Post-mortem computed tomography in forensic investigations of lethal gunshot incidents: is there an added value?

The aim of this study is to assess the added value of post-mortem computed tomography (PMCT) in fatal shooting incidents compared with autopsy findings. For this study, the analysis was restricted to the following four features: location of the entrance and exit wounds, internal injuries, location of projectiles or metal fragments and course of the trajectories. These features were selected because they provide essential information on the cause and manner of death. All data were retrospectively collected from medical forensic examinations of fatal shooting incidents in the Netherlands that occurred in 2010-2014. Twenty-one fatal shooting victims were included in this study, with a total of 100 trajectories. For all 100 trajectories, the forensic radiologist and pathologist came to a consensus on which examination had the highest diagnostic value for each of the four features. PMCT provides superior information on the presence of metal fragments, internal injuries and the course of trajectories. PMCT provides limited information on the discrimination of entrance and exit wounds. In conclusion, PMCT provides additional relevant information in over 60% of forensic medical examinations of deceased victims of shooting incidents. We therefore recommend adding PMCT as a standard examination in these cases.

Pulse conductance and flow-induced hemolysis during pulsatile cardiopulmonary bypass.

In this study, the hypothesis was tested that a low-resistant, high-compliant oxygenator provides better pulse conductance and less hemolysis than a high-resistant, low-compliant oxygenator during pulsatile cardiopulmonary bypass. Forty adults undergoing coronary artery bypass surgery were randomly divided into two groups using either an oxygenator with a relatively low hydraulic resistance (Quadrox BE-HMO 2000, Maquet Cardiopulmonary AG, Hirrlingen, Germany) or with a relatively high hydraulic resistance (Capiox SX18, Terumo Cardiovascular Systems, Tokyo, Japan). The phase shift between the flow signals measured at the inlet and outlet of the oxygenator was used to assess compliance. Pulse conductance in terms of pressure attenuation was calculated by dividing the outlet pulse pressure of the oxygenator by the inlet pulse pressure. A normalized index was used to assess hemolysis. The phase shifts in time of the flow pulses were 36 +/- 6 ms in the low-resistant (high-compliant) oxygenator, and 14 +/- 2 ms in the high-resistant (low-compliant) oxygenator group (P < 0.001). The low-resistant, high-compliant oxygenator provided 27% better pulse conductance compared with the high-resistant, low-compliant oxygenator (0.84 +/- 0.02 and 0.66 +/- 0.01, respectively, P < 0.001). Inlet pulse pressures were significantly higher (29%) in the high-resistant, low-compliant (Capiox) group than in the low-resistant, high-compliant (Quadrox) group (838 +/- 38 mm Hg and 648 +/- 25 mm Hg respectively, P < 0.001), but no significant difference in hemolysis was found. A low-resistant, high-compliant oxygenator provides better pulse conduction than a high-resistant, low-compliant oxygenator. However, the study data could not confirm the association of high pressures with increased hemolysis.