Forensic Pathology Reviews F P R ORENSIC ATHOLOGY EVIEWS Michael Tsokos, MD,SERIES EDITOR FORENSIC PATHOLOGY REVIEWS, VOLUME 3, edited by Michael Tsokos, 2005 FORENSIC PATHOLOGY REVIEWS, VOLUME 2, edited by Michael Tsokos, 2005 FORENSIC PATHOLOGY REVIEWS, VOLUME 1, edited by Michael Tsokos, 2004 F ORENSIC P ATHOLOGY R EVIEWS Volume 2 Edited by Michael Tsokos, MD Institute of Legal Medicine, University of Hamburg, Hamburg, Germany © 2005 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel: 973-256-1699; Fax: 973-256-8341; E-mail: [email protected]; Website at humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. This publication is printed on acid-free paper. (cid:39) ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Production Editor: Robin B. Weisberg Cover design by Patricia F. Cleary Cover illustrations from Fig. 1, Chapter 10, “Arthropods and Corpses,” by Mark Benecke; Fig. 7, Chapter 2, “Infant and Early Childhood Asphyxial Deaths: Diagnostic Issues,” by Roger W. Byard and Michael Tsokos; Fig. 9, Chapter 8, “Sudden, Unexpected Death Related to Viral Myocarditis: A Survey of Histological, Immunohistochemical, and Molecularpathological Methods for the Postmortem Diagnosis,” by Reinhard Dettmeyer and Burkhard Madea; Fig. 1, Chapter 2, “Skull Injuries Caused by Blows With Glass Bottles,” by Burkhard Madea, Peter H. Schmidt, Eberhard Lignitz, and Stephan A. Padosch; and Fig. 3, Chapter 3, “Primary Cerebral Neoplasms as a Cause of Sudden, Unexpected Death,” by Jakob Matschke. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients is granted by Humana Press, provided that the base fee of US $25.00 per copy is paid directly to the Copyright Clearance Center (CCC), 222 Rosewood Dr., Danvers MA01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to the Humana Press. The fee code for users of the Transactional Reporting Service is 1-58829-415-3/05 $25.00. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN 1-59259-872-2 Library of Congress Cataloging-in-Publication Data Forensic pathology reviews, Volume 2 / edited by Michael Tsokos. p. cm. Includes bibliographical references and index. ISBN 1-58829-415-3 (alk. paper) 1. Forensic pathology. I. Tsokos, Michael. RA1063.4.F675 2004 614.1—dc22 2003027503 Dedication To my son Titus for the joy and fun he brings to my life day by day. —Michael Tsokos, MD v Series Introduction Over the last decade, the field of forensic science has expanded enormously. The critical subfield of forensic pathology is essentially based on a transverse, multiorgan approach that includes autopsy, histology (comprising neuro- pathological examination), immunohistochemistry, bacteriology, DNA techniques, and toxicology to resolve obscure fatalities. The expansion of the field has not only contributed to the understanding and interpretation of many pathological findings, the recognition of injury causality, and the availability of new techniques in both autopsy room and laboratories, but also has produced specific new markers for many pathological conditions within the wide variety of traumatic and nontraumatic deaths with which the forensic pathologist deals. TheForensic Pathology Reviewsseries reflects this expansion and provides up-to-date knowledge on special topics in the field, focusing closely on the dynamic and rapidly growing evolution of medical science and law. Individual chapters take a problem-oriented approach to a central issue of forensic pathology. Acomprehensive review of the international literature that is otherwise difficult to assimilate is given in each chapter. Insights into new diagnostic techniques and their application, at a high level of evidential proof, will surely provide helpful guidance and stimulus to all those involved with death investigation. It is hoped that this series will succeed in serving as a practical guide to daily forensic pathological and medicolegal routine, as well as provide encouragement and inspiration for future research projects. I wish to express my gratitude to Humana Press for the realization of Forensic Pathology Reviews. Michael Tsokos, MD vii Preface When asked by the Prussian king, “So what is new in heaven?” Friedrich Wilhelm August Argelander (1799–1875), astronomer at the University of Bonn, Germany, answered “Does his majesty already know what is old?” This second volume of Forensic Pathology Reviews is intended to complement rather than replace the classical textbooks of forensic pathology by providing those interested in death investigation with the state-of-the-art accounts of special topics from various fields of forensic pathology and death scene investigation. Chapter 1 examines the medicolegal aspects of death resulting from star- vation (i.e., as a result of deliberate withholding of food from infants). The author provides deep insight into how an expert opinion may be formed on the degree and duration of starvation by applying different classification systems of protein- energy malnutrition to such cases. In Chapter 2, the authors present a fundamental and detailed look at the pathological features of head injuries that are inflicted by glass bottles. The presentation of the characteristic morphological findings in such cases is complemented by relevant experimental biomechanical data and valuable guidelines for practical casework. Chapter 3 devotes attention to the current understanding of the clinical and pathological features of primary cerebral neoplasms, according to the World Health Organization’s classification scheme. In particular, the role of these unique tumors as a cause of sudden, unexpected death is emphasized. Chapter 4 concerns obesity, one of the pre-eminent health issues in the Western world. In the United States, approximately 300,000 adult deaths can be attributed annually to obesity-related complications. The authors provide the reader with an exhaustive overview concerning aspects of the obesity epidemic, definitions and measurements of obesity, and risk factors, as well as other issues relevant to the forensic pathologist, such as premature death relating to obesity, pathologies, and causes of death. Chapter 5 takes a comprehensive look at what the pathologist may encounter when dealing with infant and early childhood asphyxial deaths. The authors point to the differential diagnosis between inflicted (homicidal) and accidental asphyxias, airway obstruction from natural causes, foreign body impaction, and sudden infant death syndrome (SIDS). In Chapters 6 and 7, highly interesting topics related to suicide are discussed. Chapter 6 deals with planned and unplanned ix Preface x complex suicides. In addition to a complete literature review of research published to date, the criminological points of view in association with the forensic pathological investigation of complex suicide cases are presented. A thorough examination of the pathological features of occupation-related suicides is provided in Chapter 7. The authors elucidate in detail the problems that may arise in the medicolegal interpretation of occupation-related suicides and provide practical guidelines for comprehensive and conclusive forensic casework. Chapter 8 covers the subject of viral myocarditis in forensic autopsy cases. Cases of sudden, unexpected death represent a substantial proportion of forensic autopsy cases, and postmortem studies suggest that myocarditis accounts for up to 20% of all such cases. The diagnosis of viral myocarditis may present difficulties when solely based on conventional histological findings. The authors provide the reader with a survey of the latest immunohistochemical and molecular- pathological techniques that are appropriate to prove lethal myocarditis in cases with a high index of suspicion of an underlying viral myocarditis, but are not supported by traditional histological findings. Chapter 9 comprehensively examines some curious phenomena that may occasionally be observed at a scene of death (e.g., hiding, covering, and undressing). Such phenomena generally appear dubious at first sight and may raise suspicion of a crime, even by experienced observers. These behavioral patterns that take place in agony, when the conscious, rational control of thoughts is fading, and the associated behaviors, are elucidated in detail. The knowledge of these peculiar behavioral patterns is most useful to all those involved in death scene investigation in order to correctly interpret the scene and to exclude involvement of a third party. Chapter 10 addresses the subject of forensic entomology. A thorough understanding of the numerous ways in which arthropod evidence can be applied not only to the determination of the postmortem interval, but also to the proof of neglect of elderly or children, is essential for every forensic pathologist and medical examiner, respectively. Chapter 11 deals with the interpretation of toxicological findings in the setting of an entire death investigation, including a comprehensive presentation of potential pitfalls in toxicology testing that are always of concern. In Chapter 12, thorough information about long-term effects of anabolic- androgenic-steroid abuse and the associated pathological findings is provided. Since recent studies suggest that 3–12% of male adolescents and about 1–2% of female adolescents use anabolic-androgenic-steroids at some time during their lives, this issue is of considerable importance to everyone involved in medicolegal investigations. Chapter 13 devotes attention to the autopsy findings of xi Preface subendocardial hemorrhages. The author gives a detailed review of the latest literature with special reference to the underlying pathophysiological mechanisms and the significance of subendocardial hemorrhages in forensic autopsy practice as a vital reaction. This book is the result of many experts in forensic pathology coming together to share their expertise. I wish to express my deepest gratitude to all of the contributors for making their practical and scientific knowledge accessible to a broad international readership. Michael Tsokos, MD