Forens Sci Med Pathol (2007) 3:162–165 DOI 10.1007/s12024-007-0004-7
ABSTRACTS
Abstracts BAFM Winter Meeting 2006, Leicester, UK
Published online: 23 June 2007 Humana Press Inc. 2007
The use of hair analysis for the detection of drugs Fiona M. Wylie Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ In forensic toxicology, blood and urine samples have traditionally been used for drugs testing. However, in recent years the use of alternate biological specimens to provide additional information to assist in toxicological investigations has been recognised. One such alternate specimen is hair. Hair analysis has been used in the United Kingdom for a variety of purposes such as monitoring drug compliance, child custody cases, drug facilitated assault cases and other criminal cases. Its major advantage over conventional specimens is that it has a much wider window of detection (weeks to months, depending on the length of hair) than blood or urine and is able to provide information regarding an individual’s drug use history. The use of hair analysis for the detection of drugs, its merits and limitations will be discussed with the use of case examples.
The use of computed tomography in mass fatality incidents G.N. Rutty East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK Radiology is an essential component of mass fatality incidents. Traditionally up to three different types of radiology may be used within a temporary mortuary environment; fluoroscopy, plain X-ray and dental X-ray. These are used for the purposes of identification, and screening of the bodies for
example for the components of an explosive device. The use of up to three different radiological sources requires up to three different teams of radiographers to be uterlised and raises health and safety issues into where these procedures are undertaken. Traditionally the images are not formally reported, rather being reviewed by radiographers or pathologists. There may be limited data storage and the images are traditionally two dimensional. A study was undertaken in 2006 by the above unit to consider the use of mobile computed tomography (CT) at a mass fatality incident. The study considered the logistics for using mobile CT, movement and scanning protocols, personnel mix, reporting protocols including telecommunications for off-site reporting. It considered the use of CT for identification, screening, and cause of death as well as the use and interpretation of two and three dimensional imaging. During the study period the mobile CT was used for the first time in the world in the investigation of a small mass fatality vehicle incident. Following this research we concur with previous published theoretical papers that CT can be used in mass fatality incidents as demonstrated during the study period and presented to the XXth Congress of the International Academy of Legal Medicine, Budapest 2006. It was shown to have advantages over other more commonly used imaging techniques such as fluoroscopy we recommend that others should consider the use of mobile CT for mass fatality investigations.
CT and MRI in the investigation of natural death Ian SD Roberts Department of Cellular Pathology, John Radcliffe Hospital, Oxford
Forens Sci Med Pathol (2007) 3:162–165
Recent public objections to post-mortem dissection in the UK have led to a search for a non-invasive alternative. Computed tomography (CT) and magnetic resonance imaging (MRI) show the greatest potential for detection of the wide variety of pathologies that may cause sudden death, and these techniques may also be applied to answer specific clinical questions. Imaging data may be refined by combination with aspiration of tissue or fluids for toxicology, microbiology and cytology. In combination with guided needle biopsy, a histological diagnosis is also possible. In foetal and perinatal deaths, MRI is used to replace conventional autopsy when consent for the latter is withheld. MRI can detect a broad spectrum of congenital abnormalities. It is generally more accurate in identifying CNS pathology than other malformations [1, 2], and cardiac disease in particular poses diagnostic problems. In certain circumstances, such as when dissection is limited by post-mortem autolysis, MRI may provide superior information to conventional autopsy. In the UK, post-mortem MRI has been used to replace coronial autopsy when the family have expressed religious objections to dissection [3]. In most instances, a coroner has accepted the cause of death provided by MRI alone, and experience of MRI-autopsy comparison is limited. Initial validation studies indicate that, whilst it detects large tumours and vascular lesions such as aneurysms with accuracy, post-mortem MRI has a number of important limitations. In an early study, MRI was not able to visualise coronary artery lesions, nor reliably differentiate postmortem clot from thrombus and pulmonary oedema from pneumonia [4]. Post-mortem CT enables detection of calcified atheroma, and thus can identify an individual at increased risk of coronary or cerebral artery stenosis. Its definition of soft tissue pathology is, however, generally inferior to that of MRI. Some of the weaknesses of post-mortem imaging may be overcome with increased experience, improved spatial resolution of new scanners and by optimising imaging sequences. The UK Department of Health is funding prospective studies to compare post-mortem CT and MRI with conventional autopsy; these have already identified areas of potential improvement. Only by properly defining the strengths and limitations of post-mortem imaging, will it be possible to apply these techniques appropriately in routine diagnostic service. 1.
2.
Griffiths PD, Variend D, Evans M, et al. Postmortem MR imaging of the fetal and stillborn central nervous system. Am J Neuroradiol 2003;24:22–7. Woodward PJ, Sohaey R, Harris EP, et al. Postmortem fetal MR imaging: comparison with findings at autopsy. Am J Radiol 1997;168:41–6.
163
3.
4.
Bisset RAL, Thomas NB, Turnbull IW, Lee S. Postmortem examinations using magnetic resonance imaging: four year review of a working service. BMJ 2002;324:1423–4. Roberts ISD, Benbow EW, Bisset RAL, et al. Accuracy of Magnetic Resonance Imaging in determining cause of death in adults: comparison with conventional autopsy. Histopathology 2003;42:424–430.
Forensics: the engineers perspective S.V. Hainsworth Department of Engineering, University of Leicester, Leicester, LE1 7RH Forensic engineering is the application of engineering principles or techniques to the investigation of materials, products, structures or components that fail or do not perform as intended. In particular, forensic engineering can involve providing solutions to forensic problems by the application of engineering science. A criminal aspect may be involved in the investigation but often the problems are related to negligence or breach of contract. Forensic engineering may include investigation of the physical causes of accidents or other sources of claims and litigation (for example, patent disputes). It involves the preparation of technical engineering reports, and may require giving testimony and providing advice to assist in the resolution of disputes affecting life or property. Materials characterization by microscopy is an important tool for forensic engineering investigations. There have been significant advances in microscopical techniques in recent decades which have greatly enhanced the possible information which can be obtained from sample analysis. Three different types of failures are used to illustrate the types of investigation that require input from Forensic Engineers, and which take advantage of modern microscopical methods. The first investigation involved fatigue of a nylon fuel pipe initiated by stress corrosion cracking; the second case concerned analysis of a condom failure; and the third case illustrates failure of a polyester seat belt in an automotive accident. Finally, current work on investigation of knife sharpness illustrates how engineering science can be used to help in investigation of the forces required in stabbing. Dental examination for pathologists Stephen Wills Forensic Pathology Unit, Royal Liverpool and Broadgreen Hospitals NHS Trust, Duncan Building, Daulby Street, Liverpool, L69 3GA The forensic examination of the dentition is usually the role of the forensic odontologist. However, there are certain
164
Forens Sci Med Pathol (2007) 3:162–165
occasions when performing an examination of the dentition and knowledge of dentistry and dental disease may be useful for a forensic pathologist. Useful skills can include: • • •
Identifying individual human teeth. Examining, describing and charting the dentition. Recognising and recording dental disease, restorations and prostheses.
The human adult dentition comprises 32 teeth. In each quadrant there are two incisors, one canine, two premolars and three molars, numbered one to eight. The deciduous dentition comprises 20 teeth, named A to E. Each has five surfaces, occlusal, buccal, lingual/palatal, mesial and distal. Each tooth has individual morphology that enables it to be identified. This may be useful when confronted with individual recovered teeth or fragments of the jawbones. Post-mortem dental examination is usually performed to give clues to age, sex and race of an unidentified individual or to enable comparative identification with dental records. Knowledge of dental examination enables the pathologist to better understand odontological evidence or perform an examination and charting if an odontologist is not available. Features to recognise and record include: • • • • • • • • • • •
Classify skeletal and dental relationships Position of each jaw in relation to the other Missing teeth Extractions, unerupted or absent Malpositioning Restorations Removable and fixed prostheses Fractured or damaged teeth Acute or old trauma Common dental pathology Periodontal disease
These features can easily be recorded on a standard chart which can be understood by dentists and odontologists and easily compared with dental records, both paper and computerised in the NHS and the private sector.
Virtopsy—the future of forensic medicine? Stephan A. Bolliger Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Berne, Berne, Switzerland The transdisciplinary research project Virtopsy (www. virtopsy.com) is dedicated to the implementation of modern
imaging techniques into forensic medicine and pathology in order to augment or even offer alternative methods to the current examination techniques. The 3D surface scanning has delivered remarkable results in the past concerning the 3D documentation of patterned injuries and of objects of forensic interest as well as whole crime scenes. The imaging of the interior of corpses is performed using multislice computer tomography (MSCT) and magnetic resonance imaging (MRI). MSCT is the method of choice to depict osseous injuries, foreign bodies and gas. MRI is, on the other hand better suited to visualise soft tissue injuries and organ pathologies. MRI is also well suited to examine surviving victims of assault, especially choking, and helps visualise internal injuries not seen at external examination of the victim. These techniques offer several advantages to traditional forensic techniques: The corpses and objects of interest can be depicted more accurately than drawings and can visualise objects threedimensionally, a feature plain X-rays and photographs lack. Furthermore, these acquired datasets permit a visualisation of the corpse and a re-examination of the crime scene even decades later, after burial of the corpse and liberation of the crime scene. These methods, combined with MSCT guided biopsies, are likely to solve a great deal of cases without an autopsy. We believe that this virtual or rather minimally invasive approach, the essential basis of the Virtopsy project, will improve forensic medicine in the near future. Three cases of fatal methanol ingestion Tu¨rk EE, Matschke J, Pu¨schel K, Andresen H Institute of Legal Medicine, University of Hamburg, Germany Two men were admitted to a hospital in Hamburg on two successive days, presenting with severe acidosis and blindness. Toxicological analysis revealed methanol intoxication. Depsite intensive care and specific therapy with ethanol, the men died 2 and 4 days after admission. Police investigations then found that the two men had been drinking technical alcohol together with a friend. This third man was found dead in a summerhouse in Hamburg where the drinking had taken place. Medicolegal autopsy showed findings in keeping with methanol intoxication in all three cases. Toxicology revealed high methanol concentrations in the brainstem, whereas blood methanol levels were low in the men who had received treatment before their deaths. We present and discuss neuropathology and toxicology findings in these three cases of fatal methanol ingestion with different survival times.
Forens Sci Med Pathol (2007) 3:162–165
The use of DNA for disaster victim identification E.A.M. Graham East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK DNA profiling is one of the several primary scientific methods that can be used to identify victims of mass fatality incidents. Although DNA profiling can be more expensive and take longer than traditional methods such as fingerprinting and ondontology, in many situations it is the only method of identification applicable. DNA profiling can be carried out on any biological sample, providing it is collected before complete DNA degradation has occurred. This can allow for re-association of highly fragmented remains and identification burnt, decomposed and even skeletonised remains providing DNA is preserved. DNA degradation is an irreversible process that begins immediately after death. The speed at
165
which DNA degradation proceeds is dependant upon several factors including temperature, humidity and animal/microbial activity. This presentation will introduce the use of DNA profiling in disaster victim identification by taking a look at how this technique has been used in past projects, from its first use after the Waco siege of 1993 through to modern techniques employed following the 2001 terrorist attack on New York’s World Trade Centre and the Tsunami disaster of 2004. The factors that effect DNA preservation and degradation are specific to each type of incident making it difficult to produce standard protocols for sample collection during disaster victim identification projects. The current guidelines set out by Interpol and DMORT for sample collection and preservation will be discussed and original research carried out within Forensic Pathology Unit, University of Leicester for an alternative method of sample preservation will be presented.
ABSTRACTS
Abstracts BAFM Winter Meeting 2006, Leicester, UK
Published online: 23 June 2007 Humana Press Inc. 2007
The use of hair analysis for the detection of drugs Fiona M. Wylie Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ In forensic toxicology, blood and urine samples have traditionally been used for drugs testing. However, in recent years the use of alternate biological specimens to provide additional information to assist in toxicological investigations has been recognised. One such alternate specimen is hair. Hair analysis has been used in the United Kingdom for a variety of purposes such as monitoring drug compliance, child custody cases, drug facilitated assault cases and other criminal cases. Its major advantage over conventional specimens is that it has a much wider window of detection (weeks to months, depending on the length of hair) than blood or urine and is able to provide information regarding an individual’s drug use history. The use of hair analysis for the detection of drugs, its merits and limitations will be discussed with the use of case examples.
The use of computed tomography in mass fatality incidents G.N. Rutty East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK Radiology is an essential component of mass fatality incidents. Traditionally up to three different types of radiology may be used within a temporary mortuary environment; fluoroscopy, plain X-ray and dental X-ray. These are used for the purposes of identification, and screening of the bodies for
example for the components of an explosive device. The use of up to three different radiological sources requires up to three different teams of radiographers to be uterlised and raises health and safety issues into where these procedures are undertaken. Traditionally the images are not formally reported, rather being reviewed by radiographers or pathologists. There may be limited data storage and the images are traditionally two dimensional. A study was undertaken in 2006 by the above unit to consider the use of mobile computed tomography (CT) at a mass fatality incident. The study considered the logistics for using mobile CT, movement and scanning protocols, personnel mix, reporting protocols including telecommunications for off-site reporting. It considered the use of CT for identification, screening, and cause of death as well as the use and interpretation of two and three dimensional imaging. During the study period the mobile CT was used for the first time in the world in the investigation of a small mass fatality vehicle incident. Following this research we concur with previous published theoretical papers that CT can be used in mass fatality incidents as demonstrated during the study period and presented to the XXth Congress of the International Academy of Legal Medicine, Budapest 2006. It was shown to have advantages over other more commonly used imaging techniques such as fluoroscopy we recommend that others should consider the use of mobile CT for mass fatality investigations.
CT and MRI in the investigation of natural death Ian SD Roberts Department of Cellular Pathology, John Radcliffe Hospital, Oxford
Forens Sci Med Pathol (2007) 3:162–165
Recent public objections to post-mortem dissection in the UK have led to a search for a non-invasive alternative. Computed tomography (CT) and magnetic resonance imaging (MRI) show the greatest potential for detection of the wide variety of pathologies that may cause sudden death, and these techniques may also be applied to answer specific clinical questions. Imaging data may be refined by combination with aspiration of tissue or fluids for toxicology, microbiology and cytology. In combination with guided needle biopsy, a histological diagnosis is also possible. In foetal and perinatal deaths, MRI is used to replace conventional autopsy when consent for the latter is withheld. MRI can detect a broad spectrum of congenital abnormalities. It is generally more accurate in identifying CNS pathology than other malformations [1, 2], and cardiac disease in particular poses diagnostic problems. In certain circumstances, such as when dissection is limited by post-mortem autolysis, MRI may provide superior information to conventional autopsy. In the UK, post-mortem MRI has been used to replace coronial autopsy when the family have expressed religious objections to dissection [3]. In most instances, a coroner has accepted the cause of death provided by MRI alone, and experience of MRI-autopsy comparison is limited. Initial validation studies indicate that, whilst it detects large tumours and vascular lesions such as aneurysms with accuracy, post-mortem MRI has a number of important limitations. In an early study, MRI was not able to visualise coronary artery lesions, nor reliably differentiate postmortem clot from thrombus and pulmonary oedema from pneumonia [4]. Post-mortem CT enables detection of calcified atheroma, and thus can identify an individual at increased risk of coronary or cerebral artery stenosis. Its definition of soft tissue pathology is, however, generally inferior to that of MRI. Some of the weaknesses of post-mortem imaging may be overcome with increased experience, improved spatial resolution of new scanners and by optimising imaging sequences. The UK Department of Health is funding prospective studies to compare post-mortem CT and MRI with conventional autopsy; these have already identified areas of potential improvement. Only by properly defining the strengths and limitations of post-mortem imaging, will it be possible to apply these techniques appropriately in routine diagnostic service. 1.
2.
Griffiths PD, Variend D, Evans M, et al. Postmortem MR imaging of the fetal and stillborn central nervous system. Am J Neuroradiol 2003;24:22–7. Woodward PJ, Sohaey R, Harris EP, et al. Postmortem fetal MR imaging: comparison with findings at autopsy. Am J Radiol 1997;168:41–6.
163
3.
4.
Bisset RAL, Thomas NB, Turnbull IW, Lee S. Postmortem examinations using magnetic resonance imaging: four year review of a working service. BMJ 2002;324:1423–4. Roberts ISD, Benbow EW, Bisset RAL, et al. Accuracy of Magnetic Resonance Imaging in determining cause of death in adults: comparison with conventional autopsy. Histopathology 2003;42:424–430.
Forensics: the engineers perspective S.V. Hainsworth Department of Engineering, University of Leicester, Leicester, LE1 7RH Forensic engineering is the application of engineering principles or techniques to the investigation of materials, products, structures or components that fail or do not perform as intended. In particular, forensic engineering can involve providing solutions to forensic problems by the application of engineering science. A criminal aspect may be involved in the investigation but often the problems are related to negligence or breach of contract. Forensic engineering may include investigation of the physical causes of accidents or other sources of claims and litigation (for example, patent disputes). It involves the preparation of technical engineering reports, and may require giving testimony and providing advice to assist in the resolution of disputes affecting life or property. Materials characterization by microscopy is an important tool for forensic engineering investigations. There have been significant advances in microscopical techniques in recent decades which have greatly enhanced the possible information which can be obtained from sample analysis. Three different types of failures are used to illustrate the types of investigation that require input from Forensic Engineers, and which take advantage of modern microscopical methods. The first investigation involved fatigue of a nylon fuel pipe initiated by stress corrosion cracking; the second case concerned analysis of a condom failure; and the third case illustrates failure of a polyester seat belt in an automotive accident. Finally, current work on investigation of knife sharpness illustrates how engineering science can be used to help in investigation of the forces required in stabbing. Dental examination for pathologists Stephen Wills Forensic Pathology Unit, Royal Liverpool and Broadgreen Hospitals NHS Trust, Duncan Building, Daulby Street, Liverpool, L69 3GA The forensic examination of the dentition is usually the role of the forensic odontologist. However, there are certain
164
Forens Sci Med Pathol (2007) 3:162–165
occasions when performing an examination of the dentition and knowledge of dentistry and dental disease may be useful for a forensic pathologist. Useful skills can include: • • •
Identifying individual human teeth. Examining, describing and charting the dentition. Recognising and recording dental disease, restorations and prostheses.
The human adult dentition comprises 32 teeth. In each quadrant there are two incisors, one canine, two premolars and three molars, numbered one to eight. The deciduous dentition comprises 20 teeth, named A to E. Each has five surfaces, occlusal, buccal, lingual/palatal, mesial and distal. Each tooth has individual morphology that enables it to be identified. This may be useful when confronted with individual recovered teeth or fragments of the jawbones. Post-mortem dental examination is usually performed to give clues to age, sex and race of an unidentified individual or to enable comparative identification with dental records. Knowledge of dental examination enables the pathologist to better understand odontological evidence or perform an examination and charting if an odontologist is not available. Features to recognise and record include: • • • • • • • • • • •
Classify skeletal and dental relationships Position of each jaw in relation to the other Missing teeth Extractions, unerupted or absent Malpositioning Restorations Removable and fixed prostheses Fractured or damaged teeth Acute or old trauma Common dental pathology Periodontal disease
These features can easily be recorded on a standard chart which can be understood by dentists and odontologists and easily compared with dental records, both paper and computerised in the NHS and the private sector.
Virtopsy—the future of forensic medicine? Stephan A. Bolliger Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Berne, Berne, Switzerland The transdisciplinary research project Virtopsy (www. virtopsy.com) is dedicated to the implementation of modern
imaging techniques into forensic medicine and pathology in order to augment or even offer alternative methods to the current examination techniques. The 3D surface scanning has delivered remarkable results in the past concerning the 3D documentation of patterned injuries and of objects of forensic interest as well as whole crime scenes. The imaging of the interior of corpses is performed using multislice computer tomography (MSCT) and magnetic resonance imaging (MRI). MSCT is the method of choice to depict osseous injuries, foreign bodies and gas. MRI is, on the other hand better suited to visualise soft tissue injuries and organ pathologies. MRI is also well suited to examine surviving victims of assault, especially choking, and helps visualise internal injuries not seen at external examination of the victim. These techniques offer several advantages to traditional forensic techniques: The corpses and objects of interest can be depicted more accurately than drawings and can visualise objects threedimensionally, a feature plain X-rays and photographs lack. Furthermore, these acquired datasets permit a visualisation of the corpse and a re-examination of the crime scene even decades later, after burial of the corpse and liberation of the crime scene. These methods, combined with MSCT guided biopsies, are likely to solve a great deal of cases without an autopsy. We believe that this virtual or rather minimally invasive approach, the essential basis of the Virtopsy project, will improve forensic medicine in the near future. Three cases of fatal methanol ingestion Tu¨rk EE, Matschke J, Pu¨schel K, Andresen H Institute of Legal Medicine, University of Hamburg, Germany Two men were admitted to a hospital in Hamburg on two successive days, presenting with severe acidosis and blindness. Toxicological analysis revealed methanol intoxication. Depsite intensive care and specific therapy with ethanol, the men died 2 and 4 days after admission. Police investigations then found that the two men had been drinking technical alcohol together with a friend. This third man was found dead in a summerhouse in Hamburg where the drinking had taken place. Medicolegal autopsy showed findings in keeping with methanol intoxication in all three cases. Toxicology revealed high methanol concentrations in the brainstem, whereas blood methanol levels were low in the men who had received treatment before their deaths. We present and discuss neuropathology and toxicology findings in these three cases of fatal methanol ingestion with different survival times.
Forens Sci Med Pathol (2007) 3:162–165
The use of DNA for disaster victim identification E.A.M. Graham East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK DNA profiling is one of the several primary scientific methods that can be used to identify victims of mass fatality incidents. Although DNA profiling can be more expensive and take longer than traditional methods such as fingerprinting and ondontology, in many situations it is the only method of identification applicable. DNA profiling can be carried out on any biological sample, providing it is collected before complete DNA degradation has occurred. This can allow for re-association of highly fragmented remains and identification burnt, decomposed and even skeletonised remains providing DNA is preserved. DNA degradation is an irreversible process that begins immediately after death. The speed at
165
which DNA degradation proceeds is dependant upon several factors including temperature, humidity and animal/microbial activity. This presentation will introduce the use of DNA profiling in disaster victim identification by taking a look at how this technique has been used in past projects, from its first use after the Waco siege of 1993 through to modern techniques employed following the 2001 terrorist attack on New York’s World Trade Centre and the Tsunami disaster of 2004. The factors that effect DNA preservation and degradation are specific to each type of incident making it difficult to produce standard protocols for sample collection during disaster victim identification projects. The current guidelines set out by Interpol and DMORT for sample collection and preservation will be discussed and original research carried out within Forensic Pathology Unit, University of Leicester for an alternative method of sample preservation will be presented.
