Body length estimation during the post mortem interval: Preliminary study

Purpose. Body height represents an essential parameter in forensic cases. Moreover, the evaluation of stature could be helpful also in malpractice lawsuits. The reliability of cadaver length can be influenced by several factors and the difficulties in obtaining data upon precise living stature are well-known. Methods. We prospectively evaluated 100 cadavers. The cadavers were admitted to the mortuary within 2 hours of death. The body length was measured using a portable stadiometer, in three different post-mortem intervals: within the first 2 hours (T0), at 4-6 hours (T1) and after 20-24 hours (T2). Results. Showed that at T1 there was a lengthening of the cadaver by almost 1 cm while there was a small decrease in the following hours. Thus, we can state that nearly 24 hours postmortem cadaver length increases slightly (0.6 cm) from the measurement taken 2 hours postmortem, and this is very close to the estimated living height. Conclusion. Variation of body size during post mortem interval has not been fully explored despite its important implication in forensics. The findings here observed, even considering the limitation exposed in the study, do not support the theory that there is a great difference in cadaver stature postmortem

Patricide and overkill: a review of the literature and case report of a murder with Capgras delusion

Despite being an infrequent crime, parental homicide has been associated with schizophrenia spectrum disorders in adult perpetrators and a history of child abuse and family violence in adolescent perpetrators. Among severe psychiatric disorders there is initial evidence that delusional misidentification might also play a role in parricide. Parricides are often committed with undue violence and may result in overkill. The authors present the case of an adult male affected by schizoaffective disorder and Capgras syndrome who committed patricide. Forensic pathologists classify such cases as overkill by multiple fatal means comprising stabbing, blunt trauma and choking. Accurate crime scene investigations coupled with psychiatric examinations of perpetrator allow reconstruction of the murder stages. This overkill case is discussed in the context of a broad review of the literature

Death due to ingestion of nicotine-containing solution: Case report and review of the literature

Nicotine, a lipid-soluble alkaloid obtained from the dried leaves of Nicotiana, is most frequently encountered in tobacco products for smoking, chewing or sniffing as well as in a limited number of pesticides. Though nicotine is one of the most toxic drugs of abuse, it has rarely led to fatalities. Sudden death can be caused by cardiovascular arrest, respiratory muscle paralysis and/or central respiratory failure. A 42-year-old man was found dead by his wife. He was lying on the floor, next to a box containing many empty bottles of beer and vodka. Some labeled chemical bottles found at the scene contained various substances, including nicotine and brucine. Gross examination of the organs at autopsy revealed no specific findings. The toxicological examination failed to disclose any lethal toxic agents other than a high concentration of nicotine and its primary metabolite cotinine in femoral venous blood (2.2 μg/mL). Blood alcohol was determined to be 2.1 g/L in femoral venous blood. Only a paucity of fatal cases of nicotine poisoning has been reported in the literature so far. © 2009 Elsevier Ireland Ltd. All rights reserved

Assessing chronological age of unaccompanied minors in Southern Italy

The increasing volume of, and subsequent complexities resulting from, migratory flows in the broader context of globalization has led to a range of problems, not only the protection of human rights and disease control but also the identification of those with the right to apply for refugee status and the age assessment of unaccompanied minors. Italy is a magnet for immigration from other countries bordering the Mediterranean Sea because the Italian coasts are within easy reach. In Italy, as in other western countries, unaccompanied asylum seekers deemed to be younger than 18 years face a very different path through the immigration system from that experienced by adults. Generally, adults are subject to immediate deportation or detention in jail. Minors are processed through the juvenile system, where detection is not mandatory; they will often have access to educational programs and may be granted a residency permit. The Section of Legal Medicine of the University of Bari was approached by immigration police authorities and judges to explore the possibility of examining unaccompanied asylum seekers, who claim do be younger than 18 years, to assess their age. A group of forensic pathologists and odontologists performed this evaluation relying on the skeletal maturation as seen on radiographs of the wrist and the pelvis for iliac crests and on an orthopantomograph, together with background information and clinical examination of each individual. Case studies are presented. This article does not attempt to give a definitive account of the different scientific methods for the assessment of age. It is important to understand some of the methods that may be used in an attempt to assess developmental maturity and from which it may be possible to ''read off'' an approximate chronological age. © 2011 by Lippincott Williams & Wilkins

Radiographic dental implants recognition for geographic evaluation in human identification

Dental implants for prosthetic rehabilitation with fixed crown or mobile partial/total dentures is a very common oral treatment among the population in Italy as elsewhere. There is a great number of implant systems of different designs. However, a catalogue of radiographic images and a description of the dental implants available in Italy would be useful in order to identify the manufacturer and the type of implant encountered in forensic casework. When an unidentified body is found with one or more implants in the jaws, and no dental record is available, clues gleaned from the type of implants used could give direction to the investigation. In this study Italian implant manufactures were contacted and asked to provide specimen implants. Digital radiographs were taken of all the implants donated at 0°, 30°, and 60° horizontal rotation, combined with -20°, -10°, 0°, +10°, and +20° vertical inclination relative to the radiographic beam and the X-ray sensor. A total of 15 images per implant were taken and examined to identify consistent, unique features that would aid in implant recognition. Only those observations made from radiographs between -10° and +10° vertical inclination would ever be used for definite identification of any implant. The information from this study should be considered a survey of the commercial distribution of dental implants in Italy through their digital radiographic images. It is also a starting point for a wider geographical evaluation of different manufacturers in other countries and continents. The radiographic images provided should help both the forensic odontologist and the prosthodontist to identify pre-existing implants which they may discover from their radiographic images

Sudden natural death in a suicide attempt

In this article, we report an unusual case of sudden death arising from a ruptured basilar artery aneurysm during a suicide attempt. A 72-year-old male was found dead in his home after sustaining superficial flesh gunshot wounds (entrance and exit) involving the forehead. The victim had been depressed for several months and had frank suicide intention. The pertinent autopsy findings revealed a superficial nonpenetrating bullet path of the scalp with no skull fractures or brain injuries. However, brain examination identified subarachnoid hemorrhage and subdural clot about the brainstem and within the posterior fossa linked to a basilar artery aneurysm rupture. The cause and manner of death and contributing factors of the "non-lethal" gunshot wounds are discussed

Sepsis and nosocomial infections: The role of medico-legal experts in Italy

Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people’s loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers’ work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections

Sepsis and nosocomial infections: The role of medico-legal experts in Italy

Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people’s loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers’ work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections

Ceramic Total Knee Arthroplasty: Ready to Go?

Total knee arthroplasty (TKA) is a well-established surgical procedure in the late stages of knee osteoarthritis. Nevertheless, this procedure is associated with a percentage of unsatisfactory results and biomechanical failures, with aseptic loosening being the most common cause of revision. Beside these problems, cutaneous and systemic hypersensitivity reactions to metals have arisen as an increasing concern after joint arthroplasties, even if allergies against implant materials are still a quite rare and not well-known problem. Ceramic composites have been recently used in prosthetic components, showing minimum wear and excellent long-term results in total hip replacement, due to their high resistance to scratching and their better wettability with respect to cobalt-chromium alloy. Furthermore, the biologic response to debris generated from these bearings is less aggressive. Knee joint simulator tests and clinical results demonstrate promising results of TKAs with ceramic components that should led to benefit for the patients

Sudden cardiac death after robbery: Homicide or natural death?

Tako-Tsubo is one of a number of rare acquired cardiomyopathies that are characterized by left ventricular dyskinesia and symptomatology typical of acute myocardial infarction (AMI). The most important feature is that the clinical features are triggered by a severe physical or emotional stress. The authors describe the story of a woman, who was brutally assaulted by two men during a house robbery and died from sudden heart failure 8 hours later, after being taken to hospital. External examination revealed no macroscopic alteration of the inner organs, whereas microscopy showed contraction bands with myocardial necrosis, subendocardial and interstitial neutrophil infiltration and fibrosis. These findings were consistent with death due to stress cardiomyopathy even in the absence of previous heart disease. The robbers were convicted of homicide and sentenced to eighteen years in prison