — 2006-08-01

Abstract: In a context of viral gastroenteritis, we report an unusual case of sudden death in an 8-year-old child. The only macroscopic abnormality observed in the autopsy was a diffuse mesenteric adenitis. Organ samples were taken for histopathological examination and a diffuse lymphocytic infiltration was observed. A sinusoidal histiocytic hyperplasia was found in the lymph nodes. Microscopic examination of the lungs and the lymph nodes revealed haemophagocytic lesions (lymphocytes within the cytoplasm of histiocytic macrophages). Immunohistochemical studies demonstrated that the histiocytes were CD68+ PS100− CD1A−. Following this microscopic examination macrophage activation or haemophagocytic syndrome was diagnosed. The syndrome is a distinct clinical entity characterised by fever, pancytopaenia, splenomegaly, and haemophagocytosis in the bone marrow, liver and lymph nodes. It is a clinical entity that is very difficult to diagnose due to the lack of specific clinical signs. It is generally a complication of an infectious process, an aggravation of an auto-immune disease or a complication of a neoplastic process. The physiopathology involves a disregulation of T lymphocytes and particularly T helper lymphocytes. To make this diagnosis the anatomopathological examination must be performed by an experienced practitioner. The presence of a lymphocyte infiltrate of macrophagic histiocytes in myeloid organs and especially positive CD68+ immune markers are the anatomopathological proofs of diagnosis. The autopsy examination must be carefully performed and include systematic sample harvesting for anatomopathological examination. The results of all these examinations taken together allow the diagnosis of haemophagocytic syndrome to be finally made.

Cerebellar-pulmonary embolism, cause of death in the newborn

R. Clement, C. Bresson, P. Marcorelles, O. Rodat, N. Lagarde — 2006-08-01

Abstract: A 28-year-old woman delivered twin girls. The first twin was delivered without any difficulty. The head of the second twin failed to descend with pushing. A special kind of obstetrical forceps, Thierry’s spatulas, were used to extract the second twin in the occipito-posterior vertex position. She was declared dead after recording Apgar scores of 0 and 0 and after 35 min of resuscitation. An autopsy was performed for medico-legal reasons. Macroscopic examination of the brain showed a small area of leptomeningeal haemorrhage in the left sylvian fossa and the base of the brain. Histopathological studies demonstrated cerebellar tissue emboli in meningeal and pulmonary arteries. Excessive pressure on the suboccipital region during delivery can cause traumatic separation of the occipital chondral junctions, which may lead to separation of the occipital squama from lateral parts of the occipital bones. The inferior part of the occipital squama is displaced forward and upward into the posterior fossa. This produces tearing of the duramater and occipital sinuses leading to leptomeningeal haemorrhage in the posterior cranial fossa, often associated with cerebellar lesions. Major stretching and tearing of the posterior aspect of tentorium cerebelli in contact with the sinuses and the cerebellar cortex may also occur, inducing slight movement of the occipital bones and subsequent emboli. This case study is that of a newborn death due to pulmonary cerebellar tissue embolism occurring during delivery with Thierry’s forceps, which are considered less traumatic to the foetal cranium. A review of the literature identified 17 other published cases. In difficult deliveries this pathology should sought carefully. Brain, lung and placenta tissue sections must be studied.

Sudden cardiac death associates with a large right atrium thrombus in a late survivor of heart transplantation

H.L. Yin, H.K. Yip, C.Y. Wang, W.H. Chen — 2006-08-01

Abstract: A fatal circulatory collapse developed acutely in a patient six years after orthotopic heart transplantation. Autopsy revealed a large, fresh thrombus inside the right atrium which obstructed the orifice of the vena cava completely. The grafted coronary artery and pulmonary vessels were patent. There was no rejection or acute infarct in myocardium. Mildly immature organization was seen on the thrombus-adhered wall. Four chamber enlargement and a rapid decline of right ventricular hypokinesia were detected shortly before death although he did not show active cardiopulmonary symptom. Intracardiac thrombus formation is rather uncommon in late survivor. A synergic effect of atrial turbulence and ventricular hypokinesia in the right heart, superimposed by tissue organization, was proposed for thrombus formation. An empty cardiac output was favored for his mortality. These findings provide a strong evidence to suggest anticoagulation in case of complicated or highly risk of embolization such as turbulence or hypokinesia despite of an absence of active cardiopulmonary symptom.

Alcimedes

2006-08-01

Forthcoming meetings

2006-08-01