Antemortem Injuries Research Articles

Post-mortal lesions in freshwater environment

Postmortem animal feeding activity may cause considerable damage to bodies resulting in the modification of wounds, loss of identifying features and injury. Certain postmortem lesions may appear inflicted or non-inflicted antemortem injuries. At present, apart from cases in sea water, no data are available about post mortal lesions performed by aquatic organisms. This note that represents the first report concerning colonisation of a dead body by crustaceans a few hours after death, describes injuries caused by the amphipod Niphargus elegans on the face, and in particular on the eye region, of a young man dead by drowning. The lesions recorded in this case are comparable with the lesions caused by ants. The high plasticity in the food choice can allow Amphipoda to colonise drowning bodies in every moment after dead, however the benthonic behaviour of these animals suggests a more important role in the colonisation during post-mortem submersion periods.

Postmortem Skin Damage Due to Ants

Ants postmortem actions on a dead body can result in skin damage, featuring traumatic antemortem or in limine vitae events. Three observed cases are reported here where skin damages by ants' predatory activity led us to differentiate from accidental or voluntary injuries. Described cases show how the relevant skin lesions and consequential hemorrhage due to the postmortem action of these hymenoptera can be confused with antemortem injuries.

Postmortem Artifacts Made by Ants and the Effect of Ant Activity on Decompositional Rates

Ants belong to the family Formicidae of the order Hymenoptera and they are one of the world's dominant insect groups. Ants can be present at all stages of carrion decomposition as they are typically observed shortly after death or during the early postmortem period, but even later once the fly maggots had left the body. Their role in the faunal succession varies from predator on the eggs and larvae of other insects (mainly Diptera), thus reducing significantly the rate of decomposition, to scavenger on the flesh or exudates from the corpse itself. As they can deeply affect the occurrence of cadaver entomofauna, the presence or absence of ants should be taken into account in every case involving postmortem interval estimates based on entomological evidence. In fact, the effects of ants on carrion reduction seem to be mainly dependent on species, on their amount or abundance, and on geographic area. The feeding action of ants can cause many irregular, serpiginous, scalloped areas of superficial skin loss, and small punctate and scratch-type lesions may be often observed on the body, which are the result of postmortem ant bites. Usually ant injuries are orange-pink to yellow in color and diffusely scattered over the skin surface. These injuries consist of small and rather shallow gnawed holes that can be easily misinterpreted as antemortem abrasions or resulting from strong acids. No bleeding is associated with such skin lesions but sometimes considerable hemorrhage can take place, especially where removal of superficial layers of skin occurs in congested parts of the body. As ants attack the uncovered areas of the body, ant bites can frequently give rise to suspicion especially if located on the neck mimicking antemortem injuries. They are also occasionally misinterpreted as patterned abrasion due to the imprinted effect of a blunt or offending object. On closer inspection, artifacts made by ants can be immediately apparent especially when the ants are identified upon the body, but final diagnosis can be only confirmed at the autopsy by gross and microscopic analysis. The features of such lesions will be illustrated in detail by reviewing some interesting forensic cases.

Forensic pathology and problems in determining cause of death

“If it is not true it is very well invented” (Giordano Bruno 1548–1600)Forensic pathology by its very nature is a science that dealswith specimens that are no longer living, whether these areentire bodies of deceased indivi duals, or are isolated organsor tissues that have been submitted for evaluation. Thereare certain advantages to this, with dissections not beingencumbered by complex machinery and paraphernaliarequired to maintain life. However, there are also distinctdisadvantages with opinions having to be formulated basedon the examination of tissues that have been devitalized forconsiderable periods of time.The fact that organs and tissues are no longer being per-fused by oxygenated blood means that metabolic processeshave stopped and autolytic and putrefactive changes areoccurring. Decomposition begins from the moment of cel-lular death and this causes a spectrum of tissue alterations.In extreme cases there may be minimal soft tissues left toassist with the assessment of underlying organic diseases orinjuries. Given these problems however, the results of arecent study published in the journal demonstrated that theautopsy was still a “useful diagnostic exercise,” with sig-niWcant anatomical and pathological features being demon-strated in most decomposed bodies to enable both the causeand manner of death to be established [1].An associated problem is animal predation. Domesticanimals such as dogs and cats may consume signi Wcant por-tions of bodies, including organs responsible for death, inaddition to creating tissue defects that may be diYcult todistinguish from antemortem injuries. Insects may modifypre-existing injuries such as stab and bullet wounds. Theresults of such activities have to be deWned as carefully aspossible and then subtracted from the autopsy Wndings in anattempt to estimate what was truly present in the perimor-tem period. This may not, however, always be possible.While it is recognized that surgeons often perform com-plex dissections and reconstructions in the living, postmor-tem dissections may also be diYcult. The absence ofcirculation means that the vasculature is Xattened and non-pulsatile and so vessels may not be easily identiWed. Simi-larly, tissue planes and organ pathology may be obscuredby postmortem changes. Even if abnormal areas can beidentiWed, the signiWcance of subsequently demonstratedmicroscopic changes may be uncertain as tissues andorgans tend to have only a limited range of responses to avariety of pathological insults. For example an acuteinXammatory inWltrate may result from ischemia, infection,or blunt trauma, and scarring may follow burns, lacerations,or incisions. Organs may also be altered in a non-speciWcmanner by the pathophysiological changes that accompanydying, with for example disseminated intravascular coagu-lation and coagulopathy from multiorgan failure causingmarked changes in tissue morphology not due to the under-lying condition per se, but to the body’s response to it. If nomacroscopic abnormalities have been identiWed, histologycan be used to screen for occult disease; however, samplingerror may become an issue as a 5- section of tissue maynot be fully representative of a 500-g organ as a whole. Dis-eases with a patchy distribution such as myocarditis exem-plify this problem. It should also be noted that tissueresponses to subtle metabolic and electrophysiologic abnor-malities may not be detectable by standard techniques, andso it may not always be possible to demonstrate a deWnitive

Post-mortem changes of the middle ear: Multislice computed tomography study

Six dry skulls were studied by multislice computed tomography (MSCT). They had not previously been prepared, and were natural skeletonized remains. All had been found in the soil. Examination focused on the temporal bones and the ear structures. In all cases, either disruption of the ossicular chain or absence of some ossicular bones were noted. The authors concluded that the fragile ossicles were disrupted in the post-mortem state, and were not indicative of ante-mortem pathology. These observations illustrate the ability of MSCT to visualize taphonomic changes. To further illustrate these findings, we present the results of MSCT performed on an exhumed body. The left ossicular bones were missing and the right ossicular chain was disrupted. With the development of forensic radiology, structures as tiny as the ossicles can be examined. However, the radiologist who performs post-mortem imaging must be familiar with taphonomic changes to avoid interpretation as ante-mortem or peri-mortem traumatic injuries. This could potentially have considerable judicial impact, especially in the study of exhumed bodies.

Forensic Issues in Cases of Diogenes Syndrome

Diogenes syndrome is a syndrome described in the clinical literature in elderly individuals characterized by social isolation and extreme squalor. A number of typical features are found in the forensic evaluation of these deaths as the cases usually initiate medicolegal investigations due to the circumstances and the lack of recorded medical histories. Examinations of the death scenes are often difficult as victim's houses are in a state of disrepair, with filth and clutter, and pet dogs may resent the intrusion of strangers. Bodies are often filthy, with parasitic infestations, and are often putrefied due to the social isolation of the deceased and the delay in the finding of the corpse. Bodies may be traumatized from postmortem animal depredation by rodents or pets (eg, cats, dogs), and injuries such as bruises and lacerations may be present from falls associated with terminal illnesses or alcoholism. Blood or putrefactive fluids may be spread throughout the house by pets. Treatable medical conditions are often present in advanced stages, and features of hypothermia may be found. Attending police may suspect robbery due to disarray of the house and homicide due to apparent "bleeding" around the body from purging of putrefactive fluids, injuries from falls, or postmortem animal activity and "blood stains" throughout the house from antemortem injuries and/or fluid spread by animals. Finally, the identification of the deceased may be compromised by decay and/or postmortem animal activity. Thus, in addition to having typical clinical manifestations, such individuals appear to form a distinct subset of forensic cases having characteristic death scene and autopsy features and presenting particular difficulties in postmortem evaluations.

Antemortem Trauma From Rodent Activity: The Popiel Phenomenon

Injuries to bodies from animal activity are often postmortem in nature, although differentiating ante- from postmortem tissue damage may be difficult. Presented here is the case of a 73-year-old woman who died of a cerebral infarct. The woman demonstrated postmortem, and probable premortem, injuries resulting from rodent activity. Histological examination of tissues from areas of animal activity revealed a subtle early vital reaction, suggesting that the victim may have been alive during the animal feeding activity. Given the Polish folk legend of Popiel, a ninth-century ruler who was eaten alive by mice, the finding of antemortem injuries due to rodents or other animals could be designated the "Popiel phenomenon." Histological assessment of such wounds may be a crucial step in determining the timing of injuries, helping to elucidate the chronology of the fatal event, and separating pre- from postmortem wounds. If a vital reaction is detected, it can be assumed that the victim was alive for some time in an incapacitated state prior to death, and that death did not occur rapidly.

Head injuries of Roman gladiators

Gladiator remains from a recently unearthed cemetery in ancient Ephesus (Turkey) offer a unique opportunity for proving common theories involving the weaponry and techniques of gladiator fighting based on the evidence supplied by cranial bones. This mass grave is the first of its kind to undergo a thorough osteological and forensic examination. A minimum number of individuals (MNI) analyses revealed that at least 68 individuals. All individuals found turned out to have been males aged between 20 and 30 years, except for one female associated with a female slave gravestone, and one male aged 45–55 years, had been buried in this area of the cemetery. The male mean body height was 168 cm (S.D. = 5 cm), which lies inside the normal range of height for Roman populations at those times. Eleven (16% of MNI) individuals exhibit a total of 16 well-healed antemortal cranial traumata. Five of the 11 individuals showed multiple trauma. Ten (15% of MNI) individuals exhibited a total of 10 perimortal cranial traumata. This is a surprisingly high frequency of deadly head injuries, taking into account that most of the gladiator types wore helmets. A possible explanation could be the frequently reported deathblow technique used by the hammer-carrying death god “Dis Pater”. The gladiator weaponry is well known through historical sources. At least one injury per known type of offensive weapon could be identified, as well as evidence for the most popular, the gladiator trident, which was found to be represented by one perimortem and two antemortem injuries. Overall the reportedly very strict nature of combat rules for gladiator fights could be confirmed by the absence of multiple perimortal traumatized individuals, showing a lack of the excessive violence commonly observed on medieval battle ground victims. This graveyard gives the opportunity to confirm historical aspects and to check the reliability of forensic methods for identification of antemortem, perimortem, or postmortem bone lesions. Typical examples for these kinds of lesions and injuries are presented. The colour of the margins of the traumata proved to be the most distinguishing feature for postmortal lesions.

Autopsy problems associated with postmortem ant activity.

Postmortem damage to skin caused by ants may result in lesions that resemble inflicted or noninflicted antemortem injuries. In addition, if this superficial skin loss is located in a dependent area, there may be considerable passive postmortem seepage of blood. Three cases are described where such lesions caused concerns regarding the possibility of inflicted or accidental injury. These cases demonstrate that extensive skin loss and considerable hemorrhage may result from ant predation after death mimicking antemortem injury. This is particularly so in bodies that have been left outdoors, but it may also occur in bodies lying indoors. Problems may arise if ants have been removed or lost prior to postmortem assessment.

The forensic entomologist in the context of the forensic pathologist’s role

An adequate death investigation requires the combined efforts and cooperation of experts in different disciplines: crime scene technicians, death investigators, forensic pathologists, anthropologists, entomologists, other medical and non-medical professionals. These front-line experts play a crucial role in every death investigation process. The forensic pathologist normally has the legal authority to take charge of the dead body at a death scene and his primary functions are the exterior and interior examination of the cadaver by analyzing the extent of antemortem injuries and the postmortem changes and the recovery of physical evidence. He is responsible for determining how, when and why of any death which is the result of violence, suspicious or unexplained circumstances or a death which is sudden or unattended, defending and explaining the reasons for making these diagnoses in a courtroom. The forensic entomologist can provide invaluable aid in death cases where human remains are colonized by insects and in the overall investigation. His principal role is to identify the arthropods associated with such cases and to analyze entomological data for interpreting insect evidence. He is responsible for determining the period of insect activity according to all the variables affecting insect invasion of remains and their development. The major goal of medico-criminal entomology is to contribute to the determination of the time, cause, manner and place of the investigated death (especially on badly decomposed corpses or skeletonized human remains) with the support of all the elements which can be inferred from the study of insects found on the cadaver or nearby. The application of techniques devised recently in forensic entomology can allow experts in the field to collect strong entomological evidence and provide useful information not only in a death investigation including movement or storage of the remains following death, time of dismemberment, postmortem artifacts on the body but also at the scene, and even more in child neglect, sexual molestation and identification of suspects. As the role of the forensic entomologist at the death scene, at the autopsy and in the laboratory is defined and well known, this paper focuses on the difficulties that could arise if forensic pathologists and entomologists are uncertain about the procedures that they have to follow, do not realize the value of objective findings or fail to evaluate them. Although every forensic case presents a slightly different set of circumstances and has to be tackled individually, the forensic pathologist should work with the forensic entomologist from the visual observations of the cadaver on the scene, through the collection of arthropods and temperature data at the death scene and at the autopsy, up to the final report with the interpretation of entomological and other biological evidence.

Preliminary study on using changes in astrocytes and neurons in the brain-stem of the rat after stab wounds for determining the time of injury

The changes in astrocytes and neurons in the brain-stem of the rat after stab wounds were studied immunohistochemically. Anti-GFAP and anti-albumin antibodies were used to detect the changes of astrocytes and neurons, respectively. The results showed that in normal control group, the numbers of GFAP-positive cells differed in different areas of brain-stem, but remained similar in the same area of different rats. No albumin-positive cells could be found. The number of GFAP-positive cells in antemortem injury groups increased significantly followed by a decrease, and then a further increase. Albumin-positive cells including neurons and glial cells were found after injury in the midbrain, pons and medulla oblongata. In the postmortem injury groups, there were no significant changes in either anti-GFAP or anti-albumin immunoreactivities in any area of brain-stem compared to the control group. These results indicated that the changes in the number of GFAP-positive cells could be used to estimate the time of injury and to diagnose early brain-stem injury. The antemortem and postmortem injuries can also be differentiated by the presence of albumin-positive cells. The authors suggest that the timing and early diagnosis of injury in the brain-stem should be carried out on the basis of comprehensive analyses of changes in both neurons and glial cells.

Lesions that simulate gunshot wounds

A variety of postmortem and antemortem defects can be misinterpreted as true antemortem injuries. In this paper, we present a collection of six cases with defects which simulate gunshot wounds. We briefly discuss each case and emphasize the importance of scene investigation, clinical correlation and careful examination in such cases.

Biochemical reconstruction of three cases of death — Results of international cooperation

Biochemical serotonin and histamine determinations were applied to the reconstruction of three suspected homicide cases. To distinguish between ante-mortem and post-mortem wounds and to time the ante-mortem injuries the concentrations of free histamine and serotonin in the wound samples and in the control samples from neighbouring intact skin were examined. The results of these biochemical determinations allowed a reconstruction of the events and one of the three cases was shown to be suicide instead of homicide. These methods can be used at least during the first 4 – 5 days after death and some-times even longer. This allows for international cooperation when investigating and reconstructing complicated cases of death.