Comparing fist size to heart size is not a viable technique to assess cardiomegaly.

PURPOSE: Several medical textbooks state that a human heart is approximately the size of that person's fist. Stating that a heart has the size of the corpse's fist is thought to signify that the heart size is normal. We formulate two hypotheses that are tested in this article. First, we hypothesize that in cases without cardiomegaly, volumes of the hand and the heart are not significantly different. Second, we hypothesize that in cases of cardiomegaly, the heart volume statistically significantly exceeds that of the hand. MATERIALS AND METHODS: We retrospectively reviewed 130 consecutive postmortem computed tomography datasets from the BLINDED starting from 01/01/2013, covering a period of approximately 3 months. Hands and hearts were segmented and their volumes estimated. We obtained the following information from the postmortem examination reports: age, sex, body length and weight, heart weight, cardiomegaly, and cause of death. RESULTS: When exploring the correlation between mean hand volume and heart volume, only in the group of the females with cardiomegaly (N=8) could a positive, statistically significant correlation be ascertained (Pearson correlation coefficient 0.753, P=.031). DISCUSSION: In this study, we demonstrated that the commonly used idea that a heart larger than the fist of a patient suggests cardiomegaly might be incorrect. Because this perception is commonly used in autopsy reports, it might lead to avoidable errors. Until further studies confirm this hypothesis, this informal measurement should no longer be taught or used.

Why We Need Postmortem Analysis of Cardiac Implantable Electronic Devices.

The prevalence of cardiac implantable electronic devices (CIEDs), pacemakers and implantable cardioverter defibrillators (ICDs) is increasing. However, postmortem analysis of CIEDs is not performed routinely. Fourteen consecutive CIEDs were analyzed. The indication for and date of implantation, technical data, CIED reprogramming, heart rhythm disturbances, patient demographics and medical consultations were investigated. Death during the first year after implantation was seen in 54%, whereof 71% consulted a physician within 10 days before death. The time of death was attributed to a particular day in 29%. There was a relationship between CIEDs and cause/manner of death in 50%. Although limited by a small sample size, this study advocates the routine postmortem CIED analysis for forensic and clinical purposes in selected cases. Patients with CIEDs seem to show an increased risk of death during the first year after implantation. The analysis of CIEDs can be helpful in evaluating the time/cause/manner of death.

Systematic Evaluation of Radiation Dose Reduction in CT Studies of Body Packers: Accuracy Down to Submillisievert Levels.

OBJECTIVE: The objective of this study was to systematically evaluate the accuracy of abdominal CT performed at different radiation dose levels for the detection of body packs in human cadavers, in comparison with the accuracy of abdominal radiography. MATERIALS AND METHODS: In this study, differing numbers of body packs (range, 0-20) were placed in the alimentary tract of human cadavers and then underwent imaging with abdominal radiography and with CT performed at different radiation dose levels (ranging from the standard abdominal CT dose to the technical minimum dose). Depiction of body packs on abdominal radiographs and on each CT scan was assessed by two independent blinded radiologists, and the accuracy of detection of body packs was calculated. The radiation dose associated with abdominal radiography was measured, and the effective radiation dose associated with CT was estimated. RESULTS: The mean (± SD) effective radiation dose for abdominal radiography was 1.4 ± 0.3 mSv, whereas the mean effective dose of CT ranged from 0.1 to 9.6 mSv. Interobserver agreement for body pack detection was moderate (κ = 0.51) for abdominal radiography and good (κ = 0.72-0.85) for CT. In a per-body pack analysis, abdominal radiography depicted 42% of the body packs with a sensitivity of 71% and a specificity of 100%. When performed at radiation dose levels of 0.6 mSv or greater, CT correctly detected all body packs. In per-person analysis, the sensitivity and specificity of CT for the correct detection of at least one body pack per cadaver was 100% for all radiation dose levels. CONCLUSION: CT performed at a dose of 0.6 mSv can be used for the detection of body packs. With a sensitivity and specificity of 100%, CT is superior to abdominal radiography in terms of reliability, associated radiation dose, and accuracy of detection.

Development of CT-guided biopsy sampling for time-dependent postmortem redistribution investigations in blood and alternative matrices--proof of concept and application on two cases.

The postmortem redistribution (PMR) phenomenon complicates interpretation in forensic toxicology. Human data on time-dependent PMR are rare and only exist for blood so far. A new method for investigation of time-dependent PMR in blood as well as in alternative body fluids and tissues was developed and evaluated using automated biopsy sampling. At admission of the bodies, introducer needles were placed in liver, lung, kidney, muscle, spleen, adipose tissue, heart, femoral vein, and lumbar spine using a robotic arm guided by a computed tomography scanner (CT). Needle placement accuracy was analyzed and found to be acceptable for the study purpose. Tissue biopsies and small volume body fluid samples were collected in triplicate through the introducer needles. At autopsy (around 24 h after admission), samples from the same body regions were collected. After mastering of the technical challenges, two authentic cases were analyzed as a proof of concept. Drug concentrations of venlafaxine, O-desmethylvenlafaxine, bromazepam, flupentixol, paroxetine, and lorazepam were determined by LC-MS/MS, and the percentage concentration changes between the two time points were calculated. Concentration changes were observed with both increases and decreases depending on analyte and matrix. While venlafaxine, flupentixol, paroxetine, and lorazepam generally showed changes above 30% and more, O-desmethylvenlafaxine and bromazepam did not undergo extensive PMR. The presented study shows that CT-controlled biopsy collection provides a valuable tool for systematic time-dependent PMR investigation, demanding only minimal sample amount and causing minimal damage to the body.

A fatal case of electrocution with unique forensic radiological postmortem findings.

PURPOSE: Documentation of forensic radiological observations in postmortem imaging of electrical injuries is not common yet and is less prevalent compared to other forms of burn injuries. However, electrical injuries have high morbidity and mortality. The objective of this case report was the visualization and evaluation of unique electrocution-related injuries by postmortem contrast and non-contrast enhanced imaging compared to a forensic autopsy. METHODS: Forensic imaging included whole-body postmortem computed tomography (PMCT), PMCT-angiography (PMCTA), postmortem magnetic resonance tomography (PMMR), and PMMR-angiography (PMMRA). Initial external inspection and subsequent autopsy were performed. RESULTS: Imaging results revealed intestinal mucosal pathologies, particularly of the gastric vascular integrity and remarkable rhabdomyolysis of the striated muscles of the extremities. Furthermore, PMCT and PMCTA revealed a hepatic lesion with perihepatic free fluid. The results from external inspection and autopsy correlated to the well-known pathologies of electrocution in the course of a high-voltage incident. CONCLUSION: Postmortem imaging visualized electrocution-related injuries and aided substantially in the medico-legal investigation. These findings, particularly of the rhabdomyolysis in magnetic resonance tomography, may support the future image interpretation of cases with electrical injuries-in the living and the deceased.

Role of post-mortem computed tomography (PMCT) in the assessment of the challenging diagnosis of pericardial tamponade as cause of death in cases with hemopericardium.

OBJECTIVES: When hemopericardium (HP) is found at autopsy, it represents a challenge for the forensic pathologist when having to assess its role in causing death. In fact, a proper diagnosis of pericardial tamponade (PT) must be based on clinical and instrumental data, which are not often available at post-mortem investigation. The aim of this study was to individuate post-mortem (PMCT) findings indicative for the diagnosis of PT. MATERIALS AND METHODS: We revised PMCT images and autopsy reports of 14 cases with fatal HP and intact pericardium. From autopsy reports, we obtained volume and cause of HP. PMCT images were reviewed to describe appearance of HP and the presence of indirect signs of increased intrapericardial pressure. A control group of 11 cases submitted to PMCT prior to autopsy was selected with the following criteria: absence of relevant pericardial effusion, venous system congestion and bleeding. RESULTS: Of the 14 PT subjects, 13 had a double-concentric stratification of HP and compression of the coronary sinus and/or of the pulmonary trunk, all showing a flattening of the anterior surface of the heart; other findings indicative of venous system congestion were variably observed. In the control group, none of these findings was identified, with the exception of a distended or non-completely collapsed superior vena cava (11/11 cases). CONCLUSIONS: PMCT is able to provide some findings indicative of PT. Based on this evidence, in other instances HP could be judged circumstantial rather than fatal. This study suggests the possibility to use PMCT findings to retrospectively demonstrate a clinical condition, such as PT.

Dual-energy CT behavior of heroin, cocaine, and typical adulterants.

PURPOSE: To investigate the dual-energy CT behavior of cocaine and heroin and of typical adulterants, and to evaluate the elemental composition of pure cocaine and heroin compared with cocaine and heroin in bodypacks. METHODS: Pure heroin and pure synthetic cocaine samples, eight different adulterants, and in each case ten different bodypacks containing cocaine or heroin, were imaged at 80, 100, 120, and 140 kVp in a dual source CT system at two different degrees of compression. Two radiologists, blinded to the samples, measured the attenuation. The dual-energy index (DEI) was calculated. We performed atomic mass spectrometry for the elemental analysis of pure cocaine, pure heroin, and heroin and cocaine in bodypacks, and 140 kVp in a dual-source CT system. RESULTS: Inter- and intra-observer agreement for attenuation measurements was good (r = 0.61-0.72; p < 0.01). The cocaine bodypacks had a positive DEI of 0.029, while the pure drugs and the heroin bodypacks had a negative DEI (-0.051 to -0.027). Levamisole was the only substance which expressed a positive DEI of 0.011, while the remaining adulterants had negative DEIs ranging between -0.015 and -0.215. Atomic mass spectrometry revealed a concentration of tin in the cocaine bodypack that was 67 times higher than in the pure synthetic cocaine sample. CONCLUSIONS: The different DEIs of bodypacks containing cocaine and heroin allow them to be distinguished with dual-energy CT. Although the material properties of pure cocaine, pure heroin, or common drug extenders do not explain the differences in DEI, tin contamination during illicit natural cocaine production may be a possible explanation.

[Examining victims of interpersonal violence]. / Untersuchung von Opfern nach interpersoneller Gewalt.

Interpersonal violence represents a widespread phenomenon with a high prevalence. Consequences of these acts of violence are serious and extensive to the victims and from a socio-economic point of view. Physical examination of the victims is a key aspect in the medic-legal expertise. This article describes the basic principles and the standard procedures in conjunction with the examination of violent crime victims.

La violence interpersonelle représente un phénomène répandu et fréquent. Les conséquences d'actes de violence sont souvent graves et de longue portée pour les parties prenantes ainsi que dans une perspective socioéconomique. L'examen de victimes de violence sexuelle et domestique est un thème central de l'expertise judiciaire. L'article suivant décrit le fondement et les procédés d'examen.

[Fixation of cells for analysis by laser microdissection--comparative studies in forensic trace material]. / Fixierung von Zellen zur Analyse mittels Laser-Mikrodissektion: Vergleichende Untersuchungen an forensischem Spurenmaterial.

This paper is focused on the preparation of samples for laser microdissection (LM) in forensic casework. In forensic genetics, it is essential to preserve and separate cellular traces during sample preparation, as they are usually gathered in very small amounts and are often contaminated with undesired cells. This is made possible by laser microdissection, a technique developed to cut cells or tissue of a certain type from a microscopical specimen by UV laser and catapult them directly into a PCR reactor. This method minimizes the risk of getting inconclusive, mixed DNA profiles due to contamination by foreign DNA and also supplies information about the cellular origin of a DNA profile. A method for optimized fixation and staining of spermatozoa for laser microdissection was established. Four different fixation methods combined with two staining methods were tested on two different microscope slides. Moreover, the effect of a blocker pen to contain the specimen on the slide was investigated.

[Analysis with the Combur-Test--special aspects in forensic trace examination]. / Analysen mit dem Combur-test--Besonderheiten in der forensischen Spurenuntersuchung.

The Combur Test is a ready-made and easy-to-use pretest for blood. It is based on the oxidation of tetramethylbenzidine (TMB), which is catalysed by haemoglobin and its derivatives. Despite its high sensitivity, there are many known substances which are responsible for false positive and false negative test results. On the basis of experiments of our own, case reports and the pertinent literature special aspects of the application of the Combur Test in the forensic routine case work are discussed.

Method to predict the chance of developing a male profile out of mixtures of male and female DNA.

In forensic examination it is a standard to take vaginal swabs from victims of sexual assault for further molecular genetic analysis. Laboratories then are usually confronted with mixtures of lots of female and only a small amount of male DNA. Nowadays it is possible to work with specific Y chromosomal markers after DNA extraction by differential lysis. The determined ratio of autosomal DNA and Y chromosomal DNA can be used to identify the possibility of generating a male profile in these samples.

[Semen analysis using methods of molecular genetics--a case report]. / Anwendung des molekulargenetischen Spermanachweises--ein Fallbeispiel.

The presented case report describes the exclusion of the suspect of a sexual offence by means of methods of molecular genetics. Pretests for prostate-specific antigen performed at the beginning of the investigation and cytological sperm tests were negative. Nevertheless, by combining the methods of differential lysis and DNA quantification a small number of spermatozoa could be demonstrated in the trace evidence. Subsequently, the profile of the woman's boyfriend, with whom she had had unprotected vaginal intercourse two days before the incident, could be detected in the fraction of the hard lysis.

Forensic and psychiatric aspects of joint suicide with carbon monoxide.

A case of joint suicide of a young woman and man who became acquainted in a suicide web forum and used this platform to make an appointment to commit suicide together is described. During their investigation, police were able to reconstruct the events by analysing the computer of the deceased women which was also found with the bodies. An indoor charcoal burning unit was used to release carbon monoxide as the method of suicide.

Trends in methadone-related deaths in Zurich.

Methadone has a long and successful history in the treatment of opioid addiction. In recent years, it has become popular again--as potent and inexpensive analgesic in patients with chronic pain. Since methadone has been used fatalities have been reported. In our study all methadone-associated deaths in Zurich from 1998 to 2007 were analysed. Most of the 146 detected deaths of the past 10 years occurred during substitution programmes or illicit intake of methadone while only three of them could be attributed to methadone used as an analgesic. Noticeable in our study was the high percentage of cases of combined drug intoxication (76%). The most frequent co-intoxicants were alcohol and cocaine. Mortalities attributed to methadone intoxication alone were a rare finding and could only be detected in five cases of deceased who had received methadone maintenance treatment. The aim of our study is to assess the trends in the number and nature of methadone-related fatalities in Zurich during the last 19 years. For this purpose a previous study from Zurich (1989-1997) was included, whereby a very long observation period and large number of cases resulted.

[Reconstruction of sexual offences--forensic aspects of sperm traces]. / Tatrekonstruktion bei Sexualdelikten--forensische Aspekte von Spermaspuren.

The investigation of sexual offences is a real challenge, as the injuries are often unspecific or faint and may sometimes be missing completely. Evidence recovery and analysis as well as the statements of the victims and suspects are therefore of vital importance. In both presented cases, the results of trace evidence analysis were basically consistent with a sexual assault, but the victims' statements regarding the course of events and the pattern of traces showed severe discrepancies.