Postmortem diagnosis of hypothermia

The identification of hypothermia as the cause of death has always been somewhat problematic in forensic pathology because of unspecific, inconstant, or even negative macroscopic and microscopic findings. Though the simultaneous presence of frost erythema, Wischnewski spots, hemorrhages into the synovial membrane, bloody discoloration of synovial fluid of the knee, and basal vacuolization of the renal tubular epithelial cells has been indicated as strongly supportive of fatal hypothermia, their absence does not allow the diagnosis of hypothermia to be ruled out. Postmortem biochemical investigations are valuable in detecting adaptation responses to cold stress and metabolic changes that occur following cold exposure. However, ethanol intoxication prevents appearance of adaptation responses to cold, rendering the diagnosis less obvious. Immunohistochemistry, postmortem imaging, and molecular pathology have shown promising results, although at present, they do not provide pathognomonic signs of fatal hypothermia. The aim of this article is to present a review of the literature covering the significance of different postmortem investigations that are associated with hypothermia fatalities

Diagnostic performance of urinary metanephrines for the postmortem diagnosis of hypothermia

The purpose of this study was to assess the diagnostic potential of urinary metanephrines and 3-methoxytyramine compared to urinary catecholamine determination in diagnosing antemortem cold exposure and fatal hypothermia. 83 cases of fatal hypothermia and 144 control cases were included in this study. Catecholamines (adrenaline, noradrenaline and dopamine), metanephrines (metanephrine, normetanephrine) and 3-methoxytyramine were measured in urine collected during autopsy. All tested analytes were significantly higher in hypothermia cases compared to control subjects and displayed a generally satisfying discriminative value, thus indicating urinary catecholamines and their metabolites as reliable markers of cold-related stress and hypothermia related-deaths. Metanephrine and adrenaline had the best discriminative value between hypothermia and control cases compared to other tested analytes, though with different sensitivity and specificity. These can therefore be considered the most suitable markers of cold-related stress

SAŽETA POVIJEST SUDSKE MEDICINE U ČEŠKOJ REPUBLICI

This paper presents the most important historical facts about all forensic medicine workplaces in the Czech Republic since the beginning till present day, including a perspective on how to establish a new one. Each of the University Forensic Medicine Institutes or district Departments is covered by at least one author. The oldest institute is in Prague and in Brno, the youngest is in Pardubice.U radu su ukratko navedeni najvažniji podaci o povijesti svih medicinskih odjela za sudsku medicinu u Češkoj Republici od samih početaka pa do današnjice, uključujući perspektivu i mogućnosti za osnivanje novih. Svaki od sveučilišnih instituta i okružnih odjela zastupa minimalno jedan autor. Najstarija povijest sudske medicine je naravno u Pragu i u Brnu. Najmlađi odjel je u Pardubicama

Morphological Findings in Hanging Deaths

Hanging is a form of ligature strangulation in which the force applied to the neck derives from the gravitational drag of the weight of the body. The furrow on the neck is mainly a postmortem phenomenon. To establish the intravital hanging, any inner neck structure injury indicating ligature mark intravitality is to be identified. The aim of this prospective autopsy study was to determine frequency of inner neck structure injuries in hanging with regard to the point of the ligature knot and the other victims' characteristics (body suspension, gender, age, weight). We tried to identify the mechanism of injury for the neck structures and determine, according to the obtained results, a possible specific or most characteristic inner neck injury in regard to the ligature knot location. This study also aimed to determine the frequency of Simon's bleedings in the lumbar region of the spinal column in cases of hanging. The authors prospectively studied 178 consecutive cases of hanging deaths. Fracture of throat skeleton was detected in 128 cases of hanging (72%). The hyoid bone fractures were indentified in 56 cases of hanging (31,5%). Horn thyroid cartilage fractures were found in 101 cases of hanging (56,8%). The occurrance of fractures of throat skeleton was independent of gender, age, weight and..

A Rare Etiology of Diffuse Pulmonary Hemorrhage

A 36-year-old drug addict presented to the emergency room after intravenously injecting 20 milliliters of pure gasoline [...

A rare etiology of diffuse pulmonary hemorrhage

We describe the case of a 36-year-old male who presented to hospital with acute respiratory distress, and hemoptysis after intravenously injecting 20 milliliters of pure gasoline. Despite maximum supportive care he died without a definitive diagnosis 4 hours after presentation to the hospital. Postmortem examination confirmed diffuse pulmonary hemorrhage as a cause of death. Our case highlights the key clinical, and pathological features of this very rare poisoning with a volatile substance and reminds clinicians to consider it as a potential cause of hemoptysis and pulmonary hemorrhage

“Surgically created” excision of the back mimicking homicide: report of an unusual case

Fatalities due to sharp force trauma, with respect to manner of death, may be homicidal, self-inflicted, or accidental in nature. This article presents a case of an unusual sharp force injury inflicted under very specific and seemingly obscured circumstances, initially suggestive of homicidal origin. A 69-year-old, socially isolated male was found dead with a strange, heavily blood-stained excision-like lesion on the right subscapular area. The autopsy confirmed that the wound led to fatal external blood loss. Toxicological analysis of the blood and urine revealed severe alcohol intoxication. The police investigation turned up that the man had suffered from a painful skin furuncle of the right upper back. As he was worried about receiving medical treatment, he voluntarily asked his two acquaintances for “surgical” assistance to remove the skin affection. Based on the circumstances surrounding death and findings at autopsy, it was concluded that the injury was inflicted without the intent to harm or cause death, as a result of simple negligence. Consequently, the manner of death was ultimately certified as an involuntary manslaughter. Our case has clearly illustrated that even highly suspicious and atypically shaped wounds created by sharp-edged instruments with localization in non-accessible body areas does not exclusively indicate homicidal activity, hence, the accidental, suicidal or even iatrogenic origin of the wounding mechanism must be taken into consideration

Overview of clinical forensic services in various countries of the European Union

Examination of a person who has been a victim of a physical or sexual assault may be very important for upcoming legal proceedings. In the context of a clinical forensic examination, physical findings are recorded and biological trace material is gathered and secured. Ideally, all forensic findings are documented in a detailed report combined with photographic documentation, which employs a forensic scale to depict the size of the injuries. However, the integrity of such forensic findings depends particularly on two factors. First, the examination needs to be conducted professionally to ensure that the findings are properly admissible as court evidence. Second, the examination should take place as soon as possible because the opportunity to successfully secure biological samples declines rapidly with time. Access to low-threshold clinical forensic examinations is not evenly provided in all member states of the European Union (EU); in some states, they are not available at all. As part of the JUSTeU! (Juridical standards for clinical forensic examinations of victims of violence in Europe) project, the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz, Austria created (in cooperation with its international partner consortium) a questionnaire: the purpose was to collect information about support for victims of physical and/or sexual assault in obtaining a low-threshold clinical forensic examination in various countries of the EU. Our paper provides a summary of the responses and an overview of the current situation concerning provided clinical forensic services