A review of 300 attempted strangulation cases Part III: injuries in fatal cases.

A review of 300 cases of alleged strangulation assault, submitted for misdemeanor prosecution by the San Diego City Attorney's Office, led to a search for medical evidence that would be useful to prosecute these cases (see Strack et al. in this issue of the Journal). The injuries identified in these non-fatal cases are similar to injuries found in fatal domestic violence strangulation assaults. This article reviews the injuries recognizable at autopsy in cases of strangulation in domestic violence victims.

Fatalities involving bicycles: a non-random population.

Bicycle riders constitute a small subgroup of all roadway deaths. Bicycle/motor vehicle collision fatalities are less frequent than pedestrian/motor vehicle fatalities. Studies have shown that non-fatal injuries of bicyclists are not randomly distributed, but follow age and sex trends that differ in the U.S. and Scandinavia. Although the bicycle-related fatalities reviewed herein do not constitute a complete profile of all such cases within our geographic area, review of these cases does provide insight into the non-random population of fatally injured cyclists in urban and rural America. A retrospective demographic and forensic medical review of 36 bicycle-related fatalities was done to clarify features of this non-random population. Consistent features including age and sex, patterned injuries and risk-taking behavior are discussed. Three of 24 (12%) adult cyclists died of homicidal gunshot wounds.

Homicidal cardiac lacerations in children.

We report six cases of intentionally inflicted cardiac laceration. The victims ranged in age from 9 weeks to 2 1/2 years. Five victims were girls and in five cases the right atrium was lacerated. The left ventricle was lacerated in the other case. In the three cases with a confession, one victim each was struck with a fist, stomped, and kicked. Four patients had rib fractures, with at least two fractures in each case. Cardiac rupture from blunt trauma most commonly results from compression of the heart between the sternum and vertebral column, but may also occur from compression of the abdomen or legs, deceleration, blast injury, puncture of the heart by a fractured rib, and rupture through a resolving contusion. Accidentally acquired cardiac lacerations usually result from motor vehicle accidents or similarly severe forces. In children there are neither well documented cases of cardiac laceration nor of rib fractures from cardiopulmonary resuscitation. Cardiac lacerations, as with other types of severe trauma acquired at home, are almost never accidental.

Fatal anorectal injuries: a series of four cases.

Anorectal injuries associated with sexual practices have become more frequently reported in the last decade. Although anorectal injuries are commonly reported in cases of sexual abuse of children, fatalities are very rare. In this series of cases, we report a case of fatal child abuse resulting from anal intercourse. In addition, there are two cases of death in females as a result of heterosexual "fisting" or "handballing." The fourth case of the series is that of a homicidal injury produced by rectal impalement with a 31 inch length of threaded pipe.

Investigation of the 1987 Indianapolis Airport Ramada Inn incident.

On October 20, 1987, a military reserve aircraft lost power during a transcontinental flight and attempted an emergency landing at The Indianapolis International Airport. The pilot ejected and the disabled and pilotless aircraft struck a bank building. It then skidded across the street and entered the lobby of The Airport Ramada Inn where it exploded. This incident was unusual in that the fatal injuries occurred in individuals on the ground and not in the occupant of the aircraft. Seven people were killed in the lobby area and two were trapped in a laundry where they died of smoke inhalation. A tenth person died of burns ten days later. Minor injuries were reported among four hotel guests, two firefighters and the Air Force pilot. A multiagency mass disaster-plan had been formulated and rehearsed in preparation for the Panamerican Games, which had been held in Indianapolis in August 1987. A number of volunteers arrived before a security perimeter was established. They began an undocumented removal of the bodies from the scene and were about to remove valuables for "safekeeping" when stopped by coroners' office personnel. Fatalities resulted from smoke inhalation, burns or a combination. Bodies were identified by a combination of dental records, personal effects and visual means within 24 hours. The problems encountered in managing this disaster scene will also be compared with previously reported incidents.

Firearm suicides during confrontations with police.

We reviewed the case records of suicides in Marion County, Indiana (Indianapolis) and in surrounding counties from 1984 through 1992. Out of 1203 suicides, there were 14 in which armed, on-duty police officers were confronting, pursuing, or apprehending the subject of the death investigation. All subjects were male, and the peak age range was 30 to 34 years. The head, especially the right temple, was the usual site of the fatal wound. More than half of the incidents started as domestic disputes with a wife or girlfriend. Many of the others occurred when police officers pursued or arrested a suspect wanted for a previous felony. Ethanol was involved in less than half of the cases, and drugs were not a factor. In at least four cases, the presence of police was a factor that precipitated the suicide. The histories of the 14 cases demonstrate the potential for controversy and the challenges for forensic scientists investigating suicides during police confrontations.

Disinterment from paving materials: use of heavy equipment for exhumation and examination of bodies.

Common paving materials--concrete and asphalt--pose an unusual and complex barrier to disinterment and examination of human remains. Although not commonly encountered, these materials are seen with sufficient frequency to justify consideration of the procedures and equipment necessary for disinterment. Over a seven year period we have encountered paving materials seven times. In each of these cases, the material was slightly different in quality, and different tools--including heavy construction equipment--were necessary. Sometimes the paving material could be managed without heavy power tools, but occasionally specialized construction tools have proven very useful.

Atypical gunshot wound caused by cylinder index error.

Atypical gunshot wounds are caused by a diverse set of parameters relating to weapons and ammunition. Documentation of cases where atypical gunshot wounds can be explained facilitates future interpretation of wounds in unusual cases. We report an atypical gunshot wound produced by a double-action Colt .38-caliber special handgun with a cylinder index error. Cylinder index error is caused by a misalignment between the cylinder chamber and barrel forcing cone. When properly functioning, the cylinder chamber and barrel forcing cone are held in alignment by the union of the ratchet and latch pin. In this case, misalignment was caused by wear of the ratchet and latch pin, which allowed play in the cylinder. With the weapon turned on its side, and the swing arm down, the cylinder chamber overlaps the barrel forcing cone. When fired, the index error caused lead fragments to shear off the bullet and expel laterally out the cylinder gap between the cylinder chamber and barrel forcing cone, creating fragment entrance wounds several centimeters distant from the site of contact entry.

Unexpectedly homicide. Three intraoral gunshot wounds.

Determination of suicide as a manner of death can be a complex process. Whenever gunshot wounding is the cause of death, the anatomic clues useful for determining suicide versus homicide include wound location and range of fire. Contact intraoral gunshot wounds are much more frequently associated with suicide than with homicide. However, based on prosecuted cases, three of 66 consecutive cases of intraoral gunshot wounds were found to be homicides.

Asphyxial deaths due to hanging in children.

A review of the records for five years from the Coroner's Offices of Marion County, Indiana and Franklin County, Ohio, which have a combined population of 2.4 million, yielded 12 cases of hanging deaths in children 13 years of age or younger. The age range was 2 1/2 to 13 years and only two of the 12 victims were female. There were three unequivocal suicides, five accidental deaths and four cases where, despite extensive investigation, the manner of death remained undetermined. The scene and autopsy findings are presented and the cases discussed with regard to determination of manner of death. Additionally, the significance and pathophysiology of petechiae are discussed.

An autopsy case review of 142 nonpenetrating (blunt) injuries of the aorta.

This study retrospectively reviewed 142 fatal cases of aortic laceration. Data were collected from the autopsy reports (including toxicology results) and included the circumstances of the injury. In the case of automobile crashes this included the direction of impact, time of day, and vehicular damage. Seventy percent of the victims were men with a mean age of 37.5 years; 30% were women with a mean age of 46 years. Thirty-five percent of the 142 victims had elevated blood alcohol levels. Fifty-four percent of the lacerations were located at the classic site (the isthmus). The majority of the aortic lacerations (102) were sustained in automobile crashes. Of these, 42% were broadside collisions and 58% were head-on collisions. Seventy-three percent and 67% of the victims in broadside and head-on collisions, respectively, had aortic lacerations at the classic site. The results suggest that the pathogenesis of aortic rupture involves a lateral oblique compression impact to the chest, which causes thoracic mediastinal structures to shift and deflect the aortic arch, resulting in severe shearing and stretching at the isthmus. The use of seat belts and air bags may reduce the number of aortic injuries.

Incidence of sudden athletic deaths between 1985 and 1990 in Marion County, Indiana.

Relatively little information is available concerning the incidence of sudden death in athletes in the United States. The present study provides annual incidence rates of sudden athletic deaths in Marion County, Indiana, home of Indianapolis, the "amateur sports capital of the world." The overall incidence was 0.04% (18 athletic deaths in 44,481 forensic necropsies). This incidence varied slightly over the 6-year study period: 1985 (0.06%), 1986 (0.03%), 1987 (0.04%), 1988 (0.09%), 1989 (0%), 1990 (0.01%). Of the 18 sudden athletic deaths, 88% were cardiac in origin. A retrospective analysis of preparticipation screening efforts suggests that most of the cardiac conditions responsible for death could have been detected.

Cardiac pathology in 2007 consecutive forensic autopsies.

The incidence of various types of cardiovascular disease was evaluated in 2007 consecutive forensic patients. Cardiovascular deaths accounted for 22.8% of the study patients and atherosclerotic coronary heart disease was the most common type of cardiac disease (18%). Among subjects dying of atherosclerotic coronary disease, sudden death was three times more frequent than acute myocardial infarction. Expected cardiac findings included the incidence of severe coronary atherosclerosis (21%), floppy mitral valves (5%), and congenital bicuspid aortic valves (1%). Major cardiac findings occurred in 32% and minor cardiac findings were found in 40%. Only 17% of hearts were anatomically normal. An unexpected cardiac necropsy finding included the high frequency of myocardial bridges (23%). Unexpected cardiac findings included the low incidence of acute myocarditis (0.6%) and common finding of tunneled epicardial coronary arteries ("myocardial bridges") (23%).

Fatal and near-fatal animal bite injuries.

Fatal and near-fatal maulings of humans by pit bulls have recently become a topic of major public concern, resulting in the passage of laws in some jurisdictions that make the owner of a pit bull criminally liable for manslaughter if his or her pet causes a human death. The authors recently investigated two cases in which children were fatally injured by pet dogs. In the first case, a 17-day-old girl suffered fatal abdominal injuries when attacked by a pregnant Siberian husky. A 2-year-old girl expired from neck wounds inflicted by a pit bull or a rottweiler or both. Because no expert would testify as to which dog caused the fatal injury, the owner of the animals was not charged under a statute which specified criminality only if a pit bull caused the fatal injury. We also examined a 12-year-old boy who attempted to pet a circus tiger; the animal grabbed his arm with its claws and bit off the arm at the shoulder. The arm could not be reattached, but the child survived. These cases and the differentiation of animal bites from other injuries will be presented.

Specimens for teaching forensic pathology, odontology, and anthropology. I. Soft tissue.

A set of specimens has been collected, preserved, and organized specifically for the teaching of forensic pathology, odontology, and anthropology. Plastination of soft tissue, whole organs, bones, and teeth has proven valuable in preserving delicate, friable, and calcined specimens. The dry, odorless, biologically inert specimens are durable and resistant to damage caused by handling. Subtle features of soft tissue pathology are well preserved. Patterned injuries change due to shrinkage, but remain easily recognizable. Plastinated whole jaws are still readily identifiable from antemortem records. Radiographic density is essentially unchanged. Putrid and charred specimens become quite manageable.

Specimens for teaching forensic pathology, odontology, and anthropology. II. Teeth and bone.

A set of specimens has been collected, preserved, and organized specifically for the teaching of forensic pathology, odontology, and anthropology. Plastination of soft tissue, whole organs, bones, and teeth has proven valuable in preserving delicate, friable, and calcined specimens. The dry, odorless, biologically inert specimens are durable and resistant to damage caused by handling. Subtle features of soft tissue pathology are well preserved. Patterned injuries change due to shrinkage, but remain easily recognizable. Plastinated whole jaws are still readily identifiable from antemortem records. Radiograph density is essentially unchanged. Putrid and charred specimens become quite manageable.

Cardiac pathology in 470 consecutive forensic autopsies.

Cardiovascular disease continues to be the single most common generic cause of sudden and unexpected deaths. Atherosclerotic coronary heart disease and acute myocardial infarction are the most prevalent forms of fatal cardiac disease observed at autopsy. Other cardiac lesions are frequently listed as causes of death, but the prevalence of such lesions as incidental findings in the general population is unknown. In this study, 470 consecutive forensic autopsies were evaluated for minor and major anomalies. The most frequently observed major congenital finding was floppy mitral valve (5%). Tunneled coronary arteries, considered minor congenital findings, were seen in 29%. Atherosclerotic coronary heart disease was the most common major acquired finding, observed in 16% of cases. Of the 470 hearts, only 8% were considered normal.

Athletic fatalities.

In 1985, we began studying athletic fatalities in Marion County, Indiana (city of Indianapolis, population 779,966) U.S.A. We previously reported the data for calendar year 1985. The reviewed cases include all sudden, unexpected, or traumatic deaths of conditioned, competitive athletes in Marion County. This follow-up is a review of all athletic fatalities in Marion County that occurred from January 1986 through July 1988. All deaths during or immediately after athletic activity were reviewed, whether or not the participant was a conditioned athlete. Natural disease, especially heart disease without prior diagnosis, continues to be the most prevalent modality of death.

Identification of a red "fiber": chironomid larvae.

During preliminary examination of the body of a homicide victim, a peculiar red "fiber" was noticed and recovered. Initially believing this to be a carpet fiber, the item was subjected to fiber analysis. It was found to be a short coiled particle not like any known natural or synthetic fabric fiber. Subsequent examinations determined this "fiber" to be the larva of a common freshwater midge (Diptera; Chironomidae). Chironomid larvae have been observed on other bodies recovered from freshwater environments. Entomological studies of this organism have led to the conclusion that the presence of chironomid larvae indicates submersion of the body.