Search

The use of ultra-sensitive low copy number (LCN) DNA typing allows the analysis of picogram amounts of DNA. Trace evidence accidentally left at a scene of crime (SOC) by the investigating team may be inadvertently collected and analysed, potentially leading to spurious evidence being introduced into the criminal investigation. A series of experiments were undertaken to determine the extent to which an investigator could contribute to any DNA contamination of a scene of crime under different simulated activities. Further, the degree to which any contamination was reduced by the use of commercially available protective clothing was demonstrated. Precautions that should routinely be taken at a scene of crime to reduce the risk of DNA contamination are recommended.

To date there is no routinely used reliable diagnostic test that can be performed in the post-mortem period to investigate whether a deceased had a coagulation disorder. This paper describes a series of experiments to assess the use of an antigen-based method to investigate the vitamin K-dependent factor II function in the deceased. It illustrates that by using this approach the functional status of factor II can be investigated in the post-mortem period. The abnormal proteins that are investigated by this method appear to remain stable for at least 72 h and potentially up to at least 7 days. The method that is illustrated could thus be reliably used in the post-mortem period to identify a natural or drug-induced factor II abnormality. The potential for other protein components of the coagulation cascade to be investigated by similar antigen-based methodology is suggested.

The human ear has much to offer investigators in relation to many areas of forensic practice including forensic pathology, anthropology, identification and facial reconstruction and yet its full potential is often overlooked. This review paper explores current knowledge related to the human ear drawing attention to those situations where the ear could play a valuable role in a forensic investigation.

Amplification was performed on human DNA material transferred during a model of manual strangulation. A total of 29 separate experiments were performed using a single male offender-female victim combination to observe whether DNA was transferred both from the offender's fingers to the victim's neck and vice versa and to consider the period of time after the event during which the material could potentially be recovered and amplified. DNA was amplified from either the victim's neck or the offender's fingers for at least 10 days after the contact although it is discussed whether this is potentially due to primary contact or a secondary/tertiary transfer event. The study highlights the problem of contamination of the offender's hands and victim's neck with third party DNA, the presence of which could have a significant outcome for both the investigating authority and the third party.

Aims: To compare several different instruments used to open the chest wall during necropsy and to assess whether any one type reduced the production of sharp rib ends and thus the potential for receiving an injury., Methods: During the necropsy the pathologist opened the chest wall using two randomly assigned instruments from a selection of hand saw, electric saw, rib shears, and bread knife. The age, weight, sex, and height of the deceased were recorded, in addition to the textures of the resultant exposed rib ends. During the procedure, the speed, length, production of spray, and site of incision were also noted. The thoracic cavity was inspected and any details of tumours, adhesions, fluid, or organ damage were noted., Results: Twenty four necropsies were carried out on an equal number of men and women. The total number of ribs that were incised was 422, with 206 through the bony aspect (49%). Sixty seven per cent of the bony rib ends were rough, and this was found to be instrument dependent. The rib shears produced the highest number of rough bony and cartilage rib ends. The electric saw produced the smoothest contoured rib ends. Spray occurred in 29% of cases, exclusively with the use of the electric saw. Organ damage was most frequently associated with the use of the bread knife., Conclusion: Rib shears, the instrument most frequently used to open the chest wall, appear to cause the highest frequency of rough, potentially dangerous rib ends. The electric saw produced the smoothest rib ends, both in cartilage and bone, and thus seems to offer the most efficacious method of reducing the potential hazard associated with ragged, spiky bone ends during the opening of the thoracic cavity. Although each of the procedures detailed in this study was shown to have its own advantages and disadvantages, personal preference and operator experience are perhaps the most important factors in ultimately determining the method used.

A search for forensic odontology sites on the Internet revealed thousands of 'hits', of which many constituted dentists offering a private service on their homepages. Several organisations and associations were identified following extensive sifting through these addresses and, despite its growing acceptance in the forensic community, the resources available were superficial and of only moderate educational content. Although many of the sites provided non-specialist information and points of contact for local experts only one was commended for its design and depth. The need for improvement in this field is therefore recommended.

A 37-year-old man died as a result of exposure to carbon monoxide within an apartment. An investigation of the apartment showed no gas appliances or gas supply to the apartment and no evidence of any combustion event to any part of the apartment or roof space. Inhalation of dichloromethane was excluded. Heating to the apartment was found to be via an electrical storage heater, the examination of which revealed that the cast-iron core and insulating material showed evidence of heat damage with significant areas devoid of carbon. This electric storage heater is hypothesized to be the source of carbon for the fatal production of carbon monoxide within the apartment.

The chosen subject for this month's review is toxicology and covers sites touching upon prescription and illicit drugs, analytical techniques and poisonous plants. It highlights a common problem to the user of the Internet. As more and more people log on and put their web site on for public access, searching for a single, comprehensive, all-encompassing single site becomes almost impossible. Many sites are repetitive or purely personal adverts. Unless you are recommended a site or you are prepared to wade your way through all the junk, one will never find the 'El Dorado' you are seeking.

The study investigates the trends in survival age, height, weight and body mass index (BMI) in both genders for those aged 16-103 at the time of death. It also investigates the trend in the proportion of the population classified as obese using data extracted from 37,206 autopsy reports spanning the period 1947-1997. The data was analysed using the computerised statistical software SPSS with tables and figures produced of mean values per investigation value per sex per 10-year age group per decade. The data confirmed reported trends that the population is getting older, taller and heavier with the mean BMI increasing such that the proportion of individuals who can be classified as obese is increasing. These trends will potentially have an impact on healthcare as more people will have an increased risk of associated morbidity and mortality, as well as an implication on welfare and housing for the increasingly elderly population.

Aims: To determine whether the cause of death could be accurately predicted without the need for a necropsy, and thus to consider whether a "view and grant" system of issuing a cause of death could be introduced into England and Wales., Method: A one year prospective necropsy study was performed incorporating 568 deaths. Before necropsy, in each case the cause of death was predicted from the available history without examination of the body, and this cause was then compared with the cause of death found at necropsy., Results: The ability of the pathologist involved in the study to predict a cause of death before necropsy, either while in the mortuary or as a paper exercise, was shown to vary between 61% and 74% of cases. After the necropsy, the number of correct predicted causes of death ranged from 39% to 46%. Ischaemic heart disease was found to be the most common and most accurately predicted cause of death. Some natural diseases were frequently misdiagnosed, whereas certain types of unnatural disease were always identified correctly., Conclusions: This study highlights the advantages and disadvantages of a view and grant system. Although it identifies a potential use of such a system, in some cases such as natural cardiac disease, because of the potentially high diagnostic error rate, the continuation of the present system of postmortem examination as part of the coroner's enquiry is recommended.

Necrotizing fasciitis is a progressive, potentially fatal, rapid, necrotizing infection of the subcutaneous tissues and fascia often caused by a mixture of organisms or by infection with group A Streptococcus pyogenes with or without Staphylococcus aureus. Three cases are presented that have been encountered in forensic pathologic practice. Two cases presented after assaults, and the third simulated an assault and burglary. The history, scene, and pathologic findings are presented with a brief review of the literature.

Finding dedicated sites on the World Wide Web (WWW) touching upon issues related to the autopsy which could be of use to forensic practitioners is, as with other areas of forensic medicine and science, a time-consuming task. Unfortunately, one has to wade through lists related to 'Alien autopsy' sites and even 'Furby autopsy' sites that are generated by the most commonly used web search engines, which have been featured in earlier web reviews. Numerous sites containing large archives of autopsy photographs are available on the web. However, many of these sites represent the darker side of the WWW as they are often presented purely for titillation. Unfortunately, one can equate these sites to the modern-day version of the Victorian 'freak show'--Typically, these sites ask for your Visa card number to view their contents, and several have links to pornography sites; one even links to a Satanist site. Luckily a few of these sites do now require age confirmation codes. As many of these sites show autopsy photographs from real cases one has to ask how these were obtained and who is placing them on the WWW. This review does not list any of these sites for obvious reasons, but it does draw the reader's attention to sites touching upon issues related to autopsies which forensic practitioners may wish to visit or use.

Since the early 1980s axonal bulbs staining positively for beta-amyloid precursor protein (betaAPP) have been used as a marker of diffuse axonal injury (DAI), bulb formation been attributed to shearing forces generated during rotational acceleration/deceleration head injury. This study draws attention to the observation that they may form in the absence of a head injury and, thus, axonal injury cannot be assumed to result from mechanical injury alone. Out of 20 cases with no history of head injury studied, which only showed evidence of neuronal hypoxic change, 11 (55%) showed variable positive staining for betaAPP in a similar anatomical distribution to that previously described for DAI. The role of hypoxia in the formation of axonal bulbs, as well as the possible role of betaAPP as an acute phase protein, are discussed. These observations further clarify the pattern and relationship between neuronal and axonal staining observed following a brain insult and emphasize the possible role of betaAPP as a neuroprotective protein.

Since the publication of the first 'Forensic Web Watch' article a new search engine has become available, free of charge at the time of writing, to surfers of the Internet (Net). Fast Search claims to seek out sites of interest for the user from 'all the Web, all the time trade mark ' as opposed to parts of the Net as is more common with other search machines. It is easy to use, extremely fast but as it searches so much more of the Net, the end result is considerably larger. This, in turn, may lead to a longer time to seek out useful information as opposed to the obscure. Having said this, it is recommended to add to your search engine bookmarks. A search for sites on issues related to 'Police Surgeons' will yield limited information, as each country will have a different person filling this role, all referred to by different terms. The one common feature, however, to all such groups as well as forensic pathologists and scientists, is that they will work with, or in some cases for, the police services of their respective country. Thus, in this article we will look at sites related to the police which may have useful information related to their work, specific cases of interest and research and development which may effect our practice.

A study of 20 mortuaries was undertaken to assess whether contamination of instruments, tables and cutting areas due to residual material containing human DNA after routine cleaning is an actual or only a theoretical problem. Of the 20 mortuaries studied, 50% were found to have material containing quantifiable human DNA on the instruments and surfaces sampled. This DNA was amplified and found, in some cases, to have been derived from at least three people. Of those that did not yield measurable amounts of DNA, a number of samples were selected at random, amplified and were found to produce partial profiles indicating the presence of low levels of human DNA. The possible sources of human DNA from mortuaries are discussed as well as means to reduce or irradicate the problem of instrument contamination. Finally the implications of these findings for forensic investigations are discussed.

The use of phenethylamines in the dance scene is now well established. Apart from amphetamine, the commonest phenethylamine encountered in clinical and forensic settings is 3,4-methylenedioxymethamphetamine (MDMA) commonly known as ecstasy. Other phenethylamines, which have similar effects are encountered, such as 3,4-methylenedioxyethylamphetamine (MDEA) and their use has resulted in death. We report two deaths associated with another less commonly encountered member of the group, N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine (MBDB), also known as Methyl-J and Eden.

Now that one has logged onto the world wide web (WWW) and utilized one or more of the home pages listed previously (or used another equally good home page) to seek out basic information available to forensic practitioners, the question now arises of how to go about making the most of the information available. One feature consistent to most home pages is links to the home pages of Associations and Societies, one or more of which most practitioners will be members of. With access to the WWW not only have you access to your own association/society, but you can also keep up to date with all the others to which you have not paid subscriptions. Although an internet search using a WWW search engine or the 'top 6' home pages may assist in identifying a large number of association and society sites, one of the most useful places to start is the home page of the Indian Academy of Forensic Medicine (IAFM). This, to date, lists a total of 139 such sites. To access all the home pages listed may take in excess of 6 h so the following review looks at the range of sites available and recommends some places the author considers many people may wish to know and visit. Again, this is inevitably a personal choice and it is recognized that those sites not listed may, in fact, be the preferred choice for other users of the forensic WWW.

A subjective analysis of information available on the Internet to those working in forensic medicine medicine was performed. Internet web sites addressing forensic pathology, forensic science, anthropology, entomology, law enforcement, societies and journals were assessed. Ease of access, presentation, structure, specialization, links and popularity were reviewed. Each individual site assessed was graded out of 100 and ranked, by subject, to provide the reader with a generalized guide to what the authors considered was useful and/or interesting forensic sites on the internet. The need for a regulatory body for forensic Internet resources is discussed.

A retrospective study was performed using information obtained from HM Coroner for South Yorkshire (West) over the period 1992-1997. All inquests which received a suicide or open verdict were reviewed to investigate the regional suicide statistics and the actual number of cases. Particular attention was paid to the age, sex, mental health and mode of death. There were 295 deaths believed to be suicidal in nature. Of these only 79% had suicide verdicts given and these comprise the official statistics. Of the open verdicts, many were suggestive of suicide but the circumstances were insufficient for the Coroner to be satisfied beyond reasonable doubt of the victims intention to kill themselves. Males and females had the same proportion of verdicts (80 and 76% respectively). Hanging was the commonest mode of suicide, (sex ratio 4.06 male: 1 female) and received a high percentage of suicide verdicts (81.5%). Self-poisoning was second but received suicide verdicts in only 66.3% of cases, whilst carbon-monoxide poisoning had a 98.1% rate of suicide verdict. Of the 295 cases, 202 decedents (88.5%) had a history of mental illness. Depression accounted for 153 cases (75.7%). Twelve decedents had psychotic illness (4%), one-half dying by jumping from a height. Official national data may under-report the annual suicide rate by over 20%. Deaths from poisoning by solid or liquid and jumping from a height appear particularly difficult to establish as suicide in coronial practice, with one-third of cases declared an open verdict.

Aims: To assess the possible role of hypoxia in the formation of axonal bulbs., Methods: Study material comprised sections from 28 brains showing evidence of cerebral hypoxia with no history of head injury, four with a history of head trauma but no evidence of hypoxic change, eight with a history of head trauma and hypoxic change, and four from control brains originally described as "diffuse axonal injury." These were subjected to microwave antigen retrieval and immunohistochemistry using monoclonal antibodies to beta amyloid precursor protein (beta APP), glial fibrillary acid protein (GFAP), and CD68-PGM1., Results: Positive staining for beta APP was seen in all four controls, all four cases of head injury only, seven of eight cases of head injury and hypoxic changes, and 12 of 28 cases of hypoxia without history of head injury; 22 of 25 cases who had been ventilated showed positive staining. The majority of cases showed evidence of cerebral swelling., Conclusions: Axonal bulbs staining positively for beta APP may occur in the presence of hypoxia and in the absence of head injury. The role of hypoxia, raised intracranial pressure, oedema, shift effects, and ventilatory support in the formation of axonal bulbs is discussed. The presence of axonal bulbs cannot necessarily be attributed to shearing forces alone.

Hemorrhagic disease of the newborn (HDN) is usually a self-limiting hemorrhagic disorder of childhood that occurs as a result of vitamin K deficiency. It may be defined as early or late form depending on the time of onset related to birth. HDN is recognized as one of several bleeding disorders that can mimic the findings of nonaccidental head injury and may lead to a mistaken diagnosis of child abuse. We present a single fatal case of late-onset HDN with illustration of hematologic assays that can be performed to assist the pathologist in making the correct diagnosis of HDN.

Non-accidental head injury, be it shaking, impact(s) or a combination of the two, is characterised by subdural and/or subarachnoid haemorrhages with retinal haemorrhages, but minimal or absent external cranio-facial trauma. The classical assault scenario depicts the infant being gripped around the head, face, chest and abdomen and shaken or being gripped by a limb and swung. This gripping might be expected to leave physical evidence in the form of bruising. A study was undertaken to establish the prevalence, distribution and pathological association of external bruising in 24 cases of fatal non-accidental head injury in children. At autopsy, 17 cases had new external bruises, 15 old external bruises and 13, a combination of both. However, seven (29%) cases showed no fresh external bruising and five (21%) showed no external bruising at all. Thus, external bruising may be absent in children with fatal intracranial injury. The face was shown to be the commonest site of bruising followed by the forehead and buttocks. Limb, chest and abdominal bruising were found to be uncommon. Retinal haemorrhages were confirmed in 23 (96%) cases. It is hypothesised that bruising, when present, may be a result of abuse in the form of punches and slaps rather than due to gripping during the assault. We discuss why gripping does not necessarily result in external bruising.

The classic methods of examining both the pulmonary arteries and bronchi postmortem partly destroy the anatomy of one of these systems. A technique is described whereby the bronchi and pulmonary arteries are dissected and preserved. The principal difference of this technique is that most of the upper lobe vasculature is opened from the hilum. The exception to this is the lingula, which because it is the embryological homologue of the right middle lobe should be treated in the same way--that is, with the vessels opened from the pleural side and the bronchi from the hilum. One general practical point is that there is a great variation in the number of pulmonary arterial branches in each lobe, particularly in the upper lobes, and especially in the left upper lobe. Furthermore, there is some variation in the local anatomic relations of the vessels and bronchi and on occasion the technique will not work as described and will require some modification. However, most of the time this technique should allow the pathologist to preserve the anatomy of the bronchial tree and pulmonary arteries for better demonstration and photographic purposes when the need arises.

The appendix is reported to be a common site for melanosis, especially at autopsy although to date there have been few studies expanding or qualifying this statement. Based on 47 cases identified from a series of 636 consecutive surgical specimens the prevalence, pattern of distribution, nature of the pigment and current knowledge of the aetiology and pathogenesis of melanosis of the appendix is reviewed and compared with melanosis coli.

The presence of mesothelial cell inclusions within mediastinal lymph nodes is an extremely rare occurrence with apparently only two previously reported cases. We report a single case with immunohistochemistry and transmission electron microscopy. A study of 318 mediastinal nodes from 80 patients using haematoxylin and eosin and immunohistochemistry is reported with the observation of no further positive cases. A review of the literature concerning nodal inclusions found at other anatomical sites aids discussion on the aetiology of this type of nodal inclusion.

Thromboembolism is a well described complication of transfemoral arteriography. Its origin and course is rarely demonstrated. We describe a case of thromboembolism with histopathological correlation demonstrating the origin and course during contrast injection.

We have examined proliferative activity in a series of pilar and trichilemmal cysts using an antibody to proliferating cell nuclear antigen. In benign lesions proliferative activity was confined to the basal layers of the squamous epithelium. Lesions showing malignant change showed increased proliferative activity and were not confined to the basal layer. These findings were correlated with studies on DNA content using flow cytometry.

A case report of a cavernous haemangioma arising in the nasal bones is described, together with a discussion of the relevant literature. The condition, although rare, can be reliably diagnosed pre-operatively.

In 1989 an increased risk of cancer, with a higher than expected incidence of brain tumours, was reported in laboratory workers at the Pasteur Institute, Paris. Three cases of primary brain tumours occurring in three laboratory workers from one laboratory in a district general hospital also came to light. Although this may have been due to coincidence or geographic clustering, the need for stringent safety standards in all laboratories is reiterated, and it is proposed that a national register should be established to record the causes of death in laboratory workers.

A case in which oesophageal webs preceded the development of carcinoma and rupture of the oesophagus in a 77-year-old woman with cicatricial pemphigoid is reported. Oesophageal webs in cicatricial pemphigoid have been reported but are rare. Clinical, histological, radiological and post-mortem features are described. Western immunoblotting of serum demonstrated a 180-kDa antigen which comprises one of the antigens reported in cicatricial pemphigoid.