Osteological proofs of torture and cruelty: forensic findings form a secret cemetery in Tirana, Albania.

Two decades after the fall of the communism in Albania, documenting the human rights violations and proving torture and cruelties suffered from ex-politically persecuted and dissidents of the regime, is still a societal priority. Due to several reasons, the judicial way toward redressing the historical injustices has been slowed down. This is mainly because of the lack of proper documentation of torture, mass executions and extrajudicial ill-treatment. Several governmental and civil society organizations have tried to define the issue, but perpetrators have rarely, if ever, been brought to court. Secret cemeteries and mass graves have recently been found in different zones of Albania, and victims exhumed; thus proofs of torture and ill-treatments are being made widely known, potentially creating the necessary legal conditions for punishing the perpetrators and for identifying victims. In the present paper, authors describe osteological forensic findings from Linza secret cemetery in Tirana, where several ante mortem fractures prove the severe and cruel ill-treatment the victims suffered before the execution that was usually by bullet shot in the posterior region of the skull.

Self-infliction of faked gunshot wounds in absence of overt psychopathology.

Distinguishing deliberate self-inflicted body damage from assault represents a challenge to the forensic expert. Identifying a wound as self-inflicted can be particularly difficult in emergency room situations. We present the case of an individual who self-inflicted three bullet wounds, allegedly related to a shooting incident. This individual was lacking any overt psychopathology. When confronted with the facts, he confessed and explained his motivation. It is known that self-mutilation behavior can be related to particular, well systematized psychiatric disorders. However, in the absence of such a diagnosis, every suspicious wound should be carefully considered by the forensic expert as potentially self-inflicted with the intent by the "victim" of obtaining secondary gains.

Overzealous cardiac massage leading to unintentional infant death.

The case of an 18-month child is presented, with a picture demonstrating the thoracic trauma, caused from a hand pressure movement, perpetrated with an open right palm, in an attempt to perform an external cardiac massage. The child showed continuous episodes of 'crying spells' that the medical staff considered as benign, but an overprotective and mentally unstable mother kept on violently 'resuscitating' her son during such episodes. The last episode was characterised with a strenuous massage of the thoracic wall, causing evident bruises and leading to a cardiac contusion. The mother who perpetrated the trauma was sentenced for manslaughter, after the accidental character of the event, as well as the severity of her family situation and the precarious living environment of a socially abandoned single-acting parent, were all taken into account. The particular psychopathology of the care giver (mother) and the characteristics of the inflicted thoracic blow are described.

Fatal basilar thrombosis possibly related to minor cervical trauma: a case report.

Background. Basilar thrombosis is a potentially fatal event, whose traumatic etiology has been repeatedly stated. Methods. We performed the autopsy and the microscopic examination of the brain stem structures from an individual, whose sudden death raised logical suspicions regarding the causative factor. Results. The brain was swollen and clearly hyperemic; a massive basilar thrombus with complete occlusion of the median segment of the basilar artery was macroscopically seen. The brainstem showed an infarcted zone in the pons, with secondary hemorrhagic changes, mainly in the form of multiple petechial hemorrhages. Pontine arteries showed extensive alterations, mainly in the form of severed endothelium, which suggested a thrombotic-traumatic mechanism as the main etiological factor. Conclusions. Minor injuries, such as slight whiplashes, abrupt neck movements, neck trauma related to the slowing down of the vehicles, and critical neck positioning, can all of them explain a thrombotic event in the basilar artery, leading to a fatal occurrence. Other risk factors may obviously concur, but their importance seems unclear.

Sudden death due to medulloblastoma.

Intracranial tumours can be accompanied with intracerebral and intracerebellar non-traumatic haemorrhage; in some cases, this might be their first clinical sign. We report a case of a man who suffered sudden death due to medulloblastoma, with intratumoral haemorrhage; his tumour had a hemispheric cerebellar positioning. The cerebral oedema seen at autopsy reflected the immediate cessation of cerebral vascular circulation, leading to sudden death. Acute obstructive hydrocephaly is a mechanism widely known in the literature for causing sudden death.