Role of orthopedic implants and bone morphology in the identification of human remains.

When conventional methods of identification, such as visual recognition and dental comparison, cannot be used to identify a deceased person, it becomes necessary to consider alternative methods. The presence of an orthopedic implant in a body may assist identification if ante-mortem medical records are available for comparison. Another method of identification involves comparison of ante-mortem and postmortem radiographs. Eight cases are reported from Forensic Science SA where the presence of orthopedic implants and/or ante-mortem radiographs were used to try to establish identification. In six cases, positive identification was established, and in two cases with upper limb orthopedic implants, the bones remained unidentified. Manufacturers were unable to provide any information about the distribution and use of the implants that could be of use with identification, as there are no requirements in Australia for individual medical implants to be tracked. Such a system has the potential to aid postmortem identification if serial codes were etched onto implants that could then be traced to manufacturers, surgeons, and recipients of these devices.

Forensic issues in cases of fatal hemorrhage from arteriovenous dialysis access sites.

Angioaccess sites to enable repetitive vascular punctures for hemodialysis include temporary or permanent indwelling catheters, port access devices, autogenous vessels in native arteriovenous fistulas, or non-autogenous material in prosthetic arteriovenous grafts. While complications such as thrombosis and infection are well recognized, lethal hemorrhage is much less commonly encountered. In this paper, selected cases are reported to demonstrate the range of situations that may be encountered at autopsy, including hemorrhage from a catheter in a case of suicide, and hemorrhage from an arteriovenous fistula and an arteriovenous graft. Predisposing factors to hemorrhage include coagulation abnormalities due to anticoagulant therapy or to underlying renal failure, stenosis or obstruction that has resulted in increased intraluminal pressure, local sepsis, repeated trauma from venesection and hypertension. An approach to such cases should include careful evaluation of the medical history and death scene, with dissection at autopsy of catheters, grafts and fistulas to demonstrate the condition of anastomosis sites, and the presence or absence of ruptures, perforations, stenoses, and/or thromboses. Histologic sampling of autologous fistula walls and surrounding soft tissues may reveal evidence of sepsis.

Recovery of human remains after shark attack.

Two cases of fatal shark attack are reported where the only tissues recovered were fragments of lung. Case 1: An 18-year-old male who was in the sea behind a boat was observed by friends to be taken by a great white shark (Carcharodon carcharias). The shark dragged him under the water and then, with a second shark, dismembered the body. Witnesses noted a large amount of blood and unrecognizable body parts coming to the surface. The only tissues recovered despite an intensive beach and sea search were 2 fragments of lung. Case 2: A 19-year-old male was attacked by a great white shark while diving. A witness saw the shark swim away with the victim's body in its mouth. Again, despite intensive beach and sea searches, the only tissue recovered was a single piece of lung, along with pieces of wetsuit and diving equipment. These cases indicate that the only tissue to escape being consumed or lost in fatal shark attacks, where there is a significant attack with dismemberment and disruption of the integrity of the body, may be lung. The buoyancy of aerated pulmonary tissue ensures that it rises quickly to the surface, where it may be recovered by searchers soon after the attack. Aeration of the lung would be in keeping with death from trauma rather than from drowning and may be a useful marker in unwitnessed deaths to separate ante- from postmortem injury, using only relatively small amounts of tissues. Early organ recovery enhances the identification of human tissues as the extent of morphologic alterations by putrefactive processes and sea scavengers will have been minimized. DNA testing is also possible on such recovered fragments, enabling confirmation of the identity of the victim.

Diagnostic problems associated with cadaveric trauma from animal activity.

Analysis of a series of deaths between 1986 and 2001 resulting from natural disease, accidents, suicides, and homicide, where postmortem animal activity had traumatized bodies, was undertaken at the Forensic Science Center in Adelaide to demonstrate the range of lesions that may occur and problems in interpretation that result. Tissue damage had been caused by a variety of animals, including fly larvae, ants, birds, dogs, rodents, sea lice, and sharks. Postmortem animal activity had disguised injuries, modified wounds, and created the appearances of inflicted injury. Problems with identification occurred after postmortem facial trauma, and loss of organ parenchyma had interfered with, or precluded, the precise determination of the manner of death in some cases. Specific kinds of tissue and organ damage may occur after death, necessitating careful assessment of lesions in a search for characteristic features of animal activity. The pattern of lesions may enable identification of the particular species of animal involved.

An autopsy approach to bee sting-related deaths.

Although severe reactions to the sting of the common honey bee (Apis mellifera) are a common problem in Australia, reported deaths are uncommon, with the estimated mortality varying from one to four persons each year. The following study presents the postmortem findings in three cases of bee sting fatality, including one in which no observable sting was found. An autopsy approach to such cases is detailed. Overreporting of bee sting-related deaths may occur due to the inclusion of deaths unrelated to a reaction to bee venom, while under-reporting may be due to unexplained deaths where a history of a bee sting is not available or apparent at autopsy. A classification of bee sting-related deaths is proposed, which would allow more accurate reporting of bee sting-related fatalies. A serum tryptase and specific IgE to bee venom on serum obtained at autopsy can assist in confirming anaphylactic reaction to bee venom as the cause of death, particularly in the absence of observable stings. Although there are limitations to the usefulness of serum tryptase tests in the postmortem situation, it may still be useful to confirm suspected anaphylaxis in autopsy cases with an undetermined cause of death.

Clinicopathologic features of fatal self-inflicted incised and stab wounds: a 20-year study.

The files of the Forensic Science Center in Adelaide, South Australia, were examined for all cases listed as suicide in which death had been caused by the use of a sharp instrument during the 20-year period from January 1981 to December 2000. Fifty-one cases were identified, consisting of 35 men and 16 women. The age range was 23 to 83 years (mean 49 years) representing 1.6% of total suicides (513182). Fatal injuries included incised wounds to the arms in 51.4% of men (n = 1835) compared with 87.5% of women (n = 1416), incised and stab wounds to the neck in 40% of men (n = 1435) and 25% of women (n = 416), and stab wounds to the chest or abdomen in 28.6% of men (n = 1035) and 12.5% of women (n = 216). In 8 cases, multiple sites were involved. The use of sharp instruments in suicide was favored by older, rather than younger, individuals, with a tendency for women to incise their wrists. Hesitation marks were present in 23 cases (54%) and scarring of the wrists from previous suicide attempts in 5 cases. Although this study demonstrated a higher number of men than women committing suicide by using sharp objects, this method of suicide remains uncommon.