What can we learn about posthumous sperm retrieval after extra long-term follow-up?

PURPOSE: To describe spermatozoa extraction rate by testicular sperm extraction (TESE) for posthumous sperm retrieval (PMSR) and examine harvest time impact on sperm motility; to compare long-term sperm usage between married vs. single deceased men. METHODS: This retrospective study included all PMSR cases in Shamir Medical Center during 2003-2021. We evaluated sperm cryopreservation according to latency time after death. Then, we assessed sperm usage according to Israeli PMSR regulations. RESULTS: The study included 69 (35 married and 34 singles) deceased men with average age of 30.3 ± 7.8 years. Sperm was cryopreserved in 65 cases (94.2%) after maximum and average harvest time of 40 and 16.5 ± 8.1 h, respectively. Motile sperm extraction was associated with significantly shorter harvest time compared with non-motile sperm (13.8 ± 7.3 vs. 18.7 ± 8.1 h, p = 0.046). Sperm usage among married deceased was significantly higher than single (15.6% vs. 0%, p = 0.05). Disposal requests were lower among single compared to married men relatives without reaching statistical difference. Eventually, single men had significantly higher rate of non-used cryopreserved samples (93.8% vs 69.6%, p = 0.01). CONCLUSION: This large long-term cohort study demonstrates high efficacy of PMSR. We found significant harvest latency time difference between motile and non-motile preserved sperm. Clinical sperm usage rate justifies the efforts for PMSR among married deceased. However, contradicting policy on the topic of single men (which implies liberal sperm preservation but rigid prevention of usage) results with high non-used sperm rate and relatives' extremely sophisticated emotional burden.

[IDENTIFICATION OF COMINGLED TISSUE WITHIN A FORMALIN-FIXED PARAFFIN-EMBEDDED SAMPLE USING FORENSIC GENETICS - A TOOL FOR PREVENTION OF MISDIAGNOSIS].

INTRODUCTION: Processing of formalin-fixed, paraffin-embedded (FFPE) tissues is routine practice in the preparation of biopsy specimens for pathological evaluation. Avoiding misdiagnosis due to a mix-up of tissues from different patients requires the utilization of molecular techniques since routine histopathology cannot detect such occurrences, especially if the comingled tissues are of the same type. The Biology Laboratory of the National Center of Forensic Medicine utilizes dedicated forensic procedures to ensure reliable DNA profiles based on short tandem repeats (STR's) from various sample types. These protocols are designed to evaluate even highly degraded samples such as those expected from FFPE tissues. The highly discriminative power profiles are then matched to a reference DNA sample taken from the patient to allow for inclusion or exclusion of the tissue source in question. The following case represents the effective usage of forensic genetics for detection of tissues' cross contamination in FFPE. A 52-year-old female patient was diagnosed with High Grade Dysplasia (HGD) from a sample excised during colonoscopy. DNA extractions taken from FFPE tissues matched the patient. A few additional alleles found in one of the profiles suggested the presence of a residual minor contributor. Out of six embedded tissue fragments, one was found to be a HGD and was marked as such on the slide. The HGD speck was then scraped from the microscopic slide and processed for DNA extraction. The results showed a single DNA profile of a male. Molecular analysis detected a cross contamination of colon tissues. In this case, collaboration between the medical examiner and the forensic laboratory permitted this important discovery that prevented misdiagnosis and possible severe consequences of inappropriate treatment.

The effect of impact tool geometry and soft material covering on long bone fracture patterns in children.

INTRODUCTION: The effect of impact tool geometry and soft material covering on bone fracture patterns plays a major role in fracture patterns. However, the literature is nearly void of such studies and only general correlations between the fracture pattern and the mechanism underlying the insult were reported. PURPOSE: The aim of this study is to reveal the association between the geometry of the impact tool and the presence of soft material covering on bone fracture patterns. The Dynatup Model POE 2000 (Instron Co.) low energy pendulum impact machine was utilized to apply impact loading on fresh pig femoral bones (n = 50). The bone clamp shaft was adjusted to position the bone for three-point bending with additional bone compression simulating a situation occurring in pedestrian road traffic accidents. Five different tests using varying impact tool sizes with and without soft interface covering were carried out. RESULTS: A significant positive correlation was found between the fracture features and the impact tool's geometry. Only bones that were damaged by a rounded impact body result in a "false" butterfly fragment; in all other cases where the impact body is flat and wide, double trapezoid fragments are observed in the area of impact. The impacted aspect is the most affected. All fracture line features were significantly greater in bones subjected to an impact by tools without soft covering. With an impact with soft covering, the impacted aspect exhibits numerous unique fracture lines and a fragmented pattern. Our study clearly shows that impact tool geometry and soft material covering markedly affect the fracture pattern.

Dr. Tulp's Anatomy Lesson by Rembrandt: the third day hypothesis.

An autopsy was an important event in 17th century Holland. Autopsies were held in an 'anatomy theater' and performed according to a fixed protocol that often took up to 3 days to complete. Of the five group portraits painted by Rembrandt over the course of his career, two were anatomy lessons given by Dr. Tulp and Dr. Deyman. An examination of Rembrandt's painting Dr. Tulp's Anatomy Lesson (1632) and an X-ray image of the painting, as compared to other paintings of anatomy lessons from the same period, reveal interesting differences, such as positioning, and light and shadow. Not only was the autopsy not performed according to the usual protocol, but in this painting Rembrandt created a unique dramatic scene in his effort to tell a story. We suggest that Dr. Tulp and Rembrandt "modified" the painting of Dr. Tulp's anatomy lesson to emphasize Dr. Tulp's position as the greatest anatomist of his era--"Vesalius of Amsterdam," and as a way of demonstrating God's greatness by highlighting the hand as a symbol of the most glorious of God's creations.

Usefulness of unenhanced post mortem computed tomography - Findings in postmortem non-contrast computed tomography of the head, neck and spine compared to traditional medicolegal autopsy.

INTRODUCTION/BACKGROUND: Post-mortem CT (PMCT) is becoming an essential tool available to forensic pathologists worldwide, but its validity with respect to evidence for legal purposes still requires more comprehensive large-scale studies, comparing PMCT to autopsy. This article compares PMCT and autopsy findings of the head, neck, and spine during a period of five years. MATERIALS AND METHODS: The study included 203 cases for which both autopsy and PMCT were performed. All relevant findings were extracted from the reports and divided into 30 categories based on anatomical location and tissue characteristics. Data were evaluated quantitatively in a binary fashion. RESULTS/FINDINGS: A high level of agreement was noted for skull fractures, intraventricular- and subarachnoid hemorrhages, bullet trajectories, and intracranial shrapnel. A fair correlation was demonstrated for brain atrophy or herniation, and findings in the facial soft tissues. PMCT had higher sensitivity to brain edema, presence of gas in tissues or cavities, and findings in the spinal column and spinal canal, whereas autopsy better demonstrated pathologies in the brain tissue, hemorrhages in the neck and fractures of the larynx and hyoid bone. A relatively low correlation was noted for subdural and epidural hematomata. CONCLUSIONS/INTERPRETATION: For several locations, structures, and specific findings in the head, neck and spine, autopsy remains indispensable. However, PMCT better demonstrated some findings in locations that are difficult to access by autopsy, or structures that might be damaged due to autopsy procedure. For the examinations of these, PMCT may in specific cases serve as an alternative to autopsy. Generally, however, due to the vast and fundamental differences that distinguish each case from the next, and the different purposes that autopsy may serve, we propose that the decision as to which method (or a combination of both) should be used, be made according to the circumstances and expected findings of each case.

The influence of impact direction and axial loading on the bone fracture pattern.

The effect of the direction of the impact and the presence of axial loading on fracture patterns have not yet been established in experimental 3-point bending studies. PURPOSE: To reveal the association between the direction of the force and the fracture pattern, with and without axial loading. MATERIAL AND METHODS: A Dynatup Model POE 2000 (Instron Co.) low energy pendulum impact machine was utilized to apply impact loading on fresh pig femoral bones (n=50). The bone clamp shaft was adjusted to position the bone for three-point bending with and without additional bone compression. Four different directions of the force were applied: anterior, posterior, lateral, and medial. RESULTS: The impacted aspect can be distinguished from the non-impacted aspects based on the fracture pattern alone (the most fractured one); the impact point can be identified on bare bones (the area from which all oblique lines radiate and/or the presence of a chip fragment). None of our experiments (with and without compression) yielded a "true" butterfly fracture, but instead, oblique radiating lines emerged from the point of impact (also known as "false" butterfly). Impacts on the lateral and anterior aspects of the bones produce more and longer fracture lines than impacts on the contralateral side; bones subjected to an impact with axial loading are significantly more comminuted and fragmented. Under axial loading, the number of fracture lines is independent of the impact direction. Our study presents an experimental model for fracture analysis and shows that the impact direction and the presence of axial loading during impact significantly affect the fracture pattern obtained.

The impact velocity and bone fracture pattern: Forensic perspective.

Studies on bone-energy interaction are meager and revealed only a general correlation between the fracture pattern and the mechanism of the insult. This study has two objectives, to establish a usable fracture analysis method and to reveal the association between the energy of the force and the fracture pattern. Dynatup Model POE 2000 (Instron Co.) low energy pendulum impact machine was utilized to apply impact loading on fresh pig femoral bones (n=30). The bone clamp shaft was adjusted to position the bone for three-point bending with additional bone compression. Three different velocities of the forced applied were carried out. On average, the number, length and the curviness of the fracture lines created under moderate and high-energy impact is significantly higher compared to a low-energy impact. Most fractures lines were located on the impacted aspect in bones subjected to moderate- and high-velocity impact. Four oblique-radial fracture lines running from the point of impact creating a double butterfly pattern were found in bones subjected to moderate and high-velocity impact. Only "false" wedge-shaped (butterfly) fragments were found in the current study. Our results suggest an association between fracture pattern and the velocity of the impact.

[Physicians and terror: the historical perspective].

The topic of physicians who committed crimes or were involved in terrorists' activities, is not well known. This article does not present the well known horrific stories of the atrocities of the Nazi German physicians. The authors describe a number of doctors who were active during the French revolution, some murderous physicians-leaders, and present a few historical anecdotes. These examples might only emphasize the fact that, like other human beings, doctors, too, may suffer from bad character.

Delayed diagnosis of self-inflicted cuts - a case report.

Assessment of individuals with injuries that may have been caused by intentional self-harm is part of routine work of forensic physicians. We present a case of deliberate self-harm of a 19 years old woman who claimed she had been cut by her partner during a quarrel while her partner claimed that she had injured herself. No forensic examination was performed. The case was first reviewed several months after the incident by experts giving consultations for the defense (the authors) by that time the only documentation of injury available were scant medical records and photos of very low quality. This case shows the importance of recognizing self-inflicted injuries even when only scant documentation is available, by comparing the injuries described to the different accounts of the incident as described by the complainant and defendant. Also the importance of availability of access of defense lawyers to forensic medical consultations is stressed.