Jivaro tsantsas or shrunken head: an expertise of authenticity evaluation.

Forensic scientists sometimes apply knowledge and modern techniques to various historical challenges. Reported here is an unusual expertise of a shrunken head authenticity evaluation. Tsantsas, or shrunken head, are an ancient traditional technique of the Jivaro Indians from Northern Peru and Southern Ecuador. Tsantsas were made from enemies' heads cut on the battlefield. Then, during spiritual ceremonies, enemies' heads were carefully reduced through boiling and heating, in the attempt to lock the enemy's spirit and protect the killers from spiritual revenge. However, forgers have made fake tsantsas out of sloth heads, selling them as curios to international travelers. Morphologic criteria can help in the distinction of forged and authentic tsantsas. Presence of sealed eyelids, pierced lips with strings sealing the mouth, shiny black skin, a posterior sewn incision, long glossy black hair, and lateral head compression are characteristic of authentic tsantsas. On the other hand, fake tsantsas usually present few or none of those criteria. To establish authenticity of the shrunken head, we used all of the above-mentioned morphologic criteria along with microscopic hair examination and DNA analysis.

Postmortem changes mistaken for traumatic lesions: a highly prevalent reason for coroner's autopsy request.

Postmortem changes are well known for their possible misinterpretation as traumatic lesions which can mislead to suspicion of violent death and therefore to a forensic autopsy request. As far as we know, a systematic review of the prevalence of such a reason for coroner's autopsy request has not been done yet. A retrospective study of 230 forensic autopsies requested by the Coroner's office from 2002 to 2004 in the province of Quebec, Canada, was conducted by the authors. Of the 230 reviewed cases, postmortem artifacts mistaken for traumatic lesions were found in 18 cases. These misinterpretation were based on 5 categories of portmortem changes: purge fluid drainage in 12 cases (66.7%), bluish discoloration by lividity in 5 cases (27.8%), parchment-like drying of the skin in 4 cases (22.2%), bloating from gas formation in 4 cases (22.2%), and skin slippage in 1 case (5.56%). Therefore, postmortem artifacts misinterpretation occurred in 7.83% (95% confidence interval 0.05-0.12) of all requested forensic autopsies and in 35.29% (95% confidence interval 0.23-0.50) of decomposed autopsy cases. This study clearly establishes the high prevalence of postmortem artifacts as main reason for forensic autopsy request. Hence, in a context of forensic pathologist shortage, the improvement of coroner continuous training may reduce the workload.

Suicide by drowning after two gunshots to the head: a case report.

Differentiation between suicide and homicide can be problematic for forensic pathologists, especially when a complex method of suicide is used by the victim. Multiple gunshot suicides have been previously reported in the forensic literature. However, multiple gunshots combined with other suicidal methods are rare. In this article the authors report the unusual case of a floating body recovered from a river, with two gunshot wounds to the head. The autopsy showed that both gunshot wounds were nonlethal and the cause of death was attributed to drowning. Though homicide was strongly suspected at first, the manner of death was later established as suicide.

Child and adolescent victims in forensic autopsy: a 5-year retrospective study.

Children of more than 3 years of age and adolescents have been largely overlooked in the forensic literature, especially the 4-9 age group. Thus, the present study was undertaken to address this particular issue of child and adolescent victims in forensic autopsies. On a 5-year period (2000-2004) in Quebec province (Canada), all forensic autopsy cases of children and adolescents from 4 to 19 years of age were retrospectively studied. A total of 223 cases of child and adolescent deaths (148 males, 75 females; 6.6% of all forensic autopsies) were reviewed. Age, gender, manner of death and cause of death were analyzed for all victims organized into three groups of age: 4-9, 10-14, and 15-19. Moreover, homicide cases (n = 54) are further analyzed in terms of method(s) used (firearm, sharp force, asphyxia, blunt force, intoxication). This 5-year retrospective study may contribute to a better understanding of typical deaths in the 4-19 group of age and therefore, bring a working basis for the forensic pathologist or medical examiner/coroner.

Discrimination of falls and blows in blunt head trauma: systematic study of the hat brim line rule in relation to skull fractures.

In the discrimination of falls from blows in blunt head trauma, the hat brim line rule is one of the most often used criteria. The present study assesses the validity of the hat brim line rule for skull fractures and looks at other possible criteria. All autopsy cases were retrospectively analyzed on a 5-year period. Cases selected consisted of downstairs falls (n = 13), falls from one's own height (n = 23), and homicidal blows (n = 44). Results show that fractures above the hat brim line are more in favor of blows, while fractures in the hat brim line zone are more difficult to distinguish. The majority of fractures were located on the left side for homicidal blows and on the right side for falls. A higher average number of lacerations was revealed for homicidal blows. In conclusion, this study establishes three criteria in favor of blows: (i) localization of a wound above the hat brim line; (ii) left side lateralization; and (iii) a high number of lacerations.

Cerebral traumatism with a playground rocking toy mimicking shaken baby syndrome.

Shaken baby syndrome (SBS), one of the most deadly and devastating forms of child abuse, is caused by violent shaking. The combination of subdural hematoma, retinal hemorrhage, brain swelling, and diffuse axonal injury is highly typical of this syndrome and faced with these autopsy findings, induced traumatic lesions are strongly considered. However, it is known that motor-vehicle accidents and falls from great height can also produce this pattern of injury. Nevertheless, stories of arms fall, couch fall, or bumped head while the baby is being carried are generally considered incompatible with SBS. We here report a case of a 2-year-old boy presenting with all the classic autopsy findings of SBS from a playground rocking toy shaken by an older child.

Radiographs interpretation by forensic pathologists: a word of warning.

In child deaths investigation, radiologic examination is particularly important in the diagnosis of child abuse. In the province of Quebec, Canada, all autopsies for suspicious deaths are performed at a centralized forensic laboratory where, because of budget restrictions, forensic pathologists rely on their own knowledge for radiographs interpretations. To assess the validity of this radiologic examination by nonradiologist forensic specialist, we reviewed all cases of child death on a 1-year period. A total of 20 cases were reviewed by an experienced pediatric radiologist, and this interpretation was compared with pathologist's conclusions. Forensic pathologists missed an important finding in 3 positive cases. Yet, none of those missed findings would have significantly changed the cases outcome, because other autopsy findings had already oriented the final diagnosis. Nevertheless, this result is alarming. In a general context of financing problems, it can be appealing to management team to restrict access to external consultants. This study is important in reminding that such money savings do not come without a decrease in quality.

Suicidal and homicidal sharp force injury: a 5-year retrospective comparative study of hesitation marks and defense wounds.

In sharp force injury cases, the presence of hesitation marks or defense wounds figures among useful characteristics in the distinction of suicide and homicide. However, there are very few systematic comparative studies of hesitation marks and defense wounds in the forensic literature. This study was thus undertaken to systematically compare features of hesitation marks and defense wounds, with a particular emphasis on dispersion patterns. Over a 5-year period, all suicidal and homicidal sharp force cases were retrospectively reviewed for hesitation marks and defense wounds. A total of 58 suicides (7 women; 51 men) and 149 homicides (59 women; 60 men) were found, of which 74% (n = 43) were positive for hesitation marks and 61% (n = 91) for defense wounds. On the upper limbs, hesitations marks were more often observed on the anterior aspect of the limb, while defense wounds were equally distributed on the anterior and posterior aspect. For hand lesions, hesitation marks were generally located on one side only, while defense wounds more commonly involved both sides. No left or right predominance was observed in hesitations marks or defense wounds. Defense wounds were more widely distributed on the upper limbs than hesitation marks.

Deaths in a head-down position: a case report and review of the literature.

Deaths in a head-down position, mostly accidental events, are rare deaths in which a victim is found in an inverted body posture, with marked congestion of dependent body parts and no definite pathoanatomical cause of death. Such an exclusion diagnosis can only be put forward after elimination of other possible causes of death, following a scene investigation, medical record review, complete autopsy, and toxicological analysis. Particular attention should be taken not to confuse deaths by head-down position from the more usual positional asphyxia. We here report the case of an 82-year-old woman found stuck in the railings of the staircase leading to her house, her body freely suspended downward below the stairs. Death was finally attributed to a head-down position when correlating the autopsy findings with elements from the scene. Case reports of death by head-down position in the literature are reviewed. Furthermore, results from human experimental studies of head-down tilt are compiled. This systematic review allows an interesting insight into the physiopathology of those deaths, pointing more toward heart failure than to an asphyxial phenomenon per se.

Tameshi-giri, or Japanese sword test-cutting: a historic overview.

The martial Japanese history is characterized by the development of a particular samurai sword known as the katana. It was believed that this sword was the reflection of the warrior's soul, and thus it had to be tested to estimate its sharpness, efficiency, and cutting ability. A variety of cutting tests was done on animals and bamboos, but some were also carried out on human beings. This technique was called tameshi-giri. Although the practice on human beings has since disappeared, the remaining cutting test records represent precious information about human body's resistance to sharp weapons.

Suicide in the bath using weight and elevation of feet.

Suicide by drowning in the bath is rare. Because it implies to drown in a small volume of water, adult victims are often under the influence of alcohol and/or drugs. More rarely, the use of weights is seen to induce drowning. Here is the case of a 62-year-old woman found dead in the bath. Her feet were tied and elevated by a rope attached to the shower head and a hammer was taped to her forehead. This very unique suicide is reported along with review of the literature on suicide in the bath.

Traumatic heart perforation by a D5 osteophyte: a case report.

Osteophytes are bony outgrowths usually found in the context of osteoarthritis and diffuse idiopathic skeletal hyperostosis (DISH). Even if they are usually asymptomatic, they may present with complications such as spinal stenosis, myelopathy and radiculopathy. We here present the case of a 56-year-old woman found dead from a homicidal traumatic heart perforation by a D5 osteophyte.

Utility of the caput succedaneum in the forensic investigation of neonaticide: a case report.

Suspicion of neonaticide often leads to a request for a forensic autopsy. In that setting, it is important to correlate autopsy findings with the history given by the mother. So far, caput succedaneum has not raised interest in forensic pathology. A caput succedaneum is a haemorrhagic oedema involving the skin and superficial fascia of the head that results from circulatory stasis caused by compression exerted by the uterus or cervix on the presenting part. It is usually seen with prolonged labour. We report a case of caput succedaneum in a forensic autopsy that overturned the mother's history of giving birth suddenly, consequently increasing the evidence of neonaticide.

Complex autoerotic death with full body wrapping in a plastic body bag.

Autoerotic deaths are normally classified as accidental deaths occurring during individual, and usually solitary, sexual activity in which a device, apparatus, or prop used to enhance sexual stimulation of the deceased somehow causes unintended death. The most common methods of autoerotic practices are asphyxia by hanging, ligature, plastic bag, chemical substances, or a mixture of these. However, atypical methods such as overdressing/body wrapping have also been reported. In fact, overdressing/body wrapping is so rare that it is implicated in only 1.5% of published cases. Although plastic bags are often implicated in autoerotic deaths, there has been only one previous case that involved a plastic covering the victim's body from head to toe. We here report the case of a 34-year-old man who died due to asphyxia, secondary to body wrapping in the largest and most complex plastic bag ever involved in a published case of autoerotic death.

Agonal sequences in a filmed suicidal hanging: analysis of respiratory and movement responses to asphyxia by hanging.

The forensic literature on the pathophysiology of human hanging is still limited. Therefore, forensic pathologists often feel uncomfortable when confronted with related questions. Here presented is the filmed suicidal hanging of a 37-year-old man. This recording allows a unique analysis of agonal movement sequences: loss of consciousness (13 sec), convulsions (15 sec), decortication rigidity (21 sec), decerebration rigidity (46 sec), second decortication rigidity (1 min 11 sec), loss of muscle tone, (1 min 38 sec) and last isolated muscle movement (4 min 10 sec). As for respiratory responses, very deep respiratory attempts started at 20 sec. Respiratory movements progressively decreased and completely stopped at 2 min. Despite the fact that extending the presented data on all cases of hanging asphyxia would be a mistake, this case gives a very interesting insight into movement and respiratory response to asphyxia by hanging.

Planned and unplanned complex suicides: a 5-year retrospective study.

The notion of planned and unplanned complex suicides first appeared in 1974 by Marcinkowski and, since then, no systematic study of complex suicides has been published in the English forensic literature. Here, the authors present a 5-year retrospective study of complex suicides. Nineteen complex suicides were reviewed: five unplanned and 14 planned, including the first case of an unplanned complex suicide in a woman. All cases were analyzed in terms of gender, age, methods of suicide, the presence of a suicide note, and past suicide attempts, and statistically compared with a 50-case sample of simple suicides. A further comparison was established with compiled data from the literature. Similarities were revealed regarding incidence of complex suicides, male gender predominance, and types of methods used. In contrast, results showed a higher average age for planned complex suicide victims. Finally, the authors discuss the application of the complex suicide definition.

Bloodstain pattern analysis in a case of fatal varicose vein rupture.

Rupture of a varicose vein is a rare cause of sudden death. It occurs when the failure of venous valves causes an increase in venous pressure great enough to provoke rupture of the blood vessel. When it does happen, the victim is often found surrounded by a pool of blood, and the examination of the scene can mislead the forensic team to think of violent death. Until now, the bloodstain patterns in these fatal cases have not been described. An examination of the bloodstain pattern in a case of fatal varicose vein rupture in an 84-year-old man is here reported.

Brain arteriovenous malformation and its implication in forensic pathology.

Despite the fact that brain arteriovenous malformations (BAVMs) are a possible cause of sudden and unexplained death, very few papers have discussed their importance in the forensic context. BAVMs consist of tangled masses of tortuous arteries and veins devoid of intervening capillaries that frequently extend from brain parenchyma into the subarachnoid space. Apart from BAVMs, three major groups of vascular malformations of the brain are known: cavernous hemangioma, venous angioma, and capillary telangiectasia. BAVMs and cavernous hemangioma often cause hemorrhages, while venous angioma and capillary telangiectasia are typically asymptomatic. Presented here is the case of a 14-year-old girl who died from a ruptured BAVM. The present case is a reminder that the forensic pathologist should be able to recognize BAVMs and to differentiate it from other types of vascular malformations. Although rare, it is a cause of sudden death not to be overlooked, especially in children.

Suicidal decapitation using a tractor loader: a case report and review of the literature.

In forensic practice, decapitated bodies are predominantly associated with decapitation by wheels of trains or with postmortem dismemberment following homicide. In the suicidal context, decapitation accounts for less than 1% of total suicide. Apart from decapitation by trains, other encountered methods involve suicidal hanging and vehicle-assisted ligature suicide. Reported here is a unique case of suicidal decapitation in a 45-year-old man using a tractor loader at the foot of a silo, on his farm. The head was recovered in the loader and there were several impact spots from the loader as well as blood on the silo wall. The autopsy revealed a complete decapitation wound with the severance plane located between the third and fourth cervical vertebra. A 1.5 cm wide abrasion on the anterior part of the neck and abrasions under the chin were noted. This very unique case of intentional suicidal decapitation is the first reported case of a planned system intended to create decapitation outside the unique case of homemade guillotine and the more common decapitation by train.

Female autoerotic deaths--still often overlooked: a case report.

Female autoerotic deaths are less common than male ones and usually present in a less obvious way. Thus, such deaths can be easily overlooked, even by senior investigators, if the latter are not fully aware of the particularities of female autoerotic cases. We present the case of a 34-year-old woman, found dead in her apartment, with several foreign body insertions and a dog leash around the neck. Despite the great experience of the investigative team, autoerotic death was not considered at first. This case illustrates the importance of forensic teams having knowledge of the particularities of female autoerotic deaths.