Cause of Death in Charred Bodies: Reflections and Operational Insights Based on a Large Cases Study.

Our study aims to demonstrate the experience of analyzing fully or partially charred corpses to offer a proper implementation protocol for determining the cause of death. In this study, we present a total of 103 cases obtained from the University of Rome La Sapienza and the University of Pisa archives. All cases were classified based on the extent and severity of burns using a visual method. We divided all cases into two groups. The first group included grade I-II burns (21 cases) without the need for identification. The second group (82 cases) included injuries worse than grade burns II, so all cases were analyzed using an analytical method. For each case, we have documented which of the following analyses have been used and the corresponding findings: inspection, autopsy examination, imaging examination, genetic and toxicological examinations, and histological examination. The results describe the main diagnostic findings and show that only the application of all the above systematic analyses can provide greater accuracy and reliability in describing the causes of death or solving problems, such as identification. In conclusion, we propose an available protocol that defines the main steps of a complete diagnostic pathway that pathologists should follow daily in studying charred bodies.

Don't Forget Rare Causes of Postpartum Headache! Cases Report and Literature Review.

Headache is a common finding in the postpartum period, caused by a spectrum of different conditions. Most headaches in the postpartum period are self-limiting and benign in etiology, but there are some potentially serious causes to be considered. We disclose two cases of postpartum headache, initially considered as post-dural puncture headache (PDPH), that evolved into a harmful condition and showed that an expanded differential diagnosis for headache in the postpartum is mandatory, requiring a high level of attention from health professionals. In fact, a careful examination of the medical history, physical examination, and the recognition for the need for early neuroradiological imaging should increase diagnostic accuracy.

Traumatic brain injury: Estimate of the age of the injury based on neuroinflammation, endothelial activation markers and adhesion molecules.

Studies on traumatic brain injury (TBI) are applicable not only in the clinical context, but also in the forensic field. Over time, the literature has accumulated scientific evidence supporting the use of specific histopathological tests in dating traumatic brain injuries. In primary damage, cell death occurs by necrosis/apoptosis. In secondary injury, the underlying mechanisms are inflammation and ischemia. The inflammatory response of the central nervous system (CNS) follows the common steps of the innate response. In head injury, the blood brain barrier (BBB) undergoes both functional damage and, subsequently, finer structural changes. Scientific evidence has shown modifications of the junctional-endothelial system that favors the extravasation of immunocompetent cells. The histological evaluation of the subdural hematoma, of the cerebral contusions, of the diffuse axonal damage can certainly bring useful elements, with limitations, to the chronological evaluation of the lesions. Many markers have been used to better define the dating of the head injury. Several authors also analyzed the usefulness of secondary damage markers in brain tissue. The progress achieved with immunohistochemistry is significant compared to the use of routine staining. With immunohistochemistry it is possible to identify much narrower and more precise time intervals and, above all, with greater probative reliability. Recently attention has been paid to the modification of structural proteins and miRNAs. Future research is already started and entrusted to multidisciplinary teams that know how to combine their specific skills in search of a reproducible standard of known and sufficient accuracy.

The forensic approach to plastic bag suffocation: Case reports and review of the literature.

Death from plastic bag suffocation is unusual and rare in under-developed countries. Initially, deaths were accidental mostly of children but with time homicides, suicides and deaths in auto-erotic situations were noted. It is not always possible to discover the dynamics leading to the death especially when suicide is suspected. Often, the typical signs of asphyxia - petechial haemorrhages, facial congestion, oedema and cyanosis - are not there. The authors present two cases of plastic bag suffocation, where a multi-disciplinary approach was applied. This study reviews international literature on plastic bag suffocation, analysing the frequency of suicides, homicides and accidental deaths associated with plastic suffocation.

The Troponin-I fast skeletal muscle is reliable marker for the determination of vitality in the suicide hanging.

Troponin I (TnI) is the inhibitory subunit of the troponin complex in the sarcomeric thin filament of striated muscle and plays a central role in the calcium regulation of contraction and relaxation. Vertebrate TnI has evolved into three isoforms encoded by three homologous genes: TNNI1 for slow skeletal muscle TnI, TNNI2 for fast skeletal muscle TnI and TNNI3 for cardiac TnI, which are expressed under muscle type-specific and developmental regulations in both the atrium and ventricle of the heart. Skeletal muscle TnI (both sTnI iso-forms) have been proposed as a sensitive and fast fiber-specific serum marker of skeletal muscle damage; fsTnI concentration in increased peripheral blood when fast twitch fibers were damaged. In our study we investigate if the 'Troponin I, fast skeletal muscle' can also be used as a reliable diagnostic tool in forensic practice, to perform differential diagnosis about vitality in suicide by hanging and simulated hanging (suspension of the victim after murder). We selected 8 women and 13 men, mean age 52.2 years, who died from suicidal hanging. The ligature material used for hanging was soft material in 11 cases and hard material in 10 cases. We chose cases as a control group of adults (n = 10; six women, four men, mean age 47.3 years) that died from opioid overdose (n = 2), car accident (n = 3) and sudden cardiac death (n = 5). Those deaths were characterized by their rapidity. To test the Anti-Troponin I fast skeletal muscle Antibody (Abcam clone-134,838), we used a case of a subject who died of myocardial infarction (timing infarct dated to 24-36 h prior to death). The reactions to Troponin I (namely the amount and extent of marker depletion) was scored for each section from 0 to -3: 0 = no loss of staining; -1 = minimal decrease in staining, compared to normally stained tissue; -2 = clear decrease in staining with some positivity (brown color) remaining; and -3 = no positive (brown) staining. The set of results obtained leads us to believe that the use of this antibody (Anti-Troponin I fast skeletal muscle antibody) is very promising to be able to make a certain differential diagnosis between antemortem and postmortem hangings. It should be emphasized that the present study seems to open new and promising horizons in the possibility to discriminate between suicidal hanging and simulated hanging (suspension of the victim after murder).

Death due to external compression of the trachea in a patient with multinodular hemorrhagic goiter.

In this paper we describe the case of an 81-year-old Caucasian female (142 cm tall, weighing 45 kg) who suffered from a multinodular goiter for approximately 40 years. Following the onset of a clinical condition characterized by acute respiratory failure, she was transported to the emergency room by ambulance, where she died within a few hours after admission. A recent cardiac examination showed the absence of risk factors for cardiovascular disease, sinus tachycardia with a heart rate of 131 bpm, negative objectivity for signs of cardiocirculatory failure, a blood pressure of 120/80 mmHg and modest exertional dyspnea. A recent hemochemical laboratory analysis showed a TSH value of 0.01microUI/mL, FT3 value of 4.76 pg/mL and FT4 value of 2.33 ng/mL, pointing to a pattern of hyperthyroidism, attributable to Basedow's goiter. Autopsy showed some peculiarities, and we came across two extremely rare findings; the thyroid gland had reached a very large size in relation to the patient's body mass (1510 g, in a patient of 142 cm and 45 kg), and the death of the patient was due to the development of a massive intra-thyroid hemorrhage that had caused acute external compression of the trachea. To the best of our knowledge this very rare event has not previously been reported in the international scientific literature.

A scream from the past: a multidisciplinary approach in a concealment of a corpse found mummified.

When a mummified body is found, it requires the forensic pathologist to determine the manner and cause of death. The mummified body of an older man was found walled in an alcove in a silicon-sealed bedroom, in a semi-supine position with the back on the floor and the legs on the wall. Two plastic bags covered the body. Having removed the plastic bags, the body was fully wrapped in a brown adhesive tape. At the scene, there was no evidence of microfauna. The subject's son stated that after his father's death, he concealed the corpse in order to obtain his annual pension. A postmortem CT scan was performed before the autopsy, which excluded traumatic injuries. The autopsy together with the toxicological and microscopic findings helped us to understand the manner of death. In this case, the mummification process developed under specific environmental conditions and a multidisciplinary approach was required in order to solve it.

A rare occupation causing mesothelioma: mechanisms and differential etiology.

BACKGROUND: In a mesothelioma lawsuit, the Public Prosecutor commissioned an expert evidence on the legal accountability for the disease, because the patient experienced multiple exposures to asbestos in both occupational and environmental settings. OBJECTIVES: To collect information on asbestos exposure from all available sources and to quantify the contribution of each source of exposure as a percentage of the total risk. METHODS: We retrieved information on jobs done and asbestos exposure from a work colleague and a database maintained by the National Institute for Insurance of Occupational Accidents/Diseases, respectively. Information on environmental exposure was searched through the scientific literature. The contribution of each source of exposure was quantified with a method of risk apportionment, taking into account time elapsed since first and last exposure, intensity and frequency of exposure and carcinogenic potency of asbestos fiber mix. RESULTS: The subject worked in the maintenance of railway electrification system. The mechanical compression stress induced on the ballast during passage of trains released chrysotile (from fragmented stones) and crocidolite (through abrasive action of crushed gravel on the underbody of rolling stocks insulated with friable crocidolite). Despite the low cumulative exposure (about 2 ff×years/cc), 99% of the mesothelioma risk was attributable to the work done because of the high content of crocidolite of inhaled asbestos. CONCLUSIONS: The report of an uncommon source of occupational asbestos exposure and a scientifically based method to allocate mesothelioma risk among multiple exposure could help to recognize mesothelioma as occupational disease in the workers employed in maintenance of the railway electrification system under the Italian National Railways.

When the hidden features become evident: the usefulness of PMCT in a strangulation-related death.

Asphyxia related-death is a common incident in forensic practice, since they can be related to suicide, homicide and accident. The deep structures of the neck can be very difficult to reach using the traditional neck dissection when no certain information about potential injuries are obtained. Furthermore in this kind of deaths no specific signs or injuries can be found at the external and internal examination of the body (such as the slight, if any, displacement of a body structure following a infraction and fissures, as well as injuries involving lamellae of the thyroid cartilage, cricoid cartilage, trachea). In recent years a great contribute to the field of postmortem diagnostics (e.g. gunshot wounds, sharp and blunt forces, etc.) has been given by the introduction of the post-mortem CT (PMCT); that is becoming a standard procedure performed before the traditional postmortem examination. In cases of asphyxia related-death (with special regards to homicidal strangulation) the PMCT with 3D documentation can be very helpful in revealing injuries on the small structures of the neck, that can be also masked by soft tissues and surrounding bleedings and provides a useful guide for the pathologist to choose the right dissecting technique and avoid artifacts or iatrogenic injury to delicate structures, such as hyoid bone or thyroid cartilage. The case of a homicide by ligature strangulation using two items (electric wire and cotton bed sheet) is presented, in which the PMCT was performed before the autopsy, showing helpful features concerning the mechanism of death.

A peculiar case of suicide enacted through the ancient Japanese ritual of Jigai.

In the past, self-infliction of sharp force was a classic form of suicide, while in modern times it is quite rare, constituting only 2% to 3% of all self-inflicted deaths. In Japan, the jigai (Japanese characters: see text) ritual is a traditional method of female suicide, carried out by cutting the jugular vein using a knife called a tanto. The jigai ritual is the feminine counterpart of seppuku (well-known as harakiri), the ritual suicide of samurai warriors, which was carried out by a deep slash into the abdomen. In contrast to seppuku, jigai can be performed without assistance, which was fundamental for seppuku.The case we describe here involves an unusual case of suicide in which the victim was a male devotee of Japanese culture and weapons. He was found dead in his bathtub with a deep slash in the right lateral-cervical area, having cut only the internal jugular vein with a tanto knife, exactly as specified by the jigai ritual.

Exposure to anesthetic gases and Parkinson's disease: a case report.

BACKGROUND: The administration of anesthetics determines depression of the central nervous system and general anesthesia by inhalation may cause an environmental pollution of the operating rooms. It may therefore conceive a possible occupational etiology of Parkinson's Disease (PD). CASE PRESENTATION: In a Caucasian male aged 59 years, PD was diagnosed by brain scans with a presynaptic radioactive tracer of the dopaminergic system. Family history was negative for Parkinson's disease or essential tremor. He was a smoker, a moderate consumer of coffee and alcohol, and never exposed to pesticides/metals. For 30 years (since the age of 29 until today), he worked as an anesthesiologist in private clinics in the Veneto (Northern Italy), exposed to anesthetic gases. The time elapsed from first exposure to onset of disease is 22 years, fulfilling the requirement of the induction/latency period. A literature search demonstrated unacceptable levels of anesthetic gases in public hospitals of the Veneto region from 1990 to 1999. This exposure was presumably high also in private hospitals of the region until at least 2007, when an overexposure to sevoflurane was repeatedly measured in this patient. The association between occupational exposure to anesthetic gases and risk of Parkinson's disease was supported by a case-control study (reporting a two-fold increase in the risk of PD associated with a clinical history of general anesthesia) and a cohort study comparing mortality from PD between US anesthesiologists and internists (showing a statistically significant excess (p=0.01) in anesthesiologists compared to internists). Numerous recent mechanistic studies (in vitro essays and in vivo short-term studies) strengthened the association between exposure to anesthetic gases (nitrous oxide, halothane, isoflurane, levoflurane) and PD. CONCLUSION: In view of the limited evidence of human studies and the sufficient evidence of experimental studies, the high exposure to anesthetic gases could have induced PD in the subject under study.