Remains identification by frontal sinus radiographs.
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Anthropology, Physical↗
Biomedical subjects
K Sperry
Publications and source records attributed to K Sperry.
Tattoos and tattooing. Part II: Gross pathology, histopathology, medical complications, and applications.
Tattooing involves piercing the skin with needles bearing various pigments, to cause the permanent imprint of a design. The body responds to these incursions in specific and predictable ways, with initial sloughing of the overlying epidermis, variable dermal inflammation, and gradual assimilation of the pigment into macrophages. Eventually, much of the pigment is carried to the regional draining lymph nodes, with a residue staying within macrophages localized to dermal perivascular regions. The age of tattoos may be estimated, both grossly and microscopically. Tattooing can result in a variety of relatively uncommon complications and adverse reactions to the pigment, and certain infectious diseases may be inadvertently transmitted through tattooing when the instruments are inadequately sterilized, or when poor technique is used. This article, the second of three, describes the gross and microscopic pathology of both fresh and healed tattoos, and discusses the various complications (infectious and otherwise) that can occur. Tattooing has specific applications in both dermatology and plastic and reconstructive surgery, and these are also discussed.
Humans↗
Tattoos and tattooing. Part I: History and methodology.
Most medical examiners and pathologists who routinely perform autopsies identify tattoos on a daily basis. However, these dermagraphics generally are given only cursory inspection and description, if at all, although many pathologists photograph particularly unique, unusual, or bizarre examples. From a medicolegal perspective, these permanent skin designs are most often used as identification markers, especially in cases of unknown or questionable identity. The majority of pathologists and other physicians are not familiar with the way in which tattoos are applied, much less the history of this unusual art or the various aspects of tattoos that may provide even more complete information as to how, where, why, and when the tattoos were done. This article, the first of three parts, provides a brief but comprehensive history of tattooing from both the worldwide and Western perspectives, describes how professional tattooing is done, and illustrates the machines involved and the various constituents of the inks that are currently used. The second and third articles will explore the gross and histopathology of tattoos, methods of tattoo removal, medical applications and complications associated with tattoos, psychology and psychopathology of tattoos, and the importance of tattoos in forensic medicine.
Europe↗
Radiographic identification by mastoid sinus and arterial pattern.
A skull and some incomplete postcranial remains were discovered in two searches over a two-month period near Santa Fe, New Mexico. The discoveries could be demonstrated to be from the same person, and the remains were shown to be consistent with a specific missing person on the basis of anthropological analysis. Further work led to a positive identification on multiple grounds, including agreement of the details of the mastoid sinus and endocranial arterial patterns observed radiographically. These features may be useful for establishing positive identification from skeletal remains when antemortem radiographic studies for comparison are limited to lateral cranial vault studies.
Adult↗
Anterior thoracic wall trauma in elderly homicide victims. The "CPR defense".
During the course of medicolegal postmortem examinations, forensic pathologists often encounter the sequelae of cardiopulmonary resuscitation (CPR) that was administered by medical and paramedical personnel. A wide variety of CPR-related injuries have been described since the institution nearly 30 years ago of this now common-place emergency technique. The forensic pathologist must be aware of both typical and unusual CPR-related trauma patterns in order to differentiate between injury produced during emergency therapy procedures and injury sustained through other mechanisms (for example, during an assault or an accident). This article describes two recent separate and unrelated incidents in which an elderly woman was murdered. In each instance, bony injuries of the anterior thoracic wall structures were identified during the autopsy. Defense attorneys in each case attempted to use these injuries as proof that their accused clients had performed external cardiac massage on their victims, thus indicating that the homicides had not been intentional, and that the perpetrators showed remorse. These cases are presented, with a discussion of the typical features of CPR-related thoracic wall trauma as compared with willfully inflicted injury.
Aged↗
Fatal ethanol intoxication from household products not intended for ingestion.
Fatal acute ethanol intoxication is frequently encountered in medicolegal practice. Although the vast majority of acute ethanol toxicity deaths follow the ingestion of conventional alcoholic beverages, ethanol can be obtained from a variety of commercial products, which often contain high levels of ethyl alcohol but are not manufactured or designed for consumption. Such products may be easily purchased in locales where statutory limitations restrict liquor availability on Sundays or during the early morning hours. Several acute ethanol fatalities have been encountered in New Mexico that were directly related to consumption of non-beverage ethanol-containing products, all of them occurring during times when alcoholic beverage sales were restricted. Despite the fact that manufacturers deliberately include compounds in these products that discourage ingestion, this policy apparently does little to deter individuals who are searching for a source of ethanol when no conventional beverages are available. The products that were consumed in these fatalities also contained other compounds which would be toxic at much greater concentrations, but which were inconsequential in their effects in comparison with the direct toxic effect of ethanol. Investigation of the scene and awareness that alcohol-containing products can be fatally abused are essential to detecting these unconventional ethanol sources.
Adult↗
Inadvertent clavicular fractures caused by "chiropractic" manipulations in an infant: an unusual form of pseudoabuse.
A nine-month-old child was found unresponsive in his crib, five hours after his last feeding. At autopsy, there were no external or internal signs of abuse or neglect, and a few visceral pleural and epicardial petechiae were consistent with the sudden infant death syndrome (SIDS). However, postmortem total body radiographs revealed healing, symmetrical clavicular fractures and a healing left medial humeral epicondyle fracture. The parents had no explanation for these injuries and denied causing any harm to the child. The location and nature of the fractures strongly suggested abusive origin, and the case was reported to the police and the district attorney's office as child abuse. During the investigation, information from the parents indicated that the child had undergone "chiropractic" manipulations by an unlicensed therapist, between three and four weeks prior to death, to correct supposed "shoulder dislocations." This time interval correlated with the histologic age of the injuries, and the history explained their unusual bilateral location and appearance. The parents were exonerated of abuse charges, and the death was ascribed to SIDS.
Cause of Death↗
An elliptical incised wound of the breast misinterpreted as a bite injury.
Bite injuries upon homicide victims are most often initially identified by the forensic pathologist during the course of the autopsy examination. Following such recognition, the injury or photographs of the traumatized site are then referred to a forensic odontologist for his or her examination, further characterization, and subsequent comparison with any suspect's dentition. However, if the pathologist misidentifies an injury caused by another mechanism as a human bite, this mistake can potentially be perpetuated by the dental consultant, since relatively few dentists regularly examine traumatic injuries other than those arising from bites. To illustrate such an event, a case is presented involving an incised wound of the breast, which was originally identified as an avulsive bite wound. Detailed examination by two odontologic consultants confirmed the wound as having been caused by human teeth, and further, they related the "bite injury" to a specific individual. The bite injury interpretation represented the only scientific evidence implicating the suspect at a subsequent trial for capital murder. Later examination of the tissues and photographs by a forensic pathologist and another dental consultant revealed that the injury was not due to human dentition, but rather resulted from a sharp-edged instrument. These consultants conducted a unique experiment to reduplicate the injury and prove its causation. This information was presented to the jury during the suspect's trial and resulted in his acquittal on all charges.
Adult↗
A piece of my mind. Belinda, asleep without dreams.
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Child Abuse↗
Fatal intraoperative hemorrhage during spinal fusion surgery for osteogenesis imperfecta.
Osteogenesis imperfecta (OI) is an uncommon inherited systemic disorder of the connective tissues characterized primarily by varying degrees of bony fragility. Consequently, individuals affected by this condition frequently suffer severe skeletal injuries from otherwise innocuous traumatic events. This syndrome has other associated abnormalities, including hydrocephalus and brain stem compression on the basis of cranial developmental defects (platybasia), cardiac and vascular problems, respiratory disease from spinal deformities, vascular fragility, a bleeding disorder caused by an apparent platelet function abnormality, and anesthesia-related hyperpyrexia. A case is presented here of a young girl with advanced OI in whom intraoperative death occurred as a consequence of inadvertent rib fractures, with subsequent uncontrollable hemorrhage. OI may also potentially be mistaken for child abuse by an inexperienced examiner.
Child↗
Suicide by intravenous injection of cocaine. A report of three cases.
Death as a consequence of cocaine abuse is continuing to increase in all parts of the United States. Cocaine use may cause the development of psychosis, with subsequent expression of suicidal ideations, and potentially even successful suicide. Cocaine dependence may also cause depression in the individual who is unable to control his or her craving for the drug, and suicide may be perceived as the only solution to a desperate problem. Despite the dramatic escalation of cocaine abuse and the potential toxicity of this drug, there have been no reports within the United States of cocaine being used as the agent to accomplish a suicide. Herewith are reported three cases in which depression and desperation over cocaine dependence were the motivations for successful suicide, which was accomplished through the intravenous injection of cocaine to the point of death. True cocaine suicide is probably only identified through the presence of objective scene information that unequivocally proves suicidal intent, such as notes or letters which contain information to this effect. A careful search of the scene of death in cocaine fatalities is mandatory, and diligent application of routine scene investigation principles may reveal that suicide through the use of cocaine is more widespread than first appearances would suggest.
Adult↗
Suicide with, and because of, cocaine.
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Adult↗
Earlobe creases and coronary atherosclerosis.
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Adult↗
An epidemic of intravenous narcoticism deaths associated with the resurgence of black tar heroin.
In the latter part of 1985, a dramatic rise in the number of illicit narcotic (heroin) related deaths in the State of New Mexico became apparent, and this increase persisted through the majority of the following year. A careful inspection of samples of narcotics found at the scenes of death, coupled with changes in the illicit drug traffic detected by local and state law enforcement agencies, revealed that the rising death rate corresponded with the distinctively increased availability of a form of heroin that is produced in Mexico, commonly termed "black tar" heroin. An analysis of heroin deaths, comparing characteristics of cumulative deaths in the six years before the increase with those deaths associated with the apparent epidemic, revealed several significant observations. These factors, along with the distinctive physical features of black tar heroin, suggest that the rise in the narcotic abuse death rate may be related to both unfamiliarity with this type of heroin on the part of the user and the inherent difficulty of diluting nonpowdered forms of the drug to sublethal levels.
Adult↗
An unusual, deep lingual hemorrhage as a consequence of ligature strangulation.
During the course of the daily practice of forensic pathology, little or no attention is generally devoted to the tongue (if it is even removed at all during the autopsy examination) except in a handful of relatively well-defined situations. In some other instances, such as injuries involving the neck and laryngopharyngeal organs, the tongue may be removed, but examined in only a cursory manner, since the serious pathology which caused or contributed to death is most often located in adjacent structures. While the postmortem examination was being carried out on a victim of ligature strangulation who exhibited relatively sparse external and laryngeal findings of significance, a unique and apparently heretofore undescribed patterned hemorrhage was discovered within the deep musculature of the tongue, having an appearance and contour identical to that of the curved edge of the subjacent hyoid bone. In difficult cases where strangulation is suspected as well as other potentially medicolegal problems with trauma involving the neck organs, a detailed inspection of the tongue through an easily accomplished dissection technique may provide invaluable information as to the mechanism of injury.
Aged↗
Terminal ballistic characteristics of Hydra-Shok ammunition: a description of three cases.
The Hydra-Shok bullet is characterized by a hollow-point construction, with a distinctive central post in the base of the hollow. These features allow such missiles to be easily identified during the course of an autopsy examination of a gunshot victim. Higher velocity loadings of the Hydra-Shok may fragment along the wound path, occasionally forming a ring-like fragment that suggests this ammunition, but this feature cannot be considered unique. Although radiographic examination is helpful in bullet localization, the characteristic central post may be identified by X-ray only if sufficient expansion results in its exposure. Three cases of shooting deaths involving Hydra-Shok bullets are presented and discussed; in each case, the entrance wounds were indistinguishable from entrances associated with conventional ammunition, and in no instance did the missiles exit from the body (including head, chest, and abdominal wounds). Familiarity with relatively unusual ammunition types such as the Hydra-Shok allows for quick identification by the pathologist at the time of autopsy.
Abdominal Injuries↗
Ultrastructural and immunofluorescent detection of herpes simplex virus after embalming and burial.
The practice of embalming preserves body tissues, and embalmed bodies may resist decay processes for many decades with relatively little change. As the chemicals used for embalming are poisonous to microorganisms, bacterial and viral cultures are futile after such funerary procedures are performed. However, embalming may act as a virtual tissue fixative, especially with arterial perfusion, and identification methods other than culture may be used to detect and identify pathogenic organisms. In the case presented here, a death from a fulminating, but unidentified, illness in a young girl was successfully diagnosed as herpes hepatitis by immunofluorescent and electron-microscopic studies of tissue obtained 3 weeks after she was embalmed and interred. Routine embalming and burial should not eliminate these diagnostic procedures from consideration in specific situations where potentially useful information may be realized.
Autopsy↗
Fatal intoxication by tocainide.
A 26-year-old woman committed suicide by ingestion of a large quantity of tocainide, a recently developed oral antiarrhythmic agent with chemical similarities to lidocaine. Blood and bodily fluid analysis by thin-layer chromatography, high pressure liquid chromatography, and mass spectroscopy confirmed the presence of tocainide, with a serum level of 68 mg/L, nearly 7 times the upper recommended therapeutic level for this drug. Tocainide was also detected at significant levels in vitreous fluid and bile. Although the mechanism of death from tocainide intoxication in animal studies is related to central nervous system toxicity, the presentation of ventricular tachyarrhythmias with coma in this patient suggests that tocainide at high levels may have primary myocardiotoxicity in humans.
Adult↗