Clinical forensic sample collection techniques following consensual intercourse in volunteers - cervical canal brush compared to conventional swabs.

The purpose of the research was to evaluate gynecological evidence collection techniques; the benefit of cervical canal brush sample compared to vaginal fornix and cervical swab samples and the time frame for detecting Y-chromosomal material QiAmp DNA Mini Kit(®) and Quantifiler Y Human Male DNA Quantification Kit(®) in adult volunteers following consensual intercourse. Eighty-four adult female volunteers following consensual intercourse were recruited for the study. By combining all sample collecting techniques, 81.0% of the volunteers were Y-DNA positive. Up to 60 h the conventional swab sampling techniques detected more Y-DNA positive samples when compared to the brush technique. However, after 60 h, the cervical canal brush sample technique showed its benefit by detecting 27.3% (6/22) of Y-DNA positive samples, which were Y-DNA negative in both conventional swab sampling techniques. By combining swab and brush techniques, 75% of the volunteers were still Y-DNA positive in 72-144 post-coital hours. The rate of measurable Y-DNA decreased approximately 3% per hour. Despite reported consensual intercourse, 6.8% (3/44) of volunteers were Y-DNA negative within 48 h. Y-DNA was not detected after 144 post-coital hours (6 days). In conclusion, the brush as a forensic evidence collection method may provide additional biological trace evidence from the cervical canal, although the best biological trace evidence collection can be obtained by combining all three sampling techniques. The time frame for gynecological forensic evidence sample collection should be considered to be at least a week if sexual violence is suspected.

Evaluation of anogenital injuries using white and UV-light among adult volunteers following consensual sexual intercourse.

OBJECTIVES: New clinical forensic examination techniques for sexual assaults have not been introduced over the last few decades. We evaluated the benefit of ultraviolet light compared to white light for detecting minor anogenital injuries and scars, following consensual sexual intercourse among adult volunteers. DESIGN: A prospective study comparing female genital findings utilising white and ultraviolet light. A colposcopy with photographic documentation was used. SETTING: Personal invitation to healthcare students, hospital employees or acquaintances to volunteer for a gynecological examination, with a focus on clinical forensic aspects. PARTICIPANTS: Eighty-eight adult female volunteers were recruited for the study. The examination was performed after consensual intercourse. Age ranged from 20 to 52 years (median 26.5 years). MAIN OUTCOME MEASURES: Presence of acute findings and scars in the genital area using white and UV-light. RESULTS: Acute genital injury rate was 14.8% under white light colposcopy and 23.0% using UV light. Submucosal hemorrhages in the genital area were documented significantly better under UV-light than white light (14.9% vs. 6.8%; p=0.016), whereas petechiaes (4.5%) and abrasions (2.3%) were detected using either method. UV-light revealed significantly more often delivery-associated genital scars compared to white light (39.8% vs. 31.8%; p=0.016). Furthermore, 10 out of 31 (33.3%) women had no residual anogenital skin or mucosal surface findings, despite a prior episiotomy or rupture of the vaginal outlet wall during delivery, supporting its enormous ability to heal even after major trauma. CONCLUSIONS: UV-light may provide additional value for the evaluation of physical findings in clinical forensic examinations after sexual assault, and is especially useful in detecting otherwise invisible early submucosal hemorrhages and scars.

Comparison of ethyl glucuronide and carbohydrate-deficient transferrin in different body fluids for post-mortem identification of alcohol use.

AIMS: Alcohol abuse is a major risk factor for premature death. Confirming the role of alcohol consumption in cause-of-death investigations has, however, remained difficult, due to lack of reliable biomarkers. METHODS: We compared ethyl glucuronide (EtG) and carbohydrate-deficient transferrin (CDT) assays from serum, urine, cerebrospinal fluid and vitreous humor in a forensic autopsy population with either a positive (n = 38) or negative (n = 22) history of alcohol abuse based on detailed medical and police records and forensic toxicological investigations. RESULTS: A positive blood alcohol concentration (median 1.15‰, range 0-3.3‰) was found in 26/38 (68%) of the cases with a documented history of alcohol abuse. EtG concentrations (mean ± SD) in urine (339 ± 389 mg/l, P < 0.001), vitreous humor (4.2 ± 4.8 mg/l, P < 0.001), serum (6.9 ± 8.9 mg/l, P < 0.01) and cerebrospinal fluid (1.7 ± 2.7 mg/l, P < 0.01) were significantly higher among the cases with a positive history of alcohol use than those in the alcohol-history negative group, whereas in corresponding comparisons CDT was significantly different only in cerebrospinal fluid (4.3 ± 2.1 vs. 2.3 ± 0.6%, P < 0.05). The highest sensitivities (92%) in detecting ante-mortem alcohol use were obtained for urine and vitreous humor EtG assays. CONCLUSION: Our data indicate that measurements of EtG in urine or vitreous humor show the highest diagnostic accuracies in post-mortem investigations of excessive alcohol consumption and can be recommended for routine applications.

Immunoassay for ethyl glucuronide in vitreous humor: a new tool for postmortem diagnostics of alcohol use.

Although excessive alcohol consumption plays a major role in fatal events, the role of alcohol use as a possible contributing factor at the time of death is not easy to establish due to lack of suitable biomarkers for postmortem analyses. We used an immunological approach to measure ethyl glucuronide (EtG) concentrations from vitreous humor (VH) and serum from 58 individuals representing a forensic autopsy population of cases with either a well-documented history of excessive alcohol use (n=37) or cases without such history (n=21), according to medical and police records and blood alcohol determinations (BAC). The immunoassay was based on the Microgenics DRI-EtG EIA reagents applied on an automated Abbott Architect c8000 clinical chemistry analyzer. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) determination of EtG and ethyl sulfate (EtS) was used as a reference method. At a cut-off of 0.3mg/l for VH-EtG, the immunoassay correctly identified 92% of the cases with a history of excessive alcohol use, whereas the BAC was positive (cut-off 10mg/dl) in 68% of the cases. A significant correlation emerged between VH-EtG and serum EtG (r=0.77, p<0.001) and between VH-EtG and BAC (r=0.62, p<0.001), although VH-EtG was frequently elevated also in cases with no detectable BAC. The EtG immunoassay showed a strong correlation with the LC-MS/MS reference method (r=0.94, p<0.001) and there was 100% agreement in the frequency of marker positive and negative findings between the immunoassay EtG results and the LC-MS/MS analysis of EtG and EtS. The present data indicate that the immunoassay for VH-EtG is a useful forensic tool for screening of antemortem alcohol use.

Fatal blunt injuries possibly resulting from sexual abuse of a calf: a case report.

We report a case of a calf-related fatality on a farm. The victim was a 60-year-old man who was possibly attempting to sexually approach the animal from behind when he was struck by it, sustaining fatal blunt injuries, mostly to the thorax. This case is reported because of its rarity and because of the particular circumstances of death. Fatal trauma associated with bovines is rare on the whole, and when it does occur it is usually caused by kicking or pushing during regular agricultural activity. Although the cause of death in our case could be determined, the circumstances and the manner of death remain speculative to some degree.

Objective post-mortem diagnosis of chronic alcohol abuse--a review of studies on new markers.

Identification of chronic excessive alcohol consumption in living and deceased individuals is a fundamental task in forensic pathology. Reliable methods for post-mortem diagnosis of chronic alcohol abuse are required because morphological findings are unspecific and ante-mortem data are often unreliable. In clinical practice, several biochemical markers indirectly demonstrating chronic alcohol abuse are employed, but thus far these methods have not been used in routine post-mortem investigations. We reviewed publications in which these markers have been applied to autopsy material. Based on this review, some of these biochemical parameters are useful in post-mortem diagnostics, although further systematic research is required.

Post-mortem stability and redistribution of carbohydrate-deficient transferrin (CDT).

Post-mortem diagnosis of chronic alcohol abuse is a challenge for forensic experts due to the lack of pathognomonic morphological findings and often also inadequate background information. Objective methods demonstrating chronic excessive alcohol consumption would therefore be a useful tool for forensic pathologists. In clinical practice, several markers of chronic alcohol abuse have recently been introduced, among which carbohydrate-deficient transferrin (CDT) is the most accepted, but the use of these markers in autopsy has not yet been established. We examined post-mortem stability and possible post-mortem redistribution of CDT and compared two analytical methods, capillary zone electrophoresis and high-performance liquid chromatography. According to our results, CDT remains stable for an appreciable time after death. The results further indicate that CDT is not subject to major post-mortem redistribution.

Two entrances, one exit--an atypical shotgun injury: a case report.

Firearm-related injuries are a major problem worldwide and one of the central issues in forensic pathology. An atypical appearance of a gunshot wound can create surgical or medico-legal diagnostic problems. We report a case of a homicidal shotgun fatality with an unusual trajectory of pellets in the body. Two large pellets perforated the anterior chest wall near to each other but made their exit through a common wound in the back. Our report describes the results of the medico-legal investigation and discusses problems related to examination of firearm wounds.

Fatal stroke in a young cocaine drug addict: chemical hair analysis and cervical artery examination twenty months after death.

We present a case of a 26-year-old female who died of acute cerebral infarction after thrombosis of the left internal carotid artery, conceivably related to cocaine use. The forensic examination was performed only twenty months post-mortem. Revaluation of clinical data was carried out after exhumation and forensic autopsy examination were done, including anatomic dissection of cervical vessels and histological and toxicological analyses. Interestingly, comparative histological examination of cervical arteries was more useful in determining the putative site of vascular damage than gross and histological examination of the brain itself, although the state of preservation of tissues was poor. In conclusion, when a vascular accident is suspected or has to be demonstrated, we suggest performing comparative histological examinations of selected artery samples, even several months after death.

Diseases and motor vehicle fatalities in Finland in 2001 and 2002.

OBJECTIVES: The possible connection between diseases among drivers and traffic accidents was examined for traffic safety purposes. METHODS: We studied medical conditions of drivers and passengers in all motor vehicle crashes with fatalities in Finland in 2001 and 2002 by using reports of road accident investigation teams, including autopsy reports. We analyzed a total of 542 crashes with 640 fatalities. Findings were also compared with available epidemiological data in Finland. RESULTS: An insignificant difference in the number of reported diseases was present between the different parties involved in crashes. However, among killed key drivers, so-called A-parties, psychiatric diseases, especially alcoholism, depression, and unspecific mental disorders, were diagnosed more often than in the groups of other drivers or passengers. In addition, A-parties were reported to more frequently suffer from cerebral arteriosclerosis and arterial hypertension. CONCLUSIONS: Drivers' diseases can be a risk factor for traffic accidents. Fitness to drive should therefore be considered in medical practice, particularly in patients with alcoholism and other psychiatric disorders.

Bear attack--A unique fatality in Finland.

Fatalities due to animal bites, the vast majority of which are associated with dogs and big cats, are relatively uncommon and rarely described in the literature. Especially rare are fatal bear attacks on humans. We herein present a forensic investigation of a fatal assault, involving numerous bites on a 42-year-old man in Finland by an European brown bear (Ursus arctos arctos).

Death from renal cyst: spontaneous or traumatic rupture?

We report an unusual death of an apparently healthy 56-year-old male due to massive hemorrhage caused by rupture of an artery in the wall of a solitary renal cyst, possibly after a relatively minor trauma. Fatalities due to spontaneous or posttraumatic rupture of renal cysts are extremely rare but can represent a potential danger for people with acquired cystic kidney disease. Our report describes results of the forensic investigation and discusses possible mechanisms of the rupture.

The examination and reporting of war crimes-an example from Finnish history.

We present a historical example of forensic investigation of civilian victims of an armed conflict. During the Civil War in Finland in 1918, 77 external examinations with photographic documentation and 10 forensic autopsies were carried out. However, incorrect conclusions concerning post-mortem changes made by non-medical persons led into erroneous interpretations of the events. Post-mortem changes were considered to be signs of torture and post-mortem mutilation. This example demonstrates how political purposes may falsify results of a forensic investigation.

The death of Adolf Hitler--forensic aspects.

The death of Adolf Hitler is one of the unsolved mysteries of the twentieth century. Numerous historians and journalists have attempted to piece together the details, but despite the interest in the forensic literature regarding the identification of the body, there has not been much scientific debate about the alleged cause of death--cyanide poisoning, gunshot injury, or both. The available literature concerning Hitler's cause of death is incomplete because the toxicological analysis has not been performed and because the skull bone fragment with a gunshot wound possibly from Hitler's corpse has not been properly examined. This has given basis for various theories, which are reviewed. We believe that mtDNA analysis of the skull fragments and of Hitler's jaw, now filed in Moscow, and samples from maternal relatives of Hitler are crucial linking the skull fragment with the gunshot wound to Hitler.

Suicide by pencil.

We report an unusual suicide, committed with a common pencil. A 72-year-old male inflicted himself a penetrating thoracic wound while being hospitalized for a hip prosthesis operation. Although the patient was immediately operated, the cardiac injury appeared to be fatal. Cases of suicidal penetrating wounds of the anterior chest wall are rare and they are mostly inflicted by knives, glass fragments, or other sharp instruments. The potential danger of a pencil should be taken into consideration, especially in psychiatric hospitals and imprisonment facilities. We examined the legislation in Italy and Finland concerning the regulation of privacy in special care institutions.

Fatal gunshot wounds between 1995 and 2001 in a highly populated region in Finland.

Gunshot injuries are a major problem worldwide from the human, medical, and economic perspectives. The number and characteristics of gunshot fatalities have been observed to vary significantly between countries. This study analyzes fatal gunshot wounds in the region of Uusimaa, Southern Finland, between 1995 and 2001. Gunshot wounds were typically found in suicides committed by men aged between 20 and 60 years. In most cases, a handgun was used. Mental disorders were present in the history of almost one quarter of the victims. Alcohol was identified in postmortem toxicology in half of the cases, but drugs of abuse were relatively uncommon. The autopsy rate in Finland is among the highest of the European Union countries, and a medicolegal investigation is performed in virtually all fatal gunshot incidents. This study is therefore representative of forensic investigations of gunshot fatalities in Finland overall.

Cocaine found in a child's hair due to environmental exposure?

We report a case of a 6-year-old boy who had been living with his parents, both cocaine smokers, and who was urgently admitted to hospital for general distress. Upon examination, cocaine and cocaine metabolites were detected in hair and urine samples. These toxicological findings most likely indicate that the child had passively consumed the drug when living in a heavily contaminated environment.

Amniotic fluid embolism as cause of death in a car accident--a case report.

Amniotic fluid embolism (AFE), a relatively rare complication in pregnancy, has a high mortality rate. We describe a case of a 38-week pregnant woman with such an embolism leading to almost immediate death after a blunt abdominal trauma inflicted in a motor vehicle accident and probably associated with improper positioning of a seat belt. It has been assumed that the pathophysiology of amniotic fluid embolism is related to an anaphylactoid reaction and that mast cell degranulation indicates this mechanism. Moreover, immunohistochemical antitryptase staining of pulmonary tissue samples in our case revealed mast cell degranulation.

Morphology of experimental assault rifle skin wounds.

Finnish forensic experts who had performed investigations of victims of alleged political violence in Kosovo, in the Federal Republic of Yugoslavia, under the mandate of the European Union, carried out experimental shooting in Finland to confirm observations made during the earlier forensic investigation. Experimental shooting can be of benefit for autopsy conclusions, because the wounding potential of military weapons differs from that of non-military weapons. Assault rifle gunshot wounds were inflicted upon anaesthetised swine from various distances and angles and with variable shielding of the skin. The morphology of the skin wounds was studied and post-mortem changes were documented while the wounds were being observed in cool and room temperature conditions for 13 days. Large variation was found in the size, form, and regularity, and in the presence and width of the abrasion zone of entrance and exit wounds, in addition to secondary wounds. The maximum diameter of entrance wounds varied between 4 and 40 mm and that of exit wounds between 10 and 110 mm. The width of the abrasion zone surrounding entrance wounds ranged from 2 to 11 mm. Extreme care and caution are needed when drawing conclusions with regard to cases of multiple gunshot injuries, and especially when post-mortem changes are considerable.