An inusual catastrofic intra-abdominal hemorrhage caused by spontaneus segmental arterial mediolysis dissection

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Abstracts / Forensic Science International 169S (2007) S2–S21

apparent in April and November, while in June and August no death of that cause was registered.

S. Zerbo *, G. Bono, A. Argo, V. Triolo, C. Sortino, S. Cinque, A. Bonifacio, E. Maresi, P. Procaccianti

Keywords: Sudden death; Causes; Statistics

Department of legal Medicine – University of Palermo, Palermo, Italy

DOI: 10.1016/j.forsciint.2007.04.182

PAT-TP-20 Natural mortality among people who came to live in Leningrad Region O.V. Burkov, Yu.A. Molin Forensic Medicine Bureau of Leningrad Region, Saint-Petersburg, Russia To study fatal cases when adults died of diseases outside inpatient departments within the area of the Leningrad Region, we have selected three choice districts (Podporozhye, Vyborg, and Tikhvin) with diverse social structures. We have also studied natural mortality of those who had arrived for various reasons from different areas, cities and towns, according to the data of forensic and pathological examinations of dead bodies. Of the total 1040 cases examined (in 2002), the given category numbered 117 dead people: 38.5% women and 61.5% men with their age ranging from 31 to 91 years old. In the first place, there were cardiovascular diseases among the causes of death—83%, and chronic heart ischemia predominated in most cases (70 cases). A smaller number – 13 cases – had suffered from different forms of the acute cardiac ischemia. In the second place, there were fatal cases of malignant neoplasms differing in locations—7.6%. In the third place, there were registered 4.3% (4 cases) of those who had died of respiratory diseases—four persons died of pneumonia. The distribution of the examined cases according to months and age groups registered a great death rate increase during the summer months, especially in June, and its decrease during the winter period; fatal cases were minimal in November. Most people in the age of 30–50 years old died in July–September, while those who were 60—in July. Most of the people advanced in years who died in those districts had come from Saint-Petersburg for the summer and autumn periods to their summer cottages—the so-called ‘‘dachniks’’. Besides, the older age groups included people who had suffered from chronic diseases and had been brought from some regional town. A younger age group consisted of active migrants who had come in search of work to earn their living, people on business trips, as well as alcohol addicts who had lost their living quarters in Saint-Petersburg and other cities. Keywords: Sudden death; Causes; Seasonal character

The authors report about the dismembering of a 50-years old man recovered in the store of his house. Cases of dismemberment of cadavers are rare and the victims of dismemberment is usually victim of homicide. The dismemberment should be classified in the ‘‘defensive dismemberment’’ and ‘‘aggressive dismemberment’’. As reported in literature, in the most cases the perpetrators of dismemberment are predominantly motivated by the need of removing the bodies from the place of homicide or render identification of the victim impossible. In our experience the victim was found prone on the floor. A puddle of blood was on the floor under his head and chest. The dismembered body parts were found in oven of his kitchen (the oven was turn off). Near the body were found many blood-stained things: a knife, a pick, a gas-pipe with safety valve and a wood tablet. At autopsy, the external examination showed multiple and several fractures and lacerated and contused wounds on the left side of face; vault fractures associated to lacerated and contused area. Lacerated and contused wound on right shoulder, on thoracic, dorsal and lumbar regions were observed. A recent amputation of left upper limb on proximal humeral epiphysis and recent amputation of left lower limb on proximal femoral epiphysis were showed. It was also observed previous amputation of right lower limb on proximal femoral epiphysis. The autoptical examination confirmed vault fractures and revealed below subarachnoid haemorrhages (SAH) in left cerebral hemisphere. Nothing else was found in the other organs. The histological exam of the cutaneous sample drawed near the cutting sections did not show signs of vital reaction. Toxicological exam performed on sample or urine and blood was negative. The cause of death was attributed to craniumencephalic injuries due to blunt trauma. Keywords: Forensic pathology; Homicide; Dismemberment; Post mortem injuries DOI: 10.1016/j.forsciint.2007.04.184

PAT-TP-22 An inusual catastrofic intra-abdominal hemorrhage caused by spontaneus segmental arterial mediolysis dissection A. Bonifacio *, A. Maresi, N. Albano, A. Argo, G. Scuderi, P. Fleres, G. Bono, S. Zerbo, R. Liotta, P. Procaccianti

DOI: 10.1016/j.forsciint.2007.04.183

Department of Legal Medicine – University of Palermo, Palermo, Italy

PAT-TP-21 Homicide with post mortem dismemberment of the victim

This contribute reports a patient with acute intra-abdominal hemorrhage secondary to a rare vascular disease, segmental arterial mediolysis (SMA). This report describes the rare

Abstracts / Forensic Science International 169S (2007) S2–S21

complication of SMA rupture, which often result to be fatal. Segmental mediolytic arteriopathy is an uncommon nonatherosclerotic and nonvasculitic arteriopathy. This disease is characterized by lytic degeneration of the arterial media, intramural dissection and thrombosed or ruptured aneurysm. The segmental mediolytic arteriopathy mainly involves the intra-abdominal arterial system, resulting in intra-abdominal and retroperitoneal hemorrhage. The pathogenesis of this condition is unclear. This patient was a 38-year-old female who was admitted to the hospital with severe and increasing deep abdominal pain. She died the first day after admission for sudden loss of consciousness secondary to haemorrhagic shock. At autopsy, the affected vessels included the splenic and left renal arteries and the abdominal aorta. Histopathologically, the arteries showed segmental lytic degeneration and disappearance of medial smooth muscle cells, medial dissection and formation of pseudo-aneurysms, the wall of which consisted of a thin membrane of the adventitia. Histologic examination of abdominal aorta showed also cystic medial necrosis. Keywords: Forensic pathology; Sudden death; Segmental mediolytic arteriopathy DOI: 10.1016/j.forsciint.2007.04.185

PAT-TP-23 The identification of diatoms in the fluid from os clinoideus cavity in drowning cases D. Malakiene, L. Gogelis Mykolas Romeris University, Institute of Forensic Medicine, Vilnius, Lithuania A number of tests have been developed over the years to determine whether a person drowned. One of them involves the identification of diatoms in the tissue of drowning victims. The diatoms are microscopic unicellular algae, which reach the lung with inhalation of liquid, and if effective cardio-circulatory activity exists, penetrate the pulmonary filter and disseminate to closed organs through the blood stream. However, in a case of ‘‘dry drowning’’ when a laryngeal spasm occur, the water possibly containing diatoms may not be inhaled and enter the blood stream. In a drowning case there is no barrier for the water to enter the cavity of os clinoideus. According to our data the investigation of the fluid from os clinoideus cavity for diatoms is sufficiently informative. We present the results of the investigation of diatoms found in the fluid from os clinoideus cavity. This test in many cases allows a forensic pathologist to form well-grounded opinion concerning the type of drowning and cause of death. Keywords: Diatom; Clinoideus cavity DOI: 10.1016/j.forsciint.2007.04.186

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PAT-TP-24 Snowmobile fatalities in Sweden, 1999–2006 ¨ stro¨m, A. Eriksson J. Eriksson-Strand *, M. O Section of Forensic Medicine, Department of Community Medicine and Rehabilitation, Umea˚ University, Umea˚, Sweden During seven snowmobile seasons (1999/2000 through 2005/2006) 85 snowmobile fatalities were autopsied at the Departments of Forensic Medicine in Sweden. On average, there were 12.1 fatalities per season, evenly spread over the study period. Most fatalities occurred in February (21%), on weekends and holidays (68%), between 7 p.m. and 10 p.m. (40%), and during darkness (62%). Driving into water (59%) was the most common event, followed by accidents in forest terrain (22%) and on roads (14%). The median age of the victims was 41 years and the great majority were men (92%). Blunt injuries was the most common cause of death (51%) followed by drowning (35%). A majority of the drivers (67%) tested positive for alcohol, with a mean blood alcohol concentration of 1.7 g/l. Most alcohol positive victims were found during weekends and holidays and during night time. In the 50–59-year age group 89% tested positive for alcohol. In at least 60% of the crashes, alcohol was judged to contribute to the accident and/or to the fatal outcome. In addition, speeding contributed to the event in 53% cases. Most fatalities occurred during leisure time (n = 82) and 9 out of 10 during short rides. Only occasionally the environment was unknown to the driver. In 40% of the cases, a flotation snowmobile suit would have been of benefit to the victim, a helmet in 28%, a cellular phone in 12%, and extra clothing and food in 2%. Keywords: Snowmobiles; Accidents; Fatalities; Prevention DOI: 10.1016/j.forsciint.2007.04.187

PAT-TP-25 Hypothalamo-pituitary haemorrhages in hypothermia

A post-mortem study Verdicchio Mario 1,*, Rosen Thord 2, Orndal Charlotte 3 1

National Board of Forensic Medicine, Department of Forensic Medicine, Gothenburg, Sweden; 2 Endocrine Section, Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; 3 Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden Background: Death by hypothermia is often an uncertain diagnosis, based on circumstances and supported by few, nonspecific findings at the autopsy. However, in several cases the diagnosis is made just by exclusion. Our previous, occasional finding of haemorrhage within the hypothalamo-pituitary structures in a death case by hypothermia, raised questions