Study on the performance of different craniofacial superimposition approaches (II): Best practices proposal.

Craniofacial superimposition, although existing for one century, is still a controversial technique within the scientific community. Objective and unbiased validation studies over a significant number of cases are required to establish a more solid picture on the reliability. However, there is lack of protocols and standards in the application of the technique leading to contradictory information concerning reliability. Instead of following a uniform methodology, every expert tends to apply his own approach to the problem, based on the available technology and deep knowledge on human craniofacial anatomy, soft tissues, and their relationships. The aim of this study was to assess the reliability of different craniofacial superimposition methodologies and the corresponding technical approaches to this type of identification. With all the data generated, some of the most representative experts in craniofacial identification joined in a discussion intended to identify and agree on the most important issues that have to be considered to properly employ the craniofacial superimposition technique. As a consequence, the consortium has produced the current manuscript, which can be considered the first standard in the field; including good and bad practices, sources of error and uncertainties, technological requirements and desirable features, and finally a common scale for the craniofacial matching evaluation. Such a document is intended to be part of a more complete framework for craniofacial superimposition, to be developed during the FP7-founded project MEPROCS, which will favour and standardize its proper application.

Multidisciplinary forensic approach--investigation of a neonaticide and alleged concomitant rape.

In the case presented, a young woman claimed to have spontaneously aborted a 30-weeks old fetus conceived after being raped by her cousin. The police investigation was centred on a probable neonaticide, mitigated by a possible rape. In Israel, the crime of rape carries a heavy punishment similar to that of first degree murder. Thus the implementation of the most recent scientific forensic techniques is of paramount importance in charging or clearing a suspected rapist. The skeletonized fetal remains were found four months after the reputed abortion. The alleged neonaticide was supported by the results of the forensic clinical and anthropological examinations, while the rape accusation was dismissed by the results of the molecular biology identification of the skeletonized fetal remains. The aim of this report is to encourage the forensic community to apply a multi-disciplinary approach, thus maximizing the decision making competence of the courts of law.

Estimation of age in adolescents --the basilar synchondrosis.

The state of fusion of the basilar synchondrosis as a biological age indicator was assessed in a sample of 91 cadavers of both sexes whose ages ranged between 8 and 26 years. The correlation between the degree of closure and chronological age was investigated. Although the female population sample was very small (n = 21), the data indicate a tendency of differences in age between the "open" and "closed" groups. In the male population (n = 70), no significant differences were detected between the "open" and "closed" categories; in fact, the mean age of the two groups was the same (p = 0.9). These findings indicate that the stage of fusion of the basilar synchondrosis is not a good indicator of age in male cadavers, while in females the feature could be useful when estimating age of unknown human remains, although further investigation on a larger sample is advocated.

Self inflicted gunshot wound caused by a home-made gun--medico-legal and ballistic examination.

The reconstruction of the mechanism of a fatal gunshot wound inflicted with a zip gun is presented. The joint investigation of medico-legal team and firearms experts teams resulted in an explanation of the unusual distribution of gunpowder encountered around the entry wound. Although the use of crude home-made weapons associated with various criminal activities and suicide is widespread, the forensic literature on this subject is sparse especially concerning tests conducted on the weapon.

Confusing exit gunshot wound--"two for the price of one".

During the post-mortem examination of a 36-year-old shooting victim, two entrance gunshot wounds in the back and only one corresponding exit wound in the chest were detected. The likelihood of a retained fragmented or whole bullet, or an embolic phenomenon was eliminated by full body x-ray examination. The only remaining plausible explanation was that the two bullet tracts had converged within the thorax, eventually exiting through a common exit wound. Dissection of the projectiles' path confirmed this unusual phenomenon. Autopsy techniques for gunshot wound cases are discussed.

Personal identification based on radiographic vertebral features.

Personal identification of human remains constitutes about 10% of the normal caseload of any forensic medicine practice. Identification can be achieved by a variety of methods, one of which is the comparison of antemortem and postmortem radiographs. There are numerous accounts of cranial and dental radiographic features useful for identification, whereas the availability of postcranial radiographs and especially plates that depict the vertebral column is less widespread among the forensic community. The authors here review the various vertebral features instrumental in positive identification that can be identified on radiographs of the spine.

Suprapelvic and pelvic phleboliths--a reliable radiographic marker for positive identification.

Identification of unknown human remains is often achieved by radiographic comparisons. Among the markers compared in antemortem and postmortem radiographs is the presence of concordant pelvic and supra-pelvic phleboliths which are calcified intravenous blood clots. An illustrative case is presented, where an unidentified decomposed cadaver of an elderly male was positively identified with the aid of medical data provided by the Israel National Police. Two missing persons' records were suggested as possible matches and the concordant presence of phleboliths in one of the cases was useful for the identification. The reliability of phleboliths for radiographic positive identification is discussed along with the etiology and frequency of this phenomenon.

Fingerprinting the deceased: traditional and new techniques.

Identification of the deceased is an important task in medicolegal investigations. Fingerprints rank as the most widely used identification method, although obtaining the prints from the cadaver is not always easily accomplished. Various techniques for fingerprinting decomposed, mummified and burn victims have been suggested in the literature. In the present review, the diverse fingerprinting procedures implemented for cadavers in various conditions, with an emphasis on mummified fingers, are presented.

Fatal haemorrhage following male ritual circumcision.

Lethal complications following ritual circumcision are extremely rare, the most common being sepsis. We present here a case of fatal haemorrhage from a tiny incision of the glans, following a 'home' circumcision of a 6-week-old baby. The post-mortem examination disclosed idiopathic neonatal hepatitis. It is suggested that the previously undiagnosed hepatic condition was responsible for the fatal haemorrhage.

Child neglect or tragic misadventure?

The body of a 2-month-old baby was found inside the pram where he had been left overnight. Initial assessment of the event by a paramedic unit seemed to indicate foul play, based on the presence of a prominent linear pressure mark on the child's scalp and face. Thorough police and medicolegal investigation cleared the suspect and disclosed that the death resulted from accidental positional asphyxia, related to a faulty mechanism of the pram. We advise that when examining sudden unexpected death of children, forensic investigators should be aware of the potential hazards associated with baby accessories.

Trauma and identification of victims of suicidal terrorism in Israel.

The postmortem examination and identification procedures performed by medical and law enforcement personnel involved in mass disaster management in Israel are reported. The Israel National Police, the Israel Defense Forces, and the L. Greenberg Institute of Forensic Medicine's experts examined 171 victims who died in 21 incidents of suicidal terrorism. The trauma sustained by the victims and perpetrators of suicidal bombings included complete body disruption and explosive, flying missile, and blast injuries. The modus operandi of the perpetrators, reconstructed from the distribution and type of injury of the victims, is discussed. Fifty-five victims perished in open space bombings and 91 inside buses. All perpetrators of these bombings died at the time of the incident regardless of their location. Identification of the victims was achieved using fingerprints, dental records, medical intervention signs, anatomic variation, genetic profile, and personal recognition. Prompt identification of the perpetrators allowed speedy apprehension of the accomplices and prevention of similar attacks. Collaboration between the different forensic, military, and law enforcement teams increased the efficiency of disaster management efforts.

Marine taphonomy: adipocere formation in a series of bodies recovered from a single shipwreck.

Taphonomy of marine environments has been studied mostly from individual cases. The formation of adipocere, or "grave-wax," is an important indicator of the postmortem interval. In the present paper, the conditions and the timing of adipoceric formation are observed in a series of 15 cadavers recovered at different times, over a period of 433 days, from the same contained environment. Initial foci of adipocere on the subcutaneous tissue of the cadavers were detected as early as 38 days from the time of immersion in cold (10-12 degrees C) sea water. The discrepancies between our findings and previous reports on the correlation between time since death and decomposition stages in marine environments are discussed.

Forensic radiology.

Imaging techniques are a powerful tool in forensic science. Medical examiners and forensic anthropologists are less versed in the finer points of radiology than radiologists; nevertheless they are required to interpret findings from imaging studies to further medico-legal investigations. The forensic investigator often should call upon the radiologist whose expertise might prove invaluable in forensic consultations. The radiologist should be aware of the importance of storing radiographs over prolonged periods of time and of efficient record keeping methods, because various legal problems may require the radiographs for additional interpretation or for their presentation in court. Some of the main issues that might be encountered in forensic radiology are discussed in this review.

Quantitative assessment of trabecular bone pattern identification.

The results of the research described in this paper demonstrate that the trabecular architecture is unique to each individual and stable enough to be used as a forensic marker for positive identification of human remains. The trabecular bone architecture depicted on radiographs is often used as an individualizing forensic marker for positive identification of human remains. The aim of the present study was to ascertain the reliability of the trabecular pattern in forensic identification. The trabecular pattern is potentially the best radiographic forensic marker since its presence on a radiograph doesn't depend on a previous pathology or traumatic event. A sample of 305 radiographs of the left wrist of 103 postmenopausal women was studied using an image analyzer. The uniqueness and stability over time of the trabecular architecture was examined by creating line maps or "densitographs" of the ultra-distal point of the radius of each roentgenogram. Pearson's correlation coefficients were calculated for all possible combinations of pairs of radiographs. The correlation coefficient of pairs of radiographs of the same individual, taken at different times (2 to 6 years apart), was always higher than 0.72, while the correlation coefficients of radiographs of different individuals was always below 0.62.

Suicide bombers in Israel.

Between 1993 and 1995, 14 suicidal terrorist bombings took place in Israel; 86 victims perished in these attacks, which were carried out by militant Palestinian organizations that oppose peace treaties between the state of Israel and the Palestinian people. The modus operandi of the perpetrators was detonating, in a public area, an explosive device carried on or in close proximity to the terrorist's body. We reviewed the postmortem examinations and identification procedures performed by the medical and law enforcement personnel involved in mass disaster management. The types of injuries sustained by the victims and perpetrators include body disruption, explosive injuries, flying missile injuries, and blast injuries. Blunt trauma directly produced by the explosion and flying missile injuries account for 80.1% of the wounds. The number of fatalities was more closely related to the type of the attack rather than to the amount and type of explosives used. Swift identification of all victims and perpetrators was obtained through collaboration between the different professional teams involved: forensic scientists, law enforcement agencies, and secret service investigators. Based on the analysis of the data obtained from the necroscopic examinations, we observed that most of the wounds sustained fall within the realm of blunt force injuries; emergency medical facilities that might be faced with similar situations should prepare accordingly. Collaboration between the various forensic and law enforcement teams results in swift resolution of disaster management. Prompt identification of the perpetrators allows the authorities to apprehend any accomplices and to prevent similar attacks.

Forensic medicine in Israel.

We discuss the Israeli medicolegal system, which is rooted in remnants of British jurisprudence. Forensic services for the entire country and the occupied territories (Judea and Samaria), and now the Palestinian Autonomy (Gaza Strip and Jericho), are supplied by one central institute located in Tel Aviv. That organization, the L. Greenberg Institute of Forensic Medicine, is a department of the Ministry of Health and has academic affiliation with the University of Tel Aviv. About 2,000 necroscopic examinations are performed annually, and the types of cases encountered in the forensic practices in Israel are noted. The academic and research activities of the Institute's staff are described, with emphasis on collaboration with overseas forensic scientists. The modern history of the country is reflected in the chronicle of the evolution of its forensic medicine.

Rubber and plastic ammunition lethal injuries: the Israeli experience.

Rubber and plastic ammunition was used by the Israeli Defence Forces between the years 1987 and 1993 (Intifada) almost exclusively as a deterrent to aggression by the Palestinian civilian population in the occupied territories of Gaza, Judea and Samaria. While designed to avoid the serious wounds and deaths caused by the use of conventional military ammunition, the firing of rubber and plastic bullets has resulted in extensive injuries and more than 20 deaths. The data from the autopsies of 17 of these victims, mostly teenagers, were analysed. Ten of the victims died from injuries inflicted by Improved Rubber Bullets, while the other seven succumbed to injuries caused by Plastic Bullets. In most instances, the cause of death was related to injuries to the brain. Ballistic features of non-conventional bullets are discussed, and suggestions to curtail the serious injuries and fatalities arising from their use are given, with emphasis on firing from a safe range. British and South African experience with this type of ammunition is compared with our observations.

Suicidal terrorist bombings in Israel--identification of human remains.

Positive identification of human remains is one of the most important tasks in mass disaster investigations. Religious and jurisdictional demands in Israel, require the identification process to be completed in the shortest possible time. In the 18 suicidal terrorist bombings that took place in Israel between the years 1993-1996, 127 victims and 19 perpetrators were killed, and their severely fragmented bodies were identified within 24 h. The efficient completion of the identification endeavor was enabled by the implementation of a variety of techniques and the close collaboration in the investigation between the different emergency and forensic agencies. This paper presents the mass disaster identification policy and techniques currently used in Israel. The importance of an interdisciplinary approach for the identification of extremely fragmented human remains from mass disasters and the creation of a central data bank of fingerprints and genetic markers is emphasized.

Radiographic identification of fragmentary human remains from a mass disaster.

Positive identification of human remains is one of the most important tasks in mass disaster management. Here we report on the use of radiography for positive identification of fragmentary human remains recovered from the scene of a terrorist bombing in the Jewish-Argentine Mutual Association Center in Buenos Aires, Argentina, in July 1994. Radiographic examination of all human remains from mass disaster scenes is recommended for identification purposes. Establishing a computerized data bank of antemortem information on missing persons and postmortem findings in disaster victims greatly facilitates and expedites the identification process.

Identification of human remains: forensic radiology.

The identification of human remains is of paramount importance in medicolegal investigations. The comparison of antemortem and postmortem radiographic records is one of the main techniques used to achieve a positive identification. The purpose of this paper is to present a comprehensive review of the use of roentgenography in forensic medicine with special emphasis on the nature of the radiographic markers often utilized for identification. Clinical radiologists should be aware of the importance of storing radiographs over prolonged periods of time and of efficient record keeping methods to enable prompt retrieval of X-ray films in mass disaster situations. Furthermore, because of his skills in radiographic evaluation, the radiologist's expertise might prove invaluable in forensic consultations.