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SNP and mtDNA Analysis by PLEX-ID Assay in Maternity Testing When the False Mother Can’t be Excluded by 46 STRs Genotyping

Li Li 1, Suhua Zhang1, Yuan Lin1, Yan Liu1, Chengtao Li1, Shumin Zhao1

1Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, China

2Research and Development, Ibis Biosciences Inc., A Subsidiary of Abbott Molecular, Inc

Objective: To reach an accurate conclusion, mtDNA and SNP analysis by PLEX-ID assay was applied to an extreme maternity case where the false mother and the child have at least one allele shared at autosomal 46 STR loci, giving inclusion of maternity with maternity indices of 3.3E + 13.

Method: Genomic DNA was extracted using the Chelex-100 and proteinase K protocol from blood samples of the child and the adopting woman. The quantity of recovered DNA was determined by a spectrophotometric method. 19 autosomal STR loci plus Amelogenin were amplified using the AmpFlSTR® SinofilerTM kit (Life Technologies, Carlsbad, CA) and PowerPlex®16 System (Promega, USA) following the manufacturers’ recommendations. An additional 27 autosomal STR loci plus Amelogenin were analyzed using two domestic kits AGCU 21 + 1 ( and STRtyper-10 G ( Locus D19S433 was included in SinofilerTM kit and the domestic kit 21 + 1. Amplification reactions were carried out using the GeneAmp PCR system 9700 (Life Technologies). The amplified products were analyzed using 3130xl Genetic Analyzer (Life Technologies). Genotyping data were determined by GeneMapper v3.2.1 software. Additional assay was carried out that genotypes 40 ideal forensic autosomal SNPs (heterozygosity is near 0.5) identified in Kenneth Kidd’s lab at Yale. Besides, mtDNA assay was applied that has 24 primer pairs in 8 triplex reactions for HVIand HVII.

Results: The alleged mother and the boy shared at least one allele at all 46 tested autosomal STR loci which yielded a very high maternity index between them. But, according to the SNP profile data for 40 autosomal SNP markers, different homozygous genotypes between the alleged mother and son at five exclusionary loci (rs7229946, rs985492, rs9951171, rs214955, rs1109037) excluded maternity. Mitochondrial profiles also clearly exclude mother as a parent of the alleged son because the two persons have multiple differences(i.e. the base compositions are not the same at the fragments 16102-16224nt, 16130–16224 nt,16154-16268 nt,16231-16338 nt,16256-16366 nt,16318-16402 nt in HV-I and 83–187 nt,113-245 nt,204-330 nt,239-363 nt,239-363,262-390nt in HV-II.

Conclusions: Different kinds of genetic markers are needed to supplement the use of autosomal STR loci in case where the alleged parent is suspected to be related to the true parent. In the case herein, ESI-TOF-MS SNP and mtDNA analysis using the PLEX-ID platform is more discriminating than STR genotyping by CGE method.


The Retrospective Analysis of 15 Burned Cases Caused by Laser and Solarium(Tanning Booths) in Beauty-Medical Centers Evaluated Between 2006–2010 in Istanbul Council of Forensic Medicine 3rd Specialization Board

Süheyla F. Aliustaoğlu1, Harun Akkaya2, Seyfullah Şahin3, Erdinç Özdemir 3, C. Haluk İnce4

1Council of Forensic Medicine, 4th Specialty Board, Istanbul, Turkey.

2Council of Forensic Medicine, 2nd Specialty Board, Istanbul, Turkey.

3Council of Forensic Medicine, Istanbul, Turkey.

4President of Council of Forensic Medicine, Istanbul, Turkey.

Introduction: It is a well known fact that since old times people are making efforts for their physical appearance. With significant progress in technology, laser epilations and tanning booths etc. (radiation and UV rays) became helpful aesthetically, making an impact in a very shortest time. Nowadays in large-scaled beauty-medical centers nearly all kind of laser and tanning booths can be seen. Since these machines are medical, they need to be used by doctors or medical staff.

Methods: Between January 2006 and December 2010, the demographic data of 15 people analysed retrospectively in this study whose physical examination held in Council of Forensic Medicine 3rd Specialization Board, who applied to beauty-medical centers for laser epilation, to erase tattoo, get tan in solarium (tanning booth) and as a consequence burn scars arose and they brought a suit against those centers.

Results: The average age is 32.13 ± 8.2 of the total 15 people, 12 (80 % ) of them is female. 10 of them brought suit for the bad consequences of laser epilation, 1 for needle electric epilation, 2 for erasing tattoo and 2 for getting burn in tanning booths. 7 (46.6 %) of 15 people were assessed in 2010. 2 people got burnt in tanning booth had 2nd degree of massive burnt; one of them died of burnt complications. 10 people who applied laser epilation had burnt scars and hiperpigmented lesions; 2 people who applied tattoo erasure by laser had burnt scars and cheloid tissue. 7 people stated they were not informed sufficiently, not any informed consent found in the dossier. In the reports of Council of Forensic Medicine; 9 (60 %) of 15 cases occurred by wrong medical application without any surveillance of experts.

Conclusion: The utilization of those devices increasing in a very short time by non-medical or uncertified people is forbidden. Within the frame of laser applications; different laser rays should vary according to the skin and hair colour, allergen texture, like many other factors. After the application of laser epilation; for 1–3 days hyperemia may occur as an expected complication; before the application informed consent must be taken from the person. Similar cases may diminish if the increasing application of laser in our country especially in recent years are made by experienced medical employees and if informed consent of the person is taken.


Self-ignition: a suicidal method between demonstrative gesture and psychopathological problems

Filippo Maria Cascino, Tommaso Savì, Massimo Grillo, Calogero Mazzola, Livio Milone

Department of Medical and Forensic Biopathology e Biotecnhology - University of Palermo – Section of Forensic Medicine - Policlinico “P. Giaccone”, Palermo

Suicide by self-ignition (burning), is a rather rare event, estimated roughly in the order of 1–1,5 % of Italian national statistics about suicides. It happens when one burns himself alive autonomously, by an action intense and concentrated over time, usually made (at least initially) with the aid of a liquid fuel spread on the body surface (oil, petrol, fuel, etc.), that guarantees rapid combustion and high temperatures, then maintained by the combustion of clothing worn by the victim.

In the literature, such events are rarely described, and usually happen in people suffering from personality disorder psychopathologies (relating to voluntary search to receive intense and cruel sufferings) or are carried out for demonstrative purposes ("ethical suicides" or "self-immolation") such as political or religious reasons (the so-called "bonzes" in historical reference to the suicide of Vietnamese Bonze Thich Quang Duc in 1965, and Jan Palach, anti-Soviet activist of the "Prague Spring" in 1969).

The purpose of this paper is sharing the experience of the authors, who had the opportunity to evaluate subjects died by self-ignition; the willingness to make a striking public protest gesture against their conditions of economic insecurity was clear in some cases, especially those concerning immigrants or subjects with socio-economic problems, professional troubles, people suffering from distance from the country of origin and their families.

In other cases, less frequent as observed by the authors, the self-ignition was not made as a gesture of protest, either directly connected to the main intent of ending their lives, but it was assessable in serious mental illness that afflicted victims.


Fire-Related Deaths in The Temporary Housing After the Earthquake in Van City of Turkey

Yavuz Hekimoğlu 1, Mustafa Gökhan Dizdar1, Nergis Cantürk2, Ipek Esen Melez3, Gürol Cantürk4, Zehra Zerrin Erkol5, Osman Nuri Güler6, Recep Dursun7

1Van Branch of the Ministry of Justice Council of Forensic Medicine, Van, Turkey

2Department of Criminalistics, Institute of Forensic Sciences, Ankara University; Ankara, Turkey

3The Ministry of Justice Council of Forensic Medicine, Istanbul, Turkey

4Department of Forensic Medicine, Ankara University Medical Faculty, Ankara, Turkey

5Department of Forensic Medicine, Abant İzzet Baysal University, Bolu, Turkey

6Ministry of Justice Van Attorney General, Van, Turkey

7Van Training Research Hospital, Van, Turkey

Background: An earthquake, which lasted for 25 seconds, occurred in Van city of Turkey on October 23, 2011 at 13:41. In that region, 9 temporary suburbs were built which consisted of 3030 tents and containers for 19130 individuals. Even though the earthquake occurred in autumn, the construction for the new permanent settlement could not be finished before the winter. Electric and wood-burning stoves used for heating, led to the accidental fires in tents. The aim of our study was to analyze the fire-related deaths in the temporary housing.

Methods: The fire-related deaths occurring in the temporary settlement region following the earthquake in Van city were evaluated retrospectively. The deaths were assessed based on the age, gender, the cause of death, the place of death and the time of the death. Statistical analysis of the data was performed by using SPSS 16.0 Packet Program.

Results: A total of 10 deaths and 5 cases of injuries were reported in 16 fire incidents in Van and its vicinity. Only 5 cases of death were sent for autopsy, 2 of the cases were females and 3 were males. The age distribution was between 0–30 and the mean age was 14.2 years. Four of the cases were children. The cause of death was burn and burn-related complications in all of these cases. All of these incidents occurred in tents and in one event 3 cases were from the same family.

Conclusion: Although the earthquake is a natural disaster, which can cause a wide range of death and destruction, human factor can also be a significant contributing cause due to the negligence in the temporary housing. The stoves and electrical equipment in the tents can be hazardous and children are the most vulnerable group in these incidents.


A case of spontaneous human combustion in Bulgaria – what and how is it happening?

Ivan Stoyanov1, William Dokov 2, Plamen Dimitrov1

1Department of forensic medicine, multiprofile hospital for active treatment Russe

2Department of general and clinical pathology, forensic medicine and deontology, Medical university of Varna

The scientifically documented cases of spontaneous human combustion, in the absence of a proved external source of heat are very rare. We present a case from the village of Piperkovo, the region of Russe, Bulgaria.

On 19th of February 2012 a combusted body was found on the floor in one of the rooms in a deserted house in a small village. There was no electricity and no other source of heat in the house. The body of an eighty year old woman who lived in the house, her upper and lower extremities were burned to ashes. The head, small parts of both arms and shanks and the clothes on them were not damaged by the process of burning. The medico-legal expertise of the case proved 35 % carbon monoxide in the preserved parts of the shanks.

All analysis during the investigation process failed to prove an external source of heat, which could explain the heavy bodily burns. A detailed photo-documentation of the case was made. The authors suggest to the participant in this scientific forum to provide their hypothesis explaining the damages in that case.



Domestic physical and sexual child abuse by the father of the infant - Case Report

Fotios Chatzinikolaou 1, Eleni Zagelidou1, Polichronis Voultsos1, Roubini Leodari3, Orthodoxia Mastrogianni2, Nikolaos Raikos1, Charoula Florou1, Elani Kalyva1, Lazaros Papadopoulos2, Konstantinos Chalazas2

1Department of Forensic Medicine & Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece

2Laborator of Forensic Service, Thessaloniki, Greece

3Laborator of Forensic Service, Larissa, Greece

Introduction & objectives: The incident referred to domestic abuse and thus to lethal physical and sexual child abuse by the father of the minor, a 24 years old Roma heroin abuser. The child’s mother is a heroin abuser as well.

Case: We present a lethal case of 1 and 1/2 year old Roma girl who found dead by the mother some hours later. The incidence took place in their home, in front of the three older children. The victim was hardly physically and sexually abused: Multiple bruises were found (head / upper abdomen / buttocks / arms / legs). Sexual abuse with swollen, bruised labia major, vaginal and anal penetration injuries was present. The child died from severe craniocerebral injury with cranial fractures and brain injury.

Discussion & conclusion: In this case, a multi infant abuse is concerned, in which: 1) the coexisting severe form of sexual abuse (by nature and unnatural intercourse) with severe physical abuse, 2) the victim is very vulnerable to abuse in early infancy, where it there is no involvement in the crime, 3) the death occurred because the of abuse of the victim (severe brain injury). 4) the offender is the father of the victim (domestic violence), 5) the victim belongs to a socially marginalized and low wages, low socio-economic status of Roma social group. It is argued that in Greece about 68 % of head injuries in children younger than two years old and most deaths in this age due to abuse by their parents. The actual figure is rather higher because of inadequate identification of cases. On criminal side the perpetrator is responsible for homicide with intent (since there was deception even possible), but we believe that the distinguished character of particularly heinous murder. We believe that a thorough study of such severity incidents of child abuse will greatly facilitate the proper organization of detection and prevention (in the first and second level) and to face the very important issue of child abuse.


Multi Child Abuse and Neglect (a case report)

Eleni Zagelidou1, Roubini Leodari3, Christos Kravaritis3, Polichronis Voultsos2, Nikolaos Raikos2, Charoula Florou2, Fotios Chatzinikolaou 2

1Lab. Of Forensic Service, Thessaloniki, Greece

2Lab. of Forensic Medicine & Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece

3Lab. Of Forensic Service, Larissa, Greece

Introduction & objectives: Child abuse is the bad treatment of a child under the age of 18 by a parent, caretaker, someone living in their home or someone who works with or around children.

Case: We present a rare case of co-occurrence of domestic violence and three types of child maltreatment: physical child abuse, psychological child abuse, and child neglect. It concerns all six (6) children, a girl and five boys, aged from 2 ½ months up to 10 years old of a family who were examined at the Forensic Service of Greek Ministry of Justice in the town of Larissa.

Characteristic presentations of the maltreatment and risk factors in family background are discussed.

Discussion & conclusion: The minors suffered physical and moral abuse. In civil law there is a significant breach of personality (Article 57CC) in terms of penal law there is influx of criminal acts committed by persistent, such as physical damage (Article 308 PC) rather dangerous (Article 309 PC), rape (Article 336 PC) in which there are at least accomplices (e.g. injuries) and associates (particularly directly). The underage of the victim is an aggravating factor for the perpetrators. It seems difficult to establish for them dwindling allocation, while the deceit is primarily first grade (objective).


The comparison of the concentration of cytokines in serum between young and adult mouse exposed to single or chronic stress

Keita Shingu 1, Kazuya Ikematsu2, Takahiro Umehara2, Yuki Abe1, Ichiro Nakasono2

1Nagasaki University, School of Medicine, Nagasaki, Japan

2Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University, School of Medicine, Nagasaki, Japan

Introduction Child abuse is one of the most serious social issues in Japan, and it is seriously difficult that abused children re-integrate into society. Stress induces cortisol secretion, and the hormone also affects the immune system. The development of immune function was different from age, especially, pre and post puberty. After chronic stress exposure, it was considered that time of initiation of the exposure was one of the important factor effected to immune system. Thus, we investigated the level of cytokines concerning immune system such as Interleukin (IL)-1a, 1b and 2 in serum between young and adult mouse after single and chronic stress exposure.

Material and methods: 4-week-old (young) and 9-week-old (adult) mice were restricted as stress for an hour once daily for 2 weeks as chronic, or once at the last day of choric treatment as single. They were euthanized at 60 min after the last treatment. The blood was collected and centrifuged to obtain serum. No restricted mice were employed as control. The serum concentration of IL-1a, 1b and 2 was measured with MILLIPLEX MAP Kit.

Results and discussion: The level of IL-1a in young mice significantly increased but decreased that in adult mice of single and chronic treatment compared with control groups. The level of IL-1b in young significantly increased in single but decreased to the level of control in chronic. That of adult significantly decreased in single and chronic. The expression of IL-2 in young was similar to that of IL-1b. The IL-2 level significantly decreased at single and chronic in adult. Our results suggested that single and chronic stress exposure decreased IL-1a, 1b, and 2 in adult as corticosterone increased due to stress and suppressed both cytokines. But, IL-1b, and 2 in young was increased in single, and IL-1a was increased in single and chronic, although stress also induced corticosterone secretion in young. Unfortunately, we could not fully explain the difference of the results between young and adult.

Conclusion We showed that the increase of cytokines after stress differed by age. This result indicated that the pathophysiology of the response to stress might be different by age.


Ruthless with his own child: report of a serious and complex case of child abuse

Shimi Maha, Allouche Mohammad, Bekir Olfa, Gloulou Fatma, Ben Khlil Mahdi, Banasr Ahmed, Hamdoun Moncef

Department of Forensic Medicine, Charles Nicolle Hospital, Tunis, Tunisia

Introduction: Child abuse, long neglected by both society and medicine is now a focus of public attention.

Child maltreatment is intentional harm or a threat of harm to a child by someone acting in the role of caretaker, for even a short time. Maltreatment is commonly divided into four categories: physical abuse, sexual abuse, emotional abuse, and neglect. Neglect is thought to be the most common of the four and probably the most life threatening.

Method: This is a case report about a serious case of child abuse that met the physical, psychological and sexual abuse in addition to neglect.

This case was a subject of expertise in Department of Forensic Medicine of Charles Nicolle Hospital in Tunis.

Results: It is a little girl of 9 years old who was brought by her neighbors to the emergency department. She reported being a victim of burns means of a heated knife and cigarette butts. She also reported being hit by punches and kicks as well as various blunt objects on different parts of her body.

Moreover, the child says he was sexually abused by anal and vaginal intercourse. Despite multiple fractures to his limbs and pelvis, she never consulted and has been forcibly confined by her parents in their home.

Examination at the medical report produced in our Department of forensic medicine confirmed the effects of burns and fractures in the pelvis and limbs. Examination of the genital organ showed signs of chronic sodomy and even vulvar lesions corresponding to genital herpes. Psychological effects were considered severe. Permanente partial disability was assessed at 67 %.

Conclusion: Child abuse is more than bruises and broken bones. While physical abuse might be the most visible sign, other types of abuse, such as emotional abuse or child neglect, also leave deep, long lasting scars. Physicians and others in the medical community play an important part in identifying possible victims of child abuse. Some cases raise profound questions about the relative rights of parents, children, and those charged with child abuse.


Descriptive evaluation of the alleged child sexual abuse cases in Kartal district in Istanbul

Alev Yalçınkaya1, Mehmet Akif Inanici 2, Sinem Yıldız3

1Institute of Health Sciences, Forensic Nursing MSc Program, Marmara University, Istanbul, Turkey

2Department of Forensic Medicine, Marmara University, Istanbul, Turkey

3Department of Medical Education, Marmara University, Istanbul, Turkey

Objectives: It is important to understand the variables which are related to the abuser, the victim and the occurrence of the sexual abuse events to manage those cases both legally, psychologically and socially. In this study it is aimed to lay out the descriptive information of alleged child sexual abuse cases in specific region in Istanbul to design detailed prospective research and prevention techniques in the future.

Material-method: The medico-legal reports of Kartal Office of Forensic Medicine and verdict files of Office of the Chief Public Prosecutor Court concerning the alleged child sexual abuse cases which registered between years 2005–2010 are reviewed. One of the researchers visited the courts with the written permission of both Marmara University Ethical Committee and the Ministry of Justice. She investigated the related files and documented them in a classified manner. Statistical analysis is executed by SPSS 16.0.

Results: The total number of reviewed cases is 479 and of those, 118 verdict files were reachable to the researchers. Results indicate that %82.3 (n = 394) of all cases consist of girls and the average ages of the genders are 14.5 (sd = 2.40) for girls and 11.0 (sd = 3.92) for boys.

It is found that in 65.3 % (n = 77) of the cases, the crime committed in a house; the allegation types are aggravated child sexual abuse (only) (46.6 %, n = 55), simple child sexual abuse (33 %, n = 39) and the rest is aggravated sexual abuse with another type of crime (divest of freedom i.e.). %44.9 (n = 53) of the cases are settled by the court and the verdict is imprisonment for 16 of these cases (30.2 %) and “not guilty” for 37 of the cases (69.8 %). The duration between the time when the crime committed and when the cases are settled is 14.9 (SD = 1.24) months.

The most cited probable sexual abusers are male friends (61.9 %, n = 73), strangers (15.3 %, n = 18) and brothers (8.5 %, n = 10) and the three most frequent age ranges of the abusers are 19–29 (44.1 %, n = 52), 16–18 (18.7 %, n = 22) and 30–39 (17 %, n = 20).

Discussion: Determination of child sexual abuse cases in local districts is essential to understand geographical area specific needs of interventions. The most prominent result related to this region is that, juvenile girls are under the risk of being abused by their male friends. So it is imperative that the prospective prevention program has emphasis on self borders in both romantic and social relationship with the opposite sex.


Algerian Law management of Sexual Child Abuse

Fatiha Amara Boulala

Department of Legal Medicine C.H.A, Algiers, Algeria

The authors report here the case of an older little girl of 5 years misused sexually by knowledge of the father and that lasting more than two years during the absence of the parents. We received the young girl accompanied by his mother at the department of legal medicine, on requisition of the national gendarmerie criminal division.

She was smiling, calm, state contrasting paradoxically with the ploughed up state of the mother.

The authors propose to expose the absence of judicial apparatus and social in the sexual abuses in the child, putting side by side the accent on the syndrome of Stockholm developed by this child, the legal definition which gives the legislator to the rape and the absence of penalization of the psycho-traumatism in the Penal code.


Real child abuse or premeditated murder: a case report

Fatiha Amara Boulala

Department of Legal Medicine, C.H A, Algiers, Algeria

The authors refer you the tragic case of an infant with Down syndrome, aged 20 months, admitted to the ICU for febrile coma, who died after a week of hospitalization.

To the presence of multiple signs of violence, the prosecutor ordered an autopsy.

The mother told us that the father has never accepted this handicap and she suspected that he beat his song during her absence (she was being treated for breast cancer).

Autopsy revealed multiple old and recent fractures of limbs and skull with many hemorrhages brain.

The statements of the mother contrasted with those of the father who told cops that the child often banged his head against the bars of his bed!.

The results of the autopsy and the forensic discussion put us at an impasse that we will describe.


Determination of Sariyer Family Health Centers’ Health Professionals’ Awareness Levels about Child Abuse and Neglect in Istanbul

Yesim Pancaroglu1, Ahsen Kaya 2, Omur Senyuz3, Coskun Yorulmaz2

1Tarabya Family Health Center, Sariyer, Istanbul, Turkey

2Istanbul University Cerrahpasa Faculty of Medicine, Department of Forensic Medicine, Istanbul, Turkey

3The Council of Forensic Medicine, Istanbul, Turkey

Background: One of the prevention strategies of child abuse and neglect titled as primary prevention is defined as any intervention that prevents child abuse before it occurs. So, it is thought that the most effective outcomes are obtained about protection and prevention of child abuse and neglect with this method. Primary prevention involves the programmes like giving health care services, identification and treatment of psychological problems, alcohol and drug abuse, family planning, detection of risky groups, educating parents about child behavior, discipline, safety and development, encouraging positive parenting, promotion of social institutions to support families such as nurseries and kindergartens. In this study, it is aimed to determine the awareness levels of health personals, who works in primary health care services and to confirm the effect of their awareness to primary prevention.

Method: For this study, ethics permission document and corporation permission from Istanbul Provincial Directorate of Health were taken. It was interviewed with health personals, who work in 15 Family Health Centers in Sariyer, county of Istanbul. They were asked to fill the questionnaires with the principles of voluntary participation. Data were statistically analyzed using SPSS programme (version 14.0).

Results: In this study, questionnaires supported by 64 people were evaluated. 20 males and 44 females, having the mean age 38.3 ± 8.9 years were studied. 58 (90.6 %) participants stated that child abuse and neglect is a medical problem in Turkey. 26 (43.4 %) participants remarked that they thought the frequency of this problem is more than 50 % in Turkey. 22 (34.4 %) people said that they received an education about this subject and 8 (12.7 %) participants signed that diagnosed the abuse. Only 5 (7.8 %) participants defined a prevention team for child abuse and neglect in their family health centers. 54 (84.4 %) participants indicated that they went to house calls and half of the participants said that the house calls were beneficial for determination of child abuse and neglect.

Conclusion: For success on primary prevention about child abuse and neglect, it must be handled by all areas about children. One of these areas is health services. House calls, which are one of the primary health care, provide prevention. Because of this, increasing of the awareness of all staffs in primary health providers in child abuse and neglect, giving more importance to house calls - keeping in mind and evaluating the child abuse and neglect in house calls- must be developed a primary prevention strategy.


Review of 89 Autopsies of Child Deaths From Violence and Neglect in Suez Canal Area, Egypt

Azza H El Elemi

Suez Canal University, Faculty of Medicine, Department of Forensic Medicine and Clinical Toxicology, Egypt. University of Tabuk, Faculty of Medicine, Department of Forensic Medicine, KSA

Background: Child homicide is a significant cause of child mortality through inflicted abusive injuries and neglect in several countries. The extent of child abuse in Arab countries is not well identified. In Egypt there is no true data about the incidence of fatal child deaths from violence and neglect. All available data are related to natural death and death from deferent types of diseases. The study aims to investigate child deaths associated with violence and neglect.

Methods: Cases of suspected child deaths from 2000 to 2007 in Suez Canal area were retrospectively reviewed. Cases were collected from the data base of the Forensic Institution of Port-said. A medico-legal autopsy had been carried out for all cases. Suspicious child deaths under 18 years old or equal were reviewed. Variables assessed were age, gender, cause of death and perpetrators of the crime.

Results: Of the 89 cases, 56 were males and 33 were females. Results revealed that child death was 41.6 % in newborns less than one month, 29.2 % in age group between 15 and 18 years and 5.6 % in age group between 10 and 14 years old. The majority of perpetrators were unknown (44.95 %), followed by the victim’s colleagues and neighbors (22.47 %). Neglect with no outward signs represented the majority of child deaths (41.57 %). Blunt trauma in abusive manner during street arguments was the second cause of homicidal deaths (19.1 %). The highest rate of child deaths was in newborn and early youth.

Conclusion: While the exact number of child deaths from violence and neglect is uncertain and unknown, child fatalities remain a serious problem in Egypt. There is need for further examination of child fatality profiles associated with abuse and neglect in this age group and increase community outreach efforts to prevent fatal child abuse in Egypt.


Does late and non - intensive intervention in children with autism spectrum disorders, considered medical negligence: an overview on child neglect

Metwally El Sayed Abdalla

Faculty of Medicine, Suez Canal University, Ismailia, Egypt

Introduction: Child abuse and neglect are often considered in broad categories that include physical abuse, sexual abuse, emotional abuse and neglect. Neglect is the most common, accounting for approximately half of the reports made to child welfare agencies. Child neglect is defined by omissions that prevent a child's basic needs from being met. Autism spectrum disorders include people with autistic disorder, Asperger syndrome, and Pervasive Developmental disorder-Not Otherwise specified.

Autistic spectrum disorders, presents at 2–4 years with impaired social interaction, speech and language disorder and imposition of routines with ritualistic and repetitive behavior. And is usually managed by behavior modification using applied behavioral analysis. Recommendations by the American Academy of Pediatrics that all children be screened for autism at 18 months of age oblige the development of interventions that are appropriate for toddlers with ASD. According to the evidence based medicine, ABA could integrate 49 % of children with ASD into the mainstream primary school.

Conclusion: it is beyond debate that the appropriate treatment is ABA or early intensive behavioral intervention. The concept of early and intensive intervention should be highlighted and notified to child's parents, aiming at giving children with ASD the chance they deserve to be integrated into the mainstream in primary school.


Sexual Abuse Identified After Suicide; Case Report

Kenan Kaya1, Ahmet Hilal 1, Demet Meral2, Necmi Çekin1, Mete K Gülmen1

1Çukurova Üniversitesi Tıp Fakültesi Adli Tıp Ana Bilim Dalı, Adana

2Adli Tıp Kurumu Adana Grup Başkanlığı

Child abuse is the bad treatment of a child under the age of 18 by a parent, caretaker, someone living in their home or someone who works with or around children. Abuse of a child is anything that causes injury or puts the child in danger of physical injury. Child abuse can be physical, sexual or emotional.

Sexual abuse reported as a largest part of suicide attempt causes among the childhood. The incidence of suicide between 1950–1993 among the causes of death for children under 15 years of age as increased 4-fold and suicides were 6th of causes of death between the ages of 5–14, in 1994.

The case; In 14 year-old girl's body external examination, we saw that the rigidity of the death body was continuing, dead spots were starting in the regions not compressed, as purple spots. Teleprinter was starting from neck’s midline, rising characterized to back and a parchmented area that was 10 cm on right side of the midline and width of 1.5 cm at the thickest region, the outer side of the left knee were 3x2 cm scar tissue. In the examination of the hymen we saw that the hymen was 2 cm wide and notched structure, and a partial tear at the level of 7 o'clock. Ecchymosis and bleeding was not observed around the anus and hymen. In the internal examination we found a fetus in the uterus as the product of pregnancy and the fetus was 2.5 cm sized. As a result of toxicological analyzes, there was no substance in the blood. Fetus in the uterus was detected 6–8 gestational weeks, death was consisted as a result of mechanical asphyxia due to hanging, the only male DNA profile type was detected from pregnancy material.

14-year-old girl's suicide and pregnant detected after the determination of the autopsy will be examined in the light of literature regarding for child abuse and pregnancy.


An Unusual Face of Sibling Jealousy; Intersibling Violence

Aysun Balseven Odabaşı1, Gökhan Gitmiş 1, Ramazan Akçan1, Emre Karacaoğlu1, Kaya Yorgancı2, Türkan Yılmaz2, Ali Rıza Tümer1

1Department of Forensic Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

2Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey

Background: Burns, a common cause of pediatric injuries, are responsible for severe functional, social and psychological damage. Most burn-related injuries in childhood are encountered in home environment and originally can be accidental or due to child abuse or neglect. Caretakers and parents are generally responsible for child abuse related burns, while rarely siblings or peers might cause burn injuries on minors. Here we present a case of girl burned by her elder brother, in order to draw attention to the morbidity and mortality caused by sibling rivalry, jealousy and inter-sibling aggression.

Case history: An 11 months-old girl allegedly burned by her 4 years-old elder brother was admitted to burn unit of our hospital. Second and third degree burn injuries covering face, scalp, trunk and bilateral upper extremities, a total of 70 % of total body surface area, were detected. Bilateral upper-extremity amputation through or above the wrist was performed because of necrosis due to extensive burns. In following 2.5 years-period, she was underwent a series of skin transplantation operations, which are still going on, in Plastic and Reconstructive Surgery Department. Interviewing with the family members revealed that the elder brother was jealous of his sister since her birth. Elder brother was said to be frequently obsessively mention about burning his sister. At incident day, when mother left home for a short time period; he enflamed his sister’s blanket while she was sleeping in the cradle. Elder brother stated that he was jealous of his sister and had burned her, in the forensic psychiatric examination.

Conclusion: Inter-sibling aggression, sibling rivalry and jealousy, which might cause high morbidity and mortality, have been extensively studied in the literature. However, to our best knowledge, this is the first ever case of intersibling violence involving such extensive burn injuries caused by a four year-old elder brother due to lack of parental supervision. Intensified parental supervision, and education and rehabilitation of siblings will play an important role in tackling such cases.


Prevalence And Correlations Of School Violence Among Adolescents In Tokat-Turkey

Ali Yıldırım 1, Mehmet Karataş1, Resul Yılmaz1, İlhan Çetin2, İbrahim Şenel3

1Gaziosmanpasa University,Tokat Türkey

2Cumhuriyet University, Sivas-TURKEY

3Tokat National Education Directorate,Tokat Turkey

Background: The aims of this cross-sectional study were to examine the prevalence of school violence and of physical and sexual abuse with an internationally accepted child abuse screening tool in schools. We also sought to determine the sociodemographic characteristics (relation between school violence and abuse with students’ sex, age (grade), parental education, family income, parental profession or job) of victimized adolescents in Turkey.

Methods: The study is based on a sample of 5032 students in grade 6–8 in all schools of Tokat city in Turkey. The instrument used in the study was a Turkish translation of the International Child Abuse Screening Tool-children’s version (ICAST-C) developed by the International Society for the Prevention of Child Abuse and Neglect (ISPCAN). In addition, the questionnaire collected data on the sociodemographic characteristics of the students and their family structure.

Results: Students were subjected to physical (57.0 %), psychological (59.8 %), and sexual (6.4 %) abuse with varying frequencies. A large majority (73.4 %) of students experienced one or more of the types of violence. All types of violent behaviors were more common among male than female students and were experienced significantly more frequently in urban areas than in villages or districts. Emotional violence was most common (63.6 %) in families with a single child, whereas it was relatively lower (55.4 %) among children with > =5 siblings. On the other hand, the incidence of sexual violence was lowest (3.3 %) in families with a single child, whereas it was highest (7.8 %) among children with > =5 siblings. Interestingly, children in families with higher incomes were more likely to experience physical, emotional, and sexual violence, whereas these were rarely encountered in families with lower incomes.

Conclusion: To address violence against students, we must first conduct nationwide studies to provide a more definitive picture of incidence and prevalence rates and to clarify relevant risk and protective factors. Second, to ensure the accuracy of the data, specific guidelines and questionnaires are needed, as was the case in our study. Third, the deleterious consequences of violence must be explained to achieve greater public awareness about victimization in schools. Fourth, the authorities must ensure and reinforce the safety and rights of children by enacting strict laws against violence and abuse.


Close abdominal blunt trauma in child abuse: images under the skin

Anna Aprile1, Francesca Menegazzo 2, Melissa Rosa Rizzotto2, Cristina Ranzato2, Paola Facchin2

1Legal Medicine Institute, Environmental & Public Health Department, University of Padua, Italy

2Child Abuse & Neglect Unit, Pediatrics Department, University of Padua, Italy

Background: Abdominal injuries are the second leading cause of mortality in child physical abuse and account for 6 % to 8 % of all physical abuse. Solid organs (liver, pancreas, kidneys, spleen), hollow organs (hypopharynx, esophagus, stomach, duodenum, jejunum, small intestine, large intestine), blood vessels, lymphatics, and nerves may be affected. Reported case fatalities are between 40 % and 50 %. Those injuries may be detected on abdominal computed tomography (CT) scans if suspicion of their existence prompts investigation.

Method: We report the case of a child fatality due to inflicted brain injury and abdominal blunt trauma.

Results: The child was brought to the ER unconscious. At initial assessment, she was in cardiac arrest, asystolic, mydriatic. After resuscitation procedures, the cardiac activity reappeared, but the neurological picture did not change. (GCS = 3). The child underwent total body CT which showed: subdural hemorrhage with cerebral oedema, pneumoperitoneum. Cerebral injury was referred to shaken baby syndrome and did not require surgical intervention, while abdominal clinical picture needed a surgical look. The laparotomy showed jejunum burst injuries and bruising. Neurological picture continued to be critical and after 2 days brain death was declared. The caregiver denied having shaken the baby and admitted to have hit her, slapping her twice on the abdomen. The autopsy confirmed the Shaken Baby Syndrome diagnosis; the abdominal cavity presented foci of diffuse contusions of jejunum and a peculiar pattern lesion, with three parallel linear bruises 2 cm long, referred subsequently to rib mark. The cutaneous exam of the abdomen revealed no or minimal signs and no pattern bruising similar to the one observed on jejunum.

Conclusions: The burst injuries of jejunum in children are very rare and this finding is observed in road traffic accidents or in child abuse. In our case the burst injury was determined by a violent blunt trauma. The external signs were too few to suspect the severe injuries observed “under the skin”. In abdominal injury, the force applied to the abdominal wall is typically dissipated so that the skin is minimally involved while the underlying solid organ absorbs the force and ruptures. In case of child abuse suspect, the visceral injuries should always be considered and excluded due to their high rate of existing in fatal events.


Interviewing child sexual abuse victims: Police officers’ experiences about the phenomena

Dilek Celik 1, Ahsen Kaya2, Burak Gonultas3, Murat Kocak3, Gokhan Oral2

1Istanbul University, Institute of Forensic Sciences, Istanbul, Turkey

2Istanbul University Cerrahpasa Faculty of Medicine, Department of Forensic Medicine, Istanbul, Turkey

3Istanbul Police Department, Juvenile Justice Department, Istanbul, Turkey

Background: Alleged child sexual abuse cases are highly sensitive and complicated phenomena, since the testimony of the child is often the only evidence at hand and the quality of child’s testimony leads to prosecution process. Police officers are one of the main figures among professionals working in legal context since they are integral part of the investigation team about the allegations. The aim of the present study is to determine some of the characteristics of police officers, who interview child victims as well as some of the characteristics of alleged child sexual abuse cases and investigative interviewing process in Istanbul. In addition, police officers’ beliefs about the credibility of children and their self-evaluated competence as an interviewer are examined.

Method: The participants were 51 police officers, working with children in various different regions of Istanbul. The survey was conducted during the seminar which is a part of a psychosocial support project for sexual abuse victims organized by Istanbul Special Provincial Administration. The survey was approved by the General Directorate of Security and the participation rests on a voluntary bases. The data was analyzed in SPSS 20.0 program.

Results: Among 51 participants, 46 of them are males and 5 of them are females. The mean age of participants is 30.4. Mean of working period in Security Department is 6.9 years, while mean of working period as police officers in Child Department is 2.8 years. Forty-three percent of the participants involved in interview of child victims more than 20 times. Thirty-nine percent of them mentioned each interview, takes approximately 30–60 minutes. Sixty-one percent of them mentioned that it takes 12 to 24 hours to deliver the file to the prosecutor's office. Most of them (72.5 %) stated that they interview the victim more than once. It is found that the year of working as child police officer is positively correlated with believing in child victims’ credibility and self-evaluated investigation competence. However, year of working as child police officer is not related with self-evaluated communication skills with children.

Conclusion: One of the most striking finding of the study is the difference between the length of interview process of the child victim and the length of the prosecutors’ office delivery process. Another point is that, the working period in Child Department did not facilitate the self-evaluated communication skills. It should be concluded that there is a need for communication skills support programs for police officers.


Stepsibling Incest Resulting In Pregnancy And Delivery: A Case Report

Muhammed Mehtar 1, Muhlis Yıldız2, Muhammet Demir2

1Council of Forensic Medicine, VI Board, Istanbul, Turkey

2Council of Forensic Medicine, Istanbul, Turkey

Introduction: Although sibling incest is thought as the most common form of incest abuse and is predicted to occur almost 5 times more than father/stepfather incest, literature is inadequate regarding this subject (1,2,9,10). Our knowledge is restricted to father/stepfather and daughter/stepdaughter incest (11). Due to limited empirical research, sibling sexual abuse definition suffered certain inconsistencies: “sexual interaction beyond age appropriate exploration” (6), “sexual behavior between siblings that is not age appropriate, not transitory, and not motivated by developmentally appropriate curiosity” (7), or “when the older sibling is 5 or more years senior to the younger sibling or when force is used no matter what the age difference” (3). Some authors mentioned sibling incest to be less harmful than father/stepfather incest while others claimed that ≥5 years of age difference between siblings causes more harm (1,4,8). Sibling incest was also noted by some authors to be as harmful as father/stepfather incest (5). No information on stepsibling incest was found.

Case: Girl (8 years 6 months old) started living with her mother, stepfather and stepbrother (9 years 7 months old) in a 2 bedroom flat and was sharing her bedroom with her stepbrother. After few months, explorative sexual contact with her stepbrother took place and continued for a course of 2 years beyond her mother and stepfather knowledge. When she reached 11 years 5 months of age, her stepbrother assaulted her and sexual penetration took place to later continue his abuse repeatedly by threatening her until she got pregnant with 7 months when her mother had knowledge of the abuse. Delivery took place when she was 13 years 5 months of age and her stepbrother was proved to be the father by DNA analysis. She was assessed thoroughly 3 days after delivery by a university psychiatric council and diagnosed with Major Depression and Posttraumatic Stress Disorder according to DSM-IV criteria. Another evaluation was made at our Council of Forensic Medicine 3 years 6 months after delivery and she was diagnosed with Posttraumatic Stress Disorder, Dysthymia and Borderline mental capacity according to DSM-IV criteria.

Conclusion: Sibling incest, whether biological or non-biological, is an insidious problem that should be addressed thoroughly as major consequences might emerge. Age difference should not be considered a main factor in implying the impact of sibling incestuous relationships and age appropriate sexual interaction should carefully be monitored.


Infant neglect – a forensic and legal emergency

Alexandra Enache1, Alexandra Mercescu2, Veronica Ciocan1, Bogdan Enache1, Fotios Chatzinikolaou 3

1University of Medicine and Pharmacy Victor Babeş Timisoara, Romania

2Paris 1 Panthéon-Sorbonne University, PhD student

3Aristotle University, Lab of Forensic Medicine & Toxicology, Faculty of Medicine, Thessaloniki, Greece

Aim: to highlight the urgency of the forensic examination and of the legal procedures in case of intentional trauma inflicted upon an infant

Materials-methods: casuistic analysis of the forensic examinations on the basis of the gravity of inflicted lesions criteria at the request of the police.

Results and discussions: of the 173 forensic examinations requested by the police for minors, 12 were cases of young children between 0 and 5 years old (on a period of 3 years). The trauma was recent in 78 % of the cases and old or of different aging in 22 % of the cases. We have identified excoriations, ecchymosis, erosions, hematoma and fractures, thus the gravity of the lesions varies from minor to major lesions which required hospitalization and emergency treatment. A special case was of a 6 weeks old infant, admitted in the emergency room with the following diagnostic: acute cranio-cerebral traumatism, open fracture of the right humerus, thoracic traumatism, abdominal traumatism, suspect of human aggression, Silverman syndrome, long oblique punctiform open fracture 1/3 distal diaphysis right humerus, massive hematoma right arm, abdominal concussion, multiple ecchymosis (face, torso, abdomen), ocular concussion left eye. Legal inquiry was focused on the method of producing the trauma (direct injury or falling), the objects which could produce the fracture and the concussions, how many days of medical treatment were required, if the life of the minor was endangered. By corroborating the clinical, investigative and forensic data it has been noted that the lesions require 50 days of medical treatment and that they did not endanger the life of the victim. However, we are of the opinion that, in relation to the age and vulnerability of the victims, the legislation should further protect this category by applying more severe punishment.

Conclusions: We have established that the trauma inflicted upon the minors were of varied gravity and age and produced repeatedly. The aggressed minors represent medical, forensic and implicitly legal emergencies. These cases require complex documentations and investigations with careful conservation of the evidence.


Child’s Death from Physical Abuse: A Case Report

Veysi Asoğlu, Esra Özgün Ünal, Gözde Şirin, Bülent Şam

Council of Forensic Medicine, Department of Morgue, İstanbul, Turkey

Medical records; medical history was taken from father. 1 year, 8 months girl, father brought her to hospital because of sudden developed cyanosis and pulmonary depression that happens while she was eating. İn the hospital she was entubated because of pulmonary arrest and sent to another hospital with an ICU.

Medical background; 1.5 months ago her leg was broken while he was playing with her brother/sister

Physical examination; physical progress is 10–25 percentile, she was not conscious, her general situation was bad, she was hypothermic and pale, there were a lot of differently aged ecchymoses on her face, neck, arms and trunk, a combustion scar on her left hand, deformity due to broke on her left leg, on cranial CT, multiple subarchnoidal hemorrhage areas, on X-Rays on the left fibula diaphyses broken section that is started to heal and there were no special finding at gynaecologic examination. On the 12th day of treatment brain death occurs and on the 13th day she died. Thinking of the findings are concordant to child abuse, the situation was denounced to the government and autopsy was requested

At the autopsy; beside the physical examination findings, we found hemorrhagic areas under the scalp, suture disintegration due to intracranial pressure, generalize subarachnoidal hemorrhage, subdural hemorrhage with neomembrane contusion, hemorrhage in pons, left optic nerve fiber and retina, partially healed broken area and callus formation on left fibula and tibia.

In conclusion; the death was reported occurred of intracerebral hemorrhage and complications due to blunt head trauma. consideration of the autopsy findings and medical records the case is compatible to child abuse. This case includes typical, clinically diagnosed and confirmed by an autopsy, findings of child abuse, and worth to be presented to emphasize the correlation of clinical and forensic approach


Complexity in a case of child sexual abuse: Girl to girl sexual abuse with an atypical foreign object (mascara)

Fuat Kircelli 1, Zafer Liman2, Erdinc Ozdemir2, Husrev Demirel2, Ergul Fidan Kircelli3

1Department of Child and Adolescent Psychiatry, Insitute of Forensic Medicine, Istanbul, Turkey

2Department of Forensic Medicine, Insitute of Forensic Medicine, Istanbul, Turkey

3Department of Psychiatry, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey

Background: Child sexual abuse is defined as a form of child abuse in which an adult or older adolescent engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification. Majority of the victims is female; the act is mostly repetitive, affects all parts of the society and often kept secret by the victim. In this case, we report a complex case of child sexual abuse, where three girls, staying at a dormitory, with similar ages and having a history of previous sexual, physical and emotional abuse were involved in an atypical sexual abuse.

Case: Three adolescent girls; one being the victim (17 years old) and the other two being the offenders (18 year-old), staying at a dormitory of the Social Services and Child Protection Service, was seen at the outpatient clinic to assess their mental health in a case of an atypical foreign object insertion (mascara) into the vagina by the offenders. 4 other girls staying at the same dormitory were also involved. Anamnesis revealed a prior sexual abuse in all 7 girls. After clinical interview, post-traumatic stress disorder and dissociative experiences scales were applied to all actors. Mental capacity was determined by clinical evaluation and psychometric tests. The victim was identified to have mild mental retardation and post-traumatic stress disorder, whereas the offender had anti-social personality, normal mental capacity and a post-traumatic stress disorder due to the previous history of physical and sexual abuse.

Conclusion: The children with a prior history of sexual abuse have later the tendency to become victims or offenders. This case shows that girls may also exert antisocial behaviours that develop in parallel to previous physical and sexual abuse which is mostly observed in boys. Dormitories, by influencing interactions between previous victims and offenders, may also be contributing to the occurrence of sexual abuses. Close follow-up of the cases staying at dormitories with a prior history of physical and sexual abuse seems to be very important in prevention of cases such as the one presented in this report.


Sexually abused victims with intellectual disability

Sefer Bilgi1, Nesime Yaycı 1, Mehmet Akif Inanici1, Emrullah Tolga Dagli2

1Department of Forensic Medicine, Marmara University, Istanbul, Turkey

2Department of Pediatric Surgery, Marmara University, Istanbul, Turkey

Children with any kinds of disability are more than twice as likely to be physically and almost twice as likely to be sexually abused as children without disabilities. We prefer to use of terminology instead of mental retardation as still label by many in the public. The claims of the victims with intellectual disabilities are unlikely to be reported to authorities and also they are viewed defectively in terms of cognitive abilities but positively in terms of trustworthiness and honesty.

In this study we examined the characteristics of the sexually abused five victims with intellectual disabilities that we assessed at the Child Protection Center of Marmara University Pendik Hospital, Istanbul. They all underwent legal interview, child psychiatric consultation and WISC-R testing.

The victims are all girls between 13–17 years old. Three of them are borderline limited intellectual disability, one of them is mildly limited intellectual disability and the other is moderately limited one.

The forms of abuse are penetration anal and/or vaginal. All of them were abused more than once and by more than one abuser. The type of sexual abuse is more severe in cases with intellectual disability. This vulnerable group of adolescents deserves a special interest of health workers.


Multidisciplinary child protection: Making decision about child abuse

Ahsen Kaya 1, Mehmet Altinok1, Ozlem Melek Kolusayin1, Beytullah Karadayi1, Dilek Celik2, Alaz Ozbek2, Abdi Ozaslan1, Gökhan Oral1, Gursel Cetin1, Coskun Yorulmaz1

1Istanbul University Cerrahpasa Faculty of Medicine, Department of Forensic Medicine, Istanbul, Turkey

2Istanbul University, Institute of Forensic Sciences, Istanbul, Turkey

Background: In recent years, awareness of child abuse and neglect has been increased in Turkey. The work with abused children involves several courses of action between institutions, namely as to the starting procedures to follow reporting of suspicion, diagnosis and preservation of evidence for penal purposes, as well as to the protection of the victim(s), all of which still lack a clear procedure. Several institutes often take part simultaneously in these early procedures and it is crucial that their own personal intervention be articulated with one another’s. The mission of Children’s protection Unit of Department of Forensic Medicine, Cerrahpasa Medical School is to reduce the emotional trauma to child abuse victims by facilitating a multidisciplinary team approach, which supports the prevention of child abuse through community education and promotes the effective prosecution of those who perpetrate crimes against children. In this study, it is aimed to share experience of Cerrahpasa Medical School.

Method: It is observed that the explanation of the High Court and the Prosecutors and Judges High Council in Turkey since 2012 which tells examinations of child abuse and other kind of violence cases can be done in universities which have a mirrored room and multidisciplinary team.

Results: Turkish Criminal Procedure Code, which has been changed, gives a chance to the different perspective of expert and expertise system. That change has brought new hope for the protection and reporting of abused children. The legal authorities’ decision reporting that they have been accepting the universities' Department of Forensics medicine as legal expertise institution and also giving priority considers a milestone decision. Because in these institutions including the investigation phase all the legal and medicolegal processes can be settled. After the text, the number of cases admitted to our department has increased surprisingly. This situation is a cornerstone for the beginning of the change for the universities which hasn't found their desired position in the expertise system.

Conclusion: The decision to verify child abuse allegations requires simultaneous consideration of a specified level of evidence of abuse, the severity of harm a child experienced, and in some jurisdictions, the risk of harm to a child. The decision making process is complex and the resultant recommendations multidisciplinary protection team make about services or court involvement may have significant implications for the immediate and long term functioning and safety of a family.



Work-related disability among Egyptian workers

Amany Salah Mohammad 1, Hoda Abdel Megeid El Ghamry1, Dina Soliman Badran1, Mohammad El Hafez Nouri2

1Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine – Cairo University

2Sudanese Federal Ministry of Health, Sudan

Background: Work-related injuries involve a great number of workers, especially young people at productive age all over the world. They are highly disabling, leading to major social and economic consequences. Thorough knowledge of the trends of workplace disabilities is essential for the development of strategies to better assessment and fair judgment.

The aim of this work was to study cases of disability in workplaces presented to the forensic medicine authority in Cairo, Ministry of Justice during 2 years (2008 and 2009) and to evaluate the disability rating percentage.

Methods: This is a retrospective study based on the data obtained from reports written by Medico Legal Experts (MLE) for workplace disability victims who were presented to the Medico-legal Administration Department of Cairo, Ministry of Justice during the years; 2008 and 2009. These data were then submitted to statistical analysis.

Results: There were a total of 142 cases of workplace disabilities in different establishments. Most cases lie between 18 and 34 years of age. Limitation of joint movements was the most frequent type of injury (49.3 %), followed by fractures and nerve, tendon or muscle injuries (26.8 % for each). Caught by a machine was the most frequent event (40 %), followed by falls/slips (20 %). Hands were the most affected part of the body (28.2 %). After assessment by MLE, the highest number of workplace disabilities fell in the 0 to 20 % range, and presented in 86 victims (60.6 %). Disabilities due to falls/slips and being hit by an object scored the highest rating percentages. Of all current study cases, general establishments recorded 89.2 % where private ones were only 10.8 %.

Conclusion: In Egypt, the accurate and reliable recording system for cases of work-injuries is still lacking. There is a clear need for better and more reliable data on the nature, causes and extent of injuries.


A case report on writing sample of a paranoid schizophrenia patient who reduced a word to a single letter

Nabi Kantarcı, Feruh Baklacıoğlu, Eyüp Kandemir, Esat Şahin

Adli Tıp Kurumu

In this case, the court file, that was interviewed in the Civil Court of First Instance and sent to Physics Specialization Department Document Review Branch of Forensic Medicine Institution with the aim of signature study, has been investigated. In the court file, there is committee report that states the paranoid schizophrenia, arranged by the Commune State Hospital regarding the complainant. The complainant knows how to write a letter of application to the court as of form, considering the establishment that the complainant was retired. He typewrites the letters of applications. In 2010, throughout the year he submitted 16 petitions to the court of the case, and the petitions were initialized by the Chief Judge and put to the court file. In the filed petitions, it was seen that there is a lack of meaning unity between the sentences. It was also seen that, without being based on a specific norm, some word’s initial letter was capitalized and made dots on both ends of the word. Moreover, it was seen that the petitions were underlined by yellow, red, blue, purple, pink, orange and green lead pencils. As a conclusion, on the writing samples belonging to our case, racing thoughts mentioned in the previous studies and also that is seen on schizophrenia patients. Together with the absurd patterns of behavior, for the first time we have been encountered with an absurd pattern of reducing the word to a letter and making a dots on the right and especially left side of the word. We think that the ascertained characteristic has a diagnostic value for the schizophrenia illness.


Epidemiological Study of post traumatic orofacial damage based on Portuguese Civil, Criminal and Labor Laws

Patricia Santos1, Jorge Costa Santos2, Cristiana Palmela Pereira 2

1Faculty of Dental Medicine at the University of Lisbon

2South Delegation, Portuguese Institute of Legal Medicine and Forensic Sciences

Purpose: The purpose of this study was to identify the type of orofacial injuries found in reports of Clinical Forensic of South Delegation from Medico Legal Institute, in Portugal, between 2005 and 2009, based on Civil, Criminal and Labor Law.

The final objectives were, determine: (1) the most frequent types of trauma, (2) the orofacial areas most affected, (3) the prevalence of orofacial lesions/sequelae, (4) the average number of disabilities evaluated or period of illness from those, based on Civil, Criminal and Labor Law.

Materials-methods: This retrospective study was conducted entirely in Clinical Forensic of South Delegation from INML. The target population consisted of the victims of preliminary, interlayer and final reports of the clinical forensic procedures carried out between 2005 and 2009. The population sample comprised a total of 1422 victims of both sexes, without restriction of age, of whom 232 had suffered some type of orofacial injury.

All the variables were defined according to the authors to discriminated the lesions/sequelae of orofacial area.

Results and conclusions: The most common trauma was the facial (54 %), followed by oro-facial (15 %). The most frequent injuries/sequelae were: Scars (27.91 %), excoriations (15.05 %) and ecchymosis (8.25 %).


Prevalence of gang rapes in Mthatha area of South Africa

Banwari Lal Meel

Department of Forensic Medicine, Walter Sisulu University, Mthatha 5117, South Africa

Background: Gang rape is one of the most conspicuous forms of violence and has reached epidemic proportions in South Africa. It occurs in all spheres of society and all women are potential victims.

Objectives: To determine the prevalence of gang rapes in the Transkei region of South Africa.

Methods: This one-year retrospective study focused on all cases of gang rape reported by complainants over 16 years at Sinawe Rape Crisis Center in Umtata General Hospital during January 2008 to December 2008. Recorded details included the age, addresses, number of perpetrators, relation with perpetrator and physical violence.

Result: There were 379 cases of rape recorded. Of this, 63 (16.6 %) were gang rapes. Majority 181 (47.8 %) were between the age of 16 and 20 years. The highest number 30 (47.6 %) were in the area of Mthatha followed by Tsolo 9 (14.3 %), Engocobo 9 (14.3 %), and Libode 7 (11.1 %). In majority 47 (74.6 %) of victims had two perpetrators, 10(15.8 %) had three perpetrators, and 3 (4.8 %) had four perpetrators. Most of the perpetrators 44 (69.8 %) were not know to the victims. Most of the gang rapes were part of robbery and take place at victim home.

Conclusion: There is a high prevalence of gang rape in Mthatha area of South Africa.


A comparative study of HIV sero-prevalence between nulliparous and parous women of the reproductive age who attended the Sinawe Centre, Mthatha, South Africa in 2005

Banwari Lal Meel

Department of Forensic Medicine, Walter Sisulu University, Mthatha 5117, South Africa

The aim of this study is to compare the sero-prevalence of HIV between nulliparous and parous women who attended the Sinawe Center following sexual abuse. A record review of victims of sexual abuse who presented to the center at Mthatha (Umtata) Hospital.

Six hundred and eighty five females attended the centre between 1st January and 31st December 2005. Of this, 268 had testing for HIV done, and 72 (26.8 %) were found to be positive. The highest number of positives, 30 (11.2 %) were between 21 and 25 years. There were 160 (59.7 %) nulliparous women with 30 (11.1 %) being HIV positive, and 108 (40.3 %) parous women with 42(15.7 %) positive. Among the nulliparae the highest positivity, 17 (6.3 %) was in the 16 to 20 year age group while in the parous women it was in the 21–25 year 26 (9.7 %) age group. There is a higher prevalence of HIV among parous women than in nulliparae who attended the Sinawe Centre.


A Drowning Case Including Mother And Her Own Children's Homicide-Suicide

Kenan Karbeyaz 1, Harun Akkaya2, Yasemin Balcı3

1Council Of Forensic Medicine, Eskisehir Branch Manager, Eskisehir, Turkey

2Council Of Forensic Medicine, Istanbul, Turkey

3Department Of Forensic Science, Mugla University, Faculty Of Medicine, Mugla, Turkey

Introduction: Homicide-suicide, is a relatively common in forensic medicine literature. Homicide-suicide is more common among family members. The Murderers are men, while victims are usually women and firearm is most commonly used instrument. There are rare cases of homicide-suicide by drowning for both murderer and victim or victims.

Aim: In this study, the mother who committed suicide by throwing herself into the water after murdering her two children by also throwing them into water is aimed to present.

The case/cases: A 25 years old mother who had been married for six years, killed her two children ( one of them is 5-years-old and the other is six months old) by throwing them into the water, and she also committed suicide by jumping into the water. The event took place by the river that pass through the park in the city. Her husband couldn't receive any news from his wife since the morning of the event, and stated that he found a suicide letter in his wife's bag. Eyewitnesses told that a man, a woman and two children chatted for a long time, then man leaved the park, women and children wandered around the river for a while, then the corpse of a woman and two children were seen in the evening of the day of the event. Postmortem toxicological and histopathologic examination showed that the cause of deaths was mechanical asphyxia due to suffocation in all three cases. According to the investigation file, the family migrated from the southeast region of Turkey and they had low socioeconomic levels, and it is determined that the husband was in prison for a period of time in the past.

Conclusion: The case of the mother who committed suicide by throwing herself into the water after murdering her two children by throwing them into water is a rare condition. The case is interesting for the manner of deaths and the reasons leading the mother to suicide and murder her children in terms of discussion.


Legal Cases’ Evaluations in Terms of Public Health

Gülçin Yapıcı1, Nursel Gamsız Bilgin 2

1Department of Public Health, Mersin University, School of Medicine, Mersin, Turkey

2Department of Forensic Medicine, Mersin University, School of Medicine, Mersin, Turkey

Purpose: Injury is identified as physical damage in human body due to a suddenly rising energy level. Our purpose in this study is to determine injury types and the causes of injury and to evaluate the injury’s results in term of public health.

Method: Mersin University Medical Faculty Forensic Medicine Department’s legal reports of year 2010 were evaluated for this descriptive study. Besides cases’ demographic features such as age, sexuality, home cities, some other features were obtained such as causes of injury, injury style, date and place of injury, injured body part, the hospitalization need due to injury, clinics where injured patients were hospitalized (if any), hospitalization duration. Data are presented as mean ± standard deviation and in percentages.

Results: There are 1042 reported legal injury cases in 2010. 67.7 % of them (n = 705) are male, 32.3 % are female, average age is 26.6 ± 16.8. Injuries occurred generally due to traffic accidents (%28.7), sharp objects (%15.3), assault (%14.5) and poisoning (%13.4). Injuries occurred mostly in streets (%30.9), and in or around house (%24.1). The most injured body parts were face (%30.5), arm (%16.2), head (%15.9) and leg (%15.3). 61.3 % of patients who applied to hospital (n = 639) were treated in emergency clinics and there were no need to hospitalize. When we evaluate injuries in terms of sexuality; the first place belongs to traffic accidents (both for males and females), second place belongs to poison for females and sharp objects for males. When we evaluate the reasons of injuries; the ranking is accidents, interpersonal violence and suicides respectively for women while the same ranking for accident, interpersonal violence and industrial accidents respectively for men. The evaluation in terms of age groups; accident is first ranked reason for every age group. Suicide was determined from the 10th age and seen most frequently between 15-19th years for females. Suicide was determined in females 5–8 times more than males in all of age groups.

Conclusion: Accidents and interpersonal violence were first two reasons of injury of males and females. The first protection method for injuries in traffic accidents was prevention from accidents. If it is not possible to prevent, injury’s prevention is other precaution. Public trainings must be organized in these topics. Besides, families must receive consultancy about girls’ tendency to self damages in especially adolescent era.


Evaluation of Sciatic Nerve Injury Cases at the Department of Forensic Medicine Between 2002 to 2011

Mustafa Talip Sener 1, Muhammed Ziya Kir2, Sadik Sahingoz1, Yuksel Anci1, Ahmet Nezih Kok1

1Department of Forensic Medicine of Medicine Faculty of University of Ataturk, Erzurum

2Branch of Council of Forensic Medicine, Erzurum

Introduction: Sciatic nerve is the largest nerve in the body is composed of the peroneal and tibial branches. Sciatic nerve injuries may occur as a result of traumatic events, and on the other hand may occur in result of medical interventions during the injections.

Aim and method: 16. 827 cases were analyzed between 2002–2011 retrospectively. Sciatic nerve injury in total 21 cases were evaluated. Cases were examined for demographic data such as gender, age, number of cases, event type, EMG and examination findings.

Findings and result: Of the cases, 19 (95 %) were male and 2 (5 %) were female. 2 cases (9.5 %) were sent by Patrol, 18 cases (85.7 %) were sent by Chief Public Prosecutor, and 1 cases (4.8 %) were sent by the Court. In 1 case (4.8 %) was not recorded age, in 1 case (4.8 %) was in 0–10 age group, in 3 cases (14.8 %) were in 11–20 age group, in 6 cases (28.6 %) were in 21–30 age group, in 4 cases(19 %) were in 31–40 age group, in 4 cases (19 %) were in 51–60 age group, in 2 cases (9.5 %) were in 70 + age groups were determined. In 2 cases (9.5 %) were not recorded event type, in 10 cases (47.6 %) were determined injection, in 5 cases (23.8 %) were determined stab wound, and in 4 cases (19 %) were determined gunshot wounds. In EMG reports, 10 cases (47.6 %) were identified tibial-peroneal nerve injury, 4 cases (19 %) were identified sciatic nerve injury, 5 cases (23.8 %) were identified peroneal nerve injury and 2 cases (9.5 %) were normal EMG recorded. During the examination in 7 cases (33.3 %) were detected foot drop, in 8 cases (38.1 %) were detected dorsiflexion or plantar flexion weakness, in 2 cases (9.5 %) were detected normal findings on examination, and in 4 patients (19 %) were not mentioned the findings of the inspection.

Discussion: Intramuscular injections are often performed by medical staff of medical interventions. In our study, more than half of the cases with sciatic nerve injury were observed the emergence of an intramuscular injection, raises the question whether these injuries is defective behavior of medical staff. To minimize and eliminate the intramuscular injection of sciatic nerve damage due to defective behavior of medical staff, intramuscular injection to be made the authorized persons, in appropriate circumstances and accurate localization is a basic requirement.


Sexual Assault Cases in Department of Forensic Medicine in Erzurum

Mustafa Talip Şener 1, Sadik Sahingoz1, Yuksel Anci1, Muhammed Ziya Kir2, Ahmet Nezih Kok1

1Department of Forensic Medicine of Medicine Faculty of University of Ataturk, Erzurum

2Branch of Council of Forensic Medicine, Erzurum

Introduction: Sexual assault is defined as any unwanted sexual act in which a person is threatened, coerced, or forced to engage against their will, or any sexual touching (rape, inappropriate touching, forced kissing, child sexual abuse, or the torture of the victim in a sexual manner) of a person who has not consented.

Aim and method: In the present research we aimed to define sexual assault cases according to determined parameters retrospectively at Department of Forensic Medicine of Ataturk University, at year of 2011.

Findings and result: One hundred and seventeen cases of sexual assault were evaluated. Of the cases 37 (31.6 %) were male and 80 (68.4 %) were female. The age range of cases were from 4 to 60 years. 75 cases (64.1 %) were in 11–20 age group. Of the cases 106 (90.6 %) were healthy with no mental problems and 11 (9.4 %) were mental retardation. The offender was known by the victim in 96 (82.1 %) cases. 40 (34.2 %) occurred in the cases or offender's home. There were not examination in 74 cases (63.2 %). The incidence of positive sign of anal penetration was 7 cases (6 %). In 14 cases (12 %) were suffered vaginal intercourse and in 22 cases (18.8 %) were not positive sign of anal or vaginal penetration. Based on psychiatric examinations, in 59 cases (50.4 %) were normal psychiatric signs, in 17 cases (14.5 %) were diagnosed post traumatic stress disorder (PTSD) and the other cases were diagnosed other psychiatric illness.

Discussion: In our study, the majority of cases of sexual assault were earlier adolescent girls between the ages of 11–20 as well as many studies made before and the offenders were family relatives, neighbors and also previously recognized by the cases. Cases of exposed to sexual or physical attack are exist psychiatric signs such as depression, PTSD, anxiety and sexual dysfunction. In this study, nearly half of the cases of were diagnosed psychiatric disorders such as depression, PTSD and anxiety. Sexual assault is one of the most severe trauma due to the negative effects of both physical and mental signs. A significant portion of the cases are not reported to judicial authorities. We suggest that to prevent sexual assault, individuals be made aware of this issue, the events were reported earlier and support for the cases to the negative effects of sexual assault such as psychological and physical trauma


The role of the Forensic Pathologist: from the lifting body to the forensic report writing

Laidaoui Zeddam Dalila, Sbaihi Cherouat Atika, Mostefaoui Azzedine, Merah Fatiha

University Hospital Center Beni Messous

The role of the pathologist is usually subordinate to the judicial process which is developed in three steps:

1. The research and establishment of the crime or offense which requires frequent intervention by the forensic pathologist in the case of attempt on the life, injury, murder, poisoning.

Forensic operations are intended to determine the nature of the fact and its judicial criminal cause and include:

The lifting body, autopsy, toxicology, histopathological, and bacteriology.

2. Research of the agent of the offense involves the study of pieces of evidence, trace evidence and that means the implementation of the capacity of police and legal medicine laboratories.

3. The drafting of the forensic report is a summary of the facts leading to conclusions, when the establishment of guilt, it belongs to the magistrate responsibility.


A Murderer or Victim? The Importance of Differentiation of Suicidal/Homicidal Sharp Force Injuries: Case report

Ugur Kayhan, Yalçın Büyük, Fatih Şahin, Burak Hakkı Erkılınç, Ümit Naci Gündoğmuş

Council of Legal Medicine

The determination of the manner of death in general and the differentiation between homicidal and suicidal sharp force injuries in particular is a major issue in forensic medicine. Actually sharp force is a rare method of suicide constituting only 2–3 % of all suicides in various countries. In a case with multiple, deep, lethal stab wounds, it may be easy to define the mode of death, but in some other cases it may not be so easy. The classical criteria for discriminating self-inflicted fatal sharp force trauma from homicide are generally considered as follows: (1) several injuries are observed on the possible sites of self-infliction; (2) hesitation marks are present; (3) clothing injuries are present. In spite of these facts, there are many case reports showing unusual features in the literature.

Self-inflicted sharp force trauma may, in some other cases, be a part of a scenario aiming to deceive legal authorities. The perpetrator may injure him in order to show him as the murder of the incident.

A 58 years-old man who is the suspect of murder of his wife was referred to Council of Forensic Medicine for medico-legal evaluation of his wounds claimed to be inflicted by himself in order to accuse the decedent as the perpetrator. Crime scene findings, hospital records, autopsy report of the victim, nature of the wounds of both victim and the suspect were all evaluated and presented.


Death in Emergencies: Confrontation Diagnoses Emergency Physician – Forensic Pathologist

Mohamed Allouche 1, Nédia Boudriga2, Mongi Zhioua1, Moncef Hamdoun1, Béchir Bouhejja2

1Service de Médecine Légale de Tunis, Hôpital Charles Nicolle

2Service des urgences et de SMUR, Hôpital Régional de Ben Arous

Introduction: The autopsy is an indispensable diagnostic tool to understanding the causes and mechanisms of death like to the improvement of the quality of care. In every case of violent, suspect and sudden death, an autopsy is required.

The purpose of this study is to confront the diagnosis established by the emergency physician and that of the forensic scientist.

Material-method: Retrospective study including all the patients' deaths admitted in emergencies of Ben Arous's regional Hospital between May 2009 and December 2010. For each patient: age, sex, histories, symptomatology before the death, means of transport, pre and intra-hospital resuscitation, the attitude of the family, were collected. For each death, a diagnosis was established by the emergency physician.

Results: 112 deaths are included. The average age of dead patients was of 52.6 years. A sex ratio was 1.7. Patients presented pathological antecedents in 76 cases (66 %). Patients joined emergencies by their own means in 81 cases, by emergency services 26 cases. The pre-hospitable resuscitation was undertaken for 10 patients. The intra-hospital resuscitation was tried for 94 patients.

The attitude of the family was acceptance in 51 cases, a usual crisis of mourning in 44 cases, a verbal aggression in 13 cases and a physical aggression in 1 case.

In 37.5 % case the autopsy was not required in spite of the obligation to sign on the medical certificate of death, the presence of a medico-legal obstacle to the burial. The main reasons are pathological antecedents of the victim, absence of traumatic injury on the body and advanced age.

The diagnostic concordance was perfect in all cases of traumatic deaths. In 15 % of the cases (12 victims), the diagnosis advanced by the emergency physician was different from the conclusions of the autopsy. These cases concerned young subjects without histories, died suddenly or patients with pathologies difficult to diagnose (myocarditis, aneurism of the abdominal aorta).

Conclusion: This study shows that the autopsy diagnosis is of a big contribution for the knowledge of the causes of death in emergencies. A discussion between the forensic scientist and the emergency physician is necessary in case of diagnostic discordance.


Sudden intraoperatory death during percutaneous vertebroplasty

Luigi Papi 1, Stefania Fornaro1, Tommaso Guerrini1, Ferruccio Po'2, Marco Pieri3

1Department of Legal Medicine – University of Pisa

2Department of Orthopaedic Surgery – University of Pisa

3Department of Anaesthesia – University of Pisa

Percutaneous Vertebroplasty (PV) is a minimally invasive surgical procedure performed in the vertebral collapse treatment, following osteoporosis and others diseases (eg. cancer) associated to severe pain.

The procedure includes the following: transpeduncolar introduction performed under endoscopic guided, needle-cannula application within the fractured vertebral bodies and subsequent injection of cement bone, typically consisting of polymethylmethacrylate (PMMA).

This procedure was first described in France in 1987 for the treatment of an aggressive hemangioma of C2 and subsequently spread throughout the world.

Nowadays, we can conclude that there are no reliable data concerning long-term effects and complications due to this procedure, however generally considered as a procedure at minimum risk for major complications.

Moreover, some recent cases reports have highlighted the existence of a minimum risk for cardio-respiratory impairment, sometimes associated to fatal outcomes. This eventuality, from an etiopathogenetic point of view, has been linked to the so-called “Bone Cement Implantation Syndrome”, already known and described in the cemented hip prosthesis implantation.

Nonetheless, the pathogenic mechanism of this serious complication, clinically characterized by hypoxia, hypotension, bradycardia, arrhythmia, increase in the pulmonary resistance and cardiac arrest, is not yet sufficiently clarified. The predominant scientific approach pays great importance to pulmonary embolism (adipose, bone marrow, cement, bone spicules) but other studies have suggested also other hypothesis, such as the release of histamine or complement activation, with hypotensive effects, or the vasodilatation induced by endogenous cannabinoids, as well as the direct PMMA toxicity.

In our case, the patient was suffering from multiple vertebral collapse from L1 to L5, thus suggesting a multilevel approach. After the preoperative tests, the patient underwent surgery under local anaesthesia and mild sedation during the cement injection. Nonetheless, since a small intravenous cement diffusion at the level of L3 was produced, the procedure was immediately arrested but the patient presented immediate hypotension and bradycardia followed by irreversible cardiac arrest. At first medico-legal investigation was not ordered, but an autopsy was anyway performed to establish the cause of the death. The autopsy revealed a severe ischemic heart disease, but a later histological examination for medico-legal purpose showed diffuse pulmonary microembolization related to the surgical procedure.

The literature review and the study of the case point out the need for future clinical observations on the risks, even if statistically low, of major complications in percutaneous vertebroplasty, which should require a specific mention in the informed consent.


Evaluation of the delay in execution of the penalty of imprisonment because of diseases

Volkan Ünal, Sadi Çağdır, Yusuf Özer, Uğur Çom

Adli Tıp Kurumu, İstanbul,Turkey

In our country, delay in the execution of the penalty of imprisonment is defined in the article 16 of Law No 5275 on the execution of penalties and security measures. According to the Law of Council of Forensic Medicine, these cases are sent to 3rd Specialization Board of Council of Forensic Medicine by prosecutor’s offices and their examinations are organized. According to the article 16 of law No 5275; in case of disease, execution continues at the public hospitals’ separated parts for prisoners. However, if the execution risks the convict’s health, execution is delayed until the convict gets better. Delay decision is given by the chief public prosecutor’s office on report prepared by the health committees of general hospitals and approved by Council of Forensic Medicine or prepared by Council of Forensic Medicine.

In 2011, totally 667 case appealed to 3rd Specialization Board of Council of Forensic Medicine, to benefit by the delay of execution and by our board 14 were evaluated in this context.

We want to present four cases to show the approach of 3rd Specialization Board of Council of Forensic Medicine. First two cases are the examples of that we were of the opinion that delay in the execution can be given. First one is 47 years old male, he has Multiple Myeloma since November 2010, bone marrow examination after chemotherapy treatment is concordant to remission, as post remission treatment autologus stem cell transplantation is being planned. Second one is, 71 years old male, he has chemotherapy resistant epitheloid mesothelioma diagnosis since February 2010, he has supportive treatment, his general situation was bad.

These two are the examples of delay in the execution was not approved. First one is 48 years old male, he has decompensed liver cirrhosis secondary to Hepatitis B since June 2011, he has hypersplenism, oesophagus varicosis, hepatosplenomegaly, in our examination, he has sclerotic icterus, second one is 64 years old male, he has chronic obstructive pulmonary disease, senility, bilateral renal calculi, bilateral sensorineural hearing loss diagnoses,

As a conclusion, if the diagnosis of the convict is a risk for life contingency or prison conditions are not adequate for treatment or according to medical records cases that do not have the chance to get better are evaluated in terms of delay in the execution.


Fatal Undiagnosed Pulmonary Hydatid Cyst: A Case Report

Muhammed Ziya Kir, Ufuk Ilingi, Gökmen Karabağ

Branch of Council of Forensic Medicine, Erzurum

Introduction: Hydatid disease is a parasitosis and is endemic in many sheep-rearing regions in the world especially in the Middle East and the Mediterranean countries. The lungs are the most common sites of infection in children and the liver is the most common site affected in adults. Spontaneous rupture of the hydatid cyst into the peritoneum or pulmonary, which is accompanied by serious morbidity and mortality generally.

Case: A 48-year-old woman was admitted to State Hospital with the complaints of dyspnea. The The pulmonologist was receipted antibiotic and anti-inflammatory tablets and was sent to her to taken her chest graphies. On the same day after she had taken her drugs she was vomiting blood. Then she was taken to the hospital and died in emergency room. Autopsy were done by Director of Forensic Medicine, Erzurum. The post-mortem examination revealed a large cyst (10x5 × 4 cm) in the right lung and there was no daughter vesicle. The histopathological examination of the cyst and lung tissue samples confirmed the diagnosis of pulmonary hydatid cyst.

Conclusion: Hydatid disease is a serious health problem in endemic areas as well as in Turkey. The diagnosis and appropriate surgical therapy is usually delayed because most of the hydatid cysts remain asymptomatic until it is getting complicated. Treatment of dogs with antihelmintics is the main procedure to control the parasite. In rural areas of Turkey this treatment is not applied routinely. In the rural area, sheep are home-slaughtered routinely. Dogs can access to the infected viscera. Diagnosis of the hydatid cyst is mainly based on ultrasonography and computed tomography. The choice of treatment is still surgical approach in the management of pulmonary hydatid disease. In endemic regions, it is useful to consider hydatid cyst disease for patients with dyspnea admitted to the emergency room. Rupture of the hydatid cyst may be fatal.


A case of toxic shock due to clandestine medical abortion

Natalia Minelli1, Francesca Cittadini 1, Letizia Caradonna1, Francesco Ausania1, Riccardo Rossi1, Giovanni Loyola2

1Institute of Forensic Medicine, Catholic University, School of Medicine, Rome Italy

2Department of Gynaecology and Obstetrics, Sant’Eugenio Hospital, Rome Italy

Background: Unsafe abortion is one of the least documented reproductive health problems and, not coincidentally, it's difficult to document.

Millions women worldwide still have an unsafe termination of pregnancy each year, resulting in estimated 66500 deaths in countries with restrictive abortion laws, largely among the most vulnerable women, such as the poor, the unmarried and the young women.

We encountered a case of septic shock due to misoprostol induction of labor at 9.2 weeks in a 42 year old white woman (gravida 10, para 10). She died 6 days after she ingested 12 tablets of 200 mg of oral misoprostol, illegally prescribed, without prophylactic antibiotics.

Her symptoms included uterine haemorrhage, abdominal cramping, vomiting, and diarrhoea on day 2 when she was hospitalized with anaemia (Hb 10.6 g/dl), pancitopenia (1,92 white cells/mm3, 69 plaquetes/mm3), with lack of fever. Revision of uterine cavity and curettage were performed due to minor retained necrotic decidua. After repeated haemostatics and uterotonics she died.

Method: Autopsy and histological examination were performed.

Results: It was proved that the woman died from septic shock. Lung findings were mononuclear cell infiltration, thick alveolar septae, intraalveolar haemorrhage. The other findings were congested pulmonary blood vessels, pulmonary oedema, cytomegaly, fibrin accumulation and formation of eosinophilic membrane.

Conclusion: Administration of mifepristone in combination with misoprostol, a prostaglandin analogue, is currently the most widely used regimen for medical abortion approved by World Health Organization and it is a safe and efficient alternative to the surgical abortion method.

The risk of serious complication is exceptionally low compared with other medical interventions, and very few patients require emergency referral. After medical abortion, prophylactic antibiotics should be administered because of reports of serious infection.

Common practice is that women administer misoprostol themselves at home, handling the treatment and most stages of the termination process themselves.

The importance of this case concerns the question of real public access to information regarding abortion as a clinical procedure and the specific obligations related to the part of health care professionals. Although improvements in technology and changed perspectives on rights had an impact on the abortion debate, remain crucial the significant disparities and inequities in access even within health systems that provide basic health coverage for all.

In the meantime physicians providers of abortion care play an important role: prevent fatal injury through knowledge of the common clinical toxic shock after medical abortions and advanced postabortion care.


Domestic Violence Assault versus non-Domestic Violence Assault: a retrospective study of Criminal Law reports in the Centre of Portugal (2008–2010)

Daniel André Martins Henriques, César Santos, Gonçalo Castanheira, Rita Sanches, Graça Costa, Francisco Corte Real

Centre Branch of the Portuguese National Legal Medicine Institute

Domestic violence is contemplated in the Portuguese Criminal Law Code since 2000. According to the Portuguese Association for Victim Support (APAV), in Portugal, during the year of 2010, there were a total of 16972 domestic violence complaints, a number that increased in 2011 to 18470. It represents 31.7 % of all Criminal Law exams underwent in the Centre Branch of the Portuguese National Legal Medicine Institute (INML, I.P.), during a three year time lapse (2008–2010).

This study has the objective to compare the victims, instrument of assault, location of injuries and impairment period resulting from lesions in Domestic Violence Assaults versus non-Domestic Violence Assaults.

Data was analyzed according to age, gender, nature of lesions, the instrument of assault, location of injuries, and period to cure suffered lesions. Levene’s test for variance and Welch's t-test were utilized to compare both groups.

During the previously mentioned period a total of 3844 Criminal Law reports were analyzed. 1217 of these corresponded to Domestic Violence Assaults cases, 960 female and 257 male victims, ages varied from 1 to 97, with a mean value of 39 (38.5892 ± 15.02762) years. 942 resulted of blunt trauma. The period to cure suffered lesions had a mean value of 4 (3.7442 ± 3.50393) days, resulting in daily work impairment of a mean value of 3 (2.6927 ± 10.72988) days and in usual labor impairment of a mean value of 2 (1.7472 ± 6.76170) days.

2627 of these corresponded to non-Domestic Violence Assault cases, 1035 female and 1565 male victims, ages varied from 1 to 91, with a mean value of 39 (38.5454 ± 17.07986) years. 1983 cases resulted of blunt trauma. The period to cure suffered lesions had a mean value of 5 (4.2667 ± 12.07120) days, resulting in daily work impairment of a mean value of 6 (5.7118 ± 29.47528) days and in usual labor impairment of a mean value of 5 (4.3037 ± 24.69471) days. The authors also characterized the instrument of assault and location of injuries in both groups.

Most of the cases comprehend a female victims suffering blunt trauma. Comparing both groups, the authors conclude that the age in both populations is fairly the same and that domestic violence assault normally results in lesions that are faster to cure, originating fewer impairment days for general work and for usual labor, than non-domestic violence assault. The authors consider that domestic violence assaults’ physical component is only the tip of the iceberg of a continuous and complex form of violence.


Postural Dyslexia: a medico-legal evaluation

Daniel André Martins Henriques, António Mestre, Graça Costa, Francisco Corte Real

Centre Branch of the Portuguese National Legal Medicine Institute

According to Da Cunha (1979), Postural Deficiency Syndrome is a disorder in the central nervous system functioning, characterized by impairment in transmission and integration of information necessary for postural balance. Various symptoms can appear within the same subject, such as, musculoskeletal complaints, as well as perceptual and cognitive deficit symptoms. This Syndrome can occur at any time of life. In children, after the acquisition of upright posture and bipedal walking, impairment of spatial reference, for instance the decrease of referential vision will hinder the balanced development of the body’s posture. It is usually during school years that disorders such as dyslexia, hyperactivity, loss of interest, attention deficit disorder will appear. Later in adolescence these symptoms will manifest themselves through musculoskeletal disorders.

The authors were requested by Coimbra’s Court related to Family Law matters, to infer if an adolescent was bearer of Postural Deficiency Syndrome, in a child custody dispute. Clinical signs and symptoms of this syndrome were taken in consideration to evaluate if the patient suffered from the disorder in appraisal. Ophthalmologic, psychological and neurologic evaluations of the patient were undertook in idoneous institutions to ensure the validity of results.

The patient presented himself to the Ophthalmologic evaluation wearing prismatic lenses, having a visual acuity of 8/10 bilaterally, in monocular and binocular conditions, he didn’t present any facial asymmetry, anomalous posture or gait abnormalities. A new correction was proposed, having a visual acuity of 10/10 in monocular conditions and a visual acuity of 12/10 in binocular conditions, Jaegger 1 for close distance visual acuity. Psychological evaluation concluded that the patient presented an intellectual level within the average patterns, with personality characteristics that can lead him to be a stable person, with a good level of cognitive function and psychosocial adjustment. Neurologic evaluation didn’t show any abnormality of the neurologic functions or in the patients gait or posture, thus no neurologic cognitive, mnesic or intellectual deficit was found to justify the possibility of a lexical difficulty.

The authors had to go through a thorough investigation of all the signs and symptoms of Postural Deficiency Syndrome. Other causes for dyslexia were excluded before that.

To rigorously ascertain this Syndrome’s broad clinical spectrum, a suitable evaluation by a multidisciplinary team must be performed.

Proprioception, gait and posture abnormalities, as well as dyslexia, major signs that comprise this Syndrome, weren’t confirmed in this precise case, therefore overruling the hypothesis of Postural Deficiency Syndrome.


Facial Emotion Recognition in Patients with Violent Schizophrenia

Murat Emül 1, Sedat Karabuga2, Suheyla Aliustaoğlu2, Eyup Kandemir2, Mihriban Varkal1, Esat Sahin2, Haluk Ince2

1İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi

2Forensic Medical Council, Istanbul, Ministry of Justice, Turkey

It is well known that patients with schizophrenia have more violent behaviors than general population. Some impairment in facial emotion recognition ability was detected in these patients that lead deficiency in communication, social withdrawn and development of delusions. In this study, the ability of facial emotion recognition in violent patients with schizophrenia was aimed to investigate. Forty one violent patients with schizophrenia and 35 non-violent patients with schizophrenia were included in the study. Sociodemographic inquiry including the characteristics of violent behavior, facial emotion recognition test, positive and negative symptom scale for schizophrenia were performed in both groups. Sociodemographic findings in violent patients with schizophrenia were in accordance with literature findings. There were no statistically significances among right responses of recognizing the emotions according to facial emotion recognition test. In both groups, the most right recognized facial emotion was happiness and the worst right was recognized facial emotion was fear. However, the dispersions of misattributions to facial emotions were significantly different between groups, although there was no difference according to right responses. Some significance according to symptom severity scores was observed between groups. In addition, there was a weak correlation between the right response to facial emotion and symptom severity in groups. The insignificance among right response to facial emotion recognition between groups supports the proposal that the ability of facial emotion recognition is a trait feature of the disorder. Nevertheless, the new studies indicate the importance of some strategic education programs in facial emotion perception and recognition to gain the patients with schizophrenia to community, to improve the interaction and functionalities of the patients. As the findings in facial emotion recognition ability of violent patients with schizophrenia increase, it might lead to develop some preventive interventions and preclude recidivism in patients with schizophrenia.


A case of death for recurrence of Giant Condylomata Acuminata Buschke-Lowestein’s tumor

David Forni, Valentina Bugelli, Luigi Papi

Department of Legal Medicine – University of Pisa

Background: A case of death for recurrence of Giant Condylomata Acuminata Buschke-Lowestein’s (GCBL) tumor after 20 years from the previous diagnosis is presented.

The victim was a 40 years old man with mental disorders found dead in his folding bed in the home where he lived with his old mother in very poor hygienic condition. When he was 20 years old perianal condyloma was diagnosed, and only two years before the death, which occurred in March 2011, he underwent surgical exeresis with percutaneous enterostomy for GCBL.

Results: At medico-legal investigation, the external examination showed signs of extreme thinness, cachexia and remarkable unsanitary conditions associated with many extensive ulcerations of the skin of the dorso-lumbar district.

The examination of the perineal district revealed a large ulcerated and necrotic mass tumor (diam. 15 cm) referable to the Buschke-Lowestein’s cancer. The autopsy revealed the presence of necrotizing fasciitis localized in the posterior surface of the tights. Other relevant findings were represented by gastric ulcers and microembolic phenomena, secondary to the septic shock caused by the necrotizing fasciitis responsible for the death.

Conclusion: The Buschke-Lowestein’s cancer is a verrucous carcinoma related to previous infection by papilloma virus type 6 and 11. Risk factors are represented by unsanitary conditions, condyloma acuminata, smoke and alcohol. The prognosis of the disease is generally favorable and it is related to the timing of diagnosis and treatment; mortality is low when early surgical eradication of tumoral mass with wide margins of excision is performed.

The complications of the disease are related to the growth of the tumor and consist of secondary infections, necrosis, fistula and recurrent abscess poorly responsive to antibiotic therapy, with possible progression to necrotizing fasciitis and septic shock.

In our case, as showed by health records and autopsy result, there were no other conditions responsible of the prolonged immobilization and the state of deep starvation except for the tumor of Buschke-Lowestein and its related complications.

The particularity of the case consists in the remarkable evolution of the disease, rarely lethal if promptly and adequately treated.


Forensic evaluation issues in dysexecutive syndrome after traumatic brain injury

Bárbara Santa Rosa 1, António Mestre2, Rosário Silva1, Graça Santos Costa1, Francisco Corte Real3, Duarte Nuno Vieira3

1National Institute of Legal Medicine, Centre Branch, Coimbra, Portugal; Forensic Sciences Centre, Coimbra, Portugal

2National Institute of Legal Medicine, Centre Branch, Coimbra, Portugal

3National Institute of Legal Medicine, Centre Branch, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Forensic Sciences Centre, Coimbra, Portugal

Traumatic brain injury (TBI) is a serious public health problem with a high incidence, usually associated with significant neuropsychological deficits primarily in the domains of behavior, emotion and cognition.

Both the orbito-frontal and temporo-polar areas are disproportionately susceptible to damage after TBI. Their proximity to the frontal plate of the skull and the floor protuberances make these areas especially vulnerable to deceleration injuries in a blunt head trauma.

Depending on the frontostriatothalamic circuit damaged there are three clinically observable frontal behavioral syndromes. The dorsolateral prefrontal circuit has been associated with disorganization, inflexibility, loss of hypothesis generation and testing, impulsivity and distractibility, known as dysexecutive syndrome. The lateral orbital prefrontal circuit has been associated with disorders of self-regulation, such as the syndrome of frontal disinhibition. The anterior cingulate circuit has been associated with disorders of activation, spontaneous behavior and motivation resulting in syndromes such as apathy.

Furthermore the threshold for the clinical expression of dementia among predisposed individuals may be lower after TBI.

The authors present a case of a man who was struck in the head by an object, with loss of consciousness, submitted in the context of civil law, to a forensic examination, at Portuguese National Institute of Legal Medicine. After the traumatic event he developed not only global apathy with reduction in drive and motivation but also dementia. The ability to deal with situations that require goal formulation and planning was lost. Consequently he became personally, socially and occupationally disabled.

The variable nature of the injury mechanism, lesion location and severity makes the attribution of causal nexus challenging in patients with TBI.

Although clinical assessment is essential for the diagnoses and identification of behavioral abnormalities, it may underestimate the presence of cognitive deficits. A formal evaluation should be performed based on tests assessing: response inhibition, rules deduction, set maintenance and shifting, and planning and information generation.


Causal nexus issues in meralgia paresthetica: regarding two cases

Bárbara Santa Rosa 1, Antía Simón1, António Mestre2, Rosário Silva1, Graça Santos Costa1, Francisco Corte Real3

1National Institute of Legal Medicine, Centre Branch, Coimbra, Portugal;Forensic Sciences Centre, Coimbra, Portugal

2National Institute of Legal Medicine, Centre Branch, Coimbra, Portugal

3National Institute of Legal Medicine, Centre Branch, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Forensic Sciences Centre, Coimbra, Portugal

The lateral femoral cutaneous nerve is a sensory nerve that originates from the first three lumbar nerve roots and travels along the posterolateral aspect of the psoas over the iliacus muscle in the region of the anterosuperior iliac spine. It enters the anterior region of the thigh by passing under, trough, or above the inguinal ligament and innervates the anterolateral part of the thigh. The highly varied regional anatomy of the lateral femoral cutaneous nerve may account for its susceptibility to local trauma by direct injury or compression.

Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve characterized by numbness, decreased sensation to pinprick, pain, tingling and burning of its skin innervation area. It is a relatively uncommon disease. In a recent case control study of a large cohort, in the primary care setting, the incidence rate of this condition was 4 per 10000 individuals. Medical history and neurological examination are essential in making the diagnosis. However sensory nerve conduction velocity studies are a useful additional diagnostic tool.

Meralgia paresthetica has many etiologies and can be subdivided into two main groups: post traumatic and spontaneous onset. The spontaneous type can be idiopathic, metabolic or mechanical (from increased intra abdominal pressure or external direct pressure). Even though this neurological condition can develop spontaneously at any age, it usually presents in the 30 to 40 year age group.

In the forensic setting it is important to acknowledge that traumatic events like seat belt injuries following motor vehicle accidents and injury during medical procedures with iliac crest bone harvesting can arouse this disease.

The authors present two cases of males subjected to forensic corporal damage evaluation at the Centre Branch of the Portuguese National Institute of Legal Medicine. One of them was a victim of a traffic collision and the other one was performed a diagnostic iliac bone biopsy. After these traumatic events both started a clinical syndrome of meralgia paresthetica. However taking in account the injury mechanism we only attributed causal nexus in one of the cases.

Regarding these two cases the authors discuss the relevance of different injury mechanisms for the differential diagnosis between spontaneous and post traumatic meralgia paresthetica. It is an issue of great importance to a correct forensic analysis of the causal nexus.


A comparative study of Spanish and immigrant victims of violence during the years 2009 and 2010

Elvira Samanes1, Begoña Martinez Jarreta2, Emilo Abecia2, Miguel Bolea2, Maria Dolores Perez Carceles3, Aurelio Luna 3

1Accident and Emergency Department. Nuestra Señora de Gracia Hospital, Zaragoza (Spain).

2Department of Forensic Medicine. University of Zaragoza, Zaragoza (Spain).

3Department of Forensic Medicine. University of Murcia, Murcia (Spain)

Background: Official statistics provide data on the violence that comes to the attention of the police and the court system. However, there is also violence that goes unreported, the extent of which is unknown. Hospital A&E departments are a valuable source of data on this underlying violence since in many cases they are the only points of contact between the victim and the institutions.

Methods: Descriptive observational study in a single location of a sample comprising 3,340 clinical histories of violence and 108 questionnaires administered to the victims during the years 2009 and 2010 in the A&E Department of Nuestra Señora de Gracia Hospital, Zaragoza (Spain).

The dependent variable was nationality. We distinguished between Spanish citizens and immigrants (from Latin America, North Africa, Sub-Saharan Africa, Eastern Europe and Asia). The independent variables were: age, gender, medical card holder or not, place of residence (i.e. neighbourhood), day of the week and time of day, type of violence and medical diagnosis. The survey also contained a number of other variables concerning the victim (length of residency in Spain, civil status, co-habitees, level of education, employment status, place of the assault, command of Spanish language, previous assaults, threats and reported incidents to the police) as well as questions concerning the aggressor (relationship with the victim, if any, origin of the aggressor, cause(s) of the assault, indications of intoxication with alcohol/drugs or narcotics).

Results: The number of foreign patients who were victims of violence was greater than the number of patients treated for a normal ailment. Immigrant victims outnumbered Spanish victims.

Immigrant victims were less likely to hold a medical card (81.6 %/96.5 %), were more likely to be the victims of sexual assault (32.3 %/21.5 %) and were younger on average than Spanish victims (31.4/35.8 years).

The largest proportion of victims came from Latin America (38.1 %) followed by North Africans (22.6 %), Sub-Saharan Africans (13.4 %) and Asians (4.4 %).

In all cases, the ratio between male and female victims was close to parity (50 %) with the exception of North Africans, among whom the percentage of female victims was just 12 %.

Victim questionnaires revealed that the frequency of assaults diminished the longer the person had been living in Spain, 86 % of the victims had an intermediate to advanced command of the Spanish language, a low level of education (68 % having completed only primary education or were illiterate), a high level of unemployment (32 % unemployed) and 54 % were unmarried.


Proposal for a guide to medical assessment of the aesthetic alterations: aesthetic damage/deformity

Fernanda Capurucho Bouchardet 1, Fernando Esbérard Leite2, María Teresa Criado Del Río3

1Puc Minas, Belo Horizonte, Brasil

2Hospital da Força Aérea do Galeão, Rio de Janeiro, Brasil

3Faculdad de Medicina de la Universidad de Zaragoza, España

This article proposes to contribute with a “open guide” for medical assessment of the aesthetic alterations in the distinct judicial fields, whose applicability and development only will be shown through the forensic and juridical experience of all the involved in the assessment and repair of personal damages. After obtaining a representative number of cases, in the future this guide can be used for different teams of professionals to translate their results into a qualitative method using also quantitative methods of qualitative translation of this damage (analytical and mathematic formulas that might to be chosen) to proceed afterwards to the exchange of cases and discussion between groups of the criteria of qualification in order to obtain consensual reference parameters.


Utilisation of the “AIPE” method in the assessment of the aesthetic damage and its application in the Brazilian civil and penal legislation

Fernanda Capurucho Bouchardet 1, Juan Antonio Cobo Plana2

1Puc Minas, Belo Horizonte, Brasil

2Instituto de Medicina Legal de Aragón, España

The evaluation of body damage that causes aesthetic alteration should follow the principle of reasonability and also the conventional standard of proof in the legal proceedings. The objective of this essay is to propose the possible use of the Aesthetic Perception of Injury Analysis (AIPE) method in cases of valuation of disfigurement in the civil scope or the degree of deformity in criminal proceedings, since it is a method that facilitates for the user, the doctor, the dentist or the lawyer when creating a criteria of intensity or severity of this aesthetic damage and upon the resulting deformity, which may take the principle of contradiction by establishing some rules of use subject to reassessment by other evaluators, and be able to improve the principles of advertising and mediation when conveying to the judge the basis of this assessment as a simple and evident way in its construction. Once a method of assessing the intensity or severity of the disfigurement is established, it seems that this method can be perfectly applied to any civil or criminal legislation.


Elderly Deaths Whose Autopsies were Performed in Istanbul City of Turkey Between 2005–2008

Bora Büken1, Zerrin Erkol 2, Nezih Anolay3, Erhan Büken4, Ferhan Kandemir1

1Duzce University, Faculty of Medicine, Forensic Medicine Department, Duzce, Turkey

2Abant Izzet Baysal University, Faculty of Medicine, Forensic Medicine Department, Bolu, Turkey

3Ministry of Justice, Council of Forensic Medicine, Istanbul, Turkey

4Baskent University, Faculty of Medicine, Forensic Medicine Department, Ankara, Turkey

Background: The study is aimed to analyze the properties of elderly cases whose autopsies were performed, and to discuss the precautions for preventing such deaths.

Material-methods: Autopsy reports between 2005–2008 of Morgue Specialization Department of Council of Forensic Medicine, were investigated retrospectively. Characteristics of 65-year-old or older cases were analyzed.

Results: Out of 1715 cases in total, 537 (31.31 %) were female, 1178 (68.69 %) were male. The overall mean age was 74.32 ± 6.57 SD (min: 62, max: 99, median: 74). Among 1715 cases, 1505 (87.75 %) cases [451 (29.97 %) of which were female] were included in the study, because their death causes could be determined. In 977 (64.92 %) cases (n:302, 30.91 % female), death resulted from non-natural causes. According to the genders, there was not a significant difference between natural and non-natural deaths (p > 0.05).

In the group of non-natural deaths, the most frequently seen death causes in females include general body trauma (GBT) (n:160, 52.98 %), hanging (n:29, 9.60 %), carbon monoxide poisoning (n:27, 8.94 %); whereas those in males were GBT (n:341, 50.52 %), firearm injuries (n:66, 9.78 %), and hanging (n:65, 9.63 %). In non-natural deaths, out-of-house deaths in males (n:246, 36.44 %) and house deaths in females (n:99, 32.78 %) were the most frequently seen location of death. There was a significant difference between the locations of death according to the genders (p < 0.001). When the non-natural deaths were evaluated according to the origin; 587 (60.08 %) cases were accidental (n:182, 31.01 % female), 189 (19.34 %) cases were suicidal (n:57, 30.16 % female), 89 (9.11 %) cases were homicidal (n:24–26.97 % female). The origins of 112 (11.46 %) cases (n:39, 34.82 % female) could not be determined. The analysis of accidental cases showed that 360 (36.85 %) cases (n:96, 26.67 % female) were traffic accidents, 161 (16.48 %) cases (n:68, 42.24 % female) were home accidents, 8 (0.82 %) cases (n:4, 50.00 %) include falling down on the street, 7 (0.72 %) cases (n:1–14, 29 % female) were work accidents, whilst 51 (5.22 %) cases (n:13, 25.49 % female) were the other accidents. There was not a significant difference between origins, when compared with respect to genders. (p > 0.05).

In 528 (35.08 %) cases (n:149, 28.22 % female), death was natural. Cardiovascular diseases were the most frequently seen ones in both genders (n:287, 75.73 % male, n:101, 67.79 % female) followed by pneumonia (n:37, 9.76 %) and cancer (n:23, 6.07 %) in males whereas cerebral hemorrhage (n:23, 15.44 %) and pneumonia (n:15, 10.07 %) in females.

Conclusion:Precautions to prevent the elderly from traumas especially from accidents, as well as education programs can be useful for decreasing the rate of accidental deaths whilst the support for care at home of elderly can be considered to decrease deaths at home.


Lethal Outcome Sepsis as a Complication of Amniocentesis: Two Case Reports

Zerrin Erkol 1, Mustafa Balkay2, Ibrahim Üzün2, Mehmet Özbay2

1Abant Izzet Baysal University, Faculty of Medicine, Forensic Medicine Department, Bolu, Turkey

2Ministry of Justice, Council of Forensic Medicine, Istanbul, Turkey

Background: Amniocentesis is a method used in diagnosis of chromosomal abnormalities and fetal infections, in which a sample of amniotic fluid is taken from the amnion during the 15th and 20th week of pregnancy. This procedure has risk for developing some complications. Lethal outcome sepsis can be seen rarely. In the study, two amniocentesis cases were presented in which both fetus and mother have died due to sepsis and amniocentesis’ complications were reviewed.

Case-1: Because 1/200 risk for Down Syndrome was detected on screening tests, amniocentesis procedure applied to the 29-year-old woman, who has 18,4 weeks pregnancy. Two days after, she came back to the hospital due to complaints of pain, nausea, vomiting, high fever. She was hospitalized with the diagnosis of “Chorioamnionitis and intrauterine exitus of fetus”. Her fever was 40°C, blood pressure: 90/60 mmHg, pulse: 96/min, leukocyte:10100, thrombocyte:172000. Blood control values were as follows: leukocyte:1980, thrombocyte:57000. She was transported to the another hospital for the treatment of sepsis. Unfortunately, disseminated intravascular coagulopathy developed at this hospital at the same day. Defibrillation applied two times for cardiac arrest. Despite this, she died at 20.15 o’clock at the same day, two days after from amniocentesis.

Olgu 2: Two times amniocentesis procedure applied to the 20-year-old woman by one day interval, who has 18 weeks pregnancy, because increased risk was detected on ternary screening tests. After two days, she came back to the hospital due to disturbance of general condition, high fever, respiratory distress. She hospitalized by the diagnosis of “septic shock and multiple organ failure”. Fetus was taken out from uterus and the cavum was controlled by curettage. Mechanic ventilation support was began two days after because of respiratory insufficiency. In the following days, her theraphy was continued in intensive care unit. After 27 days from amniocentesis, cardiac arrest developed. Although cardiopulmonary resuscitation and defibrillation application, she died at the same day.

Both of the cases’ medical documents were investigated in the First Specialty Board of Council of Forensic Medicine, it was decided that death cause was sepsis and it’s complications.

Conclusion: Although all of the modern progresses in medicine, amniocentesis is still a difficult medical procedure which is carrying risks for certain serious complications such as fetal and maternal mortality.


Mini-Mental State Examination Implementations for Civil Responsibility Evaluation

Gurol Canturk, Ayten Doyuk, Nevriye Temel, Ibrahim Acungil, Aynur Inan

Depatrment of Forensic Medicine, Ankara University, School of Medicine, Ankara, Turkey

Background: Law gives certain rights and authorities to individuals. These are issues in daily life like the freedom to act (like the marriage); to own, to use, to benefit from, to transport to keep or to refuse something, to do or let someone do something, and to become indebted or creditor to someone. Civil responsibility indicates the ability to be holder of a right or to become indebted to someone. Civil responsibility is defined in the civil law. Courts are sent persons to the expert witnesses to determine that they have civil responsibilities or not. The mini–mental state examination (MMSE) or Folstein test is a brief 30-point questionnaire test that is used to screen for cognitive impairment.

Method: We aimed, civil responsibility cases admitted to Forensic Medicine Department and official reports which were prepared after the obligatory examinations were analyzed with the assistance of Mini-Mental State Examinations. In this study about cases with civil responsibility referred to Forensic Medicine Department of Ankara University Hospital (Ankara, Turkey), which evaluated 30 cases for the purposes of socio-demographical characteristics and medical diagnosis between January 1, 2011 and March 15, 2012 were reviewed.

Results: Cases which performed Mini-Mental state examination after evaluated court file and signs of examinations it is purposed to investigate and discuss related with civil responsibility consent.

Conclusion: Mini-Mental state examination can provide support for complete evaluation of civil responsibility cases.


Analysis of pediatric forensic cases who appealed to the emergency service

Tanzer Korkmaz 1, Nurettin Kahramansoy2, Zerrin Erkol3

1Abant Izzet Baysal University, Faculty of Medicine, Emergency Medicine Department, Bolu, Turkey

2Abant Izzet Baysal University, Faculty of Medicine, General Surgery Department, Bolu, Turkey

3Abant Izzet Baysal University, Faculty of Medicine, Forensic Medicine Department, Bolu, Turkey

Background: In the study, it was aimed to determine the profile of the pediatric forensic cases who applied to the emergency service and to analyze the relationship with pediatric age groups.

Material-methods: Forensic reports and medical documents of the pediatric cases who had appealed to the emergency service of Abant Izzet Baysal University Research and Application Center between 01.01.2008-31.12.2009 were analyzed retrospectively. Statistical analysis were performed by using chi squared and One way-Anova tests.

Results: Total 1317 cases had appealed to the emergency service and 20,6 % (n:271) of them were pediatric cases. Of the cases, 62.0 % (n:168) were male and the mean age was 10.51 ± 5.71. Most frequently seen age group and month were 15–18 and August respectively. Type of forensic events were motor vehicle crash (55.4 %) (47.2 % intra-vehicle and 8.2 % extra-vehicle), falls (15.9 %), stab injuries (11.4 %), intoxication (4.4 %), beating/blunt trauma (4.1 %), the others (8.1 %). Forensic incidents were reported to occur mostly during daytime (12:00–18:00). Arrival time to hospital was 74.68 ± 92.54 min. (between 10–555 min.) in average and staying time in emergency service was 1–4 hours (42.8 %). There wasn’t statistically meaningful difference between age groups and arrival time to hospital, and staying time in emergency service (respectively p = 0.149, p = 0.958). Head-neck (44.7 %), lower extremity (78.7 %), trunk (80.5) injuries were most frequently seen regions in traffic accidents whereas upper extremity injuries were most frequently seen in stab injuries (33.7 %). Head-neck region injuries were significantly high in 15–18 age group (p = 0.039). There wasn’t meaningful relationship between lower extremity (p = 0.116), upper extremity (p = 0.901), trunk (p = 0.337) injuries and age groups. Last diagnosis were soft tissue injury (52.8 %), epidermal-dermal incision (26.6 %), bone fracture (19.2 %), tendon incision (6.3 %), hemo- pneumothorax or intracranial hemorrhage (3.3 %). All of the cases, 16.2 % have been sent from another health center to the our service. Discharging rate from the emergency service was 65.7 % and hospitalization rate was 28.8 %. The remainder cases were sent to the other hospitals or died in the emergency service.

Conclusion: Pediatric age group injuries mostly occurred as intra-vehicle traffic accident (47.2 %). Therefore, this type of injuries is preventable. Giving education to the parents and children about pediatric home accidents, intoxications and how to prevent them will be useful for prevent such events.


Aggressions perpetrated by siblings. A study in the North of Portugal

Rita Figueiredo1, Cristina Silveira Ribeiro1, Cristina Silveira Ribeiro2,3, Teresa Magalhães 1,2,3,4

1Faculty of Medicine of the University of Porto, Porto, Portugal

2National Institute of Legal Medicine - North Branch, Porto, Portugal

3Forensic Sciences Center - CENCIFOR, Portugal

4Biomedical Sciences Institute Abel Salazar of the University of Porto, Porto, Portugal

Background: egative sibling interactions in conjunction with poor parenting practices during middle childhood predict social and psychological adjustment problems like psychopathology, poor peer relations, academic difficulties, engagement in antisocial behaviors and number of law violations and arrests through adolescence and young adulthood. Thus, the general aim of this study is to provide more information about non-fatal violence between siblings in Portugal, stressing the need to create public policies in order to draw the attention to this particular type of intra-familial violence and to prevent it.

Method: A retrospective study was conducted based on the analysis of forensic reports, regarding the following inclusion criteria (n = 1594): victims of alleged physical offense; perpetrated by a sibling; observed at the north forensic services of the National Institute of Legal Medicine (Portugal); between 2006 and 2010.

Results: Results allowed us to draw the following: (1) Aggressions perpetrated by siblings represent 14 % of the domestic violence cases and 2 % of the offenses against physical integrity cases reported to the forensic services in the north of Portugal, but the real number may be masked by underreport; (2) This represents a cross-sectional problem that affects people of all ages (min = 1; max = 81; mean = 40.56); (3) Most of the victims were females (62 %) and aggressors were males (73 %); (4) Alleged perpetrators presented at least one risk factor in 21 % of the cases; (5) Physical violence was the most frequent offense – 91 % blunt trauma; (6) Injuries were present in 85 % of the cases (mild injuries in 95 %), mostly at the upper limbs (56 %) and face (44 %); (7) Victims search medical in 66 % of cases; (8) Mean time for injuries’ heal was 9.06 days; (9) Mean time of absence from work was 4.35 days; (10) Injuries represented danger to the victim´s life in 0.3 % of cases; (11) In 7 % of the cases there were permanent consequences: 78 % aesthetic, 17 % orthodontic, 7 % orthopedic, 5 % neurologic and 1 % psychological; (12) More violent aggressions were significantly associated with male victims, male aggressors and with brother-brother dyads (p < 0.05).

Conclusion: Future research is needed for a better understanding regarding this phenomenon, namely prospective studies. Nevertheless, this study represents a step forward in addressing questions about a phenomenon that has not been much researched, until now, in Portugal.


Matricide and chronic mental illness: a case report

Simona Damian1, Gabriela Elena Chele2, Beatrice Gabriela Ioan 1

1Department of Legal Medicine, Medical Deontology and Bioethics, "Gr.T.Popa" University of Medicine and Pharmacy, Iasi, Romania

2Department of Psychiatry, "Gr.T.Popa" University of Medicine and Pharmacy, Iasi, Romania

Background: A review of literature indicates that chronic mental illness or lack of appropriate treatment for individuals with a psychiatric history are significant risk factors that are associated with matricide. As a particularity, the murder is usually committed in the victim’s house.

Method: In this paper the authors present a case of matricide committed by a mentally ill young man, alongside the review of relevant literature.

Following a contradictory discussion, X.Y., boy, 17 years old, killed his mother and grandmother by multiple stabbing and strangulation by hand. During the police investigation X.Y. underwent a medico-legal psychiatric examination which revealed many particular aspects of the case.

Results: X.Y. showed behavioral disturbances since he was 4 years old. Later he was diagnosed with paranoid schizophrenia according to ICD-10 and DSM IV-TR diagnostic criteria. The evolution of the disease was chronic with numerous admissions to the psychiatric hospital. His mother always wanted to protect him, tried to hide his condition and did not acknowledge the seriousness and severity of his chronic mental illness.

Studies have shown an association between homicidal behavior and psychiatric disorders although it is difficult to conclude that a clear causal relationship exists between specific chronic mental illnesses and particular types of homicide. In some cases there are certain early warning signs, such as a recent disorganization of behavior or a significant degradation of a preexisting psychotic illness. According to the police investigation, X.Y. committed many previous assaults against the members of his family. He committed the double murder on the background of the loss of self control and impaired judgment, which played a major role in the outcome of events.

Conclusions: According to the results of the medico-legal examination, we assume that this tragedy could have been predicted. An adequate family conduct and climate added to additional therapies might have prevented X.Y. criminal outburst. The ambivalent relationship that might exist between the schizophrenics and their mothers suggests the need for an adequate clinical intervention in the families in order to resolve the psychological tension which might become the provoking stimulus for committing murder.


Evaluation of forensic cases in emergency service, Mustafa Kemal University Hospital of Medical Faculty

Cem Zeren 1, Ali Karakuş2, Adnan Çelikel1, Koca Çalışkan2, Akın Aydoğan3, Ramazan Karanfil4, Murat Çelik5

1Mustafa Kemal University Medical Faculty Department of Forensic Medicine

2Mustafa Kemal University Medical Faculty, Department of Emergency

3Mustafa Kemal University Medical Faculty, Department of General Surgery

4Kahramanmaraş Sutcu İmam University Medical Faculty Department of Forensic Medicine

5Mustafa Kemal University Medical Faculty Department of İnternal Medicine

Recording and reporting the findings of trauma patients admitted to emergency departments, is among important responsibilities of physicians. In this study. İt is aimed to draw attention to the importance of the forensic reporting about trauma patients issued by emergency physicians. Records of forensic cases admitted to Emergency Department of Hospital of Medical School of Mustafa Kemal University, between January 2008 and October 2011 were retrospectively investigated.

There was 843 forensic cases in the study period. Of these, 581 (68.9 %) were male and 262 (31.1 %) were female. Their ages ranged between 1 and 121 years. The most frequent cause of admission was traffic accidents (40.1 %), followed by intoxications (16.7 %). Most of forensic cases were concentrated during summer months, especially in August. Preparing forensic reports accounts for a workload for physicians working in emergency departments.. Besides providing emergent medical interventions, they are obliged to fulfill the legal responsibilities of preparing a complete forensic report.


McArdle Disease and Trauma: A Case Report

Kenan Karbeyaz 1, Serdar Özdil2, Sait Özsoy3, Süheyla F. Aliustaoğlu4, Harun Akkaya5

1Council of Forensic Medicine, Branch Office, Eskişehir, Turkey.

2Council of Forensic Medicine, 3rd Specialty Board, Istanbul, Turkey.

3Ankara Gülhane Military Academy(GATA) Forensic Science Department, Ankara, Turkey

4Council of Forensic Medicine, 4th Specialty Board, Istanbul, Turkey

5Council of Forensic Medicine, 2nd Specialty Board, Istanbul, Turkey

Introduction: Forensic traumatology, includes a wide range from simple abrasions up to fatal wounds. The people who have systemic, inherited or acquired diseases, when exposed even to a mild trauma can result to severe consequences. In this case, the person having a disease, injured by a simple trauma concluding to a serious result, will be evaluated by forensic medical point of view.

Case: 19 year old male patient, was discharged from hospital after diagnosing no other findings but superficial abrasions on his right knee. The case 5 hours after being released from the hospital returned with abdominal pain, nausea and vomiting. The result of the examination and tests such as BUN, Cr, CKMB and CK values were very high. After diagnosing rhabdomyolisis and acute renal failure, he had hospitalized in Nephrology Clinic. By the deterioration of the overall situation and elevation in laboratory findings, he had received dialysis treatment. His general condition improved after dialysis and medication. In his story he told; he couldn't remove heavy objects since he was younger, getting tired fast and muscles toughened when making sports. After research; Carnitine Palmitoiltransferase enzyme deficiency and muscle biopsy findings were defined compatible with glycogen storage disease type 5(Mc Ardtle).

Conclusion: Our case, was a McArdtle disease patient which had gone into acute renal faiulure, by the insuficiency of Carnitine palmitoiltransferase enzyme after overdose destruction of muscles. In normal conditions the wounds which can be cured by simple dressing, affect people having these kinds of disorders, ending up to deathly results. Similarly, cases were known resulted by death, like hemophilia patients, or patients having large cysts in visceral organs. The awareness of the attacker, of the victim's disease should not be counted as an excuse.


Incidence of Firearm Injuries in Upper Egypt

Hala Ahmed Kashila, Saly Yahia Abd El Hamid, Amal Ali Mohamed, Rdaa Farouk Mikhael

Background: Firearm injuries are very common nowadays. They may result from criminal, accidental discharge or suicidal attempt. Firearm is fast becoming a major killing apparatus. The invention of firearm has come as a curse to this world; it has become the most dreaded killing tool used by human being to kill themselves. The frequency of firearm related deaths appear to be higher in nations where firearms are more readily available, either legally or illegally.

Objectives: A study was conducted on the firearm injured cases collected from medico legal files of the Medico legal Department, Ministry of Justice and comparing the incidence of its fatalities in different Upper Egypt Governorates and analyzing data from one of them according to different items.

Material & methods: Firearm injuries cases were selected from archive files of cases examined by Medico legal Departments, Ministry of Justice in Assiut and different Egyptian Governorates in Upper Egypt (Sohage, Qena and Aswan). The cases were analyzed for evaluation of seasonal variation and distribution among cities. The cases collected from medico legal files of the Medico legal Department, Ministry of Justice in Assiut Governorate were analyzed for age and sex of the victims, site and direction of injuries. In addition to the value of examination of clothes and type of weapon used. All data subsequently underwent descriptive statistical analysis using SPSS program version II.

Results: The summer season represent the highest season of firearm injuries followed by spring. the highest percentage of injuries belong to male victims in 4th decade. Head was most common target for inference followed by chest (31.25 % and 21.43 %) and the anterior-posterior direction was common (24.11 %). Examination of clothes was of value in 63.40 % of cases and about 59.82 % of cases forensic doctors couldn’t determine the type of weapon.

Conclusions: In spite of legal restrictions on the illegal access of firearms, access is easy and deaths by firearm wounding are still increasing. Recommendations: Strong and effective measure to control the unlicensed arms. Using modern techniques in crime scene investigation. Educate medical personnel in emergency department about importance of clothes in firearm cases.


Non-fatal self-inflicted injuries - The relevance of its characterization in forensic evaluations

Lino Aranda Assunção 1,2,3, Dina Almeida1,3, Fernanda Rodrigues1,3,4, Teresa Magalhães1,2,3,4

1National Institute of Legal Medicine and Forensic Sciences, North Branch, Porto, Portugal

2Faculty of Medicine of Porto University, Portugal

3Forensic Sciences Center - CENCIFOR, Portugal

4Biomedical Sciences Institute Abel Salazar of Porto University, Portugal

Background: In Portugal, after a given victim suffers an assault and presents a police complaint, he or she is submitted to a forensic evaluation at the National Institute of Legal Medicine and Forensic Sciences (INMLCF). The goal is to provide the court information concerning the injuries resulting from the offense, the plausibility between the described trauma mechanism and the findings, as well as the consequences that arouse or are expected to arise from the offense. Of all the issues to be considered and discussed in the forensic expert’s report, one of the most complex may often be the compatibility between the victim’s description of trauma and the injuries observed during the medical examination, namely the differential diagnosis with self-inflicted injuries (generally with simulation purposes).

Methods: Cases from the North Branch of the INMLCF were selected (n = 13), where the injuries presented were considered by the forensic medical doctor as self-inflicted or (highly) suggestive of such, between 2009 and 2011.

Results: The cases studied represent 0.07 % of the total of alleged assaults in the same time period (n = 18586). In such cases, often the consistency between the victim’s information and the injuries observed lacks, not only because the trauma mechanism may not be the one described, but also because the injuries’ specific characteristics can lead to the hypothesis of self-infliction, commonly using some sort of a sharp object. The characteristics associated with self-inflicted injuries are well known in literature and include the following: lesions located in an accessible anatomical region, shallow lesions in the non-dominant side of the body, parallel lesions, among others. Also in common is a background of mental disorder or some perspective of gain (e.g. in one of the cases the victim had been robbed and some injuries were added to increase the visual impact).

Conclusion: Even though the diagnosis may be virtually immediate and intuitive on first looking at the victim, such perception is hardly of any use in a legal context, where a reasoned opinion is demanded. A structured argument has to be made and thus previous medical records and photographs of the lesions are of paramount importance to document and ground the observation before a Judge. Moreover, a psychological assessment may also be in order in some of these cases and its relevance must also be pointed out to the Judge.


The Evaluation of Casualty Relation Between Trauma and Clinical Statements Developed by Myocardial Ischemia as a Consequence of Post-trauma

Ümit Naci Gündoğmuş1, Haldun Kanat 2, Harun Akkaya1, Kenan Karbeyaz3, Süheyla F. Aliustaoğlu4, C. Haluk İnce5

1Council of Forensic Medicine, 2nd Speciality Board, Istanbul, Turkey

2Council of Forensic Medicine, Istanbul, Turkey.

3Council of Forensic Medicine, Branch Office, Eskişehir, Turkey

4Council of Forensic Medicine, 4th Speciality Board, Istanbul, Turkey

5President of Council of Forensic Medicine, Istanbul, Turkey

Coronary artery disease may be in existence for many long years without any symptoms. The development of cardiac vascular system diseases without any symptoms was accepted to accelerate in relation with the external factors like effort, stress by all scientific environments. In this point of view, in a person exposed to unwanted external factors, clinical statements resulted dramatically bounded with coronary artery disease without any symptoms, might be seen. This situation brings the necessity of ambidextrous evaluations for both victim and defendant. To establish the casualty relation between the traumatic influence and clinical statement is the most important stage. The time period of establishing the casualty relation between the traumatic influence and clinical statement, the character of trauma and clinical statement, symptoms determined by supportive diagnosis, whether the person before the case has coronary artery disease or other cardiac problems or not were evaluated all together and medical opinions were held as well.

Between 2006–2010, in 5 years time period, the cases which 2nd Forensic Medicine Specialization Board asked to submit their opinion about the people exposed to a traumatic deed and then after showed cardiac pathological symptoms analyzed retrospectively in this study. Totally 26 cases determined in supposed period. All cases consist of men and the average age is 55.8. Cases examined with the character of injury, the time period between trauma and cardiac pathologic symptoms, clinical statement, visualization, laboratory input and opinion of medical consultant by taking the literature into consideration.


Stab Wound Caused Winged Scapula: A Case Report

Ümit N. Gündoğmuş1, Harun Akkaya 1, Mehmet Ali Selçuk1, Erdem Hösükler2, Muhammet Demir2, İbrahim Tuncay3

1Council of Forensic Medicine, 2nd Speciality Board, Istanbul, Turkey

2Council of Forensic Medicine, Istanbul, Turkey

3Bezm-i Alem Vakıf Gureba Hospital, Istanbul Turkey

Introduction: There are many causes of winged scapula as well as a result of traumatic, idiopathic and iatrogenic injury, it is characterised by at least one of the paralysed muscles of serratus anterior, trapezius or rhomboid causing the edge of scapula medial diverging from the chest wall. Our case developed winged scapula caused by nerve injury during a fight, injured by cutlery from the left side of the neck and left back side of the chest wall and the case will be evaluated by becuase it is rarely encountered in forensic medicine.

Case: 38 years old male, taken to emergency service of the hospital after he was stab wounded during a fight; under the left scapula on 6th intercostal space, thorax preponderant cut, under the left earlap cuts caused skin-underskin muscle hematomas and cuts in mandible and slight cuts on right hand was described. Left pneumothorax observed in graphies, tube thoracostomy placed and the patient discharged from the hospital after lung expansion. One month later after the incident, the patient suffered from shoulder pain and diagnosed by scapula lata in the hospital. In his examination in our Board, 3 cm under the left earlap, under left scapula nearly on 6th intercostal space, on the left earlobe, on the left mandible, on the second finger proximal of right hand scars observed. Permanent neurologic deficit not detected in the neurologic examination.

Orthopedics examination revealed scapula lata on the left scapula, left shoulder abduction 80–85 degrees restricted, during abduction of left shoulder the inner and external rotations were limited. The most important symptom of the physical examination observed when the patient trying to push the wall with his two hands the scapula coming up at his back. Our Board diagnosed it as winged scapula and its casually connected with stab wound.

Conclusion: “The life-threatening condition" was reported due to pneumothorax in juridicial report. “Winged scapula” constitutes the sequela of stab wound, established by us after the examination. In juridical reports, collateral damages and sequelas as a result of the crime, should also be evaluated beside the main damages. Furthermore, the juridical reports should be prepared after physical examination by experts rather than preparing reports by taking only dossier into consideration.


Dental damage in Penal Law. A 7 year long analysis

Goncalo Castanheira 1, Carolina Verçosa2, Ana Teresa Corte Real3, Rosário Silva1, Graça Santos Costa1, Francisco Corte Real3, Duarte Nuno Vieira1

1National Institute of Legal Medicine – Centre Branch, Portugal (INML,IP)

2University of São Paulo, Brazil – Faculty of Odontology (FOUSP)

3University of Coimbra, Portugal – Faculty of Medicine (FMUC)

Crimes against physical integrity are contemplated within the 3rd chapter, 1st title of the Second Book of the Portuguese Penal Code, of which we point out the articles 143rd (simple bodily harm) and 144th (serious bodily harm).

The penalty for a bodily harm offence is determined by the Judge, after reading the description of the sequels reported by a medical expert, hence the great importance of a rigorous and extensive report, in order to minimize the damage towards the victim.

Within the last few years, dental damage has often been referred to as a secondary element amongst other types of bodily harm, since a tendency exists to minimize the severity of this kind of injury, not accrediting it´s real importance.

The authors hereby present a Criminal Law retrospective study of all body-damage evaluation exams, conducted between the years of 2005 and 2011, of which 141 (1.31 %) of them were related to victims who had suffered dental damage.

Several variables were characterized in order to establish the victims’ profiles, circumstances of the occurrence, temporary damage and resulting sequels.

There has been a slight increase in the number of victims who suffered dental damage, most of them pertaining to male individuals aged between 19 and 30 years of age. All of these lesions were caused by a blunt trauma, with dental fractures as the most frequent type of injury. These lesions led to all of the victims having to take sick days of, having affected the working capacity in 109 cases. Only 25 victims were left with sequels, one of which was considered serious bodily harm.

Given the complexity of the dental system, specific knowledge is required, becoming essential for the understanding and accurate assessment of dental damage.

Due to the ease with which the face can get struck by traumas, the occurrence of dental lesions is frequent. In spite of it, the majority of the cases studied did not result in permanent damage.

Even though this kind of injury is less significant when compared to other sensory and motor lesions, it must not be underestimated or undervalued.

Forensic Medicine is faced with increasingly complex demands regarding probative scientific activity, being responsible not only for the diagnosis of the cases but also for contributing to the eradication of this type of violence, by providing evidence to the enforcement of Justice.


Alleged sexual offenses. An audit to the forensic reports in the north of Portugal

Fernanda Rodrigues 1, Duarte Nuno Vieira1, Teresa Magalhães1, Fernanda Rodrigues 2, Duarte Nuno Vieira4, Teresa Magalhães3

1National Institute of Legal Medicine and Forensic Sciences – Portugal

2Biomedical Sciences Institute “Abel Salazar”, University of Porto – Portugal

3Faculty of Medicine, University of Porto – Portugal

4Faculty of Medicine, University of Coimbra - Portugal

Background: The National Institute of Legal Medicine and Forensic Sciences (NILMFS) of Portugal has a formal competence to guarantee quality standards of forensic expertise, in order to perform a skilled intervention and the legal validity of the proof. Quality standards are assessed through regular internal audits to the forensic reports. This system allows monitoring reports’ quality, identifying weaknesses and strengths, to support NILMFC strategies in this area. The aim of this study is to analyse the relevance of reports’ audits regarding alleged sexual offenses (SO).

Material and methods: An audit form was created for quality control of reports regarding sexual physical evaluation. It includes 9 items: (1) turnaround time (gap between the dates of exam and conclusion of the report) and data encompassed by the report: (2) history of case (3) documentation data; (4) personal and familial antecedents; (5) complaints; (6) physical examination; (7) ancillary exams; (8) discussion; (9) conclusions. Each of these items is classified according to the following score of points (pts): -1, 1, 2 and 3. These values were added and led to a final score which classifies the quality level of the forensic report (QL) as: very good - grade 3 (24 to 27 pts); relevant - grade 2 (18 to 23 pts); adequate - grade 1 (10 to 17 pts); inadequate - grade −1 (−9 to 9 pts). In the present study, 376 audit forms related to SO, performed between 2009 and 2011 at the 9 north departments of the NILMFC, were analyzed – 63.6 % of the reports (n = 591). Peer review of each report was performed by a four forensic experts’ team.

Main results: The final scores achieved in the audits of forensic reports of alleged sexual offenses, allow an analysis in order to assess their progressive uniformity, harmonization and approaching to NILMFS standards. We can compare the evolution in this field, along 2009, 2010 and 2011, among the different forensic offices in the north of Portugal.

Conclusions: We believe this model of auditing reports of SO physical evaluation is a powerful tool, not only to improve the quality of medico-legal reports but also to promote the harmonization of this activity, leading to a best support to the court decisions. It may serve as a model for other Clinical Forensic Medicine Services, particularly those with residency training programs. Audit form criteria development could be a possible mean to improve Quality standards.


Characteristics of Geriatric Forensic Cases who Applied to the Emergency Service

Tanzer Korkmaz 1, Nurettin Kahramansoy2, Zerrin Erkol3

1Abant Izzet Baysal University, Faculty of Medicine, Emergency Medicine Department, Bolu, Turkey

2Abant Izzet Baysal University, Faculty of Medicine, General Surgery Department, Bolu, Turkey

3Abant Izzet Baysal University, Faculty of Medicine, Forensic Medicine Department, Bolu, Turkey

Background: In this study, it was aimed to evaluate the demographical properties and events’ characteristics of the geriatric forensic cases who applied to the emergency service.

Material-methods: Data of 65-year-old or older forensic cases who applied to the Emergency Department of Abant Izzet Baysal University Research and Application Center between 01.01.2008-31.12.2009 were evaluated retrospectively from their medical documents and forensic reports.

Results: Of total 986 adult forensic cases, 75 (7.6 %) were geriatric. Among them 42.7 % were female, 57.3 % were male. The ages were between 65–94. Average age was 72.4 ± 6.4 whereas 75 ± 7.4 in females and 70.2 ± 4.4 in males. Incidents were most frequently occurred in June and in the summer. Type of the forensic events were motor vehicle crash in 40.0 % (33.3 % intra-vehicle and 6.7 % extra-vehicle), falls in 32.0 %, others in 18.0 % (stab injuries in 5 cases, intoxication in 4 cases, pounding in 3 cases, burns in 3 cases whereas firearm injuries, occupational accident, kicking by an animal in 1 case each other. The case was brought to the hospital in 79.6 ± 92.8 min. (between 10–360 min.) in average and by ambulance (77.3 %). The most often staying time in the emergency service was 4 hours (53.3 %). Events mostly occurred between 12:00–18:00 o’clock, however most often discharging time is between 18:00–24:00. There wasn’t meaningful difference between the type of the event and staying time in the emergency service for along four hours or more (p = 0.285). The cases of motor vehicle crash were arrived to the hospital (43.3 ± 40.3 min.) earlier than the cases taking place in the group of others (132.9 ± 143.9 min.) (p = 0.024). Head-neck (56.7 %) (p = 0.094), lower extremity ((20.7 %), trunk ((46.7 %)(p = 0.005) were most frequently seen injured regions in motor vehicle crash, but there wasn’t meaningful relationship between them and type of the event. Upper extremity injuries were most frequently seen (55.6 %) in the cases taking place in the group of others (p = 0.0001). The majority of the injuries were soft tissue injuries (40.0 %), bone fractures (30.7 %). Soft tissue injuries were more seen in motor vehicle crash than the other type of incidents (p = 0.0001). Orthopedic consultation was required for 48.0 % of the cases and 14.7 % of them hospitalized in the Orthopedic Department. The discharge rate from the emergency service was 46.7 %.

Conclusion: Precautions to prevent the geriatric people from traumas especially from traffic and home accidents, giving information about using drugs and intoxications may be useful for reducing risks of such events to occur.


Non-fatal occupational accidents in the Lisbon Area: victims and circumstances

Jorge Costa Santos, Ana Cabrita

National Institute of Legal Medicine and Forensic Sciences of Portugal, South Branch, Faculty of Medicine, University of Lisbon, Portugal, Cencifor, Centre of Forensic Sciences, Portugal

Background: Occupational accidents have an enormous impact on the national economy and health of the workers. In Portugal, more than 240,000 employees are injured or killed in workplace accidents each year, with more than 7,000,000 days off, according to the official statistics. The Law nº 98/2009 defines occupational accident as a sudden and unexpected event suffered by an individual at the workplace or during working hours, performing work related tasks and/or during work related transportation. The aim of this study is to characterize a population of victims of occupational accidents occurred in the Lisbon jurisdiction in the first semester of 2010.

Methods: The data was collected from 484 medico-legal files of the South Branch of the National Institute of Legal Medicine and Forensic Sciences, where, under the Portuguese law, the vast majority of the survival victims of this kind of accidents are examined by specialists in Legal Medicine. The data include either medico-legal examination reports, all the information related to accident circumstances and subsequent medical intervention (treatment and rehabilitation). The information was reviewed for general socio-demographic characteristics as well as accident temporary and permanent consequences to the victims.

Results: About 59 % of those were males and more than a half of the total was between 21 and 50 years old. The majority of the injured people were related to employees in the tertiary sector of activities (61 %) who had been victims of accidental falls (35 %). The main injuries were related to fractures and sprains of the limbs (65 %). The time average of treatment was 301 days (from a minimum of 1 to a maximum of 1621 days, with a SD = 216). Among those who had suffered a permanent damage, the vast majority of this (89 %) was related to the locomotion apparatus. Impairment of the victims to their work was differentially evaluated by insurance experts and the official ones (average: 4.41 vs 7.37).

Conclusions: As expected, the majority of the injured people were related to the tertiary sector of activities, however most of these accidents were related to failure to comply with the safety rules in work which are fixed by law. These findings claim for a better regulatory framework of the work conditions with a stricter monitoring by legal authorities and more severe penalties for the employers. Otherwise, official medico-legal evaluation of damage shows to be more fare for victims’ compensation than the evaluation done for insurance companies.


Elder abuse. A preliminary forensic approach

Sofia Lalanda Frazão 1,2,3, Teresa Magalhães1,2,3,4

1National Institute of Legal Medicine – North Branch, Portugal

2Forensic Science Center – CENCIFOR, Portugal

3Biomedical Sciences Institute Abel Salazar, University of Porto, Portugal

4Faculty of Medicine, University of Porto, Portugal

Introduction: The idea that elder abuse should be considered as a disease is starting to arouse between the health community, but there is still a lack of information in detecting and diagnosing these cases and identifying risk factors. The cases reported to the clinical forensic services, which are physically evaluated, represent only a few of the real number, but their analysis can bring us important knowledge about this problem.

Objectives: Since there are few studies in Portugal concerning this issue, the general aim of the present study is to contribute to a better characterization of elder abuse in this country. This will allow an early detection and diagnosis of this kind of abuse, namely by the health care professionals, as well as a better orientation for the implementation of prevention strategies

Material and methods: This study included alleged victims of intra-familial abuse, more than 64 years old, observed at the North Branch of the National Institute of Legal Medicine in 2010 (n = 272). Data was analyzed using software SPSS 17.0.

Results: Elder abuse corresponds to 4.3 % of all types of abuses reported in that area and year.

The majority of the victims were women (71.3 %), retired (84.9 %), married (65.8 %), in a relationship with the alleged offender (54.1 %) and with an average of 72.24 years old. The alleged offenders were mostly males (78.3 %) with an average of 53.7 years. In 21 % of the cases the abuse was recurrent and in 10.3 % occurred for more than 35 years. Most of the reported cases were related with physical abuse (93.4 %) and consisted in kicking, slapping, punching and pushing (68 %). The limbs (23.9 %) and the head/face/neck (23.2 %) were the main locations of aggression. Only half attended the health services (57 %) and there was need to suture the skin in 8.8 %. In 30.2 % of the cases there were no injuries; in the other cases, mostly were mild injuries and only in one case a bone fracture was diagnosed. The elapsed time since the last abuse and the forensic evaluation was superior to 8 days in 12.9 % of the cases.

Discussion and conclusions: Even without any serious physical injuries, this kind of violence can represent a relevant physical and mental health problem with socio-familial and financial consequences, which must be considered in future studies.


Evaluation of Some Cephalometric Parameters in 4- to 11-Year-Old Boys of Kurmanj Ethnic Origin (North Khorasan, Iran)

Mahdi Esmaeilzadeh, Zahra Ganj Bakhsh

Department of Basic Science, University of Bojnourd

Statement of problem: Anthropometry is applied in medical profession such as forensic medicine, maxillofacial surgery, plastic surgery, bioengineering and non-medical branches such as like respiratory equipment and eye-glasses industries.

Aim: The aim of this study was to determine cephalo-facial anthropometric ratios and assessment of cephalo-facial development in 4- to 11-year-old boys of Iranian Kurmanj population.

Materials-methods: This cross sectional analytical study was conducted randomly on 564 boys from North Khorasan (Shirvan), with normal face patterns. Cephalo-facial ratios were estimated and compared. The regression line and the growth coefficient was determined for each Parameter. Finally, the mean values of these parameters were determined. Data were analyzed by SPSS software. Pared t-test were used for statistic analysis.

Results: Anthropometric results obtained from 4 to 11-year-old Kurmanj boys residing in the city of Shirvan show that there is a special discipline in growth of different parts of face and skull. We reached formulas that may have a wide range of applications such as prediction of facial situation of an individual before or after his/her present situation. Such predictions can be helpful in forensic medicine, for instance in finding the lost kids.

Conclusion: We have proposed a craniofacial development model that takes into account both psychophysical evidences on how humans perceive age progression in faces and anthropometric evidences on facial growth Based on our findings and by using artificial intelligence technology, computer programs can be designed to reconstruct facial forms of the individuals from a specific ethnicity at different ages.


Pseudoaneurysm and A-V Fistula Case Associated with Firearm Injury

Ayşe Gül Bilen1, Necmi Çekin 2, Ali Eren1

1Council of Forensic Science, Adana Group Administration, Adana, Turkey

2Cukurova University, Faculty of Medicine, Forensic Science Department, Adana, Turkey

Complications related to peripheral blood vessels are seen frequently in firearm injuries of extremities. In most of these cases artery and the vein next to it (and sometimes the neuron also) are injured together and clinical findings related to the injury are frequently present during first aid. In serious blood vessel injuries, early diagnosis and intervention is usually vital in saving the extremity.

In perforans injuries of the extremities, physical examination findings only may not be enough for eliminating a possible vascular pathology totally. Keeping potential complications in mind, non-invasive, and if necessary invasive techniques should not be hesitated to be applied.

Blood vessel injuries created by firearm injuries during forensic reporting are not seen as frequent as complications such as broken bones, yet pseudoaneurysm or A-V fistula development is also seen and it is obvious that determination of these clinical situations will have an effect on the forensic report that is to be edited.

In this study, we shall present a pseudoaneurysm case which has happened in early period due to femoral artery being isolated and experiencing trauma with the case coming to our council for a report request and having developed after a firearm injury on the left proximal femur.


Etiology, pathogenesis, outcome and costs of nosocomial infections in the Intensive Care Unit

Lidia Dalfino1, Alessandro Bonsignore2, Sara Sblano 2, Fiorenza Zotti3, Nicola Brienza1, Alessandro Dell'Erba3

1Anaesthesia and Intensive Care Unit. Emergency and Organ Transplantation Department

2Department of Legal Medicine, University of Bari, Italy

3Risk Management Unit, Policlinico Hospital of Bari, Italy

Background: The epidemiology of nosocomial infections (NIs) in Intensive Care Unit (ICU) is critical for both patients and professionals/healthcare teams safety, impairing efficiency and effectiveness of therapies as well as increasing healthcare costs.

Methods: The goal of our study was to identify and to assess costs attributable to NIs in the ICU of “Policlinico” Hospital in Bari. We prospectively followed patients admitted to ICU between January 1th, 2012 and March 31th, 2012, collecting age, sex, admission typology, comorbidities (Charlson Index), severity on admission (APACHE II score), sepsis severity, ICU length of stay (LOS), ICU mortality. In order to identify the independent predictors of ICU LOS a stepwise analysis was performed.

Results: Out of 57 patients evaluated, 26 (45.6 %) patients were already infected on ICU admission, 8 by a community-acquired infection (6 severe pneumonia, 2 urinary-tract infections) and 18 by a total of 24 hospital-acquired infections (9 pneumonia, 1 bacterial meningitis, 5 abdominal, 3 skin-soft tissue, 2 urinary tract, 1 catheter-related bloodstream, and 3 primary bloodstream infections). Demographic and clinical characteristics of patients with nosocomial infections on admission were: median age 71.5 (IQR 62–81) years, Charlson Index 3.8 ± 3, APACHE II 22 (IQR 18–28), major surgery 9 patients (50 %), steroid therapy 3 patients (16.6 %), septic shock 13 patients (72.2), pre-ICU admission hospital stay 13.5 days (5–25), ICU LOS 19 days (5–31), ICU mortality 9 patients (50 %). In 10 patients ICU LOS was shorter than 3 days, and therefore, a total of 47 patients were evaluated during ICU stay. Twenty (42.5 %) patients acquired a total of 26 NIs, with an incidence rate of 34.9/1000 patient-days, distributed as follows: 10 ventilator-associated pneumonia (VAP), 6 urinary-tract infections (UTIs), 6 catheter-related (CR) bloodstream infections (BSI), 4 primary BSI. Incidence rates of VAP, CRBSI and UTIs were 15/1000 ventilator-days, 4.4/1000 intra-vascular lines-days, and 8.06/1000 urinary catheter-days, respectively. The onset time of NIs was of 16 ± 8 days from ICU admission. Clinical characteristics and outcome of NI and control groups are reported in the table. In the stepwise analysis, ICU-acquired NI was the only independent predictor of ICU LOS (p = 0.001).

Conclusion: When patients develop NIs there are important implications in terms of quality of care, mortality and increase of length of stay and costs.

Strategically, implementing quality assurance and quality control measures to the health care sectors and evidence-based management are effective techniques of controlling NIs, and it seems the most feasible approach.


Relationship between Chronobiology and Delinquent Behaviors in Euthymic Bipolar Disorders

Murat Emül 1, Husrev Demirel2, Tevfik Kalelioglu3, Abdullah Akpınar3, Akif Taspinar3, Ismail Ozver3, Sedat Demirbuga2, Suheyla Aliustaoglu2, Eyup Kandemir2

1Department of Psychiatry, Medical School of Cerrahpasa, İstanbul University, Istanbul, Turkey

2Forensic Medicine, Forensic Institute, Ministery of Justice, Istanbul, Turkey

3Bakırkoy Mental Health, Research and Education Hospital, Istanbul, Turkey

Aims: Dysfunction of circadian rhythms is thought to have roles in the pathophysiology of bipolar disorder. Besides, the types of circadian types are thought to relate with aggressive and delinquent behaviors. Thus, we aimed to compare the chronobiologic aspects in euthymic bipolar patients with or without delinquent behaviors.

Methods: Twenty six euthymic bipolar patients with delinquent behaviors and 71 bipolar patients without delinquent behaviors were included in the study after giving consent. They were asked to full fill Morningness-Eveningness Questionnaire of Horne and Östberg which assesses the chronotype and Barratt Impulsiveness Scale.

Results: The mean age of delinquent bipolar patients was 36.04 ± 9.43 and 36.92 ± 11.12 in non-delinquent group (p = 0.721). The mean duration of illness was 10.38 ± 8.35 years in delinquent group and 12.60 ± 7.82 years (p = 0.224). There were 6 eveningness type, 13 neither type, and 7 morningness type patients in delinquent group while these numbers were 9, 43 and 19 in non-delinquent group, respectively. There were no significant differences according to the types of chronobiology among groups (X2 = 1.69 and p = 0.428). Mean impulsivity scores were 59.38 ± 11.33 in delinquent group and 55.97 ± 13.84 points in non-delinquent group. There was no significance between groups among impulsivity scores (p = 0.265).

Conclusion: Previous studies regarding the personality of chronotype suggest that morningness-types have a healthier lifestyle, have a stronger internal locus of control, are more conscientious, and show higher self-esteem than eveningness types. In a recent study, impulsivity was significantly higher in eveningness type than other chronotypes in depressive patients. Also, being male and eveningness type was significantly correlated with higher impulsivity scores in a study of healthy university students. However, contrast to our hypothesis, we could not find any significant differences according to chronotypes or impulsivity between euthymic bipolar affective patients with delinquent or without delinquent behaviors.


Two cases of dural sinus thrombosis and review of the literature

Sema Demirçin, Mehmet Atılgan, Yaşar Mustafa Karagöz

Akdeniz University Faculty of Medicine, Forensic Medicine Department, Antalya, Turkish Republic

Dural sinus thrombosis (DST) may occur due to infection, surgery, hypercoagulability or compression of the sinuses by tumors. DST in the cases of intracranial hematoma may also occur after head injury such that depressed skull fractures or skull fractures that cross the sinus obstruct the blood flow in the sinus.

DTS is rare and the signs and symptoms are extremely varied as well as nonspecific, ranging in severity from mild headache to coma and death. We present two cases of DST and review the literature for this condition which has high risk of morbidity and mortality in this report. The first case was a 16 years old boy hospitalized because of history of headache, nausea and repeated vomiting for two day after a motorcycle traffic accident who died at third day of his hospitalization. The second case was an 18 year old girl who had a history of upper respiratory infection and diarrhoea for four days and died several hours after her admission to emergency service. In both cases, DTS was diagnosed at medicolegal autopsy.


An Abnormality of Willis Polygon; Aplasia of The Right A1 Segment of The Anterior Cerebral Artery

Cihan Gokturk, Ziyaettin Erdem, Murat Nihat Arslan, Ipek Esen Melez, Deniz Oguzhan Melez

Republic of Turkey Ministry of Justice The Council of Forensic Medicine

Willis Polygon, is an arterial structure in the base of the brain, and is composed by an anastomosis between the right and the left carotid arteries and the vertebral basilar arterial systems. While the anterior communicating artery connects both anterior cerebral arteries to each other; the posterior communicating artery connects the internal carotid artery and the posterior cerebral artery. More variations can be seen in the posterior circulation in this polygon. A complete Willis Polygon, which means that there is no absent component or hypoplasia, is only seen in 20-25 % of the individuals. The most common variation is hypoplasia of one or both posterior communicating arteries and is found in 34 % of the individuals.

The aim of this study is to discuss the coincidental presence of the arterial variations of the Willis Polygon in the autopsies, and to compare the findings with the literature.

This case, a 54 year-old male body, was found in the water and the reason of death was drowning based on the autopsy. The variation of Willis Polygon was the aplasia of the right A1 segment of the anterior cerebral artery and therefore the absence of the anterior communicating artery. On the other hand, the left A1 segment, which was larger than usual, was branching out of the frontal interhemispheric region and continued its normal path as the A2 segment of the right and the left anterior cerebral arteries.

The forensic medicine is in close relation with all other scientific fields and can serve as a bridge between the scientific fields that appear to be unrelated to each other. Although the primary purpose of an autopsy is to explain the cause of death and help the law enforcement, it also can uncover some findings that can be helpful for other scientific disciplines.


Characteristics of the hospitalized forensic cases: A retrospective study

Arzu Ilçe1, Hacer Alpteker1, Zerrin Erkol 2, Semra Bulut3

1Abant Izzet Baysal University, Bolu Health School, Department of Surgical Diseases Nursing, Bolu, Turkey

2Abant Izzet Baysal University, Faculty of Medicine, Forensic Medicine Department, Bolu, Turkey

3Abant Izzet Baysal University, Bolu Health School, Bolu, Turkey

Background: The study was planned for the purpose of investigation of the forensic cases’ characteristics who applied to the emergency service and hospitalized.

Method: Medical documents of the forensic cases who had appealed to the emergency service and hospitalized in Bolu State Hospital and Bolu Gynecology and Child Hospital in Bolu City (Turkey) between 01.01.2007-31.12.2007 were investigated retrospectively. Statistical analysis were realized by using SPSS 15.0 Packet Program and chi squared test.

Results: Total 365 cases were evaluated. Of the cases, 62.7 % (n:229) were male and 37,3 % (n:136) were female. The average age was 36,7 ± 18 between 1–88. The analysis of the age groups as follows; 49 cases (13, 4 %) were under 18-year-old, whilst 59 cases (16,2 %) were in 18–24, 80 cases (21,9 %) were in 25–34, 64 cases (17,5 %) were in 35–44, 46 cases (12,6 %) were in 45–54, 29 cases (7,9 %) were in 55–64 and 38 cases (10,4 %) were in 65-year-old or older age group. Most frequently seen event was motor vehicle accidents with 184 (50,4 %) cases and 166 cases (%90,2) of them were occured as intra-vehicle accident and the remain cases (n:18–9,8 %) were occured as extra-vehicle cases. Motor vehicle accidents were followed by intoxications (n:79–21,7 %) (62 cases were suicidal drug intoxications), falls (n:45–12,3 %), stab injuries (n:19–5,2 %), occupational accidents (n:17–4,7 %), firearm injuries (n:10–2,7 %), hitting cases (n:10–2,7 %), burn (n:1, 0,3 %). There was a meaningful relationship between the gender and type of the forensic case and between the age groups and type of the forensic case (p:0,00). Motor vehicle accidents, falls and occupational accidents in males and suicidal intoxications in females were mostly seen type of events. Motor vehicle accidents were mostly happened in under 18-year-old and 25–34 age groups whereas suicidal intoxications were mostly occured in 18–24 age group. According to the evaluation of the cases’ general condition; it was good in 61,7 % (n:142), moderate in 27,0 % (n:42), worse in 10,9 % (n:25) of the cases. Consciousness was clear in 77,5 % (n:196) of the cases whilst 13,0 % (n:33) cases were unconscious, and 8,7 % (n:22) of them were confused. There wasn’t any data about general condition and consciousness in the remaining cases’s medical documents.

Conclusion: Injuries of the hospitalized forensic cases’ mostly occurred as intra-vehicle traffic accidents, intoxications and falls. Taking precations for prevent occuring this cases and psychiatric supports for the persons who have psychiatric problems will be useful for prevent such events.


Assessment of Forensic Reports Prepared By the Department of Forensic Medicine of Gulhane Military Medical Academy between 2006–2011

Sait Özsoy, Harun Tuğcu

Department of Forensic Medicine of Gulhane Military Medical Academy

Besides preventive and curative duties, physicians are also responsible for legal liabilities such as preparing reports. As they hold a crucial place for victims and suspects in the course of adjudication, these reports must be prepared in line with certain standards. This study aims to present and discuss the epidemiological characteristics of the reports prepared by the Department of Forensic Medicine of Gulhane Military Medical Academy (GMMA).

In this cross-sectional study, reports prepared by the Department of Forensic Medicine of GMMA between 01.01.2006 –12.31.2011 were examined retrospectively. Statistical analysis was performed on epidemiological characteristics of the cases, dates that the events took place, injury sites and data obtained according to injury qualifications defined in clauses 86 and 87 of the Turkish Penal Code (TPC).

The number of forensic reports prepared by Department of Forensic Medicine of GMMA between January 2006 and December 2011 was 2238. Average age of the cases was 24.7 ± 6,8 years (min. = 3, max. = 70) and 97.6 % (n = 2185) of them were male. 82.5 % (n = 1848) of the cases was the group of 20–29 years.

According to the type of the event, injuries in 50 % of the cases were because of battery. Other frequent reasons were firearm injuries (14.7 %; n = 330), traffic accidents (12.3 %; n = 275) and explosive injuries (9.1 %; n = 204).

According to the part of the body, in 1242 cases (55.5 %), the most common sites of injury were head and neck. Skeletal system fractures were detected in 887 cases, and fractures were found to be most frequent in the head and neck site (in 287 cases; 12.8 %).

According to clauses 86 and 87 of TPC, 990 (44.2 %) of the injuries were mild that were requiring a simple medical intervention, 1248 (55.8 %) were not mild, that were requiring more than a simple medical intervention, and 443 (19.8 %) were life threatening. In 19 % (n = 425) of the cases, persistent functional weakness or loss of function in one of the organs was observed.


Civil capacity in moderate dementia; a case report

Ali Rıza Tümer1, Emre Karacaoğlu 1, Ramazan Akçan1, Aysun Balseven Odabaşı1, Alper Keten2

1Department of Forensic Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

2Ankara Atatürk Trainin and Research Hospital

Background: Cognitive impairment, as in dementia, generally affects a person’s decision-making capacity. In such conditions older people suffering from early dementia are mostly anticipated to be capable of performing cognitive skills yet they might need to be supported. Because of deteriorated cognitive functions, in severe dementia a guardianship should be initiated for civil-law administration of these individuals. However, evaluating civil and financial capacity in older adults is still controversial, in moderate dementia in particular. Here we aim to discuss the evaluation of civil capacity of moderate dementia cases by presenting a case through its clinical features and treatment approaches.

Case history: Civil capacity of an 83 years old female was asked to be evaluated, by a local Civil Court. The case needed to be evaluated only based on medical records as she died two years ago. In 2006, she was admitted to a university hospital complaining of amnesia. She was given medications and continuously followed-up with control examinations. Besides used medications and medical follow-up her clinical conditions deteriorated, thereby she was recommended to live in a nursing home. In February 2008, one of her inheritors got a capacity report, from a local health center, stating that she had full cognitive and decision-making capacity; however, she was on medications and her mini-mental test points (14/30) were dramatically low in that period. Two weeks after obtaining the capacity report, her inheritor (niece) possessed her house by selling agreement. In 2010, after her death, other inheritors (nieces) filed a lawsuit against the one possessed house to cancel the selling agreement.

Conclusion: In conclusion, the presented case was decided to have diminished civil and financial capacity in the period of selling process because of decreased mini-mental tests’ points, need for increasing dose of medications, antipsychotic medication use because of behavioral disorders indicating further grade of dementia.

In conditions requiring evaluation of civil capacity in moderate dementia cases, by using only medical records; all medical records, particularly those related the capacity-questioned period, should carefully be examined. In addition to the detailed examination of patients suffering from moderate dementia, carefully recorded clinical findings, appropriate evaluation methods will play an important role in evaluating the civil capacity.


The Characteristics Of Sexual Abuse Victims Referred For Forensic Psychiatric Examination

Serap Erdoğan Teycan, Ali Yıldırım, Feryal Çelikel, Erdal Özer

Gaziosmanpaşa University,Tokat Türkey

Background: Population data on clinical and demographic characteristics of sexual abuse victims in Turkey is limited. This paper aims to investigate the demographic and abuse characteristics of sexually abused children, adolescents and adults who were referred for psychiatric examination to our psychiatry outpatient clinic from the forensic medicine department. The preliminary results of an ongoing research will be discussed in this presentation.

Method: Fifty-one sexual abuse victims, examined on request by the legal offices between September 2010 and July 2012 at our outpatient psychiatry clinic, were included in the study. The collected data on the features of all cases were analyzed retrospectively.

Results: Ninety-two per cent of all cases were women and 8 % were men. The mean age of the total group was 19.03 ± 6.68. Sixty-five per cent were under the age of 18. Seventy-six per cent were single, 16 % married, 4 % divorced and 4 % widow. Most of the victims were in a low-middle socioeconomical level. The perpetrator’s familiarity information was missing for 3 cases. In 10 % of cases, the perpetrator was a family member, in 6 % a relative, in 41 % a familiar person, either a friend or a neighbor, in 18 % a boy friend and in 20 % a stranger. The mean duration between the psychiatric examination and the sexual assault was 146.45 ± 146.97 months. As much as 35 % experienced fondling and 35 % vaginal penetration, while 18 % experienced physical violence, as well. Of all cases, 20 % were diagnosed as acute stress disorder, 18 % as post-traumatic stress disorder, and 24 % as adjustment disorder.

Conclusion: Sexual violence occurs worldwide and affects up to one third of women over a life-time. Although both men and women can be sexually assaulted, women are at greatest risk. Most sexual assaults are committed by someone known to the survivor. Some groups are more vulnerable, including adolescents, survivors of childhood sexual or physical abuse, persons who are disabled, persons with substance abuse problems, sex workers, persons who are poor or homeless, and persons living in prisons and institutions. Sexual assault may result in long-term mental and physical health problems. Psychiatric examination is crucial not only for the healing of the traumatised individual but also for its impact on the legal processes.


An unusual non-fatal case of impaling injury

Fabio De Giorgio 1, Massimo Miscusi2, Luca De Martino2, Piero Cascone2, Vincenzo M. Grassi1, Antonino Raco2, Vincenzo L. Pascali1

1Institute of Legal Medicine, Catholic University, Medical School, Rome, Italy.

2Institute of Neurosurgery, La Sapienza University, Rome, Italy

Impaling injuries are quite unusual. When they do occur, are typically produced by falls and traffic accidents. Occasionally, individuals fall on an object that they are carrying. More commonly, individuals fall or jump from a structure onto a pointed object such as a fence.

We present the case of a 35 years-old man. He was stealing into an apartment when the owners came back home. He tried to escape jumping from the second floor. He fell five meters and had a high energy penetrating transorbital head injury by a metal rod fence. Firefighters cut the fence and he was taken to the emergency department with the foreign body still in his head. At him arrival, GCS score was 6. A CT scan revealed a complex fracture of right orbit floor and roof, zygoma and both frontal sinuses, with an injury of both frontal lobes. Surprisingly right ocular globe was intact, being rod fence passed through the orbit just above it. The patient was immediately operated through a bifrontal craniotomy to repair cranial and facial defects. Rust was found intradurally and wound was carefully debrided. A cranialisation of frontal sinuses by a large galeal flap and a meticolous duroplasty was performed. Orbital and zygoma were repaired by mobilization of bone fragments and plated by microscrews.

In the following weeks, the patient presented a progressive neurological improvement. A postoperative CT scan showed the good reconstruction of cranial and facial defects, with a chronic evolution of frontal lobes injury. Fourty-five days after injury, patient was discharged with a GCS15, with a diplopia due to a paresis of right superior rectus muscle.

Penetrating intracranial injuries caused by metallic foreign bodies are very rare among the civilian population. In literature there are few reported cases and to our knowledge, this is the first report of a high-energy, penetrating brain injury caused by such an object.


Case Report: Tattoo mimetizing lower limbs varicosities: a differential diagnosis to be considered?

Leandro Duarte De Carvalho, Lucas Roquim E Silva, Carolina Beatriz Brum Paiva, Matheus Magalhães Dos Santos Ribeiro Junqueira, Thales Bittencourt De Barcelos

Medical Sciences Faculty of Minas Gerais

Context: It is expected that 35 % of the Brazilian population over 15 years-old have varicose veins. This incidence grows up according to age, affecting 70 % of mans and women who have more than 70 years-old. The lower limb varicose veins are related to human aging and degenerative aspects. Long periods in the orthostatic position with little muscular activity predisposes to venous ingurgitation and vascular dilatation, contributing to the formation of varicosities. Due to the high prevalence, it is common the association between varicose veins and the labor activity. If proved this relationship, the workers would file an occupational lawsuit against the employer. However, some workers are searching for secondary gains.

Case: Male, 41 years-old, gas station attendant. He had an 8-hour work journey, eventually exceeded, and said that after 34 months in this job, he started to feel legs and feet pains, but he did not asked for medical help. In this condition he continued in his profession for 5 months, when he was dismissed. He had no occupational medical follow up. Currently, he claims that the pain persists and remains without medical help until the day of the forensic-medical expertise. In the physical examination was verified a superficial venous plexus of the legs and feet with vessels slightly dilated, easily visible bluish-blackish in color. However, it had not been verified protrusions or dilatations of superficial veins of the lower limbs. It had been noted a tattoo mimetizing varicosities aspects at the medial face of right foot. With the present case, it is intended to warn the existence and similarity of the exogenous skin pigmentation, tattoo, with lower limb varicose veins. This case clearly demonstrates the existence of secondary gain intention against the employer.


Epidemiological study of cases of hand injury - Occupational Justice in Brazil

Leandro Duarte De Carvalho, Isaac Pêgo Santos, João Pedro Rodrigues Pereira, Júlio César Rezende De Carvalho, Ricardo Abreu Vilela

Medical Sciences Faculty of Minas Gerais

Introduction: The hand is essential to almost all personal performance, economic and leisure. The human hand has an important evolutionary characteristic relative to other primates and animals, which is an opposite finger to the remaining ones - the "thumb". Therefore, any damage to the human hand, compromises one of the primary characteristics of human evolution. For the human it is essential to perform any work, and statistics show that trauma is the leading cause of disability. Hand injuries have unique characteristics that differentiate them from other lesions. The traumas of the hand present no threat to the lives of individuals, but carry a high functional risk with serious socioeconomic consequences for himself, his family and the whole society.

Objective and methods: To analyze 64 cases of medical-legal evaluation concerning occupational accidents resulting with damage in the human hand, drawing an epidemiological profile, conducted by Dr. Leandro Duarte de Carvalho between the years 2007 to 2010.

Results and conclusion: We analyzed 64 cases of individuals between 17 and 59 years, among whom 86 % were male and 14 % female. Lesions analyzed, 39 % occurred in the right hand (4 also reached portions of the upper limb) and 61 % in the left hand (7 also affected portions of the upper limb). Among those analyzed, 78 % received social security benefits. Traumatic injuries of the hand is a very serious problem for the victim, victim´s family, company and security-social institution, since the injuries of the hand lead to both physical and psychological changes. The lesions studied include finger amputation, crushing, fractures and cuts in the distal portion of the upper limbs. The accident at work remains a serious problem and often results in personal injuries or functional disorders leading to permanent or temporary reduction of working capacity.


Case-report: chromium poisoning and damage to upper respiratory tract

Leandro Duarte De Carvalho, Ana Vitória Ribeiro Pereccine, Isaac Pêgo Santos, João Pedro Rodrigues Pereira, Ricardo Abreu Vilela, Eduardo Machado Rossi Monteiro

Medical Sciences Faculty of Minas Gerais

Introduction: Chromium is a metal used especially in metallurgy, in processes called electrodeposition. Its excess can cause dermatitis, ulcers, kidney and liver. In this case report we present LSB, 40, who worked as painter. He bears nasal septum perforation and chronic vasomotor (ICD-10 T56.2 - Chromium and its compounds) for probable exposure to chemicals and should stay away from professional activities that expose these products (mainly chromium). Chronic rhinitis ulcer may occur through local action of aerosol irritant, producing a chronic inflammatory process characterized clinically by bloody rhinorrhea, burning and pain in the nostrils.

Objective: To report the case of litigation forensic labor of a professional labor victim of chromium poisoning, showing damage to the upper respiratory tract.

Results and conclusion: The diagnosis of chronic ulcerated rhinitis is essentially rhinoscopy. Edema, ulceration, crusting and eventually bleeding may also be observed. Ulcers may progress to necrosis and perforation of the nasal septum, situation very well known among workers exposed to chromium. It is relatively difficult to establish criteria for evaluating disability caused by the condition, but it is important to note that the person may develop parosmia (abnormal smell) or anosmia residual, which may cause significant impact on workers, both in their defense mechanisms (odor substances toxic chemicals or dangerous), and on their ability to work, depending on their job. The disordered breathing by nasal stenosis also constitutes an important injury to the patient's life. In exposed workers, excluding other underlying causes, chronic rhinitis must be classified in Group I of Schilling Classification. In other words, diseases where the "work" or "occupation" are necessary causes. Without them, it is unlikely that workers develop the disease, with clinical features described. It is often described in workers exposed to chromium.


Evaluation of the Sexual Assault Cases

Ramazan Karanfil 1, M. Mustafa Arslan2, Cem Zeren2, Alper Keten3

1Department of Forensic Medicine, Medical Faculty, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey

2Department of Forensic Medicine, Medical Faculty, Mustafa Kemal University, Hatay, Turkey

3Unit of Forensic Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey

Introduction: Sex crimes remain an important problem all over the world. In this study, we aimed to investigate the sociodemographic features of the victims, assailant-victim relationships and sexual assault findings.

Material-methods: A total of 324 sexual assault victims presented and examined in Kahramanmaras Sutcu Imam University Medical Faculty, Department of Forensic Medicine between January 2007 and December 2010 were included in the study. A survey was applied to the victims through face to face interviews. In addition, examination findings were included in the study and results of the analysis were discussed in the light of the literature.

Results: Of the victims, 268 (82.7 %) were female and 56 (17.3 %) were male. Mean age of the victims was 16.78 ± 7.16 years. In all cases, type of the assault was as following; vaginal penetration in 160 (49.4 %), anal penetration in 117 (36.1 %), oral penetration with penis in 7 (2,2 %) and in form of kissing, fondling, touching the sex organ and rubbing the sex organ in 60 (18.5 %) of the cases. Of the assaults, 149 (46 %) were found to take place in the house of the assailants and 49 (15.1 %) in the house of the victims. Of all the cases, 289 (89.2 %) victims knew the assailant, 103 (31.8 %) of the victims were students, 76 (23.5 %) were teenage girl, 50 (15.4) were housewife, 23 (7.1 %) were unemployed and 21 (6.5 %) of the subjects were employees. Of 139 cases, genital injury alone was found in 85 (26.3 %) and anal injury in 54 (16.7 %) of the subjects.

Conclusion: On the contrary to the previous studies, sexual assaults were found to occur mostly in the house of the assailants and incidence involving anal trauma were found to be higher.


Suicide of Four Siblings by Hanging

Ramazan Karanfil 1, Cem Zeren2, Alper Keten3, M. Mustafa Arslan2

1Department of Forensic Medicine, Medical Faculty, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey

2Department of Forensic Medicine, Medical Faculty, Mustafa Kemal University, Hatay, Turkey

3Unit of Forensic Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey

Introduction: Mass suicide is defined as the members of the groups with social and cultural nature to commit suicide at the same time. Objective of this study was to present the cases of four siblings who killed themselves by hanging at the same time and to compare the case with the literature.

Case: Four siblings were found hung by the person who was working for their father in a vineyard house. The house was a duplex apartment surrounded by a wall and wire fence. The balcony and rooms of the house were seen to be untidy with hulls, rubbish and broken pieces of glass everywhere. Four siblings were found hung with the same thick rope just at the entrance of the ground balcony, next to the entrance door, next to the toilet wall separate from the house and in the garden shed. The corpses was belonging to the siblings aged 26, 27, 30 and 31. Two of them were female and the others were male. At the autopsy all the siblings were defined to be dead from mechanical asphyxia due to hanging. Alcohol was found in the blood of three siblings and in the liquid in the pet bottles on the ground. No alcohol was detected in the blood of one sibling. All siblings were found to commit suicide at the same period of time and three of them to take alcohol before the suicide.

When familial structure and social characteristics of the siblings were examined; it was found that the children had a poor relationship with their father and grown too dependent on their mother. They had difficulty to adaptation to the environment, had few friends and unemployed. It was stated that they had got depressed after the death of their mother, said to the persons in their environment “they could not live without their mother” and had committed suicide.

Conclusion: In this study, we presented the case of four siblings who committed suicide at the same time which has not been previously reported in the literature. Suicidal act is an action with bio-psycho-social aspects. Besides psychological and environmental factors, investigation of the biological aspects is important in etiology of the suicide, which will be useful for development of the preventive public health measures.


Effects of soil on decomposition

Murat Mert1, Sema Tetiker 2, Ahmet Selcuk Gurler3, Muhammed Feyzi Sahin3, Ayten Namli4, Murat Nihat Arslan3, Ahmet Sadi Cagdir3

1Geology Engineer, Ministry of Justice, Council of Forensic Medicine, Istanbul, Turkey

2Department of Geological Engineering, Batman University, Batman, Turkey

3Medical Doctor, Ministry of Justice, Council of Forensic Medicine, Istanbul, Turkey

4Department of Soil and Plant Nutrition, Faculty of Agriculture, Ankara University, Ankara, Turkey

The effects of soil on decomposition, and estimation of burial time period regarding this, has been the focus of attention of many researchers working in the field of forensic soil science. Pathogens that affect decay is controlled their proliferation and bacterias forming the normal body flora together with death. Decay in the buried corpses more slowly than in the open-air and water environments. Decay under the ground; varies in proportion as well as climatic factors, Eh, pH, soil texture and mineralogical content of soil.

In this study 45 corpses, which were exhumed from environments with different physical features each, were studied. Certain time of death, burial and disinterment periods of the corpses were well known. In the fields related to burial land, it is tried to explain the event mineralogical, chemical and physical examinations of the body caused by deterioration of corpses (decomposition) event, autolysis and decay (putrefication). This study also includes the first data of the project on buried time determination and the effects on decay of soil.

Firstly, in this study; the soil characteristics of total 45 cases, which are divided into groups of basic rock types according to the geological structure of the region, were determined base properties of environments faster of decay. If Fe, Pb, Zn, S and sulfide minerals are found in the content of soil, quick decomposition and decay of corpse occurs; otherwise, in the locations where swellable clays such as montmorillonite and smectite is contact with water, corpses were preserved for a long time because of isolation from environment.


Post-traumatic Stress Disorder among Anti-terrorism Veterans, in Turkey

Alper Keten 1, Arda Karagöl2, Hamit Sırrı Keten3, Emine Avcı4

1Department of Forensic Medicine, Ataturk Traning and Research Hospital, Ankara, Turkey

2Department of Physiatry, Ataturk Traning and Research Hospital, Ankara, Turkey

3Department of Family Medicine, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey

4Department of Public Health, Gazi University Faculty of Medicine, Ankara, Turkey

Introduction: Terorism which is considered in the concept of trauma is a form of war designed as to have the highest psychological impact on the massess. Fight against terorism is continued for almost thirty years in Turkey. Objective of this study was to respectively examine the health commission reports of the handicapped individuals during fight against terrorism and in terms of psychiatric diagnoses, in particular.

Material-methods: In this study, health commission reports (n:92) of the diseabled people prepared by Ankara Atatürk Training and Reseach Hospital Health Care Commision between 01/01/2007 and 01/01/2011were retrospectively examined, and psychiatric diagnoses and other injuries of the patients injured during the fight with terorism were evaluated.

Results: Mean age of the subjects included in the study was 30.67 ± 5.94. Majority of cases were injured as a result of mine explosion by a rate of 63 %. There was eye lost (single/double) in 11 (12 %) of the cases, while amputation in one or more extremity was identified in 58 (63 %) of the subjects. On the psychiatric examinations, 20 (21.7 %) of the subjects were diagnosed with a psychiatric disease, while post-traumatic disorder was found in 6 and no psychopathology was mentioned in 72 (78.3) of subjects. As results of the reports, 53.18 % ±21.27 of the subjects were stated to be handicapped. A positive and significant correlation (correlation coefficient: 0.25) was found between the subjects with a psychiatric disorder and the disability rate (p = 0.16).

Conclusion: The disability resulting from the terrorist attacks leads to significant physical and mental deterioration. Consideration of post-traumatic stress disorder is extremely important both in treatment planning and preparing of the health commission reports in the cases exposed to the war trauma.


Evaluation Of Forensic Reports Prepared By Emergency Services Within The Frame Of Turkish Penal Code

Alper Keten 1, Ferhat İçme2, Metin Eser3, İbrahim Kılınç3, Ali Rıza Tümer4

1Department of Forensic Medicine, Ataturk Traning and Research Hospital, Ankara, Turkey

2Department of Emergency Medicine, Ataturk Traning and Research Hospital, Ankara, Turkey

3epartment of General Surgery, Ataturk Traning and Research Hospital, Ankara, Turkey

4Department of Forensic Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

Introduction: Preparation of forensic reports following the examinations of forensic cases is among the legal responsibilities of physicians. Several guidelines have been published to guide the physicians for preparing these reports. In this study we aimed to investigate the forensic reports prepared by emergency services in light of the legislations.

Material-methods: In this study, general forensic examination reports and hospital records of 100 patients admitted to Emergency Department of Ankara Atatürk Training and Research Hospital were examined.

Results: Mean age of the patients was 36; 78 of the cases were male and 22 female. On medical evaluation of the patients; a great majority of cases (68 %) had no consultation and most common consultations were demanded from orthopedics and traumatology clinic. On examination of the cases according to the causes of forensic reporting, the most common presentation was found to be due to traffic accidents with 43 cases. On examination of the cases in terms of whether alcohol abuses and injuries were resolved with basic medical interventions, 72 of them had not been analyzed for alcohol use and 27 had examined for alcohol. In 87 of the cases, issue of whether the damage occurred can be resolved with basic medical interventions had not been stated at the report, while injuries could be resolved with basic medical interventions in 8 cases and could not resolved in 5 cases. Out of all reports, 79 were preliminary forensic reports, 9 were final reports and 12 had no statement regarding to be preliminary or final.

Conclusion: Forensic case notifications and forensic reporting are medical tasks as well as legal responsibility of a physician. Issue of the approach by a physician to the forensic cases and procedures must take part both in medical education and postgraduate training.


A series of Suicidal Attempt cases; Data from Ankara

Alper Keten 1, Ferhat İçme2, Ramazan Akçan3, Emre Karacaoğlu3, Arda Karagöl4, Emine Avcı5

1Department of Forensic Medicine, Ataturk Traning and Research Hospital, Ankara, Turkey

2Department of Emergency Medicine, Ataturk Traning and Research Hospital, Ankara, Turkey

3Department of Forensic Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

4Department of Physiatry, Ataturk Traning and Research Hospital, Ankara, Turkey

5Department of Public Health, Gazi University Faculty of Medicine, Ankara, Turkey

Introduction: Suicidal behavior, as an intentional act aiming to end one’s life, is a phenomenon having psychiatric, forensic medicine, public health as well as economical, cultural, social and legal aspects and consequences.

In this study, we aimed to define demographic and sociocultural factors causing to suicide attempt and results of the attempts in the cases presented to the emergency department due to suicide attempt.

Material-methods: In this study, records of 245 cases presented to the emergency department of Atatürk Training and Research Hospital due to suicide attempt between 31/12/2009 and 01/01/2011 were retrospectively studied. Socio-demographic data of cases were investigated. For the analysis of data, descriptive statistics and Pearson chi-square test were used.

Results: Of 245 patients included in the study, 66 (26.9 %) were male and 179 (73.1 %) were female with a mean age of 28.1 ± 9.9. On analysis of educational status; 49 (20 %) were primary, 93 (26.5 %) high school and 65 (26.5 %) were college graduates. Of the patients, 139 (56.7 %) were single.

The most frequent cause of the suicide attempt was marital discord (n:72; 29.4 %) followed by the problems with spouse (n:55; 22.4 %) and psychiatric disorders (n:45; 18.4 %). Economical factors among the causes of suicide in males were found to be significantly higher than in females (P < 0.001).

On interrogation of previous suicidal attempts, 56 (22.8 %) cases stated that they had attempted suicide one or more times. Thirty-eight (15.5 %) of the cases stated that their relatives also had attempted suicide. The most frequently used method of suicide was medical drug intake (n:220; 90.2 %). Percentage of the men who attempt suicide with a sharp and pointed objects was significantly higher than in women (P < 0.001). Fifty-one (20.8 %) of the cases had diagnosed with any psychiatric disorder before the suicide attempt.

Of the cases, 35 (14.2 %) stated that they was on psicotic medication in the period of suicide. Sixty-six (26.9 %) of the patients were consulted in psychiatry department. However, only 26 of the cases (10.6 %) presented to the psychiatry clinic later.

Conclusion: Being female, young aged, single, existence of previous suicidal attempt, marital discord and psychiatric disorder were found to be suicidal risk factors, in this study. In this context, patients with psychiatric disorders should carefully followed-up since these disorders are among the etiology of suicidal attempts.


Evaluation of presidential amnesty cases in Forensic Medicine practice

Volkan Ünal, Sadi Çağdır, Yusuf Özer, Fatih Özner, Esra Ünal, Cengiz Haluk İnce

Adli Tıp Kurumu, İstanbul, Turkey

According to article 104/2-b of our valid constitution, president of republic has the authority of diminishing or canceling the penalty of convicts due to continual disease, disability or senescence.In reference to the current regulations, convict should attend to Presidency personally. After that, authorized prosecutors offices want health committees of hospitals to examine and report the situation of convict, then this report sent to Council of Forensic Medicine through the prosecutors’ offices to arrange a report. If continual disease, disability or senescence can be accepted, convict can derive benefit from the article 104/2-b by the decree which is signed by the Minister of Justice, Prime Minister and President.

In 2011, totally 467 case appealed to 3rd Specialization Board of Council of Forensic Medicine, to benefit by the presidential amnesty and by our board 14 were evaluated in this context.

We want to present four cases to show the approach of 3rd Specialization Board of Council of Forensic Medicine. First two cases are the examples of that we were of the opinion that the convict has continual disease, disability or senescence. First one is 42 years old male, he has high degree B –cell immunolymphoblastic lymphoma since July 2009, he has chemotheraphy but it relapses, we found common body pains, lymadenopathies on the neck and axilla, considering the disease is stage IV, LDH level is high and ECOG scor is III it is thought that life expectancy is approximately 1–2 years. Next one is 91 years old male, he has right keratopathy, pseudophacia, left total calcific cornea opacity, paraparesis, polineuropathy diagnoses; in our examination we found mild-moderate dementia.

Other two cases are chosen to show the cases that Presidental amnesty is not appropriate. First one is 30 years old male, he has acute lymphoblastic leukemia diagnosis since July 2011, he has chemotherapy treatment and after treatment he has total remission, second case is 72 years old male, he has hypertension, Type II Diabetes Mellitus, chronic obstructive pulmonary disease due to our examination his general situation was moderate and TA was 200/100 mmHg.

As a result; if the mental faculties disappeared, treatment is over and due to medical records no response to treatment, there is an extreme disability that doesn’t let convict to live on his/her own or death is an expectable result for people we evaluate this situations in terms of this context.


Medicolegal Examination of Acut Thinner Ingestion: A Case Report

Volkan Zeybek, Gözde Yeşiltepe, Mehmet Hakan Özdemir

Department of Forensic Medicine, Dokuz Eylül Univercity,Izmir, Turkey

Background: Thinner, commonly used for removing household paints removing, and contains 60-70 % toluen, 20-25 % n-butilasetat ve 10-15 % ethanol. Although, its physical features as a clear, colorless liquid with a sweet, pungent odor makes it a potential agent for household accidents and an ingestible poison especially for infants. Symptoms of acute ingestion of thinner are fewer, irritability, loss of consciousness, nausea, upper gastrointestinal injury, renal failure, polyneuropathy, chemical pneumonia, disrhythmia, methemoglobinemia, and sudden death. Acute thinner intoxication is unusual and its clinical effects after ingestion are relatively unknown. We will discuss about diffucilities of medicolegal examinations after thinner ingestion.

Case: A 3-year-old male ingested orally a unknown quantity of toluene. After ingestion he had respiratory distress and cough then he was vomitted by his father at home. First he went to a state hospital and observed about 2 hours but we couldn’t reach his medical reports from this hospital. Then, he came to our hospital emergency service about 30 minutes later. He was lethargic and vital findings were stabilized. Blood chemistries of liver and renal function were normal. A chest X-ray film, taken approximately 3 h after ingestion, revealed parancimal consolidated areas at upper and basal lobes of right lung. He observed about 35 hours and then he discharged from hospital.

5 days later he came our departmant for medicolegal examination but the reports of patient was deficient. We wanted consultations from pediatrics, pediatric surgery. But they recommended that they have nothing to do right now.

Conclusion: We will discuss about diffucilties of unsuffucient medical records while performing medicolegal examiniation.


Evaluation of the term “Permanent Facial Change” in terms of Turkish Penal Code: Four cases

Bahadır Kumral, Ü. Naci Gündoğmuş, C. Haluk Ince

Council of Forensic Medicine

According to the laws in our country, scars within the facial region resulting from any type of trauma are accepted as “aggravating circumstance”. If a scar in facial region is easily visible when examining in daylight or in a well-lighted room, with a talking distance (about 1–2 meters) then it is named as “constant (fixed) scar”; if the natural appearance of the face is so damaged that even the ones who are familiar to him/her feel hesitation in recognizing then it is named as “permanent facial change”. Heavy burning and application of nitric acid to the face are some examples for the permanent facial damage.

We retrospectively analyzed all the files of Second Specialization Board of The Council of Forensic Medicine between the years of 2005 and 2009 and four cases of “permanent facial change” were detected. Of the four cases, 3 were male (75 %) and 1 was female (25 %). The cause of the severe damage was flame burns in 2 cases and chemical burns in 2 other cases.


Management of patient complaints and medicolegal consultation at VKF American Hospital

Gizem Konuş 1, Bilge Köstekçi1, Meral Ebru Dikmen1, Mehmet Erdal Aksoy1, Ömür Erçelen1, Abdullah Coşkun Yorulmaz2

1VKF American Hospital, İstanbul, Turkey

2İstanbul University, Department of Forensic Medicine, Cerrahpaşa Medical School, İstanbul,Turkey

In July 2001, Patient Rights Office (PRO) was established authorized by the Chief of Medical Office. PRO is working, taking into consideration the terms of 1998 Patients' Rights Legislation, to create a new health culture. PRO process has been designed on ISO, JCI ve EFQM requirements, monitoring and fulfilling their standards. PRO has been supported by medicolegal consultations, provided on a regular basis since 2006. Data obtained from patient complaints has been provided to service more efficiently on issues such as risk management, medicolegal consultations. In this study, it is aimed to share the experiences of VKF American Hospital which has the longest history in Turkey on the management of patient complaints.

Data, obtained from the cases managed by the PRO at American Hospital between the years 2001–2011, is evaluated. The data obtained from all applications has been shown on a yearly basis and analyzed separately. Cases with claim of malpractice were also evaluated according to the complaint category.

Applications are recorded under eight main headings. Since 2001, the number of applied cases is 1873, 3236 of which (%39) organizational problems, 3230 of which (%39) care and treatment service, 1572 of which (%19) attitudes and behavior, 1326 of which (%16) situations related to billing, 676 of which (%8) physical conditions, 165 of which (%2) food service, 95 of which (%1) extra services and 51 of which (%1) is related to cleaning services.

62 cases were carried to courts against the hospital related to medical processes. Distribution of cases by years is as follows: 2001–2, 2002–4, 2003–4, 2004–8, 2005–7, 2006–5, 2007–4, 2008–9, 2009–5, 2010–7, 2011–5.

86 complaints were proposed as amendment by PRO and included procedural / systematic, remedial action plan for the hospital.

Patients can help promote safety and reduce risk in several ways. One is to make known their concerns about their health care experiences because complaints might suggest unsafe systems and providers. The complaints could be used more effectively in health care and be regarded as important evidence when working with quality improvement. To systematically use patient stories as a reflective tool in education and supervision could be one way to improve communication and bring new understanding about the patient’s perspective in health care. Besides, complaints from patients were the most common reason for doctors seeking medicolegal advice. We conclude that patient complaints can be an important force for promoting safety for both medical staff and patient.


Hand Tendon Injuries

Yıldıray Zeyfeoğlu 1, Mehmet Sunay Yavuz1, Mahmut Aşırdizer1, Ertuğrul Tatlısumak2, Yeşim Tujyi3

1Department of Forensic Medicine, Celal Bayar University, Manisa, Turkey

2Department of Anatomy, Celal Bayar University, Manisa, Turkey

3Department of Anaesthesiology, Celal Bayar University, Turkey

Introduction: Our hands is the most active organ which we use in daily life. But is the most injured organ after trauma due to too little preservation. Hand injuries, Although they are not usually cause life-threatening conditions, has an important place in the practice of forensic medicine.

Materials-methods: Hand tendon injuries detected 48 cases, forensic reports were evaluated retrospectively.

Results: The age of the patients ranged between 4 to 73 years and the mean age was 30.75 ± … years. Most cases were accumulated in the 18–27 age group where it was followed by 28–37 age group. The months hand injuries most frequently occurred wereApril- May with 14 cases and October with 7 cases. Penetrating injuries were the most frequent cause of the hand tendon injuries with 22 cases and followed by blunt-crushing injuries with 15 cases. 10 cases had extensor tendon and 13 cases had flexor tendon injuries. In 23 cases injuries of the both tendons had been detected.


Thoracic Traumatic Deaths in Izmir, Turkey

Tarık Uluçay 1, Mustafa Dalgıç2, Akan Karakus3, Mustafa Yasin Selçuk3, Nuri İdiz2

1Ministry of Justice-Council of Forensic Medicine, Manisa, Turkey.

2Ministry of Justice-Council of Forensic Medicine, Bayraklı, Izmir, Turkey.

3Ondokuz Mayıs University School of Medicine, Department of Medical Education, Ondokuz Mayıs Samsun, Turkey.

Aim: Injuries are the largest source of premature mortality and the leading cause of death among people ages 1 to 44. By focusing prevention strategies and implementing integrated surveillance programs, it will be probable to reduce deaths and disabilities occurred due to injuries. The purpose of current study was to identify the proportion, origin and cause of thoracic traumatic deaths and its pathologic consequences.

Material-method: We conducted a retrospective study of autopsy cases at Izmir Branch of the Council of Forensic Medicine to describe the characteristics of one hundred eighty nine thoracic traumatic death cases between April 2011 and December 2011.

Result: The distributions of the cases according to gender and age were as follows; males 81.5 % (n = 154, mean age 42.9 ± 17.8), females 18.5 % (n = 35, mean age 41.6 ±17.4). The causes of thoracic traumatic deaths were traffic accidents (48.7 %), gunshot wounds (18 %), sharp force (incised or stab) wounds (14.8 %) and fall from high (11.1 %), work accidents (2.6 %), fall from low (2.6 %) and aircraft accidents (1.6 %). Rib fractures had seen more frequently in blunt traumatic deaths (OR = 42.38, p < 0,001) and gunshot deaths (OR = 14.00, p < 0,001) than sharp force deaths. Cardiac laceration had seen more frequently in gunshot deaths (OR = 12.88, p < 0,001) and sharp force deaths (OR = 8.29, p < 0,001) than blunt traumatic deaths.

Conclusion: It is concluded from the current study that death occurred due to thoracic trauma was an important problem causing premature mortality and morbidity in our region. A computer based public health surveillance system for identifying the causes of these injuries is needed. Also new prevention strategies to reduce the incidence of traffic accidents and violent injuries must be developed to prevent thoracic traumatic deaths.


Comparing The Handwritings Of Healthy Controlled Group Associated Wıth Schizophrenia

Ilhami Kömür 1, Selçuk Gürler1, Mehmet Akın1, Eyüp Kandemir1, Murat Emül2, Bülent Üner1

1The Council of Forensic Medicine, Istanbul, Turkey

2Department of Psychiatry, Istanbul University, Istanbul, Turkey

This study has been conducted to see the difference between the handwritings of schizophreniac patients and healthy controlled group. 29 hospitalized schizophrenic patients and a controlled group of 29 healthy people, appropriate with regard to their age, gender, education and the hand used, were included in the study.

204 handwriting samples written on A4 papers, taken from 58 cases, 29 of which were taken from hospitalized schizophrenic patients and 29 from healthy controlled group were analyzed. 102 of handwriting samples are free texts written on A4 papers, and the other 102 are written forms of a previously chosen paragraph.

The first handwritings of 29 schizophrenic patients, taken just after they were hospitalized, were compared to those of controlled group, chosen from healthy people, according to 44 parameters.

Compared with those of healthy controlled group, the handwritings of schizophrenic patients demonstrates a meaningful bigger size in length and width, and lower pressure. In addititon, omission in punctuation, scratches on letters, missing letters, and extra words were observed in the writings of these patients. Besides, meaningful differences in the repetitive drawings of letters were seen in the writings of the patients compared to those of healthy group. Schizophrenic patients have less meaningul and less coherent sentences than controlled group.

These differences, observed in the handwritings of schizophrenic patients, are thought to have been resulted from the effects of the illness itself and the medication used on the neurophysiologic and motor system as well as positive and negative symptoms of schizophrenia.


Traumatic Tattoo; A Case Report

Azem İrez, Mehmet Cavlak, Bilgin Hösükler, Adem Gür, Cihan Göktürk

Council of Forensic Medicine, Istanbul, Turkey

Background: Traumatic tattoo occurs as a permanent mark by mechanical penetration of foreign bodies into the skin as a result of delayed effective and earlier treatments. The foreign bodies penetrate into the skin may be carbon particules, gun powder, soil and asphalt. These tattoos can be appeared by variable reasons as: traffic accidents, falls from height, firearm and fireworks explosions and puncture of pencil or pen. The most common places are face, hands and eyes. Best and effective way of preventing penetrating injuries to transform to a traumatic tattoo is an effective treatment in earlier period. The main objective of this study is to provide a better recognition of traumatic tattoo that result a permanent mark on face.

Case: 20-year-old woman admitted to an hospital after a motor vehicle accident. Deep laceration from lateral side of the lower right eyelid reaching to the glabella and abrasions on the upper and lower right eyelid were observed in the first examination. After 1,5 year peirod of time, 4 cm long wide stigma was determined on the right lower eyelid starting from inner side of nasal radix to the connection border of lower eyelid to the cheek dermis, 4 cm long greenish irregular stigma below the right eyelid and a greenish stigma on the subciliar right eyelid. All these findings are diagnosed as traumatic tattoos caused by the traffic accident.

Conclusion: In the countries’ laws, penalty imposed to an injuring crime is judged according to the degree of the damage which affects an individual’s life. A permanent mark on face gives damage to an individual by affecting his/her psychology and social life. So causing a permanent mark on face should be punished more. Doctors examining the patient for forensic purpose have to know the mechanism involved in wound formation and wound healing. They have to recognize and differantiate different types of wounds such as traumatic tattoos, together with earlier skin lesions occured naturally, traumatically or by a disease.


Changes Appeared On The Hanwrittings Of Schizophrenic Patients After The Treatment

Ilhami Kömür 1, Selçuk Gürler1, Nabi Kantarcı1, Eyüp Kandemir1, Murat Emül2, Bülent Üner1

1The Council of Forensic Medicine, Istanbul, Turkey

2Department of Psychiatry, Istanbul University, Istanbul, Turkey

This study has been conducted to see the changes appeared on the handwritings of schizophrenic patients after the treatment they got.

In the study, 102 handwritngs samples of 29 schizophrenic patients written on A4 papers were analyzed. While 51 of these samples are free texts written on A4 papers, the other 51 are written forms of previously determined paragraphs.

Changes, appeared on the handwritings of these hospitalized patients after the treatment, were analyzed according to 43 parameters.

When these changes are analyzed, it can be seen that there is a meaningful decresease in the frequency of omitting words, punctuation, and letters, and correcting the letters.

Moreover, there is a meaningful decrease in the length and width of the letters, word omitting frequency, and leaned lines. In addition to this, there is an increase in the number of repetitive letter drawings, mistakes in capitalization, and extra words after the treatment.

These changes appeared on the handwritings of schizophrenic patients are thought to have been resulted from the effects of the illness itself and the medication used on the neurophysiologic and motor system as well as positive and negative symptoms of schizophrenia.


Evaluation of Cognitive Functions in Elderly Patients Composed Forensic Report

Ümit Kaldirim 1, Murat Durusu1, Ali Osman Yildirim1, Salim Kemal Tuncer1, Yusuf Emrah Eyi1, Ibrahim Arziman1, Cengiz Kaya1, Murat Eroğlu1, Cengiz Han Açikel2, Levent Yamanel1, Mehmet Toygar3

1Gulhane Military Medical Academy, Dept.of Emergency Medicine

2Gulhane Military Medical Academy, Dept.of Public Health

3Gulhane Military Medical Academy, Dept.of Forensic Medicine

Introduction: The number of elderly cases who required forensic evaluation is gradually increasing in parallel with the increase in visits of geriatric population to the hospital and emergency department in the community. In this study it is aimed to research the contribution of cognitive functions to judicial review process in elderly patients admitted to emergency service and have forensic characteristic.

Methods: The study data were obtained with the reassesment of cases composed forensic report who is included in a theses entitled “the evaluation of mental status change with six-item screening test in elderly patients who applied to the emergency service and the comparison of the relationship between complaints of the applicant and final diagnosis in these patients”.

Results: The cases over 65 years old who applied to the GATA Emergency Department between 2009–2011 years were included in this study. Six-item screening test (Six Item Screener) was used in assesment of cognitive functions. It was observed that the forensic report was composed in 26 of 755 cases (3.4 %) who included in theses study. The defect was detected in cognitive function in 6 of (23.07 %) above mentioned 26 cases in analysis of forensic report composedcases. Similarly, the cognitive function failure was detected in 198 of other cases included in study but without forensic.

Discussion: The patient’s statement is preferential in information about how the event takes place, presenting symptoms, anamnesis and taking history. But, mental functions deteriorate depending on physiopathological changes caused by aging; and the statements of persons can appear a confounding factor in clarification of forensic events in some cases. For this reason, it is thought that the routinely assesment of mental functions with objective measurement tests is contribute to process in forensic evaluation of elderly patients.


May Risperidone/Paliperidone blood concentration ratio predict the phenotype of CYP2D6 enzyme?

Selda Mercan, Munevver Acikkol

Forensic Science Institute, Istanbul University, Istanbul, Turkey

Background: CYP2D6 enzyme encoded by the CYP2D6gene is the principal enzyme for the metabolism of risperidone to its major metabolite of paliperidone (9OH-risperidone). Certain CYP2D6 mutations impair or abolish enzyme activity, resulting in reduced metabolism of risperidone and high plasma risperidone concentration even at low doses. CYP2D6 genotyping has been proposed as a clinical laboratory method for predicting plasma concentration of risperidone and other antipsychotics or antidepressant medication.

Aim: The aim of the study was to determine the CYP2D6*3 and *4 genotyping of psychotic patients and also to determine the risperidon and paliperidon levels in blood.

Materials-methods: Subjects were 17 patients recruited from the psychiatric inpatient units of Cerrahpasa Medical Faculty, Istanbul University. All patients provided written informed consent. Blood risperidone and paliperidone concentrations were measured by Liquid Chromatography - Tandem Mass Spectrometry method. CYP2D6*3 and *4 alleles were determined by Real-Time-Polymerase Chain Reaction.

Results: Only one patient was found as poor metabolizer for CYP2D6*4 (*4/*4), three patients were found intermediate metabolizers (*4/wt) and other 13 were found extensive metabolizers (wt/wt). Retention times of risperidon and paliperidon were found 1,841 min and 1,767 min respectively. Calibrations of risperidon and paliperidon were linear within the selected range of 0,5-100 ng/mL in blood (r > 0,999), Limit of Detection and Limit of Quantification were found 0,006 and 0,18 ng/mL respectively for risperidone; 0,019 and 0,063 ng/mL for paliperidone. Recoveries were found from 100,8 % to 105.5 % in different concentrations with minimum six replicates of each point. According to the genotyping and drug monitoring results; RSP/PLP ratios of poor and intermediated metabolizers were higher than extensive metabolizers.

Conclusion: Subjects carrying alleles encoding impaired CYP2D6 enzyme had significantly greater Risperidone concentrations in blood. Results demonstrate that CYP2D6 genotyping can be used to predict blood risperidone concentration despite advanced patients.


Predicting aggression with the Reading the Mind in the Eyes Test

Cemal Onur Noyan, Seyma Sipahioglu Ortac

Department of psychiatry service, gumussuyu military hospital, Istanbul, Turkey

Theory of Mind(ToM) also referred as mind reading, mentalising or social intelligence is the ability of identifying mental state of others. Deficits in this process can lead to maladjusted social behavior and aggressive or criminal behavior. There have been suggestions that ToM is disrupted among individuals with psychopathy mainly characterized with lack of empathy and inability to identify of feelings and needs of others as well as behavioral elements such as antisocial and criminal behavior. The “Reading the Mind in the Eyes Test(RMET)” is one of the most widely used tasks for examining the ToM. The aim of this study is examining the relationship between ToM disabilities, psychopathy and agression.

Methods: 40 male subjects with diagnosis of Antisocial Personality Disorder(APD), without any comorbid neurologic conditions, assessed by a semi-structured questionnaire form, SCID-II, Psychopathy Checklist-Revised(PCL-R), Aggression Questionnaire(AQ) and the Turkish version of the RMET. Subjects with APD diagnosis divided into two groups as ‘psychopathic’ and ‘nonpsychopathic’ group by using PCL-R scores. 30 point was used as cut point for psychopathy diagnosis regarding previous studies

Results: Psychopathic group(n = 15) showed significantly worse performance(p < 0,001) on the RMET than the nonpsychopathic group(n = 25). RMET and aggression scores correlated significantly(p < 0,05) within the subjects with APD.

Conclusion: Contrary to the previous studies revealing the absence of ToM impairment for psychopathy formation, worse RMET performances of the psychopathic group shows us that individuals with psychopathy can not identify of others mental state which can cause subsequently aggression. RMET can be used for assessing the aggression within the forensic population. Effects of ToM disabilities on formation of psychopathy and aggression should be investigated in the larger samples.


Risk factors for violent offences

Cemal Onur Noyan 1, Gencer Genc2

1Department of psychiatry service, gumussuyu military hospital, Istanbul, Turkey

2Department of neurology service, maresal cakmak military hospital, Erzurum, Turkey

Introduction: Aggression and violence which can cause death, disease and morbidity mostly related to antisocial personality disorder and psychopathy that is of particular concern to the criminal justice system and to the general public. Causes of violence are the result of complex interactions between genetic/biological factors and social/environmental factors. Differentiation of violent offences from non-violent offences may help us to understand the aetiologies of violence and to develop strategies to cope with violence. The purpose of this study was to compare violent offenders with non-violent offenders on demographic and criminal variables.

Methods: 100 male subjects who admitted to the general out-patients unit of the Department of Psychiatry and forensic patient diagnosed with Antisocial Personality Disorder according to DSM-IV without any comorbid neurologic diseases included the study. All the patients assessed by semi-structured questionnaire including data on onset age of delinquent behavior, age of first conviction, number of prior convictions, and frequency of delinquency in the past. Aggression Questionnaire(AQ) and Psychopathy Checklist-Revised(PCL-R) data were collected. Subjects divided into two group as ‘violent offender group’ and ‘non-violent offender group’according to interview with subjects and data obtained from legal documents and previous records of offences committed by the subjects. Offences including especially murder, rape and assault defined as violent, other offences including robbery, burglary defined as less or non-violent.

Results: Violent offender group(n = 55) significantly differed from non-violent offender group(n = 45) whith lower education level(p = 0,006), unemployment status(p = 0,023), lower residential status(p = 0,038) experiencing criminality at earlier age(p = 0,000), higher number of prior convictions(0,000), history of parental mental health problems(p = 0,035), higher rates and frequencies of previous self injuries behavior(p = 0,000), higher rates of substance abuse(p = 0,009) higher AQ scores(p = 0,003) and PCL-R scores(p = 0,000)

Conclusion: This results showed us that violent offender group has under the greater risk with lower residential and education level, unemployment status, experiencing criminality, substance and self injuries behavior at earlier age. To establish crime prevention and rehabilitation programs we should use these results as risk factors to be improved and should target rehabilitating specifically the young offenders.



Poverty and domestic violence in the Transkei region of South Africa: Case Reports

Banwari Lal Meel

Banwari L. Meel

Domestic violence is a major contributor to physical, mental and social ill-health of women. Poverty is directly or indirectly linked to violence. Despite the fact that a large number of women reside in rural areas like the Transkei, and domestic violence statistics are high in South Africa, there is sparse literature on domestic violence in rural communities. The purpose of this report is to highlight the problem of domestic violence in this Xhosa community of the Eastern Cape.

Emotion abuse and physical assault often result in depression which may lead to suicide. Abused women often present in hospital for their psychosomatic health problems which are manifested by this repetitive cycle of violence. On many occasions, suspicion of sexual infidelity by the woman is a cause for this abuse. Male abusers are often either alcoholic or dependent on some drugs, or both. Children from abusive homes suffer emotionally, if not always physically, and their performance often deteriorates both in academic and social spheres.

In this paper, twenty case reports, with their history, physical findings and interpretation, are discussed.


Intimate partner violence in the region of Coimbra (Portugal). A 7 year-long analysis - regarding a case

Goncalo Castanheira 1, Joao Nobrega1, Andre Henriques1, Rosario Silva1, Graca Santos Costa1, Francisco Corte Real2

1National Institute of Legal Medicine – Coimbra, Portugal (INML, IP)

2University of Coimbra, Portugal – Faculty of Medicine (FMUC)

Intimate partner violence is a phenomenon that has been assuming major proportions throughout the world and that has only been reported since the 60’s/70’s by the feminist movements. It consists of any behavior, conduct or omission that leads to physical, sexual, mental or economical damage to the spouse or former spouse, or to a person with whom the subject maintains or has maintained a similar relationship to those of spouses, even without cohabitation.

The United Nations have identified this has a global problem, since it has been practiced throughout the ages in various countries with distinct cultural and geographic characteristics. According to the World Health Organization, between 10 % to 34 % of all the women in the world have been physically abused by their partners.

There is an urgent need to launch global coordinated efforts to prevent this unnecessary tragedy, by establishing the similarities between this and other conjunctures, through quantitative and comparative methods.

The authors hereby present a Criminal Law retrospective study of all body-damage evaluation exams, conducted between January 2005 and December 2011, of which 9347 concerned physical abuse. Of these, 2263 (24.21 %) referred to intimate partner violence victims.

Several variables were established, in order to ascertain the victims profile and the circumstances of these aggressions. Another intention was to compare the obtained sample with the current national and also some European standards.

The authors also present the case of a 38 year old female individual, kidnap victim and attempted murder, perpetrated by a former partner.

There has been a percentual increase in this kind of violent behavior, between the years 2005 and 2011, and also a similar increase regarding male victims.

It has been verified that the victim is typically a female, between 25 and 40 years of age, married and with a profession that requires a basic education degree.

Most lesions have resulted from blunt trauma, having caused temporary damage to 63.85 % of the victims, of which 47.65 % resorted to medical assistance.

The justice system must intervene and take appropriate legal measures, to assure that the victim won´t replicate his/hers traumatic experience, and guarantee their protection, before, during and after the trial.

Forensic medicine is thus challenged with ever more complex demands regarding probative scientific activity, having the responsibility of not only diagnosing the cases but also contributing to eradicate such violent behaviors, by providing evidence for the administration of Justice.


Not Death Resulted Cord Suffocating Case Caused by Domestic Violence

Harun Akkaya 1, Ümit Naci Gündoğmuş1, Kenan Karbeyaz2, Erdoğan Kara1, Ahmet Necati Şanlı3, Süheyla F. Aliustaoğlu4, Gülşen Aydoğan4

1Council of Forensic Medicine, 2nd Speciality Board, Istanbul, Turkey.

2Council of Forensic Medicine, Branch Office, Eskişehir, Turkey.

3Council of Forensic Medicine, Istanbul, Turkey.

4Council of Forensic Medicine, 4th Speciality Board, Istanbul, Turkey.

Domestic violence, primarily against the spouse and to all family individuals is a frequent communal problem in all over the world as well as in our country. Our case subject to her brother’s suffocation attempt with a tie because of her peculiar social life, her brother tried to string up her by taking up the tie, she had a temporary blackout of consciousness, taken to a hospital by her parents whom intervened the violent act, in her first physical examination it is determined that she was conscious, oriented-cooperative, hyperemic erosion defined in her neck and sent home afterwards. The case having a juridical character, sent to 2nd Speciality Board to issue a report one day after the occurrence. In physical examination; dermabrasion seen in compliance with telem on the neck, lesion starting from left bottom of mandibula broadening to the bottom front under larynx, slightly ascending and rising to the surface ends in right nucha in scalp and it’s observed that it’s partially crusted, except this diagnosis on the sternum 1 cm 1 unit and 0,5 cm 2 units dermabrasion observed which the person claims occurred during the suffocation attempt, except having difficulties of swallowing and neck moves, hoarseness complaints, there are no other physical and psychological diagnosis appointed. The diagnosis assessed by Otorhinolaryngologic Diseases and it is observed that oropharynx and oral cavity is natural, in endoscopic larynx examination; bilateral vocal cord is seen as active and respiration passage is open, traumatic osseus pathology not observed during cervical tomography. This case is worth submitting due to the existence of social cultural elements to be the reasons of suffocation attempt, the appearance of the cord sequela surronds the neck and in spite of blackout consciousness, not any neurologic sequel diagnosis developed.


Intimate Partners Violence: An Italian Investigation

Felice Francesco Carabellese1, Manuela Tamma2, Donatella La Tegola3, Maricla Marrone 4, Francesco Vinci5

1 F. Carabellese jr, Section of Criminology and Forensic Psychiatry, University of Bari, Piazza Giulio Cesare, 70124 Bari, Italy

2 M. Tamma, PsyD

3D. La Tegola, PsyD

4 M. Marrone, MD, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare, 70124 Bari, Italy

5 F. Vinci, MD

Background: In 2007, the Statistics Institute of the Italian Government (ISTAT) conducted an investigation of a vast sample of women representative of the female universe, demonstrating that violence, both physical and psychological, perpetrated against the woman is a common phenomenon, even if it tends to be kept dark. Approximately 31.9 % of women suffer at least one episode of physical, sexual or psychological violence during the course of their lives.

Method: Despite the heavy implications of this high figure, the Istat data suggest that only a small percentage (18 %) of the women interviewed seemed to regard the violence they suffered as a true crime. In fact, only a very small number of cases of rape or violence (6.7 %) are reported to the Police and, moreover, physical and sexual violence very rarely come to the attention of the Health Authorities. Women tend to keep quiet about such attacks made on them, and prefer not to mention them to anyone, either the family or the authorities.

Of all episodes of violence, about 14 % are perpetrated by the partner. Violent attacks of this nature are frequently repetitive (in 67.1 % of the entire sample). In such cases there is a long history of quarrels, violence, separations and subsequent attempts to make peace. The final epilogue is sometimes dramatic, involving very grave violence and even murder.

Results: Often it is jealousy that triggers the attack against the woman; this jealousy is often borderline pathological but almost never due to a delusional disorder. It is likely, therefore, that social and cultural factors contribute to the manifestations of violence within the couple (these commonly occur in large urban conglomerations; they may involve the victim’s work setting and profession; the victim’s level of education).

Conclusions: These factors underline that a change is currently occurring in the traditional male/female relationship, and a growing independance of women. In this sense, some aspects of the Italian phenomenon differ from the situation in the USA (Caetano et al, 2008; Jewkes, 2002). It cannot be excluded, in any case, that old sterotypes may still hold fast in some social milieux in our nation. These may induce the woman to accept a certain degree of violence in order to “keep the family together”; meanwhile the man is being obliged to adopt a new model within the family, quite unlike the previous dominant role, and that he may have great difficulty in accepting.


Spousal homicide: about a case

Salim Boumeslout 1, Mokhtaria Souag1, Nawel Ayadi1, Abdelmadjid Aboubeker2, Ahmed Reda Hakem1

1Departement of Legale Medicine, C.H.U.Oran Algeria

2Departement of Legal Medicine, E.H.U.Oran Algeira

In a relationship marked by domestic violence, homicide risk is minor as the victim submits to the aggressor and as the control of power is maintained, that is to say, as the cycle of violence rotates.

The risk of homicide increases when the victim decides not to obey the partner anymore, to keep distance and to end the relationship.

Generally speaking, the spousal homicide is often a premeditated murder; it is often the result of a long relationship violence, domination and control. It is the iceberg peak of domestic violence.

Several conjugal homicides are a result of a split in which the victim took the initiative. Unable to accept that his spouse will escape his grip and losing all trust that she will come back, the violent man would desire to see her dead rather than out of his control or with another man.

You are offered to study an interesting case of spousal homicide which happened in Oran (western Algeria's capital).

Our team participated at -the -scene forensic examination and an autopsy was carried out in our department to find out the exact causes of the death.

The results and the forensic conclusions confirmed a violent, criminal death.


Abuse against the elderly: Brazilian epidemiological study

Carmen Silvia Molleis Galego Miziara 1, Ivan Dieb Miziara2, Fernando Hélio Da Silva De Oliveira1, Marcelo Aparecido Romano3, Daniel Romero Muñoz1

1Department of Legal, Ethical, Social and Work Health at the School of Health at São Paulo University (USP)

2Legal Medicine and Medical Deontology at the ABC Medicine School

3Medical Sciences Santa Casa de São Paulo

The aging phenomenon in Brazil follows the trend in the rest of the world. As this vulnerable population grows, so does the number of violent occurrences against it. The objectives of this study were to evaluate the main characteristics of this violence in Brazil and to alert health professionals about the identifiable physical signs that identify these victims and their abusers.

Results: The Southeast region represents 42 % of the overall population and, along with the South, it accounts for 8.1 % of the total number of people over 65 years old. We analyzed 201 filed complaints between May 2006–2010, 79 % were of female victims. Neglect was the most frequent type of isolated aggression followed by physical assault. The most common cause was the combination of neglect and physical abuse. The frequent aggressor being the son or the daughter. Of the aggressions committed by daughters, the neglect was of 59 % and physical aggression was 39 %. In turn, of the aggressions committed by sons, the neglect was (53 %) and physical violence was (41 %). The perpetrator’s chemical dependency was determined to be an important associated factor. In Brazil between 2006–2010 there were 425 reported deaths resulting from elderly mistreatment, 79 % were male, 45 % white and 78 % were as a result of physical violence. In the same period 2.5 % of those admitted for abuse were elderly. In the medico-legal expertise field it is important to consider the following characteristics that suggest abuse: physical injuries: a) wounds at different stages of healing or bruises (purple, brown-green, yellow and lastly brownish yellow), lesions that denote an instrument, restraint injuries on wrists, ankles and heels, traumatic alopecia, scalp edema, broken teeth, nose and x-ray images showing ancient misaligned fractures and burns; b) injuries indicative of sexual violence are: itching, anal or vaginal bleeding, pain, sexually transmitted diseases, spotting or bleeding in the underwear. Most battered body areas: face, side region of the right arm and back.

Conclusion: The majority of the abuse suffered by the elderly occurs in the form of neglect and physical abuse. Many deaths were not identified as violent by lack of diagnostic elements, especially because of the omission of violence by family members who are usually the aggressors. This is a fundamental reason for the coroner to pay close attention to possible external aggression signs in his victims in order to assist victims and the justice system to accurately determine the cause of death.


Profile of assault and battery victims aged 70+

Bertrand Becour, Zakia Médiouni, Ahmed Hammache, Jean Louis Pourriat

Assistance publique - hôpitaux de paris

Background: Every other day, one of the victims examined at the Paris UMJ (medico-judicial emergency unit) is over 70 years old. This study aims to differentiate the various types of violence and determine the epidemiological characteristics of these elderly assault and battery victims.

Methods: This prospective study reviewed the medical files of 189 patients, aged 70 years or more, who were examined at the Paris UMJ unit between January 1st and December 31st 2011.

Results: The oldest victim was 95 years old and 66.5 % of the study population were women. Cases were distributed into three categories according to the type of violence: extrafamilial assaults (137), intrafamilial assaults (35) or accidents (17). In 68 % of cases, the victims did not know their attacker. The most frequently injured body parts were the head (44 %) and the upper limbs (39 %). Average TTD (temporary total disability) duration was 9 days. Cases leading to legal proceedings mainly involved robbery with assault and battery: 60 % of extrafamilial assaults involved robbery, mainly bag-snatching. In average, TTD lasted 10 days after extrafamilial aggressions. Intrafamilial violence victims were essentially women (82 %). Taking into account the presence of several perpetrators in certain cases, 67 % of intrafamilial assaults consisted in parent abuse and 38 % in conjugal violence. Intrafamilial violence most often resulted in benign injuries, with an average TTD duration of 5 days. The most serious injuries were found in the “accidental violence” category, where average TTD duration was 16 days and where fractures were present in 19 % of cases. These mainly concerned the upper limbs (63 %), predominantly the shoulder (19 % of all fractures). Average TTD duration increased to 30 days in cases involving a fracture.

Conclusion: Although extrafamilial assaults are the most frequently reported type of violence, our hypothesis is that numerous intrafamilial assaults remain unreported. The most severe injuries result from “accidental violence”. In terms of wound severity, this is followed by extrafamilial assaults with intrafamilial violence coming last. Because they are particularly fragile, elderly victims usually suffer quite lengthy post-injury TTD, notably in case of accident. In order to improve our understanding of victimization phenomena and identify which factors influence the risk for 70+ victims of becoming bedridden, we need to explore and analyse the factors connected with physical and psychological vulnerability.


Knives and Cultures

Ahmet Nezih Kök 1, Münevver İrem Kök2, Ömer Melih Kök3

1Atatürk University Medical Faculty, Erzurum,Turkey

2Uludağ University Medical Faculty,Bursa, Turkey

3Aydin University Law Faculty, Istanbul, Turkey

Knives are known as one of the oldest human tools. It is estimated that first human used sharp stones as knives. With the invention of metal, as civilization advanced, various types of metals used in making knives (through the Stone Age, Bronze Age, and Iron Age) emerged. All advances in technology make knives more sharper and more violent. Although, a knife has been accepted as a symbol of bravery through all era, sometimes it is identified with dirty trick.

The meaning of a knife is different for each culture. For a Japanese, a knife is a tool for commiting hara-kiri. For an American, Rambo-knife is a symbol of heroism. Similarly, a knife has a culturel meaning in Erzurum.

In Erzurum, which is a city founded at the foot of the Palandöken Mountains at the altitude of 1950 meter in the east part of Turkey, knives are a part of social life. Especially, the folk dance indigenous to Erzurum called as “bar” has a main figure with knives. All cast are men with knives. This folk dance is a mark of courage and manhood.

In this study we aim to point out the relationship between knives and culture.

The type of social life doubtlessly determines the values, and these values consequently determine the behaviour of individual. On this basis, violence with knives are commonly seen in Erzurum. In 2011, 7.6 % of the judicial cases applying to Department of Forensic Medicine of Atatürk University Research Hospital to get a judicial report were suffering from stabbing. Our study doesn’t include the cases having stab wounds on head region. 92.3 % of them were male. It is a natural result because of the knife is a symbol of manhood.


Concurrent Diyadic Death Case Report

Deniz Oguzhan Melez 1, Bünyamin Baspinar1, Abdullah Avsar1, Ipek Esen Melez1, Fatih Sahin1, Taskin Ozdes2

1The Ministry of Justice Council of Forensic Medicine, Istanbul, Turkey

2Department of Forensic Medicine, Abant Izzet Baysal University, Bolu, Turkey

Introduction: If one commits suicide after a murder, this incident is defined as “suicide after homicide”. The following terms are used in the literature for this entity: ‘murder-suicide’, ‘homicide-suicide’, ‘homicide followed by suicide’, ‘murder followed by suicide’ and ‘dyadic death’.

The term of “multiple death” can be a more appropriate umbrella term for these types of events. The multiple deaths are subject to various classifications in many ways. The multiple deaths can be sorted as dyadic death (dual death), triple etc. based on the number of victims. The diadic deaths can be divided into two categories according to the timing of the incidents.

1. Concurring (or simultaneous) suicide-homicide act

These incidents are intentionally prepared with careful planning and dominated by escape psychology. These types of dyadic death events can be a result of a traffic accident, exposure to toxic gas, jumping from a height, jumping to the water for drowning, or being a suicide bomber.

2. Nonconcurring suicide-homicide act

These are suicide acts conducted by one individual starting with somewhat an unintentional homicide like a burst of rage etc. which is followed by a feel of regret or a fear of future and resulted in suicide. These types of diyadic death incidents can show variations in different societies.

Case report: In this multiple death case, a 30 year-old male and 5 year-old girl who were tied to each other with a rope was found in the water. The crime scene report, pictures, eyewitness testimonies and related media articles regarding this incident are evaluated.

In our study, our aim was to clarify the terminology and examine the perpetrator characteristics based on the motivation of this concurrent diyadic death case by mentioning the definition differences of the multiple death cases in the literature.

Discussion: The perpetrator’s main motivation in the concurrent diyadic deaths can be the concern for the person left behind or the desire to punish a third person. In these types of events in which there is no direct violent feelings to the victim, the murderer does not intend to use methods where significant external trauma is involved.

Besides, one should not disregard the fact that there is always a doubt for the possibility of a third party murdering both people or all people and preparing a fake crime scene for giving a wrong impression of diyadic death to hide his/her murder.


Case Report: The Analysis of the Motivation on Rarely Seen Multiple Death Type

Bünyamin Baspinar, Deniz Oguzhan Melez, Ipek Esen Melez, Kenan Karbeyaz, Murat Nihat Arslan

The Ministry of Justice Council of Forensic Medicine, Istanbul, Turkey

Introduction: Suicide followed by homicide (SFH) is referred to an act where the perpetrator commits suicide after he/she murders someone within a certain period of time. This circumstance is defined as ‘murder-suicide’, ‘homicide-suicide’, ‘homicide followed by suicide’, ‘murder followed by suicide’ or ‘dyadic death’ in the literature. However, there is no agreement on the definitive terms in literature.

A through search of the literature reveals that the perpetrators are males aged between 19–86 years (most between 40–59) in most cases. The perpetrators determine the pattern of the incident, which show variations based on the society and the gender. The victims are usually the individuals in close relation to the perpetrator. This type of incident is quite remarkable since it usually occurs with an unusual manner, by an unexpected person and can causes indignation in the society and sometimes an “innocent” third individual’s death. However, the law enforcement does not always pay enough attention to these incidents and the court can refuse the prosecution and the investigation can be closed due to the death of the murderer.

The aim of this study is to define the terms properly, investigate the incident pattern, possible motivations and the profiles of the involved individuals emphasizing the infrequency of female perpetrators.

Case report: The suspected perpetrator was a 33-year-old female, who was sleep-deprived, losing weight and treated for anxiety disorder with introverted personality. She committed suicide after having murdered her 33-year-old husband and 7-year-old daughter with a 9-mm pistol. According to the crime scene report and pictures, they had a fight in the bedroom prior to the incident. The body of the male, who was the actual target, was found in the bedroom. The girl was possibly murdered by accident with her body found curled up between the bed and opposite wall of the entrance of the bedroom having showed an apparent effort to hide.

Discussion: The perpetrators in multiple death cases are typically a males and the murder incident is followed by a suicide act. In our case, a female perpetrator who was in need of psychiatric treatment murdered her husband and her daughter following a discussion which was interpreted due to the mess in the house and the locations of the bodies. She possibly murdered her daughter by accident and then committed suicide due to the significant regret.



Forensic study of death by drowning in Malaga (Spain) considering several variables

Leticia Rubio 1, Fernando Martin2, Maria Jesus Gaitan1, Ignacio Miguel Santos1

1Department of Anatomy and Legal Medicine, University of Málaga, Málaga, Spain

2Institute of Legal Medicine and Pathology, Malaga, Spain

Background: The cause and the establishment of the manner of death by submersion are routine challenge for forensic pathologists that present considerable difficulties for a correct diagnosis.

The aim of the present study was to describe the most common findings in individuals who presumably died by drowning and give documented answers to relevant questions during the investigation of the death by drowning.

Methods: Based on 78 selected adult victims who presumably drowned, we analyzed the victims, autopsies, histopathology, circumstances of death, toxicology and environmental postmortem findings.

Results: From 2004 to 2011, 200 deaths by drowning occurred in the province of Malaga (Spain) in fresh and seawater. The exclusion criteria (victims < 18 years old, significant putrefactive changes, death with resuscitation attempts, no evidence of pre-existing lung pathology) left us 78 cases from which 56 cases were males and 22 cases were females, with a mean age of 57.79 and 68.45 years respectively. From 78 cases, foam was found in 49 victims (62.82 %). Lungs weighted higher than 1000 grams in the majority (80.76) of presumed victims by drowning. The remaining cases (19.24 %) showed a lung weight less than 1000 grams. Histopathological findings indicated a high incidence of rupture of alveolar septa (95.6 %) and the presence of alveolar edema (88.02 %). In female victims suicide happened in most cases (63.63 %) in contrast to the 8 cases of suicide (14.28 %) described in males. Additionally, 30.36 % of males and 18.18 % of females analyzed presented an alcohol concentration in blood higher than 0.2 g/dl.

Conclusions: A complete autopsy, histopathological examination and toxicological screening are important to determinate the manner of death.


Scuba diver deaths due to air embolism: two case reports

Nursel Türkmen1, Okan Akan2, Selçuk Çetin 1, Bülent Eren2, Murat Serdar Gürses1, Ümit Naci Gündoğmuş3

1Department of Forensic Medicine, Uludag University Medical School, Bursa, Turkey

2Bursa Branch of the Council of Forensic Medicine of the Ministry of Justice, Turkey

3The Council of Forensic Medicine of the Ministry of Justice, İstanbul, Turkey

Background: Barotrauma and decompression sickness are the two most well-known complications of diving. A diver is breathing gas at increased pressure after descending, which often leads to tissue gas supersaturating. When the ambient pressure decreases quickly following ascent to the surface, excessive formation of gas bubbles, which can enter into circulation, occurred in supersaturated tissues.

Method: We present two cases of diving fatalities due to arterial air embolism and discussed with a review of literature.

Results: Case 1: A 32 year-old male with unknown significant medical history who was a recreational diver. He was found floating prone position on the bottom of sea in a depth of 33 m. He had been carried to the surface in a controlled ascent. There were no signs of life when he arrived the hospital. Despite resuscitation attempts, he did not revive.

Case 2: This was a 39 year-old male who was experienced dive instructor in a diving school. There was no problem in the initial stage of diving. Following an uneventful duration of dive, he was found unconscious with a floating supine position in a depth of 30 m and there was no sign of life.

In both cases; post-mortem external examinations showed hemorrhagic foams around the mouth and nostrils. Extensive subcutaneous emphysema of the extremities detected by palpation of skin. X-ray images, performed before autopsy, supported subcutaneous emphysema and showed extensive gas bubbles in the great vessels. Performed autopsy and diffuse gas bubbles like beads were seen in the coronary arteries and in ventricles, basilar artery and all of the cerebral arteries. No toxic substances were found in the toxicological analysis of the blood and urine.

The pathologic cause of death was given as gas embolism and drowning for each case.

Conclusions: Air embolus, another form of decompression illness and arterial gas embolization is the second most common cause of death to divers, with squeal dependent on the final destination of the emboli with mortality rate from 7 to 14 %. In scuba diving, these gas bubbles most commonly occur in uncontrolled ascents with decreasing partial ambient pressure which results in gas coming out of supersaturated tissues into the intra-vascular space. Air embolism, associated with decompression sickness or pulmonary barotrauma during diving, can lead to various tissue and vital organ damages and may result in undesirable consequences if it enters cerebral or coronary circulation.


Inundation in Genoa: cases report of six deaths

Sara Candosin, Francesca Fossati, Luca Vallega Bernucci, Federica Portunato, Francesco Ventura

Department of Legal Medicine, University of Genoa, Italy

Background: Frequent and abundant rains, especially if lasting for several days, can pose significant problems in urban areas and emergency management is often difficult.

Additional risks arise in cases of careless town planning and maintenance of riverbeds.

Case report: Due to abundant rainfalls the city of Genoa was flooded on November 4th, 2011. More than 400 mm fell on the urban area in twelve hours, a third of the yearly precipitations.

Ferreggiano stream overflew its banks at a point of considerable narrowing, mud poured on the roads and on the nearby neighborhood where there is a high density of schools and shops.

At 13.50 many people in this area were overwhelmed, roads and buildings being flooded. The water level increased till 2–3 meters.

A mother with her own two children and another woman drowned after the lobby of the apartment building they were sheltering in filled with water. Once floodwaters receded, rescuers found the body of two other women who had been crashed between cars swept up in the current.

Autopsies on all victims were performed.

Mud and debris were found on the bodies along with non-fatal injuries probably due to crashing; muddy material mixed with water was also recovered in the airways.

In all cases cause of death was asphyxia due to flooding of the airways.

Conclusion/Discussion: The Authors emphasize the problems related to management and prevention of hazards that might occur during floods.

Over the years maintenance of riverbeds was not carried out, so riverbeds were full of vegetation and building was poorly controlled thus narrowing the riverbed hence favouring the overspill.

Furthermore, in previous days, weather forecasts predicted joining of multiple fronts of precipitation, which would have caused heavy rainfall.

Despite authorities declared a second grade state of alert (scale 0–2), schools remained open and people underestimated all warnings.

When muddy torrent arrived many people were in the streets, including workers and those who had gone to take their children from school.

In natural events citizens must be adequately informed and invited to avoid places where escape is difficult.

In this report it is important to underline that serious damages and deaths might have been avoided with proper management of the emergency and risks.


Postmortem macropathologic findings in drowning: saltwater and freshwater drowning

María D Pérez Cárceles 1, Agustin Sibón2, Estefanía Barrera2, Juan P Hernández Del Rincón1, Aurelio Luna1

1Department of Legal and Forensic Medicine, University of Murcia, Spain

2Institute of Legal and Forensic Medicine, Cádiz, Spain

The pathologic findings in autopsies of drowning victims are nonspecific and vary from case to case. The first step in the autopsy room to the diagnosis of drowning is the detailed analysis of postmortem macropathologic changes. The aim of study is to analyze the pathological data in cases of drowning and if there are significant differences between saltwater and freshwater drowning. We studied 140 cases (132 males and 8 females) of drowning (107 saltwater drowning and 33 freshwater drowning) selected from medico-legal autopsies performed in the Institute of Forensic Medicine, Cadiz (southern Spain). The mean age of the subjects was 47.1 years (SD 18.6; range 2–87 years), while the mean post-mortem interval was 27.5 h (SD 19.8; range 3–96 h). We evaluate macropathologic changes with particular attention to the presence of a external foam, a frothy exudate in the airway, the presence of a pleural effusion, water into the stomach >500 ml and lung weight. The presence of these pathological changes were 36.4 %, 46.4 %, 14.3 %, 52.1 %, respectively. Mean of lung right weight was 691.9 g and lung left weight 633.5 g. We found statistical significant differences between saltwater drowning and freshwater drowning in the presence of external foam (41.1 % vs 21.2 %; P = 0.028), pleural effusion (16.8 % vs 6.1 %; P = 0.04), lung right weight (738.5 g vs 537.5 g; P < 0.0001) and lung left weight (669 g vs 516 g; P < 0.0001). Macromorphologic pathologic findings no allow a definite diagnosis of drowning and there are differences in the presence of these signs between saltwater and freshwater drowning.


Drowing: autopsy and laboratory findings in 197 cases in the Attica region

Dimitrios Vlachodimitropoulos, Emmanouil Sakelliadis, Nikolaos Goutas, Sotirios Athanaselis, Stavroula Papaodima, Chara Spiliopoulou

Department of Forensic Medicine & Toxicology, Faculty of Medicine, National & Kapodistrian University of Athens, Athens, Greece

Introduction: The purpose of this report is to describe the main autopsy and laboratory findings from a large number of drowning victims in Greece. In most countries the average age of drowning victims is relatively young.

Methods: A retrospective analysis was carried out of the consecutive cases of drowning victims autopsied in our department during the period 1997–2004.

Results: A total of 197 submersion cases were referred to the Department. In 168 cases drowning was considered as the cause of death. In 82 cases (49 %) significant histopathological findings from the cardiovascular system were present. Alcohol was found in 21 cases (13 %) and psychoactive substances in 4 cases (2 %). Food was found in the stomach of 45 drowning victims (27 %). Men (65 %) and elderly people (60 years and older, 74 %) made up the majority of drowning victims. In 29 submersion cases the cause of death was other than drowning; in 25 of these cases death was attributed to cardiovascular disease (complication of coronary artery disease, 23 cases; dissecting aortic aneurysm, 1 case; cerebral stroke, 1 case).

Conclusions: The great majority of drowning victims are the elderly and men. Moreover, in a considerable number of submersion cases cardiovascular disease was related to the death, either as a contributing factor, or as the cause of death.



Fatal victim by natural or cosmic electrical discharge (Fulmination) occurred in Mato Grosso State- Brazil

Manoel Campos Neto 1, Vidal Haddad Júnior2, Caroline A. Magalhães Castlhone3, Ivo Antonio Vieira4

1POLITEC - Perícia e Identificação Técnica - Seção de Medicina Legal - Regional de Cáceres-Mato Grosso-Brasil.

2UNESP-Universidade Estadual Paulista-Departamento de Dermatologia e Radioterapia-Botucatu-São Paulo-Brasil

3IFSP-Instituto Federal de Educação Ciência e Tecnologia de São Paulo

4MINISTÉRIO DA FAZENDA - Departamento de Perícia Oficial Federal - Cuiabá - Mato Grosso - Brasil

Introduction: the Pantanal of Mato Grosso belongs to the Midwest Region and is part of the Amazon. In the summer temperatures, and has flooded large areas, favoring evaporation. The tropical rains (six months per year) are more constant, always accompanied by lightning. Human losses by cosmic electricity are rare. REPORT: E.F.S., 38 year-old man was in a landing boat during a storm and protect himself, sought shelter under a tree (Jatobá). Supported the right hand on the trunk and instantly fell an electric shock on the crown, hitting the victim, who died instantly.

Autopsy: The body was completely wet and smelled a strong odor of burnt hair. The clothes were partially torn. We find second-degree burns with the presence of hair and hair scorched and brittle, and blistering routes in the path of the passage of electricity through the body. Regions: the right axillary, anterior chest, peri-umbilical, groin, scrotum, and left leg, had burned by blistering and small routes, also present in the gluteal region.

Signs of choking: small areas of bleeding and intra-ocular congestion and cyanosis of the face, lips, tongue, oral mucosa and neck regions. At the autopsy itself, we find in the cranial cavity, small areas of parenchymal hemorrhages involving regions of the nervous centers. The lungs were slightly enlarged with various regions of visceral bruising and a small tear in the right upper lobe, through which flowed a small amount of dark liquid blood, the blood had pericardial cavity (hemopericardium), liquid and well-looking dark. The heart had a laceration of about 3.5 cm long, located in the lobby, through which flowed too small amount of blood drained into the pericardial cavity. As part of the heart muscle still showed fasciculations, probably due to the action of electricity in parts of the cardiac walls.

Discussion: the atria have thinner walls, especially the auricle, with a maximum of 2 mm thick and therefore more easily break. (information taken from an interview with the cardiologist Nivaldo Cortella). Apud França (2011): "The site survey is essential. Death is due to pulmonary tetanization of respiratory muscles (diaphragm and intercostals) and vasomotor phenomena. The stop breathing before the cardiac arrest".

Conclusion: the victim's death was caused by asphyxia, acute respiratory failure, cardiopulmonary arrest, atrial wall rupture and hemopericardium with cardiac tamponade, cerebral edema and hemorrhage by the action of natural electricity or cosmic - fulmination.


Two fatal cases of high-voltage electrocution during theft of copper wires from the same abandoned warehouse

Alessandro Bonsignore, Camilla Tettamanti, Anna Smith, Francesco Ventura

Department of Legal Medicine, University of Genova, Italy

Background: Electrocution while trying to steal copper wire that is carrying a live current is an uncommon cause of death seen in our Department and around the world. Death is related to abnormal electrical rhythms in the heart and brain, and production of internal and external electrical burns. Particularly, high-voltage electrical injuries result in high mortality and morbidity. Theft of copper, mainly from electrical wires, is becoming a more frequent crime as the value of this metal rises and it is easily re-salable. Thieves are generally young and socially disadvantaged.

Case report: In the last year our Department of Legal Medicine examined firstly a 22 year-old men found lifeless inside a high-voltage central electric unit of an abandoned warehouse. 8 months later, another guy (19-year-old) of the same ethnic group died in the same place, which was still restricted for the previous case, and circumstances. Scene investigations in both cases showed the bodies close to bits of copper wires, and the presence of cutters and other electrical tools. Forensic autopsies were performed in order to define the cause of death. Gross and internal examinations revealed electrical burns all over the body showing central erythema with charring of skin and loss of tissue.

Toxicological analysis of urine samples resulted as negative for the first decedent, while the second one was intoxicated with tetrahydrocannabinol. Carboxyhemoglobin analysis revealed a value of 8,2 % and 8,9 % respectively. Evaluation of the circumstances surrounding death made it reasonably clear that in both cases the decedents underwent electrocution while trying to steal copper wires from the electrical substation (15000 V).

Discussion: Despite the fact that numerous fatal accidents caused by copper theft are reported by the media, the number of thieves does not appear to be diminishing, and the incidence of electrocution due to the theft of copper wires will likely continue to be a problem as long as copper prices remain high and thieves believe they know how to identify inactive electric substations.

Conclusion: Our report clearly shows that theft of copper-related electrical injury is becoming more frequent in the community and should be added as a “new” risk factor for electrocution. According to that, forensic pathologists need to consider these circumstances as possible cause of electrical deaths. To keep copper theft to a minimum and consequently prevent copper-related life-threatening events, metal recyclers should be subject to tighter regulations and monitored more frequently.


A retrospective descriptive study of electrocution deaths in Northern Tunisia: 2007–2011

Fatma Gloulou, Olfa Bekir, Maha Shimi, Mohamed Allouche, Mehdi Ben Khelil, Anis Benzarti, Ahmed Banasr, Mongi Zhioua, Moncef Hamdoun

Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia

Electrical injuries are responsible for considerable morbidity and mortality all over the world. Yet, they are usually preventable with simple safety measures, making death by electrocution one of the most preventable causes of death.

There is a paucity of data with regards to non-lightning, electrical-related injuries in Tunisia.

This study aimed to retrospectively review all high- and low-voltage-electrocution-fatality cases investigated in the department of forensic medicine in Tunis for the period 2007–2011.

Altogether, 151 electrocution-related deaths were identified, of which 85 cases (56 %) represented low-voltage-electrocution deaths and 66 (44 %) represented high-voltage-electrocution deaths. All cases were reviewed from a demographic and pathology-of-trauma point of view.

Victims were most frequently males (131) with a male to female ratio of 6.5:1. Victims were aged 2 to 81 years old with a mean age of 32.37 years. The majority of deaths occurred in the 21–30 year age group (49 cases, 32.45 %), during the summer (54 cases, 35.7 %) and autumn (44 cases, 29 %) with the lowest number of deaths occurring in winter (25 cases, 16.5 %). There was no electrical contact mark present in 18 cases (12 %). One hundred and sixteen cases (76.8 %) were dead on arrival at hospital.

Electrocution was most frequently accidental, on the workplace (65 cases, 43 %), at home (50 cases, 33 %) and in common public areas (32 cases, 21 %). Two cases were classified suicides and the victims were both men with psychiatric illness who electrocuted themselves in public areas. Only one case was classified homicide in which a 52-year old man was electrocuted by his wife and her lover.

This study shows a high number of electrocution-related fatality cases in Northern Tunisia as compared with the rest of the world. It also shows a significantly higher rate of electrocution deaths among males, a high proportion of high-voltage-electrocution deaths and a lack of safety on the workplace.

It also serves to highlight the need for more active workplace and domestic safety campaigns.


Medicolegal Approach to Electric Cataract: A Case Report

Ertuğrul Gök 1, Recep Fedakar1, Naile Esra Saka2

1Department of Forensic Medicine, School of Medicine, Uludağ University, Bursa, Turkey

2Bursa Branch of the Council of Forensic Medicine, Bursa, Turkey

Background: Electrical current injuries are still in effect today. Besides high paced industrialization, carelessness is also a cause of these incidents. In fact, cataract caused by electricity injuries are quite rare.

Methods: Following the examination of the individual who was sent to our branch management for forensic examination report, by DA’s office, we have reviewed the medical and forensics investigation document of the case and literature about this incident. We reported a case, whose in both eyes bilateral cataract developed after some time exposing to high voltage current and survived.

Results: 24 year old male; injured 3 years ago, due to accidental contact with a power line while working in the farm. In the hospital he was taken, 2nd degree burn on the face and neck, one entry wound on the scalp with hair, plus, necrosed exit wounds on bilateral inner sides of both ankles with a wound scar in the sole of left foot additionally an exit scar under the 4th toe of the right foot were recognized.

Emergency scanning was negative for any significant pathology. Patient received multidisciplinary treatment by many physicians and follow-up at the burn unit for 35 days.

During his stay at the hospital, eye consultations showed no discrepancy. In the end, he was discharged without any visible deficit. Several weeks following his discharge, as he has gone back to another hospital for vision impairment, he was diagnosed for bilateral cataract. Vision impairment was resolved by bilateral lens implantation.

Conclusion: It shouldn’t be forgotten that cataract due to electric injury may appear long after the primary incident. Therefore physicians should always be alert and aware of this issue.


Neuron loss in the dentate gyrus due to electric injury: An experimental rat study

Ayşe Kurtuluş 1, Goksin Nilufer Yonguc2, Kemalettin Acar1, Esat Adiguzel3, Bora Boz1

1Pamukkale University, Faculty of Medicine, Department of Forensic Medicine

2Izmir University, Faculty of Medicine, Department of Anatomy

3Pamukkale University, Faculty of Medicine, Department of Anatomy

Neuropsychological changes including deficits of cognitive functions have been reported in electrical injury survivors. The dentate gyrus is a part of the hippocampal formation. It is thought to contribute to the formation of new memories as well as possessing other functional roles. The aim of the present study is to examine the effect of electrical injury in the dentate gyrus granule cell layer.

Fifteen Wistar rats were diveded into three groups: 1st Group, control group; 2nd Group, the points of electrical contact were on the dorsal skin in this group; 3rd Group, the points of electrical contact were on the temporal region in this group. The current was the usual city current (110 V, 50 Hz, 100A AC). On the 3rd day, rats were decapitated; brains were removed, sectioned and stained with H&E. The total granule neuron number in the granule cell layer of the rat dentate gyrus was estimated using by optical fractionator method, an unbiased stereological method.

The total neuron number (mean ± SEM) of the dentate gyrus was 248155 ± 3940, 196094 ± 6526 and 173752 ± 5219 in the 1st, 2nd and 3rd groups, respectively. The total neuron number was significantly decreased in the 2nd and 3rd groups compared to 1th group (p < 0.05). There was no significant difference between the 2nd and 3rd groups (p > 0.05).

In conclusion, electrocution leads to granule neuron loss in the dentate gyrus in rats. Localization of the contact point may have no effect on granule neuron loss in the dentate gyrus even it is on head or dorsal region.


Untypical Circumstances Of Death During Angling

Pawel Swiderski, Czeslaw Zaba, Dorota Lorkiewicz Muszynska, Artur Tezyk

Chair and Department of Forensic Medicine, Poznan University of Medical Sciences, Poland

Background: The authors present a case of sudden death of a 56-year-old male during angling. The man was found sitting on a stool on the shore of the lake, presenting symptoms of cardiac arrest. Medical Air Rescue arrived at the place and started CPR procedures but without success and the patient was pronounced dead. Near the body a fishing rod was found. The prosecutor ordered the autopsy examination of the cadaver.

Methods: The autopsy with toxicological and microscopic examinations were performed. The external inspection of the body revealed the presence of electrical burns on the palmar surface of the right hand, right thumb, forefinger and middle finger and the same type of lesions on the left toe and on the posterior surface of the right thigh. The internal examination showed enlargement of the heart and coronary atherosclerosis. The toxicological examination revealed the presence of ethyl alcohol in the blood (1,2 ‰) and in the urine (1,6 ‰). In the microscopic examination of the electrical burns the epidermis showed a ‘Swiss cheese appearance’. The autopsy findings proved that the cause of death of the 56-year-old male was electrocution.

During the inspection of the place of death the Police noticed that above the stool of the angler was a high-voltage line (15000 V). The height from the ground to the high-voltage line reached 8,5 meters. The length of the fishing rod lying near the body was 8 meters and the rod was made of carbon fibre. Carbon fibre is a very good conductor of electric current. The stool which the angler was sitting on was made of metal.

Results and conclusion: The Police investigation and the autopsy results explained the manner and mechanism of death of the angler. During angling the man was holding the fishing rod in the right hand and he was sitting on the stool. Accidentally he must have touched the high-voltage line above him by the end of the long fishing rod. That caused the electrocution and location of the electrical burns on the body fits the sitting position of the angler in the moment of electrical injury. The point of entry of current was in the right palm and fingers and the point of exit was situated on the posterior surface of the right thigh and on the left toe. The victim didn’t preserve appropriate caution during angling and didn’t notice the high-voltage line above him.


Lightning associated deaths: a case report

Mustafa Balkay 1, Safa Celik1, Cem Uysal2, Taşkın Özdeş3, Ibrahim Üzün1

1Council of Forensic Medicine, Istanbul, Turkey

2Dicle Universty, Faculty of Medicine, Department of Forensic Medicine, Diyarbakır, Turkey

3Abant Izzet Baysal Universty, Faculty of Medicine, Department of Forensic Medicine, Bolu, Turkey

Lightning shock (LS) related deaths shows the regional and seasonal changes. Lightning shock related injuries are parallel with the number of the lightning and frequently seen in June, July, August and September. The victims are people who often exist or work outdoors such as farmers, campers, hikers, construction workers, golfers and hunters. Inside the home the victims are especially telephone or other household appliances users. Lightning shock related deaths usually exist with a high-voltage current. Death occurs as a result of cardiac and respiratory arrest or electrothermal injuries. In this poster presentation, a lightning shock death case is discussed and evaluated with literature.

In our case, while 3 shepherd grazing their sheeps, the lightning fell on two of them. One of them injuried and the other one died at the scene of accident. At the same, lightning also was died three goats. Our case was a 49-year-old man, his systematic autopsy was performed another provicial branch of the Council of Forensic Medicine. The typical lightning shock related skin lesions, edema and hyperemia of internal organs and fumigated areas on the hair were detected at autopsy. The criminal investigation file and autopsy report were sent to the Council of Forensic Medicine First Specialization Board and asked the cause of death by the prosecutor's office. After evaluation of death scene investigation report and autopsy findings Council of Forensic Medicine First Specialization Board was decided that the cause of was originated from lightning shock.

Lightning shock related deaths generally occur at the open field. This type of deaths are rarely seen. For this reason death scene investigation and performing autopsy should be done. Lightning protection information should be described people, who especially exist or work outdoors, to reduce lightning shock-related injuries and death.



Whose Decision is this or Hippocrates’ Dilemma

Tamer Akça1, Nursel Gamsız Bilgin 2

1Department of General Surgery, Medical Faculty of Mersin University, Mersin, Turkey.

2Department of Forensic Medicine, Medical Faculty of Mersin University, Mersin, Turkey.

There sit the sons of Dark Night,

Sleep and Death, the horrible gods.

Sun never sends its light to them

During neither rising to sky nor sunset,

One walks over the backing of the soil and sea

Brings sweet peace for people,

Others heart is from iron, its soul is from bronze.

Captured human cannot escape from its hands

It hates even immortal gods …

In his book “Thegonia”, Hesiodos told so about the Death (Thanatos) staying with its brother Sleep (Hypnos) in deepness of Underground (Tartaros). Hesiodos is accepted as creator of Greek Pantheon with great Poet Homeros and granted numberless descriptions and names to medicine science. Thanatos (Death) the eponym of “Euthanasia” was one of them. Euthanasia comes from Greek words “eu” (good, beautiful) and “thanatosis” (death). It is used nowadays as the same meaning with “death without pain”, “death without ache” or “mercy killing”.

Ok, but why does a people want to die? While continuing their bloodline is expressed into their genes and (consciously or unconsciously) they are looking for getting back their natural immortality right which was taken from them since first sin, how can the human beings abandon their right?

Is the reason the fact that life is together with death? Or is it fatalism ruling to surrender the unique inevitable reality?

Like Ivan Illich brought forward, I think that sterilized death desire in the conditions of today (death desire while all of clinical data are normal and people is under diligent control of intensive care units till the last breath) is the decision of very strong people. However just a couple of thousands years ago (I mean before the people became enemy of nature); aging, patience and death was a postulated part of life.

Well, which changes made human beings to claim the right to speak about their own bodies so loudly?

In this study, these changes causing the loudly claiming the right of euthanasia and some examples for ethical discussions about these changes will be provided.


Perimortem Cesarean Section on an Ambulance: case report and bioethical considerations

Marco Chiaravalli 1, Laura Guzzetti2, Francesca Gatti3, Mario Picozzi1

1Dipartimento di Biotecnologie e Scienze della Vita, Università degli Studi dell'Insubria, Varese, Italy

2Dipartimento di Specialità Chirurgiche, Scienze Radiologiche e Medico Forensi, Università degli Studi di Brescia, Brescia, Italy

3Azienda Ospedaliera Sant'Anna, Unità Operativa di Anestesia e Rianimazione 2, Como, Italy

The authors describe a rare case of Perimortem Cesarean Section, performed on an ambulance in an external hospital emergency call, with survival of the fetus in the immediate future and a year from the event (without neurological deficiencies). This fact is analyzed both from a legal (according to the Italian law) and ethical-deontological aspect. In particular: the behaviour of a non specialist in obstetrics in a non-hospital environment, the role of international guidelines (conceived for the intra-hospital environment) and the value given to the evaluation of the chances of the mother’s survival are analyzed. The authors, in accordance with international guidelines, affirm that the fetus survival is strictly related to the mother’s life, thus consider it a priority to make sure that the mother gets all the cures recommended by the protocol, saving the Perimortem Caesarean Section in a non-hospital environment in those cases in which the evaluation of the mother’s chances to survive are equal or close to zero (emphasis on the attempt to save the fetus) or to those cases in which the evacuation of the fetus could re-establish the mother’s cardio-circulatory activity (attempt to save both the mother and the fetus).


Frozen Undeads or Legal Deads

Nursel Gamsız Bilgin 1, Tamer Akça2

1Department of Forensic Medicine, Medical Faculty of Mersin University, Mersin, Turkey.

2Department of General Surgery, Medical Faculty of Mersin University, Mersin, Turkey.

“Ah, there is ice around me; my hand burneth with the iciness! Ah, there is thirst in me; it panteth after your thirst! ”

Friedrich Nietzsche

She took a last look around before entering the building with a writing “LIFE THROUGH ETERNITY” at the door. The place, like an oasis, located in the middle of the land, reminded her, the Garden of Eden. Under the trees reaching to the sky to catch the clouds, colorful flowerbeds in dark shadows lied over emerald green grass, filling the heart with a childish happiness. She could even hear the voice of her thoughts in a deep and calm silence. She thought “my childhood” and sighed, “so far away”. Then, she desperately looked at the building: “especially at this very moment…”

As she headed to the entrance, an inner voice kept saying “turn back”. “Turn back and run away.”

She said “no” to the inner voice. For a moment, she thought she heard her own voice. Was she really talking to herself, or was it just a trick of her own mind? She said “no”, “the heaven is standing right in front of me. I am facing the door that leads to immortality.”

The inner voice was not listening to her. “Funny. Not immortality, but an endless uncertainty is waiting for you. The real heaven is out of the door you are trying to enter, not behind. If you have the courage, turn back and look at the world again. Do you think that you will see all these things again once you wake up?”

No way… She built all her plans and spent all her money. Determined not to make any more discussion, she entered the building between sliding doors. As she shook hands with a man with a white coat, she pretended not to hear the last words of her inner voice:

“What about your family, your friends? Tell me, are you going to take them with you?”

“Immortality” is the new pledge of this technology which entered in our lives. Technical, legal, theological and ethical discussions about this topic do not seem to end, just like any other innovations. We cannot explain all of them together in details; one example question for each topic will be discussed in this study.


Elder Discrimination Towards Hospitalized Patients

Oya Öğenler1, Gülçin Yaıpıcı2, Nursel Gamsız Bilgin 3

1Department of History of Medicine and Ethics, Mersin University Medical Faculty, Mersin, Turkey

2Department of Public Health, Mersin University Medical Faculty, Mersin, Turkey

3Department of Forensic Medicine, Mersin University Medical Faculty, Mersin, Turkey

Introduction: Elders need more health services than other age groups. During the provision of health services age discrimination may negatively affect elder patients. In this study, it was aimed to determine that whether age discrimination exists for hospitalized patients.

Material-method: Our study was conducted on 298 hospitalized patients. The questionnaire consists of 8 questions trying to determine patients’ socio-demographic attributes and 22 items prepared by the authors for the purpose of determining age discrimination through the physical properties of the hospital and the behaviors of the staff. While frequency and mean ± standard deviation were used in summarizing the data, chi-square and t-test were utilized for comparing the groups.

Findings: It was determined that 54.9 % of the patients included in the study were male, 72.8 % of them were married, 79.5 % were subject to the social security institution and 16.8 % had green card security. The average of age of the patients was 53.1 ± 17.4. It was determined that, as the ages of the patients get older they have more difficulty in finding the rooms for examination and staying at the hospital, the operation the patients will undergo are most of the time explained to their relatives, that older patients are given priority during examination in comparison with younger patients, that health personnel tend to shout more to older patients and spend less time with them in comparison with younger patients, and that they show signs of exasperation when dealing with older patients (p < 0.05). As the patients’ ages get older they showed less consent in giving their beds to younger patients (p < 0.001). Health personnel tend to address female patients (58.6 %), patients with primary school or lower education (53.3 %) and patients with green card (66.0 %) as aunt or uncle (p < 0.05). It was also determined that 53.7 % of the patients prefer to be addressed with their names.

Conclusion: It was determined in our study that, older patients are negatively affected from the physical characteristics of the hospital and are uncomfortable with some negative attitudes of the health staff. In order to ensure that the patients benefit from health services equally the determined negativities have to be rectified and positive aspects have to be strengthened. Raising the patients’ awareness on their rights and increasing the sensitivity of health personnel will negate the existing discriminations based on age.


Post Partum Abortion as an extreme expression of the Bioethical views that are dangerous to human life

Polichronis Voultsos1, Fotios Chatzinikolaou 1, Alexandra Enache2

1Aristotle University of Thessaloniki, Lab of Forensic Medicine and Toxicology, Greece

2University of Medicine and Pharmacy Victor Babeş Timisoara, Romania

A significant deviation from the principles of ontological personalism and self-determination has been noted in the trends of modern bioethics, which entail a risk to human life. To this end it is considered that there is no “person” when certain brain functions are missing (self-realisation, communication, emotion, minimum moral conscience, etc) or where there is no conscious interest in life, a vital prospect and the assessment by its agency. The threat to human life becomes even more apparent in the marginal phases of the end (cortical death, patients in PVS, dementia etc) and its commencement: minimal protection for the in vitro embryo, wide acceptance of premature (passive) euthanasia, the extension of eugenic abortion until the end of the pregnancy, abortion permitted during childbirth and during the neonatal period (post partum), i.e. permissible infanticide! It is a fact that during the modern age of the technical sciences in medical biology, the neural sciences and genomics, the fundamental bioethical concepts are redefined in terms of their content and hierarchical position through a multilevel cultural interaction. Some concepts need to have an absolute force despite the pluralistic nature of bioethics in order to avoid absolute and dangerous relativism and legal positivism. This is the concept of the “person”, where the meaning and limits cannot be defined by anthropological or socio-cultural criteria. The purpose of this study is to demonstrate that the view in favour of the admissibility of infanticide is an extreme form of the dangerous approach to the bioethics of the person and to investigate whether the deviation from ontological personalism to less severe forms of personalism is in line with the excellent protection of human life.


Organ donation for transplantation: a survey among medical students

Harald Jung, Imre Egyed Zsigmond, Klara Brînzaniuc

Univer Med & Pharm Tg-Mures

Introduction: organ transplantation is a synonym with modernism in nowadays medicine. Tissue donation has become recently a preoccupation of forensic pathologists as well. Organ and tissue shortage is a consequence of donation refusal by the family members in some cases. Investigation of medical students’ opinions may provide evidence for educational strategies to be used in the medical universities in order to improve people’s perception of the donation act.

Material-method: we performed a cross-sectional study by interviewing 140 second and third year medical students from the University of Medicine and Pharmacy Tîrgu Mureş, Romania. The questionnaire contained 22 items and included questions concerning legislative knowledge about autopsy and organ donation and for exploration of the reasons not to donate organs or tissues from a deceased person (family member).

Results: We interviewed 140 students (mean age of 20.5 years), 42 (30 %) and 98 females (70 %). Most of the respondents lived in urban areas (78.6 %). 89 students (63.6) declared they already talked within their families about organ donation. Overall 81.4 % agreed to donate their own organs after death (no significant gender-difference) while only 61.4 % expressed their willingness to donate a close relative’s organs in the eventuality of brain-death. Desire of beloved body integrity preservation for emotional reasons was the most indicated answer when asking about reasoning, the second argument being “respect towards the deceased person”. Religious motives have been indicated only three times. Church attendance was irrelevant in relation to the willingness to donate.

Discussions: the Eurobarometer survey (2010) concerning organ donation in Europe revealed that 31 % of the Europeans unwilling to donate are unable to give a reason for their decision while only 7 % indicated religious reasons. Within our group the distrust in the health system and fear of improper body manipulation were less significant than in the European survey, possible due to the specificity of our group.

Conclusions: reluctance to donate a close relative’s organs after death is more increased compared to that to donate own organs after deaths. Social and religious affiliation do not seem to influence, instead emotional and moral factors are most frequently invoked by medical students in our survey group as justification of indecision or refusal of organ donation.

Acknowledgement: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 60782.


Ethical decision making in neonatal resuscitation, a case report

Cécile Manaouil, Maxime Gignon, George Adrian Patru, Olivier Jarde

University hospital Amiens, Department of Forensic Medicine

On 2 June 2009, the Nîmes administrative court condemned the Hospital of Orange (France) for unreasonable obstinacy after neonatal resuscitation.

On 14 December 2002, an apparently stillborn child was resuscitated after approximately 30 minutes of foetal distress. Cardiac activity was recovered, but the child has since suffered from severe disabilities.

The court did not find any fault committed by the hospital regarding maternal care. However, the hospital was sentenced to compensate for the injuries caused by unreasonable obstinacy. According to the court, the medical team should have taken into account the harmful neurological consequences of prolonged foetal distress.

The court did not condemn the act of resuscitation itself, but its excessive length.

This court ruling serves as a basis for reflection regarding the limits by which unreasonable obstinacy should be set.


Ethical and forensic psychiatric contributions to living organ donors’ evaluation

Harald Jung 1, Klara Brînzaniuc2, Mihai Ardelean3, Imre Egyed Zsigmond2

1Univer Med & Pharm Tg-Mures, Institute of Legal Medicine, Romania

2Univer Med & Pharm Tg-Mures, Romania

3Mental Health Centre Tirgu Mures, Romania

Background: evaluation of living organ, tissue or cell donors is required in order to establish both the existence and the capacity to express a free and informed consent on the donation for transplantation process. Different views of autonomy might influence the decision if a donor’s offer is ethically acceptable. Acceptability of a prospective donor might be influenced by cultural, legal and social situations in different countries. Evaluation of the capacity to donate is in Romania the task of a joint forensic medicine and psychiatric commission.

Method: we analyze the case of a young man with mild mental retardation who was willing to donate a kidney to distant relative and in whom a rejection decision was finally made by the ethics commission based on a forensic expert opinion. We investigated elements of mental status examination, the process of understanding the recipient’s illness and transplantation outcomes, aspects of psychosocial stability, affective relationship with the recipient, education, social and familial insertion.

Results: based on our case analysis and review of the literature we aimed to elaborate a semi-structured interview as tool of assessment of living donors consent and capacity to donate an organ for transplantation. We propose the following items: understanding of the recipient’s illness, understanding of the transplantation process (including risks), decision to donate development, knowledge of post-donation health risks, right to reconsider. Each item contains a range of questions and finally a scoring from one to three is established by the interviewer. Moreover, a context of psychiatric history, personality style and mental status examination should complete the interview.

Conclusions: the donor’s autonomous and voluntary decision is a necessary prerequisite for allowing a physician to hurt one person in order to help another. Ethical principles must be completed with medico-legal psychiatric standards for settle some cases in the “grey zone”.

Acknowledgement: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 60782.


Anencephaly organ donation: how the Brazilian government understands this issue

Fabiana Iglesias De Carvalho 1, Francisco Iglesias De Carvalho3, Carmen Silvia Molleis Galego Miziara1, Ivan Dieb Miziara2, Daniel Romero Muñoz1

1Department of Legal, Ethical, Social and Work Health at the School of Health at São Paulo University (USP)

2Legal Medicine and Medical Deontology at the ABC Medicine School

3Mackenzie University

Brazil ranks as the fourth country in the world with the most prevalence of anencephaly according to recent data from the World Health Organization. However, it is still forbidden in Brazil to interrupt the pregnancy of an anencephalic fetus. The present study objective is to analyze the medical, legal and ethical challenges imposed by the debate of use of organs from anencephalic neonates for transplantation from the point of view of bioethics in Brazil. The path chosen to achieve this goal was a descriptive and exploratory method through the use of literature search conducted from books, magazines, papers, journals. Anencephaly is a severe defect of the embryonic central nervous system and has been the subject of heated debates in various sectors of Brazilian society and several questions can be brought up: 1. Should babies with anencephaly be considered as persons? 2. Are they potential organ donors? 3. If so, under which circumstances? 4. Can the definition of death or brain death be changed? 5. Should we practice intensive support of life for neonates with anencephaly in anticipation of brain death? 6. How should priorities be determined in neonatal units with limited resources? The present project has as its main goal to contribute to the debate about the anencephalic as organ donor and to the legal and ethical issues surrounding the topic. The current Brazilian law prevents the use of anencephalic as a donor, while holding signs of life with spontaneous breathing and crying, because they are positive signs of activity in the brainstem and not full characterization of brain death. Therefore, it is evident that there is no consensus about the procedures that should be employed to the neonate anencephalic, in that its death is merely a matter of time. The fact is that, pending meeting the criteria for brainstem death, you cannot get organs that are viable for transplant. Even with intensive therapy, the typical repeated apneas and bradycardia will cause hypoxic and ischemic lesions in the organs before death, becoming limited to the anencephalic organ donation. The stillborn fetus with anencephaly is a potential organ donor, if this is the will of the pregnant woman to do so.


Medicolegal Evaluation of Informed Consent Forms Used in A Cardiology Clinic in A Training and Research Hospital in Istanbul

Berna Aybek 1, Ahsen Kaya2, Coskun Yorulmaz2

1Istanbul University, Faculty of Health Sciences, Postgraduate Student of Health Care Management, Turkey

2Istanbul University Cerrahpasa Faculty of Medicine, Department of Forensic Medicine, Turkey

Background: Informed consent originates from the legal and ethical rights of the patients. Patients have to know what will happen or what will be done to their body and make decision about their own body. Physicians’ one of the ethical duties is to give their patients information about their health. In this study, it is aimed to analyze the informed consent forms in medico legal aspect and to determine if they are accordance with Turkish Laws or not and if there is any need for revision of forms or not. In this context, it is wanted to emphasize that why the informed consent is necessary, how the informed consents should be taken, what the physician's legal responsibility about informed consent.

Method: For this study, ethics permission document and corporation permission from Istanbul Provincial Directorate of Health were taken. Records of patients, who were hospitalized in a cardiology clinic in a Training and Research Hospital between 01 January 2011 and 30 June 2011, were analyzed retrospectively. 189 patients’ records were randomly selected from among 1807 hospitalized patients’ records. Data about informed consents were statistically analyzed using SPSS programme (version 14.0).

Results: In this study, 189 patients’ informed consent forms were analyzed. 127 males and 62 females, having the age range 16 to 92 years, were studied. It was detected that 99 patients (52.3 %) had signed the informed consent forms themselves. There wasn’t any signature on 3 (1.5 %) of 189. There were 186 (98.4 %) informed consents for hospitalization. Also, there were informed consents forms for 75.5 % (n = 73) of patients with stent, 84.1 % (n = 117) of patients applied angiography, 86.7 % (n = 13) of patients applied transesophageal echocardiography and 50 % of the patients with pacemaker.

Conclusion: Patients must be enough and voluntary to make decision and also understand the application about themselves. These are mandatory for informed consent in medical ethics. Informed consent is a very important medicolegal risk management tool. With this tool, physicians can minimize their juridical and criminal risks. An informed consent includes the nature of the decision/procedure, reasonable alternatives to the proposed intervention, the relevant risks, benefits, and uncertainties related to each alternative, assessment of patient understanding, the acceptance of the intervention by the patient. Success in informed consent increases parallel with the communication skills. There are some deficiencies about using forms in Turkey. For both patients and physicians goodness, knowledge about informed consents must be increased.


The responsibilities of a health volunteer rescuer: ethical and medical-legal considerations

Marco Chiaravalli 1, Laura Guzzetti2, Giuliano Zocchi3, Jutta Maria Birkhoff1

1Dipartimento di Biotecnologie e Scienze della Vita, Università degli Studi dell'Insubria, Varese, Italy

2Dipartimento di Specialità Chirurgiche, Scienze Radiologiche e Medico Forensi, Università degli Studi di Brescia, Brescia, Italy

3Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Unità Operativa di Anestesia e Rianimazione B, Varese, Italy

In Italy, the organization of health services of external hospital emergency and urgency calls is based on skilled rescue teams (made up of a doctor, a nurse and technical staff) and rescue teams of volunteers coming from rescue associations. The authors analyze the figure of the health volunteer rescuer into the external hospital emergency and urgency system, focusing on the peculiar ethical and medical-legal aspects that characterize the responsibilities in civil and penal areas (according to the Italian legal system). Furthermore, also the responsibilities of the health volunteer rescuer that works in a team with the medical staff are analyzed together with the form of responsibility that characterizes the doctor or nurse that carries out voluntary activities in his/her free time.


Smoking Ban In Turkey Through Different Ethical Arguments and Legal Approach

İnci Hot1, Elif Vatanoglu Lutz 2

1istanbul University Cerrahpaşa Medical Faculty

2Yeditepe University Medical Faculty

In Turkey, The World Health Organization Tobacco Control Framework Agreement was approved on 25 November 2004 by the act no 5261 and as an agreement that was published in the Official Gazette, it has the same status as any other Turkish Act. Although the use of tobacco is a global problem the parties to the agreement, whilst their commitment on the subject of protection of public health is indisputable, have indicated their worries; on the international public consumption of tobacco products and exposure to smoke and the consequences of this on the global population in economic, social and environmental terms. Also, in the new amendment applied to Act no 4207 in 2008, that it inarguably complies with the Tobacco Control Framework Agreement on the subjects of, the ban of use of tobacco products in indoor premises and smoke free air space applications and the tobacco control and the prevention of damages. The restrictions and bans imposed for “The control of tobacco products and prevention harm“in order to ensure and protect the right to health of the individual and society is not only in compliance with the constitution and the Tobacco Control Framework Agreement but is also a scientific and contemporary necessity from the perspective of protecting human health and future generations.In this study, we aim to discuss the smoking ban in Turkey through different ethical arguments.


Legal and regulatory issues about a study protocol comparing 2 strategies for management of body packers carrying ingested drug packets

Bertrand Becour, Zakia Médiouni, Ahmed Hammache, Jean Louis Pourriat

Assistance publique-hôpitaux de paris

Background: About one hundred individuals are apprehended each year in Paris for transporting internally concealed narcotic substances or body packing. The medical implications of this practice stem from its potentially life-threatening complications. Body packers are monitored in a secure hospital ward until the complete evacuation of the ingested foreign bodies.

Method: A monocentric randomized controlled trial comparing two treatment strategies will take place on October 2012. Legally speaking, this study comes under the label of “usual care” studies.

Results: One of its specificities is that it is conducted on detainees. The French legislation is attentive to the rights of detainees participating to biomedical research projects. The validity of their consent to participate to the study is scrutinized, regarding possible language-barrier issues or the intelligibility of the information provided. Three administrative authorities have to be approached based on the following legal fundamentals. The protection of persons in health-related matters comes under book 1 of the French Public Health Code (Livre 1 du Code de la Santé Publique). Biomedical research issues come under section 2 of the same book.

Legislative aspects are covered by articles L.1121-1 to L.1123-14 and L.1126-1 to L.1126-11 of the Public Health Code; regulatory aspects are covered by articles R.1123-1 to R.1125-13.

The elements to be included in the request for advice from the Committee for the Protection of Persons (Comité de Protection des Personnes ) included in research aimed at assessing “usual care” mentioned in the second paragraph of article L.1121-1 of the Public Health Code, are listed in the decree dated March 9th 2007. Under these rules and regulations, the person sponsoring the research work must consult the French Agency for the Safety of Health Products, the AFFSAPS (Agence Française de Sécurité Sanitaire des Produits de Santé) and the Committee for the protection of individuals of the region where the study is to be conducted.

The third administrative authority to validate such study protocols is the French National Commission on Information Technology and Liberties, the CNIL (Commission Nationale de l’Informatique et des Libertés), as dictated by article 25 of law number 78–17, dated January 6th 1978 and modified in 2004.

Conclusion: This restrictive legal frame aims to reconcile the human right to free will with the imperatives of biomedical research. If we are to ensure legal consistency, standards should be developed to harmonize the obligations that currently weigh down medical research investigators.


Evaluation of Informed Consent From Viewpoints of Patients, Physicians and Patient Relatives

Deniz Oğuzhan Melez 1, Ipek Esen Melez1, Cengiz Haluk Ince1, Gulsum Nurhan Ince2, Fatma Suheyla Aliustaoglu1

1Ministry of Justice The Council of Forensic Medicine, Istanbul / Turkey

2Department of Public Health, Istanbul University, Istanbul Medical Faculty, Istanbul / Turkey

The first patient-physician relationship has been started with the one who cried with pain and the other who came to the crying one. So the crying one was the first patient, and the other who came to him for helping was the first physician. Early on, this relationship was formed with the unquestionable hegemony of the physician. In other words, the destiny of the patient was in a way resigned to the physician’s paternalistic attitude. This term which was firstly introduced legislation in the United States of America, was entitled as ‘informed consent’. When referred meaning of this term is considered, it is being translated in Turkish as ‘Aydınlatılmış Onam’ or ‘Bilgilendirilmiş Rıza’.

In this study, the results of physicians’ informing patients and patient relatives or not, have been tried to be evaluated with depth interview technique. With this aim, 3 groups (patients, physicians and patient relatives), each of them consisting of 10 individuals have been taken to be interviewed with the technique of depth interview in order to analyze their sociodemographic features, their first meeting with ‘informed consent’, attitudes they experienced and their opinions about what should be done.

With this study, the fact that education, social environment and experiences are one to one related with being conscious about one’s own personality rights has been understood. Thus, it can be concluded that all social problems about rights and responsibilities, including the ones related with informed consent, may be solved in a more reliable way with making up the deficiencies in education.


Mandatory Reporting Law: Problems and Solutions in Turkey

Çiğdem Adar 1, Rahime Erbaş1, Ahsen Kaya2, Adem Sözüer1, Coşkun Yorulmaz2

1Faculty of Law, İstanbul University,İstanbul,Turkey

2Cerrahpaşa Medical School, İstanbul University, İstanbul,Turkey

Background: Knowledge of mandatory reporting laws has become integral to the practice of medical care because many reportable conditions are regularly encountered in medical departments. Mandatory reporting laws impose requirements on physicians to report certain conditions or suspected conditions to local legal authorities for further action. These laws, which govern various conditions from infectious diseases as a HIV infection to situations of abuse, are contentious. Although debates surrounding these laws are condition specific, in general, they pit concerns of patient and community safety against desires to maintain patient-physician confidentiality and arguments that mandatory re porting laws may be ineffective at promoting safety. This study discusses Turkish Criminal law and subsequently examines the rationale for and against mandatory reporting laws as they apply to medical conditions.

Method: In this process, the important issue of mandatory reporting law, which takes place in Turkey, was examined and discussed closely. Unsatisfied with it, the mandatory reporting problems that the other countries have been facing were analyzed.

Results: As a general result of negligence on Medical Ethics and jurisprudence, there is a big discrepancy between these two important instruments. In many countries, lots of applications of the mandatory reporting system have been observed and it was realized that there was no uniformity in these different applications even the different states of the one country. Owing to various approach suggestions of different groups such as Chamber of Physicians in Turkey and law society, mandatory reporting system hasn’t been implemented equally and homogeneously among physicians.

Conclusion: Medicine, as a profession, is quite a hard commitment, with the aim of taking care of patients. Physicians assume professional accountability not only to their patients and relatives but also to legal authorities. In case of insufficiency in exercising this multi-dimensional accountability, they may confront legal and ethical issues. In an attempt to remove this situation; legislator have to empathize with the physicians. Additively, the unacceptable disparity shows that each concrete case needs different obligation. Ultimately pre- and post-graduate forensic medicine education must be considered highly important, and periodic on-the- job training must be organized, creating a better awareness among doctors regarding their legal responsibilities.


Assessment of the Deaths in Nursing Homes and Hospices in Istanbul

Deniz Oguzhan Melez 1, Bahadır Kumral1, Ipek Esen Melez1, Muhammed Feyzi Sahin1, Yalcin Buyuk1, Umit Naci Gundogmus2

1The Ministry of Justice Council of Forensic Medicine, Istanbul, Turkey

2Institute of Forensic Medicine, Istanbul University, Istanbul, Turkey

Introduction: Aging starts with birth and is an inevitable process, which is difficult to accept. The definition and borders of the care in this period is important also for expert witness viewpoint.

Methods: This is a retrospective study assessing the death cases that were sent to the Council of Forensic Medicine Morgue Department for autopsy between 2005 and mid 2011. The statistical analysis was performed using SPSS 11.

Results: The retrospective evaluation determined 29 death cases in the hospices and nursing homes. The mean age was 73.41 + 14.10 years (range: 35 to 101). There were 17 males (58.62 %), and 12 females (41.48 %). Natural causes of death were more frequent (n = 17, 58.62 %) and non-natural causes of death were accident (n = 8, 27.59 %) and suicide (n = 4, 13.79 %). The pathological deaths were as follows: cardiovascular system diseases (n = 12, 41.37 %), gastrointestinal system diseases (n = 3, 10.34 %), respiratory diseases (n = 1, 3.45 %), and central nervous system diseases (n = 1, 3.45 %). Accidental deaths were as follows: 3 (10.34 %) secondary to falling from a height, 3 (10.34 %) due to falling on a flat surface and 2 (6.90 %) due to traffic accidents. Two (6.90 %) of the suicidal deaths were due to hanging and two (6.90 %) were due to jumping from a height. Histopathologic assessment with H&E staining revealed findings that would explain the cause of death in 21 cases of 29 (72.41 %), while in 8 (27.58 %) no such findings were found. In these 8 cases, the origins of deaths were as follows: accident in 4, suicide in 2 and in the rest of the 2, autopsies could not identify any etiology other than possible unidentified disease. The toxicological screening was also performed.

Conclusion: This study demonstrates that the most frequent cause of death was related to the health problems associated with the advanced age. With evaluating suicides and accidents and the reason of autopsy in natural deaths, a dilemma of how broad an elderly person’s autonomy and freedom should be kept in hospices and nursing homes by the personnel, can be discussed to decide if they are juristically negligent to the elderly individuals or not according to the level of close-follow up they are obliged to perform on elderly individuals. In this consideration, all evidences, autopsy reports and other scientific - ethic viewpoints on elderly rights should be synthesized by the the expert witness.


The Use of Animals in Forensic Sciences

Antonella Rendinelli, Daniele Gibelli, Cristina Cattaneo

Sezione di Medicina Legale - Dipartimento di Morfologia Umana e Scienze Biomediche, Università degli Studi, Milano, Italy

Background: Hundreds of millions of animals are used every year in laboratories all over the world, and 11 million in the European Union, among which less than one million in Italy. With time the need for fast scientific improvements has caused the pandemic diffusion of such a practice in every field of science. However, if in clinical research the sacrifice of an animal and the consequent ethical aspects may be considered secondary to the therapeutic advantages which may derive from its application, in forensic sciences the use of animal models may be questionable. Nonetheless literature includes several experimental protocols which envisage, for example, verifying the effects of hanging, electrocution, trauma, drowning in mice, rabbits, cats and dogs.

This presentation has as its main goal a brief review of the existing literature concerning experimental protocols on animals in forensic sciences in order to shed light on this sensitive, ethical and often ignored aspect in legal medicine.

Methods: A meta analysis of scientific articles published in the last decade in the field of forensic sciences in major scientific journals and concerning animal experimentation was performed. The species involved, the types of lesions, the types of sedation and methods of performing euthanasia according to local laws and ethical committee approval, type of results, their applicability to the human species and frequency of citations were taken into account.

Results: over 100 articles were evaluated, concerning experimental projects involving animal models in vivo; in a significant proportion application to human situations could seem questionable and citation of the articles was low or inexistent. Rats and mice were most frequently used, but pigs, dogs and rabbits are still commonly encountered in the forensic scenario. In some cases animals were not anaesthetised during all procedures. This leads to the problem of different local ethical committee standards.

Conclusion: Experiments on animals may be widely justified in the field of clinical medicine, where possible advantages for the improvement of life conditions and health are expected; however in forensic sciences ethical and scientific implications may not be the same. The present communication simply wishes to draw the attention of forensic scientists to the issue of animal experimentation, in a third millennium where ethical, ethological and cultural evolution seem to be leading more and more towards an inter-species society.


To Be Gynecologist in Private Hospital: Administration, Ethics and Medicolegal Issues

Yesim Islegen 1, Eda Yorulmaz2, Abdullah Coskun Yorulmaz3

1Huzur Hospital, Department of Obstetric and Gynocology, Istanbul Turkey

2Medicalpark Bahçelievler Hospital, Responsible Manager, Istanbul. Turkey

3Istanbul Universitiy, Cerrahpaşa Medical School Department of Forensis Medicine, Istanbul, Turkey

Introduction: Obstetrics and Gynecology is a specialty that is widely perceived to be associated with a high risk of litigation. Most of the potential problems in that field usually result from the lack of knowledge about ethics and medicolegal principle. Ethics is an essential dimension of obstetric and gynecologic practice. In this study, we present an ethical and medicolegal framework for clinical judgment and decision-making in the obstetrician-gynecologist–patient relationship. The presentation emphasizes a preventive ethics approach, which appreciates the potential for ethical and legal conflict and adopts ethically justified strategies to prevent those conflicts from occurring.

Material method: The most important medicolegal problems in Obstetrics and Gynecology in private practice were analyzed and separately discussed in terms of Turkish Criminal Code.

Findings: Management of child sexual abuse and sexual assault cases in private hospital were the most anxious situation with fertilization problems. On the other hand failure/delayed diagnosis, failure/delayed treatment, failure to recognize complication, failed sterilization, failure to obtain consent and inappropriate treatment had been very often complained by the patients and relatives.

Conclusion: Health administration ethics is an important (but often overlooked) subject. Unethical conduct on the part of healthcare administrators can result in legal and reputation costs to the hospital where they work, meaning that ethical behavior is ultimately in the hospital's best interests. Preventive medicolegal risk management helps to build and sustain a strong physician–patient relationship in the especially private practice of obstetrics and gynecology. We examine ethical issues in responsible resource management, emphasizing the virtues of the physician as a professional. Finally, we provide suggestion for critically appraising the literature of ethics and medicolegal issues in obstetrics and gynecology. In critical condition, medicolegal consultation is necessary for safe practice. Like Cerrahpasa Medical School, Department of Forensic Medicine which provides medicolegal consultation is critical importance. Identification of specific characteristics of medicolegal problems in private hospitals can be the dual quality of the patient’s self perception that appears in parallel with finance model and the problems’ appearing on the implications of physician practice and the solution may be hidden in good physician practices.


A lethal case due to septicaemia after massive burning injuries as a result of patient’s refusal to treatment: ethical and legal aspects

Anna Mavroforou, Katerina Kanaki, Manolis Michalodimitrakis

Department of Forensic Sciences, University of Crete - Medical School, Heraklion, Crete, Greece

A fatal case of a 46-year old man, who died after massive burning injuries, is presented. The patient was transferred to the emergency department of a university hospital, where a diagnosis of 1st to 3rd degree burns affecting more than 30 % of his total body surface was made. The event was accidental in nature. First aid care was provided and the patient was subjected to the appropriate blood tests and investigations. Admission was suggested as necessary from the caring physicians who provided him all the information justifying their decision. However, the patient refused it and he left the hospital being conscious and having signed on his medical records that this was his own decision. The man was discovered dead by his neighbours at his home 12 days later. Septicemia and systemic inflammatory response syndrome (SIRS) was confirmed as the cause of death.

The aim of the presentation of this case is to highlight the ethical and legal issues related to an adult patient’s refusal to medical life-saving treatment. The conflict between the patient’s right to make autonomous decisions and the medical practitioner’s duty to provide life-saving treatment are also discussed investigating the edges on which medical negligence may be founded.


Legal consequences in case of an inadvertedly left instrument inside the patient’s body after an operation

Anna Mavroforou1, Katerina Kanaki 1, Pavlos Pavlidis2, Policronis Voultsos2, Konstantinos Hourdakis2

1Department of Forensic Sciences, University of Crete - Medical School, 71110, Heraklion, Crete, Greece

2Department of Forensic Sciences, Democritus University of Thrace - Medical School, Alexandroupolis, Greece

A case of an inadvertedly left instrument inside the patient’s body after an operation is presented. A patient who was subjected to aortocoronary by-pass, at the end of the operation presented ventricular fibrillation. The surgeon immediately injected adrenaline by puncturing the aortic root using a syringe with a small needle (length 1.6 cm). The small needle after the injection was left in place for air evacuation from the circulation while the surgeon started cardiac massage with subsequent cardiac defibrillation. The two other surgeon-assistants who were doing other parts of the operation were unaware of the fact that the small needle was left embedded in the aortic root. Thus after the patient’s heart function recovery they proceeded to wound closure without removing the small needle. Postoperatively he developed pericardial effusion and he was admitted to another hospital in which he was subjected to a chest magnetic resonance tomography, as a consequence of which the needle migrated. A year later the patient was subjected to a chest x-ray for persisting coughing and fatiqueness and on this occasion the small needle was discovered inside his chest. The patient lived for 8 years after the operation but during this period he developed psychological problems as he could not accept to live having a foreign body inside his chest. The presence of the needle in the chest was confirmed also on an x-ray done within the context of post-mortem investigation and it was found to be well incorporated by fibrous tissue in the pericardial space. On post-mortem investigation it was also confirmed an acute myocardial infarction along with findings suggesting old ones, while no injury of the aorta or the heart as a result of the presence of the needle was noticed.

The aim of the presentation of this case is to highlight the legal and ethical issues related to an inadvertedly left instrument inside the patient’s body after the operation and to investigate the edges on which medical negligence can be founded.


The Assessment of Consent Form’s Readability And Understandability In Turkish Language

Erhan Buken 1, Bora Buken5, Nermin Yazıcı4, Faik Sarıalioğlu2, Haldun Müderrisoğlu3

1Baskent University Faculty of Medicine Department of Forensic Medicine

2Baskent UniversityFaculty of Medicine Department of Pediatry

3Baskent University Faculty of Medicine Department Of Cardiology

4Baskent University Faculty of Education

5Düzce University Faculty of Medicine Department of Forensic Medicine

Objective: It is an ethical and legal obligation for consent forms to be understandable to the patient. Long sentences, confusing structure, foreign words make the text difficult to read. For evaluating the readability and understandability, mathematical models, like Flesch Kincaid index and Gunning Fog formula were developed. Sönmez and Ateşman’s formulas are proved to be valid that are the adaptations of Flesch Kincaid and Gunning formula.

In this research; the terms difficult to understand were determined with a subject group, and with a new contribution, applying the Sönmez and Ateşman’s formulas to Turkish consent forms were researched.

Methods: Hardly understandable terms and foreign words in Baskent University Hospital’s “Coroner Angiography Consent Form” were determined by a group with 100 participants. Forms were researched in scopes of readability and understandability using Sönmez and Ateşman’s methods. Form revised by authors. New form were determined by another group with 100 participants. Data were compared.

Results: Difficult terms the respondent detected were 86.2 % corresponded to the experts’ determined words and terms. Old form’s understandability is, according to the Sönmez formula “text is understandable”and new form’s is “full communication can be established”. According to the Ateşman’s formula old form’s readability, is evaluated “medium-hard difficulty”and new forms is “clear and understandible”. 71 % of participants evaluated that new form is more understandable and readable.

Conclusion: This research; with its “determining foreign words and difficult terms to understand with a subject group attachment”, has the quality of being the first research done on Turkish consent forms’ readability and understandability.


The Educational Needs of Prison Physicians in Turkey: Views from the field

Murat Aksu1, İlhan Çetin2, Ali Yıldırım 3, Berna Arda4

1Adnan Menderes University,Aydın,Turkey

2Cumhuriyet University,Sivas,Turkey

3Gaziosmanpasa University,Tokat,Turkey

4Ankara University,Ankara,Turkey

Background: The medical treatment of prisoners is an important question for a humane society. Prison health care should be equivalent to health care in the community. Despite these important points, generally, training programs of medical faculties does not cover enough time and content for prison medicine. In this study, we aim to identify the educational status and their perception of prison doctors and their educational needs related to prison health service.

Method: The study was designed as a cross sectional survey and it was carried out in 2009–2010. We got permission to carry out for our survey from General Directorate of Prisons and Detention Houses. In the first step, we reached all doctors(64) by phone and invited to participate in the study.

Result: 59(92 %) prison doctors participated our study. 84 % of doctors had no any experiences about offenders as a patient in their undergraduate education period. All of them expressed that they had not received training program related to prison health problem and services. 84 % of doctors stated that they had difficulty to adapt to working conditions in prison. 93 % of our participants thought that physician patient relationship obviously is different in prison than daily community health service practice. 50 % of participants believed that their medical ability and proficiency is enough to work out patients’ health problems in prison. 74 % doctors think that special education is a necessity working in prison. They expressed that education program should include psychiatric management of patients (64 %), management in prison & autonomy of medical professional (56 %), emergency practice in prison condition (49 %), patient-physician relationship and communication skills for prison condition (40 %). They think that additional education for doctors should be organized by medical faculty (49.2), ministry of health (45.8) or Turkish Medical Association (33.9). Interestingly, we found that 61 % of prison doctors had poor knowledge about national and international regulation about prison physician practice and 20 % of doctors had any knowledge related to regulations about their daily practice.

Conclusion: In light of our results, we can say that undergraduate and postgraduate education focused on prison health problem efforts are poorly in Turkey. In prison daily life, because of this lack of medical education, it leads to human rights problems. We suggest that medical faculty undergraduate program should cover prison health topics and this program should put into practice with collaboration of different academic areas which are public health, forensic pathology and medical ethics.


The Evaluation of Verbal Information During The Process of Informed Consent

Erhan Buken 1, Alp Aydınalp2, Bora Büken2, I. Haldun Müderrisoğlu3

1Baskent University Faculty of Medicine Department of Forensic Medicine

2Baskent University Faculty of Medicine Department of Cardiology

3Düzce University Faculty of Medicine Department of Forensic Medicine

The effectiveness of the process of information might depend on cognitive functions, mood and the level of intelligence of the patient. The effectiveness of information is also highly dependable on the informative skills of the informer.

Information is in a sense education of the patient on the subject.

The aim of this study is to develop an objective method for the evaluation of verbal information.

Primary studies suggest that various methods of how much students understand the subjects they are taught. In this study, as information of the patient is taken as a kind of education, it is assumed possible to evaluate the success of the process of informed consent by fiil inthe blank tests.

In the study, "fill in the blanks" tests which have been made up of the text standardized of Ateşman and Sönmez formulas (which are the Turkish versions of the Gunning Fog formulas and the Flesch Kincaid index) have been used on a random sample of 200 students who had no information whatsoever on Coroner Angiography and whose relatives of first degree had never had Coroner angiography.

Two different fill-in tests in English have been handed out to students, half of them (100 students) received test number 1 first, while the other half received test number 2 before test number 1. 50 students from both groups have been verbally informed about Coroner Angiography between the two tests and the rest have not been verbally informed, instead they have been made to listen to music for 3 minutes ( the duration of information for the others). The number of correct answers and the time students took to answer all the questions for both groups have been recorded and compared.

Results: The average age of students was 21.80 ± 3.72 for the study. On matters of age, sex and level of education, the groups were normally distributed.

No difference has been detected between the two groups that received first the test number one, then test number two and the group that received the second test first and the first test second (p > 0,005). The difference between the two groups of which one received information and the other didn't, is statistically significant. (p > 0,05).

Conclusion: "Fill in the blanks" tests may be used in the process of verbal information in order to determine the success of patients on understanding the information given correctly and the doctor on informing.


Hymen Perforation via Vaginal USG Probe: A Case Report

Harun Akkaya 1, Kenan Karbeyaz2, Hüseyin Eş3, Mücteba Gülden3, Sema Baloğlu4

1Council of Forensic Medicine, 2nd Speciality Board, Istanbul, Turkey

2Council of Forensic Medicine, Branch Office, Eskişehir, Turkey

3Council of Forensic Medicine, Istanbul, Turkey

4Council of Forensic Medicine, 6th Speciality Board, Istanbul, Turkey

Introduction: The crime is accepted as aggravated if its committed by penetrating limb or an object into the body, in the clause of Turkish Criminal Code about sexual crimes. Although this case is generally a sexual action, it may happen rarely by accident. In this study, hymen perforation case submitted which occured during genital examination for medical purposes, It is worth to discuss the incident not only for its juridicial character but also for the informed consent responsibility of the doctors against the patient.

Case: The virgin woman who went to her gynecologist because of her complaint of dysmenorrhoea, USG probe applied like in her previous examinations. In the last examination, doctor penetrated into the vaginal canal with transvaginal USG probe, the patient who was virgin, had to react instantly because of hymen perforation. It was understood that the patient neither enlightened by the doctor nor asked if she was virgin or not in anamnesis before the examination. As a consequence of hyper perforation, the patient brought a complaint about the doctor who examined her. In vaginal examination by Forensic Science Department by the permission of Prosecution Office, it was informed that there was a laceration at 9 o’clock side which its exremity is hyperemic and recently arised (1–2 days), the patient was not virgin anymore, the incident happened by penetrating limb or an object into the body.

Conclusion: The clauses editing sexual crimes, comprise the penalties due to the effects of the incident on the person. In this case, the doctor is held responsible for sexual assault and not executing his job outrightly. Especially giving sufficient information to the patients is the first responsibility of the doctors who are doing genital examination.


The knowledge and awareness level of university hospital staff about patient rights

Akan Karakus 1, Mustafa Yasin Selcuk1, Mustafa Ünal2, Ömer Tontus1, Levent Altintop3

1Department of Medical Education, Ondokuz Mayıs University, Samsun, Turkey.

2Department of Family Medicine, Ondokuz Mayıs University, Samsun, Turkey.

3Department of Internal Medicine, Ondokuz Mayıs University, Samsun, Turkey.

Objective: Developing health care delivery systems in medical sciences must have a priority for patient oriented approach. From this point of view, becoming informed about the patient rights by heath care professionals can help to achieve this development. So not only doctors but also all staffs working in health services must have enough knowledge about this issue. The aim of this study was to evaluate the knowledge and awareness level of hospital staff about patient rights.

Material and Methods: A self-administered questionnaire about patient rights was hand-delivered to 124 university hospital personnel before an education program settled in 29 March 2012. Pearson's chi-square test was conducted to identify the statistically significant factors related to hospital staffs' knowledge about patient rights.

Results: 92 (74.2 %) respondents were female and 32 (25.8 %) were male. 69 (55.6 %) medical staff had received education about patient rights one or more times. 57 (46 %) medical staff had known the type of legal regulation on Patient's Rights declared in 1998 in Turkey. In this study, the value of ORs suggests that women medical staff had answered right answer about the type of the legal regulation of patient rights (OR = 2.486, 95 % C.I. = 1.19-6.90).

Conclusion: In the light of this study, we conclude that educational activities about patient rights are beneficial in medical services education. These efforts can help hospital personnel prepare to improve capability to deliver respectful and culturally sensitive care.



Forensic Age Estimation in living subjects. Spanish Better Practice Manual on FAE in minors

Pedro Manuel Garamendi González 1, Rafael Bañón2, Amadeo Pujol Robirat3, Maria Irene Landa Tabuyo5, Fernando Serrulla Rech4, Jose Luis Prieto Carrero6

1Council of Forensic Medicine of Istanbul (Turkey)

2Instituto de Medicina Legal de Murcia (España)

3Instituto de Medicina Legal de Cataluña (España)

4Instituto de Medicina Legal de Galicia (España)

5Instituto Vasco de Medicina Legal (España)

6Universidad Complutense de Madrid (España)

In 2010 October 7th a group of representative persons from nearly all Legal Medicine Institutes (LMI) of Spain met in Madrid at Spanish Ombudsman Office (SOO) premises to discuss about the situation of Forensic Age Estimation (FAE) in Living Minors in Spain. SOO promoted this meeting due to the evident differences of methods applied all over Spain in this forensic practice and also due to the complaints of different national and international committees about the way our country had been facing this issue. Neither methods applied nor professionals responsible of this medical evaluations were until then the same in different Spanish communities and no methodology was uniquely considered the gold standard. After this session, another meeting was promoted by SOO with members of Spanish Ministry of Justice, Public Prosecutors and Judges to discuss the legal implications of implementing an unique National Protocol about FAE. The conclusions of these two sessions settled the basis of a Spanish National Protocol about FAE in living minors. The protocol was published in the SOO website as an open access ebook and in one of the Spanish Forensic Medicine journals, Revista Española de Medicina Legal (REML), as two papers: conclusions of the sessions and Better Practice Manual on FAE in living foreigner unaccompained minors. This protocol was agreed by all LMI and Spanish Public Prosecutor Office made a final decision about sending all cases of minors unaccompained of an unknown age only to LMI were examinations and tests must be performed since then under a forensic physician supervision. The aim of the Better Practice Manual is to standardise and harmonise the minimum technical requirements of expert reports, and how the standard deviation due to normal distribution as well as how the variability in individual physical development should be handled. The proposals include making these examinations only by experienced and supervised staff of Forensic Institutions, following informed consent of the presumed minor. Evaluation must consist of an interview, with a physical examination, radiological examination of the wrist, and dental pantomography. Radiological or computerized tomography of the proximal epiphysis of the collar bone might be done in particular cases. It is also recommended that the Courts, not forensic physicians,should make the final decision on whether the person is a minor or not due to the important legal implications of such a decision.


Protocol for collection of Biological samples for Examination Autopsy: Practical Method to avoid unnecessary exhumations

Manoel Campos Neto 1, Vidal Haddad Júnior2, Alessandra Paiva Puertas Alves3, Ana Cristina Lepinsk Romio3, Ivo Antonio Vieira4, Caroline A. Magalhães Castilhone5

1POLITEC - Perícia e Identificação Técnica - Seção de Medicina Legal - Regional de Cáceres-Mato Grosso-Brasil.

2UNESP-Universidade Estadual Paulista-Departamento de Dermatologia e Radioterapia-Botucatu-São Paulo-Brasil

3POLITEC - Perícia e Identificação Técnica - Laboratório Forense de DNA - Biologia Molecular - Cuiabá - Mato Grosso - Brasil

4MINISTÉRIO DA FAZENDA - Departamento de Perícia Oficial Federal - Cuiabá - Mato Grosso - Brasil

5IFSP - Instituto Federal de Educação Ciência e Tecnologia de São Paulo - Brasil

Introduction: Most of the identifications of the bodies referred to medical legal centers is made for family members of the dead. This identification may be false by various factors beyond the control of them, as the emotion before the deceased. The documentation does not always have photos and some cases of advanced decay, even images do not allow identification. After the release of the body if the identification for the first release of the body is not true, either by communication of error by the family or by finding that the name written on the death certificate corresponds to a live person or by Police Authority in investigating cases of fraud, there must be an exhumation and autopsy for the collection of material for laboratory identification. The rectification of the document only can be made after this action.

Objectives: There is need for an alternative to the solution of this problem. Thus, the exhumation and collection of material could be replaced by a simple, almost free of charge, perpetual and permanent measure.

Methodology: After external inspection, the scalp shall be washed with running water and with the aid of a clean haemostatic tweezers we remove a sample of hairs with their bulbs. The hair shall be dried on a clean and dried bench to inhibit fungal growth and packed in a plastic or paper envelope. The samples are stapled on the cover of the report of the documentation and a note be placed saying that "are on file samples of the hair of the victim for DNA exam, if happen any doubt of his identification."

Results: In the last three years, when the method was implemented, there were no more cases of exhumation for confirmation of identity.

Conclusions: The authors consider that the implementation of this method simple, convenient and with no cost will decreased the performance of exhumation for the collection of material and, perhaps, discourage fraud in the identification of unknown bodies. This simple method is available to persons other than medical or even non-medical examiners, once they are taught to simply collect the material, and file the envelope containing the sample, in a safe place for later comparison.


Golden proportion in skeletonized skulls

Liz Magalhães Brito1, Fábio Santos Correia2, Heitor Marques Honório1, Fernanda Capurucho Bouchardet 3, Rogério Nogueira Oliveira1

1Faculdade de Odontologia da USP. São Paulo, Brasil

2Instituto Médico Legal Nina Rodrigues. Bahia, Brasil

3Faculdade de Odontologia da PUC Minas. Minas Gerais, Brasil

Introduction: The proportions of the face and body have been analyzed since ancient times, as in the Vitruvian Man by Leonardo da Vinci. Studying the Divine Proportion or Proportions in skeletonized skulls is of great value because they may contribute to forensic facial reconstruction and photographs superimposition, auxiliary techniques used in the identification of unknown bodies.

Objectives: The objective of this study was to check the Golden Ratio and establish craniometric indices in sixty skulls skeletonized (n = 60), from the Institute of Forensic Medicine of Bahia.

Methods: The measurements were performed directly on the skulls, using digital calipers and millimetric scales. After statistical analysis of the pilot project, in ten skulls, it was chosen: six horizontal golden relationships, four vertical golden relationships, six facial indexes and three geometric shapes defined by fourteen different measures in this research. The data were compiled. Means and standard deviations were calculated. The inferential analysis was obtained by description of the measures using the confidence interval of the mean (p <0.05).

Results: The results showed the most significant golden relations by confidence interval and standard deviation, and establish specific craniometric indices for the studied population.

Conclusion: This study intend to improve the techniques of Facial Reconstruction and photographs superimposition. Therefore, a reduction in the number of missing people is expected and also an improve in the positive identification of unknown bodies, supporting the action of Forensic Experts, thus beneficing the society as all.


Utilization of bone impedance for age estimation in postmortem cases

Noboru Ishikawa 1, Hironao Hunaki1, Stuart Mclean1, Daisuke Miyamori1, Atsushi Nishida2, Naotake Yamada2, Kim Wook Cheol2, Toshikazu Kubo2, Hiroshi Ikegaya1

1Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

2Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

Background: In the field of Forensic Medicine the number of unidentified cadavers has increased due to natural disasters and international terrorism. In addition to conventional anthropological methods, a simple, objective and precise method to estimate the age of unidentified cadavers to assist personal identification is necessary. The degree of sagittal closure is one of such age estimation methods. However it depends on subjective evaluation, leaving it open to error.

Method: In this study, we have examined whether measuring impedance value (z-value) of the sagittal suture of the skull could be utilized to estimate age in men and women of various ages.

In a second experiment, importantly, a comparison was made between the z-values from short postmortem time and remoistened rat bone.

A third experiment compared age estimation through the conventional visual method and the proposed bone impedance measurement technique.

Results: As results of first experiment showed that bone impedance values increased with aging in males. Meanwhile, in females, it increased with age and the decreased after the age of 71. As results of second experiment, the bone impedance values found from remoistened rat skulls were very similar to those found in short postmortem time conditions (R2 = 0.74). Therefore, this technique may be able to use for decomposed body and skeletonized body.

The results of using conventional visual method did not necessarily correspond to the results of proposed bone impedance measurement technique.

Conclusion: It was found that bone impedance values increase with age. Through experiments on rats it is believed that impedance values may not change significantly with time or changes in moisture. Most importantly, it has been demonstrated that the bone impedance measuring technique is an effective objective method of estimating age superior to the subjective traditional visual method. That is to say, it is suggested that the bone impedance measuring technique can, with further research, be of value to forensic science as a method of age estimation.


Anthropological and pathological analysis of medieval skeletal remains: identification of monks from historical records

Nikola Velickovic, Tamara Pavlovic, Milos Dakic, Stefan Velickovic, Ksenija Djukic, Danijela Djonic

Laboratory for Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade,

Background: During 2006 excavations on Crkviste site, in Bosnia and Herzegovina, skeletal remains of four individuals were found. According to church archives these people were monks who were fleeing from the Turkish army and settled in the area. The question addressed to anthropologists was whether these remains belong to the monks as it was stated in the records.

Method: Anthropological and pathological examinations comprised of age assessment at the moment of death, sex, stature, dental status, as well as recording the signs of skeletal disease or trauma and possible cause of death (natural or violent).

Results: Our results suggested that the skeletal remains belonged to four adult males of advanced age. One individual demonstrated depressed fracture of the frontal bone caused by a blunt object. Signs of healing indicated that the individual survived this trauma. No traces of injuries indicating a violent death were found on the examined skeletal remains.

Conclusion: Place of burial and state of preservation of skeletons indicate that these remains could belong to monks who lived in this church around 1460. Skeletal findings, i.e. number of skeletons, sex and age at death, and morphological features of the skulls correspond to the characteristics of the medieval Serbian population, and also suggest that the investigated skeletal remains belong to the monks who were stated in the historical records.


Human and nonhuman radiological bone identification in mummies

Anja Petaros 1, Mislav Cavka2, Alan Bosnar1, Ivor Jankovic3, Boris Brkljacic2

1Department of Forensic Medicine and Criminalistics, Rijeka University School of Medicine, Rijeka, Croatia

2University Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia

3Institute for Anthropological Research, Zagreb, Croatia

Background: One of the first tasks forensic anthropologists are faced with is to estimate the forensic significance of a skeletal find by determining whether or not the remains belong to human. This is an important step in bone identification because skeletal parts of a wide variety of animals are often submitted to departments of forensic medicine as supposedly human. The identification in such cases depends on the preservation and size of the sample and ranges from macroscopical to histological and molecular analysis of the bone. In some cases, radiological examination adds important details to the interpretation of the material.

Aims: We present a particular case where a forensic anthropologist and radiologist were requested to identify the mummified remains of animals curated in the Archeological Museum in Zagreb, Croatia. The main purpose of the analysis was to identify the taxon and attest the stage of preservation of the delicate remains. The specialists were requested also to analyze two mummified hands in order to attest whether they come from humans or primates.

Methods: A total of seven remains were analyzed in the study: five remains of unidentified animals and two mummified hands. The remains were examined by radiologic analysis at the University Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia and included x-ray and MSCT imaging.

Results and conclusion: Mummification of animals was a common practice in ancient Egypt performed as a funerary rite for pets and worshiped animals or simply as an offering to gods. Although the animals were usually mummified in manner to conserve their external appearance, this was not the case in our study. Paleoradiologic examination helped to overcome this issue and allowed a noninvasive study of the remains. We were able to identify two animal species (a cat and the remains of crocodile hatchlings) while the third could not be identified with certainty. Another mummy that had no natural structure preserved was classified as an imitation of an ibis. The two hands were identified as being human, one belonging to an adult and the other to a two-year old child.

In addition, the poster will present the history of animal mummification practice in ancient Egypt, describe the main steps undertaken in examining the radiological finds, point out the main differences between primate and human hand anatomy and discuss the difficulties encountered during the radiological interpretation of mummified material.


Sacral Measurements as a Prediction Tool to Stature & Gender in North-West Indian subjects

Dalbir Singh

Department of Forensic Medicine,Postgraduate Institute of Medical Education and Research,Chandigarh,India

Introduction: Identification is the most crucial parameter in a forensic investigation and also becomes most difficult task in cases of highly disfigured and dismembered bodies. With the ever increasing frequency of mass disasters (both man-made and natural), homicides, road and train accidents, airplane crashes, tsunami, there is utmost need of studies which can lend a helping hand in identifying the unknown from the dismembered and fragmentary remains. In such cases, skeletal examination may help since bones resist decomposition for a long time. However, in most of the cases recovery of intact bones is not possible, therefore bones which remain intact long after death such as vertebral column especially its sacral vertebrae may prove useful in giving a conclusive opinion on identity of the deceased and can give approximation of stature.

Although various vertebrae column measurements were significantly used for these estimation but possibility of estimating only from sacral vertebrae which invariably found intact has been explored comparatively in fewer studies that too on limited study material in the Western population. Literature on the subject from India in general and from north-west India in particular is very scanty. Keeping in view the above facts present study is an attempt to estimate the gender and stature of an individual from various measurements of sacral vertebrae as applicable to North-West Indian population.

Material-methods: With a valid consent of the legal heirs of the deceased, body length and after debridement,cleaning & properly exposing,various other anthropometric measurements of the sacrum were taken according to the landmark and procedures described by Giraux et al in 717 adults subjects (549 males and 168 females) at the time of medico-legal postmortems.

Results & conclusion: Mean length of sacrum was more in males (11.095 ± 0.891cms) where as its width was more in females particularly at the level of first & second sacral vertebrae (10.595 ± 0.665cms, 8.954 ± 0.616 cms respectively). There was a highly significant correlation ship between the body height and sacrum length, width of 1st to 3rd sacral vertebrae (p < 0.001) in both the sexes. From regression equations stature of an individual can be predicted with a Standard Error of the Estimate of 6.014, 5.142 &7.171cms. in males, females and combined materials respectively. Mean value of sacral vertebral index which was higher in females (103.865 ± 9.370) statistically plays a significant role in determination of gender of an individual


Identification Using MATLAB Software: a New Idea

Arash Ghodousi 1, Elham Zamani Pozveh2

1Department of Nursing and Midwifery, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, IRAN

2School of Dentistry, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, IRAN

Introduction & aim: Identification using photographs is one of the forensic procedures in which a comparison between before and after photographs of missing person is made. The aim of this study was assessment the possibility of using MATLAB software to identify and provide a new method with easy implementation and few steps.

Method: At first the photographs of before and after death were selected and seven clear and reliable landmarks were determined in MATLAB software. Ten line segments between the landmark points were set and the length of each segment was calculated with accuracy of two decimal places. Fifteen different ratios between segments were determined and finally the average similarity between two groups was compared by the correlation coefficient analysis using SPSS software.

RESULT: Due to the number of defined segments, similarity of two photographs (before and after death) by calculating the correlation coefficients method was 85 %.

Conclusion: The introduction of computer software has led to new methods for identification. Using MATLAB software with the methodology used in this study as a less costly, faster, and with the help of a smaller database method that can analyze and identify individuals with high precision is recommended.


Genetics variation of the NGM STR loci in a population sample from Argentina

Gustavo Gabriel Martinez 1, Laura Cecilia Schaller1, Andrea Carolina Brondani1, Miguel Bolea2, Begoña Martinez Jarreta2, Aurelio Luna Maldonado3

1Servicio de Genética Forense, Superior Tribunal de Justicia, Entre Ríos, Argentina.

2Departamento de Medicina Legal y Forense, Facultad de Medicina, Universidad de Zaragoza, España.

3Cátedra de Medicina Legal, Universidad de Murcia, España

The AmpFℓSTR® NGM™ PCR Amplification Kit (Life Technologies, Foster City, CA) enables amplification of 15 autosomal short tandem repeat (STR) loci, ten of them included in AmpFℓSTR® Identifiler™ PCR Amplification Kit (Life Technologies, Foster City, CA) and the remaining five formed mainly by medium or small sized STR amplicons (D1S1656, D12S391, D10S1248, D22S1045 and D2S441). Allele frequency and other forensically relevant statistics data were generated for the NGM loci in an Argentine population (Entre Ríos province, mostly caucasoids). The analyses support that the NGM™ multiplex is most informative STR multiplex kits than Identifier™ in this population, and is a good complement to this in the investigation of complex family relationships, showing an increased amplification performance in cadaveric remains and forensic evidence. At the population level, all markers were found to be in Hardy-Weinberg equilibrium and overall non-discrimination probability decreased one order of magnitude compared to Identifiler™.


Personal identification on human remains through an holistic approach involving 3D morphometric analysis: a case report

Pasquale Beltempo, Sergio Lubelli, Antonio De Donno, Valeria Bruno, Valentina Ronco, Liliana Innamorato, Francesco Introna

Dipartimento Interdisciplinare DI Medicina (D.I.M.) Sezione DI Medicina Legale, Universita' Degli Studi Di Bari Aldo Moro, Bari, Italy

The goal of this presentation is to show attendees that personal identification on skeletal remains.

This presentation will impact the forensic science community by stressing out the importance of a complete forensic approach, using alternative methods, when DNA results are not available.

Background: Skeletal remains were found at the bottom of a rainwater collect cistern in an abandoned farm in Apulian countryside. Men’s clothing and an ID card, allegedly belonging to the victim, were found too. All the remains were collected and analyzed: the skeletal remains included animal bones, belonging to a bat and to a canine specimen, and human remains from a single subject. Both patellas, a thoracic vertebra and 9 teeth were not found.

Method: The cause of death was determined in a single head gunshot, while ribs, vertebrae and left scapula fractures were made post mortem, probably as a consequence of the 20 meters fall of the corpse at the bottom of the cistern were the remains were found. Time since death was assessed based on the degree of skeletonization and on chemical test. Race and gender were assessed based on both morphological and metric evaluation of cranial and skeletal indices. The subject age at the time of death was determined by evaluating dentition, ossification centers and cranial sutures closure; stature was estimated by anthropometric analysis of femur, tibia, fibula, humerus, radius and ulna. All data were matched with data reported on the ID card; DNA results were not conclusive, due to the poor preservation of skeletal remains. Then was performed a 3D skull-face superimposition technique. A 3D parameterized avatar of the skull was created with a photogrammetric technique and photos of the missing person were selected and acquired. The 3D skull was then carefully spatially oriented, in the same position as in the photos, and snapshots were taken. In the metric image analysis step, a quantitative comparison between the image of the missing person face and the snapshot obtained was carried out. Objective landmarks, as exocanthions, glabella and subspinal point were marked both on the 3D skull and on the missing person face.

Results: The absolute and relative distances between the marked points, the perimeters and the areas of the triangles, obtained by connecting the points, and the compactness indices were automatically calculated with a suitable program.

Conclusion: The correlation coefficients of this values, higher than 0.997, allowed to confirm the identification hypothesis.


Evaluation of Combined Use of Frontal Sinus and Nasal Septum Patterns for Identification in an Iranian Samples

Arash Ghodousi 1, Roshanak Ghafari2, Elham Zamani Pozveh3, Nima Rahim Zadeh3

1Department of Nursing and Midwifery, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, IRAN

2Department of Oral and Maxillofacial Radiology, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, IRAN

3School of Dentistry, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, IRAN

Objective: Frontal sinuses are valuable for human identification. Water's radiograph provided a view of frontal sinus and nasal septum. Combined use of nasal septum and frontal sinus patterns may be useful for identification due to individual variations. The aim of this study was combined use of frontal sinus and nasal septum patterns evaluation in Iranian population samples for identity of unknown persons.

Materials-methods: In this descriptive analytic study, water's radiographs of 198 cases between 18 to 40 were collected. The information about frontal sinuses such as presence or absence, symmetry or asymmetry, kind of septum, superior border outline form and deviation of nasal septum were evaluated and data were analyzed using Chi-Square test.

Results: Presence of frontal sinus was observed in all subjects and there was no significant relation between sex and frontal sinus presence or absence, symmetry or asymmetry, kind of septum and nasal septum deviation pattern. There was a significant relation between the sex and the presence of scallop form in the superior border outline of frontal sinuses and this index was observed more in men than women (p = 0.05).

Conclusion: There were no significant relation between sex and mentioned indexes (except presence of scallop form in the superior border outline of frontal sinuses) so the combination of these indexes is not useful for identification in Iranian population.


The Use of Hand-Held Laser Scanning in the Assessment of Femoral Anthroposcopic Features in Sex Determination

Pavel Todorov Timonov 1, Antoaneta Vasileva Fusova2, Ivan Dimitrov Doychinov1, Stefan Todorov Sivkov2, Tsvetanka Dimitrova Petleshkova2, Ljubomir Dimitrov Paunov1

1Department of Forensic medicine, Medical University, Plovdiv, Bulgaria

2Department of Anatomy, Medical University, Plovdiv, Bulgaria

Background: This study is focused on an innovative approach to the numerical assessment of gluteal tuberosity through 3D visualization and its use as sex discriminant.


1. Subjects- The study was based on 40 right femura, male and female in equal proportion.

2. 3D laser surface scanning- Surfaces of gluteal tuberosity of the femora were recorded in 3D using a lightweight hand-held laser scanner (FastSCAN). The points were placed as follows – on the uppermost point, on the roughness – femoral surface border /a/, on the lowest point of the roughness – femoral surface border /d/, on the most medial point, on the roughness – femoral surface border /b/, on the most lateral point, on the roughness – femoral surface border /f / a few uppermost placed and distinctly protruding points are selected on the roughness itself /1,2,3,4,5 and 6 /. Each point contains x, y, and z values.

3. Measuring parameters- The following steps were taken: Determination of the midpoint of straight lines bf (g). Plane determination by points a, g and d. Points 1,2,3,4,5 and 6 are transposed to the plane formed. 4. A 2D polygonal shape is created, limited by points a, g, d and the transposed 1,2,3,4,5 and 6. 5. The area and the elevation of the figure created are measured, as they are the variables themselves.

4. Statistics- The statistical analyses were carried out using the SPSS system

Results: The means of the two variables of male femora exceed females’ (P < 0.001). The mean of the area indicated for males is 1,32 ± 0,16, and for females - 1,11 ± 0,16. The mean of males’ height is 0,43 ± 0,07, and of females’ - 0,25 ± 0,07. Cut point is calculated for both variables, respectively, being the arithmetic mean of the total of male and female means. Cut point for the area is 1,21 /females < 1.21 cm < males/, and for the height is 0,34 cm /females < 0,34 < males/. According to these values, based on area, the accuracy of determination of the male sex is 65 % and of females - 85 %, and based on elevation, 85 % of males and 90 % of females, respectively.

Conclusion: This study demonstrates an innovative method of objective evaluation of the muscles’ attachment points, which can be used successfully for sex determination, especially in case of highly fragmented bones that impede anthropometric analyses.


Processing of facial reconstruction from skull: ABAB method (new model)

Bora Boz 1, Mehmet Bülent Özdemir2, Ahmet Özer3, Ali Boz4

1Pamukkale University, School Of Medicine, Forensic Medicine Dep, Denizli,TURKEY*

2Pamukkale University, School Of Medicine, Anatomy Dep, Denizli,TURKEY**

3Pamukkale University, School Of Science and Letter, Fine Art-Painting Dep, Denizli,TURKEY***

4Electrical and Electronic Engineer(METU), Denizli,TURKEY****

Background: Facial reconstruction has been done due to different reasons such as the forensic studies and surgical requirements. The uses of facial reconstruction provide the way of the true identification of a significantly changed traumatic face in forensic medicine. Previously, there are several studies that make possible identification of a face by using the methods of facial soft tissue on underneath bone structure. Up to today, 3 dimensional (3D) techniques and conventional methods like Russian (Gerasimov), American, and English (Manchester) have raised for facial reconstruction.

Objective: The aim of this study was to make a facial reconstruction for our own skull excavated from our land (Anatolia) using our ABAB technique.

Material-methods: For this reason, a computed tomography study (CT) of an excavated skull was completed. Data were saved to a computer. At the same time the skull was examined by a Forensic medicine specialist and anatomist by naked eyes.

Results: By the help of all data, eventually, a computer and a sculptor made the facial reconstruction together.

Conclusion: Every region of our country is the center of world civilization. Be found or discovered skulls or other bone fragments in all applicants with the facial reconstruction will show us the general panorama of people who lived in this region at different times of history. In addition, hundreds of tons of data of the analysis-synthesis is possible to collect in this way. We want to come to these studies is to make the top spot phenotype and genotype comparison. In other words, configure the face from the genetic information.


The identification of human skeletal remains: a multidisciplinary approach

Valentina Piredda 1, Renzo Bigazzi2, Gian Aristide Norelli2, Vilma Pinchi2, Elena Mazzeo1

1Dept. Sec. Legal-Medicine, University of Sassari, Sassari, Italy

2Dept. Sec. Legal-Medicine, University of Florence, Firenze, Italy

Background: In forensic practice, it is recommended that one uses a multidisciplinary approach for the identification of human skeletal remains. A specialized team of forensic scientists is required. This consists of a medical examiner, an anthropologist and an odontologist. Primarily, macroscopic examination of the skull and teeth are needed. Next, the assessment of age is gathered from the skull based on the anthropological findings. However, more accurate results of age estimation can be determined using dental morphology. The sex characteristics can be precisely ascertained through DNA dental analysis. Then, a complete X-ray study of the skeleton and an image-guided virtual autopsy using multislice computed tomography (MSCT) must match the radiologic images, anthropologic data and macroscopic findings.

Materials-methods: The goal of this presentation is to elucidate the team’s investigation of the skeletal remains of “Felice” Martyr, patron saint of Sennori, from the province of Sassari, who has been preserved in a reliquary. The aim was to find out the sex, age, height and the cause of death. The team included a medical examiner, an anthropologist and an odontologist. A DNA test, complete X-ray and multislice computed tomography examinations were performed. A radiocarbon test was performed to date the remains.

Results and conclusions: The investigation team was able to identify the age, sex and height of patron saint “Felice,” as well as the perimortem traumatic lesion. In this presentation we expound upon the conclusions of this investigation.


Evaluation of dental characteristics in an ancient population

Bahar Mergen 1, Feryal Karaman2

1Istanbul University Institute of Forensic Sciences Department of Forensic Anhropology, Istanbul Turkey

2Istanbul University Institute of Forensic Sciences Department of Forensic Odontology, Istanbul Turkey

Examination of teeth obtained from skeletal remains is one of the combined works of forensic anthropology and forensic odontology. These teeth characteristics provide information about life style, diet, habits, genetics and health status of ancient populations. The study material composed from 5 graves of a small population where had been lived in Istanbul dated to Late Byzantine period. Age and sex were determined and dentally distinguish features were analyzed specific to population. The population is consists of 5 children and 15 adults. 85 permanent and 14 deciduous teeth of 20 individuals were evaluated in terms of sex, age, growth and health. The size of the sample seemed to be smaller than the compared the others. Hypoplasia was detected in all canins and premolars. A rare case of pink teeth was found only in one tooth. Generally pink teeth occur as a result of sudden increasing pressure in tooth pulp and frequently seen in asphyxia cases.

It is assumed that this population located near by the Marmara Sea had survived an urban life. Although the sample size is small and archaeological findings are limited, present pathologies pointed out the evidences of malnutrition and stress.


Age estimation in an adopted girl with precocious puberty

Antonio De Donno, Roberta Roca, Francesco Introna, Valeria Santoro

Section of Legal Medicine – DIM - University of Bari – Italy

Age estimation is one of the main tasks of forensic anthropology and odontology, both on the dead and the living. In living subjects, age estimation may be used to establish an individual’s status as a minor in cases involving adoption, criminal responsibility, child pornography, and those seeking asylum, especially where adequate identification documents are lacking. The Authors report a case about age assessment of a girl born in Mbujimayi (Congo) and later adopted in Italy. The birth certificate issued after finding the child in a state of abandonment (in December 2007), bore date of 12.12.2004, but this was in contrast with the year of birth – 2003 – stated on the certification available to the center that had provided accommodation to the girl in Africa. Her adoptive parents reported that the child had been diagnosed with precocious puberty and was thus under treatment. She weighed 32.5 kg and was 132.5 cm tall. Basing on height and weight, body mass index (BMI) corresponded to the range between 9.5 and 14 years of age. The assessment of maturity indicators (sexual characteristics) placed the child at the lower limits of Stage II of Tanner’s classification (sparse growth of long, slightly darkened, downy straight pubic hair; elevation of the breast and nipple as a small mound with increased diameter of the areolae). The skeletal age was determined by taking X-Rays of the hand and wrist using Fels, TW2 and Greulich and Pyle methods. Dental growth was assessed through orthopantomogram using Demirjian’s technique. The methods applied were adjusted considering the studies on African population found in the literature, and a skeletal and dental age of 10 years was established. Afterwards, the wrist X-Rays performed at the Children’s Hospital of Bari, 7 months before our investigation, revealed a skeletal age of 7 years. This evidence showed that, despite the treatment the child had promptly initiated, early puberty had influenced the skeletal growth with an acceleration of about 2 years. Therefore, the age we detected (10 years) was the result of precocious puberty. Then, we backdated the girl’s birth (by about 2 years, based on current studies), stating that she was about 8 at the time of our investigation.

This case is significant both for the racial differences that need to be considered in age assessment, and for the importance of any pathology (growth disorders) that may affect physiological development and make the applied methods poorly reliable.


Morphological Analysis of Sharp Force Trauma Patterns Using High Resolution Casts

Samantha Donnellan1, Fotios Chatzinikolaou 2, Elena Kranioti1

1Forensic Anthropology, School of History, Classics and Archaeology, University of Edinburgh, UK

2Lab. of Forensic Medicine & Toxicology, Medical School, Aristotle University of Thessaloniki, Greece

Background: Sharp implements are the predominant weapons used in homicidal attacks in the United Kingdom. There is a paucity of literature on sharp force trauma and studies into weapon identification are limited. Moreover the few studies that exist are often based on experimental procedures using semi-fleshed and de-fleshed bones. For the legal authorities investigating violent crimes and homicides, the identification of the weapon employed is of paramount importance.

Methods: Five fully fleshed domestic pig (Sus Scrofa) heads were stabbed by male subjects, using five commercially available sharp implements. The subjects were selected to fit the UK average weight, height and age of offending males, and were asked to stab each head twice, exerting the greatest possible force. Each individual was assigned a weapon and told which side of the head to stab, aiming for the frontal bones. The side of the head to stab was chosen according to the handedness of the subject. Subsequently, each head was macerated using hot water with dissolved biological washing powder and high resolution casts were created of the cut marks and the weapon tips for comparative purposes. The positive casts of the weapons and the skull cut marks were studied macroscopically and microscopically using an Olympus B2 metallurgical microscope. Microscopic analysis provided a magnified visual depiction of the surfaces of the weapon tips and the cut floor and walls of the bone. Macroscopic analysis employed digital sliding calipers to measure the length and breadth of the cut marks and weapon tips.

Results: Various analytical methods were utilized to compare and contrast the results When combining macroscopic and microscopic analysis for each cast weapon tip and cut mark, a ‘match’ was based on the level of correlation. In some instances, macroscopic analysis was adequate to match the weapon type (class) to the cut mark, based on the shape alone, however this was not detailed enough to match an individual weapon of the recognised type.

Conclusions: The combination of both microscopic and macroscopic examination results in a match between the casts of the weapon tips and the cut marks leading to the identification of the weapon class. Further analysis using SEM is expected to enhance the possibilities of identification of the individual weapon.


Search Engines

Alexey Abramov

Department of Call Experts, State Bureau of Forensic Medicine, Moscow, Russia

This review is dedicated to the issue of creating search engines capable of performing independent face image analysis and database search.

Introduction: Computerization nowadays invades various aspects of our life. We are presenting a review of the ways in which up-to-date technologies can be implemented to automatic and semi-automatic identification hardware and software suites. We consider this research issue particularly topical, as, for instance, over 200 thousand investigative files are currently registered in the database of the chief information analysis centre of Russian Ministry of the Interior. This enormous amount of information requires creation of computerized systems which could perform independent preliminary search of similar objects registered in the database.

Materials and methods: The systems which we have developed for these purposes will be described with examples.

“TADD SM” is a hardware and software suite providing database search in databases containing such information as 3D skull models or photographic images of people wanted and / missing”.

“Portrait Search” is a hardware and software suite generating search by photo- and video images of individuals, unidentified corpses, skulls and identikit images (personal reconstruction of appearance).

“Identity Search” is a module which allows creation of a database containing social and anthropological (biological and physiological) information concerning people missing and unidentified corpses, as well as performing search in such database.

The « TADD » is a computer modification of the photo superimposition method (developed by: Abramov S., Boldyrev N., Bannikov A.). It consists of an optical system of noncontact measurement creating 3D skull models and of a hardware and software suite. The “TADD” system creates a partially automatic process of photo superimposition facilitating and improving search on a database. 3D skull models are mathematically accurate half-tone computer copies of the skull surface, presented on a PC screen as “virtual skulls”.

“Portrait Search” is a system which, by means of several comparison algorithms, allows database scanning and revealing face images maximally similar to the examined face.

“Identity Search” is the database providing storage and rapid use of various data files, which could have direct relationship to the identity of a person (for instance, blood type, fingerprints, DNA code and foot size), as well as indirect evidence (licensed vehicles or firearms of the person).

Thus we consider that conversion to the up-to-date level of data accumulation and analysis, including computerization elements, will provide positive results required for the evidence of identification.


Craniofacial Identification Case

Alexey Abramov 1, Nataliya Romanko2

1Department of Call Experts, State Bureau of Forensic Medicine, Moscow, Russia

2Department of Medical Criminalistics, Moscow Regional State Bureau of Forensic Medicine, Moscow, Russia

This review invites your attention to a practical case of craniofacial identification and gives you the gist of typical methods used in identification of individuals via the skull in Russia.

Introduction: The most commonly used methods in forensic analysis for identification are:

1. anatomical techniques identifying sex, age and descent of a victim;

2. comparison technique based on comparing separate elements of the appearance including individual peculiarities;

3. congruence of photographic images by means of the hardware and software suite “TADD SM”.

A fragmentary skull was delivered to the forensic department from the investigation agency.

The cranium and the mandible were significantly damaged, with most of the dentition loose. After comparison of the fragments the skull was reconstructed which subsequently helped to reveal significant defects as well as a gun-shot entrance wound on the left temporal bone.

The skull belonged to a man of the European descent aged 32–42 years- such details were discovered by means of anatomic and osteometric methods.

Materials and methods: In vivo photographs helped to reconstruct the victim's appearance and structural features of the facial bones skull.

Similar features were discovered on the skull.

The emphasis of the examination became focused on the structural asymmetry of the facial skull bones, relating to identifying features of the individual.

As soon as certain similarities of the compared objects were revealed in all discovered common features, the cranial skull images were superimposed with the person’s photographs.

A photo of an individual is scanned and represented on the screen. Then it is corrected within the program: 16 constant anatomic points are generated. These constants are matched with the same constants of the skull surface. The visible calvarium outlines are traced as well as the contours of the middle and bottom parts of the face, eyebrows, ear lobes and other features.

A 3D skull model was created by "TADD SM" and used as a skull sample.

During the superimposition analysis, one should take into account the location of the points of the skull model as well as and the head constants towards each other. Afterwards, the skull image is fixed in the found position. Besides the constant points, the skull outlines and the isolated features contours are marked.

Furthermore, certain congruence in location of all constant points and skull outlines was discovered in all examined projections. This allowed to conclude that the examined skull belonged to the missing Mr. X.


3D modeling in forensic medicine

Alexey Sergeevich Abramov 1, Elena Nikolaevna Grigoryeva2, Nataliya Aleksandrovna Romanko3, Anna Makartseva4

1Department of Call Experts, State Bureau of Forensic Medicine, Moscow, Russia

2Department for Work with Victims and Defendants, State Bureau of Forensic Medicine, Moscow, Russia

3Department of Medical Criminalistics, Moscow Regional State Bureau of Forensic Medicine, Moscow, Russia

4Department of English Philology, Moscow Humanities Teachers Training Institute, Moscow, Russia

This review will provide you with the information on the application and long-term development of 3D computer modeling technologies used in Russian forensics.

Introduction: Nowadays various up-to-date computer methodologies are widely used in modern forensics. We offer ways of using up-to-date technologies of noncontact 3D computer modeling that can be applied in the procedure of forensic identification.

Materials and methods: Some cases of portrait identification, craniofacial identification, as well as the procedure of confirming the identity of a living person, will be described as the examples of using such technologies. A number of examinations (investigations), the results of which are given below, were held using original methods and our own computer products.

1. 3D computer modeling technologies are especially effective for the identification by means of congruence, to an image of an identified person. This is because the perspective of the image is not significant in this case. This allowed producing the software which can do an automatic search on a large database of facial images (portrait search).

2. A computer modification of the photo superimposition (craniofacial identification) method is based upon the use of the software system “TADD SM” (developed by Abramov S., Boldyrev N., Bannikov A.) There are some configurations of this system including those which use 3D skull models. It has been demonstrated that it is possible to achieve rather positive results in automatic searching on the database with the images of missing people.

3. Utterly new possibilities are given by the method of producing 3D models of people’s injuries when identifying a living person or examining a corpse. It provides a special way of capturing the objects that drastically differs from making a photo or a video.


Mitochondrial DNA and 17 Y-STR Loci Analysis from Turkey

Emine Kaleintzi 1, Kuaybe Yücebilgili2, Cihat Güner1, Mustafa Fatih Abasıyanık1

1Fatih University

2İstanbul Medeniyet University

Mitochondrial control regions of 112 unrelated individuals from different geographical regions of Turkey were analyzed. Whole mitochondrial control region were sequenced with 10 primers. 201 variable positions were observed and 111 different haplotypes were determined in 112 samples. According to our findings, there are high frequency of Western Euroasian haplogroups in Turkey. 31 % of the people from Turkey are haplogroup R0. Other common clusters are K1a(5,4 %),H5(5 %),T2(3,6 %) and U3(3,6 %). The data obtained were also compared with other populations. Y-STR analysis of the same samples were done with 17 STR loci. The percent of the uniqueness is 99.1 % in Y_STR analysis and the most common haplotype was observed in 2(1.77 %) individuals.


Is the body height correlated with the foot length? A preliminary Tunisian male population study

Abir Aissaoui, Meriam Belhaj, Nidhal Haj Salem, Mohamed Amin Mosrati, Ali Chadly

Department of Forensic Medicine University Hospital Fattouma Bourguiba of Monastir- Faculty of Medicine- University of Monastir Tunisia

Aim: to study the correlation between the body height and the foot length in a Tunisian adult male population.

Material-methods: This study is prospective. The body height and both feet length of 112 Tunisian adult males (age-range from 18 to 89 years) were measured during autopsies performed in the department of Forensic Medicine of the University Hospital “Fattouma Bourguiba” of Monastir (Tunisia). The correlation regression coefficient “r” between the measures items was evaluated.

Main results: The correlation regression coefficient “r” between the right and the left foot length and the body height was respectively 0.457 and 0.452. These values show a medium positive correlation between these measures. For persons under forty, the correlation was slightly better (r: 0.520 for the right and left foot).

Conclusion: Foot length measurement is not reliable enough to estimate the body height because of skeletal individual variations and abnormalities occurring mainly after forty. Under this age, it is an approximate method which could be acceptable in cases where there are not other parts of the body to be measured.


Patterns of traumatic and heat-related fractures of blunt forces and gunshot lesions on cremated bone

Valeria Luisa Regazzola, Alberto Amadasi, Annalisa Di blasio, Davide Porta, Cristina Cattaneo

Labanof-laboratorio di antropologia ed osteologia forense, Dipartment of legal medicine and insurance, Università statale degli studi di milano, Milan, Italy

Background: Arson can be very destructive on human tissues and is in fact used as an attempt to destroy a corpse and to hinder identification or signs of trauma. If characteristic features of blunt and gunshot lesions on fresh bone are well-known, in cases of charred remains the challenge of a pathologist becomes tougher. Hence, can trauma features be reliable even in case of charred remains? And what kind of alterations do they undergo?

Method: Two kinds of lesions were created in two groups of bovine skeletonized ribs: nine samples were hit with a hammer creating blunt force lesions, while each of the other eleven samples underwent a shooting test creating a gunshot wound. Then, in order to simulate severe combustion, a charring cycle in an oven led to the complete calcination of the samples. Patterns and metric parameters of every bone fracture were recorded and compared before and after carbonization, in order to evaluate the effect of heat, such as the appearance of new fractures (heat-fractures) or significant modifications of pre-existing fractures.

Results: First of all, Student’s t-test and ANOVA tests clearly demonstrated how heat can effectively affect fracture features and new fracture formation on bone in both groups; in the case of blunt force fractures heat affected the dimensions of fractures in an unpredictable manner, whereas in the case of gunshot lesions heat definitely caused an increase in the length of radial fractures. Secondly, in the shot samples the number of new fractures (heat-related) is significantly higher, most of which radiating from the entry wound but some also longitudinal and transverse.

Conclusion: The highest number and type of fractures in shot samples could be due to the weakness of the bone, in the sense that the full-thickness of the gunshot wound makes the bone weaker than in the case of blunt force lesions, where the lesion is only depressed. In case of gunshot wounds heat can reliably yield an increase in the fracture length, while this cannot be surely stated with blunt force fractures. Thus, morphological and metric alterations of fractures related to trauma and the appearance of new heat-related fractures must be taken in serious consideration when a pathologist has to deal with charred remains.


Radiographic and morphological study to estimate the adult individual age in the clavicle

María Benito Sánchez, José Antonio Sánchez Sánchez, María Del Mar Robledo Acinas, Raquel Dominguez López

Legal medicine school of madrid, complutense university of madrid, spain

Currently, the estimation of the age is one of the most important issues to identify human remains in the forensic anthropology area. However, it can be difficult in some forensic cases because the methods don't have a very good correlation between chronological and biological ages in adult individuals. For this reason, it is important to develop other studies in this area, in order to improve the actual tecnhiques. The aim of the present study has been the creation of patterns of morphological variability to relate them to the age. To start, 280 standardized clavicles radiographic images have been done using the known sex and age bones from "The School of Legal Medicine of Madrid" collection. On them, some morphological patterns have been created using the anterior and posterior clavicle cortical thickness and density, and the medular cavity, and esternal and acromial extremities trabecular system. The results show a high descent in the anterior and posterior cortical thickness, and the trabecular system density, according to the age increase. In addiction, some trabecular diameter growth patterns have been related with the age advance. In conclusion, the morphological parameters studied are some useful tools to create some new techniques to improve the adult age estimation in forensic cases.


Here’s looking at you, Fordisc®…

Mikolas Jurda, Miroslav Dvorak, Petra Urbanova

Department of Anthropology, Masaryk University, Brno, Czech Republic

Introduction: In the framework of forensic anthropology, osteometric characteristics are often preferred in estimating the biological profile of unknown skeletal remains, in particular assessments of sex and ancestry. Fordisc® was developed to facilitate sex, ancestry and stature estimation of skeletal remains using Howells database and FDB as reference samples. The authors have pointed out repeatedly that an acceptable rate of reliability can be achieved when two basic rules are followed – an assessment must be based on the maximum number of measurements and an unknown specimen must belong to one of the reference samples. In practice, however, there are many cases when a fulfilment of these two conditions is difficult and thus a very unsatisfactory rate of reliability is to be expected.

Objectives: The main goal of our study was to assess the reliability of discriminant functions generated using Fordisc® 3.1 software when applied on human crania, which have no relevance to Fordisc reference populations.

Materials-methods: Sex and ancestry determination of 914 crania of known sex from six different skeletal collections (Athens, Coimbra, Lisbon, Săo Paulo and two collections from Prague) was carried out. Crania were analyzed using 13 cranial measures computed from 3D Cartesian coordinates of landmarks. Computation of measurements is being used with an increasing frequency in anthropological examination due to expansion of modern data acquisition methods. Discriminate functions derived from both Howells and FDB database were used to assess sex and ancestry.

Results: The accuracy of sex determination varied between 65 % and 90 % depending on specified ancestry. The crania were assigned to their historically or geographically related reference population at a rate exceeding their odds but not with the widely accepted reliability of 95 %. Even with a limited number of variables Fordisc 3 was able to correctly classify some of the crania from independent samples. Still, a large number of specimens are clearly misclassified and the software provided no clue to reveal these cases. Our results support the assumptions that the reliability of Fordisc® 3.1 is limited when the complete set of measurements is not available for the analysis and specimen doesn´t belong to the reference population. Therefore, true serviceability of Fordisc® 3.1 in the European and non-European context and its true merit for the anthropologists has to be further discussed.


Anthropological, histological and genetic features of three Neolithic skeletal remains from an Apulian town (Italy)

Marilidia Piglionica 1, Francesca Radina2, Stefania Lonero Baldassarra1, Vito Scattarella3, Gianfranco Favia1, Alessandro Dell' Erba1

1Interdisciplinary Department of Medicine, University of Bari, Italy

2Superintendence for Archaeological Heritage in Bari, Italy

3Department of Biology, University of Bari, Italy

In 1997, a monumental burial was discovered in Rutigliano, a little Apulian town (Italy), dating back to Final Neolithic Age (4th millennium B.C., Diana culture). The grave contained skeletal remains of three males, two of about 25 years old (individual 1 and individual 3) and one 18–20 years old (individual 2).

The aim of the study was to define physical characteristics, life habits, health conditions and possible parental relationship between them.

According to our study on both morphometric and metric features, the individual 1 was 171 cm (“tall height class”), the individual 2 was 152 cm (under the “average height class”) and individual 3 was 159 cm (“short height class”).

Body biomasses were 67 kg, 55 kg and 47 kg for individual 1, individual 2 and individual 3, respectively.

Enamel hypoplasia frequency, that is an indicator of nutritional deficiency linked by calcium uptake or disease with fever, was analyzed in order to evaluate the health conditions of the three subjects. Individual 1 was in good health conditions, showing 3 hypoplasic lines, individual 2 and individual 3 were in bad health conditions, with 16 and 13 hypoplasic lines, respectively.

All subjects presented no dental caries, abscess, intra vitam dental losses and 1°-3° degree tartar.

All the above conditions of the three subjects resulted in a good dental hygiene.

High-grade osteoporosis was histologically detected with intense rarefaction of bone trabeculae and enlarged of medullary spaces.

Biomechanical stress indicators analysis showed a modus vivendi characterized by hard and lasting ergonomic activities for individual 1, reduced workload for individual 2 and poor workload for individual 3.

Paleonutritional analysis revealed a rich and balanced diet for the individual 1, with good protein and cereal contribution, unlike individuals 2 and 3.

The finding of three individuals in a monumental grave allows us to suppose that the skeletal remains belonged to related upper class persons. The parental relationship between them was revealed by genetic analysis, using a modified protocol for extracting DNA from human bones and a specific amplification protocol for degraded DNA. The result was the characterization of hypervariable small genomic regions, called miniSTRs, usefull for identification of ancient skeletal remains.


Cranial Sutures As Age-At-Death Indicators In The Elderly

Ana Rodrigues 1, Francisco Curate2, Eugénia Cunha3

1Faculty of Medicine, University of Lisbon

2Research Centre for Anthropology and Health

3Life Sciences Department, University of Coimbra

Background: Estimating age at death in adult individuals is one of the fundamental steps when studying human skeletal remains. Nevertheless, it represents one of the most difficult challenges for forensic anthropology.

For years, methods to estimate age at death have been studied and different results have been reported by investigators.

Age-at-death estimation methods depend significantly on the skeletal elements available for analysis. The skull has been one of the most studied elements of the human skeleton used for that purpose.

The Luís Lopes Collection, from which our sample is derived, comprises of 1692 identified and 75 non-identified skeletons of individuals born between1805 and 1972, and who died between 1880 and 1975. These skeletons were removed from three cemeteries in the Lisbon area. The ages of the individuals range from newborn to 98 years. Most individuals in the collection belonged to the low and medium socio-economic classes.

Method: The sample from the Luís Lopes Collection initially comprised of 200 individuals older than 55 years. It was later reduced to 116 individuals because some skulls, whose preservation did not allow for the correct observation of the sutures, had to be excluded. The final sample consisted of 49 males and 67 females (n = 116) who ranged in age from 55 to 94 years.

Every skull was macroscopically observed. The three studied sutures (coronal, sagittal and lambdoid) were divided into segments. The coronal suture and the lambdoid suture were divided into three segments, this both on the left and right sides of the skull; the sagittal suture was divided into four segments. Each segment was assigned a score from zero to four (0- suture completely open; 4- suture completely obliterated).

The mean of the segment scores of each suture was calculated and registered.

Statistical analysis was performed on the entire sample.

Results and conclusion: No satisfactory estimates of age were yielded for most of the sampled individuals. Correct age estimations were obtained in only 44 of the 116 individuals (37.93 %) using the coronal suture (Wilcoxon Z = −1,925; p = 0,054) or the sagittal suture (Wilcoxon Z = −0,059; p = 0,953) and, in the case of 36 individuals (31.03 %), using the lambdoid suture (Wilcoxon Z = −5,736; p = 0,000). Cranial suture closure is neither an accurate nor a reliable method for estimating age at death in older populations.


A flow-chart for estimating age of unaccompanied minors

Roberto Cameriere 1, Luigi Ferrante2, Dora Mirtella1, Mariano Cingolani1, Luigi Oncini3

1Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, 62100 Macerata, Italy.

2Department of Clinical Medicine and Applied Biotechnology, Faculty of Medicine, University of Ancona, Via Tronto 10/A, 60020 Ancona, Italy.

3Radiology Unit, Hospital of Macerata, 62100 Macerata, Italy

This paper presents a flow-chart for estimating the age of subjects without identification papers, applying Italian legislation covering unaccompanied minors. The flow-chart is arranged as a decision-making tree, in which the first step is physical examination and, if secondary sexual characteristics are fully developed and there are no obvious signs of abnormal growth, X-rays of teeth are studied. If the roots of the seven left mandibular teeth, between the central incisor and the second molar, are completely developed, we then study the I3M of the third molar. If the I3M idex value is less than 0.08, or third molars are not assessed, we study the clavicle which, if fully formed, indicates that the subject is an adult at probability 99.9 %; otherwise, probability is 96 %. In all other cases, the subject is a major, with probability less than 60 %.


Body Mass Estimation In Polish Modern Population

Dorota Lorkiewicz Muszynska1, Wojciech Kociemba2, Agnieszka Przystanska3, Alicja Sroka3, Marzena Labecka1, Pawel Swiderski 1

1Department of Forensic Medicine, Poznan University of Medical Sciences, Poland

2Department of Neuroradiology, Poznan University of Medical Sciences, Poland

3Department of Anatomy, Poznan University of Medical Sciences, Poland

Background: The forensic anthropologists using different methods are able to estimate the, sex, biological age at death, stature of a skeleton with a relatively high degree of accuracy. Estimation body mass from the skeleton can be useful addition to analysis in forensic investigations involving unidentified skeletal remains. Body mass can be estimated from stature and bi-iliac (maximum pelvic) breadth, femoral head breadth.

Unfortunately, the accuracy of body mass prediction from skeletal remains will always involve significant inaccuracy. It is due to the high variability of soft tissue thickness and because high accuracy of body mass estimation proves best at average body mass estimation, disregarding body mass extremes.

The present study includes group of widely differing body types individuals of modern Polish populations for purpose to test body mass estimation methods from pelvic breadth and femoral head breadth.

Method: Multi-slice computed tomography (MSCT) was performed in Department of Neuroradiology at Poznan University of Medical Sciences using the 64 slice CT. Patients with known age, sex, weight and stature were evaluated to test the relationship morphometric correlation between real weight ant body mass estimated from stature and bi-iliac (maximum pelvic) breadth and femoral head breadth. Maximum pelvic breadth, anteroposterior femoral head breadth and adipose tissue thickness at the abdomen were measured directly from appropriate CT scan slices for each individual. Body mass index was establish for each individual. For the stature/bi-iliac technique, a revised equation was used (Ruff at al., 2005). Three equations based on femoral head breadth were used (Ruff et al., 1991, McHenry, 1992 and Grine et al., 1995).

Results: Body mass prediction methods based on bi-iliac breadth with known stature and the femoral head breadth show strong correspondence. The results of body mass estimation using different methods were in high correlation with normal (healthy weight) BMI. Results of body mass estimation compared with patient known weight showed higher correlation in bi-iliac breadth technique. The accuracy of body mass prediction of underweight and obesity cases (BMI extremes ) showed significant inaccuracy.

Conclusions: The equations for estimating body mass from stature and bi-iliac breadth, seem to do quite well in predicting body mass in modern Polish population. In forensic investigations involving unidentified skeletal remains, when bi-iliac breadth can be measured and stature estimated, the stature/bi-iliac technique should be use first of all.


New Methodologies and Protocols of Forensic Identification by Craniofacial Superimposition

Sónia Codinha1, Sérgio Damas3, Eugénia Cunha 2

1CENCIFOR- Forensic Sciences Centre, South Delegation of the National Legal Medicine Institute, Lisbon, Portugal

2Department of Life Sciences, University of Coimbra, Portugal; CENCIFOR-Forensic Sciences Centre, Portugal

3European Centre for Soft Computing, Mieres, Spain

One of the most important objectives of forensic anthropology is the determination of a victim’s identity, a process that always requires a suspect in order to compare ante and post mortem data. Unfortunately, often ante mortem records are unavailable and DNA may be impossible in circumstances where, for example, there aren’t known relatives of the supposed victim. Moreover, there are situations where many individuals share the same biological profile (mass disasters; mass graves) a condition that clearly complicates the identification process. In these situations the Craniofacial Superimposition technique (a forensic identification process where photographs of a suspected victim are superimposed over an unidentified skull in order to establish whether they belong to the same person) has been successfully applied to exclude or establish identity. Nevertheless, it is important to notice that instead of following a uniform methodology, forensic experts tend to apply their own approach to the problem based on the available technology and their knowledge and expertise. Having this in mind, in order to establish specific forensic protocols for the application of CS to different scenarios the new methodologies and protocols of forensic identification by craniofacial superimposition (MEPROCS) project aims to propose a common EU framework to allow the extensive application of the CS technique in practical forensic identification scenarios commonly tackled by the European scientific police units and promote the validation and exchange of CS protocols and methodologies among different European organisations (EUROPEAN CENTRE FOR SOFT COMPUTING - Spain; CONSORZIO DI RICERCA SISTEMI AD AGENTI - Italy; EUROPEAN COUNCIL OF LEGAL MEDICINE - Germany; UNIVERSITY OF GRANADA- Spain; MINISTRY OF PUBLIC SECURITY- ISRAEL; FORENSIC SCIENCES CENTRE- UNIVERSITY OF COIMBRA-PORTUGAL; MINISTERIO DEL INTERIOR- Spain).

The objectives of this project concern the 1) definition of standard protocols for the application of CS to different forensic scenarios; the2) Specification of objective and automatic validation techniques for the CS identification results; the 3) Simplification of the defined CS processes to promote their extensive application; and 4) the dissemination of the results. The MEPROCS project aims to propose a EU framework and methodology for forensic science to provide an objective evaluation of the forensic identification results achieved by CS.


Clavicle Superimposition for Human Identification: Quantification of Perspective-Effects Induced by a 'Point' Source of X-Rays

Carl Stephan, Pierre Guyomarch

Joint Pow/Mia Accounting Command, Central Identification Laboratory, Joint Base Pearl Harbor-Hickam, USA

In forensic anthropology, the comparison of ante- and postmortem (AM & PM) radiographs is routine for human identification. The clavicle lends itself to these comparisons because: it is routinely captured on chest radiographs (= the most frequently recorded clinical x-ray); resists field degradation; and possesses large variance in shape. Radiographic comparison of the clavicles is, however, complicated by perspective of the osseous element relative to a single (and fixed) ‘point’ source of x-rays. Source-to-image-receptor distance (SID), bone-to-image-receptor distance (BID) and position of the osseous element on the image receptor all potentially influence the shape of the clavicle that is recorded on the radiograph. This study aims to quantify the change in clavicle shape that occurs with manipulation of each of these variables, and to evaluate their impact on the superimposition process.

Twenty right clavicles were radiographed with three different SIDs, three different BIDs, and four different clavicle positions on the image receptor. A total of 36 images were thus obtained for each clavicle. Geometric morphometric methods were used to record the outline shapes of the clavicles using four type II and ninety-six type III (equidistant) landmarks, and deformation grids were computed between the mean shapes using thin-plate-splines (TPS). Linear distances on the radiographs were also recorded and superimpositions of the radiographs conducted.

The deformation grids reveal significant variations in shape of the clavicles between the different conditions evaluated. Shorter SIDs and larger BIDs increased the size of the osseous shadow, as recorded on the radiograph, and movement of the clavicle - from the center of the image receptor to its lateral edge - decreased the visibility of the conoid tubercle and exaggerated the clavicle’s sigmoid bend. Linear measurements of the radiographs mirrored these changes.

Superimpositions of ante- and postmortem radiographs of the exact same clavicle are not possible if the perspective of the bone relative to the x-ray source on the AM image is not replicated at PM radiography. An understanding of perspective-induced shape change is crucial for superimposition techniques if the AM morphology is to be quickly and efficiently replicated at PM radiography. Quantified modeling of these shape changes may prove useful for automated searching of AM chest radiograph libraries using 3D laser scans of clavicles.


Quantifying Thermal Damage on Bone with the Aid of Novel FTIR Absorption Peaks

Sarah Ellingham, Tim Thompson, Meez Islam, Gillian Taylor

School of Science and Engineering, Teesside University, Middlesbrough, England

Background: To a forensic anthropologist, bone has the potential to reveal insightful information about an individual’s life and death. Professionals of multiple disciplines have an interest in comprehending the changes undergone by bone subjected to thermal damage; be it archaeologists wishing to understand ancient burial practises or forensic professionals tasked with the reconstruction of an accident or crime scene. Conventionally, the Crystallinity Index (CI), which is defined by the splitting of the two absorption peaks at 605 and 565 cm-1 when using spectroscopy as a means of analysis, has been utilized to gain an understanding of the degree of heat exposure undergone by the bone; bone which has been heated exhibits larger hydroxyl apatite crystals, forming a more ordered structure. This present study is investigating the use of new absorption peaks in order to determine the burning time and temperature of bones more accurately. These ratios are CO/P with FTIR absorption peaks ratio of A1650/A1035, C/P = A1415/1035, CO/CO3 = A1650/A1415, CO3/P = A900/A1035 and the Phosphate High Temperature (PHT) which is calculated A625/A610.

Methods: Research was carried out using long bones from domestic sheep (ovis aries) which were experimentally burned in a furnace for 45 minutes at temperatures between 100°C and 1100°C in 100°C increments. Samples of the periosteal surface of the diaphysis of each bone were collected and analysed using the Nicolet 5700 FTIR-ATR, which exhibits the optical range of 30 000 cm-1 to 200 cm-1. The spectra are used to calculate the CI as well as the new ratios: C/P, CO/CO3, CO/P, CO/CO3, CO3/P and the PHT as well as the line width, which is defined as the full width at half the maximum of the phosphate peak at 1035 cm-1.

Results: Analysis of variance, principle component analysis and linear discriminant analysis were carried out on the data; blind tests utilizing these new absorption peak ratios found the rate of accurate temperature prediction using a combination of the newly calculated indexes to be 96.3 %.

Conclusions: Research at Teesside University has shown that the indexes mentioned above can predict burning temperatures accurately in over 95 % of the experimentally burned samples, which is a significant increase in accuracy compared to the 66.7 % obtained when only the CI was used. These findings are highly promising in the advancement of burned bone analysis.


Towards an algorithm for determining age ranges from faces of juveniles on photographs: a tool for detecting juvenile pornography and for face aging

Marco Cummaudo 1, Margherita Guerzoni1, Alfredo Cigada2, Laura Marasciuolo1, Remo Sala2, Pasquale Poppa1, Daniele Gibelli1, Cristina Cattaneo1

1LABANOF, Laboratorio di Antropologia e Odontologia Forense - Sezione di Medicina Legale, Dipartimento di Morfologia e Scienze Biomediche, Università degli Studi, Milano, Italy

2Sezione di Misure Meccaniche e Tecniche Sperimentali - Dipartimento di Meccanica, IV Facoltà di Ingegneria Industriale, Politecnico, Milano, Italy

Background: In the last years the analysis of faces has gained great interest in forensic anthropology, both for personal identification and for the issue of juvenile pornography. The age of the victim has a crucial role for ascertaining the crime of juvenile pornography, but methods of aging which use the assessment of sexual characteristics have proven to be too subjective and deceiving for age estimation. The application of facial landmarks may bring about relevant advantages for the analysis of 2D images by measuring the distances and extracting quantitative indices. This study aims at evaluating the modification of facial indices with age on pictures.

Methods: The experimental project includes two phases: during the first one 2046 photos in frontal view and 2043 in lateral view were taken from Caucasoid subjects aged between 3 and 32 years without relevant pathologies and facial deformities. The photos underwent analysis with Mathworks Matlab, via the collocation of 22 landmarks on faces taken in the frontal view and 11 in the lateral view. The inter- and intra-observer error in definition of each landmark was also evaluated. In the second phase 18 anthropometrical indices for the frontal view and 5 for the lateral view were calculated by distances between different landmarks; the correlation with age was evaluated.

Results: Both in the frontal and lateral view the landmarks which showed less dispersion were the pupil (pu), cheilion (ch), endocanthion (en) and stomion (st); the landmarks with the highest dispersion were gonion (go), zygion (zy), frontotemporale (fr), tragion (t) and selion (se). In the lateral view the landmarks with the least dispersion were selion (se), pronasale (prn), subnasale (sn) and stomion (st), whereas landmarks with the highest dispersion were gnathion (gn), pogonion (pg) and tragion (t). Indices showing a possible correlation with age were ch-ch/ex-ex, ch-ch/pu-pu, ch-ch/ft-ft, en-en/ch-ch and se-sto/ex-ex in the frontal view, se-prn/se-sn, se-prn/se-sto and se-sn/se-sto in the lateral view. As concerns correlation of the indices with age, though with some error, ch-ch/ex-ex, ch-ch/pu-pu and se-sto/ex-ex do seem to relate with age even on photographs.

Conclusion: results show that anthropometric studies on 2D images must be preceded by the assessment of the reliability of the positioning of facial landmarks in order to avoid gross errors. In addition the metrical data derived from the experiment may provide interesting insight for aging faces from pictures and for face aging techniques.


Virtual 3D reconstitution of human skeletal remains in forensic context: benefits and costs

Petra Urbanova

Department of Anthropology, Faculty of Science, Masaryk University

As far as forensic anthropology is concerned modern 3D virtual technologies enable to apply new approaches in order to answer traditionally asked questions, i.e. what is the identity of a person, when did he/she die and what was the cause of death. While dealing with skeletal remains, forensic anthropologists frequently examine evidence that is fractured, deformed or otherwise altered by a variety of peri mortem or post mortem factors. Consequently, it is often required to restore the original bone integrity to a degree that would allow a proper anthropological examination, personal identification included. Traditionally, a layer of synthetic material (glue or resin) is applied between fragments in order to assemble bones permanently or temporarily. Virtual 3D reconstitutions offer a helpful assistance for the task as they are non-invasive, contactless and allow creating as many possible scenarios of a given situation as wished.

As it is up to professionals to balance advanced, but costly and time-consuming techniques with traditional ones, they must be aware of all benefits and costs. The contribution will present a critical review of the virtual 3D restoration approach based on a forensic case involving 3 victims found in a deep mass grave in a poor state of preservation with heavily fragmented skulls. The presumed peri mortem cranial injuries had been altered by a severe post mortem destruction and decomposition. As the traditional restoration approach was impossible to carry out 3D virtual approach was employed in order to state the cause of death and its mechanisms. In the process, all fragments were scanned with a laser scanner, assembled using 3D modeling programs and further adjusted with a virtual clay tool modeling program. The final virtual 3D reconstituted skulls enabled to identify gunshot injuries on all three victims and distinguish mechanisms of observed damage.


Age estimation by rib-phase analysis in Indian females

Prashantha Bhagavath 1, Francis Np Monteiro2, Pradeep G Kumar1

1Department of Forensic Medicine, Kasturba Medical College, Manipal University, Manipal, India

2Department of Forensic Medicine, AJ Institute of Medical Sciences, Mangalore, India

Introduction: Currently there are different parameters available to determine the age of a person like study of teeth, ossification of bones and other ancillary data, but the reliability of these measures is only limited to a particular age group i.e. less than 25 years. The Iscan’s phase method for the estimation of adult age at death from the sternal extremity of the fourth rib was introduced in 1985. Over the years, numerous tests have confirmed the reliability of this technique on varied samples in different age groups.

Aim: To determine the age of the individual at time of death using rib phase analysis in Indian male population.

Material-methods: 205 samples of sternal ends of the right fourth ribs belonging to Indian female population with known age at the time of death. Each rib was phased using the standards developed by Iscan and associates in 1985. The phase estimations were then subjected to an analysis of variance.

Results and conclusions: The results of the study indicated that Indian female ribs show the same morphological characteristics that define the phases at nearly identical ages. Variation as measured by the standard deviation increased from phase 5. In conclusion, this study demonstrated that the rib phase standards can be accurately applied to Indian females. Investigations of this nature are vital because one cannot assume that a method developed from one group is applicable to a distant population, especially in medico-legal proceedings.


A forensic anthropology study of a mass grave belonging to world war one

Daniel Gaudio1, Matteo Morelli 3, Andrea Betto4, Andrea Galassi2, Agostino Rizzi5, Cristina Cattaneo1

1Labanof, Laboratorio di Antropologia e Odontologia Forense Sezione di Medicina Legale e delle Assicurazioni DMU – Dipartimento di Morfologia Umana e Scienze Biomediche. Università degli Studi di Milano, Italy

2U.O.S. of Legal Medicine ULSS N. 6 S. Bortolo Civil Hospital of Vicenza, Italy

3Department of Public Health and Community Medicine, Institute of Legal Medicine, University of Verona, Policlinico G.B. Rossi, Italy

4Dipartimento di Archeologia, Università Di Padova, Italy

5Cnr - Idpa – Istituto Dinamica Processi Ambientali, Milano, Italy

Background: The study presented consists in the forensic anthropological analysis of seven skeletons recovered in a World War One Mass Grave on the mountains of the Veneto Region (Site of Soglio Melegnon di Arsiero, Vicenza, Italy). Although the finding of skeletal remains belonging to World War One is not such a rare phenomenon on the mountainous areas which had been involved in the First Conflict, it is rather exceptional, on these mountains, to find a mass grave with soldiers in primary burials.

Methods: The skeletons were recovered using archaeological methods. Moreover the grave was scanned with a 3D Laser Scanner. The biological profile was defined by sexing, aging, stature and ancestry determination according to standard anthropological methods. Pathologies and stress markers were evaluated; an extensive study was conducted on skeletal trauma in order to establish the type of trauma and ammunition involved.

Results: Except for one case the skeletal remains were in anatomical connection and in primary burials. Four soldiers lied prone, two subjects were lying on their side. Only two soldiers had personal effects: one had a badge concerning military vaccinations, the other had religious medals. By the remains of the uniforms it was deduced that all individuals belonged to the Italian army. The anthropological study revealed the presence of seven male subjects, of ages included between 18 and 35 years. The soldiers showed diseases of a degenerative type, occupational stress (enthesopathies) and, in one case, metabolic stress (cribra orbitalia and cribra cranii). The study of injuries revealed a surprising variety of types of lesions, mostly lethal: a few subjects were struck by a Shrapnell grenade, one soldier was certainly torn apart by a grenade explosion. Two soldiers showed handgun shots (9 mm) to the skull. On the basis of the location of entry and exit wounds and the direction/angle of the shots it is plausible that these were executions. Scanning Electron Microscopy coupled with Energy Dispersive Xray Spectrometry allowed us to detect metal residues related to Shrapnell and grenades.

Conclusion: The study carried out on this rare case of a mass grave belonging to World War One, allowed for the recovery of a piece of buried History; from a forensic point of view it allowed for the observation of several kinds of perimortem injuries caused by different WWI weapons.


Estimation of Stature From Hand And Handprint Measurements in Anatolian Girls: A Preliminary Study

Erhan Buken 1, Can Pelin1, Bora Buken2, Ayla Kürkçüoğlu1

1Baskent University

2Düzce University

Estimation of adult height from long bones plays an important role in forensic examinations. In modern forensic anthropology the investigator not only interests in skeletal remains. Percutaneous body measurements are also known to give reliable results.

In the present study the relationship between various dimensions of hands and body height were evaluated for the Anatolian population. Besides the measurements from hands and handprints were also evaluated related with stature since hand prints were easily left in crime scene. The purpose of this study was to analyze anthropometric relationships between dimensions of the hand, handprint and body height. In this preliminary study the correlation of stature and various measurements of hands have shown along with the multiplication factors used to estimate the stature from these relationships between specific measurements and stature.

Materials-methods: The study consists of a sample of 85 female university students from several parts of Turkey, but living in Ankara at the time of the study. The mean age of the sample was 21.40 ± 3.22. The images of the right and left hands were acquired by using a flat bed scanner. The seven measurements on each hand were acquired with a sliding caliper respectively. Correlation analysis and linear, multiple regression equations for stature estimation were calculated using the aforementioned variables and multiplication factors were computed.

Results: The mean stature and mean length of the left and right were 1634.83 (S.D. 57,21) mm, 174.65 (S.D. 7.35) mm, 174.40 (S.D. 7.47) mm. Correlation coefficients between stature and all the measurements were found to be positive and statistically significant. The highest correlation was observed between right hand length and stature (0,607; p < 0.01). Prediction of stature was found to be most accurate by linear regression analysis.

Conclusion: This finding indicates that the hand length provides the moderate reliability and accuracy in estimating stature of an unknown female. In forensic field measurements from hand could also be used for the estimation of stature. It may consider differences between populations to apply such functions to other populations. The comparisons made with other population could contribute to understanding of the relative status of our population in the context of the anthropometric variations around the world.


Facial Reconstructions on Two Historical Skulls

Ahmet Sadi Çağdır 1, Fatma Nur Konukman2, Hüseyin Afşin1, Sevim Başer1

1Council of Forensic Medicine, İstanbul, Turkey

2Ministry of the Interior, Ankara

Facial reconstruction is not only used for forensic cases, it is also useful at some historical cases. There have been many studies on the historical skulls. These studies have been practiced on famous people’s skulls or unidentified people’s skulls. Similar studies were practiced in Forensic Medicine Institution Laboratory. The two cases which will be presented here are unusual because of their reconstruction being done at the excavation site.

Cases: Metropolis is an ancient city which was built on today’s Smyrna’s Torbalı county 5000 years ago. There has been an excavation since 1992. Since then, many human bones have been retrieved from the excavation site. Dr Çağdır carried out investigations on the human bones and performed two facial reconstructions at the excavation site in the summer months of 2008 and 2009. In 2008, a facial reconstruction was performed on a 30–35 years old Roman’s shattered skull. Also in 2009, a 20–25 years old woman’s skull had a facial reconstruction whose body was retrieved from a grave. Thanks to the fact that woman’s whole skeleton was retrieved, all of her bones could be studied. Busts which were built on these two different skulls were prepared to be presented.

Conclusion: In the field of Forensic Sciences, multi-disciplinary working has an important value. It is important to determine the age of the studied bones which are retrieved from the excavations. This is the reason why it is important for Forensic Medicine experts to gain experience on the excavation sites. Facial Reconstruction is an application which helps to the identification of missing people. Nevertheless, the facial reconstruction of the historical skulls are important for the history and archeology sciences.


Presentation of Case on Identification by the Aid of Facial Reconstruction

Sevim Başer, Ahmet Sadi Çağdır, Safa Çelik

Council of Forensic Medicine, İstanbul Turkey

One of the operations related to the identification of the unidentified skeletal remnants, is facial reconstruction. The skeletal remnants which are unidentified are sent to Istanbul Council of Forensic Medicine (ATK)

The photographs related to the facial reconstruction which, are included in ATK’s facial reconstruction laboratory, are sent to prosecution offices in order to find the missing people. In ATK laboratory, both 2D and 3D facial reconstructions are practiced. In 3D reconstructions, “Istanbul method” is applied. This method is based on tissue depth principles and tissue depths are measured by callipers. In this presentation, one of ATK’s facial reconstruction cases which gave a positive result will be presented.

Case: A mandible skull and 29 pieces of bones, which were found in a forest in Mersin, a city in Akdeniz region of Turkey, were sent to ATK to be investigated on. After the investigations, it was found out that the bones belonged to an adult male. A firearm wound was spotted on the skull. Then a facial reconstruction of the skull was constructed and the acquired facial photographs were sent to the prosecution office. In return, the prosecution sent a photograph of a missing person to ATK in order to be compared with the acquired photo from the facial reconstruction. Upon the comparison, a remarkable similarity was discovered between the two different photographs. Finally, with a DNA analysis, it was confirmed that the bones were belonged to the missing person.

Facial reconstruction is one of the succesful methods practiced in identification processes. ATK has played a crucial role in many identifications of missing people with the usage of this method.


Three Dimensional (3D) Forensic Craniofacial Superimposition

Ozgur Bulut

Department of Forensic Anthropology, Police Forensic Laboratory, Ankara, Turkey

The main aim of Forensic Anthropology is the identification of human beings from their skeletal remains. Craniofacial superimposition, one of the forensic process of craniofacial identification, is employed for the identification of the unidentified skulls. An antemortem facial image (photograph or video frame) of a missing person and an unknown skull are compared each other by the projection of the skull into the face image in order to establish whether that is the same person.

In this study, three dimensional (3D) craniofacial identification is described. After reviewing 3D craniofacial superimposition procedure and 3d devices used in this process, a case study is presented.


Comparison Between Trotter Glesser's Formula with Atmadja's Formula on the Height Examination on Human remains of Second World War Japanese Soldier in Biak, West Papua

Evi Untoro 1, Djaja Surya Atmadja2

1Cengkareng Hospital, Jakarta, Indonesia

2Forensic and Medicolegal Department, Univ of Indonesia, Jakarta

Background: Around year of 1942–1945 on Second World War, Japan fleet about 44.000 of their armies to occupied West Papua, Indonesia. But, unfortunately there are aready occupied by US Army under the command of General Mc.Arthur and the war cannot be resist. Many soldiers died in that incident. For Japanese Culture and Religion, the Human Remains should be identified and cremated so they can be released and have another journey of their spirits life.

Method: We separate the human remains between caucasoid and mongoloid bones, diffferentiate the animal remains also other artefacts and fragmented bones. The Human remains of the long bone such as Femur, Tibia, and Fibulas were height measure by Trotter Glesser's Formula and by Atmadja's Formula.

Result: After a long bones measurement and comparison it between the both formula, we conclude that there has been about ten centimeters differentiation between them. And the most appropiate measurement of the height of the human remains of Japanese Soldiers is using the Atmadja's Formula after we matched it with the height measurement of the identity some of the Japanese soldiers.

Conclusion: Even the appropiate measurement of human remains for Japanese soldiers is using atmadja's Formula, but there are still need more continuing research for having the best Method on Forenisic Anthropology.


Forensic anthropology and criminal investigation - the importance of an interdisciplinary approach

Filipa Gallo1, Clarice Mestre1, João Sousa2, Luisa Eiras1, Jorge Costa Santos1, Eugénia Cunha 3

1National Institute of Legal Medicine and Forensic Sciences of Portugal – South Branch

2Polícia Judiciária (Criminal Investigative Police) - Department of Criminal Investigation of Setubal

3Department of Anthropology, Faculty of Sciences and Technology, University of Coimbra

The authors present a case where a joint and thorough interdisciplinary approach between the forensic anthropologist and the investigative police agency, although in a suspicious setting, allowed a successful identification of human remains.

A skull was initially found in the surroundings of a jail house, under a fallen tree. The rest of the skeleton, except for the bones of both feet, left forearm and left hand, was recovered afterwards. In laboratory, the forensic anthropologist analyzed the human remains, built a biological profile of the remains and detected bone traumatic injuries. The human remains were that of a European origin male, estimated age between 30–50 years, whose stature was 170 ± 6.9 cm. Antemortem, perimortem and postmortem bone traumatic injuries were present. Entomological specimens were sent to analysis to assist in determining the postmortem interval.

The biological profile along with antemortem bone traumatic injuries and estimation of the postmortem interval allowed the investigative police agency to narrow the search for the decedent’s identity from the initial 220 missing persons in the inmate population and to ultimately confirm the remains’ identity with genetic analysis.

Definitely perimortem injuries, located in the base of the skull (including petrous right bone) and mandible were considered as assisting cause of death. Longitudinal linear fractures on the long bones of the inferior limbs could not be definitely assessed as perimortem or postmortem due to sun exposure and absence of the feet and the distal extremities of the fibula.

Through a complete description of the forensic anthropological analysis and the police investigative work, the authors demonstrate the need for an interdisciplinary approach, fluent in bidirectional communication flow, in order to successfully identify human remains and establish a cause of death.

Even though in the reported case the circumstances of death were not clarified, justice was served and the deceased was released to the proper relatives.



Sarcophaga species (Diptera, Sarcophagidae) recovered from human corpses during autopsies in Granada (Spain)

Alejandro González Medina 1, Lucas González Herrera2, Gilberto Jiménez Ríos1

1Instituto de Medicina Legal de Granada, Granada (Spain)

2Department of Forensic Medicine, Toxicology and Physical Anthropology; Faculty of Medicine of Granada (Spain)

Background: Genus Sarcophaga (Diptera, Sarcophagidae) consists of a group of species considered to be very useful for the establishment of postmortem interval since the dawn of Forensic Entomology. Some species are characterized by reaching the corpses in initial stages of decomposition (primary colonizers); others, by contrast, have a great interest as component of the faunal succession in corpses in advanced stage of decomposition. Despite the undeniable interest of these insects, very little is known of their biology. In this work, we analyze the occurrence of this genus during judiciary autopsies performed in Granada (SE Iberian Peninsula) in order to assess their interest as forensic indicators.

Method: Autopsies were performed according to the guidelines of the European legislation and the sampling of entomological evidences was fitted to the standards of the European Association for Forensic Entomology (EAFE). Those immature stages that could not be identified through larval morphology were reared under controlled conditions in a breeding chamber at constant temperature and humidity with liver of pig ad libitum. Only adult males were identified directly after dissection of their genitalia, one of the most important morphological features when it´s necessary to discriminate species in this family. Some females, which retained larvae in the abdomen, were fed up to larviposition and, from the resulting adult males after breeding, an indirect identification could be performed.

Results: in all forensic cases that occurred in the period 2010–2011, Sarcophaga genus have been sampled in 45 % of the cases where some kind of entomological evidence was recovered. Sarcophaga (Bercaea) africa (Wiedemann, 1824) and Sarcophaga (Liopygia) argyrostoma (Robineau-Desvoidy, 1830) were the two most common species. The first was sampled in 32 % of the cases, the second in 43 %. The remaining 25 % was distributed equally among S. (Sarcophaga) carnaria (Linnaeus, 1758), S. (Liosarcophaga) jacobsoni, S. (Sarcophaga) subvicina Rohdendorf, 1937 and cases where we couldn´t manage a satisfactory identification of Sarcophaga larvae or pupae, given the lack of bibliography about preimaginal instars of this family and difficult conditions of rearing. On the corpse, we could only find larvae of S. africa, S. argyrostoma and S. jacobsoni.

Conclusions: the proven occurrence of the genus Sarcophaga shows that certain species of little-known biology may occur in cases of legal interest. The need of answers to their finding in a human corpse implies the obligation of carrying out more research on the genus Sarcophaga and, in particular, on these species.


Successional patterns of sarcosaprophagous insects on pig carcasses in Granada (Southeast Iberian Peninsula)

Alejandro González Medina, José De La Higuera Hidalgo, Gilberto Jiménez Ríos

Instituto de Medicina Legal de Granada, Granada (Spain)

Background: Forensic entomology is the scientific discipline that uses knowledge about the life cycles and the dynamics of arthropod populations to clarify circumstances related to cases which will be considered in a Court of Law. The two main strategies used to deal with the problem are the study of larval development (for corpses in the early stages of decomposition) and the comparison of fauna found in the body with typical patterns of faunal succession of the habitat where the corpse has been found (for more advanced stages of decomposition). In this study, we describe the successional models for the seasons in which Forensic Entomology cases are more usual in Andalusia (Southern Iberian Peninsula): summer and fall.

Method: The study was conducted during summer 2011 (1 August - 26 August) and autumn 2011 (29 September – 24 October) in two agricultural biotopes consisting of vacant lots without any vegetal cover, arid soil and enclosed with a fence. Two domestic piglets, Sus domesticus L., of of 19 to 22 Kg weight were killed per season by penetrative captive bolt and disposed in the sampling sites within the next 2 hours. In order to avoid incomplete and biased successional inventories, we used a cubical trap based in the same functional principle of Schoenly, with a lower removable sandbox with pitfall traps to ensure the sampling of “walking scavengers”. Statistically, we only included in our model indicator species according to the IndVal method (IndVal index > 25).

Results: A total of 11507 individuals of the order Diptera, belonging to 17 families, were sampled. Coleoptera were represented by a total abundance of 1092 specimens agrupated in 12 families. Many families were discarded in the statistical analysis. Significant differences in the faunal composition between both seasons have been observed. Species found in both sampling periods showed differential behavior in their appareance and residence periods, perhaps because of the drop in temperatures in the fall.

Conclusions: These differences allow us to conclude that successional studies covering the entire annual climate spectra are necessary to avoid incorrect inferences. Similarly, a larger number of biogeographical regions within our peninsula must be covered with these studies with the aim of knowing the variations due to local fauna.


Edaphic fauna and buried corpses: arthropods found in coffins during exhumations in Granada (Spain)

Alejandro González Medina 1, Lucas González Herrera2, Gilberto Jiménez Ríos1

1Instituto de Medicina Legal de Granada, Granada (Spain)

2Department of Forensic Medicine, Toxicology and Physical Anthropology; Faculty of Medicine of Granada (Spain)

Background: Mateo Orfila and Pierre Mégnin were the first researchers that exploited exhumations to summarize the fauna associated with corpses. While Orfila simply enumerated the species he found, Mégnin laid the cornerstone for the forensic entomology when he grouped species in eight waves called "workers of the death". Since then, many studies were performed but very few dealt again with the problem of buried corpses and the information that exhumations can provide. In October 2008, a series of restoration works began at the San José graveyard (Granada, Spain). In order to move to an ossuary those corpses which were not claimed within a period of one year, 20 non-judiciary exhumations were performed. We focused our sampling on mites (Acari: Oribatida, Prostigmata and Mesostigmata) and Collembola. We wanted to test if there were differences among the faunistic composition of burials with different Post-burial Intervals (PBI).

Method: Sampling of mites and collembola was conducted in three stages. First of all, we took dust samples with a manual vacuum above and below the body, taking special care on the bottom and corners of the coffins. Second, we removed manually pieces of soil that penetrated through the chinks of wood. Finally, we inspected again the corpses and coffins once removed the corpse and running arthropods were captured with the help of a brush soaked in saline solution. Dust collected by manual vacuuming was processed by a flotation method in a sodium chloride saturated solution (Arlian method modified by Solarz). Soil found in the tombs were sampled with the help of Tullgren funnels using ethylene glycol as preservative liquid.

Results: In a preliminary analysis, we grouped the fauna of each group (oribatid, mesostigmatid, prostigmatid mites and collembola) in 17 morphotypes, without identification purposes at first. Subsequently, we were able to observe an association between the occurrence of certain species and PBI, given the significative differences observed in the faunistic diversity of each group of exhumations. The biggest differences could be appreciated in the range of 5–10 years PBI, while certain stability was found in the first 1–5 years.

Conclusions: Given that we have observed significantive differences among groups, we can assert that the edaphic fauna can be used apart from the classic forensic markers (Diptera and Coleoptera) in the assesment of the postmortem interval, when burial is close to the time of the death.


A Mistake In Entomological Investigations Into Drowning Case In Water A Case Report

Hülya Aksoy Aydınlı 1, Mesut Eryürük2, Hakan Toka2

1Osmangazi University, Science Faculty, Department of Biology, Eskişehir

2Osmangazi University, Department of Forensic Medicine, Eskişehir

Purpose: An investigation of structures like white insect eggs found on a drowning case in water, determination of whether they have got an entomological value.

In forensic science, the field refers to Forensic Entomological, which examines of information obtained from entomological evidence in solving of case. While forensic cases are solving, entomological information collecting on or around corpse is very important. In toxicological investigation and location, time, reason of death, insects and their eggs are used. In order to make investigation on cases, there is a requirement of professionals who are brought up in this field.

Case: In 11 December 20111, a corpse who drowning in 2 metres dwell which was dig for train subway was found in Eskisehir. The corpse was taken into the Osmangazi University forensic medicine institute. The experts observed white foreign matters locating around eyes and in nose, ear and mouth. These white foreign matters were like to insect eggs packets and were asked to make an entomological assessment. Since the season was winter and the temperature was below zero, the data which were thought to be entomological were supposed very amazing and important because insects don’t bring their eggs in winter. In addition, it is important to reach data about how the case occurred owing to find terrestrial insect eggs on a corpse taken out water. But it was understood that white matters mass was not insect eggs but styropor particle in consequence of making entomological analyses.

Discussion and conclusion: Insects provide important biological data to enlighten forensic case. In this case, the entomological data which was found on corpse being take out water gave rise to thought that the person was killed before to throw, then waited a little time and then thrown to water. As a result of making investigation by entomologist, it was seen that the data did not have an entomological value. Forensic entomology institute was a field to improve in Turkey. We were satisfied that it was useful for the period of Forensic science with conducting project and shared studies, taking support from other forensic science field,being known the forensic entomology science field.


Investigations on Development Stages of Lucilia illustris Meigen (Calliphoridae: Diptera) in Terms of Forensic Entomology

Hülya Aydınlı

Osmangazi University, Science Faculty, Department of Biology, Eskişehir

Calliphoridae family larvae are important for forensic entomology. For that reason development biology of larvae are very important. Larvae and adult stage nutrition habits are different at members of that family which get holometabol metamorphosis. In generally Calliphoridae species lives on that dead or living inn at larval stages. Species that lives on dead inn at larval stage helps for ecological balance by easier to take to pieces and decay. On the other hand classes which lives on living in at larval stage causes “Myiasis” illness. Larvae that have the ability of take texture in to pieces very faster, uses in uncured bruise.

This study make with samples taken by one stations in city Eskişehir. For continue that study putrid hepatic pieces had put at station and egg packets add together over that hepatic. Egg packet which are in Calliphoridae family and the time of larval stages to reach adult.

At that study one base family inculudes one genus and one species Lucilia illustris Meigen, 1826, had fasten down. İt has seen that development of investigated with Lucilia illustris at 17–21 days were finished.


Distribution of Diptera Species on Corpses from Ankara and the Cities nearby: The First Study from Turkey

Halide Nihal Açıkgöz 1, Ali Açıkgöz2

1Ankara University, Forensic Sciences Institute, Ankara, Turkey

2Republic of Turkey, Ministry of Health Ankara, Provincial Health Directorate, Family Health Center, Ankara, Turkey

Background: In forensic research, forensic entomology is the science solving forensic cases by examining arthropods coming to corpses. Mostly, Diptera and Coleoptera can be found on human corpses and animal carcasses. A map of forensic insect fauna in Turkey is needed. The aim of this study was to identify Diptera species in Diptera larvae on suspicious deaths and to determine the fauna in Ankara and the cities nearby.

Method: Specimens containing entomological evidence were collected from corpses referred to The Council of Forensic Medicine Ankara Morgue Department by the courts. After the larvae were killed in boiling water, they were dried, put in tubes containing 96 % alcohol and sent to Ankara University, Institute of Forensic Sciences laboratory of Forensic Entomology /Forensic Biology. Species of the larvae were identified.

Results: The larvae on the corpses coming from the cities around Ankara, namely, Yozgat, Corum, Cankiri, Zonguldak, Giresun, Kastamonu, Bartin and Bolu belonged to species of Calliphoridae, Muscidae, Sarcophagidae and Heleomyzidae families. The most frequent species were from Calliphoridae family.

Conclusion: In forensic cases, entomological evidence can be used to determine the link between a suspect and a crime scene and place, manner and time of death. This is the first study to determine the insect fauna in Turkey and underlines the importance of knowing local forensic insect species.


Is It Possible to Use House Dust Mites (HDMs) in Criminological Sciences?

Kasım Guven 1, Hüseyin Cakan1, Filiz Ekim Cevik1, İsmail Cakır1, Erdal Polat2

1Istanbul University Institute of Forensic Sciences, Istanbul,Turkey

2Istanbul University Cerrahpasa Medical Faculty,Medical Microbiology Department,Istanbul,Turkey

Introduction: It is indicated that some types of HMDs are deemed the most remarkable effects of allergic diseases. Primary food source of HDMs are skin epithelial cells which are available in house dust and scaled off humans. Biological evidences containing DNA constitutes the most important part of crime investigation in criminological sciences. Biological evidences are generally visible materials such as body hair, hair, bloodstain, but also they might be invisible microscopic sizes. Microscopic-sized skin epithelial cells which are available in house dust and containing human DNA may be exampled for biological evidences. Therefore, we think that these microscopic livings may be used in criminological sciences by evaluating biological characteristics of Mites surviving with epithelial in house dust.

Material-method: We collected house dust at random in Istanbul in order to determine if mites are sufficiently available in house dust for the purpose of our study. We developed a special filter apparatus which can be adapted to standard vacuum machines and keep the house dust in order to collect dusts. By using this apparatus, we collected approximately one gram house dust by vacuuming from the bedroom and surrounding of each house on two meters square surface at least five minutes. Saturated saltwater was added on dusts in beakers as it would not pour forth dusts, mixed and floated. House dust mixture obtained from the surface of beaker by using lamella were analyzed under microscope; after description and types of mites found out were determined, they were collected into eppendorph tubes including ethyl alcohol by means of sterilized needle tip.

Findings: Mites were determined in 59 of 60 house researched as a result of analysis of house dusts. Determined mites were 3 kinds, 6 families, 5 races and 2 types which different from each other taxonomically. In 53 of house dusts in which mites were determined, at least of one of kind, family, race and type of mites were fixed. Dermatophagoides mites were found as the most dominating group in house dusts.

Result: In criminological sciences, it is remarkable biological evidence that microscopic HDMs feeding on human skin epithelial is available almost in every house. We are of the opinion that it would not be wrong to say that it shall become important with researches to be performed if these microscopic mites carry human evidences by analyzing in detail.


Microscopy at the crime scene: the benefit of new digital devices applied on forensic entomology

Karl Heinz Schiwy Bochat, Kristina Baumjohann, Markus Rothschild

Institute of Forensic Medicine, University of Cologne, Germany

The knowledge of which fly settles on a corpse and under which condition (outdoor vs. indoor, soiled vs. unsoiled) can give early important hints in forensic investigations. Forensic entomology mostly deals with larvae of calliphorid flies which prefer to deposit their eggs on corpses and, in Europe, colonize the body first. However, another group of flies (family Muscidae) is often present on the corpse yet often overlooked. Muscid flies are usually coprophiles, i.e. they are attracted by feces, urine and associated bacteria. Muscid flies are, therefore, an indicator for unsanitary conditions, including severely stained clothing and shoes, and for neglect. On corpses, they are usually found in later stages of decay. Muscid larvae can also infest wounds in living humans or animals, which means they may be observed in myiasis cases.

The muscid genus Hydrotaea is not thoroughly researched and described in forensic entomological literature. Hydrotaea flies are often overlooked because of their size. Their second and third instar larvae predate larvae of flies of other species, some are carnivorous in all developmental stages. They prefer a later as

Some species of muscid and calliphorid flies have adapted to human environments, others are more commonly found in rural habits. For example if a body is moved from a rural to an urban area, the fly species found on the body can serve as indicators for such an action.

Sometimes a quick determination of different flies is possible. For example, muscid and fanniid flies, in contrast to calliphorids, lack hypopleural bristles.

Three case studies show the importance of early identification of the flies and the benefit of a digital microscopy for early identification. For its large depth of field the zoom lens provides a “natural” view and the high quality images can directly be stored on the integrated hard-disk-drive. In particular cases this device can be carried to the crime scene for immediate investigations.


Applicability of the Forensic Entomology for Estimaton of Time of Death in Forensic Cases

Yasemin Yuksel Cavusoglu 1, Huseyin Cakan2, Sermet Koc1, Yalcın Buyuk1

1ministry of juctice council of forensic medicine

2university of istanbul institute of forensic medicine

Introduction: Forensic entomology is application of insect knowledge to legal matters. Although insects are terrestrial animals as a rule, there are lots of species that adapted all bio types; corpses are important food sources for insects. Insects play an important role in solving legal cases in addition to their ecological importance.

Insects feed, live or breed in and on bodies, depending on the stage of decomposition.

Over the death of days, weeks or even months after the time of the death of a corpse, insects are often the most important indicator in determining time of death. One of method for determining time of death by using insects is determination the age and development phase of maggots that come to bodies after death. Another method is based on analysis of succession of arthropods on, in or around bodies.

To use all this information, the biology of insects must be known very well. Our goal is to contribute the time of death for the suspicious deaths by using entomological evidences.

Material-methods: The study includes 113 forensic autopsy cases referred to our institution for determination of cause of death and the postmortem interval between the years 2006 and 2011.

Results: Insects were belong to Diptera and Coleoptera; most common species of flies fed on bodies were Calliphora vicina, Calliphora vomitoria, and Chrysomya albiceps. Among these cases we managed to calculate the time of death in about 85 %, but not in about 15 % (due to improper sample collection, transfer and storage, and deficiencies and/or inaccuracies information).

Conclusion: In this study, we discussed the methodology for using the insects for determining time of death; in order to contribute to determination of the exact PMI and we also focused the need of standardization in the procedures of this discipline in Turkey.



Case report: Observation of altering intra-abdominal hemorrhage through CT imagining with time

Hiroshi Ikegaya, Noboru Ishikawa, Stuart Mclean, Daisuke Miyamori

Kyoto Prefectural University of Medicine

Background: Recently, Computed Tomography (CT) is often reported as an effective tool for postmortem diagnosis. However, reports of the utilization of postmortem images to establish postmortem changes are limited.

Case presentation: A drunk 66 year old male was ran over by a taxi at 01:28 after falling asleep on the road. While being immediately transferred to hospital the man lost consciousness and fell into a cardiopulmonary arrest. Despite resuscitation he died. CT images were taken at 02:30. Following this, CT images were re-taken 54 hours after death before a medicolegal autopsy.

Result & discussion: In this case, small amounts of intra-abdominal hemorrhaging was visible in the immediatatly taken CT images. However, the extent of intra-abdominal bleeding observed through CT images 54 hours later was greatly increased. During the autopsy, 1700 mL of intra-abdominal hemorrhage was observed. In addition, mesentery, liver and pancreas injuries were observed. Futher injuries were found during the autopsy included, multiple rib fractures, skin abrasions and lacerations of the head, subarachnoid hemorrhage, pelvic fracture, and right humerus fracture. The deceased's postmortem blood alcohol level was 2.4 mg/mL. A hemorrhagic shock due to the systemic injuries was determined as the cause of death.

The amount of intra-abdominal bleeding found during autopsies may differ from that found at the time of death. As a result, the criteria for the diagnosis of the cause of death in autopsies should be carefully reconsidered, because if autopsies are performed immediately after death, bleeing sufficient to diagnose exsanguination may not be present. Alternatively, the commonly believed extent of bleeding necessary to cause death by exsanguination may need to be revised.

In addition, it is recommended that cause of death is not exclusively determined through CT images and where this is the case CT images are taken over a period of time.


Camera Identification for collections of images and video with Photo Response Non Uniformity

Zeno J Geradts, Wiger Van Houten

Netherlands Forensic Institute

A digital (video-) camera consists of many electronic components. After the image has been formed on the image sensor, the image information will pass through all of the components before the final data file is written to flash memory. Each step in this process may add random noise to the image. Even during the image formation process itself, a noise-like pattern from the sensor may be introduced in the image. This noise-like pattern is a small but measurable systematic contribution to the signal, and is called the Photo Response Non Uniformity (PRNU) pattern. The visibility of this signal is limited and may be a small difference depending on the intensity of the signal. In practice, this means that well illuminated images will result in a better extraction of this signal compared to when the image is dark.

The PRNU pattern itself can be determined from the image and it preferably is done with images with no discernible textures (flat field image, for example from a grey surface). The examining of the PRNU pattern for forensic use is well researched by Jessica Fridrich and others.

In practice, it is not always possible to have the camera for casework; however, it is possible to determine if a set of images have been made with the same camera or different cameras based on the PRNU pattern. By comparing the pattern from a questioned image with the pattern from a set of reference images made with a suspect camera, it can be determined whether the questioned image was produced with the suspect camera or not. This works when the image is authentic, but fails when the image underwent any spatial transformations (e.g., rotation, shearing, resizing) because the “fingerprint” is desynchronized, unless the same transformations are applied to the reference material. It is also possible to alter the image such that the PRNU pattern is filtered out, although this is complicated and time consuming.

The use of large image or video databases, such as child pornography and other databases of relevant images will require significant processing power. For a good comparison, it is important to have the most original images, or to know exactly what kind of operations have been conducted on the image. Since in casework the ground truth may not be known, conclusions in Bayesian framwork.


Brain death confirmation by Cerebral Perfusion Scintigraphy. Ethical and legal value

Gonçalo Castanheira 1, Joana Correia Castanheira2, Maria João Cunha2, Cristina Cordeiro1, Gracinda Costa2, João Pedroso De Lima3, Duarte Nuno Vieira1

1National Institute of Legal Medicine - Centre Branch, Portugal

2Coimbra´s University Hospitals, Portugal - Department of Nuclear Medicine

3University of Coimbra, Portugal - School of Medicine

The concept of brain death, first described decades ago, still presents medical, ethical, legal and cultural challenges. The legal statements deal with the question of the definition of death and how death can be confirmed. Irrefutable and simple legal definitions of death must be provided before organs may be harvested from brain dead individuals. Consequently legislation updating the concept of death has been published internationally along with organ transplantation programs.

Brain death is defined as total and irreversible cessation of brain stem functions. Its diagnosis is primarily clinical, based on a thorough and systematic neurological clinical examination, and requires the exclusion of all the causes for reversible coma. Therefore the concept of brain death is often difficult to be established clinically and understood by relatives. When the clinical examination is equivocal or limited, the need of a good confirmatory study becomes obvious.

Cerebral perfusion scintigraphy allows the identification of a cerebral perfusion absence (“hollow skull phenomenon”), which is incompatible with neuronal viability, hence becoming a diagnostic for brain death.

This study aimed to portray the significance of cerebral perfusion scintigraphy in the diagnosis of brain death.

The authors present a retrospective study of the 86 functional studies that resorted to cerebral perfusion scintigraphy performed in their institution between 2005 and 2011, concerning 79 patients. Dynamic and planar brain images were performed after intravenous administration of 740 MBq (20 mCi) of 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO).

Several variables (age, genre, clinical data and occurrence year) were characterized in order to establish the patients’ profiles and the circumstances of the occurrences that lead to the deaths.

There has been a variation in the number of examinations performed throughout the years, with a significant decrease from 25 (2005) to 3 (2011).

Sixty four patients (75.58 %) were male individuals, aged between 14 and 87 years (mean age 46.94).

Regarding the clinical information that led to this type of examination, craniocerebral injuries were the most frequent (41.86 %), followed by cerebral vascular accidents (13.95 %).

In 74 patients (93.67 %) the study confirmed the diagnosis of brain death, which allowed a subsequent harvesting of these individuals’ organs for transplantation.

In our experience confirmation of brain death by cerebral perfusion scintigraphy is a reliable, safe, easily readable and low-cost method that enables an urgent diagnosis of brain death as anticipated in transplantation programs.


Sexual Dimorphism Of Lunate And Capitate Bones With Magnetic Resonance Imaging (MRI) Method In Ankara

Semra Duran1, Hacer Yaşar Teke2, İsmail Birincioğlu 3

1Numune Hospital

2Ankara Council of Forensic Medicine

3Karadeniz Technical University

Intruduction: Sex determination is a vital part of the medico-legal system but can be difficult in cases where the body is damaged. The present work was performed to investigate the possibility of estimation of sex from some radiological measurements among a known cross-section of Ankara who live in.

Materyal and method: In this study, by the use of Magnetic Resonance Imaging (MRI) scan, three both lunate and capitate measurements were assessed in 62 living non-pathologic Ankara who live in, comprising 30 males and 32 females aged 17–70 years referred to the Radiology Department. These were subjected to statistical analysis.

Results: All dimensions were significantly greater in males than females (p < 0.005). In the step wise discriminating analysis, while lunate bone measurements classified the original group accurately by 83.9 %, capitate bone measurements classified the original group accurately by 77.4 %.

Discussion: The literature on the sex differences of metacarpals reported accuracy levels of 71.7-94 %. The present study has shown the potential for assessing sex from antero-posterior measurement of lunate bone (83.9 %).

Conclusion: The results suggest that can be used for assessing sex in both forensic and bio-archaeological identification procedures.


An Association between Bite Mark Characteristics and the Tendency of Perpetrator to Repeat the Crime

Huseyin Afsin1, Beytullah Karadayi 2, Safak Taktak3, Sadi Cagdır1, Tansev Boran1

1The Council of Forensic Medicine, Istanbul, Turkey

2Forensic Medicine Department, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey

3Psychiatry Department, Ahi Evran University, Kırsehir, Turkey

Bite marks which have the specialty of forensic case give not only information about the dental characteristics of the criminal but also enlightening opinions pertaining to his/her psychological background and tendency to repeat the crime. It has been thought that the aggressors can not express their immediate needs due to the rituals determined by the society in which they live. The aim of this study is to determine psychological background of the perpetrator of bite marks, which have led to this crime, and to show the tendency of repeating the crime in three forensic cases. Bite marks determined on three different victims and in three different times, caused by the same aggressor were evaluated by superimposition technique in Adobe Photoshop environment. When the bite marks photographs obtained from the first victim were evaluated by a psychiatrist and a specialist of forensic odontology, the structure of bite marks -the fact that they were caused by breaking off the tissue place by place, that they were many, deep and on the face- led to the idea the fact that there was a risk for crime to repeat, with increasing the violence. Later, two cases by the same perpetrator in different times supported that our determination was true.

These clues point that an association may be established between the characteristics of bite marks and the perpetrator’s tendency to repeat the crime.


Prior Determination Photografic Inhalation of Cocaine an Sofocation to a Manual Strangulation

Oscar Alonso Plaza1, William Torres 2

1Oscar Alonso Plaza Patiño, National Institute of Legal Medicine and Forensic Sciences South West Regional Office

2William Torres, National Institute of Legal Medicine and Forensic Sciences South West Regional Office

In any criminal investigation the photographic documentation is used for preservation and subsequent analysis of trauma, scenes and impressions that can recreate the sequence of events and make quantitative differences between the causal elements and the injury pattern found in the victim. With the advent of digital photography and for this case study is demonstrated through a software as a victim of manual strangulation prior to his demise breathed cocaine and was partially stifled. In the quarter of autopsies is routine photographically documenting the external injuries and internal observed the bodies are examined to determine his cause of death. A large number of skin lesions were found by the forensic experts aren't ballistics by nature, offering multiple insights in the cause of death, time of injury, used gun and the force of the impact. The ability to rebuild an injury still depends on the use of so many lines of possible evidence. Manual strangulation leaves a few classic stigmas that in the majority of opportunities are significant at first glance as marks of nails in the neck, in the conjunctival petechiae and lesions in the laryngeal skeleton. The suffocation leaves in the body other injuries as the break-up of the frenulum, the marks of teeth in the labial mucosa, etc. The use of cocaine and alcohol is determined by the nasal smear and toxicological outcomes. To open images with and changes in the contrasts could be determined inevitably the impression of a hand and fingers on the face, also traces of cocaine on the halls nasal inhalation, which is called the "clown face" given that it is similar to the makeup used mimes or clowns in the face in the slang of addicts.


A case of suicide; three consecutive gunshots to the head

Nuri Akın 1, Necmi Çekin2, Mükerrem Doğanay Kürkcü1

1Council of Forensic Medicine, Adana Group Administration

2Department of Forensic Medicine, Cukurova University

Introduction: Forensic animation is a judicial branch of science which aims to help forensic investigators revitalizing to events and accidents in a variety of perspectives. Basic purpose of using computer technology is to clarify and explain a situation that is difficult to visualize and make it clearer. Road traffic accidents, penetration into the head of an object, a murder and explosion events may be shown by means of forensic animation method. Witness in case, crime science findings and evidence remind points which overlooked at incident and also forensic animation method helps judicial authorities to understand how it happens. Therefore, forensic animation point of view, judicial authorities and experts may attain detailed information about the object such as time of event, process.It is possible to see to the smallest detail. Witness, the defendant and the victim's statements, event location accuracy is tested according to the law and the scientific findings and concerns. For this reason, a new branch of science is becoming more popular day by day in court, and even some defense lawyers used by the 3D animations of the case.

Case: 74-years-old patient who diagnosed with lung cancer was found dead with 3 pieces of firearms bullet entrance wounds in his head and a gun beside. This 3-shot asked by the prosecutor whether it is possible is that one's own self. Crime scene examination findings (gun shot residue, fingerprints, traces of gunpowder in the hands of the person… etc. ) were evaluated as a suicide according to eye witness, event of injury.

As in this case; the position of the body, scars, wounds, marks on the scene of the incident along with the revitalization of the event are important to understand whether incident will occur or not.


Correlation between lesions and radiologic findings in cases of ejection from jet aircraft

Paola Mancarella, Angelo Landolfi, Stefano Conti, Pierandrea Trivelloni

Department of Anatomical, Histological, MedicoLegal and Hortopaedic Sciences, Faculty of Pharmacy and Medicine, “Sapienza- University of Rome” Italy

The purpose of this study is to analyze the case of an operator of the onboard electronic systems of a jet aircraft, that has sustained injuries following an ejection. The authors, after describing the case history, will pass to analyze the pathogenic mechanism in relation to radiological findings. In conclusion, They will compare the data of the individual case with the general ones, derived from the scientific literature about spinal injuries following ejection from jet aircraft


Contribution of post-mortem computed tomography in skeletal trauma: about 29 forensic cases

Céline Leconte, Pierre Antoine Peyron, Philippe Cathala, Eric Baccino

Medicolegal unit, University Hospital of Montpellier, Montpellier, France

Background: In France, post-mortem full body computed tomography (CT) is increasingly used for forensic purposes before autopsy is performed. The aim of this study was to determine the contribution of this imaging technique in skeletal trauma, comparing CT findings with autopsy results.

Method: Reports of the autopsies made in the unit in 2011 were reviewed (n = 339). A post-mortem CT was made previous to 39 autopsies involving polytraumas. Among them, 29 skeletal traumas were objectivated. In each case, a parallel was made between radiological and autopsy data, paying particular attention to the description of osteoarticular lesions, that were classified according to the topography of skeletal damage (skull, larynx, thorax, rachis, pelvis, upper and lower limbs).

Results: Selected cases included 22 males and 7 females. The mean age at death was 36 and the time elapsed between death and CT could range from a few hours to 5 days. Deaths resulted from road traffic accidents (n = 17), precipitations (n = 8), assault and battery (n = 2) and other causes (n = 2). CT allowed a better description of skull fractures (especially the ones concerning basilar region and calvarial bones) and it was more performant than autopsy in identifying mandibular (10 versus 5) and sinal fractures (17 versus 1). Nevertheless, CT objectivated only one laryngeal fracture whereas 7 were seen at the autopsy (3 interesting the lingual bone and 4 the thyroid cartilage). CT was also more efficient than autopsy in highlightening cervical dislocations (5 versus 1), but both were equivalent in finding cervical fractures, whereas half of fractures of dorsal vertebrae were missed at the autopsy (11/22). CT objectivated more fractures of vertebral processes (102 versus 8) and non-comminuted scapular fractures, and it better described sacroiliac fractures. Moreover, fractures of the extremities of long bones and of hands and feet were better visualised using this imaging technique. Even if there were many differences between both techniques in the description of fractures of the rib cage, the ones interesting the costal posterior arch were better seen at the autopsy.

Conclusion: This study demonstrates the usefulness of the post-mortem CT to assess skeletal damage, notably because of its ability to describe more precisely than autopsy craniofacial, rachis, pelvis and long-bone extremities fractures. However, laryngeal and costal posterior arch fractures are better described at the autopsy. Thus the use of the post-mortem CT in skeletal trauma is a precious complementary exam to the autopsy in forensic practice.


Airplane C-130 J crash in Pisa (Italy), November 23, 2009. Comparison between radiological and autoptic results on the victims

Marco Di Paolo 1, Claudia Giaconi2, Mirella Gherardi3, Monica Pedretti1, Matteo Barattini2

1Department of legal medicine, pisa university, pisa, italia

2III unit of university radiology, santa chiara hospital, pisa, italia

3Unit of legal medicine, aosta hospital, aosta, italia

Background: application of radiological techniques in mass disaster forensic activity (virtopsy) can be a useful tool for rapid identification and examination but also for diagnostic purpose related to cause and manner of death. The documentation and analysis of postmortem findings with multislice computed tomography (MSCT), magnetic resonance imaging (MRI) and postprocessing techniques is investigator independent, objective and non invasive and will lead to qualitative improvements in forensic pathologic investigation.

Method: the five deceased in Airplane C-130 J crash in Pisa (Italy), November 23, 2009, were investigated by MSCT (Toshiba – Aquilion 16 s) to visualize the internal body before autopsy. The images were post-processed by 3D and multiplanar reconstruction with Voxar software. Second look after autopsy was performed. MRI could be usefull in identification of oedema associated with bone lesions. In this traumatic scenario, it was not performed because of the absence of survival after crash.

Results: the MSCT has been usefull to detect the presence of comminuted fractures – that are not viewable at a simple macroscopic examination- and other fractures at sites that are not commonly inspected during autopsy. In one case the MSCT did not detect the presence of a fracture of the orbital rime of the frontal bone in the anterior cranial fossa. In another case, MSCT did not recognize some rib fractures. Second look of the images after autopsy confirmed inability of radiological technique to detect these specific bone fractures.

Conclusion: In light of these results, virtopsy cannot be considered an alternative method to autopsy, that still remain the gold standard in post-mortem examination. As a matter of fact this investigation shows that MSCT has diagnostic limits because it didn’t detect several bone fractures. This restriction can be explained by the fact that TC spatial resolution could not be sufficient to visualize excessively thin fracture lines.

As far as we are concerned, MSCT is a complementary tool able to offer modern imaging technology to optimize classical autopsy documentation. Classic forensic autopsy cannot be substituted by digital radiological approach.


Forensic medical examination including multislice computed tomography of a corpse of the victim of firearm injuries subsequently partially burned

Krzysztof Jerzy Wozniak, Tomasz Konopka, Ewa Rzepecka Wozniak, Artur Moskala

Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland

Introduction: A partially burned corpse was found next to a burned car with traces of possibility of being a victim of firearm injury / injuries. As such the case was qualified to perform post-mortem MSCT (PM-MSCT). The procedure is carried out in every case of firearm and post-explosion injuries from the year 2009 by the Chair of Forensic Medicine in collaboration with the Chair of Radiology of Jagiellonian University Medical College

Material-methods: Before the conventional autopsy PM-MSCT was performed using 16-layers CT scanner. DICOM files from the CT acquisition were analyzed using a computer program Osirix. Preliminary evaluation results were used to plan conventional autopsy examination.

Results: The results of post-mortem examination are presented in the form of images taken during conventional autopsy examination compared with selected cross-sections and 3D reconstructions obtained from evaluation of post-mortem CT.

Conclusion: Reconstructions based on post-mortem CT has shown that such examination is able to broaden the diagnostic capabilities of post-mortem forensic examination. It can be useful especially in cases of charred bodies in visualization of location of foreign bodies and injuries.



The role of forensic nursing in evaluating and diagnosing child abuse and neglect in Italy

Ignazio Grattagliano 1, Biagio Solarino2, Janet Barber Duvall3, Emilio Nuzzolese2, Sara Perrone2, Giancarlo Di Vella2

1Department of Criminology, University of Bari, Bari, Italy

2Department of Legal Medicine, University of Bari, Italy

3Indiana University School of Nursing, Indianapolis, Indiana, USA

Background: The World Health Organization (WHO) defines child abuse and maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and commercial exploitation that results in actual or potential harm to a child’s health, survival, development or dignity…” (OMS 2002). Statistics show that child abuse and neglect is rising at an alarming rate. Due to an increase in the number of such cases, the Italian Minister of Health has defined the phenomenon of abuse and violence against minors as a health problem, and not only a social or, safety issue. Such events are complex in nature and require the expertise of various disciplines.

In order to ascertain if abuse was indeed perpetrated on a minor, careful verification of the facts is required, as well as an objective “legal-medical” examination. The only suitable means for tackling this task is teamwork. One very important resource to consider is the registered nurse, who is often the first health care worker to come into contact with the presumed victim. By spending time with these young patients, it is easier for a forensic nurse to take on the role of “confidant” while at the same time looking out for unusual behaviors, or any signs of physical abuse such as lesions or burns.

Method: The aim of this poster is to examine the contributions of forensic nursing in the evaluation of child abuse and neglect.

Results: Notwithstanding recent institutional laws and regulations put into place that redefine the job descriptions of healthcare providers, nurses in Italy do not have complete decisional autonomy. A nurse’s image is still closely connected to that of the physician. This goes against current Italian ethical and penal code, which lays out the specific roles of healthcare workers with regarding juveniles who are presumed victims of abuse.

Conclusions: Forensic nursing specialized in the verification of child abuse and neglect is well established and considered to be very important in countries such as the United States. It is a hopeful sign that registered nurses’ roles and autonomy in legal-medical matters, such as child abuse and neglect, have been recognized in Italy.


The Importance of Forensic Knowledge in Pre Hospital Care

Joao Serdoura Santos, Maria Jose Pinto Costa, Elisabete Monica Cunha

Deppartment Legal Medice, Biomedical Abel Salazar Institute (ICBAS), Oporto, Portugal

Background: The work presented in this poster is to explore the importance of forensic science within the prehospital care. The crimes do not happen in hospitals, they happen in the streets, homes and even at work.

If all the forensics community agree in the importance of emergency and hospital forensic nursing, they must realize the importance of that same knowlegde in the prehospitals systems.

It is certain that many countries realizing this importance emited a series of protocols or rules of engagment when prehospital teams arrive at a suspicion site. The intruccions are clear, to preserve traces that may lead to evidence, without putting at risk the patients that need medical assistence, with no security risk also.But if the forensics specialist, coroners or technicians do not arrive on time, or the police, that already have a forensic way of thinking?

The prehospital professionals arrive many times first then other teams at crime scenes or at situations that are not identifed by phone as having legal implications. Elder or child negligence, some traffic accidents, supposed accident falls, suicides, intoxications and other may involve evidence that is essential to recover but in many situations police or other forencis worker are not require on site by law or because the triage that is made in 112 is not entirely correct because of lack of information or triage mistakes.

Method: The method used, is an inquiry/survey made to the professional involved in the prehospital in Portugal so that we can realize their forensic knowledge and legal implications in several prehospital emergency situations. Only 5 questions were made (YES or NO), to 100 prehospital professionals.

Results: The results were clear, most of emergency professional revealed weak knowledge of such forensic matters.

Conclusion: The professionals revealed almost no knowlodge of forensics or legal medicine on colecting traces that lead to evidence so that they can preserve traces and information, that are in immediate risk of being lost, not just because of time degradations or enviorment problems such as runing water, fire and others but also with lack of forensic teams.

The prehospital is one of the most importante aspects in the health systems of every country and with this work is aspected to help and improve a better and efficient work to contribute judicial system.

The fundamental reason is to defend justice to all in society with no exception.



Forensic Odontology - Cosmetic facial kept in the body post-autopsy. Techniques and Luntz / Keiser-Nielsen (modified) with access to dental arches and bones of the face by folding in block of the structures

Manoel Campos Neto 1, Vidal Haddad Júnior2, Gregório Garcia Lobato Lopes3, Ivo Antonio Vieira4

1POLITEC - Perícia e Identificação Técnica - Seção de Medicina Legal - Regional de Cáceres-Mato Grosso-Brasil.

2UNESP-Universidade Estadual Paulista-Departamento de Dermatologia e Radioterapia-Botucatu-São Paulo-Brasil

3HRAF- Hospital Regional Antonio Fontes-Departamento de Cirurgia Buco-Maxilo-Facial-Cáceres-Mato Grosso-Brasil

4MINISTÉRIO DA FAZENDA - Departamento de Perícia Oficial Federal - Cuiabá - Mato Grosso - Brasil

Introduction: The Forensic Odontology may be important in the exploration and removal of dental pieces to perform DNA tests and other information characteristics of race, sex, age and other parameters of the body.

Methodology: We did try to improve the final facial appearance, with modifications of existing techniques for incisions (Luntz and Keiser-Nielsen).

Objectives: The authors modified the techniques, focusing folding in block the structures of the face.

Discussion: Luntz technique (cited Vanrell and Fields): two bilateral incisions in the cheeks, forming an opening angle back from the labial commissure on each side, the incision superior to the zygomatic arch, the lower wound up mandibular or gonial angle, remove the soft tissue of the jaw following the lower edge of the jaw; deepen this incision to reach the floor of the mouth, all the muscular sectioning. Keiser-Nielsen technique: the first horseshoe-shaped incision 2–3 cm under the base of the mandibular angle, extending to the opposite side. A second incision is made beneath the surface of the fabric, along the surface of the jaw bone outside the body to the base of the bottom of the earlobes, sectioned distally to the masseter. The tissues of the chin and the base of the cheeks are folded down. New technique modified by the authors: the oral mucosa sectioned prey to his lips, facilitating the release of the skin. The skin incision starts at the front of the ears (bilaterally). The section is made with pressure on the scalpel, severing at once the structures to reach the periosteum of the jaws, which facilitate their detachment with the help of the "highlights the periosteum. Sectioned across the line that separates the nasal mucous membranes of the skin of the nose and push back all proximal block. We carried out photos of all stage and sutured the incisions with nylon 3–0 (intradermal). RESULTS: The end result was highly satisfactory, causing minimal deformation in the face of the corpse.


Medico-legal age estimation in living individual: Third molar mineralization

Mário Branco1, Dinis Pestana2, Cristiana Palmela Pereira 1

1Faculty of Dental Medicine at the University of Lisbon

2Center of Statistics and Applications at the University of Lisbon, CEAUL

According to the Study Group on Forensic Age Diagnostics (AGFAD), the radiological evaluation of third molar mineralization is a major criterion for chronological age estimation of living individuals.

This investigation studied third molar development in 329 orthopantomograms (40,4 % males) of Portuguese individuals, patients of Dental Medicine Faculty of Lisbon University, with an age range between 14,0 to 22,8 years, through five different methods (Demirjian, Haavikko, Harris and Nortjè, Kullman and Solari).

The results show a better correlation, between real and estimated age, in Demirjian and Solari methods. Demirjian method was used to analyse the other results statistical variables. Third molar development occurs earlier, in average 9 months, in males, in stages D-G. In stage H there’s no significant difference. There’s no significant difference between mineralization of molars in the same arch, however, in the inter-arch comparison, the maxillary molars have a premature development, statistically different in stages F (males), G and H.

The age 18 is reach in stage G and H, respectively, by females and males. Under the Portuguese Penal Code, section 19, the age is one of the factors of exceptional of criminal responsibility. For criminal pursuit, they state being minor than 16 years of age. This limit is reached for both sexes in the stadium F. However in any stage we can deduce the majority or minority in relation to the age of criminal responsibility.

New studies about the influence of socioeconomic and genetic factors, in third molar development, are necessary.

Research partially sponsored by national funds through the Fundação Nacional para a Ciência e Tecnologia, Portugal – FCT under the project (PEst-OE/MAT/UI0006/2011).


Age estimation by dental parameters – Validation in a Portuguese Population of the two methods: direct and indirect observation of teeth

Rita Caldas1, Dinis Pestana2, Cristiana Palmela Pereira 1

1Faculty of Dental Medicine at the University of Lisbon

2Center of Statistics and Applications at the University of Lisbon, CEAUL

Objective: To test the applicability of morphological and radiographic parameters used in forensic identification, particularly in estimating the age. Thus, a sample of the Portuguese adult population was used to test our hypothesis. Likewise, this experimental study intends to compare the chronological age with the estimated dental age using the methods of Kvaal and Solheim as well as the Bang and Ramm.

Materials-methods: Thirty-five single-rooted teeth were analyzed throughout this study. For the radiographic analysis which used the method of Kvaal and Solheim (1994), all measurements were made by the digital radiography software Kodak RVG 2200 intra-oral with exposure factors of 60–70 KVp and 7 mA. The morphological parameter, the translucent dentin were assessed in both the intact and sectioned tooth. The objects used in this study were sectioned by a tungsten carbide drill in a vertical surface with a buccolingual direction. The relationship between the coefficients was calculated among the age, the ratios and the level of inclusion was p <0.05.

Results and discussion: The statistical analysis showed that the Pearson's correlation was the strongest (0,86) for the Bang and Ramm (sectioned tooth)method indicating that age can be estimated better with this particular method.

Conclusions: The dental age calculated either through the method of Kvaal and Solheim or Bang and Ramm is not considerably different from the individual’s chronological age.

Research partially sponsored by national funds through the Fundação Nacional para a Ciência e Tecnologia, Portugal – FCT under the project (PEst-OE/MAT/UI0006/2011).


DNA quantification in human teeth after different storage time

Leticia Rubio 1, Ignacio Santos1, Maria Jesus Gaitan1, Stella Martin De Las Heras2

1Departament of Anatomy and Legal Medicine, University of Malaga, Malaga, Spain

2Departament of Forensic Medicine and Forensic Dentistry,University of Granada, Granada, Spain

Background: Dentin and enamel provide a protective enclosure for genomic DNA against external influence making dental DNA the best samples for forensic studies purposes. This tissue can be affected by degradation when submitted to thermal, electrical and mechanical insult. However, up to date it is unclear the rate of DNA degradation in teeth along time. The aim of this work was to determine the amount of DNA that could be obtained from teeth stored at different intervals of time under the same environmental conditions.

Methods: We analyzed 60 human teeth stored at room temperature for 0, 1, 3, 6, 12 y 18 months. First we carried out a decontamination process of the teeth and DNA extraction; after which gel electrophoresis was performed. Finally quantification of the teeth was obtained by real–time quantitative PCR using a Quantifiler™ kit assay.

Results: Data showed that DNA concentration declined significantly during the first month postextraction, and then DNA concentration stabilized, but dropped again at 18 months postextraction. One-way ANOVA revealed significant differences in DNA concentrations as a function of post-extraction time (sum of squared deviations = 617371; 5 degrees of freedom [d.f.]; p < = 0.0001). Post-hoc Newman-Keuls test revealed significant differences (p < 0.05) in DNA concentration between the fresh teeth and remaining groups (1, 3, 6, 12 and 18 months post-extraction), finding the highest significance (p < 0.001) for the difference with the 18-month group. We found no statistical differences in the amount of dental DNA compared between anterior and posterior teeth or gender.

Conclusion: The present study contributes to a better knowledge of the decomposition process driving DNA degradation, but further studies are needed to understand the effect of external variables on DNA degradation.


Dental age assessment in a recent French children population: validity of three methods

Vanessa Urzel, Jaroslav Bruzek

UMR 5199 PACEA « Anthropology of Past and Present Populations », CNRS, University of Bordeaux, France

Background: Age estimation is a common requirement in forensic practise and in bioarchaeology. For the children age assessment, methods based on dental mineralization are widely used and appeared to be more reliable than methods based on other skeletal indicators.

The aim of this study was to test the validity of three dental age estimation methods.

Materials-methods: The sample comprised 743 children (386 girls and 357 boys) aged between 4 and 15 years (mean age 11.01 ± 2.81 years), and examined between 2004 and 2010 in the South West of France. Dental age was assessed by three different methods (Demirjian and Goldstein 1976; Willems et al. 2010 and Moorrees et al. 1963) based on the evaluation of crown and root mineralization using the seven left mandibular teeth (31 to 37) for the first two methods. The last method uses only isolated teeth (for our study we used the first and second mandibular molars 36 and 37). Dental age was compared to chronological age of the individuals.

Results: Using all methods, the dental age are underestimated in the last age category. Demirjian and Goldstein (1976) method provided an overestimation of dental age (mean difference +0.51 ± 0.91 years), whereas Willems et al. (2010) gave a more accurate estimation (mean difference 0.00 ± 0.96 years). For the Moorrees et al. (1963) method, the utilisation of the second mandibular molar (37) was more accurate and reliable than the utilisation of the first mandibular molar (36); however, age assessment were worse than with Demirjian and Goldstein (1976) and Willems et al. (2010) methods. It seems that differences observed in dental age estimation may be explained by the secular changes in recent populations.

Conclusions: Willems et al. (2010) method is reliable and accurate and appears to be suitable for dental age estimation in contemporary French children population. Its main advantage is to be non-gender specific, and its main drawback, as for the Demirjian and Goldstein (1976) method, is the necessity of scoring the seven left mandibular teeth. Moorrees et al. (1963) method is usefull in forensic anthropology and in bioarchaeology, when some teeth are missing. In this case we recommend the use of the second mandibular molar.


Sexual dimorphism in forensic anthropology: using IMECRAN to improve skull measurements´ precision

Maria Gabriela Biazevic 1, Edgard Michel Crosato1, Luiz Saavedra Paiva2, Thaís Torralbo Lopez1, Roberto Bonuzzi1

1School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil

2Guarulhos´ Forensic Investigations Office, Guarulhos, Brazil

Sexual dimorphism is observed in human skeletons and its importance for medical and legal purposes is already well established. The skull is one of these parts that can present much information at this regard. In this context, IMECRAN is an invent recently published that was created to improve the precision of anthropometric measures of skulls, allowing that the Frankfurt plane be parallel to the floor, even when the skull is rotated in order to perform other analysis. The objective of the study was to use IMECRAN to carry out 41 anthropometric measures in 63 Brazilian skulls and to verify the sex dimorphism. All the skulls had registrations of sex and they are part of the Guarulhos´ Forensic Investigations collection; human remains that are not asked by their families after 3 years of death become part of the collection. The examiner didn´t have access to the registers. The skulls were put into IMECRAN and, after adequate concordance (kappa), the measurements were performed. T test was used, at 5 % of level of significance. STATA 10.0 was the statistical program used. We studied 33 male and 30 female skulls. Some variables were associated to sex dimorphism: frontal´s length and angle (both p = 0.00), frontal eminences (p = 0.02), supraorbital ridges (p = 0.01), orbit´s areas (p = 0.04, right, and p = 0.05, left), piriform aperture (p = 0.00), all mastoid´s measurements (p = 0.00), occipital´s length and height (p = 0.01, p = 0.04), occipital condyles´ length (p = 0.01, right, p = 0.03, left), foramen magnun´s height and width (both p = 0.00). IMECRAN could offer stability to the skull during the study, and it allowing the performance of reproducible studies about sex dimorphism. Financial support: State of Sao Paulo´s research fund (FAPESP, proc. 2011/18577-7).


Aesthetic damages analysis in south state of brazil dental court cases

Fernanda Capurucho Bouchardet 1, Mário Marques Fernandes2, Eduardo Daruge Jr.3

1Pontifícia universidade católica de minas gerais, Belo Horizonte, Brazil

2Brasilian dental association, Porto Alegre, Brazil.

3Faculdade de odontologia de piracicaba Unicamp, Piracicaba, Brazil

Objective: analyzing the amount paid by aesthetic, moral and material damages in civil liability processes against the Dentist judged at the Court of the State of Rio Grande do Sul from 2007 to 2010, identifying in the content of the trials if the expert or judge used the descriptive method in the evaluation of aesthetic changes as well as highlighting the importance of matching it to one of the categories referred to in qualifying graduated scale of increasing severity.

Methodology: We have analyzed trials of civil cases involving Dentists, both downloaded and printed, through electronic search on the site of the Court of the State of Rio Grande do Sul in 2007 by the year 2010. Only the texts produced by the magistrates were used in the sample, making the analysis of the full content only in cases that have been granted cosmetic damage. In these, we have checked whether any qualifier or numeric parameter had been used or not.

Conclusion: The processes related to the professional responsibility of the Dentists have showed a tendency of judges to defer more compensation for moral damages to material damages, as well as give value in a high-level requests referring to disfigurement -on average larger than the material and moral damages. According to the trialsanalyzed no objective and comparative analysis were identified in the assessment of cosmetic damage. The parameters indicated in the descriptive method should always be used to show the characteristics and importance of the evaluations of cosmetic changes, for which they need to assign percentage points or numerical scales.


The Current Status Of The Education In Forensic Odontology For Undergraduate Dentistry Students

Dorota Lorkiewicz Muszynska1, Agnieszka Przystanska2, Marzena Labecka1, Pawel Swiderski 1, Czeslaw Zaba1

1Department of Forensic Medicine, Poznan University of Medical Sciences, Poland

2Department of Anatomy, Poznań University of Medical Sciences, Poland

Background: Forensic odontology requires an interdisciplinary knowledge of dental science. It relies on the detailed knowledge of teeth and jaws. Thus, forensic odontology is an interdisciplinary subject that covers dental anatomy, interpretation of radiograms, dental materials, developmental anomalies and others. Although the forensic odontologist as a professional is well known, there is nothing like a specialty in Forensic Odontology in Poland and the most of European countries. Typically, the professionals are DMD or DDS graduates and postgraduates educated and certified in the area of forensic odontology. Apart from the basic practice of dentistry, additional extensive training is necessary to acquire different methods and technical skills.

In non- European countries there are special institutions supervising education, certification and also revision of the professional qualifications of forensic odontologists.

Whilst not every dentist recognizes the need for further postgraduate education, the educational offer in European universities and dental schools is limited to only a few, it seems that the only way to expand the qualifications of dental practitioners in the forensic odontology is to develop and extend the education at the undergraduate level.

Although the important role of forensic odontology is commonly appreciated, neither number of hours nor the scope within undergraduate education guarantees the development of basic theoretical knowledge and practical skills that are essential for the specialists involved in the forensic odontology.

The aim was to evaluate the forensic odontology teaching program at PUMS and compare it to other educational offers in European countries. The estimation of students’ needs prefaced the study.

Method: The questionnaire in paper form was prepared and completed by students of Dentistry Program studying 2nd semester. The proportion of respondents answering for each category of each question was finally calculated.

Results: The study showed that the majority of students have never heard about Forensic Dentistry. On the other hand, 96 % are interested in the subject and would like to participate in facultative classes and laboratories. A positive attitude to the mandatory classes in forensic odontology is represented by more than 80 % of students. Two thirds (66 %) of the students agreed that every dental practitioner should take part in a course dedicated to forensic odontology.

Conclusions: The survey showed that the current status of forensic odontology education for undergraduate students is unsatisfactory. Only general aspects of forensic odontology are covered in preceding university curricula and they are not constantly updated for the increasing educational needs.


The analysis of dental rehabilitation under the evaluation of body damage - date of consolidation or healing and aesthetic damage

Ana Teresa Corte Real1, Rosario Silva2, Graça Santos Costa2, Carina Oliveira 2, Duarte Nuno Vieira3

1Faculty of Medicine, University of Coimbra, Portugal

2National Institute of Legal Medicine, Central Branch, Portugal

3CENCIFOR, Center of Forensic Studies, Foundation for Science and Technology, Portugal

The increasing of the dental examination in the evaluation of body damage, is related to the complexity of the situations of accidents and violence, as well as the technologic advance in this medical field.

We emphasize in this paper the parameters of the assignment of the consolidation date or healing and valorization the analysis of the aesthetic damage.

Comparatively with other rehabilitations, in particular orthopedics, the intervals of temporary incapacity to aim a value of permanent damage through the dental rehabilitation, are high.

The interval for the allocation of consolidation data, depends, in most situations, of the laboratory work and of the relative position for individual growth peak.

By other way, the assignment of aesthetic sequel, is related to sex, age, ludic or professional activity,meanwhile it also depends of the estability of the rehabilitation carried out and the characteristics of the materials used.

This paper will be support through photographic records, the freezing of the image, in different periods of time of the forensic process, and we emphasize the importance of this document in the examination of forensic evidence.


Bitemarks analysis in foods caused by partial dentures

Jeidson Antonio Morais Marques1, Jamilly Oliveira Musse1, Carina Oliveira 2, Rosário Silva2, Graça Santos Costa2, Luis Carlos Cavalcante Galvão3, Duarte Nuno Vieira4, Ana Teresa Corte Real4

1Faculty of Medicine, University of Coimbra, Portugal

2National Institute of Legal Medicine, Central Branch, Portugal

3State University of Feira de Santana, Brazil

4CENCIFOR, Portugal

The study of human bitemarks in foods is an important topic of forensic dentistry with application to the exclusion or identification of suspected criminal acts. The aim of this paper is to assess the possibility to identify bitemarks in food, caused by dentures. The sample consists of 10 sets of partial dentures, 13 to 23 in the upper arch and 33 to 43 in the lower, performed in laboratory by the same prosthetist and assembled on occluder in Angle Class I. After numbering dentures and food, a raffle is held. Then, we proceed randomly to carry out the bites on food (four chocolates, four cheeses and two bananas). Stone models of both, dentures and food bitten, are prepared using alginate. Measurements are taken of each tooth models, food and prostheses, in accordance with the ABFO Standards. Subsequently, direct comparison is made with the bit of food models of prostheses, was classified the upper and lower arches as compatible (C) or excluded (E). The compatibility between the arches and prints are divided between bitter and not-bitter, as per ABFO-2012 guidelines. The bitter classification is found in 7 cases. However, in two cheeses and one chocolate, the suspects are found to be not excluded. According to this paper, is possible analyze, classify and identify bitemarks produced by dentures, an individualizing data, contributing to the skills held in the forensic dentistry.


Use of Digital Panoramic Radiographs in Adult Dental Age Estimation from Pulp Cavity

Beytullah Karadayi 1, Mehmet Yasar Iscan2, Sükriye Karadayi3

1Forensic Medicine Department, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey

2Institute of Forensic Sciences, Istanbul University, Istanbul, Turkey

3Refik Saydam National Health Agency, Istanbul, Turkey

Dental age estimation is necessary not only to aid identification of the dead, but also for living individiuals to clarify criminal and civil liability and social issues. Kvaal and associates have presented a technique based on radiological mesurements on peri-apical radiographs and does not require extraction. However the applicability of the technique showed different results when tested on different images (conventional, digitized, digital panoramic radiographs) by other investigators. The purpose of this study is to apply the Kvaal technique to digital panoramic radiographs (DPRs) and to help assess the potential disagreement mentioned above among earlier researchers. DPRs are collected from patients who visited the Health Ministry, Istanbul Hospital, Osmaniye Dental Unit for therapy on January-June 2009. Digital measurements are taken from a total of 50 males and 50 females at an age range of 15 to 60 years. Indices (P, R and T) reported by Kvaal coworkers which give the length reduction of the pulp of these only P showed statistically significant negative correlation with age (only lateral incisor). All variables (A, B and C) which give the breadth reduction of the pulp also showed statistically significant negative correlation with age for all teeth. These results show that the breadth reduction in the pulp cavity seems more efficient for age estimation in adults. In conclusion, three variables, which give the breadth reduction of the pulp in the Kvaal technique, maybe used for age estimation in adult Turks, only if DPRs have sufficient image quality and taken at the right angle.


Radiological Age Estimation: Based on Third Molar Mineralization and Eruption in Turkish Children and Young Adults

Beytullah Karadayi 1, Ahsen Kaya1, Melek Ozlem Kolusayın1, Sükriye Karadayi2, Abdi Ozaslan1

1Forensic Medicine Department, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey

2Refik Saydam National Health Agency, Istanbul, Turkey

Radiographic evaluation of mineralization and eruption stages of third molars using dental panoramic radiographies can be an efficient tool for chronological age estimation in both forensic sciences and legal medicine. The third molar tooth is utilized for dental age estimation about the age span of 15–23 years because it represents the only tooth still in development. The aim of this study is to obtain and analyze data regarding third molar development and eruption in Turkish population for dental age estimation. A total of 744 dental panoramic radiographies of 394 female and 350 male subjects aged between 8 and 22 years were examined. Third molar development was determined according to Nolla classification system and eruption was assessed relative to the alveolar bone level. Mandibular and maxillary third molars were generally found at similar stages of development on both sides. Nolla stage 6 (completed crown calcification) was reached at around the age of 15 in both maxillary and mandibular third molars in both sexes. Alveolar emergence was at around the age of 16 in males and around age of 17 in females. Although third molars show greater variability than the other teeth, assessment of third molars using both development and eruption stages will increase the accuracy of age estimation in children and young adults.


Ritual dental mutilation among Masai

Laura Camilla Farese 1, Vilma Pinchi2, Roberto Cristofanini3

1Dept. Of Odontology, Desio And Vimercate Hospital,P.O. Carate., Italy

2Dept. Of Legal Medicine, University of Florence, Florence, Italy

3Private practice General Dentist, Asti, Italy

Background: The practice of dental mutilation was frequent in the past worldwide except in Europe where it was in use in England.

The motivations behind these practices are the most diverse, schematically may be summarized: initiation ceremonies, functional, aesthetic reasons (for example in the Masai tribe of lower incisors extraction was believed to facilitate feeding in case of Lockjaw), religious.

However, some of these customs are still in use among certain populations, although they often lost their original motivation.

In Africa the fourth dental extractions and rituals are still common in most tribal people while in Asia are now located mainly between the populations of the islands of Java and Bali where survives the ancient custom of closing the upper incisors.

In the Austral continent are still widespread in Tasmania, New Guinea and the islands of the Pacific Ocean. In Europe and in Italy the fourth dental ritual purposes and not, are prohibited by law for each ethnic group and therefore their possible practice would raise ethics and medico-legal concerns for the dentist

Aim: The purpose of this paper is to describe specific dental mutilation found in Masai tribes, as a useful element for identification purposes both in living subjects of identity both in the skeletal remains of indeterminate origin.

Results: This work is inspired by feedback from the Maasai population resident in Zanzibar and Kenya where it was noticed the absence of the lower incisors in all young males.

This relief, not some random given the constant presence of such mutilation at Masai tribe residing in two different territories, was explained as a widespread custom in this population for the purpose of branding their sons as being subject to continuing kidnappings by neighbouring tribes. It appears as though losing motivation, this practice continues to be practiced within the same tribe. Extraction of lower central incisors, two permanent is not practiced by a doctor or Medic with a knife without anesthesia in infant

Conclusion: Dental mutilation can help forensic odontologist in detecting area of origin of a person and belonging to specific ethnic groups


Sexual Dimorphism in Teeth: A Comparison of Mesiodistal and Buccolingual Diameters and Root Length of Single-Rooted Teeth

Eleni Zorba1, Konstantinos Moraitis1, Constantine Eliopoulos 2, Anastasia Mitsea3, Chara Spiliopoulou1

1Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens, Athens, Greece

2Research Centre in Evolutionary Anthropology and Palaeoecology, School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, U.K

3Department of Oral Diagnosis and Radiology, Forensic Odontology Unit, Dental School, University of Athens, Athens, Greece

Background: Sex determination is a necessary step in the investigation of unidentified human remains from a forensic context. The most commonly used techniques for sex determination are based on the assessment of the morphological characteristics of the pelvis and skull. When these elements are recovered in a fragmentary state, teeth can be used as an additional tool for sex determination as they are very durable in comparison with skeletal tissues. Most studies of sexual dimorphism in tooth size are based on the measurement of the mesiodistal and buccolingual crown diameters. However, these dimensions may be affected by caries, attrition or dental restorations and this does not allow certain measurements to be taken. As a result, alternative dental measurements were developed, that are not affected by these problems, such as root length which is the focus of this study.

Method: A total of 586 permanent single-rooted teeth in 102 individuals (58 males and 44 females) from the Athens collection were examined. Mesiodistal (MD) and buccolingual (BL) crown diameters as well as maximum root length for all sides of the teeth were measured. Statistical analysis was carried out using IBM SPSS Statistics (IBM Inc., version 20 for Windows) software package.

Results: Paired Student’s t-test has shown that there is no intra-observer variation for root length and MD crown diameter, in contrast with BL crown diameter. In the case of root length and BL diameter almost all teeth presented significant difference between males and females, in contrast with MD diameter. For crown diameters canines were the most dimorphic teeth followed by first premolars and maxillary second premolar. For root length both maxillary and mandibular second incisors, canines and second premolars as well as the first mandibular premolar present a great degree of sexual dimorphism with the maxillary second incisor to be the most dimorphic tooth followed by the maxillary second premolar and mandibular canine. Among the dimensions studied, root length was the most dimorphic with the measurements of the mesial side to present the higher percentage of sexual dimorphism (%SD: 4.10 %-15.75 %). The least dimorphic dimension was MD diameter (% SD: 1.43 %-6.52 %).

Conclusion: The results of the present study suggest that root length is a more reliable and useful tooth dimension than crown diameters and appears to be a promising new method for sex determination. It remains to be seen whether this method present high classification accuracy in other populations.


Proposed Amendment to Traffic Spanish scale rating for bodily injury in the oral cavity

Manuel Lopez Nicolas, Maria D Pérez Cárceles, Faustina Sánchez Rodriguez, Aurelio Luna

Department of Legal and Forensic Medicine

In Spain the assessment of the corporal damage within the oral system is subject to limitations and difficulties which are caused from the deficient enumeration and assessment of the after-effects in the current and valid scales. The present study deals with the analysis and the elaboration of a proposal to modificate the current traffic scale in the bucco-dental field. It pays special attention to the after-effects of the TMD (Temporomandibular Disorder). The carried out study bears witness to the insuffiency of the scale of the current traffic in order to evaluate the dental-stomatological damage and, specially, in order to evaluate the temporomandibular joint. The traffic scale, which is currently valid, does not consider the protrusion, lateral and retrusion movements of the osteoarticular system of the face. Our proposal is to include the protrusion, lateral and retrusionmovements, that we consider as necessary from a functional viewpoint. We give a wye between the points between 1 and 10. We do not find reasonable to assign the same valoration to different dental pieces bearing its different physiological function in mind. Therefore, we consider that the punctuation assigned to canines should be 1.5 punts for incisors; 1 point for molars and 0,5 for premolars.



Dismemberment and mutilation: report of three cases

Maria Victoria Perez

Maria Victoria Perez Medico forense y antropologo

Definicion: Dismemberment is the act of cutting, tearing, pulling, wrenching or otherwise removing, the limbs of a living thing

The literature shows the biggest number of cases in Hamburgo medical examiner office with 31 cases of mutilation and criminal dismemberment. Sweden published a 29 years study with 22 dead. In our country the criminal dismemberment is used to hide the body, to move it to another scene and to produce fear in the people.

Metodologia: we perform the autopsies at the medical examiner office in Medellin, Colombia, South America with qualify people as dentistry, photographer and anthropologist. We made complete autopsies, with study of the scene, X ray, toxicology and biological samples

Casos forense: In Medellin Colombia are found five bags containing plastic in which body segments are related to three bodies

At the autopsy room the bags were classified into A, B, C, D and E.

Case 1: skeletonized corpse with stab wounds chainsaw type

Case 2: is male cadaver in adipocere with a bullet wound in the head fire

Case 3: adipocere lower member an in which are seen chainsaw cut


sudden death: intramural Coronary artery

Ruben Dario Giraldo, Catalina Vasquez Guarin, Viagnney Bravo Viloria

Definition: Intramural artery, intramyocardial bridges are defined as arterial segments that take place in the thickness of the heart muscle wall, usually have a way coronary epicardial but for lack of externalization of the primitive network cross intratrabecular muscle mass.

Methodology: Medicolegal autopsy is performed complete to the guidelines of the National Institute of Legal Medicine, pathological specimens are fixed in formaldehyde buffer, embedded in paraffin and staining techniques are performed routine hematoxylin and eosin and special. Samples are taken for toxicology

The case involves a 25-year-old man is found unconscious in his home and is driven by their families to enter hospital entity where no signs viatles. Enter the National Institute of Legal Medicine and Forensic Sciences in Medellin, Northwest Regional, with a diagnosis of sudden death.

At necropsy documenting the corpse of a man of neat, thin build, with no external traumatic injuries. Internal review marked visceral congestion, heart weight 310 gr, right ventricle thickness 0.4 cm, 1.4 cm left ventricle, valves without alterations or traumatic injuries, coronary artery anatomic variant where it is observed intramyocardial left anterior descending coronary artery of 2 cm approximately in the histopathological study shows intramural coronary artery.

Conclusion: In dealing with sudden deaths opens a range of possibilities for the expert in the search for a reason, although epidemiological bases always have on hand is made closest approach to cardiac causes, within these it is common when performing postmortem studies in adults there is a predominance of atherosclerosis as an explanation for the death but charges a vital presence of intramural coronary in previously healthy young people without a family history of cardiovascular disease who have sudden collapses, and that studies made has been documented that this anomaly may go undetected for years to be asymptomatic and debut a sudden death with a subsequent finding in the study of the autopsy. For this reason it is necessary to travel a thorough examination of the coronary arteries for possible evidence that intramyocardial bridges combined with the pathophysiological explanation expressed in this review give light to reach a conclusion on the death


Epidemiological profile of the violent death by a firearm projectile: rétropsective study of 05 years in the region of Annaba

Y. Mellouki, L. Sellami, F. Guehria, F. Kaious, Y. Zerairia, A. Mira

Department of Forensic Medicine Teaching Hospital in Annaba, Algeria

I. Introduction: Deaths from firearms projectiles take a significant place in our activities; they pose many problems that the forensic pathologist must know them well.

II. Objective: 1. identify the epidemiological profile of deaths from firearm projectile.

III. Material-methods: The study that we present is retrospective, descriptive, over a period of 05 years from January 2005, until december2009), dealing with death by a firearm projectile have undergone a medical autopsy judiciary.

IV. Results: The incidence of violent death by gun shot to 4 % of the activity thanatological;

A clear male predominance was noted;

The more the subject is old, the less attacked. Lesions of the cephalic end are the most experienced, the forensic examination has given an insight into the direction of fire, alcohol is rarely found in our sample. A clear predominance of long guns was noted.

V. Conclusion: Violent death by firearm projectile is clearly increasing, it relates more boucoups the elderly, the seat of injury is represented mainly by the cephalic end, the forensic examination has determined the circumstances killed and made to reconstruct the record.


Analysis of 354 female homicide cases in Shanghai from 2006 to 2009

Yi Wen Shen 1, Kai Jun Ma2, Wen Long Yang1

1Department of Forensic Medicine, Shanghai Medical College, Fudan University, Shanghai, China

2Shanghai Key Laboratory of Crime Science Evidence, Shanghai Security Bureau, Shanghai, China

Homicide death of women is a lost both to the family and society, and the female homicide cases partly reflect area safety. The information of 354 cases of female homicide deaths in Shanghai from the Institute of Forensic Science, Shanghai Security Bureau from 2006 to 2009 were collected and analyzed in terms of age, cause of death (COD) and cause of case.

The data showed that the mortality of homicide deaths in women decreased recently as the total homicide victims in Shanghai (table 1). 354 women were killed with the rate from 0.1/1000 to 0.16/1000 among women in Shanghai, and 26.87 % of the total 1325 cases due to homicide. The age distribution of 354 victims ranged from new arrival to 93, with a median age of 36. All victims were divided into 7groups according to their age: <1y, 1y-6y, 7-17y, 18-40y, 41-65y, 66-85y and >86y. 202 women (57.1 %) in the group of 18-40y were killed, followed by the group of 41-65y (26.8 %, table 2).

Data showed 317 female victims died from single cause. Mechanical injury was the most common COD (178 victims, 50.3 %). 121 victims died due to hemorrhagic shock, 47 to craniocerebral injury, 5 to traumatic shock, 4 to pericardium tamponade, and 1 to crush syndrome. Sharp instrument was the most common object (127 cases, 35.9 %), and 93 victims were killed from stab, 34 from chop. Mechanical asphyxia was the second common COD (137 victims, 38.7 %), 68 women died due to manner strangulation, 18 to strangulation, 9 to smothering, 8 to drowning, and 4 to choking. 2 victims were killed by electricity, 1 by gunshot to head. 33 victims died from two or more causes, such as mechanical injury complicating by mechanical asphyxia. The causes of 4 cases were unknown. 6 infants were killed due to mechanical asphyxia.

Data showed that the causes of 354 cases were different, 78 female victims died because of family conflict, 74 of robbery, 51 of rape, 45 of love imbroglio, 35 of dispute, 34 of revenge, and 6 of infanticide. 14 were died due to other reasons, such as kidnap. 17 cases were without clear reason. It's necessary for us to pay attention that 63 female were killed by their husbands, 45 by their lovers and 11 by their sons.

It is essential to establish protective system to prevent harm to women, not only from public security, but also from family.


GENDER VIOLENCE: mechanical asphyxia in airport

Viagnney Beatriz Bravo

bravo viloria viagnney

The case involved a woman of 33 years identified that the September 8, 2009, is located in the interior of an airport hangar in the city of Medellin, which is lying on the floor in a natural position, the upper and lower are attached

On inspecting the body was found with a beige jacket, two black plastic bags, a black plastic bag and a white towel completely covers the head. In the neck there is a black colored cord, after removing the packaging of the body is a young woman with bruises and abrasions on the lower third of the right forearm and left and lower right leg and left. signs of mechanical asphyxia eyelids as facial petechiae, buccal mucosa, palate, conjunctival hemorrhage, facial cyanosis. sexologist and toxicological study is performed. One of the points is important is sexual assault, and signs of restraint. Findings documented a complete autopsy, toxicological and serological studies allows us to conclude the case


Death of an adult woman after attack by two Rotweiller breed dogs: discussion about “pack attack” and postmorten anthropophagy

Pedro Manuel Garamendi González 1, Manuel López Alcaraz2

1Council of Forensic Medicine of Istanbul (Turkey)

2Instituto de Medicina Legal de Huelva (España)

We present a case report of a death of an adult woman after unwittnesed attack by two rottweiller breed dogs. Recent medicolegal literature has been reporting deaths by dogs attack in juveniles, but death of adult humans after dog attack are not common. Dog behaviour of pack attack and individual dogs attacks have different profile of autopsy findings in death cases. Postmortem anthropofagy has been reported but antemortem anthropofagy in case of attacks to adult humans is not common.

Material-methods: The crime scene was throughfully analyzed and the results of a complete medico legal autopsy after EC 99/3 Recommendations were resumed. The wounds were located in head and right arm, with severe and unusual lesions including amputation and posible intake by dogs of ears and scalp. Lesions had typical characteristics of dogs bites and dog nails wounds.

At least 6 out of 7 typical dog attack findings were elucidated in this case. The reconstruction also suggested an attack by only one dog even though first approach at crime scene had suggested a pack attack by both dogs.

Examination of dogs after dead was performed by a forensic pathologist but a complete veterinary autopsy could not be performed against pathologists advice. The study was completed by complementary samples for biological, toxicological and histopathological analysis and teeth casts were collected.

Conclusions: A list of recommendations in case of medicolegal autopsy due death by dog attack is included. A list of 7 typical findings in this scenario were also included. The location and morphplogy of wounds can help to differenciate pack attack from single dog attacks.


Postmortem Animal Predation. Effects of ants in death bodies

Pedro Manuel Garamendi González 1, Manuel López Alcaraz2, Agustín Mazón2, Jose Rodríguez2

1Council of Forensic Medicine of Istanbul (Turkey)

2Instituto de Medicina Legal de Huelva (España)

Shkrum and Ramsay define postmortem changes as the great pretenders. Postmortem predation by animals is one of the most confounding factors between these changes. Sometimes animal predation can produce postmortem damages that mimic antemortem lesions. Other times they completely distort real antemortem lesions turning them imposible to analyze precisely in the cadaver.

In the medicolegal literature different animals have been considered postmortal predators: domestic cats and dogs but also some wild big mammals and sea animals. Insects can be predators on the cadaver but also can interfere with other species of cadaveric fauna. Ants are an unusual case between insects as their predation action can start little after death and even many time before putrefaction starts. They also use to avoid other insects to attack dead bodies until they have finished their predation.

Ants use to bite the skin of the cadaver. The lesions they produce after death can be wide, without vitality signs and with a typical morphology. Injuries have a dry appearance and are usually brown coloured. Sometimes lesions in the skin can be misinterpreted as chemical lesions or abrasions. Bleeding is not exceptional in case of lesion in lower anatomical areas due to hyposthasis. Typical location of lesions are lips, eyelids and knuckles. In case of eyelids injuries, typically eyelashes are also absent.

We present an unusual case of a massive skin attack of a dead adult male who was attacked after death by a colony of domestics ants. He was also exposed during some 36 hours to heat and dry conditions. The postmortal lesions were exceptionally extent and wide, but typical profile of lesions suggested that all cutaneous lesions observed were due to ants predation.


Sudden unexpected death of an infant due to transmesocolic internal hernia

Pedro Manuel Garamendi González 1, María Dolores Jiménez2, Manuel López Alcaraz2

1Council of Forensic Medicine of Istanbul (Turkey)

2Instituto de Medicina Legal de Huelva (España)

We present a case report on a forensic autopsy performed in a 5 years old boy. The kid suffered an obstruction of small bowels, intestinal hemorrhagic necrosis and secondary shock produced by a transmesocolic internal hernia. The hernia was related with a congenital defect in the mesentery. A brief bibliographic review on general features of this anomaly and internal hernias was conducted. It is exceptional that an anomaly of this type can cause sudden death in adults or infants.


Strangulation signs and heat effect after arson. Homicide signs dissimulation

Pedro Manuel Garamendi González 1, Manuel López Alcaraz2, María Rosario Gómez Tejeda2, Julio García Tomé2, Marisol Sánchez De León Robles3

1Council of Forensic Medicine of Istanbul (Turkey)

2Instituto de Medicina Legal de Huelva (España)

3Instituto Nacional de Toxicología y Ciencias Forenses. Delegación de Madrid (España)

n recent medico-legal literature, there are some references about application of heat to disguise signs of mechanical asphyxia. They have been described case reports of dissimulation of suicidal hanging by secondary arson. In two cases in the literature reviewed heat effects in an arson were used to hide signs of an homicidal strangulation. Heat effects are seek to disappear mechanical asphyxia signs and most usually these signs can be completely absent after arsons.

We present a case report of an autopsy performed after a homicidal strangulation. The dead body was located under a car and the car was set to fire for some hours. The heat effects on the body were severe with partial amputation of extremities and destruction of nearly all cutaneous surface. Nevertheless a portion of the strangulation lace and skin furrow remained unaffected. Radiographic and histopathological analysis confirmed that these injuries were produced antemortem, leading to the final diagnosis of homicidal strangulation and secondary dissimulation by arson.

Out of an evident iconographic interest of the photographies, this case report also highlights the importance of a complete and careful crime scene investigation in arson scenarios. Judicial Police technicians but also firemen and medical emergency teams must be aware of this issue.


Unusual Mechanism of Death in a Road Traffic Accident: a case report

Banwari Lal Meel

Banwari L. Meel

Road traffic accidents are associated with deaths due to different mechanisms. Loss of blood as a result of multiple injuries is the commonest in majority of cases. The severity of these injuries depends on the force of impact of a vehicle. The speed, type of car, and direction of impact are the main determining factors in causation of injuries.

This article presents uncommon cases of RTA deaths. The first case is one of instantaneous death by a head on collision. There were multiple large lacerations on both legs and thigh associated with fractures of leg, thigh and pelvic bones, but almost no blood was found at the scene. The foul play was suspected. The history and autopsy findings have been discussed.


Postmortem interval degradation using 18 s-rRNA and microRNA

Can Wen Li1, Jun Kai Ma2, Ping Zhang1, Jun Hui Wang3, Duan Ma4, Long Chen 1

1Fudan university

2Criminal science and technology institute

3Children's hospital of fudan university

4Key Laboratory of Molecular Medicine of fudan university

Background: The importance of determining postmortem interval (PMI) is crucial to criminal, civil and forensic cases. The precise estimation of PMI is a critical step in many death investigations. A technique exploiting the level of RNA, 18 S rRNA and microRNA, to estimate the PMI was investigated. 18 S-rRNA is a main ribosomal RNA presented as part of ribosomal protein complex, while microRNA is a class of small non-coding single-stranded RNA, only 21–25 nucleotides, has a strong conservation between different species.

Method: In this study,heart tissues were removed from adult rats at various postmortem intervals. An efficient extraction and detection protocol to analyze the level of 18 S-rRNA and microRNA in postmortem tissue was carried out. The process contains total RNA extraction, transcription and visualization by quantitative real time PCR.

Results: The result indicates a characteristic parabola relationship between postmortem period and Ct values for 18 S-rRNA in dead rat hearts. Then, five human case heart tissues, whose PMI were exactly known PMI) were used for PMI estimating evaluation using 18 S-rRNA.

Conclusion: The result indicates the degradation pattern of tissue 18 S-rRNA and microRNA is useful in the determination of the postmortem interval within seven days.


Quantification of microRNAs, mRNA, 18 S rRNA in three temperature groups degradation as potential markers of postmortem interval

Heng Zhang1, Jun Kai Ma2, Ping Zhang1, Hui Ye Lv1, Can Wen Li1, Long Chen 1

1Fudan university

2Criminal science and technology institute

Background: The estimation of time since death which is known as postmortem interval (PMI), has been regarded as the most essential and elusory mission in the legal medicine science. In recent years, time-dependent degradation of RNA has been gradually applied for determination of PMI with real time PCR universally used in the molecular biology experiments. However, the use of mRNAs were limited resulting from their own shortages, meanwhile, temperature as key factor impacts RNA decay was not profoundly explored ever. Micro RNAs are belong to a family of small non-coding RNAs, which depress and silence mRNAs translating into proteins. Contrary to the traditional mRNAs, the hundreds of them found only have 18-24 bp, thereby they could be more stable; inconsistent primers and aspecific amplification can be also eliminated.

Method: We re-examined and evaluated the degradation of 18 S rRNA, GAPDHmRNA, β-actinmRNA and microRNAs (miRNA-9 of brain, miRNA-21 of kidney and miRNA-203 of skin ) extracted out of three tissues(brain, kidney, skin) of SD mice from 0 to 120 h in three temperature groups(4°C, 15°C and 35°C). And assessed reliability of qualitative RT-PCR method for RNAs.

Results: Based on the data obtained, we found the Ct value of four candidate makers of each tissue showed up-regulate before down-regulate in three temperature groups. According to this findings, we tried to build mathematic model certified subsequently by human tissue samples of collection.

Conclusion: The results suggest that in the three temperature groups each tissue has its own maker and endogenous control to be the potentially powerful adminicle of determination of PMI.


Histochemical characteristics of human myocardium obtained from individuals who died due to low oxygen tension or ATP consuming

Katsuji Nishi, Satoshi Furukawa, Lisa Wingenfeld, Wakoto Matsuda, Ikuo Sakaguchi, Tokiko Nakagawa, Akari Takaya, Kuniyo Nishi

Department of Legal Medicine, Shiga University of Medical Science, Ohtsu, Japan

Detection of early myocardial ischemia prior to neutrophilic infiltration after postmortem examination is often difficult by HE stain and poses irritation for forensic pathologists.

In this study we performed conventional and immunohistochemical staining of the myocardium obtained at sudden or sub-acute death cases where they died due to bronchopneumonia, smothering, chest compression, nitrogen asphyxia or hypothermia, using HE, Azan and antibodies against cold inducible RNA binding proteins (CIRBP), putative RNA-binding protein 3 (RBM3) and Sirtuin 1 (SIRT 1).Antibodies against CIRBP and RBM3 stained the nucleuses of the myocardial cells obtained from these victims and cardiac infarction death cases with or without resuscitation therapy. Anti SIRT 1 antibody also stained the nucleuses of myocardial cells from these victims, however this antibody did not stain the nucleuses of myocardial cells from cardiac infarction deaths. The staining results reveal that the reflex of the myocardial cells against low oxygen tension and/or ATP consuming situation is able to detect even in the postmortem examination and SIRT 1 antibody might be useful to distinguish the partial lesion, cardiac infarction, from the whole body lesion in the low oxygen tension and/or ATP-consuming situation at postmortem examination.


Anatomical and forensic pathological study on the thymus

Katsuji Nishi, Lisa Wingenfeld, Satoshi Furukawa, Wakoto Matsuda, Akari Takaya, Tokiko Nakagawa, Ikuo Sakaguchi, Kuniyo Nishi

Department of Legal Medicine, Shiga University of Medical Science, Ohtsu, Japan

The thymus is derived from both ectoderm and endoderm of third branchial clefts and descends into the mediastinum during gestation. Accessory thymus bodies may also originate from the fourth pharyngeal pouch. They may be left in the neck or be embedded in the thyroid. In this presentation we firstly show 3 infant autopsy cases in which the ectopic thymus existing inside or outside the thyroid glands. The involution of the thymus is accelerated by many kinds of stresses. Although Hassall’s corpuscles that present in the thymus at 11th gestational week are developing and disappearing with age, the morphological changes of the Hassall’s corpuscles are also inflicted by the stresses. We secondly show the thymus involution and morphological variations of Hassall’s corpuscles when infants or juveniles are affected by stress such as abuse, injuries and/or infections. Experience from autopsies indicate that thymus involution may occur in the prolong stress and morphological changes of the Hassall’s corpuscle may occur prior to thymus involution in a short durational stress.


Histopathological characteristics of human cardiac tissues in accidental hypothermia 1. Approach using conventional staining techniques: Azan-Mallory staining might be useful for detection of myocardial damage due to hypothermia

Katsuji Nishi, Satoshi Furukawa, Lisa Wingenfeld, Ikuo Sakaguchi, Tokiko Nakagawa, Akari Takaya, Kuniyo Nishi

Department of Legal Medicine, Shiga University of Medical Science, Ohtsu, Japan

We examined characteristics or cardiac cell damage in the myocardium obtained from individuals who died due to hypothermia or coldwater immersion by conventional staining such as HE and Azan. We could find four kinds of histological changes in the heart tissues obtained from hypothermia and coldwater immersion death, that is, 1) The cardiac cells remarkably closed adherence to each other, 2). The number of red or orange colored cardiac cells by HE or Azan stain, respectively, was frequent than that of control. 3). The cardiac cells with severe vacuolar, colliquative myocytolysis, were identified in the papillary and left ventricle muscles. 4) The contraction bands in the cardiac cells were recognized in all section from the septum of the hearts obtained from hypothermic and coldwater immersion death. Although the red or orange colored cardiac cells, vacuolar cardiac cells and contraction band of the cardiac cells were observed in the heart from individuals with other cause of death, the frequency and intensity of the finding was remarkable in hypothermic death, and closely adhered cardiac cells were detected only in the myocardium from hypothermic or coldwater immersion death. To detection these findings Azan staining may be useful than HE stain. We additionally discussed the mechanisms of development of these findings by comparing the results obtained in this examination with some reports in the literatures.


Sex steroid receptors as a tool in determination of postmortem interval

Eman Ismail Hasan 1, Enas Kamal Abd Elazeem1, Hala Mohammed Ahmed1, Soha Abd Elqawe Abd Elwahab2

1departmentof Forensic Medicine & toxicology, Minia university, Minia, Egypt

2departmentof histology, Minia university, Minia, Egypt

Determination of the postmortem interval PMI is one of the most valuable subjects in forensic practice. So the aim of this study was to detect postmortem interval by evaluating the distribution of sex steroid receptors (androgen and estrogen) in rat brain and testis by immunohistochemical study. For this purpose 40 male rats were used in this study and were classified into 4 groups each of 10 rats. Groups were examined at 0, 6, 12 and 24 hours after death respectively. Regarding brain, the results of the study revealed that Androgen Receptors (AR) immunoreactivity were widely distributed throughout all layers of the cerebral cortex, but the highest numbers of them were found in the large pyramidal cell layer. Cells showing Estrogen Receptors (ER) immunoreactivity were widely distributed throughout all layers of the cerebral cortex, but the highest numbers of them were found in the polemorphic cell layer.

Both AR and ER immunoreactivity showed marked changes in relation to time interval, the intensity of the immunostaining was reduced noticeably, and the positive cells were decreased in number gradually with time. As regards testis, AR immunoreactivity was very weak immediately and 6 hours after death, and there was no expression in the remaining time intervals. So the study concluded that expression of some sex steroid receptors immunoreactivity in brain and testis can be used to detect early postmortem interval.


Immunohistochemical investigation of the coma blister

Masayuki Kashiwagi 1, Akiko Ishigami2, Kenji Hara1, Aya Matsusue1, Brian Waters1, Itsuo Tokunaga2, Akiyoshi Nishimura2, Shin Ichi Kubo1

1Department of Forensic Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

2Department of Forensic Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan

Background: The erythematous patches and vesicles that are observed in coma patients, usually from an overdose of medication, are known in the dermatology field as coma blisters. In this study, we immunohistchemically examined such skin lesions from two forensic autopsy cases.

Case reports: Case 1 was a woman in her thirties. The lesions were observed in the left femoral region, the lower left thigh, and the right knee. Case 2 was a woman in her twenties. The lesions were observed on one of her fingers and the edges of both feet.

Toxicological analysis: Using gas chromatography–mass spectrometry (GC-MS), toxicological analysis detected caffeine, ibuprofen, bromovalerylurea, bromoisovaleric acid, and ethoxybenzoic acid in the blood of case 1, and the caffeine was over the toxic level as compared with the literature. In the blood of case 2, pentobarbital and phenobarbital were detected, with pentobarbital at a fatal level.

Pathological findings: Histological examination of the skin lesions showed that the keratinocytes had necrosed and the epidermis was partly thin in both cases. Eccrine sweat gland degeneration was observed. Obvious inflammatory cell infiltrations were not detected. According to previous studies, it is believed that coma blisters are formed from local low oxygen and/or pressure. However, it is unknown whether the degeneration of the sweat gland is a necrosis or apoptosis. Immunohistochemically, each skin lesion was stained against CD3, CD8, CD45RO, keratin, 70 kD heat shock protein, ubiquitin, and 150 kD oxygen regulated protein. They were also stained with an in situ apoptosis detection kit. In this paper, we report our findings from this immunohistochemical study.


Forensic Considerations of Pregnancy-related Maternal Deaths: An Overview

El Akri Abdelhafid, Naslafkih Abdelouahed, Sestier François

Program in Insurance Medicine and Medicolegal Expertise, Montreal University, Canada

During the 20th century, risks to women associated with childbirth in developed countries have been dramatically reduced on account of many factors that include technological advancements in obstetrical care, greater access to health services and fewer births occurring at the extremes of women’s reproductive age span. However, pregnancy-related maternal deaths continue to be a major health concern in developing countries. In the year 2005, an estimated 536,000 women died of maternal causes worldwide of which 86 % occurred in sub-Saharan Africa and South Asia and less than 1 % in more developed countries. The large regional differences in maternal deaths demonstrate that most of these deaths are preventable. It is nevertheless important to monitor patterns of pregnancy-related mortality and serious morbidity and to be sensitive to what observed patterns or changes may tell us in order to continue to safeguard women during this critical period and the monitoring process must begin with ascertainment of the accuracy of routine reporting of deaths associated with pregnancy and childbirth. We examine the pregnancy-related maternal deaths with a forensic view point.


Liver cirrhosis as a possible risk factor of injury death: Evaluation of forensic autopsy cases using postmortem biochemistry

Hitoshi Maeda 1, Tomomi Michiue1, Takaki Ishikawa1, Osamu Kawamoto1, Jian Hua Chen1, Qi Wang1, Bao Li Zhu2

1Department of Legal Medicine, Osaka City University Medical School, 545–8585 Osaka, Japan

2Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang 110001, P.R. China

Background: Liver cirrhosis can be a risk factor of injury death, predisposing patients to hemorrhage, tissue edema and other organ dysfunction; however, it is difficult to interpret the contribution to the death process based on pathological evidence. The present study investigated forensic autopsy cases of injury death with regard to the influence of preexisting liver cirrhosis on hepatic dysfunction after injury and the survival time using biochemical markers.

Methods: Serum albumin (Alb), cholesterol, bilirubin and choline esterase (ChE) in bilateral cardiac blood were measured in forensic autopsy cases of injury death without evident decomposition (n = 361, within 72 h postmortem). Cases included fatalities from sharp instrument injury (n = 61), non-head blunt injury (n = 123), and blunt head injury (n = 177), with/without the complication of liver cirrhosis (n = 85/276). Each injury group was subdivided into subgroups of survival time of <0.5 h, 0.5–12 h, 12 h–2 days and 2–30 days, and cases with and without medical treatment in hospital in each survival time subgroup.

Results: Liver cirrhosis was less frequently involved in fatalities with survival time of <0.5 h (11.7 %) than in longer survival cases (28.8 %). In cases without medical care, serum Alb, cholesterol and ChE levels were slightly lower in those with than without liver cirrhosis in sharp instrument and blunt head injuries; however, non-head blunt injury cases without liver cirrhosis showed a tendency toward a survival time-dependent decrease in serum Alb, cholesterol and ChE. In deaths despite medical care in hospital, these serum markers were usually lower than in cases without medical care in subgroups with survival time of >0.5 h, and were higher in blunt head injury than in other injuries in cases without liver cirrhosis. In non-head blunt injury cases, serum Alb, cholesterol and ChE levels were higher in those with than without liver cirrhosis in deaths with survival time of 0.5–12 h and 2–30 days, but were lower in deaths with survival time of 12 h–2 days. Such findings were not detected in blunt head injury cases.

Conclusions: These observations suggest that liver cirrhosis can be a risk factor of injury death in subjects who survived the acute phase under medical care in hospital. In non-head blunt injury deaths under intensive medical care in hospital, liver cirrhosis can be a predisposition aggravating hepatic dysfunction during a survival period of 12 h–2 days; however, such influences of liver cirrhosis were different in other cases.


Postmortem investigation of amino acids in heart blood and pericardial fluid and the Fischer ratio as markers of hepatic dysfunction

Hitoshi Maeda 1, Tomomi Michiue1, Takaki Ishikawa1, Osamu Kawamoto1, Jian Hua Chen1, Qi Wang1, Bao Li Zhu2

1Department of Legal Medicine, Osaka City University Medical School, 545–8585 Osaka, Japan

2Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang 110001, P.R. China

Background: Postmortem biochemistry has become a potent ancillary procedure in the forensic investigation of death. Serum free amino acids and the Fischer ratio are clinical markers of metabolic disorders due to inborn errors, inadequate nutrition and liver disease; liver pathology does not always correlate with the function. These markers may also be applied to evaluate hepatic damage as part of multiple organ dysfunction syndrome (MODS) resulting from severe traumas and diseases. The present study investigated the Fischer ratio of free amino acids in bilateral cardiac blood and pericardial fluid (PCF) in medicolegal autopsy cases, compared with other serum markers of liver function.

Methods: Free amino acids in bilateral heart blood and pericardial fluid (PCF) were measured in medicolegal autopsy cases without evident decomposition (n = 184, within 60 h postmortem), and the Fischer ratios of amino acids were estimated. These were compared with serum reference markers, including albumin (Alb), cholesterol, bilirubin and choline esterase (ChE). Cases were classified into: a) advanced liver disease (fatality from liver disease, n = 15), b) other natural deaths with survival time within 2 days (acute illness, n = 18) and c) over 2 days (prolonged illness, n = 21), and d) traumatic deaths with survival time within 2 days (early traumatic death, n = 90), and e) those with survival time over 2 days (delayed traumatic death, n = 40).

Results: There were good site-to-site correlations of free tyrosine (Tyr) and phenylalanine (Phe), the Fischer ratio and reference markers, although a slight postmortem time-dependent increase was partly detected. Postmortem serum and PCF levels of free Tyr and Phe were markedly higher than clinical reference ranges and were especially high in fatality from advanced liver disease. The Fischer ratio approximated the clinical serum value and was lower in cases of fatality from advanced liver disease, other prolonged illness and delayed traumatic death. Most of these subjects also had low serum Alb, cholesterol and ChE levels, and increased serum bilirubin in some cases; however, low serum Alb, cholesterol and ChE levels were also detected in other cases. In addition, isolated low serum ChE was detected in a case of organic phosphate pesticide intoxication.

Conclusions: These observations suggest that the postmortem serum and PCF Fischer ratio can be used as markers for biochemical evaluation of the severity of hepatic dysfunction due to liver disease, prolonged illness or trauma as the cause of death or contributory disorder, combined with other reference biomarkers, in consideration of hepatic pathology.


Evaluation of postmortem serum gamma glutamyl transferase as a marker of hepatobiliary disorder

Hitoshi Maeda 1, Tomomi Michiue1, Takaki Ishikawa1, Osamu Kawamoto1, Jian Hua Chen1, Qi Wang1, Bao Li Zhu2

1Department of Legal Medicine, Osaka City University Medical School, 545–8585 Osaka, Japan

2Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang 110001, P.R. China

Background: Postmortem biochemistry has become a potent ancillary procedure in the forensic investigation of death. Serum gamma glutamyl transferase (GGT) is a routine clinical marker for investigating hepatobiliary disorders and chronic alcohol abuse. Previous studies suggested its application in postmortem diagnosis of alcohol abuse but also an increase due to systemic deterioration following critical traumas and diseases. The present study investigated serum GGT in bilateral cardiac blood in medicolegal autopsy cases, compared with other serum markers of liver function.

Methods: Postmortem serum GGT levels in bilateral cardiac blood were measured in medicolegal autopsy cases without evident decomposition (n = 184, within 60 h postmortem), and were compared with serum reference markers, including albumin (Alb), cholesterol, bilirubin and choline esterase (ChE). Cases were classified into: a) advanced liver disease (fatality from liver disease, n = 15), b) other natural deaths with survival time within 2 days (acute illness, n = 18) and c) over 2 days (prolonged illness, n = 21), and d) traumatic deaths with survival time within 2 days (early traumatic death, n = 90), and e) those with survival time over 2 days (delayed traumatic death, n = 40).

Results: There were good correlations between bilateral cardiac blood serum levels of GGT and reference markers, although left cardiac serum GGT showed a slight postmortem time-dependent increase. Serum GGT did not show any significant correlation with other markers, and increased GGT level (>300 U/L) was mostly detected in cases of liver cirrhosis/tumor, independent of the cause of death groups, as well as in fatal alcohol abuse. Cases of liver disease had significantly higher right/left cardiac serum GGT than other cases (p < 0.001/p < 0.05); however, lower GGT with hyperbilirubinemia was detected in fatality from advanced liver disease. For reference markers, Alb, cholesterol and ChE were significantly lower but direct and indirect bilirubin were significantly higher in subjects with than without liver disease (p < 0.001–0.05).

Conclusions: Serum GGT was independent of other markers of liver function, showing an increase in cases of liver cirrhosis/tumor and in fatal alcohol abuse, but lower serum GGT with hyperbilirubinemia in fatality from advanced liver disease, suggesting end-stage hepatic failure, as seen in clinical patients. These observations suggest that postmortem serum GGT can be used as a marker for biochemical evaluation of the severity of liver disease as the cause of death or contributory disorder, and of fatal alcohol abuse, combined with other biomarkers of liver function, in consideration of hepatic pathology.


Suicide by cutting the electrical cable of left ventricular assist device (A case report)

Eleni Zagelidou1, Fotios Chatzinikolaou 2, Alexandra Enache3, Roubini Leodari4, Techn:lazaros Papadopoulos1, Techn:konstantinos Chalazas1

1Lab of Forensic Service, Thessaloniki, Greece

2Department of Forensic Medicine & Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece

3University of Medicine and Pharmacy Victor Babes, Timisoara, Romania

4Lab of Forensic Service, Larissa, Greece

Left ventricular assist device is used as a permanent therapy in patients with severe heart failure that are not candidates for organ replacement. It consists of a blood pump implanted in a patient’s chest just below the heart. An electrical cable that powers the blood pump passes through the patient’s skin to an external controller worn around the patient’s waist. We present a rare case of a 72 years old man suicide: He found dead by his wife on his house stairs when she returned home in a small town in Greece. He was transferred to the local hospital were pronounced dead. He suffered from severe heart failure since many years and had implanted left ventricular assist device two years ago. The autopsy of the case took place in Forensic Service of Ministry of Justice in Thessaloniki - Greece revealed suicide by cutting the electrical cable of the device.


crime and alcohol

Atika Cherouat, Dalila Laidaoui, Azzeddine Mostefaoui, Fatiha Merah

crime is on the rise again in Algeria, factors related to such violence are omnipresent whose alcoholism that causes abnormal behavior of the alcoholic by the author and sometimes the victim

Through a retrospective study of autopsies in forensic chu beni messous records of victims of violence received in the consultation and those forensic inpatient care unit in our prison we report the severity of the involvement of alcohol in the genesis of violence


Sudden death during thoracoscopy: a case report

Enrico Pizzorno 1, Gabriele Rocca1, Luca Tajana2, Antonio Osculati2, Francesco Ventura1

1Department of Legal Medicine, University of Genova, Italy

2Department of Legal Medicine, University of Insubria, Varese, Italy

Background: Introduced by Jacobaeus in 1910, medical thoracoscopy is a valuable diagnostic tool in patients with pleural pathology, especially when thoracentesis and pleural biopsy procedures do not provide a definitive response.

Medical thoracoscopy has the advantage that it can be performed under local anesthesia or sedation, using reusable rigid instruments, being less invasive, less expensive and relatively easy to be learnt.

Among the complications, severe hemorrhage, due to blood vessel injury during the procedure is the most severe, whereas the most serious complication of pneumothorax induction is air or gas embolism, which occurs very rarely. Mortality is very rare.

Case report: We report the case of a 72-year-old woman who died during thoracoscopy. She was admitted to hospital because of a severe thoracic pain. Her medical history revealed obesity and high blood pressure. Apart from anti-hypertensive therapy she was not under any medication. She presented also with dyspnea and fatigue. ECG was negative.

The day after fever set in with a right-inferior thoracic hypophonesis. A thorax X-ray was performed which showed pleural effusion. TC confirmed abundant pleural effusion with collapse of the nearby lung. To identify the problem a thoracoscopy was attempted. However, as soon as the optic was introduced, the patient started to present with haemoptysis and suddenly died by cardiac arrest. At the autopsy a pleural empyema and three little lesions of the lung parenchyma were found.

Conclusions/discussion: Thoracoscopy is a well-established and safe technique and deaths are rarely reported. Only two out of nine retrospective studies reported fatalities with one case each.

The present case is peculiar because death took place in a few minutes and because the lesions of the lung parenchyma, though iatrogenic in their nature, cannot be the only cause of death. A complex and faster mechanism should be suspected. In vivo experiments reported that mechanical stimulation of the pleura may induce an immediate decrease in both phrenic discharge and arterial blood pressure. Hence in this case, a vasovagal reflex combined with bleeding from the pulmonary perforations might be involved in causing death.


Fatal non-traumatic intra-peritoneal haemorrhage in portal hypertension: a very rare autopsy diagnosis to be reached with caution

Christopher Paul Johnson, Jonathan Medcalf, Mathew Lyall

Forensic Pathology Unit, Royal Liverpool University Hospital, Liverpool, UK

The identification of a large volume fatal haemoperitoneum at medico-legal autopsy, which is unexpected by history, demands a detailed and careful exploration of the abdominal cavity to establish the cause of bleeding. The likely source will depend to a certain extent on the nature of the pathologist's practice. In the hospital setting, post-procedural induced vascular damage or ruptured ectopic pregnancy or tumour, may for example be responsible. In community deaths, or were a history is lacking, it is particularly important to exclude accidental or homicidal trauma to the abdominal contents: tearing to the liver, spleen or mesentery, with or without, surface and soft tissue injury being the key pathology to look for. However, unusual non-traumatic natural causes do occur. Bleeding from intra-abdominal varices have been very rarely well documented at autopsy, and the exact bleeding site is usually not identified. Clinical examples are better defined because the active bleeding guides the surgeon to the source and some patients survive if the haemorrhaging can be dealt with surgically. Varices around the kidney and colon, as well as in the mesentery, retroperitoneum and peri-umbilcal tissues, have been considered to be responsible.

We present two autopsy cases of unexpected fatal haemoperitoneum in subjects with advanced liver disease and associated portal hypertension, which we ascribe to bleeding from intra-abdominal varices. Both cases demonstrated cirrhosis, splenomegaly, non-bleeding oesophageal varices, focal dilated vascular elements in the mesentery and retroperitoneum, along with large and obvious dilated venous channels in the para - umbilical fat. A non traumatic aetiology was only reached after a thorough police investigation into the circumstances leading up to death and following a meticulous autopsy which failed to reveal any evidence of trauma to the body, including the abdominal wall and contents.

We recommend that fatal haemoperitoneum due to intra-abdominal (ectopic)varices should be diagnosed rarely and only after the approach described above. Satisfactorily excluding trauma is particularly difficult in alcoholics who form the vast majority of subjects with portal hypertension in medico-legal practice in Europe. These individuals bruise easily, fall and not uncommonly become involved in physical altercations.

A systematic autopsy protocol including photographic and histological confirmation of all key positive and negative findings is therefore clearly advised.


Multiple Stabbing In Sex-Related Homicides

Nemanja Radojevic 1, Bojana Bjelogrlic2, Stojan Petkovic3, Miljen Maletin3, Ivana Curovic1, Dragana Cukic1, Miodrag Soc1, Slobodan Savic2

1Department of Forensic Medicine, Clinical Centre of Montenegro, Podgorica, Montenegro

2Institute of Forensic Medicine "Milovan Milovanovic", School of Medicine, University of Belgrade, Belgrade, Serbia

3Department of Forensic Medicine Clinical Center of Vojvodina, Novi Sad, Serbia

Introduction: Sexually driven homicides may be a consequence of sexual deviations, but more often the the main cause is the emotional component in a non-paraphilic person. It is known that multiple stabbing homicides are the result of a highly expressed affect of the assailant. This study is trying to establish if those homicides are, in its core, related to the sexual motives of the murderer.

Methods: This is a retrospective autopsy study which includes 770 cases of homicides observed by the motive and manner of homicide, age and gender of the victim, acquittance between the victim and the assailant. Motives of homicides were classified as non-sexual and sexual, including homicides related to rape, jealousy, cheating in a relationship, deviant sexual behavior of psychiatric patients, paraphilia, disturbed emotional relationship between victim and assailant, both hetero- and homosexual.

Results: Multiple stabbing homicides (> = 3 stab wounds) are significantly more often in sex-related homicides than in any other group. Changing the criteria for multiple stabbing (> = 4, 5,. or 25 stab wounds), the percentages of sex-related homicides rise in every group. The correlation coefficients between multiple stabbing and sex-related homicides regarding gender are all near 0.9. Homicides in the female group committed by 25 and more stab wounds are 100 % sex-related. Statistically, jealousy was the most frequent reason for sex-related multiple stabbing homicides.

Conclusion: The first idea, during a police investigation of a multiple stabbing homicide, regardless to the age and gender of the victim, should be that it is a sex-related homicide, especially if the victim is female.


Forensic approach of a bite, caused by watchdog - about a observation

Sellami Sellami Lakhdar 1

1département of médecxine

2badji Mokhtar university annaba algeria

While mild bites dog remain a very common phenomenon; fatal attacks are rare.

The main purpose of this work is to reflect the dangers of certain types of guard dogs and to highlight the assessment of the lesions secondary to the fatal attack, so special.

The author of this work is to present a exceptional case a fatal attack by a guard dog, with evidence of atypical lesions external and internal.


Rupture Of Splenic Artery Aneurysm In Late Pregnancy: A Case Report And Review Of Literature

Mohamed Allouche, Maha Shimi, Fatma Gloulou, Mahdi Ben Khlil, Anis Benzarti, Ahmed Banasr, Mongi Zhioua, Moncef Hamdoun

Service de Médecine Légale de Tunis, Hôpital Charles Nicolle

Aneurysms of the splenic artery are the most common visceral artery aneurysm. Rupture of an aneurysm occurs predominantly in late pregnancy. Its consequences can be devastating for both mother and foetus, associated with high rates of maternal and foetal mortality. We report a case of 37-year-old woman, multiparous, in the 32th week of pregnancy, died suddenly at home.

At autopsy, only the abdominal examination was remarkable. Abundant blood (approximately 3.5 l) was present in the peritoneal cavity, and a voluminous blood clot occupying the splenic bed was noted. The spleen was in normal shape and weighed 470 g.

The abdominal aorta and main branches were intact. The splenic artery was isolated inside an abundant hemorrhagic infiltrate. Examination revealed rupture of the arterial wall at the level of an aneurysm measuring 3.4 cm in diameter situated approximately 7 cm from the splenic hilus. No other fusiform dilations presented along the course of the vessel towards the hilus. Samples of the arterial wall at the level of the aneurysms and of intact wall tracts were taken.

Microscopic examination of the sections stained by standard methods demonstrated that the aneurysmatic wall was composed of a fibro-muscular layer with fragmentation of the internal elastic lamina.

The aims were to provide an up to date review of the aetiology, clinical features, diagnosis and management of splenic artery aneurysms and their rupture during pregnancy.


Changing Patterns of Suicide in North Tunisia

Mohamed Allouche, Maha Shimi, Olfa Békir, Fatma Gloulou, Mahdi Ben Khelil, Mongi Zhioua, Moncef Hamdoun

Service de Médecine Légale de Tunis, Hôpital Charles Nicolle

Introduction: The scope of activity in forensic thanatology includes four main circumstances of death: natural deaths, accidents, homicides and suicides.

We focused on studying the evolution of suicide rates in the thanatological activity of Department of forensic medicine in Charles Nicolle Hospital of Tunis, which taps the whole north of Tunisia. The interest of this study is that the year 2011 was outstanding for thanatological activity of our department since there were unique social events resulting from the revolution.

Method: We carried out a comparative study focusing on changing patterns of suicide during the last eight years. We compared cases of suicides from 2004 to 2011.

In addition to comparing the different rates of suicide, were compared various parameters: sex, age, way of suicide and the means used by victims.

Results: As expected suicide was very affected by events that are occurred in Tunisia.

The suicide rate has increased from 8 % in 2010 to 9 % in 2011 while during the previous years it had not exceeded the 5-7 %. The hanging has always remained the most used mean over the years.

However immolation, that became the representative act of our revolution, has notably very high rates in 2011 compared with other years. Indeed, the rate of immolation has risen from 5 % in 2005 to 9 % in 2008 then to 29 % in 2011.

Moreover we also noticed an increase in suicide rates by firearms with five cases reported in 2011 against only one case per year for the rest of the other years.

Conclusion: Social events that occurred during the last year in Tunisia had deeply affected thanathological activity in Forensic Pathology Department of Charles Nicolle hospital in Tunis. Compared to the rate of homicides by firearms, suicide rates have changed significantly during this year as well as the characteristic of suicide as the means used and the manner to do that act.


Fatal meat aspiration: about four cases

Mohamed Ben Dhiab, Neila Ben Mansour, Tasnim Masmoudi, Souhaiel Mlayeh, Mohamed Kamel Souguir, Majed Zemni

department of forensic pathology, HUC Farhat HACHED, Sousse, Tunisia

In adults, Cafe coronary deaths occur in individuals who are either clinically inebriated or have clinically significant neuro-muscular dysfunction.

Often the aspiration event is not witnessed, and therefore there is no history of aspiration.

We present the sudden unexpected deaths of four adults that were first thought to be due to coronary heart disease however autopsy findings revealed a larynx obstruction by meat.

The mechanism of death was an airway complete obstruction resulting in asphyxia because the meat was glued to the larynx. In the four cases the victims died during or a short time after a meal.

This accident requires the conjunction of some factors: a foreign body (meat), an event encouraging (alcohol, etc.), sometimes a predisposed land as a bad dental status,.


The role of sternum bone marrow analysis in forensic setting: new perspectives

Lucia Tattoli 1, Julia Sautter2, Eloisa Maselli1, Alessandro Dell' Erba1, Michael Tsokos2, Biagio Solarino1

1Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy

2Institute of Legal Medicine and Forensic Sciences, Charité, Universitätsmedizin Berlin, Berlin, Germany

Background: In the field of forensic sciences, some authors have suggested the usefulness of Bone Marrow (BM) as alternative matrix, especially in post-mortem toxicology. Nevertheless, there is a lack of studies regarding the potential role of BM analysis in understanding the pathophysiological changes in response to systemic stimuli (stress, infections, allergy). The importance of such tissue in clinical practice is well known and routinely used in diagnosing several blood disorders. Other studies have strongly suggested that inflammatory cells originating from the BM contribute to sustain pathophysiological processes, e.g. allergy, sepsis, healing wounds. The authors analysed BM samples for evaluating their cytomorphological and histopathological features in several causes of death.

Method: BM samples were collected from 70 autopsies performed in the Institute of Legal Medicine of Bari (Italy) and in Charitè University of Berlin (Germany). The causes of death were both natural and traumatic. BM samples were collected from the sternum by needle aspiration and osteomedullary biopsy. Aspirate films were stained with a May-Grünwald-Giemsa stain. Biopsy were decalcified, fixed, and stained with Haematoxylin Eosin staining.

Results: It was observed that hematopoietic tissue gradually decreased with aging, both in aspirate and biopsy. Few autolytic changes of the BM tissue were found if compared to other organs, even if the cellularity decreased with the increase of post-mortem interval (time elapsing from the death to the sampling). In some cases, the cytomorphological evaluation of BM allowed identifying the presence of activated mast cells and eosinophils, where anaphylaxis was not suspected as primary cause of death; these findings were compared with serum tryptase levels.

Conclusions: It is assumed that in the forensic setting the BM sampling of sternum is more suitable than iliac sampling, because sternum is more accessible in routine autopsies without compromising the integrity of corpses. Moreover, the present study shows that the post-mortem analysis of BM can help the forensics in diagnosis of causes of death such as sepsis or anaphylaxis, because that inflammatory cells originating from the BM contribute to sustain these pathophysiological processes, suggesting an involvement of this primary lymphoid organ in several systemic illness.


Death due to Arrythmogenic Right Ventricular Dysplasia: a case report

Okan Akan1, Selçuk Çetin 2, Bülent Eren1, Dilek Durak2, Nursel Türkmen2, Ümit Naci Gündoğmuş3

1Bursa Branch of the Council of Forensic Medicine of the Ministry of Justice, Turkey.

2Department of Forensic Medicine, Uludag University Medical School, Bursa, Turkey

3The Council of Forensic Medicine of the Ministry of Justice, İstanbul, Turkey

Background: Arrhythmogenic right ventricular dysplasia (ARVD) is a myocardial disease that predominantly affects the right ventricle (RV) and one of the important causes of sudden death in the young and athletes. ARVD is characterized morphologically by diffuse or segmental lack of myocardium in the RV free wall, which is replaced by fatty or fibrofatty tissue, and also histologically by fibrofatty degeneration of cardiomyocytes, which leads to electrical instability and contractility abnormalities. The replacement of the right ventricular myocardium by fibrofatty tissue is progressive, starting from the epicardium or midmyocardium and then extending to become transmural process. Although several theories have been proposed and different genetic variants have been described, the accurate aetiopathogenesis of ARVD is still unknown.

Method: We described an autopsy case who was middle-aged man with sudden death due to ARVD.

Results: A 28-year-old man with no significant medical history, applied to emergency department with feeling ill himself. The electrocardiography (ECG) showed ventricular extrasystoles as well as ventricular arrhythmia. After his initial examinations recommended him to apply the cardiology polyclinics for detailed investigation. The next day he was sickened, when had gone to hospital and he was death when arrived the hospital. White foams around the mouth and nostrils, injection marks on the inguinal and antecubital regions and the dorsal part of left hand, signs of defibrillation paddles on the anterior wall of the chest were detected during external examination. The autopsy showed the heart weight was 560 g and it had a dilated appearance. Dissection of right ventricular wall revealed yellowish fat tissue.

Histologic examination of heart samples, which were obtained from RV and LV, revealed the massive replacement of myocardium by fibrous and mature adipose tissue in right ventericle.

Conclusion: ARVD is a disease of unknown cause, characterized by fibrofatty replacement of the RV myocardium. The diagnosis of ARVD is based on major and minor criteria which include roughly structural, histological, electrocardiographic, arrhythmic and familial features of the disease. ARVD occurs in both sporadic and familial forms. A family history of ARVD is present in 30 % to 50 % of cases. The most common pattern of inheritance is autosomal dominant, although an autosomal recessive pattern has been reported. ARVD is associated with highly variable clinical presentation such as ventricular tachycardia, syncope, RV dysfunction, sudden death etc. In this case there were no symptoms, family and medical history and its clinical presentation was as unexpected sudden death.


Transsexual Homicides in Ankara, Turkey

Birol Demirel 1, Mustafa Karapirli2, Taner Akar1, Hanife Alkurt Alkan2

1Department of Forensic Medicine, Gazi University Faculty of Medicine, Ankara, Turkey

2Council of Forensic Medicine, Ankara Group Chairmanship, Ankara, Turkey

Backround: Transsexuality is a disorder characterized by the development of a gender identity opposed to phenotypic sex. Greater violence in homicides against this people than in those commited against heterosexuals. Committed crimes because of the victims essential and unchangeable features such as race, ethnic identity, nationality, religion, language, skin colour, sexuality, sexual orientation, age, physical and mental disability refer to hate crimes. The crime turn into hate crime when the perpetrator have a hostility against transsexuals and transsexuality is the only reason for homicide. The main objective of the perpetrator is threaten and obsess of all transsexuals. The perpetrator generally create numerous wounds on hate crime victims body. In ten years period included this study, only seven transsexual homicide were committed. Evaluation this rare cases and compare with other cases on this subject is the aim of this study.

Method: Between 2001–2010 years, seven transsexual homicides in Ankara were determined from police records. Then victims autopsy reports were obtained from Council of Forensic Medicine Ankara Group Chairmanship archieves and reviewed them retrospectively in terms of age, findings of external examination, features of wounds, causes of death, results of toxicological and biological analysis.

Results: Seven transsexual homicide victims were choosen for study. Two of them went under sex change operation. Five of them had female view with long and dyed hair, polished fingernails and female breasts. They had circumcised penis. Causes of death were stabbing (two), strangulation (one), blunt head injury (one), blunt head and chest injury (one) and shotgun injury (one). Two stabbing cases had thirty three and twenty nine stab wounds. Ethanol was found in only two cases blood samples. Other toxicological and biological analysis showed no findings. Two perpetrators were arrested while five perpetrators remained unknown.

Conclusion: Transsexual individuals are exposed to dense discrimination and social exclusion in our country. Also they are most common victims for hate crimes. Our study reflects only a small sample of these victims. Comprehensive investigations are needed for understanding the extensiveness of crimes intended for transsexual individuals.


Prevalence of Blood-borne Viruses Amongst Postmortem Cases in Kuala Lumpur, Malaysia

Khairul Anuar Zainun 1, Rohayu Shahar Adnan2, Siew Sheue Feng1, Khoo Lay See1, Hilmi Saidin1, Nurliza Abdullah1, Mohd Shah Mahmood1

1Department of Forensic Medicine, Kuala Lumpur Hospital, Malaysia.

2Department of Forensic Medicine, Sultan Ismail Hospital, Johor, Malaysia

Background: Blood-borne viral infections in dead bodies represent a significant occupational hazard during postmortem procedure. Infection status of cases is often not known despite detailed scrutiny of available medical history and associated risk factors. With higher seroprevalence of hepatitis virus and increasing human immunodeficiency virus (HIV) epidemic worldwide including Malaysia, this is certainly an important safety issue amongst pathologists and mortuary personnel performing postmortem examination. Therefore it is crucial to determine their prevalence so that appopriate risk reduction strategies can be employed accordingly during the procedure.

Method: Blood from ninty two sudden death cases were analysed prior to postmortem for HIV, hepatitis B and hepatitis C using both rapid commercial kit tests and confirmatory laboratory method. These sudden death cases were presented to Department of Forensic Medicine, Kuala Lumpur Hospital during a three-month study period and were later determined to have died from various cause and manner of death.

Result: Out of ninty cases sampled, five cases were positive for HIV, nine cases were positve for hepatitis B and two cases were positive for hepatitis C. The corresponding postmortem prevalence of HIV, hepatitis B and hepatitis C were calculated to be 5.4 %, 9.8 % and 2.2 % respectively.

Conclusion: This study highlights the existence of significant prevalence of blood-borne viral infections amongst postmortem cases in Kuala Lumpur, Malaysia. Therefore there is a clear need to establish their status prior to postmortem examination. We recommend, at a minimum, to have blood screening test for HIV, hepatitis B and hepatitis C using rapid commercial kits prior to postmortem of every case as part of overall infection-reduction strategies to be employed by those performimg the procedure.


Cerebral Damages in Carbon Monoxide Poisoning

Hamid Mohabbati 1, Amin Ranjbar2

1Department of Forensic Medicine, Mashhad Azad University, Medical Faculty, Mashhad, Iran

2Forensic Medicine Organization, Mashhad, Iran

Objective: Carbon monoxide (CO) is a tasteless, odorless, non-irritating but highly toxic gas produced by incomplete combustion of hydrocarbons. The present study aimed to investigate the both macroscopic and microscopic changes in brain tissue of corpses which CO toxicity was their cause of death.

Methods: This study was held on eighty seven victims of CO poisoning over a period of two years (2010–2011). The cases were divided into two groups. Group A contains sixty victims who died before any medical treatments or hospitalization and group B which includes twenty seven patients who died during their initial hospitalization because of the CO toxicity side effects. The autopsies were performed and both microscopic and macroscopic changes were studied. Data analysis was done via SPSS version 11.5.

Results: The investigation included fifty six men (40 cases in group A and 16 cases in group B) and thirty one women (20 cases in group A and 11 cases in group B) with a total average age of 40.1 ± 12.3 years. The mean age was higher in group A than in group B (P value = 0.04). Brain edema was confirmed in forty six (52.8 %) victims (35 cases in group A and 11 cases in group B). The two types of cell death occurred in the cortex, basal ganglia, thalamus, and cerebellum. Infarction of the globus pallidus and axonal destruction in white matter was detected in sixteen and nine cases respectively. Cerebral hemorrhagic infarction was noticed in five cases.

Conclusion: Brain damage is one of the most serious and lethal side effects of CO poisoning. We found a relationship between early death occurrence and brain damage severity and age. Hypoxia is the main cause of cerebral damages in CO toxicity. Brain edema was the most frequent finding. The cerebral lesions occur commonly in the basal ganglia, and central gray and white matters. Necrosis of globus pallidus and necrosis or demyelination and axonal destruction in the cerebral or cerebellar white matter were the most common histopathologic changes.


Identification of internal organs injuries in blunt trauma

Oleg Innokentievich Hvan, Baltabay Allaniyazovich Eshmuratov

Bureau of forensic medical examination of Tashkent City

Background: To identify the frequency of lesions of the abdominal cavity and retroperitoneal space, and methods of their diagnosis.

Methods: Materials for the study included 160 case histories of persons injured in 2008–2010, studied at the bases of National Center for emergency medical assistance. The greatest number of all cases of damage to abdominal organs and kidneys were in the age group 20 to 40 years (77 %). On admission, in hospitals, for the diagnosis of lesions of internal organs were used traditional survey methods, which include, along with clinical and laboratory, non-invasive diagnostic methods (ultrasound, X-ray and CT) and diagnostic laparoscopy.

Results: The analysis of case histories showed that the frequency of injury of internal organs among men is much higher than (62.5 %) cases than among women (47.5 %). The most frequently associated damage to internal organs in the form of tears the kidneys, liver, colon, pancreas and spleen occurred in the fall from height (12 %). Isolated damage to the liver in the form of the gap observed in 2 cases, bruised kidneys - in 2 cases, kidney rupture - in 7 cases, a ruptured spleen - in 5 cases, rupture of the colon - in one case, three cases have been established retroperitoneal hematoma. When the automobile injury combined injuries of the abdomen and kidneys were observed (4 %). Isolated damage to the liver in the form of the gap observed in one case, the kidney injury - in 10 cases, kidney rupture - in 2 cases, a ruptured spleen - in 2 cases, 1 case of retroperitoneal hematoma is installed. When beating combined injuries of the abdomen and kidneys were not observed. Isolated damage to the liver in the form of the gap observed in one case, a ruptured spleen - in one case, in 11cases were diagnosed contusions of the kidneys

Conclusions: Combined injuries of the head, chest, internal organs with fractures of the limbs are observed in most cases, the automobile injury. Combined injuries of the abdomen and kidneys are more often observed in the case of a fall from a height, whereas the isolated damage to internal organs are more frequently observed in the automobile injury and beatings. Diagnostic methods (echographic study, computed tomography, diagnostic laparoscopy) can identify the injured and intact zone, reveal the depth and volume of received damages.


Malrotation Syndrome resulting in fatal Ileus in Children

Gerhard Kernbach Wighton, Rainer Amberg, Burkhard Madea, Kirsten Marion Stein

Institute of Legal Medicine, The University of Bonn, Stiftsplatz 12, 53111 Bonn, Germany

Background: This report deals with two infant death cases involving intestinal volvulus, meaning a pathological knotting and twisting of the mesenterial root on the basis of congenital malrotation followed by obstruction and extensive ischaemia.

Case reports: (1) a 2-month-old premature male baby (surviving twin, 29th week) with a persisting Botallo’s duct was hospitalised over four weeks after failed surgery, due to acute general deterioration. Radiological diagnostics using a contrast medium revealed a combined vascular anomaly (right-sided aortic arch). Circa 10 hours later the infant developed an acute abdomen with ileus symptoms. Emergency surgery showed infarction of the entire small intestine, due to anti-clockwise 180°-volvulus, with death occurring after 24 h. Further examination showed a malrotation as anomaly. Apparently, the volvulus had been caused by extensive use of a contrast medium (dosage +100 %) resulting in increased intestinal mobility.- (2) A 9-year-old girl (premature, 25th week) suffered from severe disability, amaurosis and epilepsy. She was admitted to hospital due to general agitation and a bloated abdomen without peristaltic sounds, but died a few hours later. Autopsy revealed a volvulus of 2/3 of the small intestine, based on congenital malrotation with additional clamping of the intestine underneath a formation of adhesions (previous appendectomy). The abdominal cavity showed beginning peritonitis with a septic spleen what defined the cause of death. Peritonitis had been due to disruption of the intestinal circulation on the basis of congenital malrotation and intra-abdominal adhesions.

Conclusion: The complications and forensic medical implications including the anatomical basics are reported and discussed.


About the diagnostic relevance of intra-alveolar haemosiderin-deposits in SIDS

Gerhard Kernbach Wighton, Younis Albalooshi, Burkhard Madea

Institute of Legal Medicine, The University of Bonn, Stiftsplatz 12, D – 53111 Bonn, Germany

Background: Repeatedly, the presence of intra – alveolar haemosiderin deposits has been discussed regarding its diagnostic relevance. Suffocation and physical child abuse have been considered as possible causes.

Method: Lung samples from 104 SIDS cases (44 females, 60 males) and 14 controls (defined causes of death) with an overall age range from 7 days to 47 months were stained using haematoxylin – eosin and Prussian blue. Haemosiderin foci were counted in 20 high power fields for each lung lobe and assigned to five classes of positivity. Data analysis was carried out by a Levene and a two sample t-test.

Results and conclusion: The mean values came out not being significantly different between SIDS and control cases. This means a lack of possible diagnostic value and highlights the necessity to assess always carefully positive haemosiderin deposits in infants’ lungs in order to avoid false suspicion.


Intracompartimental study of different biochemical markers in c.s.f., vitreous humour and serum in a group of autopsied corpses

Faustina Sanchez Rodriguez, Carmen Torres Sánchez, Juan Pedro Hernandez Del Rincon, Maria Dolores Perez Carceles, Eduardo Osuna, Aurelio Luna

Department of Forensic medicine University of Murcia Spain

In the present work we have studied the behavior of different biochemical markers (enzymes: LDH; LAP; Aldolase and GGT. And other biochemical analytes: Ca, P, and glucose), in serum, c.s.f. and vitreous humor and its diagnostic implications.

We have studied 85 cadavers the mean age was 58,56 SD + 21 years from forensic autopsies. The biological samples were obtained during autopsies, and were preserved at -80 º C until the biochemical analysis.

Our results show that the diffusion rates are in closed relationships with the molecular size, the most closed relationships are showed between serum and csf, probably related to the vital processes through the hematoencephalic barrier. Only the small molecules are distributed by simple diffusion processes between the three fluids studied.

For diagnostic purposes are very closed c.s.f and serum, but the absence of hemolytic process in csf do more useful the use of the last named fluid for the study of cerebral suffering according with Vazquez et al (1995), Sanchez Rodriguez et al 1993, Coe (1993) and Madea and Musshoff (2007).

Vázquez. MD; Sánchez- Rodriguez F. et al: Creatine Kinase BB and neuroespecific enolase in cerebrospinal fluid in the diagnosis of brain insult. Am.J.Forensic Med Pathol1995; 16(3): 210-214 S

Sánchez-Rodriguez.F; Osuna. E: Diagnosis of brain insult by cerebrospinal fluid biockemistry. International Association of Forensic Sciences. Dusseldorf 1993. pp 75.

Coe J.I: Postmortem Chemistry Update. Emphasis on Forensic Application. Am J. Forensic Med Pathol (1993): 91–117

Madea.B; Musshoff,F: Postmortem Biochemistry Forensic Science International. 165 (2007) 165–171


Association Between Age and Thoracic Aorta Circumference - Potential for Application in Forensic Practice

William Dokov, Dobrinka Radoinova, Irina Burulyanova, Emilia Kaisheva, Diana Gospodinova

Department of General pathology and Forensic Medicine, Medicial University of Varna, Bulgaria

Background: Age determination in unidentified forensic cases is a fundamental challenge for practical work. Classical methods are often inapplicable in disintegrated and petrifying corpses, indicating a need for additional approaches to the problem. Available literature suggests a strong linear association between age and different aortic dimensions such as diameter, surface above the aortic valve and circumference of thoracic aorta at different anatomical levels. In the present study we aim to identify the strength of the association between age and inner circumference of thoracic aorta at the level of the diaphragm and to develop an equation for determining age based on the circumference of the aorta.

Methods: We studied 729 autopsy cases of deceased from the community – 549 men and 180 women. The age at death ranged from 1 to 93 years with an average for both sexes of 55,4 years. Circumference of thoracic aorta was measured at the level of the diaphragm. The association between age and aorta circumference was assessed through Pearson correlation, and the predictions for age, based on aortic circumference were developed with linear regression analysis. The level of significance was set at α = 0,05.

Results: There is a strong statistically significant correlation between age and thoracic aorta circumference in both sexes. The coefficient of correlation is 0,841 for men (p < 0,0001) and 0,829 for women (p < 0,0001). Aorta circumference is increasing gradually in every 5 year age group which allows for the development of an equation for predicting age based on the aorta circumference.

Conclusion: Defining the circumference of the aorta might be a suitable secondary method for determining age of unidentified corpses or in some specific situations.


Suicide during detention time

Magda Petcu1, Fotios Chatzinikolaou 2, Vera Luta3, Polichonis Voultsos2, Eleni Zagelidou2, Alexandra Enache3

1Institute of Legal Medicine Timisoara, Romania

2Aristotle University of Thessaloniki, Lab of Forensic Medicine and Toxicology, Greece

3University of Medicine and Pharmacy Victor Babeş Timisoara, Romania

The purpose of this study is to identify the suicidal risk of the persons during detention

Methods: This study is based on the cases of suicide during detention, examined at Institute of Forensic Medicine Timisoara

Results and discussions: Detention has an adverse outcome for the detainees, aggravating pre-existent conditions at the detainees with previous mental problems with emergence of the suicidal risk.

The literature mention that the suicidal risk is higher in the detention environment compared to the on-detention environment.

The article 114 CP says: When the detainee has a mental condition or is a drug addict, and represents a danger for the society, he/she shall be admitted in a medical institution until improving of the medical condition.

Case presentation:

1. VD, male, 35 year-old, condemned 2 years and 10 month for stealing, semi-opened detention. When admitted in detention no medical history is mentioned. Cause of death: hanging.

After death, the relatives mentioned two previous attempts of suicide. The suicide occurred at a person whose medical examination was within normal limits.

2. JF, male, 45 year-old, alien citizen, maxim security detention. He refused to feed himself. At hospital admission the diagnosis was: Reactive mental condition due to detention with simulation components. Cachexia due to feeding refusal. Cause of death: Septic shock, cachexia.

3. MP, male, 40 year-old, detained for homicide. Diagnosis: schizophrenia- paranoid type, mental retardation with severe behavioural problems. Cause of death: Septic shock due to a perforated wound of the colon due to ingestion of a foreign body. Medical history is remarkable for previous suicidal attempts. In this case, the death occurred in a psychiatric hospital due to lack of supervision.

Conclusions: Suicide prevention implies the evaluation of the suicidal risk in the beginning of the detention time and close supervision of the detainee(s).


Extended suicide using a chain saw

Christian Schyma, Younis Albalooshi, Burkhard Madea

Institute of Legal Medicine, The University of Bonn, Stiftsplatz 12, 53111 Bonn, Germany

A 24-year old man and his 3½-year old son were found dead in their car parked in a forest. The man had a gasoline-powered chain saw on his lap. His neck was deeply opened with the cervical spine almost completely severed. On the left side all the large neck vessels were cut, on the right side the carotid artery and the inner jugular vein. The larynx was severed below the glottis. As vital reactions were found: general anaemia, acute lung emphysema, partial blood aspiration and subendocardial haemorrhages. Blood staining on his hands, arms and clothes indicated a suicidal handling of the chain saw.

The child sitting on the front passenger seat was found nearly decapitated. All structures of the anterior neck were severed. A 5 cm long part of the cervical spine was completely cut out. Deep lacerated wounds of the hands were interpreted as defence injuries. Anaemia and blood aspiration indicated the vital character of the injuries.

In both cases no signs of air embolism were found although the large veins of the neck had been opened. The toxicological analysis was negative for both individuals.

Criminal investigation revealed that the child was killed by another chain saw of minor dimension which had been placed in the car boot.


Effect of pretreatment on the determination of hypoxanthine in vitreous humour and its impact on the measure of postmortem interval

Cristina Cordeiro1, Elena Lendoiro2, María Sol Rodríguez Calvo3, Manuel López Rivadulla2, Duarte Nuno Vieira1, José Ignacio Muñoz Barús 2

1National Institute of Legal Medicine and Forensic Sciences of Portugal - Centre Branch. Centre of Forensic Sciences (CENCIFOR)- University of Coimbra, Portugal

2Institute of Forensic Science, University of Santiago de Compostela, Spain

3Department of Pathology and Forensic Science, University of Santiago de Compostela, Spain

Background: Determination of postmortem interval is a critical issue in forensic science. Methodologies based in the biochemistry of the vitreous humour offers the best results for this determination, correlating the value of potassium (K) and hypoxanthine (Hx) with postmortem interval. However, vitreous humours have a viscous nature, and it is necessary that they be liquefied prior to analysis. The aim of this study was to compare different preanalytical treatments (centrifugation, sonication, enzymatic digestion and heat treatment), and their influence in the value of Hx by LC-MSMS determination.

Method: 30 vitreous humours of different sources were analyzed. All samples were centrifuged and the supernatant was divided into four aliquots of 200 μL. Each aliquot was submitted to one of the different studied pretreament methods. After that, 150 μL of these liquefied aliquots were extracted by solid-phase extraction by OASIS MAX cartridges (Waters, Mildford, USA). Chromatographic separation was performed using an Atlantis T3 (2.1x100mm, 3 μM) analytical column, working in gradient mode, with acetonitrile and ammonium acetate 10 mM (pH = 4.5) as mobile phase. A Quattro Micro tandem mass spectrometer (Waters) was employed for the detection, working in electrospray positive mode (ESI +). Guanine, xanthine and uric acid were monitored also with this analytical method.

Results: Centrifugation was the easiest and fastest pretreament method. Moreover, centrifugation and sonication results showed only small differences between them. However, 15 minutes were necessary to perform the sonication method, while no additional time was required in the centrifugation process. With enzymatic digestion treatment, concentrations decreased slightly, but with heat treatment higher and lower values, depending on the vitreous humour, were found.

Conclusion: Variations in Hx measurement can alter the correct determination of postmortem interval, with important legal consequences. This study demonstrates how different types of pretreament methods affect the Hx determination. Centrifugation seems to be the method of choice because of its simplicity and good results.


Carbon monoxide poisonings and deaths in house fires in Estonia in 2006 – 2011

Delia Lepik1, Jana Tuusov2, Mailis Tõnisson2, Marika Väli1, Heldi Kase 2

1Department of Pathological Anatomy and Forensic Medicine, University of Tartu, Tartu, Estonia

2Estonian Forensic Science Institute, Tallinn, Estonia

Background: House fires are frequent subject of everyday practice for a forensic pathologist due to cold and wet weather conditions in Estonia. It is frequent finding ethanol in addition to carboxyhemoglobin (COHb) in blood sample of dead body.

Method: In this study, we analysed fire fatalities in Estonia in the years 2006 – 2011.

Results: In 2006 168, in 2007 124, in 2008 101, in 2009 73, in 2010 96 and in 2011 92 deaths caused by carbon monoxide and exposure to uncontrolled fire in building or structure were registered. The mean rate of fatalities per 100,000 person-years decreased from 12.50 (in 2006) to 5.45 (in 2009) and then increased a little to 6.87 (in 2011).

Totally during these years 537 carbon monoxide poisoning were registered. 412 (76.7 %) of them were male and 125 (23.3 %) female fatalities. Most of the deceased were in age between 41 and 70 years. In 378 (70.8 %) cases ethanol was found in blood samples (blood alcohol concentration – BAC, 0.5 mg/g or higher) and 43.1 % of them had BAC in high level (2.51 mg/g or higher).

The cause of death was not determined due to post-mortem thermal damage of the body in 70 cases, of them 56 (80.0 %) were male and 14 (20.0 %) female. Most of deceased were aged between 51 and 70 years. Slightly over half of the deceased 37 (52.9 %) were intoxicated with alcohol and in 30.0 % cases the alcohol level was high (BAC over 2.51 mg/g).

Another cause of death in fire incidents was burns, where the death occurred in most cases later in the hospital. In 2006 – 2011 there were 47 burn victims, 27 of them were male and 20 female. Comparing these cases with carbon monoxide poisonings, burn victims were mostly older persons (51 – 90 years). Alcohol was detected in blood in 18 (38.3 %) cases and 21.3 % of them had BAC in high level.

Conclusion: Since July the 1st 2009 in living rooms of private houses (apartments) automatic fire alarm system (smoke alarm) is obligatory, so the deaths due to carbon monoxide poisonings decreased to 54 in 2009. The extremely cold weather in December 2009 and January 2010 increased the number of deaths due to house fires. They were mostly caused by overheating of fireplaces, careless smoking or making fire in empty houses by homeless people.


Multidisciplinary approach to an explosion victim: reconstructing the event

Francesco Saverio Romolo, Mariarosaria Aromatario, Edoardo Bottoni, Paola Antonella Fiore, Costantino Ciallella

Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, “Sapienza” University of Rome, Viale Regina Elena 336, 00161 Rome, Italy

Background: Approaching a case of explosion always involves different specialists in order to evaluate the complexity of its effects on people and environment aiming to the reconstruction of the event. Usually every specialist works separately from the others focusing on the analysis of its field. Our experience wants to bring forward an early cooperation, starting from the first approach to the victims.

Method: In particular, in a case of fireworks explosion, the crime scene examination, the evidence collection, the autopsy, the examination of clothes and the histological and toxicological exams were performed, when possible, at the presence of all the specialists in charge, while, in the other cases a rapid and exhaustive exchange of information was provided to all in order to create “the big picture” of the event. We approached the case combining the different methods of the single specialist: the forensic pathologist ability to read the lesions, the forensic chemical knowledge of explosives, the forensic histologist and toxicologist capabilities. For example the lesions observed during the autopsy and the little fragments found in and on the corpse resulted in an important hint during a later search of evidence on the crime scene and actually had a great role in reconstructing the dynamics of the explosion.

Results: Having a great amount of information about all the different elements involved in the event, resulted in an easier interpretation of the found lesions: in particular the subarachnoid hemorrhage the thoracic fractures and the cavitation of the right lung and of the liver. The fragments of the explosive device, not only justified the aspect of most of the external lesions, but also provided evidences to identify the fireworks that caused the event. Other interesting results came out from the histological and toxicological examination.

Conclusions: The positive results of our experience of cooperation with different specialists approaching the complexity of a case of explosion and the great achievements in terms of new knowledge that came for each one of us, encourage us, not only, to apply this multidisciplinary approach to any other case of explosion further to come, but also to any case characterized by similar complexity. Therefore we feel confident bringing forward this approach to our colleagues.


Combustion of an animal carcass for the study of human bodies involved in fires

Francesco Saverio Romolo, Mariarosaria Aromatario, Daniela Lucidi, Edoardo Bottoni, Simone Cappelletti, Costantino Ciallella

Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, “Sapienza” University of Rome, Viale Regina Elena 336, 00161 Rome, Italy

Background: In a case examined by the authors two victims with evidence of thermal damages have been found. A key issue in the investigation was the amount of accelerant and the time of combustion needed to produce the observed pattern of thermal damages. We carried out an exhaustive library search without finding any published result giving a contribution to the case. Therefore we decided to carry out some experiments using an animal carcass with the aim of highlighting the conditions necessary to produce the observed thermal damages.

Method: The experiments were carried out in a quarry using a pig carcass, petrol and an electrical remote ignition system. Six tests have been performed, using different fuel quantities on different regions of the carcass, in some tests the skin was covered with a cotton cloth. Authors used healthy appendages in some experiments and husked ones in the last part of the study, because the response of the human body is expected to be in between the two tested situation.

Results: The six tests carried out showed that the flame action and the time frame necessary to reproduce an injury, similar to our case, on an animal carcass is influenced by many variables including the different anatomical substrates (e.g. the body fat) and the different quantity of petrol. In five out of six tests the flames extinguished before forty minutes.

The time before the flames extinguish does not depend on the quantity of petrol but it depends mainly on the depth of the pool of flammable liquid (approximately 2–3 mm/min). The studies performed enabled us to describe the deepness of the damages that in the last test, conducted with ten liters of petrol, reached six centimeters similarly to the victim’s lesions.

Only the third test, involving the abdominal area, showed a very long duration of flame due to the artificial exposition of the abdominal adipose tissue caused by the sagittal cut of the animal. The molten fat from adipose tissue contributed to the maintenance of the flame, lasting for over an hour. The damages in this test involved the internal part of the carcass.

Conclusion: In the test conducted with ten liters we have produced the lesions closer to the observed thermal damages on the victims of our case, and the flames extinguished after 28 minutes.


Domestic Violence and suicide: about a case

Maria De Fárima João Cardoso 1, Susana Tavares1, Beatriz Simões Da Silva1, Francisco Corte Real2

1Instituto Nacional de Medicina Legal, IP - Portugal (INML, IP)

2Universidade de Coimbra, Portugal - Faculdade de Medicina (FMUC)

The family being considered the fundamental core of society, this structure will demand increased attention, especially as regards domestic violence. In fact, this is a social scourge that contributes to the destruturing and emotional instability of families and, consequently, of society.

The Angolan Diário da República, 1ª série, nº 133/2011 provides a need to prevent and punish acts of domestic violence against those who are helpless and physically, psychologically and emotionally disabled, demanding better care from those obligated to protect them.

The existence of a violent situation during intimacy, weak love bounds, constant change of partners, financial, social and economic, and housing problems and drug or alcohol abuse are considered risk factors.

The intention of this work is to try to contribute for a fast and correct diagnosis of this situation, thus allowing the protection, treatment and monitoring of victims. On the other hand, to make people aware and try to avoid extreme situations that culminate in the suicide of one of those involved.

In this study we present a suicide case of a 21-year-old woman, who committed suicide by oil burning, due to a prior domestic violence situation and home abandonment by her partner. Despite the treatment in hospital unit the burns evolved into a fatal septicaemia.

Domestic Violence, in which is also included the emotional disorder that may lead to the suicide of one of the parties, is a serious social, public health and forensic problem. Thus, it is urgent we try to create the conditions that allow the screening, forwarding and prevention of this situation in Luanda, where there is a high number of such situations.


Death due to tuberculosis in homeless population in central Delhi – a retrospective study

Babu Lal Chaudhary

Department of Forensic Medicine, Lady Hardinge Medical College, New Delhi, India

Background: Homeless and marginally housed people in developing countries have specific problems predisposing them to infectious diseases; have much greater risk of developing the active form of tuberculosis and much higher mortality and shorter life expectancy. India has the largest number (14 million) of TB sufferers in the world. There are over 67,000 homeless in Delhi, of whom 15 percent are women and 10 percent children. Delhi’s total population is 16753235 according to 2011 census and Central Delhi is having 578,671 populations.

Material-method: This is a 5 year retrospective study based on the autopsy records of department of Forensic Medicine in Lady Hardinge Medical College, New Delhi, which is responsible for post-mortem examination of all medico-legal deaths in Central district of New Delhi. Almost all deaths among homeless people are regarded as suspicious and they were registered as medico-legal case and brought by police for autopsy.

Results: During this study we tried to find out the load of mortality due to tuberculosis in homeless population of central district of New Delhi (capital of India), where those unclaimed dead bodies were brought for postmortem examination, all unknown and unclaimed deaths were considered suspicion. During this 5 year period total 2773 autopsies were conducted in the morgue of LHMC, New Delhi, out of that, 749 cases (27.01 %) were homeless unclaimed people. 122 deaths (16.28 %) were due to pulmonary tuberculosis in homeless. The maximum 40 cases (32.78 %) were in age group of more than 50 years individuals, and minimum in age group of 11 – 20 years; 3 cases (2.45 %). Further, males were predominantly contributed with 116 cases (95.08 %) and remaining 6 cases (4.91 %) were females. Maximum deaths were occurred in month of July; 21 cases (17.21 %).

Conclusion: We need to do a much better job in preventing tuberculosis from spreading in this homeless vulnerable population, and in providing timely, effective primary and specialized clinical care for those who are affected by this vulnerable disease. We also need more affordable housing for homeless individuals.

Key words: Tuberculosis, death, homeless, post-mortem, natural disease


The PMSI in marine environment: a multidisciplinary approach

Antonio De Donno, Sabrina Leonardi, Francesco Introna

Interdisciplinary Department of Medicine - Section of Legal Medicine, University of Bari, Bari, Italy

Background: After attending this presentation, attendees will understand that the estimation of time of death is one of the most important questions for forensic pathologists. This answer is rather complex when the body was found in water and decomposition processes are already present. The evaluation of PMSI can be an useful instrument for understanding time of death and/or time of disappearance, for personal identification of bodies found in an aquatic environment.

Our study of forensic literature of the last three centuries highlights that in the past years, forensic pathologists had estimated time of submergence using personal observations of the decomposing degree of a few cases. Maceration was the most studied decomposing process in contrast with putrefaction in water, for which there were almost total disagreement between pathologists about chronological aspects.

PMSI estimation is the result of the combined assessment of taphonomic factors, thanatological factors and entomological/biological factors (i.e. the studies of sessile invertebrate). Furthermore, the main variable that can influence aquatic decomposition is the temperature of the water. More recently some pathologists have suggested a standardized method for the evaluation of decomposing timing, using an entomological parameter (ADD). They used a scoring system for the objective evaluation of the decomposition and found a relationship between decomposition and ADD, in order to find the PMI or the PMSI: Megyesi studied the relationship between ADD and air decomposition and Heaton analysed the relationship between ADD and freshwater decomposition.

Method: Until now, no study has analysed the reliability of this method on decomposition in seawater. The aim of our research was to study the reliability of these principles in a marine environment, identify a statistically valid method for the estimation of PMSI starting from the decomposing stage and ADD of a body found in Southern Adriatic Sea, identify a combined method for the evaluation of PMSI, using thanatological, taphonomic and biological factors.

Results and conclusion: Our research confirms the studies that have found a relationship between ADD and decomposition for the estimation of PMSI. In particular, our study represents the first research on decomposition in seawater, characterized by an equation of regression with high statistical importance (R2 0,9023). So our thanatological results, the evaluation of taphonomic factors and the study of biological elements (study of life cycle of a species of Barnacles: Lepas anatifera) can give useful indications for estimation of time of death for the decomposing corpses discovered in Southern Adriatic Sea.


CSI: special skills to access and inspect the site

Maricla Marrone, Bruno Morgese, Francesca Tarantino, Eloisa Maselli, Francesco Vinci

Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari, Italy

Background: The Crime Scene Investigation usually require multidisciplinary competences of qualified technical staff and law enforcement agencies, to analyze, collect and interpret all the elements near the cadaver. However the inaccessibility of the environment, may require special skills and equipment to access the site. So the forensic pathologist can find himself in evident difficulty to reach impervious, submerged or under-ground zones.

Method: The cases here presented highlight some criticalities which can be overcome only with the assistance of further techniques, competences and equipment, which lie often beyond the forensic doctor’s proper.

Case n. 1- In a quarry, there found the corpse of a fallen down man; because of his location on a stone slope not accessible, it was required a very high escalator to reach the cadaver. In this case, the cooperation of the Firemen was crucial.

Case n.2- The collapse of a building in Foggia, which caused the death of 63 persons, required to perform a helicopter aerial survey to obtain an overview image of the site; this allowed to make a correct descriptive report of the area, useful to reconstruct the exact position of the victims under the rubble and to correlate their injuries to the modalities of the collapse.

Case n.3- A peasant attending to a grape press machine was the victim of a fatal accident. At the crime scene investigation, the cadaver was still imprisoned in the machine, so that it was necessary to ask for the support of specialized workers who carried out the emptying and the dismantlement of the device for the preliminary examinations on the corpse.

Case n.4- In an electrical cabinet, was found the cadaver of a man. The subject was trying steal electric material when, due to a dispersion of electric current, was electrocuted by an electrical discharge of thousands volts. It was impossible to interrupt the electric current supply, so the CSI could be performed in safety conditions only with the support of skilled technical staff who forbade the use of electronic devices which could cause voltaic arcs.

Results and conclusions: The illustrated cases prove the need, in Forensic Medical field, of the competence of technical figures apparently distant from those which usually work in the judicial field, yet whose contribution allows to operate with safety and improve the qualitative standard of the investigations.


Foolish deadly games: please don’t play with the police!

Francesco Introna, Liliana Innamorato, Maricla Marrone, Francesco Vinci

Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari, Italy

Background: It is not uncommon in literature the description of decease cases due to “badly ended games” but there is scarce documentary evidence associating those deceases to the intervention of the law enforcement agencies, even though a 2008 study by NVDRS assessed that an impressive 26,4 % of the deceases due to “violence-related injuries” derived from police intervention for over-defense or killing by mistake.

Methods: The authors report the case of a tragic joke ended with the death of a young boy from a gunshot fired by a policeman.

On a summer night, a patrol car with two policemen was running along a country road where a lonely mugger had many times assaulted couples in their cars. The policemen stopped the car as the carriageway was blocked by stones; suddenly, a man with covered face and head, appeared from a dry stone wall, waving a gun with both hands. One of the policemen fired two shots, fatally wounding the boy.

At the gunshots, some friends of the victim reached the policemen, referring that the boy, emulating the aggression methodology of the mugger, was trying a joke to a couple of his friends he knew that were surely passing there.

Results: The autopsy showed the presence of a straight-trough wound channel, affecting all three lobes of the right lung with a resulting hemorrhagic pouring in the pleural cavity. The crime scene investigation allowed the retrieval of a bullet by the roadside.

At the examination of the police car was detected a deformed bullet in the front pillar of the driver-side car door, and a superficial defect of the rigid plastic border of same pillar.

Laboratory tests proved that the bullet found during the crime scene investigation had been shot by one of the two patrolling agents’ service gun. The two cartridge cases found in the car were fired by the same gun.

The examination of the bullet showed also that its tip presented a deformation typical of the impact on a crystal; that was also related to the presence of residual silica powder adherent to the bullet’s tip.

A three-dimensional reconstruction of the several stages of the event was made.

Conclusions: It is stressed the usefulness of the multidisciplinary contribution of the forensic-medical and ballistic competence in the reconstruction of events with firearm-related fatalities.


Cable ties are rarely, but easily used for completion of self-strangulation by ligature

Sang Han Lee 1, Hyun Jung Kim2

1Department of Forensic Medicine, Kyungpook National University School of Medicine, Daegu, Korea

2Tongyeong Coast Guard Station, South Regional Headquarters, Korea Coast Guard, Tongyeong, Korea

Background: Self-strangulation by ligature is very uncommon. A cable tie is useful for binding or organizing several electronic cables and wire, but warning for accidental strangulation should be stressed in children. Recently several cases of intentional self-strangulation by cable tie have been reported in the forensic literatures, and newspapers in England and the United States.

Method: Authors have paid attention of self-strangulation by cable tie since 2008 in Korea.

Results: Five cases were collected through the personal communications with death investigators of the Province Police Agencies during 4 years. All cases were male. One case was suicide-homicide case (father-son). Only one case was autopsied. Two cases of suicidal attempts and one case of suicidal strangulation by cable tie were found in the newspapers through the internet searching. One case of suicidal strangulation was suicide-homicide (father-son & daughter).

Conclusion: Legal regulation for merchandizing cable ties, especially for the industrial cable ties, may be needed for preventing suicide. Reporting of self-strangulation by cable tie in the news media should be prohibited for preventing a suicide fad, especially in the country of high suicide rate such as Korea.


Coronal Clefts in infants – differential diagnosis of child abuse related traumatic injuries of vertebral bodies

Elke Doberentz1, Annette M. Müller2, Burkhard Madea 1

1nstitute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111 Bonn, Germany

2Department of Pediatric Pathology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany

Spinal injuries are uncommon and rarely seen in child abuse. Affected vertebral bodies typically present compression fractures due to forced hyperflexion and hypertension. Radiographic examinations of the vertebral column, especially in infants in the 1st year of life can also reveal coronal clefts – a radiolucent band running through a vertebral body, visualized in the lateral spinal radiograph. They are discussed as a physiological variation of the fetal vertebral ossification pattern. The number of 10 aborted fetuses was studied radiologically concerning the incidence and appearance of coronal clefts. Coronal clefts were mainly localized in the lumbar spine. No cervical or singular sacral clefts were detected. Histologically coronal clefts showed missing ossification at the centre of the vertebral body, remnants of the notochord could be excluded. Obviously coronal clefts result from a retarded ossification of vertebral bodies in fetal development. They are a physiological variant and have to be known as differential diagnosis to peadiatrics, radiologists and forensic pathologists investigating child abuse.


Sudden Death of a Patient with Duchenne Musculer Dystrophy and Malpraxis Claim: a Case Report

İsmail Çoban, Gozde Sirin, Mehtap Tugasaygi, Umut Altunkaynak, Bedirhan Sezer Oner

Adli Tip Kurumu Baskanligi, Istanbul, Turkey

Duchenne-type muscular dystrophy (DMD) is an X-linked recessive inherited disease affecting mainly the skeletal and cardiac muscles. The most common cause of death is cardiac diysfunction as a manifestation of Duchenne muscular dystrophy. Our case was 16 years old boy diagnosed and followed up as DMD who is died at the hospital with aboundant hemorrhage from traceostomia canule started while taking lung X-ray graphy at his bed in the service room. The autopsy revealed that the atrophy of the neck muscles lead carotid artery lied parallel to trachea and neighbouring it. The hemorrhage was a result of decubital fistulisation between trakea and carotid artery, caused by the trakeostomia canula. For there was mal praxis claim about the medical staff, the case was evaluated by the 1st Specialisation Board, the Council of Forensic Medicine. The aim of submitting our case is that, DMD is not a frequent forensic autopsy subject, but gained forensic qualification because of the claim of malpractice leading to uncommon cause of death by the developping complications.


Marks of the neck during a crime scene investigation: don't judge the book by its cover!

Ilaria Scafetta, Francesca Longo, Antonio Marcelli, Letizia Caradonna, Francesco Ausania, Antonio Oliva, Massimo Senati

Institute of Legal Medicine, Catholic University, Rome

Background: Whatever the time scale, the general order of putrefactive changes is similar, though the degree of advancement may vary between different areas of even the same corpse. Usually the first external naked-eye sign is discoloration of the lower abdominal wall, most often in the right iliac fossa where the bacteria-laden caecum lies fairly superficially.

Case: A young woman was found dead inside her apartment; the body was lying on the bed, half-naked, supine, lying with the head on the pillow and the neck in hyperextension; some greenish spots with irregular margins were documented in the subhyoid region and in the sternocleidomastoid region. The inspection of the apartment revealed a disordered setting. The set of data collected at the time of the crime scene investigation led the suspicion of a violent death. In detail, at the autopsy, the dissection of the neck pointed out the lack of tissues hemorrhagic infiltration and detected only a marked swelling of the jugular veins bilaterally, in conjunction with ipercromia of surrounding soft tissues. By opening the chest a copious effusion of blood within the pericardial cavity and blood was observed to ooze through two laceration of cardiac wall. A narrowing of the ascending aorta just below the isthmus compatibly with a diagnosis of aortic coarctation was observed. Death was attributed to a cardiac tamponade following rupture of the heart.

Conclusions: The greenish areas visible on the neck skin of the woman were interpreted as a putrefactive artifact, that was the result of post-mortem changes took place in a region of stagnant blood. As blood is an excellent medium for the growth of the orgamism, the sequence of green patches spread is probably governed by distribution of blood in the various parts of the body at the particular time. In our case the greenish discolouration of the neck is an epiphenomenon of dilatation of the jugular veins that occurs in the context of the clinical syndrome that accompanies a cardiac tamponade. The interest of this case is to demonstrate how some marks observed during a crime scene investigation and misunderstood as external signs of manual strangulation, can be correctly interpreted as the epiphenomenon of a natural death during the autopsy.


Art and Forensic Science: analysis of the Panthocrator of Saint Catherine (first painting of Jesus of Nazaret) showing sequels of the Passion and crucifixion

Miguel Lorente

University of Granada. ILM. Spain

he hypothesis about the surviving to the Crucifixion is not new. We analyzed the elements of the Shroud of Turin and found some evidence of vitality and some other signs that are not compatible with the death of the person wrapped by the cloth. Continuing with the studies we found that the first known painting of Jesus of Nazareth is the Panthocrator of Saint Catherine, painted between IV-VI Century.

It shows some signs compatibles with the injuries produced during the Passion and crucifixion. The Forensic analysis prove that the painting of Panthocrator of St. Catherine shows some injuries that correspond with sequels of the initial wounds of these moments (Passion and crucifixion) and can help to understand the circumstances and perceptions around the death of Jesus of Nazareth from a rational point of view.

This is not incompatible with another level of evaluation, as it can be the beliefs.

The meaning of art is never neutral, as prove new disciplines like Neuroesthetic, and show how the art acquires its real meaning in the social and cultural context. Under this perspective, the art can be a very valuable evidence for forensic science to approach the meaning and circumstances of the past.

The first known painting of Jesus of Nazareth is the Panthocrator of St. Catherine, found in Sinai (Egypt). The forensic value is very important because it represent a number of sequels that correspond to the injuries produced during the Passion and crucifixion of Jesus of Nazareth, most of them can be observed in the Shroud of Turin.

The main findings in the painting of the Panthocrator are:

- Scars in the face and neck due to the wounds produced by the whip, some of them are specific of the Flagrum taxilatum, a special whip used by the Romans in the first century.

- Deformity in the right zygomatic region due to a traumatism with possible bone fracture produced during the Sanhedrin Trial.

- Absence of nail’s injuries in the palm of the hands. These injuries were in the wrist.

- Paralysis in the right hand with the typical position of the fingers that represent the injury of the median nerve, that usually was cut during the fixation process to the cross.

These findings in the painting reveal the existence of signs that can help to explain scientifically what happened around the crucifixion of Jesus of Nazareth.


A histological comparison of the mastoid bones in strangulation and drowning

Vidija Soerdjbalie Maikoe, Kishan Naipal, Marieke Hovinga De Boer, George Maat

Department of Forensic Medicine, The Hague, Netherlands

A forensic pathologist is frequently confronted with victims of drowning and strangulation. In drowning, non-specific signs as oedema of the lungs and subsequently froth in the air passages, overinflation of the lungs and intrathoracic fluid are observed, while in strangulation petechial hemorrhages are helpful. Hemorrhage and congestion in the mastoid bones are also used as a tool in suggesting the cause of death in those victims. According to literature, dramatic vascular congestion is observed in strangulation victims whereas drowning victims showed more mastoid hemorrhage and less vascular congestion.

We compared the histology of mastoid bones in 54 victims, who were categorised on the suggested cause of death as follows: asphyxia-drowning related (AD, n = 10), asphyxia-strangulation related (AS, n = 32) and a control group (C, n = 12). Mastoid bones were resected, formaline-fixed and decalcified, followed by embedding, sectioning and staining with hematoxylin and eosin. Examination was performed by a forensic pathologist and forensic anthropologist.

Extensive hemorraghie in the cellulae mastoidae was observed as follows: 47 % (AD), 16 % (AS) and 11 % (C), which was significant higher in AD versus AS (p = 0,028) and AD versus AS + C (p = 0,034). No significant difference in severity of vascular congestion was observed in AS versus AD + C (p = 1) and AS versus AD (p = 1).

Our study is the first case–control study in literature, where significant more hemorraghe in the cellulae mastoidae was observed in drowning victims compared with victims of strangulation and a control group. In contrast with cases in literature, no difference in vascular congestion between strangulation and drowning victims was observed.


Neonaticide in the Netherlands: a comprehensive review of pathologic and psychological findings

Vidija Soerdjbalie Maikoe, Ann Maes, Lynn Meijerman, Katinka De Wijs Heijlaerts, Toon Verheugt

Department of Forensic Medicine, The Hague, Netherlands

Neonaticide is defined as the killing of a newborn within 24 h of its birth.

82 neonates who underwent forensic autopsy in a 18 year period (1994–2011), were studied with respect to gestational age, scene information and autopsy findings. Psychological analysis of a selected group offenders was performed.

4 cases <24 weeks gestational age were excluded. The remaining cases were between 24 and 36 weeks (n = 17) and >36 weeks (n = 61). 50 % were girls, 40 % boys and in 10 % sex was not possible to determine. Minimal, moderate and severe decomposition was observed in 37 %, 19 % and 44 % respectively. In all cases with moderate and severe decomposition (63 %), the pathologist was hampered to interpret live birth and cause of death. Of the cases with minimal decomposition (n = 29), 1 was a stillbirth. In the remaining 28 live birth cases, 16 showed no cause of death and in 12 cases a (possible) cause of death was found (strangulation, suffocation, sharp force-and blunt injury, a disease). Based on circumstances, manner of death was concluded to be proven unnatural (n = 7), possible unnatural (n = 70) and natural (n = 1). 12 Defenders, all mothers, were analyzed psychologically. All but one of them demonstrated at least two psychiatric disorders, most had a low socio-economic background, half of them were single. All reflected different intelligence levels.

In the Netherlands yearly 4 to 5 forensic autopsies are performed on neonaticide cases. In most cases live birth and cause of death cannot be investigated due to decomposition, therefore manner of death is only suggested.


Putrefaction and diabetic

Rachid Belhadj, Djamil Azzouz, Charafa Bouderies, Madjid Bessaha, Youssef Mehdi

Service de médecine légale, C.H.U Mustapha Bacha, Alger centre, Algerie

As well as diabetes putrefaction present and requires a certain number of difficulties in the pane thanatological expertise, we will present our work through this difficulty potentiated by the combination of two phenomena in the same expertise.


Lightning strike, forensic approach

Djamil Azzouz, Rachid Belhadj, Charafa Bouderies, Madjid Bessaha, Youssef Mehdi

Service de médecine légale, C.H.U Mustapha Bacha, Alger centre, Algerie

Lightning is one of the natural phenomena of interest to researchers across borders, and this share any implications on the physical complex that applying both theoretical, and who never ceases to amaze the world of the researcher. This phenomenon even more interested doctors and forensic investigators through cases very problematic discovery of body blast, electrocuted by lightning often in a vacant lot and without witnesses, will review our work and try to solve their questions and it through autopsy cases.


The fracture of the hyoid bone in medico-legal

Djamil Azzouz, Rachid Belhadj, Charafa Bouderies, Madjid Bessaha, Youssef Mehdi

Service de médecine légale, C.H.U Mustapha Bacha, Alger centre, Algerie

Will highlight our work and through this case we appraise the difficulty to cases of violent or suspicious deaths or forensic crossroads that is the neck, is the seat of stigmata of violence with fractures of the hyoid bone, and how through an analysis by the casuistry of a fair and accurate approach can be done.


Medicolegal implications of post-traumatic nasal lesions

Rachid Belhadj, Djamil Azzouz, Charafa Bouderies, Madjid Bessaha, Youssef Mehdi

Service de médecine légale, C.H.U Mustapha Bacha, Alger centre, Algerie

Often when the findings of abuse, it happens that either in the presence of facial trauma of varying severity and who according to their assessment of the implications as well as forensic medical-reaching consequences, through case expertise we will reflect to turn the whole issue of post-traumatic nasal lesions.


A case of sudden death due to an unknown gastric carcinoma invading the lungs and the heart

Mehdi Ben Khelil 1, Maha Shimi1, Fatma Gloulou1, Mohamed Allouche1, Slim Haouet2, Moncef Hamdoun1

1Forensic Medicine Department, Charles Nicolle Hospital, Tunis, Tunisia

2Pathology Department, La Rabta Hospital, Tunis, Tunisia

We present a case of linitis plastic with massive direct invasion to the stomach, the duodenum and the pancreas and a diffuse metastasis to the heart, livers, spleen and multiple lung’s tumors thrombosis in a 28 year-old man. He had no history of personal or familial malignancies. The main symptom was a mixed dysphagia expressed three months before his death. He was dead of respiratory failure two days after being hospitalized for exploration. Autopsy showed multiple peri-pulmonar and aortic nodes, multiple whitish masses in both lungs, the posterior wall of the left ventricle of the heart and the spleen (1 – 3 cm); A whitish indurated mass of 15 cm, invading the whole stomach wall starting from the cardia, invading the pancreas, the duodenum and the meso-peritoneum. Histology findings showed a typical aspect of gastric independent cell carcinoma with an aspect of lung carcinomatosis miliary and multiple pulmonary tumor thrombotic microangiopathy, a heart metastasis and multiple tumor aortic and mediastinal nodes.


A rare case of death due to the spontaneous rupture of the urinary bladder

Beatrice Gabriela Ioan 1, Dan Dicu Serban2

1„Gr.T.Popa” University of Medicine and Pharmacy, Iasi, Romania

2Institute of Legal Medicine, Iasi, Romania

Background: The rupture of the urinary bladder can be of either traumatic or pathologic causes. The spontaneous and idiopathic rupture of the urinary bladder is a rare occurrence, with an incidence of about 1:126.000. The acute intoxication with ethanol is a risk factor due to the fibrilar distension and the ascension of the urinary bladder dom above the protective retrosymphisar space. The ethanol intoxication and the subsequent alteration of the consciousness make difficult the diagnosis of the spontaneous rupture of the urinary bladder determining an increase of mortality up to 47 %.

Method: In this paper the authors present a case of death due to the spontaneous rupture of the urinary bladder.

According to the data provided by the Police, R.D., women, 67 years old, died a few hours after drinking a big quantity of alcohol. In the victim’s medicale file there were no indication about any previous diseases and the police investigation found no indication about any recent trauma suffered by the victim. The autopsy was performed 24 post-mortem, and samples for toxicologic and microscopic examination were collected.

Results: No traumatic injuries were discoveded during the external examination of the corpse. The internal examination of the abdomen revealed about 1000 ml of bloody liquid mixed with blood clots in the peritoneal cavity. On the posterior wall of the intraperitoneal urinary bladder we discovered a transversal rupture of about 4 cm length and 3 cm width at maximum traction, with irregular and blood infiltrated margins. Inside the urinary bladder there were about 700 ml of blood clots. The toxicologic examination revealed a blood alcohol concentration of 2,05 gr%o. The macroscopic and microscopic examination revealed no signs of a pathological condition or traumatic injury of the urinarry bladder.

Conclusions: The possibility of a spontaneous, idiopathic rupture of the urinary bladder should be considered in patients with a history of unspecific abdominal pain, especially when a history of a recent alcohol intake is known. When no pathological lession of the urinary bladder (tumor, inflamation, infiltrative diseases etc.) are discovered, the traumatic cause should be considered; further if no traumatic injuries are discovered during the external and internal examination of the body and there is no history of a recent trauma against the victim, the rupture can be considered spontaneous and idiopathic.


Will to die without bothering: special devices used by suicides

Maria Carolina Romanelli 1, Marrone Maricla1, Tarantino Francesca1, Carabellese Felice2, Vinci Francesco1

1Section of Legal Medicine, Department of Internal Medicine, University of Bari, Italy

2Section of Forensic Psychiatry, Department of Internal Medicine, University of Bari, Italy

Background: suicide is one of the most important public health issues in Italy. Suicide rates for this country average approximately 4,7 per 100.000 populations and the most common method of suicide is the use of firearm. This presentation will impact the forensic community illustrating how social and psychological aspects play a key role in people who commit suicide. We show two unusual cases of suicide in which victims paid attention to preserve the environment without blood spatter on the surrounding surfaces. This was an act of respect for their relatives: the will to die, derived from terminal diseases and psychological suffering, was accompanied by the desire of reducing the painful impact in loved ones.

Methods: one case is that of a 65-year-old man, an art professor at high school. The day he committed suicide he had dinner with his wife. Once she fell asleep, he reached a separate part of the house were he had planned to commit suicide. He covered a coach with clothes and plastic bags; he sat and fired himself with a.357 magnum revolver pointing the barrel at his right mastoid bone. After firing, all blood traces were absorbed by the covering material. No reason was found to justify the suicide and only later it was discovered that his boss had fired him because he walked naked in protest in school. There was no evidence of prior suicide attempts.

The second case was that of a 57-year-old man with a history of severe terminal form of gastric tumor. Once alone in the house, the man prepared the scenario on the balcony outside the house because he did not want to soil his apartment. He wrapped a blanket around the railing of the balcony, he laid on a plastic sheet and he shot in the chest using a.12 caliber shotgun. A suicide note was found on the scene.

Results: the external examination reveled in the first case one mastoid penetrating gunshot wound with gunpowder residue; the path of the pellet came to rest in the left parietal bone. In the second case, a wide entrance wound entered the chest and no exit wound was found.

Conclusion: these two cases of suicides are unusual because both victims desired to die without “bothering”. Infact they used special devices in order to reduce the impact of the crime scene and to avoid further shock and pain in their relatives.


Suicide by insulin overdose

Letizia Caradonna, Natalia Minelli, Ilaria Scafetta, Francesco Ausania, Antonio Oliva, Riccardo Rossi, Massimo Senati

Institute of Legal Medicine, Catholic University, Rome

Background: In the literature many case reports about the occurrence of accidental insulin-induced hypoglycaemia can be found but deliberate overdose with insulin is rarely reported. We encountered a case of fatal hypoglycaemia caused by insulin overdose. A 53 year old man with insulin-dependent diabetes, was found dead in his room. Close to the body and in the kitchen there were two syringes of insulin aspart, a syringe of insulin detemir, a box of lorazepam and packets of other drugs. He had attempted suicide once in the previous months, so he was receiving a psychiatric treatment. A farewell message addressed to his wife was found on his phone cell.

Method: Autopsy, toxicological analysis and histological examination were performed.

Results: It was proved that the man died from acute cardio-respiratory failure leading to a state of hypoglycaemic coma. Autoptic and histological findings were indicative of a direct cerebral damage (interstitial oedema, neuronal cells swelling with pale and fringed cytoplasm, capillaries micro-thrombi) with pulmonary oedema (oedema, alveolar desquamation, congestion and thick alveolar septae). Injection marks were not observed. Toxicological analyses showed therapeutic dosages of benzodiazepines.

Conclusion: Circumstantial data, autoptic, histological and toxicological findings led us to establish it was a case of deliberate self-poisoning with insulin.

As a matter of fact brain depends on constant delivery of glucose and oxygen by the blood. In this case state of coma was caused by the hypoglycaemia induced by insulin assumption. Hypoglycaemic brain damage can be considered a cerebral excitotoxic neuropathology, where neurons are selectively killed by an extracellular overflow of excitatory amino-acids produced by the brain itself. Pulmonary oedema is a complication of insulin overdose too, and it’s linked to the alveolar epithelium and pulmonary capillary endothelium dependence on glucose metabolism. Benzodiazepines can have an indirect influence on the mechanism of death. They occasionally reinforce the hypoglycaemia caused by insulin.

The importance of this case concerns the need of paying attention to circumstantial information and anamnestic data, that have to be integrated with autoptic and histological findings in order to make the right post-mortem diagnosis, especially when there is lack of external signs (fine injection needles can produce marks that are extremely hard to identify). In our case histological findings played a very important role too, as we could recognize a typical hypoglycaemic neuronal damage (neuronal cells swelling with pale and fringed cytoplasm). Finally it’s important to exclude other competitive fatal mechanism (diagnosis “per exclusionem”).


Demostrative suicides by fire in economic crisis time. Report of two cases

Francesco Introna, Liliana Innamorato

Interdisciplinary Department of Medicine, Legal Medicine, Bari, Italy

Background: Suicides rates rose sharply in Europe as the financial crisis drove up unemployment and squeezed incomes.

In Italy the last study performed by EU.R.E.S (“Suicide in Italy in Crisis time”) reveals that in 2009, when the economic crisis was just starting up, there was an increase of suicides of 5.6 % above the 2008.

The suicides in unemployed rose at +37.3 %, and more than 76 % had recently lost the job. Only the 22 % were unemployed still looking for first occupation.

Nowadays with the spread out of the financial crisis, in Italy have been described quite a suicide a day for monetary problem.

Methods: The Authors describe two cases of demonstrative suicide by fire

Results: In the first case the owner of a bakery came out crying from the State Tax Office, where he could not succeed in delaying the amount of tax to pay. His financial debts would have forced him to close the family work activity and fire his employees.

So he bought a tank, and filled it with gasoline. He went into the open country and under an olive oil tree, standing up, scattered himself with the gasoline and set fire

He was found decomposed, in the country side, two days later. He was charred with extended third degree burns on the 80 % of the body surface.

The death occurred slowly after a long suffering time as shown by the vitality of skin injuries and by the amount of carboxyhemoglobin (52 % in open space).

The second case concerned an unemployee of 55 YO. He was dismissed several years earlier, and from that time he was not able to find a new job. After one last negative attempt to obtain a job from the Local Municipality, he bought gasoline, put himself in a large rubbish plastic bag, and in the main square of the town, in the rush hours, he set himself to fire

He died 12 days later in the local Hospital for the consequences of the burns extended on 80 % of the body surface.

Conclusions: The suicide by fire is uncommon, extremely painful, and not rapidly lethal. It is usually used for demonstrative purposes: to contest the Central Government against the new poverty induced by the increase of taxes, the highly new unemployed and the lack of job.


Epidemiology of suicide deaths in the North of Portugal (2007–2011)

Ricardo Mendes 1, Maria Moura1, Agostinho Santos1, Agostinho Santos2, Agostinho Santos3, Agostinho Santos4

1National Institute of Legal Medicine, North Branch, Porto, Portugal

2Faculty of Medicine of the University of Porto, Porto, Portugal

3Sciences School of the University of Minho, Braga, Portugal

4Forensic Sciences Center - CENCIFOR, Portugal

Background: Suicide continues to be a common and one of the most preventable causes of death around the world. The importance of studies conducted on Jurisdictions that serve a specific geographical area is well known, as they are essential on identifying the local tendencies that are occurring amongst suicide victims. The objective of this study is to analyze the epidemiological trends of completed suicide in the North Region of Portugal.

Method: Data from autopsy records and social inquiry of suicide cases (ICD-10 codes X60 to X84) between 2007 and 2011 at the North services of the National Institute of Legal Medicine of Portugal were obtained and analyzed by age, gender, method, time of year and other background factors.

Results: A total of 1415 cases of suicide were autopsied in the North of Portugal. The mean interannual incidence rate of suicide in the region was 7.8 per 100.000 inhabitants, with a male:female ratio of 3:1. The age range was from 12 to 92 in males (mean = 52.60, mode = 45) and 14 to 92 in females (mean = 53.56, mode = 57). The most common method amongst male victims was hanging (n = 519; 47.1 %), followed by firearm discharge (n = 171; 15.5 %); in females, the most common method was also hanging (n = 90; 25.1 %), followed by intoxication by medicines (n = 79; 22.0 %).

Conclusion: Comparatively to other European countries, the results of the study suggest a higher rate of consummated suicide, even though the methods used are overlapping. Some population groups should be targeted for suicide preventive measures, being middle-aged men the most prominent. Determining local prevention suicide programs is important for anticipating suicide acts and suicide behavior.


Toxic Epidermal Necrolysis, And Physician Responsibility: 2 Case Reports

Necmi Çekin 1, Naciye Özeren2, Ahmet Hilal1, Ali Eren2, Ayşegül Bilen2

1Cukurova University, Faculty of Medicine, Forensic Science Department, Adana, Turkey

2Council of Forensic Science, Adana Group Administration, Adana,Turkey

Patients with toxic epidermal necrolysis (TEN), 80-in 95 % of patients with the disease, especially hydantoins drugs'', while it is accepted that the main reason, in a few cases of infection, vaccination, toxins caused by radiation therapy and reported. Incidence of 1 to 1.2 cases per million and 70 % 's reported that mortality can reach.

Council of Forensic Medicine Adana Group Administration 2 patients who underwent autopsy diagnosed with toxic epidermal necrolysis, drug treatment, presented in terms of regulating the responsibilities of the physicians planned.

1. Case: 58-year-old male. Taken because of the treatment of seizures after a head injury and frontal contusion, the rash begins until 20 days after treatment, the addition of the second, an antiepileptic, referenced to the hospital, received intensive care, where he died 15 days later, unless otherwise indicated. At autopsy, including intra-oral mucosa, bullae and desquamated erythematous areas of the body was determined, histopathological findings were consistent with TEN.

2. Case: 10-year-old girl. Diagnosis of epilepsy is under medical treatment, including oral cavity, then started an additional antiepileptic drug rash and blisters all over the body are common, are invested with the diagnosis of TEN, where she died three weeks later, unless otherwise indicated.

Hospital information, after the autopsy findings and histopathological evaluation, the cause of death was diagnosed as TEN. Addition to the child's parents suffer from anti-epileptic medication the doctor began.

Physicians accepted professional practices'' drug use'' as a complication never been in charge of situations.

However, whether or not responsibility for the correct indication, appropriate dosage, side effects of drugs and information on actions, clinical follow-up and decided to investigate compliance with the requirements of rules and controls are given in terms of medical science.


Postpartum sudden death from plexogenic pulmonary arteriopathy: two cases

Gonca Pişkin Kesici, Esra Gürlek Olgun, Zafer Karadeniz, Fatih Şen, Gülden Sözer

council of forensic medicine, mourge departmant, izmir, turkey

Backgraund: Pulmonary hypertension can ocur in association with a variety of medical conditions. Severe pulmonary hypertension, a condition associated with marked elevation of pulmonary artery pressures, heart failure, and high mortality, may present with the formation of plexiform lesions in medium sized pulmonary arteries. Pulmonary arterial hypertension carries a high maternal motality rate in peripartum period. Because of the limited availability of lung tissue samples from pregnant women with pulmonary arteriel hypertension, the frenquency and hemodynamic effects of plexogenic lesions are largely unknown.

Case 1: A 27 year old multigravida with mild anemia, diarrhea and weakness, has had a male fetus vaginally without complications. On postpartum day 10, the mother was brought to hospital death. Postmortem histopathological examination showed plexogenic pulmonary arteriopathy.

Case 2: A 28 year old primigravida without a known disease, has had an abort and discharged from the hospital. On day 8, the mother was brought to hospital death. During the resuscitation an abundant lung hemorrhage was occured. Postmortem histopathological examination showed plexogenic pulmonary arteriopathy.

Conclusion: Pulmonary hypertension carries a significant risk to mother and child during pregnancy. Plexogenic pulmonary arteriopathy is a rare lesion and associated with poor prognosis. Therefore, during the autopsy and postmortem histopathological examination of peripartum maternal sudden death cases, plexogenic pulmonary arteriopathy should be considered by pathologists.


Death due to Bleeding of Primary Aortoesophageal Fistula Secondary to Thoracic Aneurysm: A Case Report

Bülent Şam1, Harun Akkaya2, Fatih Şahin 3, Arzu Akçay Turan1, Rıfat Özgür Özdemirel1, Ufuk İlingi4

1Council of Forensic Medicine, Morgue Speciality Board, Istanbul, Turkey.

2Council of Forensic Medicine, 2nd Speciality Board, Istanbul, Turkey

3Council of Forensic Medicine, Istanbul, Turkey.

4Council of Forensic Medicine, Branch Office, Erzurum, Turkey

Aortic aneurysms in cases of sudden death is taking an important place, is a fact that known to affect homeostasis of fistulas. In this study, we presented the autopsy findings of a 74 years old woman is found dead at home. In the autopsy, 7x6x3 cm mural thrombi on the thoracic aorta, 1000 cc coagulated blood in the stomach and fistula between the aortic aneurysm and esophagus was found. Histopathological examination confirmed the fistula. The cases of bleeding into the stomach from aortoesophageal fistula is very rare in the relevant literature review. Also we couldn't find any case report about this issue in Turkish forensic medical publication. The case have been presented with crime scene investigation, autopsy and microscopic examination findings and discussed together with the mechanisms death, have attempted to explain the elements that need attention at autopsy.


“Airway Obstruction: Two Cases Report”

Antía Simón 1, Beatriz Silva2, Francisco Corte Real2

1Department of Forensic Pathology (Coimbra) - National Institute of Legal Medicine, Portugal; Forensic Sciences Centre, Portugal

2Department of Forensic Pathology (Coimbra) - National Institute of Legal Medicine, Portugal; School of Medicine, University of Coimbra, Portugal; Forensic Sciences Centre, Portugal

Death from mechanical asphyxia due to obstruction of the internal airways is relatively common in children, elderly and drunk people. Normally, the manner of death is accidental and the foreign body nature is food material or even teeth. The location of the obstruction depends on the size of the foreign body: large fragments in the glottis and small ones at the bifurcation of the trachea or main bronchi.

Sometimes the cause of death is guided by circumstantial information, because the victim has a cough or breathing problems during the meal. However, there are cases where the cause of death can be misunderstood with natural deaths of cardiac origin, which are known as coffee coronary syndrome.

The authors present two cases of mechanical asphyxia due to obstruction of the internal airways with food material. In one case, a 22-months-old female choked while she was eating in front of her mother. The death did not occur immediately, but 3 days later with hypoxic-ischemic encephalopathy. In the other case, a 49-years-old female died suddenly without witnesses and a natural cause of death was suspected.

In the forensic autopsies the classic signs of asphyxia can be observed, but all these signs are nonspecific and do not lead to diagnosis. The finding of a foreign body together with the circumstantial information provide the diagnosis of the cause of death.


“A Silent Death Sentence. Traumatic Vertebral Artery Dissection: a Case Report”

Antía Simón 1, Beatriz Silva2, Duarte Nuno Vieira2

1Department of Forensic Pathology (Coimbra) - National Institute of Legal Medicine, Portugal; Forensic Sciences Centre, Portugal

2Department of Forensic Pathology (Coimbra) - National Institute of Legal Medicine, Portugal; School of Medicine, University of Coimbra, Portugal; Forensic Sciences Centre, Portugal

Although some traumatic injuries are not noticeable at the time they are produced and cause little or no symptoms, they should not be considered harmless. In fact, some of them can lead to a mortal outcome, if not perceived and treated promptly. This is the case of vertebral artery dissection.

Vertebral artery dissection can occur after relatively minor head and neck injuries and preci-pitating events, mainly associated with minor indirect mechanisms causing hyperextension or sud-den rotation of the neck such as motor vehicle accidents. It occurs in association with cervical spine fractures in almost 70 % of the cases. Cerebellum and brainstem infarcts are typical findings that arouse neurological symptoms. These symptoms can be delayed in time, with long interval between vessel dissection and ischemia, causing the talk-and-die syndrome.

The author present a case of a 68-year-old man, who suffered a motorcycle accident, from which seemed to result only rib fractures and some abrasions. After 17 days he was hospitalized conscious, with dysarthria, drowsiness, emesis and lack of strength in the lower limbs. Over the next 12 days his condition progressed to coma and brain death. After a post mortem exam, with histopathological exam, a bilateral dissection of the vertebral vessels was found.

It is noteworthy that a detailed exam of cervical region and the brain is important, specially when there is a delay between the accident and the death, even with previous minor trauma of these regions.


Medico-legal evaluation of deaths due to decapitation

Bahadır Kumral, Yalçın Büyük, Ümit Naci Gündoğmuş, Esat Şahin, M.feyzi Şahin

Council of Forensic Medicine

Throughout history, decapitation has been used for execution fort the most diverse motives all over the world. Complete decapitation without any further mutilation of the victim in homicides is relatively rare. Decapitated bodies are predominantly associated with decapitation by wheels of trains or with postmortem dismemberment following homicide. Some methods of suicide may also result in decapitation, either as an intended outcome or as a result of some unforeseen complication of the method used.

Decapitation of bodies is a rare event in the civilian setting and is reported to account for approximately 0,1 % of medico-legal autopsies. Suicidal decapitation is a very rare method of self-destruction. In suicidal decapitation, the favored method is the one involving trains. Other encountered methods are decapitation in suicidal hanging, and vehicle-assisted ligature suicide. Though being encountered rarely, decapitation by guillotine was also reported.

In this retrospective study, in order to depict characteristic features of deaths with decapitation, we presented the findings of fatalities with decapitation over a 10-year period in a medico-legal autopsy series in Istanbul, Turkey. A total of 36270 forensic autopsies were performed over the period of the study and in 19 cases, the bodies were found to be decapitated (0.05 %).

The age range of decapitated bodies was 18 to 71 years (average, 39,1 years), with a male to female ratio of 13/6. There was only one case of suicide and the way used for suicide was a mechanism like guillotine. In this case, a guillotine-like device designed by male victim had been used for deliberately decapitating the body. The age of the suicide case was 41 years. There was no female suicide case. There were 13 deaths of accidental origin, 6 vehicle crashes and 7 train-pedestrian accidents. The age range of individuals killed in accidents was 26 to 68 years (average, 36.8 years), with a male to female ratio of 11/2. During the study period, the number of the homicide cases with decapitation was 5. The age range of homicide cases was 18 to 71 years (average, 45.2 years), with a male to female ratio of ¼. There were multiple traumas in other body parts of the bodies of homicide cases together with decapitation. In majority of homicide cases, multiple stab wounds were detected. Decapitation level of vertebrae was at the level of 3–4 cervical vertebrae in 9 cases and in different levels at cervical region in other cases.


Postmortem Bite Injuries by Domestic Cat: An Autopsy Case

Bahadır Kumral, Bülent Şam, Mehmet Özbay, Yalçın Büyük

Council of Forensic Medicine

A 71-year-old woman was found dead in her house. The body was in moderate degree of decomposition and referred to ATK for medico-legal autopsy. External examination of the body revealed the breakdown of the facial soft tissues. Almost bony parts of facial region were exposed. Apart from the facial region there were multiple bites showing binary canine marks at elbow, hand regions. There was no sign of bleeding around these lesions. Presence of several domestic cats was noted by crime scene officers and prosecutor. Given the typical morphology of the skin lesions and the observation of cats at the death scene, it was concluded that the injuries were inflicted by at least one domestic cat. The case shows that domestic cats also feed on human corpse.


Determined suicide by using different methods consecutively: case report

M.feyzi Şahin, Bahadır Kumral, Ufuk İlingi, Yalçın Büyük, Sermet Koç

Council of Forensic Medicine

Suicide is a significant health problem in the world, the rates and the methods used differ from country to country. The preferred method of suicide is hanging in Turkey, but it also shows difference between the provinces and even between the genders.

In some rare cases, the method used is very destructive and unusual in nature such as using a guillotine-like device. Unusual ways of committing suicide such as using different methods together or consecutively are reported in the forensic literature

A 49 years-old man was found dead in the kitchen of his home, in blanket lying near to the cooker. The hose which supplies natural gas was near to the nose of the decedent. External examination of the decedent showed the presence of cut wounds at wrist region. There was a suicide note explaining the multiple methods used by the victim such as inhalation of natural gas, cutting of the wrist, suffocation attempt by plastic bag. The suicide note was describing all tragic efforts and the desperation of the decedent resulting from gambling passion. The body was referred to Council of Forensic Medicine for medico-legal autopsy. Upon evaluation of macroscopic and toxicological findings obtained via autopsy, the cause of death was certified as asphyxia resulting from natural gas inhalation


Accidental hanging of a child with cord of the pacifier: an autopsy case

Abdullah Avşar, Bahadır Kumral, Sinan Sevinç, M.feyzi Şahin, İbrahim Üzün, Yalçın Büyük

Council of Forensic Medicine

Choking, suffocation and strangulation are important causes of unintentional injury and death in young children. Choking on food and toys, suffocation from plastic bags and strangulation from strings on children's items are common causes of mechanical airway obstruction. Hanging is a form of ligature strangulation in which the force applied to the neck is derived from the gravitational drag of the weight of the body or part of the body. Hanging is almost always suicidal and though very rarely being accidental.

In some countries mechanical airway obstruction from choking, suffocation and strangulation is the leading cause of unintentional injury that results in death of children less than 1 year. Many of these deaths are preventable. Children's clothing and household furniture have the potential to cause strangulation.

We report a 1,5 years old boy who was dead on admission to hospital. External examination of the boy showed classical ligature mark seen in hanging. Autopsy revealed the bleeding in the muscles beneath the ligature mark. The investigation made it clear that the boy had been struggled by the cord of pacifier after being hooked by the washing machine’s latch.

Accidental strangulation is a preventable problem with limited scientific understanding in children. Health care providers can play an important role in the dissemination of prevention information to caregivers and manufacturers in order to reduce the incidence of these injuries in young children.


An unusual fatal injury due to tyre blast: an autopsy case

Bahadır Kumral, Abdullah Avşar, Yalçın Büyük, Cihan Göktürk, Bülent Şam

Council of Forensic Medicine

An 18-years old boy was fatally injured by burst tyre air pressure while inflating a truck tyre. The tyre had shot by air pressure generated to the chest and abdominal region of the boy, and the boy had also blown the boy. He died upon admission to emergency. A medico-legal autopsy was performed which showed extensive injuries in the chest and abdominal cavity. Multiple rib fractures, lacerations of lungs, liver, and thoracic aorta were the principal injuries.

Tyre-blast injuries are rare incidents. Inflated large tyres contain a tremendous amount of potential energy and so tyre blast injuries during inflation/repair have a high morbidity and mortality.


Death due to Improper use of Rodenticide: A Case Report

Ali Eren 1, Ramazan Akcan2, Naciye Özeren1, Necmi Çekin3

1Council of Forensic Medicine Adana Group Administration, Adana, Turkey

2Hacettepe University Medical Faculty, Forensic Medicine Department, Ankara, Turkey

3Çukurova University Medical Faculty, Forensic Medicine Department, Adana, Turkey

Pesticides are toxic agents used widely in insect, pest and rodent control in agriculture. Rodenticides are used for agricultural and urban rodent control. Deaths due to these toxic agents are generally secondary to accidental exposure and less often intentional use for suicidal purpose. However, therapeutic use is extremely rare.

Here we present a case of 53 years old male who used a rodenticide and an antibiotic for self-treatment of his intestinal parasites. He was immediately sicken and applied to hospital. Gastric lavage and active coal were performed; later he admitted to the intensive care unit because of worsening general condition. He died at 36th hour of follow-up.

Areas of petechial hemorrhage on the surface of the lungs and heart were seen; and, 600 cc of transudative fluid was detected in the abdominal cavity, at autopsy.

Widespread use and easy availability of agents as Rodenticides might cause serious incident. In this context, public awareness about use and storage of such agents will help to tackle such cases.

PP-308 (Omitted)


A Planned Complex Suicide Case Committed by Using Four Suicide Methods

Çiğdem Süner1, Erdoğan Kara 2, Harun Akkaya2, Zerrin Erkol3

1Council of Forensic Medicine, 6th Speciality Board, Istanbul, Turkey

2Council of Forensic Medicine, 2nd Speciality Board, Istanbul, Turkey

3Abant Izzet Baysal University, Faculty of Medicine, Department of Forensic Medicine, Bolu, Turkey

Background: Complex suicide is using of more than one suicide method to induce death and may be planned or unplanned. In planned complex suicides, combination of two or more methods can be planned by the victim to prevent failure of the first method. In unplanned complex suicides, the victim employs the second or more methods of suicide after the first method chosen failed or proved to be painful. In the literature, the use of four or more methods in a case is very rare. In the article, a planned complex suıcide case committed by using four suicide methods was presented and the properties of the case was discussed according to the literature data.

Case: Thirty-two years old male found dead with a telephone and a bas station stick in a place which its door was locked and surrounded with wire wall. Most part of the dead body in boxer position, carbonisation degree burned, a metal chain on his neck and two lacerations seen. 1 bread knife, 1 lighter, 1 plastic bottle filled with gasoline, 1 poetry book named ‘suicide meets love’ found beside the dead body, in the book some verses underlined follow as: ’is it nice to make love with a woman or with fire ?…Tired of cutting my wrists with razor blade, tying a rope around my neck, rolling over from a balcony to the emptiness, leaning the knife on my throat, drilling a hole in my forehead… Fracture caused by falling from a high place established on the left femur during autopsy. There was an eye-witness who saw the victim 20 days ago digging a grave for himself and wanted to be burried to that grave; it was understood that the victim had psychological problems and talked about suicide all the time.

Conclusion: In order to determine the correct origin of complex suicide cases, examination of the crime scene and autopsy is crucial, any little detail and proof should not be escaped from the attention.


Estimation of postmortem interval using cardiac Troponin I

Abir Aissaoui, Meriam Belhaj, Nidhal Haj Salem, Mohamed Amin Mosrati, Ali Chadly

Department of Forensic Medicine University Hospital Fattouma Bourguiba of Monastir- Faculty of Medicine- University of Monastir Tunisia

Background: The importance of determining the time since death is crucial to criminal, civil and forensic cases. Numerous methods have been proposed in the last 60 years for the determination of the time since death by chemical means. None of these methods has gained any practical value. An assessment of levels of cardiac Troponin I (cTnI) in cadevric fluids, to estimate the postmortem interval (PMI) was carried out. cTnI is a basic regulatory protein found as part of a ternary complex responsible for calcium dependent muscle contraction.

Aim: To analyse the diagnostic efficacy of post-mortem dosage of cardiac troponine I in cadaver fluids in estimating PMI.

Material-methods: Our study is prospective interesting 72 corps autopsied at the Department of Forensic Medicine of the University Hospital Fattouma Bourguiba of Monastir-Tunisia. Were excluded from the study, resuscitated cases and those examined more than 48 hours after death.

Levels of cTnI were measured in pericardial fluid, cardiac blood and peripheral blood. Statically significant correlations between different variables levels of cTnI and PMI were studied. Correlation coefficients were calculated. SPSS (version 12.0) was used for statistical analysis. Results were considered to be statistically significant when p < 0.05

Main results: Cardiac troponin I levels in pericardial fluid, are correlated significantly (r = 0.316) with PMI with a p value at 0.033 However it was not significant correlation between levels of cTnI in cardiac and peripheral blood with PMI ( p value respectively at 0.389 and 0.461). The table below shows the variation of levels of cTnI in cadaveric fluids with PMI

Conclusion: The significant correlation between levels cTnI in pericardial fluid and PMI can be due to the fact that the pericardial fluid represents a different matrix than blood and is a filtrate produced via the serous layer of the pericardium. The fluid bathes the myocardium, enzymes and proteins may be released directly into the pericardial fluid from the cardiac muscle.

Large scale studies including more cases are needed to determine the correlation between PMI and levels of cTnI.


Café coronary syndrome: An autopsy case report

Meriam Belhaj, Abir Aissaoui, Nidhal Haj Salem, Mohamed Amin Mosrati, Ali Chadly

Department of Forensic Medicine University Hospital Fattouma Bourguiba of Monastir- Faculty of Medicine- University of Monastir Tunisia

Food asphyxiation, known as “café coronary syndrome”, is defined as a sudden and unexpected death occurring during a meal due to accidental external compression of the airway by food. This syndrome is an uncommon cause of sudden death.

Aim: To report an autopsy case of café coronary syndrome and to discuss the mechanism of death.

Case: A 38 year-old woman, without previous medical history died suddenly. A forensic autopsy was performed. External examination of the body showed a marked facial cyanosis without any violence evidence. Autopsy showed non specific asphyxia signs such as multivisceral congestion. Lungs were turgescent and oedematous with a congestion of tracheal mucosa. A compact bolus of food (“Bsissa”, a semisolid preparation consisting in cereals) was found in both infra and supra-glottic areas, obstructing the esophagus.

Toxicological screening was negative. Death was related to a mechanical asphyxia.

Conclusion: The type of food is a significant factor in café coronary syndrome. Poorly masticated foods are often involved. Alternatively, semisolid or adherent foods may also be a problem.

In our case, death may result from airway obstruction due to external compression of the trachea by food impacted in the esophagus. However the rapidity with which fatal episodes may raise the possibility of reflex vagal inhibition due to stimulation of the superior laryngeal nerve causing cardiac arrest. It may be that combinations of mechanisms contribute to the lethal outcome.


Post-traumatic epilepsy: A forensic approach

Meriam Belhaj, Abir Aissaoui, Nidhal Haj Salem, Mohamed Amin Mosrati, Ali Chadly

Department of Forensic Medicine University Hospital Fattouma Bourguiba of Monastir- Faculty of Medicine- University of Monastir Tunisia

Introduction: Post traumatic epilepsy (PTE) is a recurrent seizure disorder secondary to brain injury following head trauma. The mechanism by which trauma to the brain tissue leads to recurrent seizures is unknown. The medico legal problems associated with PTE are frequently related to the identification of head trauma as a cause of epileptic seizures and to the complexity of forensic examinations.

Aim: Study the imputability between traumatic brain injury (TBI) and epilepsy, through the review of 12 cases of post traumatic epilepsy.

Materials-methods: A retrospective study was performed in the Forensic Medicine Department of Fattouma Bourguiba Hospital in Monastir (Tunisia) during the period 1991 to 2009 including the review of forensic examinations. 5750 patients suffering from head trauma injury were selected from a total of 13990 clinical forensic examination cases.

Collection of data was carried out with an emphasis on initial medical certificates and reports.

Results: During the period of study, the diagnosis of PTE was considered in 12 patients but accepted in only 10 patients.

The mean age of the study population was 23,8 years [6 years - 37 years]. All patients were males. For the whole studied population, mean free interval (age at onset of PTE - age at onset of TBI) was 7 months. All patients had no previous medical history. Eight patients (80 %) had severe TBIs.

Conclusion: Causality assessment is relatively difficult. It is based on several criteria such as the severity of trauma, time at onset, and previous health condition. In our study, eight patients had severe TBIs and there was no previous history of epilepsy.

Post-traumatic imputability of epilepsy was refused in 2 cases despite the occurrence of disorders after head trauma.


Iatrogenic injuries induced by external cardiac compression discovered during forensic autopsy

Abir Aissaoui, Mohamed Amin Mosrati, Nidhal Haj Salem, Meriam Belhaj, Ali Chadly

Department of Forensic Medicine University Hospital Fattouma Bourguiba of Monastir- Faculty of Medicine- University of Monastir Tunisia

Introduction: External cardiac compression (ECC) is a technique for cardio-pulmonary resuscitation consisting on applying manual rhythmic pressures to the thorax. It may induce iatrogenic injuries. Therefore, pathologists must be able to distinguish between ECC related injuries and those caused by other factors, such as assaults or accidental violence.

Aim of the study: The aim is to analyze external cardiac compression induced injuries and to discuss their medico-legal implications.

Material-methods: Our study is retrospective, including 179 autopsies performed between 1990 and 2011, in the Department of Forensic Medicine of the University Hospital Fattouma Bourguiba of Monastir (Tunisia). Cases with ECC were included. The age range was 40 days- 95 years (mean-age: 52 years). Sex ratio was 4.

Results: Iatrogenic injuries generated by ECC were found in 80 cases (44.6 %). Iatrogenic injuries were mainly sternal and/or ribs fractures in 60 cases (33.5 %) and thoracic ecchymosis in 18 cases (10 %). Ribs fractures were present only on the anterior surface of the chest. Dorsal spine fracture was found in the region of the sixth, seventh, and eighth thoracic vertebrae, in one case. The thoracic vertebrae were noted to be extremely osteoporotic. A liver rupture was noticed in one case. No cardiac macroscopic injuries were found during autopsy.

Conclusion: Fractures of the ribs and sternum are frequently seen during forensic autopsies of decedents who received chest compression during cardio-pulmonary resuscitation. Sometimes, iatrogenic injuries can be misinterpreted. If in doubt as to what an unusual mark is, the pathologist should request the attendance of the clinician to explain it.


Meningeal melanocytoma as a cause of sudden death: a case report

Abir Aissaoui, Mohamed Amin Mosrati, Nidhal Haj Salem, Meriam Belhaj, Ali Chadly

Department of Forensic Medicine University Hospital Fattouma Bourguiba of Monastir- Faculty of Medicine- University of Monastir Tunisia

Introduction: Meningeal melanocytoma is a rare benign pigmented tumor. It develops from melanocytes normally present in the meninges of the posterior fossa and medulla. It is an extra-axial tumor that manifests due to compression of adjacent structures. Although classified as a benign tumor, it can cause sudden death by several mechanisms.

Aim of the study: The aim of this paper is to report a rare case of meningeal melanocytoma and to discuss the mechanism of death.

Case presentation: A 21 year-old man with a prior history of recurrent lipothymia, was admitted into the emergency room because of generalized seizures. Death occurred despite resuscitation. A medico-legal autopsy was performed. External examination of the body showed non-specific asphyxia signs without any violence evidence. Necropsy noticed a brain oedema with a dark colour of the meninges especially in the frontal part. Histological examination concluded to diffuse meningeal melanocytoma with cerebral oedema.

Conclusion: Meningeal melanocytoma is a benign tumor derived from melanocytes.It may occur with several symptoms in young age. This case report exemplified generalized seizures as a complication of this tumor which led to sudden death.


Sudden Death Syndrome Caused by Anaphylaxis Related to Hydatid Cyst Rupture: A Case Report

Sinan Sevinç 1, Gözde Şirin2, Harun Akkaya3, Yalçın Büyük4, Bülent Şam2, Sermet Koç2

1Council of Forensic Medicine, Istanbul, Turkey

2Council of Forensic Medicine, Morgue Speciality Department, Istanbul, Turkey

3Council of Forensic Medicine, 2nd Speciality Board, Istanbul, Turkey

4Vice-President of Council of Forensic Medicine, Istanbul, Turkey

Introduction: Sudden/unexpected death is the situation when a person dies within 1 to 24 hours without knowing the existing of the disease. The most frequent reason of these kind of death is cardiovascular and it is informed that the reasons of sudden death are related with almost all organs and system. Although the number of sudden death cases related to hydatid cyst rupture is high in analysed literature, the cases like those in legal medical publications is not much and the case submitted for determining the cause of sudden/unexpected/suspicious death, thought to be efficacious for the forensic medicine science.

Case: 16 year old boy, fell down and after he jumped over a hindrance and when he got up after a very short time, he lost his consciousness and fell down again and suffered death suddenly. During the forensic autopsy, it was seen that one of many hydatid cysts were ruptured to vena portae and germanium mebrane in vena portea lumen protruded partially. As a consequence of autopsy; by taking the anamnesis taken from a relative, symptoms of examinations, toxicological analysis, histopathological evaluations into consideration and there were not any symptoms detected caused death, it was well understood that the cause of death is anaphylaxis related to vein lumen of hydatid cyst rupture.

Conclusion: Forensic autopsy is required in order to determine the cause of sudden/unexpected/suspicious death and it is important to emphasise the cause of sudden/unexpected/suspicious death may be parasitologic diseases.


Congenital diaphragmatic hernia in the adult associated to intestinal malrotation and Down’s syndrome, as a necroscopic finding

Teresa Marrón Moya 1, Javier Defez Toran1, Vania Landívar Freire1, María Jesús Leal Bazán2, Raquel Esgueva Pallares3, Amparo Arroyo Fernández1, Claudina Vidal Gutiérrez1, Josep Castellà García1

1Catalan Institute of Legal Medicine. Barcelona, Spain

2Departament de Justícia. CPJ. Barcelona, Spain

3Instituto Nacional de Toxicología y Ciencias Forenses. Barcelona, Spain

Background: Bochdalek’s Hernia consists of a post-lateral congenital fault of the diaphragm, frequently the left one, which results in the rise of the abdominal viscera up into the thoracic cavity. It can be associated with other congenital malformations. It is an unusual pathology in the paediatric age and an exceptional one in the adult population.

Method: On the one hand, the assessment of a case report happened in Barcelona and was subjected to judicial investigation and medicolegal autopsy at the Department of Forensic Pathology (SPF) of the Catalan Institute of Legal Medicine (IMLC). On the other hand, the carrying out of a retrospective prevalence study of natural judicial mortality caused by digestive pathology during the period from January 2010 till February 2012, in both the south of Barcelona and the city centre. Prevalence of Congenital Diaphragmatic Hernia was determined in that chronological period. The analysis of the databases of the Department of Forensic Pathology (SPF) was carried out using SPSS 17.0.

Results: We present the case of a 49 years old male with Down’s syndrome, with no clinical follow-up until one month before exitus, when he presents abdominal pain, vomiting in repetition and cephalic instability, clinical picture oriented towards gastrointestinal infection. The autopsy demonstrates a left post-lateral diaphragmatic hernia with penetration and rise of large intestine and mesentery proper, displacing the heart to the right thus collapsing left lung. It is associated with intestinal malrotation, volvulus produced by rotation of intestinal ansa with fibrous adhesion provoking a small intestine infarct, this being the immediate cause of exitus.

Encephalic and hepatic findings compatible with whether malformations or anatomic variants derived from chrosomopathy were also detected. Toxicological studies rendered negative results and histology confirmed diagnoses.

1793 out of the 3141 autopsies performed in the 26 months of the assessment were natural deaths, 66 caused by digestive pathology, while HCDA only accounted for a 0.1 % (n = 2) of the total natural deaths and a 3.0 % of the total deaths caused by digestive pathology (from January 2010 till February 2012).

Conclusion: Digestive Pathology as a cause of death in judicial autopsies performed in Barcelona is unusual and Congenital Diaphragmatic Hernia is a cause with low prevalence in the adult.

Both our casuistics and the existing bibliography show the probability of the association between intestinal malrotation and Down’s syndrome with HDCA.

Bochdalek’s Hernia favours the apparition of mortal mesenteric infarct when there is intestinal malrotation.


The Research of Presence of P-selectin as Vitality Sign in Hanging Ligature

Erol Baduroğlu 1, Recep Fedakar2, Şaduman Balaban Adım3

1Rize Branch of the Council of Forensic Medicine of the Ministry of Justice, Turkey.

2Department of Forensic Medicine, Uludag University, Faculty of Medicine, Bursa, Turkey

3Department of Pathology, Uludag University, Faculty of Medicine, Bursa,Turkey

In our study, it is aimed to evaluate P-selectin, which is a cell adhesion molecule and recently studied on determination of wound age, as vitality sign in hanging ligature.

In our study; skin samples taken from the cases autopsied by the Morgue Departments of the Bursa branch of the Turkish Council of Forensic Medicine were investigated immunohistochemically in terms of the percentage and the positivity stained with P-selectin.

The study group is formed with the skin samples of ligature and around of 25 hanging cases; as well as the first control group is formed with the skin samples of distant neck region of ligature of the same cases. The second control group is formed with the skin samples of the neck area of 24 deaths different from hanging.

40 % of the cases in the study group +2; 60 % of the cases in the first control group +3; 91.6 % of the cases in the second control group + 2 and +3 level were stained. 16 (64 %) cases in the study group the percentage of staining were observed between 40-60 %. 23 (92 %) cases in the first control group the percentage of staining were observed between 40-80 %. 22 (91.6 %) cases in the second control group the percentage of staining were observed between 30-60 %. In the first control group positivity of staining (p = 0.018) and percentage of staining (p = 0.017) were higher than the study group and the percentage of staining (p = 0.021) were higher than the second control group to form a statistically significant difference.

In the cases of hangings; it is not found any statistically significant difference in the positivity of stain and the percentage of stain according to the type of hanging (full/ half, typical/atypical) or the presence of ecchymosis or fracture (p > 0.05).

In conclusion; in our study there is no positive correlation between P-selectin and vitality in ligature of hanging; moreover, it may be beneficial for further studies about different injury types with a larger case series with more comprehensive factor examination.


Death from massive pulmonary thromboembolism in ovarian neoplasm: a medico-legal case report

Marta Bianchi, Salvatore Andreola, Luca Barulli, Guendalina Gentile, Alessandra Rancati, Riccardo Zoja

Sezione di Medicina Legale e delle Assicurazioni dell'Università degli studi di Milano

Introduction: Pulmonary thromboembolism is a serious complication in ovarian tumors, especially if associated with large uterine fibroids that favour the compression of large venous districts facilitating stasis. The increased risk of developing deep vein thrombosis (DVT) is not related to tumor size, but rather to age and body mass index (BMI) of patients that need to be, respectively, more than 50 years and 25. The purpose of this report is to present a particular case of fatal pulmonary thromboembolism caused by pelvic compression by ovarian cancer.

The case: A 74-year-old woman, weighing 103 kg and 172 cm tall, was found dead at her home. From judicial acts it was resulted that she suffered from hypertension and was reluctant to undergo medical treatment, but that she would have to perform some health checks because she was a carrier of a massive ovarian cyst. The judicial authorities ordered the autopsy two days after the discovery of the body.

Necropsy findings: The corpse showed a proper nutritional state at the dissecting table and was well-preserved, with obvious abdominal globosity. No signs due to any harm were evident to external examination. The systematic examination of the organs showed formations completely occluding the lumen of the hilar pulmonary vessels, bilaterally; their morphological characteristics (mottled appearance, opacity, friability, tenacious adhesion to the vessel wall) permitted to identify their thromboembolic nature. Abdominal cavity dissection evidenced a voluminous neoformation (104 cm/15 kg), interesting adnexal structures, that occluded large part of the pelvic cavity with compression of the organs below. The exploration of the pudendal plexuses showed the origin of the material found in the pulmonary vessels. The cause of death was identified as massive pulmonary thromboembolism in a woman with massive ovarian neoplasm.

Results: Histopathological investigation was carried out on organs and on the material occluding the hilar vessels and pudendal plexuses, removed during autopsy and fixed in 10 % buffered formalin. The results have confirmed the same thrombotic nature and chronology of entity analyzed in the two vascular beds, making it possible to recognize the massive ovarian neoplasm, histologically identified as an "Atypical Proliferative (Borderline) Mucinous Tumor", as the risk factor for the venous thrombosis and subsequent embolization.

Conclusions: Authors describe a case of death caused by massive pulmonary thromboembolism originated from a voluminous ovarian mass that has given rise to venous stasis of the pelvic district.


Pmi estimation and multidisciplinary approach in burned remains

Valentina Bugelli1, Stefania Fornaro 1, Stefano Vanin3, Claudia Giaconi2, Davide Caramella2, Mario Giusiani1, Luigi Papi1

1Department of Legal Medicine – University of Pisa

2Department III Radiology - University of Pisa

3Department of Chemical & Biological Sciences, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK

Background: Fire is sometimes used in cases of self inflicted injuries and suicide. Burned remains can be found also in several accidents of different origin (cars, aircraft crash, industries, domestic, etc), and cases of burnt bodies, found in different locations such as open fields, cars and indoors have been reported by several authors. In these cases only a multidisciplinary approach allows the PMI estimation and the identification of the cause of death.

This case concerns a homicide/suicide in which the burned bodies of a female and her two sons (3 and 11 years-old) have been found in a car during the summer 2011, in Central Italy. In this case insects may be the only tool useful in the estimation of the minimum time of death (mPMI) as burning prevents the use of the classical thanato-chronological techniques for mPMI estimation.

Method: in order to estimate the mPMI larvae have been collected from bodies and then reared for their identification. After flames have been extinguished colonisation started in all the bodies at the same time. Lucilia sericata and Sarcophaga sp. larvae have been collected both from the abdomen and the skull, exploded because of the temperature.

Besides the autopsy, CT scan has been carried out to identify body injuries and toxicological investigations were carried out to determine whether children could have been poisoned or stunned before being been burned. All of the three bodies had undergone 16-slice multidetector CT (Toshiba Aquilion) basal scan and post processed with 3D and MPR reconstruction. Biological samples were collected for toxicological analysis.

Results: At MSCT scan none of three bodies exhibited signs of injuries like traumatic fractures or lacerations and no evidence of foreign bodies. Toxicological results revealed high concentrations of carboxyhemoglobin and extremely low levels of cyanide in all of the three bodies while only in the children the analysis was positive for benzodiazepine, according to the fact that the mother has given them Diazepam when they still were at home, as seen in the video recorded by the security cameras placed inside the house.

Conclusion: this report demonstrates the usefulness of multidisciplinary approach (pathological, radiological, entomological and toxicological) in the study of burned remains in order to confirm the event of a combined homicide-suicide as initially supposed.


Cause Of Death In Forensic Autopsy As A Pulmonary Fat Embolism: 2 Case Reports

Naciye Özeren 1, Demet Meral1, Necmi Çekin2

1Council of Forensic Science, Adana Group Administration, Adana, Turkey

2Cukurova University, Faculty of Medicine, Forensic Science Department, Adana, Turkey

Fat embolism, bone fractures, barotrauma, surgery, soft tissue damage may be due.

Fat embolism, bone marrow, soft tissue, large amounts of fat globules in the bloodstream, with the participation occurs.

Long bone fractures and orthopedic surgeries done after the main source of fat embolism.

Case 1: A 67-year-old woman

Multiple fractures of the extremities and pelvis fractures after a traffic accident at the hospital in the female patient with sinus bradycardia, respiratory distress developed.

Died did not respond to CPR applied have been accepted.

The histopathological examination revealed findings consistent with fat embolism grade 3–4.

Case 2: A 77-year-old woman.

Fallen from the tree, then the hospital with multiple pelvic fractures detected. Died 3 hours after the start of respiratory distress.

At the autopsy findings consistent with fat embolism in the lung tissue showed grade 3–4.

Fat embolism is common in forensic autopsy practice, either alone or together with other factors in assessing problems have been experienced as a cause of death.

In general, grade 1 and grade 2 cases of fat embolism, systemic dissemination, without the associated clinical features are interpreted as if the cause of death.


Immunohistochemical study of pancreas in forensic autopsy cases

Saeko Miyoshi 1, Kazuya Ikematsu2, Takahiro Umehara2, Ichiro Nakasono2

1Nagasaki University, School of Medicine, Nagasaki, Japan

2Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University, School of Medicine, Nagasaki, Japan

Introducation: In forensic practice, the finding like hemorrhage in pancreas was sometimes observed, but this finding was usually considered as degeneration.

In some textbooks, pancreas easily autolyzed after death, and this caused the finding.

However, we assumed that there might be slightly pancreatitis in those cases.

Thus, we checked the histologically findings of pancreas such as hemorrhage concerning forensic autopsy cases. Additionally, we also checked the expression of insulin and neutrophil elastase (NE) with immune-histochemical method.

Materials and methods: We used 50 autopsy cases in Nagasaki University. The postmorterm duration was from a few hours to about 3 months. The tail of pancreas was employed and stained with Hematoxylin and Eosin (HE) method. In addition, the insulin and NE was visualized immune-histochemically.

Result and discussion: There were 4 samples with the findings like hemorrhage using HE.

As there was one case without getting positive signal of insulin and NE, we considered that the sample of the case could be terrible degenerated and autolyzed, or autolyzed after pacreatitis.

The other case showed the positive stain of insulin and not that of NE. We thought that this case might be early stage of imflammation.

Since the remaining 2 cases had the positive signal of both proteins, inflammation might apparently develop after pancreatitis happened.

Therefore, our results suggested that the findings like hemorrhage in pancreas, which was observed at forensic practice, might due to antolyze. Moreover, pancreatitis must be included adding to autolyzation.


Deaths Caused by Systemic Malaria Infection: A Case Report

Taşkın Özdeş1, Fatih Şahin 2, Ayşe Özgün3, Esra Özgün Ünal2, Rıfat Özgür Özdemirel3, Hüsrev Demirel2

1Abant İzzet Baysal University, Medical Faculty, Forensic Medicine Department, Bolu, Turkey

2Council of Forensic Medicine, Istanbul, Turkey

3Council of Forensic Medicine, Morgue Specialition Department, Istanbul, Turkey

Malaria is a common disease (which occurs because of the parasites in the female anophele species of mosquitos), and it causes recurren fever and shivening. Diagnosis and treatment is possible and can easly done. It can lead serious problems if left untreated and even it can be fatal. It is estimated that more than 200 milion people in the world has caught this disease. Actually it is common Asia and Africa but because of airline access it's now spreading all over the world.

In our study, it is reported that the case was 46 years old male, he was from Holland, hotel crew who entered the room in the afternoon because at the fact that he didn't attend the breakfast; found him lying near his bed and medics told he was dead. Two bottles filled with liquid, and 92 tablets with labels of resochin was found in the hotel room investigation

At the autopsy we found various tattoings and ichteric image but not traumatic lesions. Also in internal examination we couldn't find any spesific founding. According to the report of Chemical Specialization Department report, chloroquine was found in the blood (30,7 μg/ml). In the bladder lawage, internal organs and stomach. It is also reported that they couldn't find the things that was searched at the systematic toxicological analysis of the fluids which was found at the hotel and chloroquine was found at the tablets which were labeled as Resochin. At the histopathologic examination of internal organs samples dark bashofilic stained small particles in the eritrocytes which gives an impression of plazmodium merozites was seen at the heart, lung pancreas cerebellum, brain stem and brain, that commonly filling the vessel lumens, at the liver and spleen, filing the sinosids and at the kidneys in the glomerules and at the interstisyl area in the eritrocytes filling the vessel lumens. At the autopsy report; we think that the death was caused because of the systemic malaria infection and the followings complication. According to the literature this type of case are very rare.

In our country malaria is common in East Anatolia and Southeast Anatolia but deaths are also rare in this regions. So it shows the importance of our case.

Also try to highlight the fact that the autopsies of people who came from abroad an travel frequently must be examined due to different diseases.


Endocardial Fibroelastosis; A Case Report

Demet Meral 1, Naciye Özeren1, Necmi Çekin2, Ahmet Hilal2

1Council of Forensic Medicine, Adana Group Administration, Adana, Turkey

2Çukurova University Faculty of Medicine, Department of Forensic Medicine, Adana, Turkey

Endocardial fibroelastosis is a very rare heart disease in children. Cases are generally under the age of two and most of them are asymptomatic. Some cases diagnosed during antenatal period.

A previously healthy five -month- old female was found dead on crib. At autopsy, external examination of the body was normal. Internal examination revealed a heart weighed 60 gr. Left ventricular endocardium was thickened and which have turned the colour porcelain white. Other endocardial surface and valves were normal. The aorta, pulmonary arteries and great veins were grossly normal.

Histopathological examination of the heart indicated endocardial fibroelastosis. The lungs showed bronchopneumonia, intra-alveolar fresh hemorrhage, hemosiderosin-laden macrophages within the alveoli. There were no significant abnormalities/changes in other organs.

Toxicological analyses revealed that there were no toxic substance, neither any drug and / or alcohol in his blood nor body fluids.

A forensic autopsy case of endocardial fibroelastosis will be presented and discussed on the bases of macroscopic and histopathological findings.


Fatal occupational injuries between 2000–2008 in the Lisbon Area – A retrospective study

Ana Catia Morais 1, Cátia Viana1, Tiago Costa1, Maria Cristina Mendonça2, Jorge Costa Santos3

1National Institute of Legal Medicine and Forensic Sciences of Portugal – South Branch (INMLCF)

2Faculty of Medicine, Coimbra University; National Institute of Legal Medicine and Forensic Sciences of Portugal – South Branch; CENCIFOR

3Faculty of Medicine, Lisbon University; National Institute of Legal Medicine and Forensic Sciences of Portugal – South Branch; CENCIFOR

Background: Occupational deaths are used as indicators of occupational safety worldwide. Recent literature has questioned the accuracy and completeness of ascertainment of such cases by various sources of information. In Portugal, occupational injuries are ruled by the Law 98/2009 that defines occupational injuries as a sudden and unexpected event suffered by an individual at the workplace or during working hours, performing work related tasks and/or during work related transportation. When the individual dies as a consequence of an occupational injury and enters the Forensic Pathology Department of the National Institute of Legal Medicine and Forensic Sciences (INMLCF) not all of the circumstances of the death event are necessarily known, so an underreporting of the fatal occupational fatalities can occur.

Methods: The information database of the South Branch (Lisbon) of the INMLCF, which classifies medico-legal death etiologies based on the death certificates and autopsy reports, was used. These reports include autopsy findings and laboratory and auxiliary imaging studies. Also, hospital and Police reports serve as complementary informational documents related to the event of death. Nine years (2000 to 2008) of deaths classified as occupational have been identified and reviewed for general socio-demographic characteristics and circumstances of death. Data was also compared to the official government statistics as an attempt to frame them in the country panorama for the same period.

Results: In the year 2000 a total of 234.182 occupational injuries were reported in Portugal (Social Security Ministry statistics), with a mortality rate of 0.00157. A decrease in the number of fatalities and a very subtle increase in the number of occupational injuries were subsequently recorded, reaching a mortality rate of 0.00116 per occupational injury in 2008. Our institutional data reveals a following decreasing tendency in the same period.

Conclusions: The observed consistent gradual tendency decrease in the number of occupational fatalities accompanies a national tendency, and might be explained by a number of factors such as safety measures adopted by the employers, road safety measures and slowing of the economy. An underreporting of transportation fatal injuries during work and work related activities is to be expected, due to general lack of information on the circumstances of traffic accident. The results also suggest the importance of carrying out case finding and of incorporating death certificates as one of the documents to be systematically reviewed, in order to collect more accurate statistics minimizing the underreporting of fatal occupational injuries.


Lethal Disseminated Parasitosis From P. falciparum. Imported Paludism In Milan: A Case Report

Elisa Palazzo, Antonella Piga, Graziano Domenico Luigi Crudele, Guendalina Gentile, Antonella Lazzaro, Alessandra Rancati, Riccardo Zoja

Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Morfologia Umana e Scienze Biomediche, Università degli Studi di Milano, Italy

Introduction: Most recent epidemiological studies about the surveillance and the Italian case reports of “imported malaria” confirm that there are a decrease of the number of the imported cases and a stable percentage of deaths, inferior to the European average. In our country, 83 % of cases is due to P. falciparum, that it is responsible also for the 0,004 % of deaths. The Authors report a lethal case of imported malaria that affected an Italian man (and that it was) characterized by a particular seriousness in its development.

The case: A 45 year-old man was found cadaver in his home by his relatives. They reported that he had spent his Christmas holiday in Mozambique but he did not have endemic disease prophylaxis. In the days after home-coming, he developed persistent hyperthermia with shivering for which he was also examined by his family doctor that prescribed paracetamol. It is unknown if the victim had revealed anything about his journey in a country where malaria is endemic to his doctor. Judicial Authority was informed about this death and a medico-legal autopsy was ordered two days after cadaver recovery. Autopsy did not show pathological findings that were demonstrative of the cause of death. On suspicion of a death due to a malignant form of malaria, toxicological, histological and parasitological analysis were performed on organs and biological fluids collected during autopsy.

Results: The histopathological analysis of organs stained with Heamatoxylin-Eosin showed intracytoplasmic malaria pigment located in lungs, hearth, liver, kidneys, spleen and brain. The histopathological analysis of thick blood smear stained with May-Grűnwald Giemsa (MGG) showed parasites in “ring configuration” that indicated a systemic malaria infection caused by P. falciparum. The toxicological analysis were negative.

Conclusions: This case report is particular because of the exceptional findings in Italy of an acute systemic malaria infection, the most important parasitosis in the World. For this reason, the Authors could qualify the exposed parasitosis as an imported disease diagnosed at post-mortem examination. The seriousness of this infection is also remarkable: in fact, it can be considered a pernicious malaria because of its systemic spread leading to the death of the victim, (an event considered today rare in industrialized countries.


Accidental cervical transection of a motorcyclist due to a rope tight across a driving street

Lucia Tattoli, Eloisa Maselli, Biagio Solarino, Alessandro Dell' Erba

Section of Legal Medicine, University of Bari, Bari, Italy

Background: The most common mechanism of fatal injury in motorcyclists is usually due to severe blunt force trauma, determining injuries mainly located at the head, neck and thorax. Motorcyclists typically collides with moving or stationary objects hitting them in different ways. The crashes are also influenced by several risk factors, such as the behaviour of both the victim and of other people involved. The Authors present an unusual fatal case of a man driving a scooter, who hit a rope tight across the road he was riding, suffering wide lacerated wounds of the neck, rupture of trachea, and hyoid and cervical spine fractures by hyperextension of the neck.

Method: A 53-year-old man, while he was riding a scooter, hit a rope which was tight across the road, between a tree and a car parked on the opposite side to allow the pruning of trees. The witnesses saw the rope hitting firstly the windshield of the moped and then the neck of the rider who fell to the ground, dying shortly after. According to the police report, the man was not wearing helmet, driving fast.

Results: External examination showed bruises of forehead, nose, lips, and limbs with linear transverse abrasions on mandibular and laterocervical areas. A 9 centimetres lacerated wound was observed on the base of the neck. At autopsy, a cerebral and cerebellum subarachnoid hemorrhages, with transection of the brainstem, rupture of left posterior communicating artery and trachea, fractures of hyoid bone, laceration of the left sternocleidomastoid muscle, fractures of C1, C2 with section of cervical spine, were found.

Conclusions: Trees are the most common causes in determining accidental fatal crashes in motorcyclists. In the case here presented, the cause of death was due to severe cervical spine trauma associated with subarachnoid hemorrhage, transection of brainstem, and vascular injury. Neck wounds was caused by the rope dragging and compressing upward on the anterior neck, resulting in a forced hyperextension of the cervical spine, and subsequent tearing of the skull base vessels.


Parasailing Fatalities: a Report of Three Cases

Mehmet Atılgan, Sema Demirçin, Yaşar Mustafa Karagöz

Akdeniz University Medical Faculty Department of Forensic Medicine,Antalya,Turkey

Parasailing is one of the most popular recreational activities in which a person is towed behind a motorized boat while attached by tow rope to a special designed parachute. There is only one published report of deaths occurring during parasailing activities in the forensic literature. In this study, we report for the first time, characteristics of three cases of parasailing fatalities occurred in Antalya, Turkey.

In one of these cases, a tourist and her friend, plunged into the sea while tandem parasailing as a sudden wind broke off the rope between the parachute and the boat. One of them died while the other was seriously injured. In another case, a tourist released his own safety harness while tandem parasailing, he made acrobatic moves and fell into the sea.

In third case, a tourist fell onto the beach after his safety harness failed while tandem parasailing. Autopsy findings in this case showed more fatal injuries due to hitting the ground.

These cases demonstrate some injury patterns in parasailing fatalities as well as the importance of wind conditions at the time of incidence, a thorough safety briefing before flight and the usage of proper equipment for parasailing.


Incidental Mediastinal Gossypiboma: Interpretative Medico-Legal Difficulties In A Case Of Malpractice Happened 14 Years Before Death

Elisa Palazzo, Arnaldo Migliorini, Graziano Domenico Luigi Crudele, Guendalina Gentile, Alessandra Rancati, Riccardo Zoja

Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Morfologia Umana e Scienze Biomediche, Università degli Studi di Milano, Italy

Introduction: The presence of a gauze retained in the thoracic cavity is a rare complication of a previous surgery and occurs more frequently in paediatric field, representing conversely an unusual occurrence among the adults. This report regards the accidental finding of a gauze in mediastinum, “forgotten” 14 years before the death of a woman, carrier of valvulopathy, whose death would have occurred for reasons not imputable to the intrathoracic foreign body.

The case: A fifty-three-year-old woman, Jehovah's Witness, underwent surgery of aortal and mitral replacement and plastic operations on a tricuspid valve. 14 years later, for the appearance of new symptoms, she had a further successful operation. The postoperative course was marked mostly by rehabilitative therapies, until the onset of respiratory failure, bilateral pleural effusions and fever, complicated by heart failure, which culminated in the death, due to hematemesis. At first, a not medico-legal autopsy was performed, straight afterwards suspended for the finding of a 5 cm tumefaction in the mediastinum, consisting of surgical gauze. The Judicial Authority was informed and ordered the medico-legal post-mortem examination, three day later.

Results: The judicial autopsy, in addition to the signs of previous necropsy, showed findings on heart (globose and hypertrophic), lungs (hepatized) and stomach (ulcers), thereby identifying the cause of death in the Multi Organ Failure (MOF) complicated by gastro-enterorrhagia for cardial ulcer. The mediastinal mass, consisting of partially digested and flaked surgical gauze, free from active inflammation, was radiographically compared with a sample of gauze in use at the last division of Heart Surgery where the patient was hospitalized, appearing completely different in kind. Histopathological examination of the viscera showed an acute generalized infectious involvement of multiple organs, which was quite consistent with the proposed cause of death, whereas that of garzoma, with no signs of acute and subacute inflammation, confirmed the initial macroscopic evaluation, indicative of a dated retention in the thorax of the foreign body.

Discussions: The case of malpractice, here reported, highlights the diagnostic and interpretative difficulties, regarding the incidental finding of a foreign body in the mediastinum, if the radiographic investigations, performed for chronic nonspecific symptoms, should not be conclusive. In particular, it is difficult to identify the role played by the intrathoracic foreign body, as primum movens in the genesis of sepsis responsible for the death, lacking post-mortem signs of active inflammation. Thereby, the histopathological investigation confirmed their essential importance in proper comprehension of a case.


Fatal injuries in cyclists: analysis of the epidemiological and medico-legal aspects and of the protective role of the helmet in a post-mortem case record in the territory of milan from 1995 to 2010

Luca Barulli 1, Marta Bianchi2, Graziano Crudele2, Guendalina Gentile2, Riccardo Zoja2

1Istituto di Medicina Legale – Università degli Studi di Trieste

2Laboratorio di Istopatologia forense – Sezione di Medicina Legale – Università degli Studi di Milano

Introduction: The involvement of the bicycle in traffic accidents is growing, especially in large urban conglomerates, such as, for instance, the Milanese one. The use of this form of transport is aimed for sports or recreational activities and its diffusion is due to logistic expediency. and ease of use. However, bicycle crashes are responsible for significant morbidity and mortality, due to simple falls and involvement of motor vehicles. In either event, the effect is often represented by head-brain injuries, which could be significatively reduced, if not even avoided, as reported by numerous studies, with the use of a suitable protective helmet. In Italy, despite the amendments to the legislative Decree of 30 April 1992, n° 285, introduced by the Law of 29 July 2010 n.120, the use of helmet is optional, as it is not mandatory even for children under 14. The purpose of this report is to demonstrate the efficacy of helmets, especially as regards lethal head-brain injuries.

Materials and methods: A retrospective study was performed using a post-mortem case record, collected between 1995 and 2005 at the Section of Legal Medicine of the University of Milan, relating to all cases of death due to road traumatism, with significant involvement of a bicycle. The analysis of the available necroscopic documents allowed to investigate the kind of the found lesions, the circumstances of the accident, and, if present, the protective efficacy of helmets.

Results: The number of cases was equal to 269 (1.6 % of total), examined considering various parameters: sex (male in 81 % of cases), age bracket (52 % of cases between 60 and 79 years), survival (64 %), seasonal trend of the events (oftener during spring and summer) and crash site (urban roads). The accidents happened in three ways: direct impact (231 cases), running down of the cyclist (31 cases), and impact followed by projection against obstacle (7 cases). The protective helmet was worn by only one victim. In most cases (84 %), the pathological lethal found was head-brain injuries, related with non-use of helmet.

Conclusions: The high number of helmetless cyclists, who died from injuries sustained in the cephalic region, would require legislative implementation of proper measures of prevention, such as the obligation to wear helmet, required for all two-wheelers, and the creation of special cyclists-reserved lanes.

This in order to reduce both the number of accidents and the frequency and severity of injuries suffered by road cyclist users.


Postmortem trace elements in lung and its relationship with changes due to chronic exposure to tobacco

María D Pérez Cárceles 1, Miguel Motas2, Agustin Sibón3, Silvia Jerez2, Rosa Martínez González2, Francisco J Pallarés4, Aurelio Luna1

1Department of Legal and Forensic Medicine, University of Murcia, Spain

2Department of Toxicology, University of Murcia, Spain

3Institute of Legal and Forensic Medicine, Cádiz, Spain

4Department of Pathology, University of Murcia, Spain

Different components of tobacco are heavy metals. These have proven to be carcinogenic in humans. Its main mechanism of action is to be comutagenic, i.e. involved in DNA repair processes. The aim of this study is to determine the concentrations of trace elements in lungs of deceased subjects and analyze its relationship with histopathological changes file due to chronic exposure to tobacco. We studied 62 medium lobes of lung from subjects with a mean age of 56 years. The different concentrations of trace elements (Ni, Sr, Br, Cd, Pb, Cr, Zn, As, Se) have been determinated in lungs. Solutions of lungs were prepared by acid-assisted microwave digestion by employing HNO3 and H2O2, and analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Lung tissue samples were examined under light microscopy. The severity of pathological changes was scored. Peribronchial inflammation was prominent, especially the presence of aggregates. Furthermore, the subjects exhibited alveolar destruction, emphysematous changes, epithelial proliferation, and increased alveolar macrophages, whereas control group did not. Vascular wall thickness, perivascular leukocyte-rich inflammation and interstitial inflammation were of moderate severity in subjects exposed to tobacco smoke. We found significantly higher levels of cadmium, bromine, nickel, arsenic, chromium and strontium in lung with histopathological changes due to chronic exposure to tobacco.


Carbon Monoxide Intoxication Death in the North of Portugal (2005–2011)

Maria Moura 1, Ricardo Mendes1, André Castro1, André Castro4, Sónia Tarelho1, Sónia Tarelho4, Helena M. Teixeira1, Helena M. Teixeira2, Helena M. Teixeira4, Helena M. Teixeira5, Agostinho Santos1, Agostinho Santos2, Agostinho Santos3, Agostinho Santos4

1National Institute of Legal Medicine - North Branch, Porto, Portugal

2Faculty of Medicine of the University of Porto, Porto, Portugal

3Health Sciences School of the University of Minho, Braga, Portugal

4Forensic Sciences Center - CENCIFOR, Portugal

5Faculty of Medicine of the University of Coimbra, Coimbra, Portugal

Background: Carbon monoxide (CO) is an odorless gas that can cause serious or fatal intoxications. Domestic accidents, caused by heating devices, are a public health problem worldwide; they constitute an important problem that is happening in Portugal mainly during winter, requiring special attention. CO intoxication also becomes an important subject since it can easily be used to commit suicide. This study aims to describe the epidemiology and characteristics of CO poisoning death in the North of Portugal.

Method: All the autopsy reports from the North Branch of the National Institute of Legal Medicine with CO toxicological requests were analysed, between January 2005 and December 2011. Data from circumstances of death, month of the year, gender, age, marital status, racial afinity, CO source, toxicological results, carboxyhaemoglobin (COHb) blood values and medico-legal death etiology were analyzed. SPSS 19 was used for the statistic analysis.

Results: In this period, 112 people died by CO intoxication: 70 % (n = 78) were male (ratio female:male = 1:2.4). The highest frequency of death (36 %; n = 40) occurred in the group over 65 years; the youngest was 4 and the oldest 93 years, both females. Deaths occurred mostly in winter, especially in January (27 %; n = 30) associated with fires (46 %; n = 39) and heating devices (30 %; n = 24), at home (56 %; n = 62). Mostly (63 %; n = 55) were diagnosed as domestic accident and 20 % (n = 18) as suicide; 56 % (n = 62) of the victims were alone at the moment of the occurrence. Post mortem toxicological screen revealed that almost half of the deaths (47 %) were positive for alcohol and/or drugs and 73 % (n = 80) of all presented carboxyhaemoglobin (COHb) >50 %.

Conclusion: The study results suggest that preventive interventions should be targeted at home environments and focus on at risk-groups such as men and elderly people, living alone. Setting stricter standards and environmental legislations, especially about fires, and promotion of public awareness against the dangers of CO exposure, mainly at home, are important considerations for overcoming this public health problem, trying to reduce the number of fatal events.


Concealed homicide by fire about a case

Ouallouche Kahina

chu nedir mohammed tizi ouzou algeria

The 22nd Congress IALM, Which Will Be Held in Istanbul

from 5 to 8 July 2012.




Concealed homicide by fire about a case

Summary /

Carbonization is the fourth degree burns after erythema, blisters and pressure sores. Forensic forms are dominated by accidents followed by suicide and homicide. The existence of cases of concealment of crimes by charring of corpses requires the medical examiner attention in the practice of lifting bodies and autopsies. The intent of the carbonization of a corpse is twofold: to mislead investigators about the deaths origins but also hinder identification.

The pathology and biology provide an undisputed assistance in assessing ante or post mortem burns.

During our activity, cases of concealment of crimes by the fire were autopsied; one of them has proved very informative.


Sudden death following hydatid cyst of the heart (About a case)

Ouallouche Kahina

chu nedir mohammed tizi ouzou algeria

The 22nd Congress IALM Istanbul

from 5 to 8 July 2012.

Sudden death following hydatid cyst of the heart (About a case).




Summary / Abstract.

The concept of "natural" sudden death requires clarification: unexpected and unpredictable, very short duration between onset of symptoms and death, cause thinning only by autopsy. The cardiac causes cover 75 % of cases.

We report a case of a young adult girl of 19 years, high school student, following a strong emotion, she died suddenly. The autopsy of the heart has allowed to show a renitent large mass of 05X4 cm occupying the ventricular septal which histological examination established the diagnosis of hydatid cyst.

The hydatid cyst of the heart is a rare pathology, even in countries endemic for hydatidosis, cardiac localization is 0.5 to 2 % of all other locations; This scarcity is explained partly by the need to cross the dam liver and lung by scolex before reaching the coronary circulation and partly by the natural resistance to the establishment of viable cysts offered cardiac contractions.

The etiologic diagnosis in postmortem intracardiac tumors can be difficult in the absence of obvious elements anamnestic necessitating the use of additional tests such as histopathology.


The Excessive accumulation of hemorrhage into the abdomen; Cardiopulmonary Resuscitation? A legal autopsy case

Eyyüp Yılmaz 1, Mehmet Özbay2, Elif Ömeroğlu2, Nezih Anolay2, Hüseyin Sarı2

1Directorship of Forensic Medicine Branch, Diyarbakır/ Turkey

2Ministry of Justice, The Council of Forensic Medicine, Istanbul/ Turkey

We report a legal case of a 37-year-old woman with a ruptured liver found at autopsy, which may have been related to the use of a mechanical cardiopulmonary resuscitation (CPR). At autopsy, a sign of intracardiac enjection that was performed in the hospital during CPR and strernum bone fracture was found. Unexpectedly, excessive accumulation of hemorrhage was seen into the abdomen. In addition, presence of hematom whose depth was measured as 1 centimeter was discovered through the Ligamentum Teres Hepatis. Despite prolonged continuation of mechanical CPR, she died of acute myocardial infarction. It was aimed that our case report may contribute to emergency and first aid medicine alongside with forensic pathology or forensic medicine literature.


Double-death case due to lightning strike

Eyyüp Yılmaz 1, Cem Uysal2, Süleyman Gören2

1Directorship of Forensic Medicine Branch, Diyarbakır/ Turkey

2Dicle University Medical Faculty, Department of Forensic Medicine, Diyarbakır/ Turkey

Lightning could be one of the most fatal natural events for human being. We report a legal case of double death which is related to lightning strike. According to eyewitnesses, it was clear that the event was suddenly and simultaneously occured. Cases were found as hugging to each other by crime scene investigation team in an exposed terrain near the outside of city. Ages of two boy victims who were cousin of each other were 13 and 15 years old. Torn and punctured parts on the clothes and shoes that was belong to victims were detected during the physical examination of the corpses. Asymmetric fumigated areas on the scalp, which was right temporal region of one case and left temporal region of the other, were a conspicuous clue. In our poster presentation, their sociodemographic characteristics and external traumatic findings of the cases, time of death, results of postmortem toxicological and histopathological examination as well as scene investigation features are discussed.


Diagnosis of CO intoxication with MR findings; case report

Mustafa Balkay 1, Nazım Özdemir1, Safa Çelik1, Cem Uysal2, Habib Bostan1, Ibrahim Üzün1, Sibel Çağlar1

1Cuncil of Forensic Medicine, Istanbul, Turkey

2Dicle University, Faculty of Medicine, Department of Forensic Medicine, Diyarbakır, Turkey

Carbon monoxide which is a colorless, odorless and nonirritant gases produced by noncomplete consumption of carbon fuels. It is slightly lighter than air and highly toxic gases at the lower concentrations. Carbon monoxide poisoning is the most common type of fatal air poisoning in many countries. In many countries, carbon monoxide intoxications are estimated more than half of the all fatal poisonings. When carbon-based fuels burn in the stoves, deaths and poisonings mostly can be originated from the lack of knowledge or omission. Our case was 61 years old woman. She was living alone. She was found within her house as a confusion state. She were follow-up in the intensive care unit with the diagnosis of CO intoxication. We discuss this case with her diffusion MR findings.

When people found her within the house, her house was smelt smoky. She was intoxicated from her stove. She was found by her relatives. The woman was brought to the emergency room and intubated. She was followed up with the diagnosis of carbon monoxide intoxication in the intensive care unit. Women were followed in the intensive care unit and then she died around the tenth day. When clinical symptoms have been evaluate together with the MR findings, It was decided that it was suitable with carbon monoxide poisoning. The criminal investigation file and treatment documents were sent to the Council of Forensic Medicine First Specialization Board and asked the cause of death by the prosecutor's office. When these files and diffusion MR images were evaluated, limited diffusion was observed at bilateral lentiform nuclei. As soon as poisoning occur, MR images were taken at the same day. After evaluation of diffusion MR images, stove smoke condition and confusion, Council of Forensic Medicine First Specialization Board was decided that the cause of death was originated from carbon monoxide poisoning.


Biochemical analyses of vitreous humor as a means of estimating the post-mortem interval

Zoran Mihailovic 1, Tatjana Atanasijevic1, Vesna Popovic1, Miroslav B. Milosevic2, Nemanja Radojevic3

1Institute of Forensic Medicine "Milovan Milovanovic", School of Medicine, University of Belgrade, Belgrade, Serbia

2Institute of Forensic Medicine, School of Medicine, University of Pristina(Kosovska Mitrovica), Serbia

3Department of Forensic Medicine, University Clinical Center of Montenegro, Montenegro

Vitreous humour is a useful medium for postmortem biochemical analysis due to it’s anatomic characteristics. After death, autolytic processes in vitreous humor take place, when changes in electrolyte concentration occur. The aim of this study was to analyse whether the concentrations of potassium(K+), magnesium(Mg2+), calcium(Ca2+) and lactates(L) in vitreous humor correlate with the postmortem interval. The prospective study included a total of 63 corpses, which were divided into two groups according to the temperature at which they were stored; corpses in the first group were kept at a temperature of 4°C (32 corpses), while the corpses of the other group kept at 20°C (31 body. Upon admission of the bodies to the Institute of Forensic Medicine, 0,1 ml of witreous humor was withdrawn from one eye only every three hours using the technic of repetitive sampling and immediately frozen at - 20 ° C. The concentrations of potassium, magnesium, calcium and lactate in VITREOUS HUMOR were measured using ARCHITECT C SYSTEM 8000. Highly significant correlation between VH potassium and PMI as well as between VH lactates and PMI was found, and therefore, equations for accurate estimation of the postmortem interval were defined including concentrations of potassium and lactates:

PMI = 2,561x[K+] - 8,803, r = 0,839 in the group of corpses kept at 4°C;

PMI = 2,746x[K+] - 12,305, r = 0,926 in the group of corpses kept at 20°C;

PMI = 1,493x[L] - 8,044 r = 0,688 in the group of corpses kept at 4°C and

PMI = 1,646x[L] - 10,450 r = 0,877 in the group of corpses kept at 20°C.

Calcium and magnesium demonstrated much weaker correlation against PMI and therefore, their use is not recommended. Further investigations are needed to evaluate those formulas on blinded cases with a known PMI in order to show whether the results are transferable to a single time removal of VH, what is the technique used in practical casework


study of 41 cases of suicide by self immolation in sfax (Tunisia)

Adnen Ayadi, Karama Regaieg

Department of legal medicine- habib bourguiba hospital sfax - tunisia

Objective: Given the remarkable rise in self-immolation in Tunisia in 2011

This study aims to investigate the risk factors related to the phenomenon, understanding warning signs for suicide is a crucial aspect of suicide prevention

Methods: It is a retrospective observational study condacted at the department of legal medecine of Habib Bourguiba Hospital, Sfax, from January 2003 to January 2011

All cases will reviewed for demographic variables including age, gender living area, marital status, employment status, psychological trauma, socio-economic status and trigger factor

In most of the cases, the individual had doused them selves in inflammable fluid, usually petrol

Results: among the 41 self-immolation cases recorded in the period. A majority of the victims were male (sex ratio: 4) with a mean age of 32 (between 15 and 56). 8 of the cases had previous psychological traumas. In most of the cases, immolation was done in public area. In 6 of the cases, the trigger factor was a family conflict, and in 8 others, i twas a conflict with the authorities. For the rest of the victims, they are unclear.

The median total body surface area burnt was 82.5 % (range30-100 %). All the victims had soot in their respiratory tracts soot in the respiratory tracts was associated to soot in digestive tracts in 10 cases. Blood had a mean 21 % carboxyhemoglobin concentration.

31 of the victims were jobless, 6 were daily warkers, and 4 were students. 9 were married and 31 were single.

Conclusion: This study suggest that the low socio economic statu is directely associated with this phenomena which reached epidemic proportion that spread to other cauntries like Algeria, Egypt, Yemen and Libya. Despite the relegious context strictly forbidding suicide.

In most of the cases, self immolation is seen as an act of self-glorification, symbol of humanity, and of desire to change.


Exogenous Lipoid Pneumonia: Autopsy case report

Gülden Sözer, Esra Gürlek Olgun, Gonca Pişkin Kesici

Morgue departmant, Council of Forensic Medicine, Izmir, Turkey

Backround: Lipoid pneumonia is an uncomman disease caused by the accumulation of lipid in lungs. It is usually classified into two groups, ie,exogenous or endogenous, depending on the source of lipid found in the lungs. Symptoms can vary significantly among individuals. The usual presentation occurs with nonspesific respiratory symptoms such as dyspnea and/or caugh. Radiologiacally lipoid pneumonia can manifest as consolidations or pulmonary noduls of soft tissue dansities. These presentations involve a wide differential diagnosis. Owing to the nonspesific clinical presentation and radiological features, the diagnosis is often missed or delayed. Generally acut presentation runs a benign caurse if promtly treated. Chronic cases are more persistent and difficult to treat. Possible complications include superinfection by nontuberculous mycobacteria, pulmonary fibrosis, respiratory insufficiency, cor pulmonale, and hypercalcemia.

Case: In this study, 10-year old female who had microcephally, tetraplagia, and mental-motor retardation is presented. She was presenting bronchopneumonia symptoms and hospitalized before she had died. Autopsy was performed in morgue department of Council of Forensic medicine, in Izmir. Grossly, the lungs were heavy, firm, and edematous. Microscopically, edema, hemorrhage, acut inflamatory infiltration, large lipid inclusions, foreign body giant cells, and macrophages were seen. The diagnosis is exogenous lipoid pneumonia.

Conclusion: Diagnosis of this disease requires high index of suspicion and can be comfirmed by histo/cytological examination of respiratory samples. Physicians and pathologists should consider this medical condition in order to prevent delaying of the diagnosis.


Death following malfunction of mechanical ventilation in als patient: “natural” or “mechanical” asphyxia?

Marco Di Paolo 1, Laura Evangelisti1, Nicolino Ambrosino2

1Section of Legal Medicine – Department of Neuroscience - University of Pisa, Pisa, Italy

2Pulmonary Unit, Cardio-Thoracic-Vascular Department, University Hospital, Pisa, Italy

Background: Amiotrophic Lateral Sclerosis (ALS) is a progressive, fatal, neurodegenerative disease with most affected patients dying of respiratory compromise and/or pneumonia 2 to 3 years since diagnosis. As ALS progresses, ventilatory assistance is required. In the end stages of disease, patients suffer from respiratory failure and become ventilator-dependent. Deaths due to malfunction of mechanical ventilators are reported but forensic autopsy records are very few. We report the case of a 69 years old ALS female ventilator-dependent, trachostomised patient found dead by her husband, with the ventilator in “stand-by” mode.

Method: A forensic autopsy was performed. Samples of internal organs were taken for histological and toxicological examination. The ventilator internal memory was also analyzed and tested in order to find possible malfunction.

Results: gross examination did not reveal any sign of trauma but showed brain and lung congestion. Pulmonary histological examination revealed thickening of peribronchial interstitial space, alveolar over-distension, break of inter-alveolar walls and diffuse alveolar haemorrhages. Focal microhemorrhages were also detected in other organs. Analysis of the ventilator internal memory showed that during the night of death, several voltage drops happened. Specific tests revealed malfunction of the internal battery which was unable to provide the necessary voltage, as a consequence the ventilator switched off, stopping ventilation. Battery malfunction reduced the volume of the ventilator’s alarm which was not heard by caregiver.

Conclusion: Histological pattern, with acute pulmonary emphysema and focal polivisceral haemorrhages, is strongly suggestive for a death due to “acute mechanical” asphyxia. The authors discuss the hypothesis that ALS patient maintained a residual breathing capacity and coul still answer to hypoxia. In the present case the hypothesis is that when the ventilation stopped, the patient produced a respiratory effort trying to breath spontaneously, but found a mechanical obstacle due to the presence of cuffed tracheostomy cannula.


Giant cell myocarditis in newborn

Doğuş Özdemir Kara, Dilhan Türkkan, Sultan Pehlivan, Hanife Alkan Kurt, Barış Akduman, Mustafa Karapirli

Council of Forensic Medicine, Ankara, Turkey

Background: Idiopatic giant cell myocarditis (IGCM) is a rare cause of arrhythmia, heart failure and death in children. Abouth %20 percent of cases myocarditis is associated with nu