Hypostasis and time since death: state of the art in Italy and a novel approach for an operative instrumental protocol.

Hypostasis is a common postmortem change, whose presence or absence is used by forensic pathologists as a means of determining the approximate time of death. This assessment plays a primary role in Italian forensic practice, but blanching of hypostasis is still estimated only on the basis of subjective impressions. To understand how forensic pathologists test livor mortis on the crime scene and during forensic daily practice in Italy, an inquiry was made into lividity testing. Subsequently, with the aim of proposing a more objective approach, a study on postmortem lividity was performed; 101 cadavers were analyzed, and the color of hypostasis was measured by a colorimeter. Different conditions of time and pressure on hypostasis were tested. Linear regression analysis was performed to determine the relationship between postmortem interval and the color of the skin after a predefined intensity and duration of pressure. Herein we propose a novel operative instrumental protocol using new, more standardized conditions for the analysis of hypostasis, thus providing pathologists with a more rigorous approach to postmortem interval estimation.

Complete cardiac rupture associated with closed chest cardiac massage: case report and review of the literature.

Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35-year-old workman who collapsed and underwent ECM by his co-workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre-existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic­abdominal trauma, or medical history, is unclear.

Nasal ciliary motility: a new tool in estimating the time of death.

Determination of time since death is one of the most difficult and crucial issue in forensic medicine. Apart from body cooling, which is commonly used in the early postmortem interval (PMI), supravital reactions are the most interesting postmortem changes for time of death estimation. Nasal ciliary motility has been occasionally observed in postmortem period although no studies have focused on this phenomenon for forensic purposes. We aimed to evaluate the diagnostic usefulness of ciliary motility as a potential tool in estimating the time of death. Specimens of ciliated epithelium from 100 consecutive cadavers were obtained by scraping the nasal mucosa at three different postmortem intervals. The samples were then smeared on a slide, and an in vitro evaluation of ciliary movement was analyzed by phase-contrast microscopy. A postmortem nasal ciliary motility was observed, and a statistically significant relationship between decreasing ciliary movements and increasing postmortem interval was detected even in presence of putrefactive changes of nasal ultrastructure integrity. Some peculiar causes of death seem to influence ciliary motility in the early PMI, while no significant correlations with sex or age were observed. According to the results of this study, postmortem evaluation of nasal ciliary motility may be a bona fide and a feasible option for estimating the time of death.