Forensics Daily #9: Dead Wives Tales

Q: are the dead wives tales true at all? Meaning, our nails and hair do grow after we died ?

A: Yes and No. Yes, because it does look like it grows, like illusion. No, because it is NOT REALLY GROWING.. Both hair and nails look like they grow after the heart stopped working because of the skin surrounding them are dehydrated. They shrink, and thus make it appear to be longer. Funeral homes sometimes will moisturize the bodies when they are doing the prep to counteract this.

Other than the hair and nails, the chin also dries out, and pulling towards the back of a skull, thus looks like more prominent. So does the goosebump effect, because of the contraction around the hair muscle (remember we talked about in the last few q&a, after we died, our muscles are not able to relax, not unable to contract!).

These all biological responses give the sense of horror!

Forensic Anthropology Internship Series Ep.5: Gunshot and Projectile Trauma

Trauma affects the skeleton via fracturing and dislocating the bones, which would disrupt the blood and nerve supply. Studying the osteological trauma can possibly tell the violence happened. There are three types of fractures: traumatic fracture, pathologic fracture, and periprosthetic fracture. Among these, we are going to discuss traumatic fracture, particularly from projectile trauma here with reference to the real case I encountered in the morgue.

The deceased was a male, in late twenties or early thirties. He expired at 6 am and two hours later, he is with us in the morgue. According to the death investigator back from the crime scene, he attempted to kill his girlfriend and suicide. His girlfriend survived, but not him.

Externally, there is one bullet hole on each side of the skull. According to the external condition, it is possible that the wound on the right would be the entrance wound, and the left would be the exit wound. Yet, it is the otherwise when we have shaved his hair and opened up the skull.

After shaving his hair however, the beveling is really clear. Judging from the projectile fracture and the beveling, the exit wound would be on the right and the entrance would be the wound on the left.

Trajectory of the projectile, usually gunshot wounds, can be located and identified as either penetrating when no exit wound is found, or perforating that a projectile has an entrance and exit like the captioned case. Crime investigation unit will usually use color stick to link the trajectory for verification. Speaking of beveling, a skull contains layers—inner and out table. The force of the projectile would impact differently on the layers, and caused differences performances on entrance and exit spot. Generally speaking, when a bullet enters it produces a sharp-edged on the outer surface of the skull, but “beveled-out” on the inner surface, and this is called internal beveling.

Internal beveling (Source: the University of Tennessee, Department of Anthropology)

External beveling is usually seen on the exit wound—the outer surface beveled out.  Yet occasionally would also be seen on the entrance site, depends on the way of holding the projectile and the distance of the projectile from the head. There is also one condition called the keyhole, which would only be seen when the entrance and exit wound overlapped.

External beveling (Source: the University of Tennessee, Department of Anthropology)

Keyhole wound (Source: the University of Tennessee, Department of Anthropology)

So, the entrance wound for this case is on the left and the exit on the right, does it mean the deceased is left-handed? According to the M.E., he stated that there are indeed studies done and show that no relevance with hand preferences to pull the trigger.

The M.E. also pointed out that sometimes blunt force and projectile force trauma may not directly fatal. The energy from the trauma could be transmitted and make the brain tissue hit on the foramen magnum that creates a second wave of trauma. That would delay the death a little.

Also, on the other case that another M.E. was working on, they found negative results from autopsies on cause of death. They found only hemorrhage in his brain but the skull did not fracture at all. He decided to open up the deceased at the back and see if they can trace fractures, possibly compression fracture on the neck and the spine that would cause instant death, and the autopsy later confirmed this manner of death.

Forensic Anthropology Internship Series Ep.4: Two Cases (and bone overgrown on the skull)

I really love walking into the morgue (I know it does not sound right), learning something new, and interacting with all these wonderful minds.

One of the autopsies I observed this time was about a woman found dead in her cabin on a cruise ship. She got her knee surgery before she boarded, and was prescribed antibiotics. When the Medical Examiner opened her up, she immediately found pulmonary fluid in her chest cavity (which could indicate infection). Later, she opened up her skull, and learned that her skull has a feature, Hyperostosis frontalis interna (HFI), which usually sees that on middle-aged women, sometimes men. The individuals with this feature are having a thicker frontal and occipital bone when compares with the parietal and temple bones. She also found a piece of little bone that is ossifying when she was removing her brain. Afterwards, she decided to dissect her knee too. When she opened the knee, it was totally infected. And the surgery apparently has removed her knee cap and replaced with an artificial one.

The bone from the surgery however never healed. Superficially, other than her surgical wound, she got few circular 3mm wide wounds (probably got from the infections).

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More on Hyperostosis frontalis interna (HFI) (may choose to skip this and read on about the next case 🙂 )

Hyperostosis frontalis interna (HFI) (Source: radiopedia.org)

Hyperostosis frontalis interna (HFI) is an independent yet pathological condition with an unknown etiology thus far. It refers to the manifestation of accretion of bone on the inner table of the frontal bone. Yet, this phenomenon of bone thickening on endocranial surface usually not extending beyond the coronal suture (Ruhli and Henneberg 2001). HFI was first described by Morgagni in 1769 and even with the great jump in medicine and pathology in almost three centuries, the origin and the detailed etiology are still unknown. Yet, with all the studies have done, HFI is most likely presence in post-menopausal women, which may link its presence to the hormone level disturbance in human body (Hajdu et al. 2009; Hershkovitz et al. 1999; Ruhli and Henneberg, 2001, May et al. 2010).

The origin of HFI still remains as a mystery till today. Hajdu et al. (2009) suggested that HFI could possibly link with unknown genetic predisposition, environment, hormones allocation and metabolic diseases. Specifically, HFI is clinically associated with Morgagni’s syndrome, or MSM—Morgagni-Stewart-Morel syndrome, which is a hormonal disorder that demonstrates symptoms like obesity, hirsutism and metal retardation (Barber et al., 1997; May et al., 2010).

Hershkovitz et al. (1999), May et al. (2010), and Ruhli and Henneberg (2001) purport that hormonal influences are key to understand the etiology of this phenomenon, especially about the hormonal regulation in females. Hershkovitz et al. (1999) quoted Ritcher (1939) that HFI under his study will disappear after passing of the endocrine imbalance of menopause. Ruhli and Henneberg (2001) hypothesized that because of the decrease of selective pressure has increased the metabolic rate due to the higher level of leptin (a 167 amino acid peptide coded by ob gene), which in turns may cause an increase of localized bone overgrowth (Rhuli and Henneberg, 2001). Given that leptin is strongly correlated to body mass index. Obesity, according to Haffner and Bauer (1993), is widely recognized as a major effect on bone density. This study suggests that however the adjustment for glucose and insulin concentrations does not explain the exact association between bone density and obesity, rather the bone density increased may be due to stress on the skeleton early in life, which lead to increase of bone formation, or to increase estrogen or androgen concentrations (Haffner and Bauer, 1993). Ruhli et al. (2004) particularly quoted Rudali (1968) changes of metabolism of female hormones in fat cells could link up HFI and adiposity. Other than leptin, Ruhli et al. (2004) suggested a possible microevolution of human sex steroids as the etiology of HFI.

The overgrowth bony tissue of HFI grows specifically on the inner plate of the frontal bone of the skull. It usually comes in the form of bilateral nodular, and only restricted to the area between the superior sagittal sinus medially and middle meningeal artery posteriorly (May et al., 2010). Yet, it is still unknown for frontal bone as the spot for this hormone target. Hershkovitz et al. (1999) suggested that one of clues might be the fact that HFI process “almost always begins in the middle one third of the frontal squama,” given that Morel (1930) considered that spot would be the original centers of ossification of the bone. Hormones such as estrogen may have trigger the primary center of ossification of the frontal bone to grow extra bones (Hershkovitz et al., 1999). HFI can be traced via dried skulls with naked eye inspection, radiographic studies and computerized tomography (CT) scan images. Yet, plain radiographies could be ineffective for detecting the early stages of HFI as opposed to naked eyes inspection as lesions in gauge can be distinguished) (Hajdu et al., 2010).

Various neurophysiologic, metabolic, radiologic studies performed and failed to suggest a direct linkage between HFI and behavioral disorders, rather suggesting the bone nodular lesions shown on x-ray are coincidence (Smith and Hemphill, 1956) Most of the cases of HFI are asymptomatic.

HFI are ethnicity-related and chronologically affected. Scholars like Hajdu and many others agreed that it seems that it is impossible to compare different populations and different centuries in order to get a general possible trend for now. Also, Raikos et al. (2011) pointed out that it is a rare case to find female with HFI in antiquity but males. Ruhli et al. (2004) compared the data collected before industrial revolution and those after and found resemble results as Raikos et al. (2011) but a big change for the data after industrial revolution. Ruhli et al. (2004) suggested the change of female life cycle through social developments and the longevity of modern population initiate the change. It is important to remember however, lower life span in historical times do not mean a lower prevalence of HFI (Ruhli and Henneberg, 2001).

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Back to the case…

The other male deceased was a 45-year man that survived from a four car accident April after he had a head surgery. The surgery, according to the Medical Examiner has taken out almost his right hemisphere of the skull to release pressure (which is called Trephination). He suspected that the accident caused a lot of internal bleeding, and the blood rushed all into the skull. The blood not only had increased the pressure inside the skull but also changed the shape of the brain—it presses the brain towards the left hemisphere of the brain.

The deceased has been in coma since, and stayed in the hospital. The coma did age him pretty fast (he looked like an old man by the time he was on the autopsy table) and took away lots of his nutrients.

ResearchBlogging.org

Hajdu, T., Fóthi, E., Bernert, Z., Molnár, E., Lovász, G., Ko˝vári, I., Köhler, K., & Marcsik, A. (2009). Appearance of hyperostosis frontalis interna in some osteoarcheological series from Hungary HOMO – Journal of Comparative Human Biology, 60 (3), 185-205 DOI: 10.1016/j.jchb.2008.07.004

Hershkovitz I, Greenwald C, Rothschild BM, Latimer B, Dutour O, Jellema LM, & Wish-Baratz S (1999). Hyperostosis frontalis interna: an anthropological perspective. American journal of physical anthropology, 109 (3), 303-25 PMID: 10407462

Raikos, A., Paraskevas, G., Yusuf, F., Kordali, P., Meditskou, S., Al-Haj, A., & Brand-Saberi, B. (2011). Etiopathogenesis of hyperostosis frontalis interna: A mystery still Annals of Anatomy – Anatomischer Anzeiger, 193 (5), 453-458 DOI: 10.1016/j.aanat.2011.05.004

Rühli, F., & Henneberg, M. (2002). Are hyperostosis frontalis interna and leptin linked? A hypothetical approach about hormonal influence on human microevolution Medical Hypotheses, 58 (5), 378-381 DOI: 10.1054/mehy.2001.1481

Forensic Anthropology Internship Series Ep.3: Bone Donation

Every beginning of a week in the Medical Examiner Office is the busiest, as the bodies came in throughout the weekend are all lined up for check-out check and autopsies on Monday. Also, a lot of parties going on, especially in Miami every weekend, young adults accidentally died from overdose, drunk drive and so on could happen more easily. Of one of the particular Monday, among the 5 cases that came in, there were two really remarkable ones.

Both of the cases are having young deceased individuals, with one female and one male respectively. The female was expired from a car accident, where the male was suffered nasal congestion suddenly and expired.

What really fascinating (I know this might sound inappropriate, apologize for that. Fascinating from the medical and forensic fashion,) is the stitches on both deceases’ limbs. We were told that some of their limb bones are taken out for bone donation. I have never thought about bone donation before (sorry for my ignorance). According to one of the morgue technicians, those fresh and healthy bones for “transplant” have to be removed within a day from the deceased since the heart stopped beating. After taking out the bones for donation, they would stuff towels back into the limbs and sew it up. The limbs do not look any differences, nor feel any differences when you first touch it. But when the morgue technician was trying to clean them lifted their limbs up and twisted it. The difference is huge!

Who can donate bones?

According to the Musculoskeletal Transplant Foundation, majority of bone donors were health and relatively young deceased who died in accidents, or sudden illness (heart attack or stroke). Screenings including medical histories and social histories (location of any high-risk behaviors for transmissible diseases will automatically eliminate from the pool for possible donation). Potential donors with histories of any condition that would affect long-term bone performance would also be excluded.

Bone donation counted as tissue donation. Unlike organ donation, tissue recipients do not have to match with the donors, as rejection is not the mainly concern. Organ donation donors are basically brain dead, and the donation process occurs when mechanical support that continue the organs to “live” for an extended short period of time after the death of the patient. Organ donation needs patience, as it requires matching blood type, medical status and so forth, whereas tissue donation only requires patients to be brain dead or cardiac death.

Also, for the lady who expired from the accident, she did not have any trauma in her body except for few broken ribs (which could possibly hurt her lungs), suspecting she might have been drink and drive. Her major blow was the blunt force trauma on her left posterior temple bone. The blow was so strong that the energy transmitted all across the occipital bone and reached the right temple bone, as well as fractured the base of the skull too. It gives me goose bumps. I hope that the blow did not kill her slow! The brain did not look abnormal except being bloody. The Medical Examiner says the blow could have done some traumas on the brain (yet we did not get to see the cutting of the brain today), but that amount of blood was sufficient to make her choke and swallow her own blood and caused aspiration on her lungs. Doctor says the blow should have her killed pretty quickly but may slow down due to the aspiration.

One personal thought:

I think if the government used the traumas and the fractures as warning for “Do not drink and drive” commercials would be working more effective than ordinary movie clips. This lady’s traumas definitely warn me more effectively to stay out of alcohol if I am driving.