Volume 22 (2016): Issue 1 (June 2016)

Background Accidents with nail guns are rather common, especially in the construction industry. Most injuries involve the extremities and several present with intracerebral injuries. When the patient is unconscious, it can be a big challenge to determine whether the injury is an accident, self-inflicted or a criminal act.

Case presentation A 43-year-old male worker was brought to the emergency department after his coworkers had found him on the floor in the cafeteria at work. He was admitted to the hospital due to a possible apoplexy. The CT scan revealed a nail in his skull and acute surgery was performed. The forensic examination showed lesions of intracranial surgery and minor bruises on the arms. No sign of defense injuries was found. There were no signs of malfunction of the nail gun-wielding robot. On the side of the machine, there were a handheld nail gun and the police investigated the case as a possible criminal act. They found bloodstains on the back of the machine. When awake, the man explained, that by accident, he had hit his head against a nail gun and as a result of this, the nail gun delivered a nail into his skull.

Conclusion Sometimes, the circumstances of a case are not clear and the investigators need to work with more than one theory. In criminal cases, it is important to carry out the forensic examination as soon as possible to preserve the trace evidence. In this case, the investigation of the scene of the accident disproved that a crime was committed.

A three year old girl was observed to have bluish marks on her back, arms and legs. The social services initiated an examination on the local hospital, but no conclusion regarding the marks was reached. The girl was institutionalized before a forensic examination after three days concluded that the marks were Mongolian spots. The case stresses the importance of being able to distinguish between Mongolian spots and skin hematomas and the need for a genuine clinical forensic examination in cases where child abuse is suspected. A guide for distinguishing between Mongolian spots and skin hematomas is presented.

In a criminal case involving cutting and resale of amphetamine and cocaine in the Copenhagen area of Denmark, maltitol was used as a cutting agent. The analysis of maltitol in seizures of pure diluents as well as in amphetamine and cocaine powders was carried out using reversed-phase high performance liquid chromatography (HPLC) with high-resolution (HR) mass spectrometric detection. Maltitol was identified in four out of nine amphetamine samples and in five out of six cocaine samples from the case in question. The use of maltitol as a cutting agent was considered by the police as a specific marker of the particular criminal group under investigation. To support or reject this hypothesis, cocaine and amphetamine samples from a four month period after the involved persons had been arrested were evaluated, also as part of the police investigation. None of these samples contained maltitol. The work described covers the part of the case involving the department of forensic chemistry, and not the whole police investigation, but everything was done within the frames given by the police. To the best of our knowledge, this is the first report of a disaccharide polyol being used as a cutting agent for illicit drugs.

A 63-year-old woman underwent a nephrectomy on the right side for renal cancer. Postoperatively she developed abdominal and lower back pain, which was treated with an injection of analgesics in an epidural catheter. The following morning it was discovered that the patient had cold legs with pallor and no palpable femoral pulse. Rigor mortis and livor mortis were diagnosed in both legs, even though the patient was still alive and awake. Doppler ultrasound examination revealed the absence of blood flow in the lower part of the abdominal aorta and distally. A cross disciplinary conference including specialists in urology, orthopaedics, vascular surgery, anaesthesiology, internal medicine, and intensive care concluded that no lifesaving treatment was possible, and the patient died the following day. A forensic autopsy revealed severe atherosclerosis with thrombosis and dissection of the abdominal aorta. This case clearly demonstrates that a vascular emergency should be considered when patients complain about pain in the lower back, abdomen or limbs. Clinicians should be especially aware of symptoms of tissue death that can be masked by epidural analgesia.

Introduction: The Sudden Infant Death Syndrome (SIDS) is not likely to be explained by a currently measureable presence in all cases and absence in controls, as otherwise it would have been solved already. Indeed, any proposed physiological model for SIDS causation must explain the constant mathematical and statistical properties of SIDS age and gender. We have shown previously that SIDS are characterized by a common 4-parameter lognormal age distribution sparing neonatal infants, by a nominal 50% male excess, and by a higher rate in winter than summer. We test now whether SIDS is closely related to a fulminating prodromal Acute Respiratory Infection (ARI) by a common increasing rate with the infants increasing Live Birth Order (LBO), all remaining the same, independent of the change in preferred sleeping positions of the infants, prone or supine.

Methods: We use U.S. published infant mortality data from wonder.cdc.gov and other countries (Colombia, U.K., Europe, Australasia) to make comparisons between the two causes of death (ARI and SIDS) to evaluate how closely ARI resembles the characteristics of SIDS.

Results: Gender: SIDS male excess 50%, ARI male excess 50%; Ages: SIDS 90% post-neonatal, ARI 96% post-neonatal; Seasonality: SIDS and ARI are higher in winter than summer; Live birth order: SIDS and ARI rates increase with increasing LBO with similar mathematical relationship.

Conclusion: Our results show that all SIDS are very likely relatable to a single cause tied to a fulminating prodromal ARI in a physiologically anemic infant who is genetically (X-link recessive) susceptible to cerebral anoxia. An alternative cause of all SIDS death by a collection of subsets of different causes, such as brainstem-related respiratory abnormalities and cardiac QT abnormalities, is not supported because they cannot all have the same age-gender-seasonal-familial-distributions of SIDS, required by Cramér’s Theorem.