Science.gov

Sample records for medicolegal external postmortem

  1. Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy.

    PubMed

    Quan, L; Zhu, B-L; Ishikawa, T; Michiue, T; Zhao, D; Li, D-R; Ogawa, M; Maeda, H

    2008-11-01

    Circulating erythropoietin (EPO) is mainly produced in the kidneys, depending on blood oxygen level. The present study investigated the postmortem serum EPO levels with regard to the cause of death and survival time. Serial medicolegal autopsy cases of postmortem time within 48 h (n = 536) were examined. Serum EPO levels were within the clinical reference range in most cases. Uremic patients with medical administration of an EPO agent (n = 11) showed a markedly high level (140-4,850 mU/ml; median, 1,798 mU/ml). Otherwise, an elevation in serum EPO level (>30 mU/ml) was mainly seen in protracted deaths due to blunt injury and fire fatality, depending on the survival time (r = 0.69, p < 0.0001, and r = 0.45, p < 0.0001, respectively), and in subacute deaths from gastrointestinal bleeding and infectious diseases. However, mildly to moderately elevated serum EPO levels were sporadically found in acute deaths due to mechanical asphyxiation, fire fatality, and acute ischemic heart disease, and in fatal hypothermia cases, especially for elderly subjects. Protracted deaths due to mechanical asphyxiation and ischemic heart disease did not show any survival time-dependent increase in serum EPO level (p > 0.05). EPO was immunohistochemically detected in the tubular epithelia and interstitial cells, showing no evident difference among the causes of death, independent of survival time or serum level. These findings suggest that serum EPO can be used as a marker for investigating anemia and/or hypoxia as a consequence of fatal insult in subacute or prolonged deaths, or a predisposition to traumatic deaths or fatal heart attacks in acute deaths. PMID:18682967

  2. Postmortem serotonin levels in cerebrospinal and pericardial fluids with regard to the cause of death in medicolegal autopsy.

    PubMed

    Quan, Li; Ishikawa, Takaki; Hara, Junpei; Michiue, Tomomi; Chen, Jian-Hua; Wang, Qi; Zhu, Bao-li; Maeda, Hitoshi

    2011-03-01

    Serotonin (5-hydroxytryptamine, 5-HT) is a neurotransmitter in the central nervous system (CNS) and a smooth muscle regulator in the cardiovascular and gastrointestinal systems. The present study investigated postmortem 5-HT levels in cerebrospinal fluid (CSF) and pericardial fluid (PCF) with regard to the cause of death in serial medicolegal autopsy cases within 48 h postmortem (n=351, >20 years of age). CSF and PCF 5-HT slightly increased during the postmortem period (r=0.298 and 0.253, respectively, p<0.001), showing no gender-related difference. The CSF level decreased depending on the subject age (r=0.497, p<0.001); however, the CSF and PCF levels showed similar findings with regard to the cause of death: these levels were significantly higher for sedative-hypnotic drug intoxication and hyperthermia (heat stroke), but lower for blunt head injury and hypothermia (cold exposure); the cutoff value was estimated as 25.5 ng/ml and 5.0 ng/ml, respectively. For other cause of death groups, some cases showed a higher level. These findings suggest elevations in CSF and PCF 5-HT levels due to systemic toxic or hyperthermic neuronal dysfunction, and systemic stress responses to trauma without CNS involvement. PMID:21185763

  3. Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy.

    PubMed

    Ishikawa, Takaki; Quan, Li; Michiue, Tomomi; Kawamoto, Osamu; Wang, Qi; Chen, Jian-Hua; Zhu, Bao-Li; Maeda, Hitoshi

    2013-05-10

    Previous studies have suggested that postmortem serum catecholamine levels reflect the magnitude of physical stress responses or toxic/hyperthermic neuronal dysfunction during the death process. The present study investigated postmortem adrenaline (Adr), noradrenaline (Nad), and dopamine (DA) levels in pericardial fluid (PCF) and cerebrospinal fluid (CSF) with regard to the cause of death, compared with right heart blood levels, in serial medicolegal autopsy cases with a postmortem time within 48 h (n=494). Correlations between PCF and CSF Adr levels, and those among right heart blood, PCF, and CSF DA levels were marked (r=0.66-0.83, p<0.0001), but were otherwise lower (r=0.22-0.44). With regard to the cause of death, Adr and Nad levels in PCF, CSF, and right heart blood mostly presented similar findings: these levels were generally high in injury, intoxication, and hyperthermia (heatstroke), but were low in hypothermia (cold exposure). DA levels at each site were higher in injury and intoxication. In addition, higher levels were detected for Nad levels in sharp instrument injury, as well as Adr, Nad, and DA in carbon monoxide intoxication at each site, and for CSF Nad in psychotropic drug intoxication. These findings suggest that characteristic elevations in Adr, Nad, and DA levels in PCF and CSF are involved in systemic responses to fatal stress and toxic neuronal dysfunction, reflecting the magnitude of such responses in individual cases. PMID:23597740

  4. [Postmortem dismemberment/mutilation--medicolegal and criminalistic evaluation of the autopsies performed by the Institute of Legal Medicine at the Hanover Medical School].

    PubMed

    Schulz, Yvonne; Mossakowski, Harald; Albrecht, Knut; Breitmeier, Dirk

    2008-01-01

    Among all the autopsies performed by the Institute of Legal Medicine at the Hanover Medical School between 1978 and 1998. 16 cases of postmortem dismemberment/mutilation were evaluable under criminalistic and medicolegal aspects. In the present study, particular attention was paid to the psychosocial circumstances of the perpetrator's and victim's lives and also to the classification of the different types of postmortem dismemberment/mutilation illustrated by case reports. Apart from an unfavourable personal life situation at the time of the offence, essential predisposing factors were: poor integration in society and family, occupational problems, drug abuse and mental diseases. As the interactions between these factors differ in every single case and may be combined with other factors, the analysis of such homicides should always be based on the assessment of the individual case. PMID:18389859

  5. Evaluation of postmortem S100B levels in the cerebrospinal fluid with regard to the cause of death in medicolegal autopsy.

    PubMed

    Li, Dong-Ri; Michiue, Tomomi; Zhu, Bao-Li; Ishikawa, Takaki; Quan, Li; Zhao, Dong; Yoshida, Chiemi; Chen, Jian-Hua; Wang, Qi; Komatsu, Ayumi; Azuma, Yoko; Maeda, Hitoshi

    2009-04-01

    Previous studies have suggested the usefulness of the postmortem serum S100B level as a marker of the severity of brain damage. In this study, we investigated the S100B level in the cerebrospinal fluid (CSF) in serial autopsy cases (n=216, within 3 days postmortem), including those of blunt injury (n=34: fatal head injury, n=20; others, n=14), sharp instrument injury (n=9), mechanical asphyxiation (n=19), drowning (n=11), fire fatality (n=26), intoxication (n=20), hypothermia (cold exposure, n=16), hyperthermia (heat stroke, n=9), acute cardiac death (n=52) and pneumonia (n=20). The CSF S100B level showed a moderate postmortem time-dependent increase for acute cardiac death (r=0.58, p<0.0001) and asphyxia (r=0.741, p<0.001). In cases of survival time within 48 h, drowning and hypothermia usually showed a lower CSF S100B level (around 500 ng/ml), and the level was higher for delayed head injury death, asphyxia, intoxication, and hyperthermia (around 1500 ng/ml) (p<0.05). In fatal head injury cases, however, CSF S100B did not correlate with the survival time or postmortem interval. A CSF S100B level of >2000 ng/ml in the early postmortem period might be considered a biochemical sign of fatally severe brain damage. PMID:19366640

  6. Evaluation of postmortem calcium and magnesium levels in the pericardial fluid with regard to the cause of death in medicolegal autopsy.

    PubMed

    Li, Dong-Ri; Quan, Li; Zhu, Bao-Li; Ishikawa, Takaki; Michiue, Tomomi; Zhao, Dong; Yoshida, Chiemi; Chen, Jian-Hua; Wang, Qi; Komatsu, Ayumi; Azuma, Yoko; Maeda, Hitoshi

    2009-04-01

    Previous studies have suggested the usefulness of postmortem serum calcium (Ca) and magnesium (Mg) for investigating cause of death. The present study investigated their levels in the pericardial fluid of serial autopsy cases of adults within 48 h postmortem (n=385), including fatalities from blunt injury (n=57), sharp instrument injury (n=9), mechanical asphyxiation (n=28), salt- and freshwater drowning (n=14 and n=61, respectively), fire fatality (n=35), intoxication (n=23), hypothermia (cold exposure, n=12), hyperthermia (heat stroke, n=7), acute cardiac death (ACD, n=86), pneumonia (n=9) and spontaneous cerebral hemorrhage (n=11). The pericardial Ca level was independent of the postmortem interval, showing a value similar to that of the clinical reference range in cases other than saltwater drowning, while the Mg level was higher than the clinical reference range and showed a mild postmortem time-dependent increase. Pericardial Ca was significantly higher for saltwater drowning than other groups, and a lower level was seen for hyperthermia, and some cases of blunt injury and intoxication. The Mg level was also significantly higher for saltwater drowning than the other groups, and showed a higher level for sharp instrument injury, but a lower level for hypothermia. The Mg/Ca ratio was higher for sharp instrument injury and saltwater drowning, but was lower for hypothermia. These findings suggest that postmortem pericardial Ca and Mg can be used to investigate the cause of death, especially for saltwater drowning, hypothermia and hyperthermia. PMID:19251451

  7. Medicolegal issues.

    PubMed

    Torres, Abel; Konda, Sailesh; Nino, Tanya; de Golian, Emily

    2016-01-01

    The legal landscape in dermatology is constantly evolving. Dermatologists should nurture strong physician-patient relationships with proper informed consent and stay abreast of legal issues as they pertain to today's practice of medicine. Medicolegal issues that have risen to the forefront include wrong-site surgery, delegation of procedures to nonphysician operators, and compounding of medications. Additionally, although the marriage of health care and technology has facilitated our practice of medicine, it has opened doors to new medicolegal pitfalls associated with the use of electronic medical records, teledermatology, and even social media. This contribution will highlight some of the common medicolegal issues in dermatology along with recommendations to minimize exposure to litigation. PMID:26773630

  8. Endoscopic Sedation: Medicolegal Considerations.

    PubMed

    Kralios, Andreas A; Feld, Kayla A; Feld, Andrew D

    2016-07-01

    Goals of endoscopic sedation are to provide patients with a successful procedure, and ensure that they remain safe and are relieved from anxiety and discomfort; agents should provide efficient, appropriate sedation and allow patients to recover rapidly. Sedation is usually safe and effective; however, complications may ensue. This paper outlines some medicolegal aspects of endoscopic sedation, including informed consent, possible withdrawal of consent during the procedure, standard of care for monitoring sedation, use of anesthesia personnel to deliver sedation, and new agents and devices. PMID:27372770

  9. Medicolegal hell in Texas.

    PubMed

    Korcok, M

    1995-10-01

    In the "war zones" of Texas, lawyers use billboards, television commercials and Yellow Page advertisements to announce their availability to help the "unjustly injured," and medicolegal lawsuits are as common as the rain that sweeps in from the nearby Gulf of Mexico. Almost 75% of the suits are dismissed without award or settlement, since many are plainly frivolous. However, even these can mean torment for physicians, who have to hire lawyers, answer charges, collect paperwork, take time off work for depositions and consultations, and then worry about how insurers will react the next time premiums are due--even if they are cleared. Texas estimates that defensive medicine practised because of legal fears costs the state at least $702 million annually, spending that is bound to continue as long as one lawsuit is filed annually for every 5.3 doctors in the state. PMID:7553498

  10. Seasonal variation of postmortem microbial communities.

    PubMed

    Carter, David O; Metcalf, Jessica L; Bibat, Alexander; Knight, Rob

    2015-06-01

    Body-associated microbes were recently shown to change significantly during decomposition, undergoing an ecological succession in experimental conditions using rodent and swine models. We investigated microbial succession in soils associated with swine carcasses under experimental field conditions in summer and winter. We demonstrate that these postmortem microbial communities change in a specific, reproducible fashion, and that soil microbes represent a significant component of the postmortem microbial community, contrary to widespread belief in forensic science. However, the effects of decomposition on soil microbial communities were different in summer and winter. We suggest that the microbial ecological succession will be useful in medicolegal death investigation; however, observations in winter might not be applicable to summer, which indicates a need for a greater understanding of the seasonality of decomposition. PMID:25737335

  11. [Neuropsychological testing in medicolegal cases].

    PubMed

    Muramatsu, Taro

    2013-01-01

    Because the assessment of cognitive function is among the most important diagnostic evaluations in medicolegal cases, neuropsychological testing, the optimal scientific method available to determine the manifestation of brain dysfunction, is a potentially very strong tool in those cases. However, the use of neuropsychological testing in a medicolegal setting should be done with caution. Firstly, the nature of any neuropsychological testing is complex, and cannot be simplified as "Test A measures Function A' ". Oversimplified explanation of a test is misleading, resulting in serious misjudgment in the legal procedure. Secondly, the result of the test shows someone's cognitive function at the time of the test, not the time of the act in question (i. e., a crime). Finally and most importantly, the cognitive function measured by neuropsychological testing does not directly correspond to the legal questions being asked, even when the terms used in the fields of law and neuroscience are similar. In determining whether an individual meets a specified legal standard (e. g., criminal responsibility), the results of neuropsychological testing are far from sufficient and substantial additional information is required. With these caveats in mind, an expert witness should carefully choose the neuropsychological testing battery in each case, which may greatly help to understand the individual's mental state at the time of the act in question. PMID:24341071

  12. The First Survey of Forensically Important Entomofauna Collected from Medicolegal Autopsies in South Korea

    PubMed Central

    Shin, Sang Eon; Lee, Hyun Ju; Park, Ji Hye; Ko, Kwang Soo; Kim, Yu-Hoon; Kim, Kyung Ryoul; Park, Seong Hwan

    2015-01-01

    Forensic entomology applies insect evidence to legal problems such as the estimation of minimum postmortem interval (mPMI). For this purpose, knowledge of the insect fauna that are attracted to human cadavers in each geographic region is a prerequisite. Despite many studies investigating the insect fauna attracted to meat, there has been no survey of the entomofauna on human cadavers in the East Asian temperate climate zone, particularly in Korea. Therefore, this study reports the entomofauna collected from medicolegal autopsies in northeastern Seoul and its suburbs. Insect samples were collected from 35 medicolegal autopsies in 2010, 2011, and 2013. Molecular and morphological methods were utilized for taxonomic identification. Among 1398 individual samples belonging to 3 orders, 13 families, 18 genera, and 32 species, the dominant family and species were Calliphoridae and Lucilia sericata, respectively. Despite its limited scale, this study provides a snapshot of the general entomofauna that are attracted to human cadavers in this region. PMID:26185759

  13. Injury-related mortality in South Africa: a retrospective descriptive study of postmortem investigations

    PubMed Central

    Prinsloo, Megan; Pillay-van Wyk, Victoria; Gwebushe, Nomonde; Mathews, Shanaaz; Martin, Lorna J; Laubscher, Ria; Abrahams, Naeemah; Msemburi, William; Lombard, Carl; Bradshaw, Debbie

    2015-01-01

    Abstract Objective To investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates. Methods We conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We calculated age-specific and age-standardized mortality rates for external causes of death. Findings Postmortem reports revealed 52 493 injury-related deaths in 2009 (95% confidence interval, CI: 46 930–58 057). Almost half (25 499) were intentionally inflicted. Age-standardized mortality rates per 100 000 population were as follows: all injuries: 109.0 (95% CI: 97.1–121.0); homicide 38.4 (95% CI: 33.8–43.0; suicide 13.4 (95% CI: 11.6–15.2) and road-traffic injury 36.1 (95% CI: 30.9–41.3). Using postmortem reports, we found more than three times as many deaths from homicide and road-traffic injury than had been recorded by vital registration for this period. The homicide rate was similar to the estimate for South Africa from a global analysis, but road-traffic and suicide rates were almost fourfold higher. Conclusion This is the first nationally representative sample of injury-related mortality in South Africa. It provides more accurate estimates and cause-specific profiles that are not available from other sources. PMID:26229201

  14. Fatal idiopathic pulmonary haemosiderosis in association with pregnancy - medico-legal evaluation.

    PubMed

    Töro, Klára; Herjavecz, Irén; Vereckei, Edit; Kovács, Margit

    2012-02-01

    Idiopathic pulmonary haemosiderosis is a rare disorder characterised by repeated episodes of intra-alveolar bleeding in association with consecutive anaemia, pulmonary fibrosis, pulmonary hypertension and respiratory failure. Pregnancy may exacerbate the symptoms of idiopathic pulmonary haemosiderosis typically worsening in the third trimester. A 32-year-old female after delivery was admitted to hospital with progressive dyspnoea of about 1-month duration. Sudden circulatory collapse caused fatal complication. During the post-mortem investigation, lung haemorrhage and histologically abundant iron deposition in macrophages and interstitial fibrosis were found. Medico-legal post-mortem evaluation of fatal cases may support the clinico-pathological context of the diagnosis of this entity. PMID:22281220

  15. Trends in domestic animal medico-legal pathology cases submitted to a veterinary diagnostic laboratory 1998-2010.

    PubMed

    McEwen, Beverly J

    2012-09-01

    Pathologists at veterinary diagnostic laboratories receive medico-legal cases from a variety of animal species for postmortem examination. A search of computerized records of the Animal Health Laboratory, University of Guelph, Guelph, Ontario, Canada from 1998 to 2010 identified 1706 medicolegal cases. These were categorized according to the history as criminal investigations, anesthetic-related deaths, insurance, litigation, malpractice cases, and regulatory cases. Statistically significant linear trends in the proportion of medicolegal cases for all animals and criminal cases for companion animals were identified over the 12 year period. Companion animals had significantly greater odds of being a medicolegal case in all categories except for insurance and regulatory cases, compared to noncompanion animals. Based on pathology reports for the 271 criminal cases, 43.1% were consistent with neglect, 29.2% were compatible with non-accidental injury, 4.80% were poisonings, 10.7% were deemed to be due to natural disease, and 11.43% were inconclusive. PMID:22458814

  16. Advances in post-mortem CT-angiography

    PubMed Central

    Grimm, J; Dominguez, A; Vanhaebost, J; Mangin, P

    2014-01-01

    Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial- and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the “Technical Working Group Post-mortem Angiography Methods” (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations. PMID:24234582

  17. [Current medicolegal and ethical issues in pathology].

    PubMed

    Robienski, J; Hoppe, N

    2013-02-01

    The increase in density of information available in relation to patients and research participants, in particular in the context of genetic diagnostics and analysis, results in an increased potential for uncovering details which were unexpected but are of particular significance for the patient. Deciding how this information is dealt with and who is entitled to receive this information, is a medicolegal and ethical balancing act. Incidental findings and the challenges posed by the advent of personalised medicine are but two areas which increasingly impact medical disciplines that do not conventionally work directly with patients. Both areas raise questions of what is legally required and morally necessary. The authors briefly sketch these two areas and the medicolegal and ethical implications for diagnostics and research in pathology. PMID:23322303

  18. Medicolegal aspects of doping in football

    PubMed Central

    Graf‐Baumann, T

    2006-01-01

    This article describes the historical background of the medicolegal aspects of doping in sports and especially in football. The definitions of legal terms are explained and the procedure of individual case management as part of FIFA's approach to doping is presented. Finally, three medicolegal problems awaiting urgent solution are outlined: firstly, the difficulties in decision making arising from the decrease of the T/E ratio from 6 to 4; secondly, the therapeutic application of α‐reductase inhibitors for male pattern baldness in the face of the classification of finasteride as a forbidden masking agent; and lastly, the increasing use of recreational drugs and its social and legal implications in positive cases. PMID:16799105

  19. Externalities.

    ERIC Educational Resources Information Center

    Zicht, Barbara, Ed.; And Others

    1982-01-01

    This issue explains the concept of externalities (benefits or burdens which accrue to society when there is a difference between the private cost or benefit of an action and the social cost or benefit of that action). These external or social costs of individual actions are often referred to as spillover costs. Three brief teaching units follow…

  20. Medico-legal implications of traumatic cataract.

    PubMed

    Moreschi, Carlo; Da Broi, Ugo; Lanzetta, Paolo

    2013-02-01

    Traumatic cataract is due to lens damage when mechanical, irradiative, electrical or chemical agents injury the globe. The appearance of a traumatic cataract is typically short and unilateral with rare spontaneous resolution and often involves other ocular anatomical areas. Medico-legal evaluation of the appearance and the consequences of a traumatic cataract requires a correct methodological approach with the support of qualified ophthalmological competences. PMID:23357390

  1. Profile of medicolegal autopsies in Pekanbaru, Indonesia 2007-2011.

    PubMed

    Afandi, Dedi

    2012-12-01

    Medicolegal autopsy should be carried out for all unnatural deaths to ascertain facts pertaining to death. A retrospective 5-year study was carried out by the Forensic Medicine and Medicolegal Department, Faculty of Medicine, University of Riau to describe the profile of medicolegal autopsies in Pekanbaru, Indonesia. There were 613 unnatural deaths and 73 (11.9%) medicolegal autopsies recorded between 2007 and 2011. The number of unnatural deaths showed a decreasing trend whereas the number of medicolegal autopsies increased over the years. The percentage of unnatural deaths subjected to medicolegal autopsy varied between 2.2% and 23.1% per year. Of the 73 medicolegal autopsy subjects, 68.5% (n = 50) were male and 31.5% (n = 23) females. The ages of victims ranged from newborn babies to 72 years, with a median of 28 years. 61.6% of cases were in the 20-39 years age-group. Sixty (82.2%) had unnatural deaths. The leading cause of death was blunt force (30.1%) and sharp force (20.5%). Homicide was the predominant manner of death. Our study highlights that the main interest of the police in requesting a medicolegal autopsy is for investigation of homicide. Recognizing that autopsy has an important role in the investigation of unnatural deaths, further studies should be carried out to understand the factors that impact on the low percentage of medicolegal autopsies in unnatural deaths, so that solutions may be found for the future. PMID:23424774

  2. Opioid prescribing pitfalls: medicolegal and regulatory issues

    PubMed Central

    Jammal, Walid; Gown, Grace

    2015-01-01

    Summary Inappropriate opioid prescribing can lead to patient harm as well as a medicolegal risk to prescribers. Prescribers need to be familiar with the indications, contraindications and harms associated with opioids. When prescribing opioids, doctors must be aware of their clinical, ethical and legal responsibilities, particularly the legislative requirements in their state. Failure to comply with these can result in disciplinary action. To avoid potential conflict with differing state regulations on opioid prescribing, doctors should advise patients to get their prescription dispensed in the same state in which it was written. PMID:26843712

  3. Crisis in medico-legal death investigation.

    PubMed Central

    Carter, Joye M.

    2002-01-01

    There is a crisis in the field of medico-legal death investigation! This medical practice is one that most physicians do not think about until they are called in the middle of the night and informed that their patient has died and medical history is requested. Worse still, the trauma surgeon may need to explain why the patient did not survive the life-saving techniques used at his or her medical institution. The worst-case scenario is when the clinician is hit with a malpractice lawsuit. PMID:11837352

  4. Postmortem biochemistry: Current applications.

    PubMed

    Belsey, S L; Flanagan, R J

    2016-07-01

    The results of biochemical analyses in specimens obtained postmortem may aid death investigation when diabetic and alcoholic ketoacidosis is suspected, when death may have been the result of drowning, anaphylaxis, or involved a prolonged stress response such as hypothermia, and in the diagnosis of disease processes such as inflammation, early myocardial infarction, or sepsis. There is often cross-over with different disciplines, in particular with clinical and forensic toxicology, since some endogenous substances such as sodium chloride, potassium chloride, and insulin can be used as poisons. The interpretation of results is often complicated because of the likelihood of postmortem change in analyte concentration or activity, and proper interpretation must take into account all the available evidence. The unpredictability of postmortem changes means that use of biochemical measurements in time of death estimation has little value. The use of vitreous humour is beneficial for many analytes as the eye is in a physically protected environment, this medium may be less affected by autolysis or microbial metabolism than blood, and the assays can be performed with due precaution using standard clinical chemistry analysers. However, interpretation of results may not be straightforward because (i) defined reference ranges in life are often lacking, (ii) there is a dearth of knowledge regarding, for example, the speed of equilibration of many analytes between blood, vitreous humour, and other fluids that may be sampled, and (iii) the effects of post-mortem change are difficult to quantify because of the lack of control data. A major limitation is that postmortem vitreous glucose measurements are of no help in diagnosing antemortem hypoglycaemia. PMID:27131037

  5. [Medicolegal investigation system in the state of Connecticut].

    PubMed

    Kremens, Karolina

    2006-01-01

    The paper explains the organization of medicolegal investigation system conducted in the State of Connecticut and regulated by the law of that state. The author presents issues connected with reportable deaths, possible types of medicolegal investigations, people responsible for deciding whether autopsy should be performed, individuals responsible for conducting autopsy, and other responsibilities of medical examiners in association with medicolegal investigations. The paper does not provide a detailed description of the organizational structure and legal basis of the medical examiner system in Connecticut due to space limitations. PMID:16708612

  6. [Medicolegal aspects of a survived suicide attempt by hanging].

    PubMed

    Nadjem, Hadi; Pollak, Stefan

    2013-01-01

    Report on the clinical and medicolegal findings in a survived suicide attempt by hanging. A 39-year-old woman was found unconscious in a crouching position on the balcony of her flat. The hanging device was an electric cable running around her neck in a single loop and attached to the balcony wall. After removing the noose, resuscitation measures were started immediately. For 5 hours, the victim was at first in a comatose and then in a somnolent state. The period of amnesia covered also the preparations for the suicidal act. The forensic examination performed on the same day showed a reddish, streak-like hanging mark, pronounced signs of blood congestion with dense petechial haemorrhages in the facial skin, confluent haemorrhages in the conjunctivae as well as bleeding from the left external auditory canal. BAC was 2.2 per mil. On the basis of the findings and the clinical course, criminalistic and pathophysiological aspects of near-hanging are discussed. PMID:23878897

  7. Medicolegal reconstruction of the Katyń forest massacre.

    PubMed

    Raszeja, S; Chróścielewski, E

    1994-09-01

    The genesis of the massacre of Polish officers, committed by the Soviets in the Katyń forest in 1940, is presented. Medicolegal documentation of the exhumation by the International Committee is contrary to the report by the Special Soviet Committee. The importance of the medicolegal findings concerning the time of the crime is stressed. The report by the Select Committee of the House of Representatives is also referred to. PMID:7959477

  8. Medico-legal aspects of histopathology practice.

    PubMed

    Ong, B B; Looi, L M

    2001-06-01

    Medico-legal problems experienced by histopathologists differ from those of other clinicians as they are rarely in direct contact with patients. Nevertheless, the pathologist owes a duty of care to the patient and is liable for medical negligence. In the absence of local guidelines, it is prudent to follow guidelines published by learned Colleges elsewhere. This is also true when delegating duties to non-pathologists, technical and other support staff. Errors in diagnosis and documentation pose the most common problems in histopathology. In this, liability also depends on many factors including the provision of adequate clinical information by clinicians and competence of laboratory staff. Clinicopathological discussions, participation in quality assurance programmes and adherence to standard operating procedures are important audit activities to minimize and detect errors as well as prevent grievous outcome to patients. Issues also arise over the retention of specimens and reports. In general, wet, formalin-fixed tissues should be kept until histopathological assessment is finalized and preferably after clinicopathological sessions, and even longer if there is potential litigation. Reports should be archival. Paraffin blocks should be kept for at least the lifetime of the patient, and histology slides for at least 10 years, to facilitate review and reassessment. Despite adverse publicity in the foreign press over the use of human organs and tissues for research and education, it is accepted that processed tissues can be used for research and educational purposes provided the patient's identity is kept confidential. Nevertheless, it would be prudent to revise consent forms for surgery and autopsies to include the possibility that tissues removed can be stored or used for research and education. Good medical practice in pathology encourages a willingness to consult colleagues when in doubt, but advises that the treating clinician be informed if histopathological

  9. Postmortem biochemistry in suspected starvation-induced ketoacidosis.

    PubMed

    Palmiere, Cristian; Tettamanti, Camilla; Augsburger, Marc; Burkhardt, Sandra; Sabatasso, Sara; Lardi, Christelle; Werner, Dominique

    2016-08-01

    Significantly increased blood ketone body levels can be occasionally observed in the forensic setting in situations other than exposure to cold, diabetic or alcoholic ketoacidosis. Though infrequent, these cases do occur and deserve thorough evaluation in order to establish appropriate differential diagnoses and quantify the role that hyperketonemia may play in the death process. Starvation ketoacidosis is a rare cause of metabolic acidosis and is a phenomenon that occurs normally during fasting, as the body switches from carbohydrate to lipid energy sources. The levels of ketonemia in starvation ketoacidosis is usually mild in comparison to those seen in diabetic or alcoholic ketoacidosis. In the clinical setting, several cases of starvation-induced ketoacidosis mainly associated with gastric banding, pregnancy, malnutrition and low-carbohydrate diets have been reported. However, starvation ketosis causing severe metabolic acidosis has been rarely described in the medical literature. In the realm of forensic pathology, starvation-induced hyperketonemia has been rarely described. In this paper we present the postmortem biochemical results observed in situations of suspected starvation-induced hyperketonemia that underwent medico-legal examination. In all these cases, the diagnosis of starvation induced-hyperketonemia and the subsequent ketoacidosis was established per exclusionem based on all postmortem investigation findings. A review of the literature pertaining to the clinical diagnosis of starvation ketoacidosis is also provided. PMID:27239954

  10. Medico-legal aspects of traumatic injury of the vertebrobasilar artery.

    PubMed

    Hiraiwa, Kouichi; Sato, Taku; Sasaki, Tatsuya; Mizusawa, Ikubumi; Nata, Masayuki; Kodama, Namio

    2005-11-01

    Based on our experiences with medico-legal autopsies, we analyzed traumatic injury of the vertebrobasilar artery (VBA) in traffic accident victims. VBA rupture occurred in six cases with traumatic medullary lesions, but in none with cervical cord injury. A relatively small external force applied to the head or neck can induce isolated traumatic subarachnoid hemorrhage (SAH), which accounts for approximately 11% of fatal head injuries. We examined the relationship between site of impact and site of vascular injury in 16 cases of isolated traumatic SAH. The results showed that the vertebral artery (VA) on the side of impact tended to be longitudinally injured in victims experiencing an external force equivalent to that of a fist punch to the head or face. There was no clear relationship between the site of impact and the site of vascular injury in victims who had sustained an external force greater than that of a fist punch. However, our results suggest that an external force causing rotation of the head was likely to cause tearing of the artery. In cases in which an external force equivalent to that of a fist punch was applied to the head, a raised blood alcohol level was a significant risk factor for artery rupture. Furthermore, a difference in the diameters of the left and right VAs was a risk factor for artery rupture. To determine why the VA, the most frequent site of arterial dissection, is also frequently the site of injury, we histologically examined normal and dissected VBAs. We also discuss medico-legal issues of the causal relationship between external force applied and rupture or dissection of the VA. PMID:16308512

  11. [Postmortem genetic testing in sudden cardiac death due to ion channelopathies].

    PubMed

    Guan, Da-wei; Zhao, Rui

    2010-04-01

    Sudden cardiac death accounts for majority of deaths in human. Evident cardiac lesions that may explain the cause of death can be detected in comprehensive postmortem investigation in most sudden cardiac death. However, no cardiac morphological abnormality is found in a considerable number of cases although the death is highly suspected from cardiac anomaly. With the advances in the modern molecular biology techniques, it has been discovered that many of these sudden deaths are caused by congenital ion channelopathies in myocardial cell, i.e., Brugada syndrome, long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, and short QT syndrome, etc. This article presents the molecular genetics, electrocardiographic abnormalities, clinical manifestations, and mechanisms leading to sudden cardiac death with emphasis on the role of postmortem genetic testing in certification of cause of death. It may provide helpful information in investigating sudden cardiac death due to ion channelopathies in medico-legal practice. PMID:20653139

  12. Perinatal testicular torsion and medicolegal considerations.

    PubMed

    Massoni, F; Troili, G M; Pelosi, M; Ricci, S

    2014-06-01

    Perinatal testicular torsion (PTT) is a very complex condition because of rarity of presentation and diagnostic and therapeutic difficulties. In presence of perinatal testicular torsion, the involvement of contralateral testis can be present also in absence of other indications which suggest the bilateral involvement; therefore, occurrences supported by literature do not exclude the use of surgery to avoid the risk of omitted or delayed diagnosis. The data on possible recovery of these testicles are not satisfactory, and treatment consists of an observational approach ("wait-and-see") or an interventional approach. The hypothesis of randomized clinical trials seems impracticable because of rarity of disease. The authors present a case of PTT, analyzing injuries due to clinical and surgical management of these patients, according to medicolegal profile. The delayed diagnosis and the choice of an incorrect therapeutic approach can compromise the position of healthcare professionals, defective in terms of skill, prudence and diligence. Endocrine insufficiency is an unfortunate event. The analysis of literature seems to support, because of high risk, a surgical approach aimed not only at resolution of unilateral pathology or prevention of a relapse, but also at prevention of contralateral testicular torsion. PMID:24826979

  13. Medicolegal aspects of PMA-related deaths.

    PubMed

    Rojek, Sebastian; Bolechała, Filip; Kula, Karol; Maciów-Głąb, Martyna; Kłys, Małgorzata

    2016-07-01

    Unlike amphetamine, amphetamine-like substances accessible on the drug market are less expensive and more easily available; they also produce hallucinogenic effects expected by the users. Such properties render them more attractive as compared to amphetamine. On the other hand, the knowledge of the toxicity of these compounds is very limited, what in consequence generates problems that create ever-expanding research areas, including analytical, clinical and medicolegal issues, thus leading to development of systemic databases. An example here is paramethoxyamphetamine (PMA), which appeared on the drug market in recent years as a result of creative inventiveness of producers of psychoactive substances, who aimed at PMA replacing the popular ecstasy (MDMA) as a less expensive and more available product. It is more potent than MDMA, but has a slower onset of action, which encourages users to take more. The problem is illustrated in the present paper by three fatal cases involving PMA, which were comprehensively investigated taking into consideration case histories, pathological and toxicological findings obtained with the use of LC-MS-MS method. In blood samples taken from all the three victims, very high concentrations of PMA were found (in the range of 10-27mg/L) and thus the cause of deaths was determined as overdoses of PMA with the underlying mechanism of acute cardiorespiratory failure. PMID:27497336

  14. The medicolegal and forensic aspects of fires.

    PubMed

    Eckert, W G

    1981-12-01

    Fires, their consequences and their investigations, continue to provide forensic scientists, especially those involved in medicolegal investigation (the medical examiner or forensic pathologist), with constant work and variations in problems. The recent history of mass disasters involving high-rise buildings, transport accidents, and arson-related accidents in nightclubs and prisons has emphasized the necessity for corrective and preventive means to ensure safety to the occupants of any of these areas. Problems presented by fires include the determination of the cause of the fire, the identification of the victims, and the cause and manner of their deaths. The motivation of the fire setter and the settlement by the insurance company or legal means are also aspects to be considered. The imperceptible effects of the fires include many other aspects, among which loss of loved ones and family providers and loss of industrial revenue and job potential are all felt. The most frightening development of all, however, is the insidious surfacing of arson as a possible factor in many major fires. The most recent tragedies involving the Stouffer Inn fire and the Hilton International Hotel fire were both related to arsonous acts. The scope of this article is to review the subject as it affects the forensic medical practitioner directly or indirectly so that his or her investigation may be brought to completion in conjunction with other authorities involved in the case. PMID:7340512

  15. Medico-legal aspects of doping.

    PubMed

    Madea, B; Grellner, W; Musshoff, F; Dettmeyer, R

    1998-03-01

    Abuse of anabolic steroids is an increasing problem not only among athletes but also body-builders and teenagers. A fast-developing black market has been established since the opening of the borders to eastern Europe. Medico-legal aspects of doping are addressed with particular reference to toxicology and pathology. Constituents of anabolic steroids bought on the black market were identified using gas chromatography/mass spectrometry; the products did not contain the expected ingredients in 35% of cases. Long-term effects and fatalities because of anabolic steroid abuse are reported here based on our own case material and a literature review. In our own cases, severe cardiovascular side-effects developed after long-term abuse of Dianabol (methandrostenolone) and Oral-Turinabol (chlordehydromethyltestosterone), i.e. myocardial infarction, stroke, organomegaly and/or severe atherosclerosis. The pathogenesis of cardiovascular complications (cardiotoxic effect, risk of atherosclerosis, thrombogenic risk) is discussed based on the available literature reports following fatal outcome after the abuse of anabolic steroids. PMID:15335551

  16. Current medico-legal death investigation system in China.

    PubMed

    Chang, Lin; Zhang, Baosheng; Yan, Ping; Fowler, David; Li, Ling

    2011-07-01

    Medico-legal death investigation in China has a long history that can be traced back to the Chhin era in the third century BC. We conducted a national study on the current medico-legal death investigation system in China. Our study showed that, at present, medico-legal death investigations in China are conducted by c. 12,000 forensic medical experts mainly within five relatively independent agencies: the police organizations, the prosecutors' offices, the departments/divisions of forensic medicine/science in medical colleges and universities, the Institute of Forensic Science in the Ministry of Justice, and the government or private forensic societies. Owing to China's large population and area, the medico-legal death investigation is largely based on the administrative divisions. There is a wide variation in the scope, extent, and quality of investigations among the agencies and at the different levels of county/district, municipal, and provincial governments. This article gives a general overview of medicolegal death investigation in modern China. PMID:21496020

  17. [Regulatory aspects and medicolegal considerations regarding clinical drug trials].

    PubMed

    Cammarano, Andrea; De Dominicis, Enrico; Marella, Gian Luca; Maurici, Massimo; Arcudi, Giovanni

    2016-01-01

    This article aims to explore the regulatory and medicolegal aspects of experimental drug trials. Firstly, the authors provide definitions of drug according to WHO, the European Community and our official Pharmacopoeia, and that of experimental studies. They then explain the distinction between pure or basic research and drug trials and explain the various phases of the latter. Besides providing definitions, and exploring doctrinal, theoretical but also practical aspects of drug trials, the authors also discuss and analyze legislative aspects, with particular reference to the Italian legislative framework, and medicolegal issues, including informed consent, effects on humans, and professional responsibility. PMID:27336959

  18. Postmortem imaging: MDCT features of postmortem change and decomposition.

    PubMed

    Levy, Angela D; Harcke, Howard Theodore; Mallak, Craig T

    2010-03-01

    Multidetector computed tomography (MDCT) has emerged as an effective imaging technique to augment forensic autopsy. Postmortem change and decomposition are always present at autopsy and on postmortem MDCT because they begin to occur immediately upon death. Consequently, postmortem change and decomposition on postmortem MDCT should be recognized and not mistaken for a pathologic process or injury. Livor mortis increases the attenuation of vasculature and dependent tissues on MDCT. It may also produce a hematocrit effect with fluid levels in the large caliber blood vessels and cardiac chambers from dependent layering erythrocytes. Rigor mortis and algor mortis have no specific MDCT features. In contrast, decomposition through autolysis, putrefaction, and insect and animal predation produce dramatic alterations in the appearance of the body on MDCT. Autolysis alters the attenuation of organs. The most dramatic autolytic changes on MDCT are seen in the brain where cerebral sulci and ventricles are effaced and gray-white matter differentiation is lost almost immediately after death. Putrefaction produces a pattern of gas that begins with intravascular gas and proceeds to gaseous distension of all anatomic spaces, organs, and soft tissues. Knowledge of the spectrum of postmortem change and decomposition is an important component of postmortem MDCT interpretation. PMID:20010292

  19. [Post-mortem microbiology analysis].

    PubMed

    Fernández-Rodríguez, Amparo; Alberola, Juan; Cohen, Marta Cecilia

    2013-12-01

    Post-mortem microbiology is useful in both clinical and forensic autopsies, and allows a suspected infection to be confirmed. Indeed, it is routinely applied to donor studies in the clinical setting, as well as in sudden and unexpected death in the forensic field. Implementation of specific sampling techniques in autopsy can minimize the possibility of contamination, making interpretation of the results easier. Specific interpretation criteria for post-mortem cultures, the use of molecular diagnosis, and its fusion with molecular biology and histopathology have led to post-mortem microbiology playing a major role in autopsy. Multidisciplinary work involving microbiologists, pathologists, and forensic physicians will help to improve the achievements of post-mortem microbiology, prevent infectious diseases, and contribute to a healthier population. PMID:23195835

  20. [Post-mortem examination prior to cremation--an instrument to verify the quality of medical post-mortems and uncover non-natural deaths?].

    PubMed

    Germerott, Tanja; Todt, Melanie; Bode-Jänisch, Stefanie; Albrecht, Knut; Breitmeier, Dirk

    2012-01-01

    The external post-mortem examination, its deficient quality and possible causes have been the subject of numerous political and professional discussions. The external post-mortem examination is the basis for the decision whether further criminal investigations are required to clarify the cause of death. It is thus an essential instrument to ensure legal certainty. Before cremation, a second external post-mortem examination is performed by a public medical officer to make sure that errors of the first post-mortem are corrected. In the present study, cases were retrospectively analyzed in which a forensic autopsy had been ordered on the basis of the results of the post-mortem examination performed before cremation. The entries on the death certificate regarding the manner and cause of death were compared with the autopsy results. Between 1998 and 2007, 387 autopsies were ordered after external examination before cremation. In 55 cases (14.2%), the autopsy revealed a non-natural death, although a natural death had been attested on the death certificate. In descending order, a wrong manner of death was attested by clinicians, general practitioners and emergency physicians. With regard to the place where the first external post-mortem had been performed the lowest error rate was seen in nursing homes. Concerning the cause of death, discrepancies between the first post-mortem and autopsy were found in 59.4% of the cases. In this respect, general practitioners and clinicians were ranking first, whereas in nursing homes the cause of death was wrongly assessed in over 70% of cases. At present, the medical post-mortem does not meet the required quality standards, especially with regard to legal certainty. Determination of the cause of death on the basis of the external post-mortem examination is a challenging task even for the experienced medical examiner. As to the categorization of the manner of death it has to be stated that non-natural deaths are often not recognized or

  1. Post-mortem clinical pharmacology

    PubMed Central

    Ferner, R E

    2008-01-01

    Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post-mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post-mortem redistribution. Consequently, compilations of ‘lethal concentrations’ are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post-mortem measurements. PMID:18637886

  2. The black soldier fly Hermetia illucens (Diptera: Stratiomyidae) as a potential measure of human postmortem interval: observations and case histories.

    PubMed

    Lord, W D; Goff, M L; Adkins, T R; Haskell, N H

    1994-01-01

    The black soldier fly, Hermetia illucens (L.), has been shown to be a ubiquitous inhabitant of both surface and buried human remains throughout the southern, central and western United States and Hawaii. Unlike most other species of forensically important Diptera, this species frequently dominates bodies in the dry/post decay stage of decomposition. Adults of the black soldier fly appear to initiate oviposition (egg laying) 20 to 30 days postmortem. Even at warm temperatures (27.8 degrees C), subsequent completion of the life cycle can require an additional 55 days. Life history data for H. illucens, when used in combination with data for other cohabiting arthropod species and viewed in the context of local environmental conditions, can provide medicolegal investigators with valuable parameters for estimating the postmortem intervals for badly decomposed remains. PMID:8113702

  3. Postmortem angiography using femoral cannulation and postmortem microbiology.

    PubMed

    Palmiere, Cristian; Egger, Coraline; Grabherr, Silke; Jaton-Ogay, Katia; Greub, Gilbert

    2015-07-01

    Despite the undeniable advantages of postmortem angiography, numerous questions have arisen concerning the influence that the injected contrast media may exercise on biological fluids and tissues collected for toxicological and biochemical investigations. Moreover, cardiac blood for microbiological investigations cannot be obtained post-angiography. In this study, we examined whether the peripheral blood collected prior to postmortem angiography, using percutaneous access to femoral vessels after skin surface disinfection, could be suitable for microbiological investigations when postmortem angiography with femoral vessel cannulation is also performed. A total of 66 cases were included in the study and were divided into two subgroups (angiography and bacteriology group, 33 cases and control group, 33 cases). Autopsies, histology, toxicology, bacteriology, and biochemical investigations (procalcitonin, C-reactive protein, interleukin-6, and soluble triggering receptors expressed on myeloid cells type 1) were performed in all cases. No statistically significant differences between the two groups were noted, and identified category distribution (death unrelated to infection, true infection, false positive, and undetermined) was rather similar in both studied populations. These preliminary results suggest that postmortem angiography using a femoral approach does not constitute an impediment to the collection of peripheral blood for microbiology and vice versa. Moreover, the use of femoral blood for microbiology does not lead to an increased risk of doubtful results. PMID:25381195

  4. Applications of social network media in medicolegal death investigation.

    PubMed

    Hookano, Ryan; Knight, Laura D; Brunelli, Ronald A; Stoppacher, Robert

    2013-11-01

    With the increased popularity of online social networking services (SNS) such as Facebook, LinkedIn, Twitter, and Google+, we propose that a wealth of new resources is available for medicolegal death investigation. Recognizing this potential, we identified cases in which social media had been useful in the past in our office and asked our investigative staff to consider using social media in current cases. These cases provided illustrative examples for this primer regarding how information from SNS was used in death investigations in our office. Information gleaned from online social media aided in establishing preliminary identification of a decedent, locating next-of-kin, investigating the circumstances of death as relevant to the manner of death, corroborating eyewitness accounts, and providing information relevant to time of death. Potential pitfalls were identified, such as shared accounts or online impostors. SNS proved useful to the medicolegal death investigator and medical examiner, so long as their limitations were recognized. PMID:23822156

  5. Setting up a postmortem service.

    PubMed

    der Burgt, Guda van

    2016-06-25

    Pets and pony camp, and a wish for a career that involved working with her hands, led Guda van der Burgt to study veterinary medicine at Utrecht. Starting her working life with a cattle breeding company, she moved into large animal work, industry and state veterinary medicine, all of which gave her the skills to set up a postmortem examination service. PMID:27339933

  6. Imaging of body packing: errors and medico-legal issues.

    PubMed

    Reginelli, Alfonso; Russo, Anna; Urraro, Fabrizio; Maresca, Duilia; Martiniello, Ciro; D'Andrea, Alfredo; Brunese, Luca; Pinto, Antonio

    2015-10-01

    Body packing is the ingestion or insertion in the human body of packed illicit substances. Over the last 20 years, drug smuggling has increased global and new means of transport of narcotics have emerged. Among these, the most frequent one is the gastrointestinal tract: from mouth to anus, vagina, and ears. Cocaine is one of the most traded drugs, followed by heroin. Condoms, latex gloves, and balloons are typically used as drug packets for retention in the body. There are different radiologic modalities to detect illicit drugs in body packing: Plain radiography, computed tomography (CT), ultrasound, and magnetic resonance. Current protocols recommend the use of radiography to confirm packet retention and, in case of doubt, the use of abdominal CT scan with reduced mAs. In case of packet rupture, catastrophic effects can occur. Management of patients carrying packets of drugs is a recurrent medico-legal problem. To improve diagnostic accuracy and prevent hazardous complications, radiologists and emergency physicians should be familiar with radiologic features of body packing. The radiologist plays both a social and a medico-legal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location. In this review, we focus on diagnostic errors and medico-legal issues related to the radiological assessment of body packers. PMID:26063072

  7. An experimental evaluation of electrical skin conductivity changes in postmortem interval and its assessment for time of death estimation.

    PubMed

    Cantürk, İsmail; Karabiber, Fethullah; Çelik, Safa; Şahin, M Feyzi; Yağmur, Fatih; Kara, Sadık

    2016-02-01

    In forensic medicine, estimation of the time of death (ToD) is one of the most important and challenging medico-legal problems. Despite the partial accomplishments in ToD estimations to date, the error margin of ToD estimation is still too large. In this study, electrical conductivity changes were experimentally investigated in the postmortem interval in human cases. Electrical conductivity measurements give some promising clues about the postmortem interval. A living human has a natural electrical conductivity; in the postmortem interval, intracellular fluids gradually leak out of cells. These leaked fluids combine with extra-cellular fluids in tissues and since both fluids are electrolytic, intracellular fluids help increase conductivity. Thus, the level of electrical conductivity is expected to increase with increased time after death. In this study, electrical conductivity tests were applied for six hours. The electrical conductivity of the cases exponentially increased during the tested time period, indicating a positive relationship between electrical conductivity and the postmortem interval. PMID:26751404

  8. Gabapentin concentrations and postmortem distribution.

    PubMed

    Hamm, Catherine E; Gary, Ray D; McIntyre, Iain M

    2016-05-01

    Gabapentin is a widely prescribed medication used primarily for the treatment of epilepsy and neuropathic pain. Gabapentin has a favorable adverse effect profile in therapeutic dosing with the most common reported effects being dizziness, fatigue, drowsiness, weight gain, and peripheral edema. Even with intentional self-poisonings, serious effects are generally rare. In this report, gabapentin analyses were performed on 30 postmortem cases that had peripheral blood, central blood and liver tissue. Overall the central to peripheral blood (C/P) ratio mean was 0.90±0.24 (mean±standard deviation), and a median of 0.97. The liver to peripheral blood (L/P) ratio mean was 0.68±0.26L/kg (mean±standard deviation), and a median of 0.65L/kg. An additional case, where both antemortem blood and postmortem peripheral blood specimens were available, revealed the same gabapentin concentration in both specimens. Taken together, the data presented suggests that gabapentin is unlikely to show postmortem redistribution. PMID:27038659

  9. The medico-legal aspects of prescribing vitamin D

    PubMed Central

    Davies, John S; Poole, Chris D; Feldschreiber, Peter

    2014-01-01

    Vitamin D is a particularly important sterol hormone and its effects beyond bone are increasingly recognized. Over the last decade clinical interest has grown in vitamin D, with increased recognition of deficiency and hence increased prescribing of vitamin D products. However, the increased prescription of vitamin D has generally been met with unlicensed vitamin D products which potentially expose the patient to clinical risk. This review discusses the issues relating to the clinical use of unlicensed vitamin D products, safety concerns that may arise from this, as well as discussing the medico-legal responsibilities of the prescriber and dispenser. PMID:25047693

  10. A profile of abdominal and pelvic injuries in medico-legal autopsy.

    PubMed

    Subedi, Nuwadatta; Yadav, B N; Jha, Shivendra; Paudel, Ishwari Sharma; Regmi, Rajendra

    2013-08-01

    Abdomino-pelvic region is vulnerable to injury in various forms of trauma. This study was undertaken with objectives to study the pattern and type of external and internal abdominal and pelvic injuries and to identify the risk organs in abdomen and pelvis susceptible to trauma among the medico-legal autopsies at the mortuary of a referral centre in eastern Nepal during the period of one year (n = 80). Males constituted 80% of the cases and the mean age of the victims was 30.76 years. The cause of trauma was Road Traffic Accident in 82.5%. The manner of death was accidental in 87.5% and homicidal in 11.25% cases. Liver (57.5%) was the most common organ injured followed by spleen in 37.5% cases. Multiple organs injury was seen in 67.5% and absence of any external injuries was noted in 31.25% cases. Autopsy can play a role in establishing the missed injuries and be helpful to widen the knowledge of the medical faculty in early diagnosis and management of such injuries. PMID:23910883

  11. The medico-legal observation of an aggressive urogenital fibromatosis with isolated development not related to any traumatic event.

    PubMed

    Muccino, Enrico; Gentile, Guendalina; Mantero, Stefano; Marchesi, Matteo; Rancati, Alessandra; Zoja, Riccardo

    2016-03-01

    Desmoid tumor is a fibroproliferative neoplasm with an intermediate malignancy and it can be localized in every bodily district: some locations are considered exceptional, like the urogenital localization. The Author point out a rare case of giant idiopathic scrotal fibromatosis that was found during an autopsy. A widower, that lived alone in poor hygienic conditions, was found dead in his house. The Judicial Authority ordered the autopsy, that was performed two days later at the Medico-Legal Section of Milan University. External examinations revealed only the considerable dimension of the scrotum (cm 24 × 41). The cause of death was fixed in a cardiac tamponade due to a natural heart laceration localized in correspondence of a transmural infarction. The toxicological exam resulted negative, while the histopathological and immunohistochemical analysis qualify the scrotal mass as a desmoids tumor. Due to the absence of predisposing conditions and of fibroproliferative infiltration in bladder and retroperitoneal space, the neoplasm was configured as an idiopathic desmoid tumor. The presented case gives the reason for the discussion concerning medico-legal aspects that are typical of rare neoplasms. PMID:26786144

  12. Retrospective analysis of medicolegal cases and evaluation for erectile function.

    PubMed

    Ozkara, H; Aşicioglu, F; Alici, B; Akkuş, E; Hattat, H

    1999-06-01

    Erectile function (EF) is an important question in lawsuits for divorce, rape, and damages. In this study, a method to evaluate medicolegal cases is defined, and the characteristics of the 265 cases screened for EF between 1989 and 1997 were analyzed. Interview, physical examination, psychometric evaluation, nocturnal penile tumescence, serum hormone levels and blood chemistry, intracavernosal drug injection, penile Doppler ultrasonography, and pharmacocavernosometry and pharmacocavernosography tests were used for diagnosis. The tests performed were selected according to the age of the subject. Of the 265 cases 128 (48.3%) were for divorce, 116 (43.7%) were for rape, and 21 (8%) were for indemnity relating to lawsuits for damages. In only 7 cases (2.7%) was the defendant <15 years of age. Organic pathology for erectile dysfunction (ED) was present in 22% of lawsuits for divorce, 40.5% of lawsuits for rape, and 33.4% of lawsuits for damages. Three men in cases of divorce and 2 men after genital trauma due to traffic accident suffered psychological ED. This study indicates that lawyers may abuse the assertion of ED in lawsuits for divorce and rape. In 128 divorce cases the defendant was accused of being impotent, but evaluation proved that 75.8% had normal EF. In lawsuits for rape, 59.5% of defendants had normal EF although the lawyers of the rapist claimed their clients were impotent. The investigation, interpretation, and characteristics of medicolegal cases may differ in countries with different cultures. PMID:10414654

  13. Observational case series: an algorithm incorporating multidetector computed tomography in the medicolegal investigation of human remains after a natural disaster.

    PubMed

    Berran, Philip J; Mazuchowski, Edward L; Marzouk, Abubakr; Harcke, H Theodore

    2014-07-01

    An algorithm incorporating multidetector computed tomography (MDCT), digital radiographs, and external examination was used to triage cases for noninvasive or complete autopsy after a natural disaster. The algorithm was applied to 27 individuals who died during or soon after the earthquake that struck the Republic of Haiti on January 12, 2010. Of the 27 cases reviewed, 7 (26%) required a complete autopsy to determine cause and manner of death. In the remaining 20 (74%), cause and manner of death were determined with a reasonable degree of medical certainty after review of circumstances, an external examination, and postmortem imaging by MDCT and digital radiography (noninvasive autopsy). MDCT was particularly useful in detecting skeletal fractures caused by blunt force injury which were not evident on digital radiographs. The algorithm incorporating postmortem MDCT can be useful in the triage of human remains for autopsy after a natural disaster. PMID:24684535

  14. Documentation of postmortem changes in salivary gland architecture and staining characteristics

    PubMed Central

    Agarwal, Swati; Chaudhary, Minal; Gawande, Madhuri; Gupta, Puneet

    2016-01-01

    Context: Estimation of time passed since death continues to be a major problem for the forensic pathologist and its determination plays an important and vital role in medico-legal cases. The histological studies on various tissues after death have been mostly confined to single organ or tissue by individual workers at different atmospheric conditions. Aims: The aim of this study is to determine the best rehydrating solution for dehydrated tissues in postmortem examination. Settings and Design: This study was specific to salivary gland tissues and certain pattern of changes were determined during postmortem time intervals using hematoxylin and eosin stain and special stains like mucicarmine and alcian blue. Materials and Methods: The study was divided into two groups. (1) Group A: Normal tissue samples (twenty normal salivary gland tissue samples left without fixation for varying periods of time). (2) Group B: Control group (twenty normal salivary gland tissue samples immediately fixed in formalin). The three different rehydrating agents used in this study were glycerol, normal saline and modified Ruffer solution. Statistical Analysis Used: Not required. Results: Modified Ruffer solution is the best when compared to glycerol and normal saline for rehydration of dehydrated tissues. Conclusions: Thus in our study we conclude that the tissue which had been dehydrated at the crime scene for a fairly long period showed better rehydration with modified Ruffer solution and yield good cellular and nuclear details. PMID:27555735

  15. Postmortem inflation and fixation of human lungs

    PubMed Central

    Wright, B. M.; Slavin, G.; Kreel, L.; Callan, K.; Sandin, Brenda

    1974-01-01

    Wright, B. M., Slavin, G., Kreel, L., Callan, K., and Sandin, Brenda (1974).Thorax, 29, 189-194. Postmortem inflation and fixation of human lungs. A method of fixing lungs by inflating them with heated formalin vapour is described. This method facilitates postmortem correlations between radiographic and histological appearances. Images PMID:4598582

  16. [Some findings of the lung in medicolegal autopsy cases].

    PubMed

    Ohya, I

    1994-12-01

    "At first glance the lungs may seem uncomplicated, but many wise men have gone astray in their labyrinths." These words were written by Dr. A.A. Liebow, a famous pathologist, in a foreword to the first edition of Pathology of the Lung by H. Spencer. This same thought can also be applied to the field of medicolegal autopsies. 1. The gross appearance of the lungs in medicolegal autopsies Plucks consisting of the lungs, neck organs, the esophagus and the aorta were removed from human cadavers and after taking photos of the frontal and rear view, the lungs were carefully examined to reveal whether the lung shows characteristic morphological changes depending on causes of death. Based on their appearance, the lungs were classified into the 3 following types: a collapsed, a non-collapsed and an inflated type, each of these types reflecting the probable cause of death. The collapsed type of lung was seen in cases of death from exanguination, and the lung falling into shrinkage due to traumatic pneumo- and/or hemo-thorax was also classified into the collapsed type. The non-collapsed type of lung was seen in cases whose lungs were thermo-coagulated and in a case of death from a pulmonary embolism. Also, the deflating lungs of drowning victims before falling into collapse, were classified into a non-collapsed type. The inflated type of lung consisted of lungs that showed ballooning soon after death by drowning, and lungs that had inflated due to emphysema or edema from various causes. This lung study has reconfirmed that the lungs show hypostatic changes more clearly than any other organs of the body, and in the absence of skin color changes reflecting hypostasis, the settling of the blood in the lung could be detected in most cases. 2. Early histopathological lung changes induced by shock One hundred and thirty medicolegal cases were reviewed to detect early histopathological changes of the lung induced by shock. In many cases of death from various causes, pulmonary edema

  17. Interpretation of postmortem forensic toxicology results for injury prevention research.

    PubMed

    Drummer, Olaf H; Kennedy, Briohny; Bugeja, Lyndal; Ibrahim, Joseph Elias; Ozanne-Smith, Joan

    2013-08-01

    Forensic toxicological data provides valuable insight into the potential contribution of alcohol and drugs to external-cause deaths. There is a paucity of material that guides injury researchers on the principles that need to be considered when examining the presence and contribution of alcohol and drugs to these deaths. This paper aims to describe and discuss strengths and limitations of postmortem forensic toxicology sample selection, variations in analytical capabilities and data interpretation for injury prevention research. Issues to be considered by injury researchers include: the circumstances surrounding death (including the medical and drug use history of the deceased person); time and relevant historical factors; postmortem changes (including redistribution and instability); laboratory practices; specimens used; drug concentration; and attribution of contribution to death. This paper describes the range of considerations for testing and interpreting postmortem forensic toxicology, particularly when determining impairment or toxicity as possible causal factors in injury deaths. By describing these considerations, this paper has application to decisions about study design and case inclusion in injury prevention research, and to the interpretation of research findings. PMID:23197673

  18. [About medical accidents and their medicolegal implications. Information and consent].

    PubMed

    El Banna, S; Beauthier, F; Beauthier, J P

    2013-01-01

    Medical practice today is not simple because of various factors impinging on the doctor-patient relationship. The concept of consent arises from the ethical principle of patient autonomy and basic human rights. It is also the rule of law (Civil Code article 16-3) that guarantees the patient's right and freedom to decide what should or should not happen to his/her body and to gather information before undergoing a test/procedure/surgery. No one else has the right to coerce the patient to act in a particular way. The authors after a reflexion about medical accidents and their medicolegal implications, discuss the means to display in order to provide to the patients the adequate information about their disease and proposed treatment, therefore protecting the medical practitioner from the consequences of insufficient or ill information. PMID:24505867

  19. Adjudication of fibromyalgia syndrome: Challenges in the medicolegal arena

    PubMed Central

    Fitzcharles, Mary-Ann; Ste-Marie, Peter A; Mailis, Angela; Shir, Yoram

    2014-01-01

    The medicolegal challenges surrounding fibromyalgia (FM) arise from the subjectivity of symptoms, causal attribution and reported symptoms sufficiently severe to cause disablement. In the present article, the authors have endeavoured to provide clarification of some current issues by referencing the current literature, including the 2012 Canadian Fibromyalgia Guidelines. While FM is accepted as a valid condition, its diagnosis is vulnerable to misuse due to the subjectivity of symptoms. Without a defining cause, a physical or psychological event may be alleged to trigger FM, but adjudication of causation must be prudent. Although some individuals may experience severe symptoms, the prevalent societal concept of disablement due to FM must be tempered with the knowledge that working contributes to psychosocial wellbeing. Evidence provided in the present report may assist the courts in reaching decisions concerning FM. PMID:25479148

  20. Permanent Ocular Injury Following Paintball Pellet Hit: A Medicolegal Case.

    PubMed

    Ghazanfari-Nasrabad, Mahdi; Amrollahi-Sharifabadi, Mohammad; Kargar-Bideh, Omidreza; Azizi-Sharifabad, Saeed

    2016-01-01

    Paintball is a ubiquitous recreation, with severe and occasionally irreversible injuries. In this study, a rare medicolegal case of paintball-related closed globe blunt ocular injury was described. An 18-year-old boy who was hit in his right eye by a paintball pellet presented with severe eye pain and blurred vision. Ophthalmologic examinations showed lid edema, conjunctival hyperemia, conjunctival laceration, subconjunctival hemorrhage, corneal edema, anterior vitreous hemorrhage, congested sclera, commotio retinae, vitreous hemorrhage, retinal hemorrhage, macular edema, and macular hole. After maximum medical improvement, the patient who sustained incurable maculopathy and decreased visual acuity was referred to the legal medicine center for appraisal of the impairment. AMA Guides was used to assess the impairment of the functional vision. Despite his monocular visual defect, the patient was rated in the range of mild vision loss namely AMA class 1 with 22 percentage visual system impairment. PMID:26211673

  1. The pathology and medicolegal aspects of sexual activity.

    PubMed

    Eckert, W G; Katchis, S; Donovan, W

    1991-03-01

    The pathology of injury and its complications related to sexual activities has changed remarkably when compared with that of the past, which usually involved assaults or murders of female victims of varying ages, with moderate to serve beatings that may have accidentally resulted in the victim's death. Serial murderers, serial rapists, and molesters of both boys and girls have become much more prevalent in the last two decades in the United States. Unorthodox sexual behavior, such as "fisting," has increased in frequency, as has sexual violence related to cults, such as satanism. All of these present many challenges to medicolegal investigators. This report describes general and specific pathological sexual activities and injuries, some characteristics and methods of the perpetrators, and some specific cases as examples. PMID:2063815

  2. [Medicolegal considerations. Apropos of tooth germ transplantation between 2 twins].

    PubMed

    Cros, P; Vaillant, J M; Delaire, J; Freidel, M; Clerc, J P

    1991-01-01

    With regard to medicolegal problems, semantics are of considerable importance: indeed, depending on whether we call grafting or transplantation of an organ the operation that takes a living organ to reimplant it in the same person or the operation that takes a living organ from a donor to reimplant it in a recipient, the issues raised are completely different. The transposition of a dental organ does not raise any particular problems apart from the technical requirements to be met; there is no special problem of prevention or ethics to be taken into consideration. The problem is a completely different one when it means taking a living organ from a living or dead subject and reimplanting it in another subject. All measures decreed from the point of view of law and regulations that are dictated by considerations of prevention and ethics must then be strictly applied. PMID:1784985

  3. [Death on the operating table. Anesthesiologic and medicolegal aspects].

    PubMed

    Dettmeyer, R; Reber, A

    2003-12-01

    Since death on the operating table is a relatively rare incident, it raises a number of special medicolegal questions that are discussed in this article. One of the major concerns for medical personnel is being accused of malpractice during treatment, as it is an obvious presumption on the part of laymen that death was directly related to the medical treatment as compared with other in-hospital deaths. Questions such as who is responsible for issues of informed consent and liability are discussed. Other important aspects such as communication with the bereaved, transparent chronological documentation of the death circumstances, questions regarding certification of death, questions arising from autopsy done to determine the reason of death, questions about malpractice, legal requirements concerning confidential medical communication and information about what must be sent to the professional indemnity insurance company are elucidated. There is also some special information presented for cases that involve the deaths of Jehovah's Witnesses. PMID:14714560

  4. Postmortem imaging of sudden cardiac death.

    PubMed

    Michaud, Katarzyna; Grabherr, Silke; Jackowski, Christian; Bollmann, Marc Daniel; Doenz, Franceso; Mangin, Patrice

    2014-01-01

    Postmortem imaging is increasingly used in forensic practice in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. At present, multidetector computed tomography (MDCT), CT angiography, and cardiac magnetic resonance imaging (MRI) are used in postmortem radiological investigation of cardiovascular pathologies. This review presents the actual state of postmortem imaging for cardiovascular pathologies in cases of sudden cardiac death (SCD), taking into consideration both the advantages and limitations. The radiological evaluation of ischemic heart disease (IHD), the most frequent cause of SCD in the general population of industrialized countries, includes the examination of the coronary arteries and myocardium. Postmortem CT angiography (PMCTA) is very useful for the detection of stenoses and occlusions of coronary arteries but less so for the identification of ischemic myocardium. MRI is the method of choice for the radiological investigation of the myocardium in clinical practice, but its accessibility and application are still limited in postmortem practice. There are very few reports implicating postmortem radiology in the investigation of other causes of SCD, such as cardiomyopathies, coronary artery abnormalities, and valvular pathologies. Cardiomyopathies representing the most frequent cause of SCD in young athletes cannot be diagnosed by echocardiography, the most widely available technique in clinical practice for the functional evaluation of the heart and the detection of cardiomyopathies. PMCTA and MRI have the potential to detect advanced stages of diseases when morphological substrate is present, but these methods have yet to be sufficiently validated for postmortem cases. Genetically determined

  5. [Medicolegal and compensation scientific approach to automobile accident].

    PubMed

    Yamanouchi, Haruo

    2002-09-01

    Multiple injuries are frequently observed over the whole body of traffic victims in medico-legal autopsy cases. The assessment of a traffic casualty must include not only the victim but also the vehicle and the circumstances of the accident. Only consideration of all available data permits a better assessment of the mechanism of the crash and causation of injuries. J. M. Thevenet drove the first car carried from France to Japan on February 6, 1898. On October 28th, 1905, the first death by a road traffic accident occurred in Osaka. We performed a retrospective analysis of 279 traffic fatalities examined by medico-legal autopsy in Niigata that occurred over a twenty-two-year period from 1980 to 2001. All persons who had an ICD-10 code were grouped by 153 pedestrians, 43 pedal cyclists, 20 motorcycle riders, 45 car occupants, 11 occupants of pick-up trucks or vans, 4 occupants of heavy transport vehicles and 3 others. The average of ISS (injury scale score) is 40.7 in pedestrians, 26.7 in pedal cyclists, 32.4 in motorcycle riders, 25.1 in car occupants, 16.5 in occupants of pick-up trucks or vans, 24.0 in heavy transport vehicles and 69.0 in others. Rib fractures were observed in 170 cases (60.9%) and the frequency of other injuries was shown in Table 2. Criminal Punishment for drivers involved in 261 traffic accidents amounted to 35 sentences of imprisonment (13.4%), 46 suspension of execution of sentence (17.6%) and 60 sentence of fine (23.0%). Forty prone pedestrians run over by cars showed high ethanol levels in their blood. It was necessary to identify the driver of a vehicle in twelve car accidents and simulation with a computer is very useful. The average of ISS was 34.0 in ten drivers and 22.0 in fourteen fellow passengers. Four sudden natural deaths of drivers at the wheel, eight cases of death immediately after and from one day to five months after road traffic accidents, nine suicides and one intentional accident are excluded from traffic death. Both a

  6. Postmortem calpain changes in ostrich skeletal muscle.

    PubMed

    Chang, Ya-Shiou; Hsu, Dun-Hui; Stromer, Mavin H; Chou, Rong-Ghi R

    2016-07-01

    The objective of this study was to study the postmortem calpain change in ostrich muscle. Iliotibialis cranialis and Obturatorius medialis muscles were removed from the both sides of carcasses (n=8). The muscles from the left side were sampled after 0, 1, 2, 3, and 7days of storage at 5°C, while the right-side muscles were taken at 1-, 3-, and 7-day postmortem for shear force measurements. The results showed that the calpain-1 activity was not detected in ostrich muscle during the entire 7-day postmortem storage period, while the calpain-11 was. The unautolyzed calpain-11 activity decreased and the autolyzed calpain-11 activity increased with time postmortem. Desmin content and shear force did not change during postmortem storage although a minor degradation of desmin was observed. Therefore, our results suggest that limited postmortem proteolysis (as suggested by the limited degradation of desmin) and tenderization might be due to the lack of calpain-1 and/or insufficient calpain-11 activity present in ostrich muscle. PMID:26971307

  7. [Medicolegal considerations about rape as a reason to decriminalize abortion].

    PubMed

    González-Wilhelm, Leonardo; Moreno, Leonardo; Carnevali, Raúl

    2016-06-01

    The Chilean senate is discussing a proposal to decriminalize abortion in 3 causals. One of these is when the pregnancy occurs as a result of a rape. To be legally able to perform the abortion in this circumstance, a health care team must confirm the occurrence of the facts constituting the offence. Regardless of the patient’s will, the accusation will be reported to the justice. In our view, in its current status the proposed rule does not consider certain medicolegal and procedural topics. Those flaws may determine in certain scenarios critical problems, such as: a) a wrongful conviction as a consequence of a false allegation of rape; (b) some pregnant due to a rape will not have access to the abortion procedure; (c) some accusations of rape will not be accredited nor criminally sanctioned. Employing a fictional case, we illustrate how those scenarios can actually be seen in practice. We also emphasize the difficulties and limitations that the health care team will encounter if the project is approved under the current conditions. Finally, we encourage the professional societies implicated in the theme to contribute in the legislatorial debate. Therefore, we give a set of proposals aimed to improve the bill before it may be enacted as a law. PMID:27598498

  8. Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case

    PubMed Central

    Zerbini, Talita; da Silva, Luiz Fernando Ferraz; Ferro, Antonio Carlos Gonçalves; Kay, Fernando Uliana; Junior, Edson Amaro; Pasqualucci, Carlos Augusto Gonçalves; do Nascimento Saldiva, Paulo Hilario

    2014-01-01

    OBJECTIVE: The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound. METHOD: Comparison between the findings of different methods: autopsy and postmortem computed tomography. RESULTS: In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography. CONCLUSIONS: Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations. PMID:25518020

  9. Visualizing sexual assault: an exploration of the use of optical technologies in the medico-legal context.

    PubMed

    White, Deborah; Du Mont, Janice

    2009-01-01

    This article is an exploration of the visualization of sexual assault in the context of adult women. In investigating the production of visual evidence, we outline the evolution of the specialized knowledge of medico-legal experts and describe the optical technologies involved in medical forensic examinations. We theorize that the principles and practices characterizing medicine, science and the law are mirrored in the medico-legal response to sexual assault. More specifically, we suggest that the demand for visual proof underpins the positivist approach taken in the pursuit of legal truth and that the generation of such evidence is based on producing discrete and decontextualized empirical facts through what are perceived to be objective technologies. Drawing on interview and focus group data with 14 sexual assault nurse examiners (SANEs) in Ontario, Canada, we examine perceptions and experiences of the role of the visual in sexual assault. Certain of their comments appear to lend support to our theoretical assumptions, indicating a sense of the institutional overemphasis placed on physical damage to sexually assaulted women's bodies and the drive towards the increased technologization of visual evidence documentation. They also noted that physical injuries are frequently absent and that those observed through more refined tools of microvisualization such as colposcopes may be explained away as having resulted from either vigorous consensual sex or a "trivial" sexual assault. Concerns were expressed regarding the possibly problematic ways in which either the lack or particular nature of visual evidence may play out in the legal context. The process of documenting external and internal injuries created for some an uncomfortable sense of fragmenting and objectifying the bodies of those women they must simultaneously care for. We point to the need for further research to enhance our understanding of this issue. PMID:18952339

  10. Postmortem bacteriology: a re‐evaluation

    PubMed Central

    Morris, J A; Harrison, L M; Partridge, S M

    2006-01-01

    Aim To assess the value of postmortem bacteriology in necropsy practice, with specific emphasis on bacterial invasion of blood and cerebrospinal fluid (CSF). Methods A review of published articles on postmortem bacteriology. Studies were selected to cover the full range of necropsy practice including adults, the perinatal period, and infancy. The review covers over 5000 necropsies, mainly in adults, but including 1108 perinatal cases and 468 cases of sudden unexpected death in infancy. Data are available on 4992 blood cultures, 1168 specimens of CSF, and 743 cultures of spleen. Results Studies in which careful precautions have been taken to reduce contamination show that approximately two thirds of blood cultures are negative, two in nine yield a single isolate, and one in nine have a mixed growth. The postmortem interval has only a small effect on the isolation rate. A pure growth of a known pathogen has a more than 50% likelihood of being found in association with genuine infection in adults and in the perinatal period. Conclusions The main postmortem artefact is contamination, but this can be considerably reduced by careful technique. Agonal spread is less common than is often assumed. Postmortem translocation is not a problem if the body is appropriately stored. A pure growth of a pathogen in blood or CSF should be regarded as a possible contributing factor to death at all ages. PMID:16394274

  11. Postmortem perianal findings in children.

    PubMed

    McCann, J; Reay, D; Siebert, J; Stephens, B G; Wirtz, S

    1996-12-01

    The postmortem finding of anal dilation or an exposed pectinate line in children who have died under suspicious circumstances continues to raise the concern of possible sexual abuse. The following multicenter, collaborative study was designed to help address that question. Sixty-five subjects, ranging in age from birth to 17 years, were autopsied at three different sites. A standard protocol along with 35-mm cameras were used to record the results. Thirty-eight (58%) subjects were boys, and 27 (42%) were girls. Forty-two (65%) were white, 10 (15%) African-American, five (8%) Asian, three (5%) white Hispanic and five (8%) other. Fifty-seven (88%) were in Tanner stage I of secondary sexual development. Thirty-four (52%) died of natural causes, 26 (40%) from accidental injuries, three (5%) from other causes, and four (6%) as a result of a homicide. Forty-eight subjects (74%) had some dilation of the anal sphincters. In 21 children (32%), the entire anal canal, including the rectal ampulla, could be visualized. In another 21 (32%) subjects, the pectinate line was exposed. Only the outer portion of the anal canal opened in six children (10%), whereas 17 (26%) had no dilatation of the anus. Anal laxity led to flattened skin folds in 50 (77%), a shallow anal canal in 40 (62%), the exposure of both the pectinate line in 38 (59%), and the anal mucosa in 24 (37%). Venous congestion was present in 14 (22%), venous pooling in three (5%), erythema in six (9%), and increased pigmentation in eight (12%). Funneling was found in two (3%). Blood was present in three (5%), and an abrasion was discovered in one (2%). No fissures, lacerations, hemorrhoids, or scars were found in any of the children. Anal orifice size varied with the age of the child, the amount of traction applied to the buttocks, and a history of a CNS injury at the time of death. It is suggested, finally, that anal dilatation alone cannot be used a marker for prior sexual abuse and the exposure of the pectinate line

  12. ESPR postmortem imaging task force: where we begin.

    PubMed

    Arthurs, Owen J; van Rijn, Rick R; Whitby, Elspeth H; Johnson, Karl; Miller, Elka; Stenzel, Martin; Watt, Andrew; Taranath, Ajay; Perry, David H

    2016-08-01

    A new task force on postmortem imaging was established at the annual meeting of the European Society of Paediatric Radiology (ESPR) in Graz, Austria, in 2015. The postmortem task force is separate from the child abuse task force as it covers all aspects of fetal, neonatal and non-forensic postmortem imaging. The main focus of the task force is the guidance and standardization of non-radiographic postmortem imaging, particularly postmortem CT and postmortem MRI. This manuscript outlines the starting point of the task force, with a mission statement, outline of current experience, and short- and long-term goals. PMID:27412272

  13. [Prevention of medico-legal conflicts in medical practice].

    PubMed

    Minossi, José Guilherme

    2009-02-01

    Generally, medico-legal conflicts which occur in surgical and medical practice are a source of worry for both the medical profession and the society as a whole, because on one hand, they could cause high emotional stress for doctors, and on the other hand, patients could be rejected. Once consolidated, defensive medicine increases treatment costs and the doctor-patient relationship could transform into a tragedy. There are many causes for this, including non-treatment factors, such as an unsupported and disorganized health system, lack of participation from society and the doctor in improving this system, the training machine which launches a large number of young unprepared doctors to practice in this noble profession, along with a lack of continuing training, as there are few public or private institutions providing preparation, or further medical training. The related treatment factors are generally, a deficient doctor-patient relationship, poor work condition, power abuse by the doctor, a lack of clear agreement, and poor medical record keeping. These conflicts cannot be solved by simple creating legislation, or by denying the existence of medical error, which occurs at higher frequency than the actual conflicts. It is very important to improve the doctor-patient relationship because an effective fraternal relationship reduces the chance of a judicial demand. The doctor still needs to fully understand his/her conduct obligations and mainly to avoid power abuse. Doctors must also professionally link themselves with politicians who fight for the individual's rights against the system. Society must also understand that health is not just an issue exclusive for doctors, and people must fight to improve living conditions. Society must seriously show its frustration with the increasing disparity between scientific possibilities and actual wellbeing. The training machine needs immediate profound changes to produce professionals with the highest qualifications equipped

  14. Sudden unexpected death as a result of primary aortoduodenal fistula identified with postmortem computed tomography.

    PubMed

    Williams, Andrew S; Little, D'Arcy L; Herath, Jayantha

    2015-12-01

    Aortoenteric fistula (AEF) is an uncommon source of upper gastrointestinal (GI) tract hemorrhage, commonly occurring in persons with previous aortic surgery. Non-surgery related AEFs (primary AEFs) may occur in association with atherosclerotic lesions, infections, malignancies, or, rarely, result from penetrating/eroding foreign bodies. Given its rarity, primary AEF is not commonly considered in the pathologist's preliminary list of differential diagnoses at the commencement of an autopsy; however, the use of postmortem cross-sectional imaging may allow for the identification of primary AEF as a reasonable differential diagnoses prior to conventional autopsy. The current case outlines the forensic presentation, postmortem computed tomography (PMCT) features, and autopsy findings of a recent case of primary AEF resulting in lethal gastrointestinal hemorrhage. In such cases, PMCT features supporting primary AEF as the underlying cause of death include an atherosclerotic aneurysm abutting a segment of the GI tract with no definite soft tissue plane of separation, luminal GI contents of similar radiographic density to the aortic contents, lack of previous aortic surgery, and lack of a competing explanation for GI hemorrhage or a competing cause of death. Deaths from massive enteric hemorrhage without a medical history to suggest an underlying cause for the hemorrhage would fall under medicolegal jurisdiction and may, by examination of scene and circumstances alone, initially seem suspicious. This case demonstrates how PMCT could be used by a team of expert forensic radiologists and forensic pathologists to rapidly feedback vital information on the cause and manner of death to the criminal justice system. PMID:26464132

  15. The shifting sands of medico-legal intra-partum Ctg (I-P Ctg) monitoring.

    PubMed

    Buttigieg, George G

    2016-03-01

    Intra-partum (IP) surveillance of the unborn child by cardiotacography (CTG) monitoring is the commonest obstetric procedure in the developed world.(1) It is also the most medico-legally contested obstetric procedure in labour. In 2011, 'birth asphyxia' comprised 50% of the UK National Health Service (NHS) litigation costs,(2) and in the 2000-2010 decade, the same NHS paid out £3.1 billion for maternity medico-legal claims (the highest of any speciality), mostly involving cerebral palsy and CTG misinterpretation.(3) This article looks at a number of characteristics of IP CTG monitoring which argue for its questionable solidity of base in court proceedings. PMID:26275850

  16. Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography.

    PubMed

    Inokuchi, Go; Makino, Yohsuke; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Hoshioka, Yumi; Iwase, Hirotaro

    2016-05-01

    Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically. PMID:26126482

  17. Selective culturing and genus-specific PCR detection for identification of Aeromonas in tissue samples to assist the medico-legal diagnosis of death by drowning.

    PubMed

    Huys, Geert; Coopman, Vera; Van Varenbergh, Dirk; Cordonnier, Jan

    2012-09-10

    The detection of autochthonous aquatic bacteria in tissue samples from drowning cases is increasingly considered as an alternative approach to assist the medico-legal diagnosis of death by drowning. Bacteria belonging to the genus Aeromonas may be suitable candidates for this application as they are ubiquitous in natural aquatic environments but are generally not part of the human microbiota. The research aims of this study were (i) to develop a sensitive, specific and rapid screening and confirmation method for Aeromonas species in tissue samples and (ii) to evaluate aseptic sternal puncture as a post-mortem sample technique and bone marrow as an alternative matrix to provide evidence of death by drowning. The presence of Aeromonas in tissue samples was verified by cultivation using the selective media Ampicillin Dextrin Agar (ADA) and Ryan's Aeromonas Medium. The use of ADA medium was found most optimal for the sensitive, inexpensive and quick detection of aeromonads in human tissue samples. Positive culture plates were confirmed by harvesting all colonies for DNA extraction and subsequent PCR amplification using Aeromonas genus-specific primers. Aeromonads were detected in lung swab, blood and bone marrow of drowned bodies (n=3), but were negative in these three matrices for all negative controls (n=90) tested. Bone marrow proved to be a suitable alternative matrix and can be sampled post-mortem by an aseptic sternal puncture. In conclusion, this study confirms previous indications that aeromonads in cultures from blood of water bodies can be considered a potential marker for drowning. Given the fact that the number of immersed bodies (drowned and non-drowned) included in this study is statistically not significant, however, more tissue samples need to be investigated to confirm the validity of these methods to aid the diagnosis of death by wet drowning. PMID:22497704

  18. Combined analyses of creatine kinase MB, cardiac troponin I and myoglobin in pericardial and cerebrospinal fluids to investigate myocardial and skeletal muscle injury in medicolegal autopsy cases.

    PubMed

    Wang, Qi; Michiue, Tomomi; Ishikawa, Takaki; Zhu, Bao-Li; Maeda, Hitoshi

    2011-09-01

    Creatine kinase-MB (CK-MB), cardiac troponin I (cTnI) and myoglobin (Mb) are biochemical markers of myocardial injury; however, Mb is more abundant in skeletal muscles. The present study involved analysis of these markers in pericardial and cerebrospinal fluids (PCF and CSF) from serial medicolegal autopsy cases (n=295, within 48h) to examine their efficacy in determining the cause of death. Although these markers showed a slight postmortem time-dependent elevation, except for CK-MB in CSF, the distribution depended on the cause of death. Mb levels in PCF and CSF were higher in fatal hyperthermia (heat stroke) and methamphetamine abuse, and CK-MB in both fluids was also higher in the latter. In psychotropic drug intoxication, CK-MB, cTnI and Mb were higher in PCF, but only cTnI was elevated in CSF. In electrocution and cerebrovascular disease, each marker was higher in PCF and also relatively high in CSF. PCF cTnI level was higher in acute pulmonary embolism without significant elevation of any other markers, whereas CSF CK-MB was higher in acute blunt brain injury death and methamphetamine abuse. In most cases of delayed brain injury death, hypothermia (cold exposure) and pneumonia, these markers were low or intermediate in both PCF and CSF; however, sudden cardiac death, asphyxiation and fire fatality cases showed few characteristic findings. These observations suggest that combined analyses of these markers in postmortem PCF and CSF, in addition to blood samples, are helpful for evaluating the severity of myocardial and/or skeletal muscle damage in death processes, in particular for investigating deaths due to hyperthermia, hypothermia, electrocution and intoxication. PMID:21683643

  19. Artefactual incised wounds due to postmortem predation by the Sri Lankan water monitor (kabaragoya).

    PubMed

    Gunawardena, Sameera A

    2016-09-01

    Monitor lizards are large reptilian animals mostly seen around water based habitats. Sri Lanka has an endemic water monitor lizard called the kabaragoya (Varanus salvator salvator) which is perhaps the most common large animal scavenger in the country. Scavenging by the kabaragoya can result in postmortem incised injuries which are caused by their sharp pointed claws as they grip or crawl over a dead body. The author presents four cases where these claw marks raised significant medicolegal issues. In one case of a young female they mimicked defense injuries that might be seen in a person that was killed with heavy sharp weapon trauma to the head. In another case, claw marks on the face raised homicidal allegations in an immersion death following intoxication. In a case of suicidal drowning these injuries simulated self-inflicted cuts. The fourth case shows how claw marks complicated the investigation of a dismembered upper limb. Kabaragoya claw marks are mostly seen in decomposed and macerated bodies recovered from water. Injuries are mostly superficial and limited to skin and soft tissues. Bony injuries are not seen. Awareness of the creature's scavenging habits and careful analysis of the appearance and distribution of the injuries is essential to differentiate claw marks from sharp weapon trauma. PMID:27216749

  20. Temperature-Dependent Postmortem Changes in Human Cardiac Troponin-T (cTnT): An Approach in Estimation of Time Since Death.

    PubMed

    Kumar, Sachil; Ali, Wahid; Singh, Uma S; Kumar, Ashutosh; Bhattacharya, Sandeep; Verma, Anoop K; Rupani, Raja

    2016-01-01

    Estimation of time of death is an indispensible requirement of every medico-legal autopsy, but unfortunately, there is not a single method by which it could be determined accurately. This study focused on the temperature-dependent postmortem degradation of cardiac troponin-T and its association with postmortem interval (PMI) in human. The analysis involved extraction of the protein, separation by denaturing gel electrophoresis (SDS-PAGE), and visualization by Western blot using cTnT-specific monoclonal antibodies. The area of the bands within a lane was quantified by scanning and digitizing the image using Gel Doc (Universal Hood). The results indicate a characteristic banding pattern among human cadavers (n = 6) and a pseudo-linear relationship between percentage of cTnT degradation and the log of the time since death (r > 0.95), which can be used to estimate the postmortem interval. The data presented demonstrate that this technique can provide an extended time range during which PMI can be more accurately estimated. PMID:26352514

  1. The medico-legal investigation of abandoned fetuses and newborns--a review of cases admitted to the Pretoria Medico-Legal Laboratory, South Africa.

    PubMed

    du Toit-Prinsloo, L; Pickles, C; Smith, Z; Jordaan, J; Saayman, G

    2016-03-01

    There is a dearth of literature on the extent of fetal or newborn abandonment or "dumping" and the medico-legal investigation procedures these cases require. This is despite the fact that these occurrences are a worldwide phenomenon and by definition involve criminal law concerns such as illegal abortion, concealment of birth, murder, or neonaticide, depending on the country concerned. This article contributes to current literature in both respects and provides a retrospective case audit for the period 2004-2008 pertaining to all abandoned newborns and fetuses admitted to the Pretoria Medico-Legal Laboratory (PMLL) in South Africa. Demographic details, scope, and nature of the medico-legal investigation as well as formulation of cause of death were recorded. A total of 289 cases were identified for inclusion in this study, 57% of which were considered to have been non-viable fetuses, while 45 of the viable fetuses were deemed to have been stillborn. These instances involve the crimes of concealment of birth and at times illegal abortion, yet prosecution of these cases are relatively unheard of. Signs of live birth were identified in 38 of the cases in the study. Of these infants, 9 were deemed to have died from injuries they have sustained, and in a further 9 cases, no anatomical cause of death could be identified. Homicidal cases should be brought in cases where death ensued as a result of abandonment; however, it is not known how many cases were prosecuted. A comparatively large number of cases were found to have been admitted to the Pretoria Medico-Legal Laboratory. This is alarming because South African abortion laws are liberal and services are free at point of access in the public health care sector. A substantial percentage of cases of abandoned infants were found to have shown signs of life after birth implying a homicidal manner of death or death by abandonment, but it seems these cases are merely shelved. PMID:25935238

  2. Protein phosphorylation systems in postmortem human brain

    SciTech Connect

    Walaas, S.I.; Perdahl-Wallace, E.; Winblad, B.; Greengard, P. )

    1989-01-01

    Protein phosphorylation systems regulated by cyclic adenosine 3',5'-monophosphate (cyclic AMP), or calcium in conjunction with calmodulin or phospholipid/diacylglycerol, have been studied by phosphorylation in vitro of particulate and soluble fractions from human postmortem brain samples. One-dimensional or two-dimensional gel electrophoretic protein separations were used for analysis. Protein phosphorylation catalyzed by cyclic AMP-dependent protein kinase was found to be highly active in both particulate and soluble preparations throughout the human CNS, with groups of both widely distributed and region-specific substrates being observed in different brain nuclei. Dopamine-innervated parts of the basal ganglia and cerebral cortex contained the phosphoproteins previously observed in rodent basal ganglia. In contrast, calcium/phospholipid-dependent and calcium/calmodulin-dependent protein phosphorylation systems were less prominent in human postmortem brain than in rodent brain, and only a few widely distributed substrates for these protein kinases were found. Protein staining indicated that postmortem proteolysis, particularly of high-molecular-mass proteins, was prominent in deeply located, subcortical regions in the human brain. Our results indicate that it is feasible to use human postmortem brain samples, when obtained under carefully controlled conditions, for qualitative studies on brain protein phosphorylation. Such studies should be of value in studies on human neurological and/or psychiatric disorders.

  3. Postmortem toxicology of drugs of abuse.

    PubMed

    Drummer, Olaf H

    2004-06-10

    Conducting toxicology on post-mortem specimens provides a number of very significant challenges to the scientist. The range of additional specimens include tissues such as decomposing blood and other tissues, hair, muscle, fat, lung, and even larvae feeding on the host require special techniques to isolate a foreign substance and allow detection without interference from the matrix. A number of drugs of abuse are unstable in the post-mortem environment that requires careful consideration when trying to interpret their significance. Heroin, morphine glucuronides, cocaine and the benzodiazepines are particularly prone to degradation. Moreover, redistributive process can significantly alter the concentration of drugs, particularly those with a higher tissue concentration than the surrounding blood. The designer amphetamines, methadone and other potent opioids will increase their concentration in blood post-mortem. These processes together with the development of tolerance means that no concentration of a drug of abuse can be interpreted in isolation without a thorough examination of the relevant circumstances and after the conduct of a post-mortem to eliminate or corroborate relevant factors that could impact on the drug concentration and the possible effect of a substance on the body. This article reviews particular toxicological issues associated with the more common drugs of abuse such as the amphetamines, cannabinoids, cocaine, opioids and the benzodiazepines. PMID:15172074

  4. Postmortem clinical examination by experienced clinical geneticists as an alternative to conventional autopsy for assessment of fetal and perinatal deaths in countries with limited resources.

    PubMed

    Abdalla, Ebtesam M; El Desouky, Lubna M; Hassanein, Nargues M

    2015-01-01

    The aim of this study was to investigate the usefulness of postmortem external examination performed by an experienced clinical geneticist as an alternative to autopsy in countries with limited resources. We studied a consecutive cohort of couples seeking genetic counseling for fetal loss or perinatal death over a period of 3 years. The study involved 230 couples; only 57 of them submitted a fetus or dead neonate, for whom a meticulous postmortem clinical examination was performed by an experienced clinical geneticist. The diagnosis rate for the group of cases subjected to postmortem examination (57.9%) was much higher than that of the group that comprised cases for which diagnosis was made through evaluation of medical records (27.2%). Whenever fetal or neonatal autopsy is refused or is not feasible, a comprehensive fetal or perinatal postmortem external examination by an experienced clinical geneticist may be a reasonable substitute. PMID:26690595

  5. Prevalence of Atherosclerotic Coronary Stenosis in Asymptomatic North Indian Population: A Post-mortem Coronary Angiography Study

    PubMed Central

    Mandal, Shatrugan Prasad; Kumar, Senthil; Setia, Puneet

    2015-01-01

    Aim A preliminary study of coronaries using post-mortem angiography was undertaken to see the prevalence of atherosclerotic coronary stenosis in non-cardiac unnatural deaths. Materials and Methods This study was conducted in a tertiary care centre located in Chandigarh. A total of 128 medico-legal cases were studied comprising 88 males and 40 females. Post-mortem examinations of these MLC cases were conducted in the Department of Forensic Medicine, PGIMER, Chandigarh. All hearts were visually screened by post-mortem coronary angiography first and then grossly examined using serial transverse incision technique in positive screening cases to find the degree of narrowing. Results Of the study group, 34% males and 20% females showed evidence of narrowing on angiography. Of the males showing coronary stenosis, 83% had single vessel disease and 13% had double vessel disease, while only one individual had triple vessel disease. In cases of female, all the cases of coronary stenosis were single vessel disease. Left anterior descending coronary artery (LAD) was the most common vessel involved, followed by right coronary artery (RCA) & Left circumflex artery (LCX) and in cases of double vessel disease, LAD in combination with LCX was responsible for 75% of the cases. Remarkably 23.6% of study population in the age group of less than 40 years showed appreciable narrowing in at least one of the coronaries. Conclusion In general, the prevalence of CAD is on the rise, particularly in younger population owing to the changes in their lifestyle and food habits. This preliminary study revealed evidence of narrowing of at least one coronary in 34% male and 20% female population and 23.6% subjects were less than 40 years old. Further detailed studies are needed especially in younger age group and to support the need for preventive cardiology in the early years of life. PMID:26500922

  6. Documentation of torture victims, assessment of the start procedure for medico-legal documentation.

    PubMed

    Mandel, Lene; Worm, Lise

    2007-01-01

    A Pilot Study was performed at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen in order to explore the possibilities for adding a medico-legal documentation component to the rehabilitation of torture victims already taking place. It describes the process and results on implementing medico-legal documentation in a rehabilitative setting. A modified version of the Guidelines in the Istanbul Protocol was developed on the basis of the review of literature and current practices described in "Documentation of torture victims, implementation of medico-legal protocols". The modified guidelines were tested on five clients. The aim was twofold: 1) To assess the client's attitude towards the idea of adding a documentation component to the rehabilitation process and: 2) To assess the practical circumstances of implementing the Istanbul Protocol in the everyday life of a rehabilitation centre. Results show that all five clients were positive towards the project and found comfort in being able to contribute to the fight against impunity. Also, the Pilot Study demonstrated that a large part of the medico-legal documentation was already obtained in the rehabilitation process. It was however not accessible due to lack of systematization and a data registering system. There are thus important synergies in collecting data for rehabilitation and documentation but a joint database system is necessary to realize these synergies. PMID:19289892

  7. The ethics of postmortem examinations in contemporary Islam.

    PubMed

    Rispler-Chaim, V

    1993-09-01

    Postmortem examinations have recently become common practice in Western medicine: they are used to verify the cause of death and to obtain additional scientific information on certain diseases, as well as to train medical students. For religious people of the monotheistic faiths postmortems present several ethical questions even though the advantages attributed to postmortems in the West are also acknowledged by Jews, Christians and Muslims. The Islamic way of dealing with such questions will be surveyed via contemporary fatawa (legal opinions) issued primarily by Egyptian scholars; Islamic law, which was formulated in the eighth to ninth centuries, did not speak of postmortems. I will therefore depict the means whereby contemporary scholars approach postmortems in the absence of clear legal reference. The difficulties that postmortems create for Muslims at present will be weighed against some shar i instructions which may help circumvent them. While the ethical and religious debate continues, postmortems seem to be accepted but not, however, without certain reservations. PMID:8230149

  8. The ethics of postmortem examinations in contemporary Islam.

    PubMed Central

    Rispler-Chaim, V

    1993-01-01

    Postmortem examinations have recently become common practice in Western medicine: they are used to verify the cause of death and to obtain additional scientific information on certain diseases, as well as to train medical students. For religious people of the monotheistic faiths postmortems present several ethical questions even though the advantages attributed to postmortems in the West are also acknowledged by Jews, Christians and Muslims. The Islamic way of dealing with such questions will be surveyed via contemporary fatawa (legal opinions) issued primarily by Egyptian scholars; Islamic law, which was formulated in the eighth to ninth centuries, did not speak of postmortems. I will therefore depict the means whereby contemporary scholars approach postmortems in the absence of clear legal reference. The difficulties that postmortems create for Muslims at present will be weighed against some shar i instructions which may help circumvent them. While the ethical and religious debate continues, postmortems seem to be accepted but not, however, without certain reservations. PMID:8230149

  9. Postmortem diagnosis of Marfan syndrome in a case of sudden death due to aortic rupture: Detection of a novel FBN1 frameshift mutation.

    PubMed

    Wang, Yunyun; Chen, Shu; Wang, Rongshuai; Huang, Sizhe; Yang, Mingzhen; Liu, Liang; Liu, Qian

    2016-04-01

    To investigate the sudden death of a 36-year-old Chinese man, a medicolegal autopsy was performed, combining forensic pathological examinations and genetic sequencing analysis to diagnose the cause of death. Genomic DNA samples were extracted from blood and subjected to high-throughput sequencing. Major findings included a dilated aortic root with a ruptured and dissected aorta and consequent tamponade of the pericardial sac. Moreover, arachnodactyly and other skeletal deformities were noted. By sequencing the fibrillin-1 gene (FBN1), five genetic variations were found, including four previously known single nucleotide polymorphisms (SNPs) and a novel frameshift mutation, leading to the diagnosis of Marfan syndrome. The frameshift mutation (c.4921delG, p.glu1641llysFsX9) detected in exon 40 led to a stop codon after the next 8 amino acids. The four SNPs included a splice site mutation (c.3464-5 G>A, rs11853943), a synonymous mutation (p.Asn625Asn, rs25458), and two missense mutations (p.Pro1148Ala, rs140598; p.Cys472Tyr, rs4775765). Genetic screening was recommended for the relatives as it was reported that the father and brother of the deceased had died at the ages of 40 and 25, respectively, from sudden cardiac failure. The son of the deceased lacked the relevant mutations. This report emphasizes the important contribution of medicolegal postmortem analysis on the molecular pathogenesis study of Marfan syndrome and early diagnosis of at-risk relatives. PMID:26905825

  10. Barriers to the effective use of medico-legal findings in sexual assault cases worldwide.

    PubMed

    Mont, Janice Du; White, Deborah

    2013-09-01

    Despite the increasing implementation of standardized rape kits across jurisdictions, the medico-legal findings generated by these tools are often not related to positive criminal justice outcomes. Given that there has been no global investigation of the factors that might impede their successful use in cases of sexual assault, we conducted a review of relevant scholarly and "grey" literature from industrialized and less-developed regions. One key theme to emerge from the analysis concerned certain problematic practices and behaviors of professional groups involved in the various stages of the post-sexual assault process. We found that a lack of competence in handling sexual assault cases, contempt for women who have been victimized, and corruption among some forensic examiners, police, scientists, and legal personnel often have shaped the collection, processing, analysis, and use of medico-legal evidence. We discuss recent initiatives and future directions for research that might serve to address these issues. PMID:23935160

  11. Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.

    PubMed

    Vassalini, Marzia; Verzeletti, Andrea; De Ferrari, Francesco

    2016-01-01

    Concerning recent Italian laws and jurisprudential statements, guidelines application involves several difficulties in clinical practice, regarding prevention, diagnosis and therapy of venous thromboembolism. International scientific community systematically developed statements about this disease in order to optimize the available resources in prophylaxis, diagnosis and therapy. Incongruous prevention, missed or delayed diagnosis and/or inadequate treatment of this disease can frequently give rise to medico-legal litigation. PMID:27374034

  12. The influence of the current medicolegal climate on New South Wales anaesthetic practice.

    PubMed

    Beckmann, L A

    2005-12-01

    A survey was posted to all New South Wales and Provisional Fellows of the Australian and New Zealand College of Anaesthetists to assess the influence of the current medicolegal climate on their anaesthetic practice. Information collected included demographics, opinions regarding the current medico-legal climate, medical defence organizations, and the implications for anaesthetic practice. The response rate was 78% (640/820). Nearly all (95.3%) were concerned about the current medical indemnity crisis and 80.5% felt concerned about the financial security of medical insurers. Of all these respondents 23.6% had personal experience of litigation and 73.6% expected to have a claim made against them during their career: Respondents spent an average of 8.3% of their gross annual income on medical insurance premiums and 47.2% are concerned about the viability of their practice given the rising costs of medical insurance. Obstetric anaesthesia was the most common area of practice to be ceased due to medicolegal concerns. In the next two years, 20.2% of obstetric anaesthetists who responded intend to cease practice. In the past two years, 3.1% of respondents retired due to their litigation concerns, while 12.8% (average age 56.7y) are intending to retire in the next two years for the same reasons. Changes to the conduct of the preoperative consultation were common. Other changes to practice included more thorough documentation of complications (50.8%) and a strong reluctance to perform neuraxial blocks (54%). This survey suggests that anaesthetists are concerned about the current medicolegal climate and as a result, some are retiring earlier and giving up high-risk areas of practice. PMID:16398382

  13. Mitochondrial viability in mouse and human postmortem brain

    PubMed Central

    Barksdale, Keri A.; Perez-Costas, Emma; Gandy, Johanna C.; Melendez-Ferro, Miguel; Roberts, Rosalinda C.; Bijur, Gautam N.

    2010-01-01

    Neuronal function in the brain requires energy in the form of ATP, and mitochondria are canonically associated with ATP production in neurons. The electrochemical gradient, which underlies the mitochondrial transmembrane potential (ΔΨmem), is harnessed for ATP generation. Here we show that ΔΨmem and ATP-production can be engaged in mitochondria isolated from human brains up to 8.5 h postmortem. Also, a time course of postmortem intervals from 0 to 24 h using mitochondria isolated from mouse cortex reveals that ΔΨmem in mitochondria can be reconstituted beyond 10 h postmortem. It was found that complex I of the mitochondrial electron transport chain was affected adversely with increasing postmortem intervals. Mitochondria isolated from postmortem mouse brains maintain the ability to produce ATP, but rates of production decreased with longer postmortem intervals. Furthermore, we show that postmortem brain mitochondria retain their ΔΨmem and ATP-production capacities following cryopreservation. Our finding that ΔΨmem and ATP-generating capacity can be reinitiated in brain mitochondria hours after death indicates that human postmortem brains can be an abundant source of viable mitochondria to study metabolic processes in health and disease. It is also possible to archive these mitochondria for future studies.—Barksdale, K. A., Perez-Costas, E., Gandy, J. C., Melendez-Ferro, M., Roberts, R. C., Bijur, G. N. Mitochondrial viability in mouse and human postmortem brain. PMID:20466876

  14. Antemortem vitreous potassium may strengthen postmortem interval estimates.

    PubMed

    Kokavec, Jan; Min, San H; Tan, Mei H; Gilhotra, Jagjit S; Newland, Henry S; Durkin, Shane R; Casson, Robert J

    2016-06-01

    The purpose of this letter is to highlight that postmortem interval estimates using vitreous potassium concentrations may be further optimised by calibration against antemortem vitreous samples. PMID:27080618

  15. Pre- and postmortem imaging of transplanted cells

    PubMed Central

    Andrzejewska, Anna; Nowakowski, Adam; Janowski, Miroslaw; Bulte, Jeff WM; Gilad, Assaf A; Walczak, Piotr; Lukomska, Barbara

    2015-01-01

    Therapeutic interventions based on the transplantation of stem and progenitor cells have garnered increasing interest. This interest is fueled by successful preclinical studies for indications in many diseases, including the cardiovascular, central nervous, and musculoskeletal system. Further progress in this field is contingent upon access to techniques that facilitate an unambiguous identification and characterization of grafted cells. Such methods are invaluable for optimization of cell delivery, improvement of cell survival, and assessment of the functional integration of grafted cells. Following is a focused overview of the currently available cell detection and tracking methodologies that covers the entire spectrum from pre- to postmortem cell identification. PMID:26366076

  16. Postmortem Changes in Animal Carcasses and Estimation of the Postmortem Interval.

    PubMed

    Brooks, J W

    2016-09-01

    A thorough understanding of the physical and chemical changes that occur in the body after death is critical for accurate interpretation of gross and microscopic pathology at autopsy. Furthermore, knowledge of the postmortem processes and the factors that affect them will aid in the estimation of the postmortem interval (PMI). The estimation of the PMI is important in many human and animal death investigations. Despite many decades of research, accuracy in estimation of the time of death has not significantly improved, and no single method can be reliably used to accurately estimate the time of death. Great care should be taken when formulating such an estimate, for it is dependent on multiple circumstantial and environmental factors, and the accuracy and precision of the estimate decrease as the PMI increases. The majority of the research in the field has been conducted on human bodies, but many relevant conclusions may be drawn regarding the expected postmortem changes in animals and the estimation of the PMI. The veterinary pathologist must use great caution when attempting to extrapolate data and apply formulas designed for use in humans. Methods reviewed include gross changes, microscopic changes, temperature-based methods, postmortem chemistry, molecular methods, microbial assay, ocular changes, radiography, entomology, and others. Although only several of these methods are currently practical for use in the workup of cases, it is expected that future research will result in improved techniques with enhanced accuracy in the estimation of the PMI, which will benefit both human and veterinary forensic investigations. PMID:26945004

  17. Postmortem genetic screening for the identification, verification, and reporting of genetic variants contributing to the sudden death of the young.

    PubMed

    Methner, D Nicole R; Scherer, Steven E; Welch, Katherine; Walkiewicz, Magdalena; Eng, Christine M; Belmont, John W; Powell, Mark C; Korchina, Viktoriya; Doddapaneni, Harsha Vardhan; Muzny, Donna M; Gibbs, Richard A; Wolf, Dwayne A; Sanchez, Luis A; Kahn, Roger

    2016-09-01

    Each year in the United States, thousands of cases of sudden and unexpected deaths of infants, children, and young adults are assigned an undetermined cause of death after postmortem investigation and autopsy. Heritable genetic variants have been suggested as the cause of up to a third of sudden death (SD) cases. Elucidation of the genetic variants involved in SD cases is important to not only help establish cause and manner of death of these individuals, but to also aid in determining whether familial genetic testing should be considered. Previously, these types of postmortem screenings have not been a feasible option for most county medical examiners' and coroners' offices. We sequenced full exons of 64 genes associated with SD in the largest known cohort (351) of infant and young SD decedents using massively parallel sequencing at <$600 per sample. Genetic variants were assessed through literature review and clinical evaluation by a multidisciplinary consortium of experts. Thirteen individuals (3.7%), eight infants (2.8% of those <1 yr of age) and five children/young adults (7.0% of those >1 yr of age), were found to have a reportable genetic variant contributing to SD. These percentages represent an estimate lower than those previously reported. Overall yields and results likely vary between studies due to differences in evaluation techniques and reporting. Additionally, we recommend ongoing assessment of data, including nonreported novel variants, as technology and literature continually advance. This study demonstrates a strategy to implement molecular autopsies in medicolegal investigations of young SD decedents. PMID:27435932

  18. Use of postmortem coronary computed tomography angiography with water-insoluble contrast medium to detect stenosis of the left anterior descending artery in a case of sudden death.

    PubMed

    Takahashi, Yoichiro; Sano, Rie; Takahashi, Keiko; Kominato, Yoshihiko; Takei, Hiroyuki; Kobayashi, Susumu; Shimada, Takehiro; Tokue, Hiroyuki; Awata, Sachiko; Hirasawa, Satoshi

    2016-03-01

    A 40-year-old man was found dead on a sidewalk in an expressway parking area one hour after he had entered the area on a motorcycle. A medicolegal autopsy was performed to reveal the cause of this sudden and unexpected death. Postmortem coronary CT angiography after introduction of 5% gelatin-barium emulsion as a radiopaque contrast medium into the heart demonstrated a significant arterial luminal filling defect in the left anterior descending (LAD) coronary artery. Macroscopic and microscopic examinations revealed that a thrombus had become deposited on ruptured plaque within the LAD artery, and that a small amount of the contrast medium was present between the thrombus and the vessel endothelium. These histological findings were consistent with incomplete occlusion of the LAD artery in the 3D reconstructed image. The cause of death in this case was definitively determined to be ischemic heart disease. Postmortem angiography played a role in screening of a vascular lesion that was subsequently verified by histology to have been responsible for sudden and unexpected death. PMID:26980254

  19. Examination of postmortem retinal folds: A non-invasive study.

    PubMed

    Oshima, Toru; Yoshikawa, Hiroshi; Ohtani, Maki; Mimasaka, Sohtaro

    2015-02-01

    The postmortem retinal fold has been previously documented, but its mechanism of formation is not known. All previous studies of the fold involved invasive techniques and the postmortem ocular fundus has yet to be non-invasively examined. Our study used the non-invasive techniques of monocular indirect ophthalmoscopy and ocular echography to examine 79 postmortem eyes of 42 bodies. We examined whether the postmortem retinal fold was associated with postmortem time, position, and/or age. Age was significantly associated with postmortem retinal fold formation (Mann-Whitney U test, P = 0.013), which led us to examine the effect of posterior vitreous detachment (PVD) on retinal folds. The absence of a PVD was statistically associated with the presence of a retinal fold (Fisher's exact test, P < 0.0001). Interestingly, the presence of a PVD was also significantly correlated with retinal fold height (Mann-Whitney U test, P < 0.0001). Therefore, we hypothesized that retinal folds result from postmortem vitreoretinal traction caused by eyeball flaccidity. We also believe that the loss of retinochoroidal hydrostatic pressure plays a role. It is important that forensic pathologists not confuse a postmortem retinal fold with traumatic retinal detachment or perimacular retinal folds caused by child abuse. When child abuse is suspected, forensic pathologists should perform enucleation and a subsequent histological examination for confirmation. PMID:25623189

  20. Postmortem Brain: An Underutilized Substrate for Studying Severe Mental Illness

    PubMed Central

    McCullumsmith, Robert E; Hammond, John H; Shan, Dan; Meador-Woodruff, James H

    2014-01-01

    We propose that postmortem tissue is an underutilized substrate that may be used to translate genetic and/or preclinical studies, particularly for neuropsychiatric illnesses with complex etiologies. Postmortem brain tissues from subjects with schizophrenia have been extensively studied, and thus serve as a useful vehicle for illustrating the challenges associated with this biological substrate. Schizophrenia is likely caused by a combination of genetic risk and environmental factors that combine to create a disease phenotype that is typically not apparent until late adolescence. The complexity of this illness creates challenges for hypothesis testing aimed at understanding the pathophysiology of the illness, as postmortem brain tissues collected from individuals with schizophrenia reflect neuroplastic changes from a lifetime of severe mental illness, as well as treatment with antipsychotic medications. While there are significant challenges with studying postmortem brain, such as the postmortem interval, it confers a translational element that is difficult to recapitulate in animal models. On the other hand, data derived from animal models typically provide specific mechanistic and behavioral measures that cannot be generated using human subjects. Convergence of these two approaches has led to important insights for understanding molecular deficits and their causes in this illness. In this review, we discuss the problem of schizophrenia, review the common challenges related to postmortem studies, discuss the application of biochemical approaches to this substrate, and present examples of postmortem schizophrenia studies that illustrate the role of the postmortem approach for generating important new leads for understanding the pathophysiology of severe mental illness. PMID:24091486

  1. Antemortem stress regulates protein acetylation and glycolysis in postmortem muscle.

    PubMed

    Li, Zhongwen; Li, Xin; Wang, Zhenyu; Shen, Qingwu W; Zhang, Dequan

    2016-07-01

    Although exhaustive research has established that preslaughter stress is a major factor contributing to pale, soft, exudative (PSE) meat, questions remain regarding the biochemistry of postmortem glycolysis. In this study, the influence of preslaughter stress on protein acetylation in relationship to glycolysis was studied. The data show that antemortem swimming significantly enhanced glycolysis and the total acetylated proteins in postmortem longissimus dorsi (LD) muscle of mice. Inhibition of protein acetylation by histone acetyltransferase (HAT) inhibitors eliminated stress induced increase in glycolysis. Inversely, antemortem injection of histone deacetylase (HDAC) inhibitors, trichostatin A (TSA) and nicotinamide (NAM), further increased protein acetylation early postmortem and the glycolysis. These data provide new insight into the biochemistry of postmortem glycolysis by showing that protein acetylation regulates glycolysis, which may participate in the regulation of preslaughter stress on glycolysis in postmortem muscle. PMID:26920270

  2. Nonlesions, unusual cell types, and postmortem artifacts in the central nervous system of domestic animals.

    PubMed

    Wohlsein, P; Deschl, U; Baumgärtner, W

    2013-01-01

    In the central nervous system (CNS) of domestic animals, numerous specialized normal structures, unusual cell types, findings of uncertain or no significance, artifacts, and various postmortem alterations can be observed. They may cause confusion for inexperienced pathologists and those not specialized in neuropathology, leading to misinterpretations and wrong diagnoses. Alternatively, changes may mask underlying neuropathological processes. "Specialized structures" comprising the hippocampus and the circumventricular organs, including the vascular organ of the lamina terminalis, subfornical organ, subcommissural organ, pineal gland, median eminence/neurohypophyseal complex, choroid plexus, and area postrema, are displayed. Unusual cell types, including cerebellar external germinal cells, CNS progenitor cells, and Kolmer cells, are presented. In addition, some newly recognized cell types as of yet incompletely understood significance and functionality, such as synantocytes and aldynoglia, are introduced and described. Unusual reactive astrocytes in cats, central chromatolysis, neuronal vacuolation, spheroids, spongiosis, satellitosis, melanosis, neuromelanin, lipofuscin, polyglucosan bodies, and psammoma bodies may represent incidental findings of uncertain or no significance and should not be confused with significant microscopic changes. Auto- and heterolysis as well as handling and histotechnological processing may cause postmortem morphological changes of the CNS, including vacuolization, cerebellar conglutination, dark neurons, Buscaino bodies, freezing, and shrinkage artifacts, all of which have to be differentiated from genuine lesions. Postmortem invasion of micro-organisms should not be confused with intravital infections. Awareness of these different changes and their recognition are a prerequisite for identifying genuine lesions and may help to formulate a professional morphological and etiological diagnosis. PMID:22692622

  3. Post-Mortem Whole Exome Sequencing with Gene-Specific Analysis for Autopsy Negative Sudden Unexplained Death in the Young: A Case Series

    PubMed Central

    Narula, Nupoor; Tester, David J.; Paulmichl, Anna; Maleszewski, Joseph J.; Ackerman, Michael J.

    2016-01-01

    Background Annually, thousands of sudden deaths in individuals under 35 years remain unexplained following comprehensive medico-legal autopsy. Previously, post-mortem genetic analysis by Sanger-sequencing of 4 major cardiac channelopathy genes revealed that approximately one-fourth of these autopsy-negative sudden unexplained death in the young (SUDY) cases harbored an underlying mutation. However, there are now over 100 sudden death predisposing cardiac channelopathy-, cardiomyopathy-, and metabolic disorder-susceptibility genes. Here, we set out to determine whether post-mortem whole exome sequencing (WES) is an efficient strategy to detect ultra-rare, potentially pathogenic variants. Materials and Methods We performed post-mortem WES and gene-specific analysis of 117 sudden death-susceptibility genes for 14 consecutively-referred Caucasian SUDY victims (average age at death 17.4 ± 8.6 years) to identify putative SUDY-associated mutations. Results On average, each SUDY case had 12,758 ± 2016 non-synonymous variants, of which 79 ± 15 localized to these 117 genes. Overall, 8 ultra-rare variants (7 missense, 1 in-frame insertion) absent in 3 publically available exome databases were identified in 6 genes (3 in TTN, and 1 each in CACNA1C, JPH2, MYH7, VCL, RYR2) in 7 of 14 cases (50%). Of the 7 missense alterations, 2 (T171M-CACNA1C, I22160T-TTN) were predicted damaging by 3 independent in-silico tools. Conclusions Although WES and gene-specific surveillance is an efficient means to detect rare genetic variants that might underlie the pathogenic cause of death, accurate interpretation of each variant is challenging. Great restraint and caution must be exercised less families be informed prematurely and incorrectly that the root cause has been found. PMID:25500949

  4. Using existing information from medico-legal death investigations to improve care of older people in residential aged care services.

    PubMed

    Ibrahim, Joseph Elias; Bugeja, Lyndal; Ranson, David

    2013-12-01

    The care of older people in residential aged care services could be improved by optimising the use of existing information gathered for medico-legal death investigations. The authors address three myths contributing to underuse of this information: deaths are not preventable; public health gains are too small; and it is someone else's charter or responsibility A significant proportion of deaths are preventable, specifically those occurring prematurely from natural causes or due to injury and trauma. By addressing these preventable deaths, significant public health cost savings and better health outcomes for our growing ageing population can be achieved. Despite substantive monitoring of the provision of aged care, no single entity is explicitly responsible for systematically analysing medico-legal death information. The data and skills for using information from medico-legal death investigations currently exist. Dispelling the myths removes one impediment to investing in this area of public health. PMID:24597371

  5. Bilateral chemodectoma: medicolegal considerations on a case report of aeromedical concern.

    PubMed

    Landolfi, Angelo; Giovannetti, Arianna; Mancarella, Paola; Conti, Stefano; Morgagni, Fabio; De Angelis, Claudio

    2013-05-01

    The authors describe a case of bilateral carotid chemodectoma occurring in a military pilot who was assessed and evaluated in terms of aeromedical and medico-legal aspects for his fitness to fly. In view of the lack of specific guidelines and/or regulations, both national and international, we choose to follow a multidisciplinary clinical approach that included aero-physiological tests in the hypobaric chamber, in order to identify a standard protocol that could be used as reference for similar future cases, where this kind of assessment is necessary. PMID:23622486

  6. Sudden death in advanced abdominal pregnancy: a case report and discussion of the related medicolegal issues.

    PubMed

    Pradhan, M; Sreenivas, M; Singh, Bajrang; Behera, C; Dikshit, P C

    2013-04-01

    We report sudden unexpected death in a 35-year-old woman with pregnancy of seven months duration. There was an allegation by the parents of the woman that she was subjected to an assault prior to death. Autopsy examination showed an abdominal pregnancy with a dead fetus, ruptured gestational sac, massive haemorrhage and secondary placental attachment. During her antenatal check-ups, she had persistently complained of abdominal pain and loose stools, but the diagnosis of abdominal pregnancy was missed clinically and on ultrasound scan. In this paper we discuss the diagnostic difficulties and medicolegal issues in such cases. PMID:23362236

  7. The medico-legal, social and ethical implications of surrogate parenthood.

    PubMed

    Lawrence, R A

    1992-01-01

    Infertility has existed for thousands of years and treatment has evolved with the advance of medical science. Surrogate parenthood was effected previously by sexual intercourse, but AIH, AID and GIFT have rendered this practice obsolete. The terms surrogate mother, partial and full surrogacy are defined. Medico-legal, social and ethical arguments for and against surrogacy are discussed. References are made to varying national attitudes as to the desirability of legalizing surrogate parenthood and the implications for commissioning parents, the surrogate mother and adequate counselling are considered. PMID:1302784

  8. Freezing effect on brain density in postmortem CT.

    PubMed

    Sugimoto, Miyu; Hyodoh, Hideki; Rokukawa, Masumi; Kanazawa, Ayumi; Murakami, Rina; Shimizu, Junya; Okazaki, Shunichiro; Mizuo, Keisuke; Watanabe, Satoshi

    2016-01-01

    Two 60-year-old males were found at their homes whose bodies had deteriorated due to putrefaction. To prevent worm invasion and minimize deterioration, dry ice was used prior to the autopsy investigation. Prior to autopsy, postmortem CT demonstrated a decreased density in brain parenchyma at the dry-iced side, and autopsy revealed deteriorated brain parenchyma with frozen effect (presented like sherbet). Moreover, the deteriorated cerebral parenchyma maintained their structure and they were evaluated by cutting. When lower CT density presents in postmortem CT, the freezing effect may need to be considered and the physician should evaluate the cadaver's postmortem condition to prevent misdiagnoses. PMID:26832379

  9. Medicolegal investigation in New York City. History and activities 1918-1978.

    PubMed

    Eckert, W G

    1983-03-01

    Medicolegal investigation in America can truly be said to have begun in an organized manner in 1918. The Massachusetts medical examiner system, which began in 1877, never developed with the central control and the completeness that characterizes the New York Office of the Chief Medical Examiner, nor did it influence the spread of this form of medicolegal investigation. An overview of the period before the establishment of the New York Office in 1918 and early experiences in coroner's investigation in New York is presented. The roots of the development of the office are discussed, as were the early days of the office under Dr. Charles Norris, whose influence on the spread of knowledge and of providing an important service to the community in general is detailed. The contributions of Alexander Gettler, the father of forensic toxicology in America, are also discussed. The contributions of Gonzales, Vance, Helpern, Umberger, and Wiener are also included. Special problems of New York City are described, including narcotic deaths, gas refrigerator deaths, malaria in addicts, plastic bag hazards, sudden infant deaths, operative deaths, as well as many famous cases involving murder, disasters, and unusual deaths over a period of 60 years. Milestones in the Office of the Chief Medical Examiner of New York City are listed, as are chronological details of major cases and problems. Several comparative figures of the workload and frequency of various types of death are also included. A relationship of deaths to different life-styles is noted. PMID:6340467

  10. Witnesses of the body: medico-legal cases in seventeenth-century Rome.

    PubMed

    De Renzi, Silvia

    2002-06-01

    Studying early modern medico-legal testimonies can enrich our understanding of witnessing, the focus of much research in the history of science. Expert testimonies were well established in the Roman Cannon law, but the sphere of competence of expert witnesses - one of the grounds on which seventeenth-century physicians claimed social and intellectual authority- troubled contemporary jurists. By reconstructing these debates in Counter Reformation Rome, and by placing in them the testimonies given by Poalo Zacchia, one of the founding fathers of legal medicine, this article discusses the epistemological and social issues surrounding the definition of expertise about the body in court. It shows how a high-ranking expert witness would define his competence versus the legal authority on the one hand, lower-status expert witnesses on the other. But it also explores the interactions between specific legal constraints, for example about eye witnessing, and the ways in which different kinds of witnesses would use the body as a source of evidence for testimony. While engaging with medico-legal issues including the ambiguous signs of childbirth and the (in)visibility of pain, the article examines their meanings within Counter Reformation social controversies, including control over sexuality, imposition of discipline and the social status of physicians. PMID:12240683

  11. Maxillofacial Surgeon as Fact Witness for Medico-Legal Cases: Indian Scenario.

    PubMed

    Kedarnath, N S; Shruthi, R

    2015-12-01

    An Oral and Maxillofacial surgeon at any time during the practice will encounter medicolegal cases (MLC). There are lacunae in the knowledge and understanding of the correct method of dealing with such cases. Many of the practitioners are apprehensive and anxious as they have to interact with individuals and systems outside the normal realm of practice. In today's arena, it is of utmost importance to be aware of legal system and law of the land. An OMF surgeon needs to have thorough understanding in recording and maintenance of the details of all MLCs and presenting the same in the court. Professional guidelines for expert witness are often not well recognised as those relating to the clinical practice. Surgeon has an obligation to conduct him/herself to highest ethical standards. This article provides insight into the details of registration of MLC, examination and recording of injuries, collecting medico-legal evidences and writing a medico legal report. Also discusses the court proceedings and possible questions that may be faced by the surgeon in the court. PMID:26604471

  12. Survey of medico-legal investigation of homicides in the city of Turku, Finland.

    PubMed

    Wahlsten, P; Koiranen, V; Saukko, P

    2007-07-01

    Finland has one of the highest homicide rates in western Europe but the clear-up rate is also exceptionally high. To create a detailed analysis of homicides (n=161) in a region of western Finland during the 20-year period from 1983 to 2002 all available information was collected retrospectively from multiple sources including medico-legal reports, reports of police investigations, and court proceedings. Among the data collected and analysed were location, time, circumstances, and motives of homicides, forensic pathologists' role at the scene-of-the-crime and in court, autopsy findings, demographics and substance abuse of both victims and offenders, criminal background, forensic psychiatric examinations, and the verdicts of the offenders. A typical homicide was committed without premeditation during the weekend by a drunken male with a knife at hand and with a history of violent crimes. The perpetrator was later found guilty of manslaughter and received a prison sentence. Some noted shortcomings both in the police and the medico-legal investigation procedures are discussed, as well as the forensic pathologist's role in the judicial process in Finland. PMID:17052942

  13. 14. VIEW IN THE WEST OPERATING GALLERY OF POSTMORTEM CELL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. VIEW IN THE WEST OPERATING GALLERY OF POST-MORTEM CELL WORK STATION AND MANIPULATOR ARMS. - Nevada Test Site, Engine Maintenance Assembly & Disassembly Facility, Area 25, Jackass Flats, Mercury, Nye County, NV

  14. 9 CFR 352.11 - Post-mortem inspection.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...-mortem inspection. (a) Post-mortem inspection of reindeer, elk, deer, antelope, bison and water buffalo shall be conducted in accordance with the provisions contained in 9 CFR part 310 or as determined by...

  15. 9 CFR 352.11 - Post-mortem inspection.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...-mortem inspection. (a) Post-mortem inspection of reindeer, elk, deer, antelope, bison and water buffalo shall be conducted in accordance with the provisions contained in 9 CFR part 310 or as determined by...

  16. 9 CFR 352.11 - Post-mortem inspection.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...-mortem inspection. (a) Post-mortem inspection of reindeer, elk, deer, antelope, bison and water buffalo shall be conducted in accordance with the provisions contained in 9 CFR part 310 or as determined by...

  17. 9 CFR 352.11 - Post-mortem inspection.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...-mortem inspection. (a) Post-mortem inspection of reindeer, elk, deer, antelope, bison and water buffalo shall be conducted in accordance with the provisions contained in 9 CFR part 310 or as determined by...

  18. 9 CFR 352.11 - Post-mortem inspection.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...-mortem inspection. (a) Post-mortem inspection of reindeer, elk, deer, antelope, bison and water buffalo shall be conducted in accordance with the provisions contained in 9 CFR part 310 or as determined by...

  19. New pitfalls of high-density postmortem computed tomography.

    PubMed

    Kanazawa, Ayumi; Hyodoh, Hideki; Watanabe, Satoshi; Fukuda, Marika; Baba, Miho; Okazaki, Shunichiro; Mizuo, Keisuke; Hayashi, Etsuko; Inoue, Hiromasa

    2014-09-01

    An 80-year-old female was transferred to the hospital due to a traffic accident. Multiple cranial bone fractures with intracranial hemorrhage and intracranial air were detected. Despite treatment, the patient died after 6h. Twenty-one hours after the patient died, her whole body was scanned by postmortem CT, and a region of high density was detected within the left putamen. The autopsy revealed a cerebral contusion and multiple skull base fractures. Moreover, superabsorbent polymers (SAPs) were found within the left lateral ventricle and adjacent to the putamen, which appeared as a high-density lesion on postmortem CT at the left putamen, where the SAPs were compacted. Both ante- and postmortem conditions should be considered to prevent misdiagnoses based only on postmortem CT. PMID:24916862

  20. Distribution of ether in two postmortem cases.

    PubMed

    Cox, Dawn; DeRienz, Rebecca; Jufer Phipps, Rebecca A; Levine, Barry; Jacobs, Aaron; Fowler, David

    2006-10-01

    Diethyl ether (ether) is a volatile liquid that was used in the 1800s as an anesthetic agent; however, it is no longer used for this purpose, partly because of its odor and flammability. Two postmortem cases in which ether was detected are presented. The first case was an 18-year-old male found hanging from a basement ceiling brace in a semi-sitting position with a gas mask covering his face. A container of Prestone starting fluid and a bong were found on the floor close to the body. The second case was a 20-year-old male found unresponsive in his dormitory room with two black plastic trash bags secured over his head. Two saturated rags and a resealable bag containing a clear liquid were contained within these trash bags. An almost empty can of Tradco starting fluid was also found at the scene. Ether concentrations were determined by headspace gas chromatography-mass spectrometry in the selective ion monitoring mode. In case #1, the medical examiner ruled that the cause of death was asphyxia due to hanging; the manner of death was undetermined. In case #2, the medical examiner ruled that the cause of death was asphyxia and the manner of death was suicide. PMID:17132265

  1. Coronary atherosclerosis -- a postmortem histopathological study.

    PubMed

    Kumar, S; Kumar, Verma A; Kumar, N; Baranwal, R K; Kumar, Verma R; Singh, M

    2012-01-01

    Cardiovascular disease in general and coronary heart disease in particular remains the leading cause of morbidity and mortality in developed countries. The aim of this study was to look at the prevalence of coronary atherosclerosis, its severity and site of involvement in postmortem hearts. The hearts of 30-60 yrs old, fifty dead victims were considered who died from various natural and unnatural deaths. After autopsy, coronary arteries were inspected grossly and microscopically. Out of all these cases, 10 cases (20 %) showed no pathological lesions. Total distribution of lesions in the coronaries are as follows; 34 (68 %) atheromatous lesions in Left Anterior Descending Artery, 25 (50 %) lesions in the Right Coronary Artery, 18 (36 %) lesions in Left Circumflex. Proximal involvement was more common except in the right coronary artery, which was involved distally. The overall prevalence of coronary atherosclerosis in the present study was comparable with that noted by other investigators in autopsy studied. There is a higher prevalence of atherosclerosis in Indians, which may be due to changes in life-styles and other risks factors (Tab. 1, Ref. 14). Full Text in PDF www.elis.sk. PMID:22502752

  2. Evaluation of post-mortem lateral cerebral ventricle changes using sequential scans during post-mortem computed tomography.

    PubMed

    Hasegawa, Iwao; Shimizu, Akinobu; Saito, Atsushi; Suzuki, Hideto; Vogel, Hermann; Püschel, Klaus; Heinemann, Axel

    2016-09-01

    In the present study, we evaluated post-mortem lateral cerebral ventricle (LCV) changes using computed tomography (CT). Subsequent periodical CT scans termed "sequential scans" were obtained for three cadavers. The first scan was performed immediately after the body was transferred from the emergency room to the institute of legal medicine. Sequential scans were obtained and evaluated for 24 h at maximum. The time of death had been determined in the emergency room. The sequential scans enabled us to observe periodical post-mortem changes in CT images. The series of continuous LCV images obtained up to 24 h (two cases)/16 h (1 case) after death was evaluated. The average Hounsfield units (HU) within the LCVs progressively increased, and LCV volume progressively decreased over time. The HU in the cerebrospinal fluid (CSF) increased at an individual rate proportional to the post-mortem interval (PMI). Thus, an early longitudinal radiodensity change in the CSF could be potential indicator of post-mortem interval (PMI). Sequential imaging scans reveal post-mortem changes in the CSF space which may reflect post-mortem brain alterations. Further studies are needed to evaluate the proposed CSF change markers in correlation with other validated PMI indicators. PMID:27048214

  3. When range of motion is not enough: towards an evidence-based approach to medico-legal reporting in whiplash injury.

    PubMed

    Worsfold, Christian

    2014-07-01

    Whiplash injury medico-legal reporting has traditionally been focused upon identifying restrictions in range of motion and identifying the presence of tender areas in the cervical spine in an effort both to diagnose the condition and to offer a prognosis. There have been considerable advances in this field over the last decade however that calls into question such a diminutive approach. This paper reviews the contemporary evidence base for the medico-legal assessment of whiplash injury and identifies a body of literature that strongly implicates a Claimant's physiological and psychological stress response as a key medico-legal marker in predicting prognosis following whiplash injury. PMID:24931872

  4. Teledermatology and clinical photography: safeguarding patient privacy and mitigating medico-legal risk.

    PubMed

    Stevenson, Paul; Finnane, Anna R; Soyer, H Peter

    2016-03-21

    Capturing clinical images is becoming more prevalent in everyday clinical practice, and dermatology lends itself to the use of clinical photographs and teledermatology. "Store-and-forward", whereby clinical images are forwarded to a specialist who later responds with an opinion on diagnosis and management is a popular form of teledermatology. Store-and-forward teledermatology has proven accurate and reliable, accelerating the process of diagnosis and treatment and improving patient outcomes. Practitioners' personal smartphones and other devices are often used to capture and communicate clinical images. Patient privacy can be placed at risk with the use of this technology. Practitioners should obtain consent for taking images, explain how they will be used, apply appropriate security in their digital communications, and delete images and other data on patients from personal devices after saving these to patient health records. Failing to use appropriate security precautions poses an emerging medico-legal risk for practitioners. PMID:26985853

  5. A new ethical and medico-legal issue: vascular surgery and the postoperative cognitive dysfunction.

    PubMed

    Setacci, C; Sirignano, A; Ricci, G; Spagnolo, A G; Pugliese, F; Speziale, F

    2015-08-01

    Patients undergoing major surgery are at risk for postoperative cognitive dysfunction (POCD). The consciousness of the POCD arises new ethical and medico-legal issues that should be identified, managed and, if possible, prevented. Elderly patients still represent a real challenge for physicians and medical science. This challenge can be surmounted not only through technical progress but also by safeguarding the correct ethical behavior at the base of each relationship between a patient and his physician. Effective communication with the elderly patient is a prerequisite for clear and complete information, involving family members and caregivers when necessary. In every case, the identification of patients with pre-existing risk factors of POCD, shortening the period of time preceding the surgery and a proper technique of the procedure as well as physical and intellectual exercises, nutrition and medication play an important role in decreasing the incidence of neurocognitive deficits in the elderly. PMID:25216219

  6. Danger points, complications and medico-legal aspects in endoscopic sinus surgery

    PubMed Central

    Hosemann, W.; Draf, C.

    2013-01-01

    Endoscopic endonasal sinus surgery represents the overall accepted type of surgical treatment for chronic rhinosinusitis. Notwithstanding raised and still evolving quality standards, surgeons performing routine endoscopic interventions are faced with minor complications in 5% and major complications in 0.5–1%. A comprehensive review on all minor and major complications of endoscopic surgery of the paranasal sinuses and also on the anterior skull base is presented listing the actual scientific literature. The pathogenesis, signs and symptoms of each complication are reviewed and therapeutic regimens are discussed in detail relating to actual publication references. Potential medico-legal aspects are explicated and recent algorithms of avoidance are mentioned taking into account options in surgical training and education. PMID:24403974

  7. Fetal Alcohol Syndrome in Sudden Unexpected Death in Infancy: A Case Report in Medicolegal Autopsy.

    PubMed

    Tangsermkijsakul, Aphinan

    2016-03-01

    Fetal alcohol spectrum disorder is a range of birth defects associated with prenatal alcohol exposure. Fetal alcohol syndrome (FAS) is the most serious form of fetal alcohol spectrum disorder. Infants with FAS are prone to death because of various physical abnormalities. Consequently, infants with FAS may be presented in the medicolegal investigation as a form of sudden unexpected death in infancy. The author reported a 6-month-old male infant who was found dead at home. The history of maternal ethanol consumption during pregnancy was obtained. The infant was diagnosed with FAS at the autopsy because he was presented with postnatal growth retardation, multiple facial abnormalities, and abnormal brain structures, which met the criteria of FAS. The cause of death was severe aspiration pneumonia. The purposes of this case report are to show an uncommon manifestation of sudden unexpected death in infancy case for the forensic pathologists and to emphasize on the national healthcare problem. PMID:26730801

  8. Medico-legal autopsy of abandoned foetuses and newborns in India.

    PubMed

    Behera, C; Sikary, Asit Kumar; Krishna, Karthik; Garg, Aayushi; Chopra, Saurav; Gupta, S K

    2016-06-01

    Foeticide and the abandonment of newborns are important, albeit frequently neglected, issues. Concealment of childbirth is often seen in the setting of unwanted pregnancy which has been recognised as one of the most important factors in both cases. This study highlights the medico-legal autopsy findings of 238 abandoned foetuses and newborns over a period of 17 years (1996-2012) from the region of South Delhi, India. There was no sex predilection. The majority of the cases were full term. Nearly 35% of the foetuses were still born, about 29% were live born and the remainder were non-viable. Among the live born, death by homicide was more common than a natural death and most were left by the roadside. The abandoning and killing of newborns needs urgent attention, and strict measures are needed to save thousands of innocent lives. PMID:26857075

  9. [Infections associated with percutaneous arterial closure devices: medico-legal issues].

    PubMed

    Gaultier, C J; Houselstein, T

    2014-12-01

    Percutaneous suture closure devices have reduced the time needed for manual compression and hospital stays, but several meta-analysis emphasized a higher risk of vascular damages compared to manual compression. Two cases of infections on percutaneous suture closure devices were analyzed; which had medico-legal issues. Beyond the medical point of view, the patient's complaints, the way lawyers and medical experts have examined the cases were analyzed and resulted in physicians and hospitals being sentenced. Rather than stigmatizing those devices, we just want to invite cardiologists not to underestimate this serious risk. Before using those devices, physicians should balance the risk-benefit ratio, follow prevention guidelines, and most of all, be aware of any single signs of emerging infection to detect and treat them early, and thus reduce the severity of infections thanks to a targeted antibiotic treatment adapted to the antibiogram and an active role of vascular surgeons. PMID:25440766

  10. Medico-legal aspects of dental treatment of the ageing and aged patient.

    PubMed

    Story, R D

    2015-03-01

    The medico-legal aspects of the dental management of ageing and aged patients relate mainly to the assessment of the patient's competence and the role of substitute decision makers. Dentists will assess whether or not a patient is competent to give informed consent to treatment. Lawyers use the word 'capacity' when deciding whether a person can make an important decision about their life. Competence and capacity mean the same thing. Assessment of competence and the role of substitute decision makers rests firmly on a sound understanding of the ethical basis of dental practice. This article will discuss the ethical basis of dental practice; the assessment of competence and the gaining of informed consent; the role of substitute decision makers and the nature of the decisions that are made at the end of life. PMID:25762043

  11. Responsible use of cone beam computed tomography: minimising medico-legal risks.

    PubMed

    Noffke, C E E; Farman, A G; Van der Linde, A; Nel, S

    2013-07-01

    This communication highlights some of the ethical and possible legal responsibilities which pertain to the taking, reading, reporting, and communication of findings from cone-beam computed tomography (CBCT) scans. The importance of knowledge of head and neck anatomy and pathology to reduce the likelihood of incorrect interpretation is emphasised. Failure to detect critical findings in any diagnostic image can potentially result in medico-legal consequences. CBCT is no exception to this rule. Dental schools are advised to include CBCT imaging as a diagnostic tool in their under- and postgraduate curricula thereby equipping graduates to use 3D imaging in general and CBCT in particular. Existing dental practitioners are advised to seek continuing education on 3D imaging as part of their required lifelong learning. PMID:23971277

  12. Test security in medicolegal cases: proposed guidelines for attorneys utilizing neuropsychology practice.

    PubMed

    Morel, Kenneth R

    2009-11-01

    In the context of forensic neuropsychological assessments, the professional interaction of law and psychology is viewed primarily as one where the retaining attorney or court dictates its needs to psychologists when resolving legal disputes. While this perspective is conceptually accurate, the positive and practical collaboration of law and psychology also relies on attorneys adhering to basic protections of sensitive psychological assessment procedures and tests. Objective testing is undermined when a practitioner of law engages in actions prior to, during, or following a neuropsychological examination in a manner that threatens the test security. An appreciation among practitioners of law and psychology regarding the necessity of test security is essential. This article reviews attorney actions that can affect test security, proposes a distinction by psychology between appropriate and problematic client preparation for a neuropsychological examination, integrates the available legal precedent regarding test security, and suggests productive measures to protect test security in medicolegal settings. PMID:19778915

  13. When gas analysis assists with postmortem imaging to diagnose causes of death.

    PubMed

    Varlet, V; Smith, F; Giuliani, N; Egger, C; Rinaldi, A; Dominguez, A; Chevallier, C; Bruguier, C; Augsburger, M; Mangin, P; Grabherr, S

    2015-06-01

    Postmortem imaging consists in the non-invasive examination of bodies using medical imaging techniques. However, gas volume quantification and the interpretation of the gas collection results from cadavers remain difficult. We used whole-body postmortem multi-detector computed tomography (MDCT) followed by a full autopsy or external examination to detect the gaseous volumes in bodies. Gases were sampled from cardiac cavities, and the sample compositions were analyzed by headspace gas chromatography-mass spectrometry/thermal conductivity detection (HS-GC-MS/TCD). Three categories were defined according to the presumed origin of the gas: alteration/putrefaction, high-magnitude vital gas embolism (e.g., from scuba diving accident) and gas embolism of lower magnitude (e.g., following a traumatic injury). Cadaveric alteration gas was diagnosed even if only one gas from among hydrogen, hydrogen sulfide or methane was detected. In alteration cases, the carbon dioxide/nitrogen ratio was often >0.2, except in the case of advanced alteration, when methane presence was the best indicator. In the gas embolism cases (vital or not), hydrogen, hydrogen sulfide and methane were absent. Moreover, with high-magnitude vital gas embolisms, carbon dioxide content was >20%, and the carbon dioxide/nitrogen ratio was >0.2. With gas embolisms of lower magnitude (gas presence consecutive to a traumatic injury), carbon dioxide content was <20% and the carbon dioxide/nitrogen ratio was often <0.2. We found that gas analysis provided useful assistance to the postmortem imaging diagnosis of causes of death. Based on the quantifications of gaseous cardiac samples, reliable indicators were determined to document causes of death. MDCT examination of the body must be performed as quickly as possible, as does gas sampling, to avoid generating any artifactual alteration gases. Because of cardiac gas composition analysis, it is possible to distinguish alteration gases and gas embolisms of different

  14. Post-mortem CT and MRI: appropriate post-mortem imaging appearances and changes related to cardiopulmonary resuscitation.

    PubMed

    Offiah, Curtis E; Dean, Jonathan

    2016-01-01

    Post-mortem cross-sectional imaging in the form of CT and, less frequently, MRI is an emerging facility in the evaluation of cause-of-death and human identification for the coronial service as well as in assisting the forensic investigation of suspicious deaths and homicide. There are marked differences between the radiological evaluation and interpretation of the CT and MRI features of the live patient (i.e. antemortem imaging) and the evaluation and interpretation of post-mortem CT and MRI appearances. In addition to the absence of frequently utilized tissue enhancement following intravenous contrast administration in antemortem imaging, there are a number of variable changes which occur in the tissues and organs of the body as a normal process following death, some of which are, in addition, affected significantly by environmental factors. Many patients and victims will also have undergone aggressive attempts at cardiopulmonary resuscitation in the perimortem period which will also significantly alter post-mortem CT and MRI appearances. It is paramount that the radiologist and pathologist engaged in the interpretation of such post-mortem imaging are familiar with the appropriate non-pathological imaging changes germane to death, the post-mortem interval and cardiopulmonary resuscitation in order to avoid erroneously attributing such changes to trauma or pathology. Some of the more frequently encountered radiological imaging considerations of this nature will be reviewed. PMID:26562099

  15. A case of acute subdural hematoma due to ruptured aneurysm detected by postmortem angiography.

    PubMed

    Inokuchi, Go; Makino, Yohsuke; Yajima, Daisuke; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Hoshioka, Yumi; Iwase, Hirotaro

    2016-03-01

    Acute subdural hematoma (ASDH) is mostly caused by head trauma, but intrinsic causes also exist such as aneurysm rupture. We describe here a case involving a man in his 70s who was found lying on the bedroom floor by his family. CT performed at the hospital showed ASDH and a forensic autopsy was requested. Postmortem cerebral angiography showed dilatation of the bifurcation of the middle cerebral artery, which coincided with the dilated part of the Sylvian fissure. Extravasation of contrast medium into the subdural hematoma from this site was suggestive of a ruptured aneurysm. Autopsy revealed a fleshy hematoma (total weight 110 g) in the right subdural space and findings of brain herniation. As indicated on angiography, a ruptured saccular aneurysm was confirmed at the bifurcation of the middle cerebral artery. Obvious injuries to the head or face could not be detected on either external or internal examination, and intrinsic ASDH due to a ruptured middle cerebral artery aneurysm was determined as the cause of death. One of the key points of forensic diagnosis is the strict differentiation between intrinsic and extrinsic onset for conditions leading to death. Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases. PMID:26362305

  16. Application of biochemical and X-ray diffraction analyses to establish the postmortem interval.

    PubMed

    Prieto-Castelló, M J; Hernández del Rincón, J P; Pérez-Sirvent, C; Alvarez-Jiménez, P; Pérez-Cárceles, M D; Osuna, E; Luna, A

    2007-10-25

    The determination of the date of death from bone remains is of scientific interest but also has important legal implications. The establishment of the postmortem interval (PMI) is a very complex problem because of the great number of intrinsic factors that may alter the normal course of postmortem change, such as the age, sex, constitution and previous physiological and pathological states of the subject, and external factors. In order to evaluate the utility of X-ray diffraction and the measurement of some components in dating bone remains, a total of 69 long bones from 69 different cadavers (41 males, 28 females) with a mean age of 68 years (S.D.=17.6, range 12-97) were used. The bones were removed from cement tombs of Murcia Cemetery, where they had lain for documented times of between 7 and 54 years (S.D.=11.6, mean time 17.6 years). We have studied potassium, sulphur, nitrogen, urea, total protein, phosphorus, and some X-ray diffraction (XRD) parameters related to the degree of crystallinity of the mineral component in medullar and cortical bone zones to establish which of the two provides the most useful information for calculating the PMI. In the overall analysis of our data, we believe that the use of both XRD and biochemical analyses (especially of urea, potassium and sulphur) particularly in the cortical zone of the bone could be an alternative method for dating osseous remains. PMID:17306944

  17. Search for fungi-specific metabolites of four model drugs in postmortem blood as potential indicators of postmortem fungal metabolism.

    PubMed

    Martínez-Ramírez, Jorge A; Strien, Juliane; Walther, Grit; Peters, Frank T

    2016-05-01

    Fungi colonizing cadavers are capable of drug metabolism and may thus change the metabolite pattern or concentration of drugs in forensic postmortem samples. The purpose of this study was to check for the presence of such changes by searching fungi-specific metabolites of four model drugs (amitriptyline, metoprolol, mirtazapine, and zolpidem) in decomposed postmortem blood samples from 33 cases involving these drugs. After isolation and identification of fungal strains present in the samples, each isolate was incubated in Sabouraud medium at 25°C for up to 120h with each model drug. One part of the supernatants was directly analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS), another after liquid-liquid extraction with chlorobutane and concentration. From 21 out of 33 decomposed postmortem blood samples (64%) a total of 30 different strains could be isolated, one from the class of Ascomycete and the rest belonging to 15 species from 8 different genera (number of species): Aspergillus (2), Botrytis (1), Candida (8), Fusarium (1), Mucor (1), Penicillium (1), and Rodothorula (1). In the in vitro studies, these microorganisms were found capable of N-demethylation and N-oxidation of amitriptyline and mirtazapine, O-demethylation followed by side chain oxidation of metoprolol as well as hydroxylation of all four-model drugs. In two of the postmortem blood samples, from which the fungi Aspergillus jensenii, Candida parapsilosis. and Mucor circinelloides had been isolated, a fungi-specific hydroxy zolpidem metabolite was detected. The presence of this metabolite in postmortem samples likely indicates postmortem fungal biodegradation. PMID:27022860

  18. To err is human: Quality management practices in surgical oral pathology, a safety net for medico-legal complications.

    PubMed

    Venkatraman, Narayan T; Bhadranna, Abhishek; Shenoy, Sadhana; Mohanty, Leeky

    2013-05-01

    Reading a slide and rendering a diagnosis is not only a science but also requires us to appreciate the constant artifact that is introduced in a controlled manner by tissue processing and obtaining a stained tissue section. There are a number of steps involved in getting the final stained tissue section and all these procedures if not performed properly have the potential to give rise to erroneous picture on the slide. Simple errors in judgments can lead to wrong diagnosis and unwarranted treatment. Such mistakes can put us at risk for Medico-Legal problems. The subject of Medico-Legal issues and practice of pathology has been neglected and amount of information available to the practicing professional in India is scarce. This paper focuses on standardized procedures for the various histopathology laboratory exercises. The paper highlights the importance of proper record maintenance with reporting protocols. A list of do's and don'ts for an Oral Pathologist is provided to help him/her in reducing the probable Medico-Legal issues. It does not in any way address the issue of individual competence and diagnostic abilities: That is an aspect for each individual to introspect upon and take remedial action. PMID:24250085

  19. [Post-traumatic anosmia: description of a clinical case, proposal of a standardized protocol and medico-legal comments].

    PubMed

    Miani, C; Bracale, A M Bergamin; Moreschi, C; Codarini, M; Ortolani, F

    2002-06-01

    Man's olfactory perception is considerably limited compared to that of other animals; this sense is, however, extremely important in our social lives: it helps us to "savour" our food, it enables us to appreciate perfumes and, even more important, to pick up smells that signal a danger, such as a gas leak or a fire. We describe the clinical case of a patient with anosmia and hypogeusia that appeared immediately after suffering a concussive head injury. We go through the diagnostic protocol for medico-legal assessment of hypoanosmias previously described in the literature, which includes a clinical and an imaging section. In 9% of all anosmic patients, a traumatic event precedes the onset of the disorder, with repercussions on the olfactory channels and centres of the peripherical and/or central nervous system. The overall rate of anosmia following head injury is estimated to be around 7.5%. Among the principal causes of anosmia, those of medico-legal interest constitute 35% of the total. On the basis of our personal experience and of clinical studies conducted by other Authors, we propose that a bioptic investigation of the olfactory mucosa be added to the existing protocol. The olfactory neuroepithelium of patients suffering from post-traumatic anosmia, in fact, evidences some characteristic degenerative aspects. In conclusion, we report several comments regarding the quantification of the reduction of the olfactory function in different areas of medico-legal interest. PMID:12173284

  20. Cardiac biomarkers in blood, and pericardial and cerebrospinal fluids of forensic autopsy cases: A reassessment with special regard to postmortem interval.

    PubMed

    Chen, Jian-Hua; Inamori-Kawamoto, Osamu; Michiue, Tomomi; Ikeda, Sayuko; Ishikawa, Takaki; Maeda, Hitoshi

    2015-09-01

    Previous studies suggested possible application of postmortem biochemistry of myocardial biomarkers to the investigation of sudden cardiac death; however, differences from clinical findings should be considered in autopsy materials. The present study involved a comprehensive investigation of cardiac troponin T and I (cTnT and cTnI), and creatine kinase MB (CK-MB) in cardiac and peripheral external iliac venous blood, pericardial fluid (PCF) and cerebrospinal fluid (CSF) for reassessment, with special regard to the estimated postmortem interval in relation to the cause of death, reviewing a large number of forensic autopsy cases (n=1923). These cardiac biomarkers showed cause-of-death- and postmortem-time-dependent differences: blood and PCF levels of each marker were higher in hyperthermia (heatstroke), bathwater drowning and chronic congestive heart disease in cases of postmortem interval (PMI) <12h. After 12h postmortem, these markers were also higher in fatal drug abuse, spontaneous cerebral/subarachnoid bleeding, electrocution and pulmonary embolism. In addition, most other causes of death, including ischemic heart disease, showed substantial elevations, while these markers remained low in acute hemorrhagic death from sharp instrument injury, hypothermia (cold exposure) and sea-/freshwater drowning during PMI of <48h. CSF cTnI and CK-MB showed similar findings. There was no difference between myocardial infarction and other causes of death to be discriminated, including asphyxiation, drowning and fire fatality. These findings are similar to clinical observations in critical ill patients, suggesting that elevated cardiac biomarkers cannot be a specific finding for death from acute ischemic heart disease, but indicate the severity of myocardial injury in postmortem investigation. PMID:26052007

  1. 13. VIEW OF EAST OPERATING GALLERY ALONG THE POSTMORTEM CELLS. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. VIEW OF EAST OPERATING GALLERY ALONG THE POST-MORTEM CELLS. A NUMBER OF MANIPULATOR ARMS COVERED WITH PLASTIC ARE ON THE LEFT WALL. - Nevada Test Site, Engine Maintenance Assembly & Disassembly Facility, Area 25, Jackass Flats, Mercury, Nye County, NV

  2. 18. Photocopy of photograph. VIEW WITHIN POSTMORTEM CELL OF MANIPULATOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. Photocopy of photograph. VIEW WITHIN POST-MORTEM CELL OF MANIPULATOR ARMS BEING USED TO MOVE METAL BARS FROM ONE LOCATION TO ANOTHER. Photographer unknown, ca. 1965, original photograph and negative on file at the Remote Sensing Laboratory, Department of Energy, Nevada Operations Office. - Nevada Test Site, Engine Maintenance Assembly & Disassembly Facility, Area 25, Jackass Flats, Mercury, Nye County, NV

  3. Interpretation of postmortem vitreous concentrations of sodium and chloride.

    PubMed

    Zilg, B; Alkass, K; Berg, S; Druid, H

    2016-06-01

    Vitreous fluid can be used to analyze sodium and chloride levels in deceased persons, but it remains unclear to what extent such results can be used to diagnose antemortem sodium or chloride imbalances. In this study we present vitreous sodium and chloride levels from more than 3000 cases. We show that vitreous sodium and chloride levels both decrease with approximately 2.2mmol/L per day after death. Since potassium is a well-established marker for postmortem interval (PMI) and easily can be analyzed along with sodium and chloride, we have correlated sodium and chloride levels with the potassium levels and present postmortem reference ranges relative the potassium levels. We found that virtually all cases outside the reference range show signs of antemortem hypo- or hypernatremia. Vitreous sodium or chloride levels can be the only means to diagnose cases of water or salt intoxication, beer potomania or dehydration. We further show that postmortem vitreous sodium and chloride strongly correlate and in practice can be used interchangeably if analysis of one of the ions fails. It has been suggested that vitreous sodium and chloride levels can be used to diagnose drowning or to distinguish saltwater from freshwater drowning. Our results show that in cases of freshwater drowning, vitreous sodium levels are decreased, but that this mainly is an effect of postmortem diffusion between the eye and surrounding water rather than due to the drowning process, since the decrease in sodium levels correlates with immersion time. PMID:27105154

  4. Sarcomere length influences postmortem proteolysis of excised bovine semitendinosus muscle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The interaction between sarcomere length and postmortem proteolysis as related to meat tenderness is not clear. The extent of thick and thin filament overlap alters actomyosin binding and may alter substrate availability during aging-induced tenderization. The objective of this study was to determin...

  5. Postmortem evidence of cerebral inflammation in schizophrenia: a systematic review

    PubMed Central

    Trépanier, M O; Hopperton, K E; Mizrahi, R; Mechawar, N; Bazinet, R P

    2016-01-01

    Schizophrenia is a psychiatric disorder which has a lifetime prevalence of ~1%. Multiple candidate mechanisms have been proposed in the pathogenesis of schizophrenia. One such mechanism is the involvement of neuroinflammation. Clinical studies, including neuroimaging, peripheral biomarkers and randomized control trials, have suggested the presence of neuroinflammation in schizophrenia. Many studies have also measured markers of neuroinflammation in postmortem brain samples from schizophrenia patients. The objective of this study was to conduct a systematic search of the literature on neuroinflammation in postmortem brains of schizophrenia patients indexed in MEDLINE, Embase and PsycINFO. Databases were searched up until 20th March 2016 for articles published on postmortem brains in schizophrenia evaluating microglia, astrocytes, glia, cytokines, the arachidonic cascade, substance P and other markers of neuroinflammation. Two independent reviewers extracted the data. Out of 5385 articles yielded by the search, 119 articles were identified that measured neuroinflammatory markers in schizophrenic postmortem brains. Glial fibrillary acidic protein expression was elevated, lower or unchanged in 6, 6 and 21 studies, respectively, and similar results were obtained for glial cell densities. On the other hand, microglial markers were increased, lower or unchanged in schizophrenia in 11, 3 and 8 studies, respectively. Results were variable across all other markers, but SERPINA3 and IFITM were consistently increased in 4 and 5 studies, respectively. Despite the variability, some studies evaluating neuroinflammation in postmortem brains in schizophrenia suggest an increase in microglial activity and other markers such as SERPINA3 and IFITM. Variability across studies is partially explained by multiple factors including brain region evaluated, source of the brain, diagnosis, age at time of death, age of onset and the presence of suicide victims in the cohort. PMID:27271499

  6. Postmortem evidence of cerebral inflammation in schizophrenia: a systematic review.

    PubMed

    Trépanier, M O; Hopperton, K E; Mizrahi, R; Mechawar, N; Bazinet, R P

    2016-08-01

    Schizophrenia is a psychiatric disorder which has a lifetime prevalence of ~1%. Multiple candidate mechanisms have been proposed in the pathogenesis of schizophrenia. One such mechanism is the involvement of neuroinflammation. Clinical studies, including neuroimaging, peripheral biomarkers and randomized control trials, have suggested the presence of neuroinflammation in schizophrenia. Many studies have also measured markers of neuroinflammation in postmortem brain samples from schizophrenia patients. The objective of this study was to conduct a systematic search of the literature on neuroinflammation in postmortem brains of schizophrenia patients indexed in MEDLINE, Embase and PsycINFO. Databases were searched up until 20th March 2016 for articles published on postmortem brains in schizophrenia evaluating microglia, astrocytes, glia, cytokines, the arachidonic cascade, substance P and other markers of neuroinflammation. Two independent reviewers extracted the data. Out of 5385 articles yielded by the search, 119 articles were identified that measured neuroinflammatory markers in schizophrenic postmortem brains. Glial fibrillary acidic protein expression was elevated, lower or unchanged in 6, 6 and 21 studies, respectively, and similar results were obtained for glial cell densities. On the other hand, microglial markers were increased, lower or unchanged in schizophrenia in 11, 3 and 8 studies, respectively. Results were variable across all other markers, but SERPINA3 and IFITM were consistently increased in 4 and 5 studies, respectively. Despite the variability, some studies evaluating neuroinflammation in postmortem brains in schizophrenia suggest an increase in microglial activity and other markers such as SERPINA3 and IFITM. Variability across studies is partially explained by multiple factors including brain region evaluated, source of the brain, diagnosis, age at time of death, age of onset and the presence of suicide victims in the cohort. PMID:27271499

  7. The medico-legal evaluation of injuries from falls in pediatric age groups.

    PubMed

    Kafadar, Safiye; Kafadar, Hüseyin

    2015-04-01

    Blunt trauma from accidental falls or intentional jumping from great heights occurs frequently in forensic medicine. The goal of this study was to investigate injuries due to falls in children under 19 years of age. Injuries from falls are the leading cause of visits to emergency departments and to deaths due to injuries. Various methods are used in the classification of falls. In this study, we have classified falls as "high-level" (≥ 5 m), "low-level" (<5 m) and "ground-level". We have retrospectively evaluated 814 boys (61.18%) and 512 girls (38.62%), making up a total of 1326 children (under 19 years old) with the mean age of 7.85 ± 3.46, that were admitted to State Hospital between January 2009 and December 2013 due to falls from heights and falls on ground-level. Falls were low-level in 738 cases, high-level in 176 cases, and ground-level in 412 cases. Cases were categorized by gender, age, age group, fall height, Glasgow Coma Scale (GCS), injured body part(s), mortality rate, and distribution according to months. In conclusion, falls merit attention because of their high risk of mortality and morbidity, as well as their burden on medical budgets. If the medico-legal aspects of falls were evaluated with regard to preventive event or death, the importance of the topic could be better understood. PMID:25735785

  8. Post-traumatic stress disorder and memory: prescient medicolegal testimony at the International War Crimes Tribunal?

    PubMed

    Sparr, Landy F; Bremner, J Douglas

    2005-01-01

    The nature of remembrance of traumatic events has been particularly controversial during the past decade as vigorous new research has reshaped thinking about trauma and memory. Memory alterations in traumatized individuals have been investigated within both theoretical and biological frameworks. There are different types of memory, and empirical studies have associated post-traumatic stress disorder (PTSD) with a simultaneous weakening and a strengthening of memory. Memory deficiencies in PTSD have been found to be related to problems in new learning (explicit memory), but other specific deficiencies are unvalidated. Recently, accuracy of memory has received particular scrutiny because considerable importance is attached to victims' recollections. In 1998, at the International War Crimes Tribunal in The Hague, The Netherlands, a Bosnian-Croatian soldier was tried for aiding and abetting the rape of a Muslim woman. The defendant's lawyers suggested that the woman's memory was inaccurate, having been adversely affected by her traumatic experiences, and that the defendant whom she identified was not present during her interrogation and abuse. The prosecution disagreed and argued that memories of traumatic experiences in individuals with PTSD are characteristically hyperaccessible. Expert witnesses on both sides were brought in to provide medicolegal testimony about the scientific parameters of stress and its long-term effects on brain regions associated with memory. With the expert witness discussion as background, this article reviews the most recent research about the nature of memory in the aftermath of trauma and the politics of psychological trauma and the law. PMID:15809242

  9. [Medico-legal opinionating in cases of medical errors in declaration of death].

    PubMed

    Jurek, Tomasz; Swiatek, Barbara; Drozd, Radosław

    2007-01-01

    Declaration of death is a diagnosis and it has legal consequences. While declaring death, there is a possibility of committing a medical error. The majority of irregularities in declaring an individual dead occur in emergency situations. When a physician declares death, he is released from the professional obligation of saving the individual's life. The studies were based on the results of medico-legal evaluations in criminal cases in medical errors. In case death is erroneously declared, we may face a situation of squandering the chance of saving the life of a human being. Exposure to loss of life or to severe detriment to health are possible charges here, along with failure to offer medical assistance, although a deliberate character of the offence according to article 162 of the Polish penal code renders such a legal qualification dubious in case of medical errors. In both cases verification is needed whether an interest protected by law was still in existence, i.e. whether the individual was still alive when the physician incorrectly declared him dead. PMID:18432142

  10. Immunohistochemical investigation of ubiquitin and myoglobin in the kidney in medicolegal autopsy cases.

    PubMed

    Ishikawa, Takaki; Zhu, Bao-Li; Li, Dong-Ri; Zhao, Dong; Michiue, Tomomi; Maeda, Hitoshi

    2007-09-13

    We examined the immunohistochemical distributions of ubiquitin (Ub) and myoglobin (Mb) in human kidney tissues to assist the pathological assessment of death due to trauma. Medicolegal autopsy cases at our institute (n=138: 0-96 years of age, 105 males and 33 females) were examined. Causes of death were blunt injury (n=31), sharp injury (n=15), poisoning (n=11), drowning (n=10), fire fatalities (n=25), hypothermia (n=7), asphyxiation (n=14), hyperthermia (n=3), and natural diseases (n=22) for controls. Immunostaining of Ub and Mb was performed on the formalin-fixed paraffin-embedded kidney tissue sections. Quantitative analyses by estimating the proportion of Ub- and Mb-positive cells (%positivity) of renal tubule epithelial cells showed that the positivities for Ub and Mb were higher in subjects who died due to fire, blunt injury, sharp injury and fatal hypothermia than in other groups. The Ub-positivity correlated with the severity of airway thermal injury in fire deaths, survival time in blunt injury, and serum markers for renal failure in deaths due to sharp injury. Concomitant increases in the tubular Mb- and Ub-positivities were characteristic to deaths from injury and hypothermia. These findings suggest that Ub may serve as a sensitive indicator of the fatal influence of traumas. PMID:17166680

  11. Imaging maculopathy in post-mortem human eyes.

    PubMed

    Curcio, Christine A

    2005-12-01

    Age-related maculopathy (ARM) remains a poorly understood degeneration. To discover new pathways using contemporary genomics, proteomics, and immunohistochemistry, validate emerging animal models, and validate new imaging modalities, human tissues obtained from donor eyes will be essential to ARM research for the foreseeable future. Because fundus appearance is the clinical diagnostic lingua franca, laboratory investigators adapted these standards to the distinctive appearance of post-mortem tissues in order to identify and stage ARM in donor eyes. Post-mortem tissues offer unique advantages and limitations relative to pre-mortem tissues for imaging studies. One fellow eye can be used for imaging and the other for correlative laboratory studies, if some degree of disease stage asymmetry between eyes is acceptable. Histological verification is a necessary, albeit challenging, step in validating a grading system. PMID:16171840

  12. Why We Need Postmortem Analysis of Cardiac Implantable Electronic Devices.

    PubMed

    Mauf, Sabrina; Jentzsch, Thorsten; Laberke, Patrick J; Thali, Michael J; Bartsch, Christine

    2016-07-01

    The prevalence of cardiac implantable electronic devices (CIEDs), pacemakers and implantable cardioverter defibrillators (ICDs) is increasing. However, postmortem analysis of CIEDs is not performed routinely. Fourteen consecutive CIEDs were analyzed. The indication for and date of implantation, technical data, CIED reprogramming, heart rhythm disturbances, patient demographics and medical consultations were investigated. Death during the first year after implantation was seen in 54%, whereof 71% consulted a physician within 10 days before death. The time of death was attributed to a particular day in 29%. There was a relationship between CIEDs and cause/manner of death in 50%. Although limited by a small sample size, this study advocates the routine postmortem CIED analysis for forensic and clinical purposes in selected cases. Patients with CIEDs seem to show an increased risk of death during the first year after implantation. The analysis of CIEDs can be helpful in evaluating the time/cause/manner of death. PMID:27364278

  13. Effects of postmortem delays on protein composition and oxidation.

    PubMed

    ElHajj, Zeinab; Cachot, Amélie; Müller, Terry; Riederer, Irène M; Riederer, Beat M

    2016-03-01

    Human autopsy brain tissue is widely used to study neurodegenerative diseases such as Alzheimer's, Parkinson's and other diseases. However, when it comes to an evaluation of data obtained from such tissue, it is essential to consider potential postmortem effects on protein composition, posttranslational modification and proteolysis with increasing postmortem delays. In this study, we analyzed mouse brain tissues with different postmortem delays (pmd) of 0 h, 6h and 24h, for changes in protein composition, proteolysis and modifications such as S-nitrosylation, carbonylation and ubiquitination. Proteins involved in Alzheimer's disease (AD) were of special interest, including cytoskeletal and synaptic proteins or proteins involved in inflammation. Several proteins were fairly resistant to degradation during the first 6h but started to degrade thereafter. S-nitrosylation and carbonylation showed not much variation, except for those proteins that were susceptible to degradation. Brain spectrin was S-nitrosylated at death, and S-nitrosylated degradation fragments were measured at a pmd of 24h, indicating a susceptibility of brain spectrin to degradation. Furthermore, the physiological role of S-nitrosylation remains to be investigated. When studying human brain tissue, some proteins are more susceptible to degradation than others, while ubiquitination and carbonylation were little affected during the first 24h after death. PMID:26791740

  14. Haemorrhoids leading to post-mortem bleeding artefact.

    PubMed

    Kanchan, Tanuj; Menezes, Ritesh G; Manipady, Shahnavaz

    2006-07-01

    We present a case where a 54-year-old man suffering from haemorrhoids, committed suicide by hanging. Gravitational forces due to the upright position of the body facilitated post-mortem per-rectal bleeding from the ulcerated haemorrhoids. The bleeding stained his under garment and wrap around cloth. Frank blood was also seen on the floor beneath the hanging body. The blood at the crime scene was wrongly interpreted by the investigating police as that due to self-inflicted injury or possibly case of homicide followed by post-mortem suspension of the body. Observation of the crime scene by forensic medicine experts and subsequent autopsy findings revealed that the bleeding was from the haemorrhoids. This case is reported for its rarity, for the awareness of the possible post-mortem haemorrhoidal bleeding artefact, to explain the circumstances of such a possibility, and to emphasize the importance of involving forensic medicine experts as a part of the crime scene investigation team. PMID:16442833

  15. The Role of Postmortem Studies in Pneumonia Etiology Research

    PubMed Central

    Bunthi, Charatdao; Wonodi, Chizoba B.; Morpeth, Susan C.; Molyneux, Catherine S.; Zaki, Sherif R.; Levine, Orin S.; Murdoch, David R.; Scott, J. Anthony G.

    2012-01-01

    The diagnosis of etiology in severe pneumonia remains a challenging area. Postmortem lung tissue potentially increases the sensitivity of investigations for identification of causative pathogens in fatal cases of pneumonia and can confirm antemortem microbiological diagnoses. Tissue sampling allows assessment of histological patterns of disease and ancillary immunohistochemical or molecular diagnostic techniques. It may also enhance the recognition of noninfectious conditions that clinically simulate acute pneumonia. Biobanking of lung tissue or postmortem culture isolates offers opportunities for new pathogen discovery and research into host-pathogen interactions. The Pneumonia Etiology Research for Child Health study proposes a percutaneous needle biopsy approach to obtain postmortem samples, rather than a full open autopsy. This has the advantage of greater acceptability to relatives, but risks greater sampling error. Both approaches may be susceptible to microbiological contamination or pathogen degradation. However, previous autopsy studies have confirmed the value of histological examination in revealing unsuspected pathogens and influencing clinical guidelines for the diagnosis and treatment of future pneumonia cases. PMID:22403232

  16. Estimating Time Since Death from Postmortem Human Gut Microbial Communities.

    PubMed

    Hauther, Kathleen A; Cobaugh, Kelly L; Jantz, Lee Meadows; Sparer, Tim E; DeBruyn, Jennifer M

    2015-09-01

    Postmortem succession of human-associated microbial communities ("human microbiome") has been suggested as a possible method for estimating postmortem interval (PMI) for forensic analyses. Here we evaluate human gut bacterial populations to determine quantifiable, time-dependent changes postmortem. Gut microflora were repeatedly sampled from the proximal large intestine of 12 deceased human individuals as they decayed under environmental conditions. Three intestinal bacterial genera were quantified by quantitative PCR (qPCR) using group-specific primers targeting 16S rRNA genes. Bacteroides and Lactobacillus relative abundances declined exponentially with increasing PMI at rates of Nt=0.977e(-0.0144t) (r2=0.537, p<0.001) and Nt=0.019e(-0.0087t) (r2=0.396, p<0.001), respectively, where Nt is relative abundance at time (t) in cumulative degree hours. Bifidobacterium relative abundances did not change significantly: Nt=0.003e(-0.002t) (r2=0.033, p=0.284). Therefore, Bacteroides and Lactobacillus abundances could be used as quantitative indicators of PMI. PMID:26096156

  17. Medico-Legal Findings, Legal Case Progression, and Outcomes in South African Rape Cases: Retrospective Review

    PubMed Central

    Jewkes, Rachel; Christofides, Nicola; Vetten, Lisa; Jina, Ruxana; Sigsworth, Romi; Loots, Lizle

    2009-01-01

    Background Health services for victims of rape are recognised as a particularly neglected area of the health sector internationally. Efforts to strengthen these services need to be guided by clinical research. Expert medical evidence is widely used in rape cases, but its contribution to the progress of legal cases is unclear. Only three studies have found an association between documented bodily injuries and convictions in rape cases. This article aims to describe the processing of rape cases by South African police and courts, and the association between documented injuries and DNA and case progression through the criminal justice system. Methods and Findings We analysed a provincially representative sample of 2,068 attempted and completed rape cases reported to 70 randomly selected Gauteng province police stations in 2003. Data sheets were completed from the police dockets and available medical examination forms were copied. 1,547 cases of rape had medical examinations and available forms and were analysed, which was at least 85% of the proportion of the sample having a medical examination. We present logistic regression models of the association between whether a trial started and whether the accused was found guilty and the medico-legal findings for adult and child rapes. Half the suspects were arrested (n = 771), 14% (209) of cases went to trial, and in 3% (31) of adults and 7% (44) of children there was a conviction. A report on DNA was available in 1.4% (22) of cases, but the presence or absence of injuries were documented in all cases. Documented injuries were not associated with arrest, but they were associated with children's cases (but not adult's) going to trial (adjusted odds ratio [AOR] for having genital and nongenital injuries 5.83, 95% confidence interval [CI] 1.87–18.13, p = 0.003). In adult cases a conviction was more likely if there were documented injuries, whether nongenital injuries alone AOR 6.25 (95% CI 1.14–34.3, p = 0

  18. Bio-medicolegal scientific research in Europe: a comprehensive bibliometric overview.

    PubMed

    Ferrara, Santo Davide; Bajanowski, Thomas; Cecchi, Rossana; Boscolo-Berto, Rafael; Viel, Guido

    2011-05-01

    In times of globalisation, the future of bio-medicolegal sciences in Europe depends on the scientific community's ability to develop new strategies for research, to introduce new and generally accepted standards, to develop new analytical methods, all in order to draw up inter-site, multidisciplinary and interdisciplinary long-term research projects, eligible for European Union (EU) funding. To analyse the scientific output and to identify the topics of greatest interest and appeal in these sciences, an innovative method has been developed to select and analyse publications. This method has been applied to analyse a total of 21,176 records from PubMed out of which 5,826 papers were suitable for further analysis because they were published in national and international journals in the time between January 1, 2005 and June 1, 2010 by European authors in the field of interest. In 69% of all manuscripts, authors presented results of systematic research (original articles); 84% of the papers were written in English language. The cumulative impact factor increased from 1,670 points in 2005 to 1,878 in 2009, and extrapolated 2,812 points in 2010. The most frequent topics were the description of new analytical methods in forensic toxicology (5.7% of all papers), the analysis of short tandem repeat systems (STR, 5.6%) as well as the analysis of injury mechanisms in forensic pathology and clinical forensic medicine (4.9%). If the impact factor related potential of different topics is calculated (ratio of frequency of papers and frequency of impact points achieved), SIDS research reaches 1.64 points, followed by studies on mtDNA (1.59) and the development of new analytical methods in forensic toxicology (1.49). The findings made in the present bibliometric analysis reveal a clear and interesting overall picture of the European scientific production and productivity and could be used to identify the most innovative research lines. PMID:21191611

  19. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder

    PubMed Central

    Anastasia, Annalisa; Colletti, Chiara; Cuoco, Valentina; Quartini, Adele; Urso, Stefania; Rinaldi, Raffaella; Bersani, Giuseppe

    2016-01-01

    Introduction Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. Methods A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry “A. Fiorini” Hospital, Terracina (Latina, Italy), was performed. Results The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium–high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. Conclusion Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications. PMID:27099504

  20. Diagnosis of Asbestos-Related Diseases: The Mineralogist and Pathologist's Role in Medicolegal Field.

    PubMed

    Capella, Silvana; Bellis, Donata; Belluso, Elena

    2016-03-01

    Because asbestos diseases represent a complex pattern of legal, social, and political issue, the involvement of the mineralogist and pathologist for a multidisciplinary assessment of its diagnosis helps investigate the relationship between mesothelioma or lung cancer and occupational or environmental asbestos exposure.In the present study, we consider the concentrations of asbestos bodies (ABs) detected by optical microscopy (OM) and scanning electron microscopy (SEM) and the burden of different kinds of mineral fibers (among which is asbestos) identified by SEM combined with an energy dispersive spectrometer (EDS), in 10 lung tissue samples of subjects with occupational and nonoccupational exposure to asbestos.In all subjects with occupational exposure to asbestos, more than 1000 ABs per gram of dry weight were detected both with OM and SEM; this concentration is internationally accepted as suggesting high probability of past occupational exposure to asbestos.In 9 lung samples of the 10 investigated by SEM-EDS different inorganic fibers were found. Asbestos fibers have been identified too, and more than 100,000 fibers per gram of dry weight were detected in subjects with occupational exposure; this concentration is internationally accepted as suggesting high probability of past occupational exposure to asbestos.Instead, when the ABs burden is low or moderate (such as in subjects with absent or probable asbestos exposure), the correlation between ABs concentration determined by OM and those determined by SEM is lost. Therefore, when the ABs value in OM is borderline, the SEM investigation became essential. Furthermore, the mineralogical analysis by SEM-EDS (identification and quantification of inorganic fibers in general and asbestos in particular) of the fibers detected in the lung tissues is very useful, if not necessary, to complete the pathological diagnosis of asbestos-related malignancies in medicolegal field. PMID:26566053

  1. Analysis of colored teeth from Precolumbian Tlatelolco: postmortem transformation or intravitam processes?

    PubMed

    Mansilla, J; Solis, C; Chávez-Lomeli, M E; Gama, J E

    2003-01-01

    The etiological basis of the abnormal coloration of archaeological teeth has been an unsolved question for a long time. Differences in the appearance of some archaeological teeth from Precolumbian adult and infant skeletons, detected by external optical inspection, led us to study this problem. A blue stain is visible in a few of the deciduous erupted teeth, and a brown color in various unerupted teeth in the collection, while brown spots appear on some permanent teeth. Several processes or factors that may occur during one's life, others around the time of death, and still others resulting from postmortem alterations have been reported as potential causes of abnormal tooth coloration.A sample of 35 colored teeth and two soil layers taken from Tlatelolco were analyzed by particle-induced X-ray emission (PIXE) as well as selective dissolution techniques. Concentrations of total and extractable elements in enamel and soil layers (Cg1-Cg2) were obtained. This paper describes the occurrence and implications of a substantial secondary concentration of Zinc (Zn), manganese (Mn), strontium (Sr), and iron (Fe) in the deciduous erupted and nonerupted teeth as compared to that in the adult teeth. Our interpretation is that, in this archaeological context, the brown spots and blue stains on the teeth are due to differences in tooth enamel porosity and to a postmortem biogeochemical process. The alterations involve cumulization and diagenesis of iron, manganese, and organic matter solutions that were eluviated from the soil and are not the result of antemortem or perimortem conditions such as trauma or disease. PMID:12489138

  2. Postmortem computed tomography in victims of military air mishaps: radiological-pathological correlation of CT findings.

    PubMed

    Levy, Gad; Goldstein, Liav; Blachar, Arye; Apter, Sara; Barenboim, Erez; Bar-Dayan, Yaron; Shamis, Ari; Atar, Eli

    2007-10-01

    A thorough medical inquiry is included in every aviation mishap investigation. While the gold standard of this investigation is a forensic pathology examination, numerous reports stress the important role of computed tomography in the postmortem evaluation of trauma victims. To characterize the findings identified by postmortem CT and compare its performance to conventional autopsy in victims of military aviation mishaps, we analyzed seven postmortem CT examinations. Musculoskeletal injuries accounted for 57.8% of the traumatic findings identified by postmortem CT. The most frequent findings were fractures of the rib (47%), skull (9.6%) and facial bones (8.6%). Abnormally located air accounted for 24% of findings, for which CT was superior (3.5% detected by autopsy, 100% by postmortem CT, P < 0.001). The performance of autopsy in detecting injuries was superior (autopsy detected 85.8% of all injuries, postmortem CT detected 53.9%, P < 0.001), especially in the detection of superficial lesions (100% detected by autopsy, 10.5% by postmortem CT, P < 0.001) and solid organ injuries (100% by autopsy, 18.5% by postmortem CT, P < 0.001). Performance in the detection of musculoskeletal injuries was similar (91.3% for autopsy, 90.3% for postmortem CT, P = not significant). Postmortem CT and autopsy have distinct performance profiles, and although the first cannot replace the latter it is a useful complementary examination. PMID:17987755

  3. Virtopsy -- noninvasive detection of occult bone lesions in postmortem MRI: additional information for traffic accident reconstruction.

    PubMed

    Buck, Ursula; Christe, Andreas; Naether, Silvio; Ross, Steffen; Thali, Michael J

    2009-05-01

    In traffic accidents with pedestrians, cyclists or motorcyclists, patterned impact injuries as well as marks on clothes can be matched to the injury-causing vehicle structure in order to reconstruct the accident and identify the vehicle which has hit the person. Therefore, the differentiation of the primary impact injuries from other injuries is of great importance. Impact injuries can be identified on the external injuries of the skin, the injured subcutaneous and fat tissue, as well as the fractured bones. Another sign of impact is a bone bruise. The bone bruise, or occult bone lesion, means a bleeding in the subcortical bone marrow, which is presumed to be the result of micro-fractures of the medullar trabeculae. The aim of this study was to prove that bleeding in the subcortical bone marrow of the deceased can be detected using the postmortem noninvasive magnetic resonance imaging. This is demonstrated in five accident cases, four involving pedestrians and one a cyclist, where bone bruises were detected in different bones as a sign of impact occurring in the same location as the external and soft tissue impact injuries. PMID:19034476

  4. Smartphone Image Acquisition During Postmortem Monocular Indirect Ophthalmoscopy.

    PubMed

    Lantz, Patrick E; Schoppe, Candace H; Thibault, Kirk L; Porter, William T

    2016-01-01

    The medical usefulness of smartphones continues to evolve as third-party applications exploit and expand on the smartphones' interface and capabilities. This technical report describes smartphone still-image capture techniques and video-sequence recording capabilities during postmortem monocular indirect ophthalmoscopy. Using these devices and techniques, practitioners can create photographic documentation of fundal findings, clinically and at autopsy, without the expense of a retinal camera. Smartphone image acquisition of fundal abnormalities can promote ophthalmological telemedicine--especially in regions or countries with limited resources--and facilitate prompt, accurate, and unbiased documentation of retinal hemorrhages in infants and young children. PMID:26248715

  5. Estimation of Pork Quality Traits Using Exsanguination Blood and Postmortem Muscle Metabolites

    PubMed Central

    Choe, J. H.; Choi, M. H.; Ryu, Y. C.; Go, G. W.; Choi, Y. M.; Lee, S. H.; Lim, K. S.; Lee, E. A.; Kang, J. H.; Hong, K. C.; Kim, B. C.

    2015-01-01

    The current study was designed to estimate the pork quality traits using metabolites from exsanguination blood and postmortem muscle simultaneously under the Korean standard pre- and post-slaughter conditions. A total of 111 Yorkshire (pure breed and castrated male) pigs were evaluated under the Korean standard conditions. Measurements were taken of the levels of blood glucose and lactate at exsanguination, and muscle glycogen and lactate content at 45 min and 24 h postmortem. Certain pork quality traits were also evaluated. Correlation analysis and multiple regression analysis including stepwise regression were performed. Exsanguination blood glucose and lactate levels were positively correlated with each other, negatively related to postmortem muscle glycogen content and positively associated with postmortem muscle lactate content. A rapid and extended postmortem glycolysis was associated with high levels of blood glucose and lactate, with high muscle lactate content, and with low muscle glycogen content during postmortem. In addition, these were also correlated with paler meat color and reduced water holding capacity. The results of multiple regression analyses also showed that metabolites in exsanguination blood and postmortem muscle explained variations in pork quality traits. Especially, levels of blood glucose and lactate and content of muscle glycogen at early postmortem were significantly associated with an elevated early glycolytic rate. Furthermore, muscle lactate content at 24 h postmortem alone accounted for a considerable portion of the variation in pork quality traits. Based on these results, the current study confirmed that the main factor influencing pork quality traits is the ultimate lactate content in muscle via postmortem glycolysis, and that levels of blood glucose and lactate at exsanguination and contents of muscle glycogen and lactate at postmortem can explain a large portion of the variation in pork quality even under the standard

  6. Postmortem examinations on deceased neonates: a rarely utilized procedure in an African referral center.

    PubMed

    Ugiagbe, Ezekiel E; Osifo, Osarumwense D

    2012-01-01

    Postmortem examination remains the gold standard for the correct diagnosis of many diseases and for unraveling unexplained causes of death. This paper reports on the poor utilization of autopsy services and encourages parents/caregivers and practitioners to perform postmortem examinations on deceased neonates in sub-Saharan Africa. In a retrospective study, the records of 1093 neonates (653 males and 440 females, ratio 1.5∶1) who died at the University of Benin Teaching Hospital and who were brought to the mortuary between 2006 and 2010 were reviewed to determine the utilization of and factors influencing postmortem examination. Sixty-two percent of the neonates died within the 1st week of life, and only 9 (0.8%) underwent a postmortem examination. Findings in the 9 postmortem studies performed on 7 males and 2 females provided additional information on the causes of death. The religious beliefs that neonates should not be subjected to postmortem study and beliefs that dead neonates are taboo and a punishment by the gods for past wrongdoings influenced 511 (46.8%) parents/caregivers to refuse postmortem analysis. The practitioners did not request postmortem study in 281 (25.7%) of the cases. The utilization of postmortem examination was marginal in this setting. We advocate the need for public enlightenment campaigns to modify the attitudes of parents/caregivers toward the postmortem study of deceased neonates. Policies should be formulated to mandate postmortem examinations of deceased neonates to enhance insight into neonatal disease, unravel unexplained causes of death, and improve the standard of neonatal care in this subregion. PMID:21991941

  7. Bridging the Gap between MRI and Postmortem Research in Autism

    PubMed Central

    Schumann, Cynthia Mills; Nordahl, Christine Wu

    2010-01-01

    Autism is clearly a disorder of neural development, but when, where, and how brain pathology occurs remains elusive. Typical brain development is comprised of several stages, including the proliferation and migration of neurons, creation of dendritic arbors and synaptic connections, and eventually dendritic pruning and programmed cell death. Any deviation at one or more of these stages could produce catastrophic downstream effects. MRI studies of autism have provided important clues, describing an aberrant trajectory of growth during early childhood that is both present in total brain and marked in specific structures such as the amygdala. However, given the coarse resolution of MRI, the field must also look towards postmortem human brain research to help elucidate the neurobiological underpinnings of MRI volumetric findings. Likewise, studies of postmortem tissue may benefit by looking to findings from MRI studies to narrow hypotheses and target specific brain regions. In this review, we discuss the strengths, limitations, and major contributions of each approach to autism research. We then describe how they relate and what they can learn from each other. Only by integrating these approaches will we be able to fully explain the neuropathology of autism. PMID:20869352

  8. Building models for postmortem abnormalities in hippocampus of schizophrenics.

    PubMed

    Benes, Francine M

    2015-09-01

    Postmortem studies have suggested that there is abnormal GABAergic activity in the hippocampus in schizophrenia (SZ). In micro-dissected human hippocampal slices, a loss of interneurons and a compensatory upregulation of GABAA receptor binding activity on interneurons, but not PNs, has suggested that disinhibitory GABA-to-GABA connections are abnormal in stratum oriens (SO) of CA3/2, but not CA1, in schizophrenia. Abnormal expression changes in the expression of kainate receptor (KAR) subunits 5, 6 and 7, as well as an inwardly-rectifying hyperpolarization-activated cationic channel (Ih3; HCN3) may play important roles in regulating GABA cell activity at the SO CA3/2 locus. The exclusive neurons at this site are GABAergic interneurons; these cells also receive direct projections from the basolateral amygdala (BLA). When the BLA is stimulated by stereotaxic infusion of picrotoxin in rats, KARs influence axodendritic and presynaptic inhibitory mechanisms that regulate both inhibitory and disinhibitory interneurons in the SO-CA3/2 locus. The rat model described here was specifically developed to extend our understanding of these and other postmortem findings and has suggested that GABAergic abnormalities and possible disturbances in oscillatory rhythms may be related to a dysfunction of disinhibitory interneurons at the SO-CA3/2 site of schizophrenics. PMID:25749020

  9. Carbon monoxide stability in stored postmortem blood samples.

    PubMed

    Kunsman, G W; Presses, C L; Rodriguez, P

    2000-10-01

    Carbon monoxide (CO) poisoning remains a common cause of both suicidal and accidental deaths in the United States. As a consequence, determination of the percent carboxyhemoglobin (%COHb) level in postmortem blood is a common analysis performed in toxicology laboratories. The blood specimens analyzed are generally preserved with either EDTA or sodium fluoride. Potentially problematic scenarios that may arise in conjunction with CO analysis are a first analysis or a reanalysis requested months or years after the initial toxicology testing is completed; both raise the issue of the stability of carboxyhemoglobin in stored postmortem blood specimens. A study was conducted at the Bexar County Medical Examiner's Office to evaluate the stability of CO in blood samples collected in red-, gray-, and purple-top tubes by comparing results obtained at the time of the autopsy and after two years of storage at 3 degrees C using either an IL 282 or 682 CO-Oximeter. The results from this study suggest that carboxyhemoglobin is stable in blood specimens collected in vacutainer tubes, with or without preservative, and stored refrigerated for up to two years. PMID:11043662

  10. Mitragynine 'Kratom' related fatality: a case report with postmortem concentrations.

    PubMed

    McIntyre, Iain M; Trochta, Amber; Stolberg, Susan; Campman, Steven C

    2015-03-01

    A 24-year-old man whose medical history was significant for alcohol abuse and depression was found unresponsive in bed. He had several prior suicide attempts with 'pills' and had also been hospitalized for an accidental overdose on a previous occasion. Autopsy findings were unremarkable apart from pulmonary edema and congestion, and urinary retention. Postmortem peripheral blood initially screened positive for mitragynine 'Kratom' (by routine alkaline drug screen by gas chromatography-mass spectrometry, GC-MS), which was subsequently confirmed by a specific GC-MS selective ion mode analysis following solid-phase extraction. Concentrations were determined in the peripheral blood (0.23 mg/L), central blood (0.19 mg/L), liver (0.43 mg/kg), vitreous (<0.05 mg/L), urine (0.37 mg/L) and was not detected in the gastric. Therapeutic concentrations of venlafaxine, diphenhydramine and mirtazapine were also detected together with a negligible ethanol of 0.02% (w/v). The results are discussed in relation to previous cases of toxicity, and the lack of potential for mitragynine postmortem redistribution. PMID:25516573

  11. Postmortem diagnosis of drug-induced anaphylactic death.

    PubMed

    Palmiere, Cristian

    2016-07-01

    Kounis syndrome is defined as the concurrence of acute coronary syndromes including coronary spasm, acute myocardial infarction, and stent thrombosis, together with conditions associated with mast cell and platelet activation, involving interrelated and interacting inflammatory cells. Mast cells influence the inflammatory process decisively, though they are numerically inferior in this inflammatory cascade. Accumulation of eosinophils and mast cells in the splenic red pulp is frequently observed in anaphylactic deaths and can be considered a reliable finding for the postmortem diagnosis of this condition. Moreover, a high concentration of mast cell tryptase in serum and increased numbers of eosinophils and mast cells in the spleen make the diagnosis of anaphylactic death almost conclusive. Increased mast cell tryptase levels in postmortem serum, individually considered, do not allow the diagnosis of anaphylaxis-related death to be reached. On the other hand, neither does identification of mast cells and eosinophils within the coronary artery wall and the myocardium, individually considered, allow the hypothesis of anaphylaxis-related death to be formulated. PMID:27111724

  12. Interpretation of postmortem change in cadavers in Spain.

    PubMed

    Prieto, José L; Magaña, Concepción; Ubelaker, Douglas H

    2004-09-01

    Estimating time since death is especially difficult in the examination of poorly preserved cadavers and depends on the experience of the examiner and comparison with previously documented cases showing similar characteristics. The present study reports on information obtained over the past ten years through the work of the Laboratorio de Antropología y Odontología Forense (LAF) of the Instituto Anatómico Forense de Madrid, Spain, in particular evaluating how the type of fracture influences postmortem change. From the original 225 forensic cases examined between 1992 and 2002 in the LAF, a sample of 29 cases were selected from various regions of the Spanish mainland. A data collection protocol was established to reflect factors which the existing specialized literature, documenting the relation existing in the sample analyzed between time since death and the extent of postmortem change, which in the environments examined are distributed into the following phases: Phase 1 (putrefaction): one week to one month on the surface and two months in water. Phase 2 (initial skeletonization): two months on the surface and five to six months in water. Phase 3 (advanced skeltonization): six months to 1.5 years on the surface and 2.5 years buried. Phase 4 (complete skeletonization): about one year on the surface and three years buried. This paper also provide useful information on the impact of carrion insect activity, location, climate, seasonality, and predator. PMID:15461090

  13. Bridging the gap between MRI and postmortem research in autism.

    PubMed

    Schumann, Cynthia Mills; Nordahl, Christine Wu

    2011-03-22

    Autism is clearly a disorder of neural development, but when, where, and how brain pathology occurs remain elusive. Typical brain development is comprised of several stages, including proliferation and migration of neurons, creation of dendritic arbors and synaptic connections, and eventually dendritic pruning and programmed cell death. Any deviation at one or more of these stages could produce catastrophic downstream effects. MRI studies of autism have provided important clues, describing an aberrant trajectory of growth during early childhood that is both present in the whole brain and marked in specific structures such as the amygdala. However, given the coarse resolution of MRI, the field must also look towards postmortem human brain research to help elucidate the neurobiological underpinnings of MRI volumetric findings. Likewise, studies of postmortem tissue may benefit by looking to the findings from MRI studies to narrow hypotheses and target specific brain regions and subject populations. In this review, we discuss the strengths, limitations, and major contributions of each approach to autism research. We then describe how they relate and what they can learn from each other. Only by integrating these approaches will we be able to fully explain the neuropathology of autism. PMID:20869352

  14. Effects of postmortem aging and hydrodynamic pressure processing on sarcoplasmic proteins and beef tenderness

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to determine the effects of hydrodynamic pressure processing (HDP) and postmortem aging on the sarcoplasmic protein fraction of beef strip loins. Loins (n=12) were halved at 48 h postmortem and assigned to HDP or control treatments. Following treatment, each half was ...

  15. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE... located to permit an autopsy or such other post-mortem operation under the circumstances of the particular... the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  16. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE... located to permit an autopsy or such other post-mortem operation under the circumstances of the particular... the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  17. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE... located to permit an autopsy or such other post-mortem operation under the circumstances of the particular... the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  18. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE... located to permit an autopsy or such other post-mortem operation under the circumstances of the particular... the autopsy or other post-mortem operation shall be observed. Documents embodying consent shall...

  19. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Autopsies and other post-mortem operations. 35.16 Section 35.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.16 Autopsies and other post-mortem operations. Autopsies, or other...

  20. Effect of postmortem aging on marination performance of broiler breast pectoralis major categorized by color lightness

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective was to evaluate the effect of postmortem aging on marinade uptake and retention by early-deboned chicken breast fillets with different color lightness. Effects of marination on product yield and muscle shear force were also determined. Early deboned (2 h postmortem) broiler butterflies...

  1. Postmortem chemical changes in poultry breast meat monitored with visible-near infrared spectroscopy

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Chicken meat undergoes significant chemical and structural changes with postmortem time that influence meat quality characteristics. The objective of this study was to measure the visible-near infrared (vis-NIR) spectral differences in broiler breast fillets at 0.5, 4, 24, and 120 h postmortem. Mu...

  2. Effect of postmortem aging time on tumbling marination performance of broiler breast fillets

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Previous data demonstrated that water-holding capacity (WHC), as measured by the salt-induced water uptake method, increases with aging up to 24 h postmortem in early-deboned chicken breast fillets (pectoralis major). Therefore, it was hypothesized that 24 h postmortem aging may enhance marination ...

  3. Effect of pH and postmortem aging on protein extraction from broiler breast muscle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to determine the effects of extraction buffer pH and postmortem aging on the extraction of salt-soluble and water-soluble proteins from broiler pectoralis muscle. De-boned broiler breast fillets were collected at 4 h postmortem, packaged, and then stored at 4°C until...

  4. Use of postmortem human subjects to describe injury responses and tolerances.

    PubMed

    Yoganandan, Narayan; Stemper, Brian D; Pintar, Frank A; Maiman, Dennis J

    2011-04-01

    Traumatic injuries from blunt, penetrating, and blast events expose the human body to unintentional and intentional external mechanical loads. To mitigate trauma and develop safety-engineered devices for clinical and bioengineering applications, it is critical to delineate the structural load-bearing anatomy and biomechanics of the various components of the human body. This article presents advances made in the understanding of the injury responses and tolerances through experiments conducted using intact or segmented tissues from postmortem human subjects (PMHS), and a considerable majority of data for the presentation has been extracted from studies conducted at the Institutions of the authors. The role of the PMHS model for studying traumatic injuries to the head and face, vertebral column (cervical, thoracic and lumbar spines), thorax, abdomen, pelvis, and lower extremities is discussed. Different impact loading scenarios, likely responsible for the initial trauma causation, are considered in the analysis and determination of the human response to injury. Clinical advances made using the PMHS model are discussed. This includes vertebral stabilization system evaluations secondary to traumatic injuries to the spinal column. The critical importance of using data from the PMHS model in developing validated computational models for advancing crashworthiness research, occupant safety in motor vehicle crashes, medical devices, and safety-engineering applications is highlighted. PMID:21433078

  5. Postmortem interval (PMI) determined by study sarcophagous biocenoses: three cases from the province of Venice (Italy).

    PubMed

    Turchetto, M; Lafisca, S; Costantini, G

    2001-08-15

    This paper presents and discusses three cases of cadavers found, unburied, in the province of Venice, Northern Italy. In each case, all insect species playing some role in carrion decay processes, both sarcophagous and their predators, found on or in the bodies, were collected and determined. In one case, many larvae of the black soldier fly, Hermetia illucens L. (Diptera: Stratiomyidae) were found and are reported, for the first time in Italy, as necrophagous. Experimental breeding of some fly species was also carried out in controlled temperature and humidity conditions. In particular, it was of interest to know how the Neotropical black soldier fly modified its life-cycle to adapt to a temperate climate. It was thus possible to establish the rate of larval growth and timing of pupation, emergence, oviposition and hatching in various external conditions. The postmortem interval (PMI) established by identifying the life-cycle stages of dipterofauna were later confirmed in all cases through police investigations and the results of forensic analyses. PMID:11457605

  6. Drug-related deaths with evidences of body packing: Two case reports and medico-legal issues.

    PubMed

    Cappelletti, Simone; Aromatario, Mariarosaria; Bottoni, Edoardo; Fiore, Paola Antonella; Straccamore, Marco; Umani Ronchi, Federica; De Mari, Guido Maria; Ciallella, Costantino

    2016-05-01

    Body packing is a general term used to indicate the internal transportation of drug packages, mainly cocaine, heroin, amphetamines, and methamphetamine, within the gastrointestinal tract. We described two cases of accidental drug intoxication, observed over the last year period, with evidence of intracorporeal drug concealment. The first case concerned a body packer transporting 69 drug packages of heroin adulterated with piracetam. The second body packer transported 16 drug packages of cocaine adulterated with levamisole. For both cases, forensic examination and toxicological analysis of drug packages and biological samples were carried out. Authors also wants to highlight the main medico-legal issues that commonly arise in cases of suspected or ascertained body packers. PMID:27161917

  7. Risk management in clinical practice. Part 6b. Identifying and avoiding medico-legal risks in removable dentures.

    PubMed

    Stilwell, C

    2010-10-01

    The most likely cause of complaint with prosthodontics is a denture that in some way fails to be accepted. A denture that does not perform as the patient expects can give rise to great disappointment and anger. The problem is that acceptance of a denture is not just a technical issue. Success depends on the individual's ability to tolerate and adapt to the denture. It is therefore essential to make the right assessment for the patient from the outset. This includes discovering the patient's priorities and establishing realistic expectations. With the aim of assisting the dental profession in identifying and avoiding medico-legal risks in removable dentures, this article sets out a systematic, diagnostic and collaborative approach to complete and partial denture assessment and treatment. PMID:20930774

  8. [Medico-legal opinion in establishing "exposure to direct danger of death or grave detriment to health"].

    PubMed

    Jurek, Tomasz; Maksymowicz, Krzysztof

    2005-01-01

    This paper deals with the problem of competence of the forensic expert opinions on the exposure to "direct danger of death or grave detriment to health". According to the analysis of judicial verdicts and the comments of lawyers "direct danger" depends closely on the probability, time and number of occurrences between the behavior of the perpetrator and the threatening act. The competence of the forensic expert does not allow for the legal qualification of the act but for the assessment of from the medicolegal point of view, defining the threat and possible outcomes in a descriptive fashion. The assessment of "direct danger" should be the result of close cooperation between the judicial representative and forensic expert. PMID:15984124

  9. Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). Part VIII: Medicolegal considerations and recommendations.

    PubMed

    1986-06-01

    These resuscitation guidelines were developed to "enhance the quality of care while protecting the patient's right to accept or reject therapy and to clarify the physician's role in making decisions to provide, withhold, or withdraw life support." Among the issues covered are the obligation to provide cardiopulmonary resuscitation (CPR), reasons to withhold or withdraw CPR, and the liability risks of CPR providers--laypersons, CPR teachers and organizations, and hospitals. Also discussed are the role of hospital ethics committees and medicolegal considerations in treating minors. The guidelines conclude with recommendations that states enact legislation allowing allied health personnel to render emergency care more effectively outside the hospital, providing "good samaritan" immunity to laypersons administering CPR, requiring basic life support training for police and firefighters, and acknowledging the patient's right to self determination in life-or-death decisions. PMID:11643921

  10. Managing the remains of fetuses and abandoned infants: A call to urgently review South African law and medicolegal practice.

    PubMed

    Du Toit-Prinsloo, Lorraine; Pickles, Camilla; Saayman, Gert

    2016-01-01

    This article reviews South African (SA) law and its impact on the medicolegal management of fetal remains emanating from elective and therapeutic termination of pregnancies, stillbirths and miscarriages and the remains of abandoned or exposed infants. It was found that remains are treated differently, some constituting medical waste while others have sufficient status in law to allow for burial. This approach results in some women or couples being denied a choice with regard to disposal via culturally relevant practices, and is insensitive to the fact that all remains ultimately constitute human remains. The article argues that SA law is in urgent need of reform, and turns to foreign law and forensic practice to shed light on possible alternative approaches that could assist with developing the SA position and thereby improve the practical management of fetal and infant remains in SA. PMID:27245721

  11. Postmortem Quetiapine Reference Concentrations in Brain and Blood.

    PubMed

    Skov, Louise; Johansen, Sys Stybe; Linnet, Kristian

    2015-09-01

    Brain tissue is a useful alternative to blood in postmortem forensic investigations, but scarcity of information on reference concentrations in brain tissue makes interpretation challenging. Here we present a study of 43 cases where the antipsychotic drug quetiapine was quantified in brain tissue and related to concentrations in postmortem blood. For cases, where quetiapine was unrelated to the cause of death (N = 36), the 10-90 percentiles for quetiapine concentrations in brain tissue were 0.030-1.54 mg/kg (median 0.48 mg/kg, mean 0.79 mg/kg). Corresponding blood 10-90 percentile values were 0.007-0.39 mg/kg (median 0.15 mg/kg, mean 0.19 mg/kg), giving brain-blood ratio 10-90 percentiles of 2.31-6.54 (median 3.87, mean 4.32). Both correspond well to the limited amount of data found in the literature. For cases where quetiapine was a contributing factor to death (N = 5), the median value in brain tissue of 8.02 mg/kg (range 2.69-22.98 mg/kg) was more than 15 times higher than the median of the nontoxic values, and about the same relationship occurred for blood with a median of 3.19 mg/kg (range 1.00-6.90 mg/kg). The brain-blood ratios for toxic concentrations were in the range of 2.08-6.05, which correspond to those of the nontoxic concentrations. A single case, where quetiapine was ruled as the sole cause of death, a suicide by quetiapine overdose, had an even higher value of 25.74 mg/kg in brain tissue. The blood concentration was 8.99 mg/kg, giving a brain-blood ratio of 2.86. Thus, on average the brain concentrations were about four times the blood concentrations. The brain concentrations of quetiapine observed in cases, where quetiapine was unrelated to death, may serve as a reference, when evaluating postmortem cases with no blood available. The recorded concentrations, where quetiapine was contributing to death, give an indication of likely toxic concentrations. PMID:26159868

  12. Medicolegal study of child sexual abuse in greater Cairo, Egypt, during a 7-year period: 2005-2011.

    PubMed

    Elgendy, Ibrahim Sadik; Hassan, Nermeen Adly

    2013-12-01

    Child sexual abuse has gained public attention and has become 1 of the most high-profile crimes. This study aimed to determine the demographic and medicolegal aspects of child sexual abuse in greater Cairo, Egypt. This is a retrospective study from January 1, 2005, to December 31, 2011. Data were collected from a Cairo medicolegal department and were statistically analyzed. The total number of cases was 1832 victims; 57.9% were males and 42.1% were females. Most assaults occurred in 2010 (16.2%) and 2011 (17.5%). The age group 6 to 12 years accounted for higher rate (49%), mostly in males (71.8%). A total of 83.3% of the victims belonged to low social class, and 72.3% of the victims were out of school. Only 1.9% of the victims had a mental disability. The crime scene was an unknown place in 78.1%. All offenders were males; most cases had 1 offender (82.5 %); and most offenders were extrafamilial (94.2%), of low social level, illiterate, unemployed, and between 18 and 30 years old. The unmarried offenders assaulted the females more than the males, whereas the married assaulted the males more than the females. A total of 5.8% were intrafamilial offenders; 62.7% of these cases were incest against girls and 37.3% were sodomy against boys. Clothes were normal in 48.8%. Anal assault (52.3%) and incomplete vaginal penetration (32%) were the commonest types. There was no significant relation between findings, investigations, and time. In conclusion, child sexual abuse in greater Cairo represents a problem. Therefore,forensic medicine should be a part of a multidisciplinary approach to prevent, investigate, and treat the problem. PMID:24189631

  13. Preservation of Calliphora vicina (Diptera: Calliphoridae) pupae for use in post-mortem interval estimation.

    PubMed

    Brown, Katherine; Thorne, Alan; Harvey, Michelle

    2012-11-30

    Post-mortem interval (PMI) is frequently calculated using immature stages of carrion frequenting Calliphoridae (Diptera). This is based on identification to species level, followed by age estimation of the samples. These two processes depend on suitable preservation of insects for subsequent analyses, yet preservation methods for the pupal stage are poorly defined and inappropriate methods may result in discolouration or nucleic acid degradation. This study examined the effects of 21 common preservation methods on Calliphora vicina pupae of 4 and 7d old, assessing consequences of the various methods for DNA-based species identification, age estimation using morphological analyses, and differential gene expression (DGE) studies. Pupae were examined within two weeks of preservation and again after 6-8 months. Of the methods tested, hot-water-killing (HWK) followed by storage in 80% ethanol at -20°C or 4°C was the best treatment for external morphology and histological analyses respectively. DNA based species identification was possible following all methods. RNA integrity and amplification were best when pupae were stored at -80°C or in RNAlater (-20°C), however HWK and storage in 80% ethanol at -20°C was also acceptable, and thus the latter is proposed as a universal preservative method for pupae. This study proposes a preservation method for pupae that enables DNA-based species identification, internal and external morphological analysis for age estimation, and DGE study to be carried out on a single specimen, enabling a multidisciplinary approach to age estimation from a single pupa. PMID:23000139

  14. Postmortem diagnosis of diabetes mellitus and its complications

    PubMed Central

    Palmiere, Cristian

    2015-01-01

    Diabetes mellitus has become a major cause of death worldwide and diabetic ketoacidosis is the most common cause of death in children and adolescents with type 1 diabetes. Acute complications of diabetes mellitus as causes of death may be difficult to diagnose due to missing characteristic macroscopic and microscopic findings. Biochemical analyses, including vitreous glucose, blood (or alternative specimen) beta-hydroxybutyrate, and blood glycated hemoglobin determination, may complement postmortem investigations and provide useful information for determining the cause of death even in corpses with advanced decompositional changes. In this article, we performed a review of the literature pertaining to the diagnostic performance of classical and novel biochemical parameters that may be used in the forensic casework to identify disorders in glucose metabolism. We also present a review focusing on the usefulness of traditional and alternative specimens that can be sampled and subsequently analyzed to diagnose acute complications of diabetes mellitus as causes of death. PMID:26088843

  15. The Elusive Universal Post-Mortem Interval Formula

    SciTech Connect

    Vass, Arpad Alexander

    2011-01-01

    The following manuscript details our initial attempt at developing universal post-mortem interval formulas describing human decomposition. These formulas are empirically derived from data collected over the last 20 years from the University of Tennessee's Anthropology Research Facility, in Knoxville, Tennessee, USA. Two formulas were developed (surface decomposition and burial decomposition) based on temperature, moisture, and the partial pressure of oxygen, as being three of the four primary drivers for human decomposition. It is hoped that worldwide application of these formulas to environments and situations not readily studied in Tennessee will result in interdisciplinary cooperation between scientists and law enforcement personnel that will allow for future refinements of these models leading to increased accuracy.

  16. Outdoor post-mortem depredation by local fauna.

    PubMed

    Feola, Alessandro; Campilongo, Sara; Pietra, Bruno Della

    2014-01-01

    We present the case of complete post-mortem decapitation of a 43 years old man killed by gunshots discharged from a distance of 40 - 50 cm. The corpse was left in the courtyard of his isolated carpentry and a mongrel dog lived in that courtyard, maybe attracted by the blood gushed from the wound, got a depredation of the corpse till the complete decapitation and the removal of all intrathoracic organs. The action of the dog was completed by the rats and mice that lived in the place. The case is not rare and sometimes the alteration of the features of the corpse makes it impossible for the investigators, to objectify any other signs of criminal nature. PMID:24625020

  17. Tourette's syndrome: a neurochemical analysis of postmortem cortical brain tissue.

    PubMed

    Singer, H S; Hahn, I H; Krowiak, E; Nelson, E; Moran, T

    1990-04-01

    Postmortem frontal, temporal, and occipital regions of the brain from adult patients who had a diagnosis of Tourette's syndrome were analyzed for neurochemical alterations. In 3 of 4 TS-affected brains, the concentration of adenosine 3',5'-monophosphate (cyclic AMP) was reduced in all brain regions evaluated. This diminution in cyclic AMP was not associated with a significant change in the activity of the synthesizing enzyme, adenylate cyclase. No significant differences were identified for the neurotransmitter-synthesizing enzymes choline acetyltransferase and glutamate decarboxylase. Concentrations of dopamine, norepinephrine, and the serotonin metabolite 5-hydroxyindoleacetic acid were not altered. Postsynaptic receptor-binding activity for muscarinic cholinergic ([3H]quinuclidinyl benzilate) and beta receptors ([125I]iodocyanopindolol) showed no generalized impairment. It is suggested that symptoms of Tourette's syndrome might be related to an abnormality within a second messenger system. PMID:1972320

  18. The eyeball killer: serial killings with postmortem globe enucleation.

    PubMed

    Coyle, Julie; Ross, Karen F; Barnard, Jeffrey J; Peacock, Elizabeth; Linch, Charles A; Prahlow, Joseph A

    2015-05-01

    Although serial killings are relatively rare, they can be the cause of a great deal of anxiety while the killer remains at-large. Despite the fact that the motivations for serial killings are typically quite complex, the psychological analysis of a serial killer can provide valuable insight into how and why certain individuals become serial killers. Such knowledge may be instrumental in preventing future serial killings or in solving ongoing cases. In certain serial killings, the various incidents have a variety of similar features. Identification of similarities between separate homicidal incidents is necessary to recognize that a serial killer may be actively killing. In this report, the authors present a group of serial killings involving three prostitutes who were shot to death over a 3-month period. Scene and autopsy findings, including the unusual finding of postmortem enucleation of the eyes, led investigators to recognize the serial nature of the homicides. PMID:25682709

  19. Postmortem validation of MRI cortical volume measurements in MS.

    PubMed

    Popescu, Veronica; Klaver, Roel; Versteeg, Adriaan; Voorn, Pieter; Twisk, Jos W R; Barkhof, Frederik; Geurts, Jeroen J G; Vrenken, Hugo

    2016-06-01

    Grey matter (GM) atrophy is a prominent aspect of multiple sclerosis pathology and an important outcome in studies. GM atrophy measurement requires accurate GM segmentation. Several methods are used in vivo for measuring GM volumes in MS, but assessing their validity in vivo remains challenging. In this postmortem study, we evaluated the correlation between postmortem MRI cortical volume or thickness and the cortical thickness measured on histological sections. Sixteen MS brains were scanned in situ using 3DT1-weighted MRI and these images were used to measure regional cortical volume using FSL-SIENAX, FreeSurfer, and SPM, and regional cortical thickness using FreeSurfer. Subsequently, cortical thickness was measured histologically in 5 systematically sampled cortical areas. Linear regression analyses were used to evaluate the relation between MRI regional cortical volume or thickness and histological cortical thickness to determine which postprocessing technique was most valid. After correction for multiple comparisons, we observed a significant correlation with the histological cortical thickness for FSL-SIENAX cortical volume with manual editing (std. β = 0.345, adjusted R(2)  = 0.105, P = 0.005), and FreeSurfer cortical volume with manual editing (std. β = 0.379, adjusted R(2)  = 0.129, P = 0.003). In addition, there was a significant correlation between FreeSurfer cortical thickness with manual editing and histological cortical thickness (std. β = 0.381, adjusted R(2)  = 0.130, P = 0.003). The results support the use of FSL-SIENAX and FreeSurfer in cases of severe MS pathology. Interestingly none of the methods were significant in automated mode, which supports the use of manual editing to improve the automated segmentation. Hum Brain Mapp 37:2223-2233, 2016. © 2016 Wiley Periodicals, Inc. PMID:26945922

  20. Postmortem validation of breast density using dual-energy mammography

    SciTech Connect

    Molloi, Sabee Ducote, Justin L.; Ding, Huanjun; Feig, Stephen A.

    2014-08-15

    Purpose: Mammographic density has been shown to be an indicator of breast cancer risk and also reduces the sensitivity of screening mammography. Currently, there is no accepted standard for measuring breast density. Dual energy mammography has been proposed as a technique for accurate measurement of breast density. The purpose of this study is to validate its accuracy in postmortem breasts and compare it with other existing techniques. Methods: Forty postmortem breasts were imaged using a dual energy mammography system. Glandular and adipose equivalent phantoms of uniform thickness were used to calibrate a dual energy basis decomposition algorithm. Dual energy decomposition was applied after scatter correction to calculate breast density. Breast density was also estimated using radiologist reader assessment, standard histogram thresholding and a fuzzy C-mean algorithm. Chemical analysis was used as the reference standard to assess the accuracy of different techniques to measure breast composition. Results: Breast density measurements using radiologist reader assessment, standard histogram thresholding, fuzzy C-mean algorithm, and dual energy were in good agreement with the measured fibroglandular volume fraction using chemical analysis. The standard error estimates using radiologist reader assessment, standard histogram thresholding, fuzzy C-mean, and dual energy were 9.9%, 8.6%, 7.2%, and 4.7%, respectively. Conclusions: The results indicate that dual energy mammography can be used to accurately measure breast density. The variability in breast density estimation using dual energy mammography was lower than reader assessment rankings, standard histogram thresholding, and fuzzy C-mean algorithm. Improved quantification of breast density is expected to further enhance its utility as a risk factor for breast cancer.

  1. Essentials of forensic post-mortem MR imaging in adults

    PubMed Central

    Ruder, T D; Thali, M J; Hatch, G M

    2014-01-01

    Post-mortem MR (PMMR) imaging is a powerful diagnostic tool with a wide scope in forensic radiology. In the past 20 years, PMMR has been used as both an adjunct and an alternative to autopsy. The role of PMMR in forensic death investigations largely depends on the rules and habits of local jurisdictions, availability of experts, financial resources, and individual case circumstances. PMMR images are affected by post-mortem changes, including position-dependent sedimentation, variable body temperature and decomposition. Investigators must be familiar with the appearance of normal findings on PMMR to distinguish them from disease or injury. Coronal whole-body images provide a comprehensive overview. Notably, short tau inversion–recovery (STIR) images enable investigators to screen for pathological fluid accumulation, to which we refer as “forensic sentinel sign”. If scan time is short, subsequent PMMR imaging may be focussed on regions with a positive forensic sentinel sign. PMMR offers excellent anatomical detail and is especially useful to visualize pathologies of the brain, heart, subcutaneous fat tissue and abdominal organs. PMMR may also be used to document skeletal injury. Cardiovascular imaging is a core area of PMMR imaging and growing evidence indicates that PMMR is able to detect ischaemic injury at an earlier stage than traditional autopsy and routine histology. The aim of this review is to present an overview of normal findings on forensic PMMR, provide general advice on the application of PMMR and summarise the current literature on PMMR imaging of the head and neck, cardiovascular system, abdomen and musculoskeletal system. PMID:24191122

  2. The cardiothoracic ratio on post-mortem computer tomography.

    PubMed

    Jotterand, M; Doenz, F; Grabherr, S; Faouzi, M; Boone, S; Mangin, P; Michaud, K

    2016-09-01

    In clinical practice, the cardiothoracic ratio (CTR) was first utilized on plain chest radiography, and subsequently with computed tomography (CT) to diagnose cardiomegaly with a threshold of 0.5. Using CTR in forensic practice could help to detect cardiomegaly on post-mortem CT (PMCT) prior to the autopsy. However, an adaption of the threshold could be necessary because of post-mortem changes. Our retrospective study aimed to measure the CTR on PMCT and test the possible influence of variables. We selected 109 autopsy cases in which the heart weight was within normal limits. A forensic pathologist and a radiologist measured separately the CTR on axial and scout views on PMCT. We tested the statistical concordance between the two readers and between the axial and scout view and identified factors that could be associated with a modification of the CTR. The CTR measurements revealed an overestimation of the measurements made on scout compared to axial view. The inter-reader correlation was very high for both views. Among the different variables statistically tested, heart dilatation and body mass index (BMI) were the only two factors statistically associated with an augmentation of the CTR. The CTR can be useful in the diagnosis of cardiomegaly on PMCT. However, dilatation of the cardiac chambers caused by acute heart failure may be misinterpreted radiographically as cardiomegaly. Inter-observer reliability in our study was very high. CTR may be overestimated when measured on the scout view. Further investigations with larger cohorts, including cases with cardiac hypertrophy, are necessary to better understand the relationship between radiological CTR and the morphology of the heart. PMID:26886107

  3. Postmortem diagnosis and toxicological validation of illicit substance use.

    PubMed

    Lehrmann, Elin; Afanador, Zoan R; Deep-Soboslay, Amy; Gallegos, Gloria; Darwin, William D; Lowe, Ross H; Barnes, Allan J; Huestis, Marilyn A; Cadet, Jean L; Herman, Mary M; Hyde, Thomas M; Kleinman, Joel E; Freed, William J

    2008-03-01

    The present study examines the diagnostic challenges of identifying ante-mortem illicit substance use in human postmortem cases. Substance use, assessed by clinical case history reviews, structured next-of-kin interviews, by general toxicology of blood, urine and/or brain, and by scalp hair testing, identified 33 cocaine, 29 cannabis, 10 phencyclidine and nine opioid cases. Case history identified 42% cocaine, 76% cannabis, 10% phencyclidine and 33% opioid cases. Next-of-kin interviews identified almost twice as many cocaine and cannabis cases as Medical Examiner (ME) case histories, and were crucial in establishing a detailed lifetime substance use history. Toxicology identified 91% cocaine, 68% cannabis, 80% phencyclidine and 100% opioid cases, with hair testing increasing detection for all drug classes. A cocaine or cannabis use history was corroborated by general toxicology with 50% and 32% sensitivity, respectively, and with 82% and 64% sensitivity by hair testing. Hair testing corroborated a positive general toxicology for cocaine and cannabis with 91% and 100% sensitivity, respectively. Case history corroborated hair toxicology with 38% sensitivity for cocaine and 79% sensitivity for cannabis, suggesting that both case history and general toxicology underestimated cocaine use. Identifying ante-mortem substance use in human postmortem cases are key considerations in case diagnosis and for characterization of disorder-specific changes in neurobiology. The sensitivity and specificity of substance use assessments increased when ME case history was supplemented with structured next-of-kin interviews to establish a detailed lifetime substance use history, while comprehensive toxicology, and hair testing in particular, increased detection of recent illicit substance use. PMID:18201295

  4. External Beam Therapy (EBT)

    MedlinePlus

    ... Physician Resources Professions Site Index A-Z External Beam Therapy (EBT) External beam therapy (EBT) is a ... follow-up should I expect? What is external beam therapy and how is it used? External beam ...

  5. Pork Quality Traits According to Postmortem pH and Temperature in Berkshire.

    PubMed

    Kim, Tae Wan; Kim, Chul Wook; Yang, Mi Ra; No, Gun Ryoung; Kim, Sam Woong; Kim, Il-Suk

    2016-01-01

    This study was performed to investigate the role of pH and temperature postmortem, and to demonstrate the importance of these factors in determining meat quality. Postmortem pH 45min (pH at 45 min postmortem or initial pH) via analysis of Pearson's correlation showed high positive correlation with pH change pH c24 (pH change from pH 45min to pH 24h postmortem). However, postmortem pH after 24 h (pH 24h or ultimate pH) had a high negative correlation with pH change, pH c24 , CIE L*, and protein content. Initial temperature postmortem (T 1h ) was positively associated with a change in temperature from 45 min to 24 h postmortem (T c24 ) and cooking loss, but negatively correlated with water holding capacity. Temperature at 24 h postmortem (T 24h ) was negatively associated with T c24 . Collectively, these results indicate that higher initial pH was associated with higher pH c24 , T 1h , and T c24 . However, higher initial pH was associated with a reduction in carcass weight, backfat thickness, CIE a* and b*, water holding capacity, collagen and fat content, drip loss, and cooking loss as well as decreased shear force. In contrast, CIE a* and b*, drip loss, cooking loss, and shear force in higher ultimate pH was showed by a similar pattern to higher initial pH, whereas pH c24 , carcass weight, backfat thickness, water holding capacity, fat content, moisture content, protein content, T 1h , T 24h , and T c24 were exhibited by completely differential patterns (p<0.05). Therefore, we suggest that initial pH, ultimate pH, and temperatures postmortem are important factors in determining the meat quality of pork. PMID:27499661

  6. Fluorescently labeled bacteria provide insight on post-mortem microbial transmigration.

    PubMed

    Burcham, Z M; Hood, J A; Pechal, J L; Krausz, K L; Bose, J L; Schmidt, C J; Benbow, M E; Jordan, H R

    2016-07-01

    Microbially mediated mechanisms of human decomposition begin immediately after death, and are a driving force for the conversion of a once living organism to a resource of energy and nutrients. Little is known about post-mortem microbiology in cadavers, particularly the community structure of microflora residing within the cadaver and the dynamics of these communities during decomposition. Recent work suggests these bacterial communities undergo taxa turnover and shifts in community composition throughout the post-mortem interval. In this paper we describe how the microbiome of a living host changes and transmigrates within the body after death thus linking the microbiome of a living individual to post-mortem microbiome changes. These differences in the human post-mortem from the ante-mortem microbiome have demonstrated promise as evidence in death investigations. We investigated the post-mortem structure and function dynamics of Staphylococcus aureus and Clostridium perfringens after intranasal inoculation in the animal model Mus musculus L. (mouse) to identify how transmigration of bacterial species can potentially aid in post-mortem interval estimations. S. aureus was tracked using in vivo and in vitro imaging to determine colonization routes associated with different physiological events of host decomposition, while C. perfringens was tracked using culture-based techniques. Samples were collected at discrete time intervals associated with various physiological events and host decomposition beginning at 1h and ending at 60 days post-mortem. Results suggest that S. aureus reaches its highest concentration at 5-7 days post-mortem then begins to rapidly decrease and is undetectable by culture on day 30. The ability to track these organisms as they move in to once considered sterile space may be useful for sampling during autopsy to aid in determining post-mortem interval range estimations, cause of death, and origins associated with the geographic location of human

  7. Pork Quality Traits According to Postmortem pH and Temperature in Berkshire

    PubMed Central

    Kim, Tae Wan; Kim, Chul Wook; Yang, Mi Ra; No, Gun Ryoung; Kim, Il-Suk

    2016-01-01

    This study was performed to investigate the role of pH and temperature postmortem, and to demonstrate the importance of these factors in determining meat quality. Postmortem pH45min (pH at 45 min postmortem or initial pH) via analysis of Pearson’s correlation showed high positive correlation with pH change pHc24 (pH change from pH45min to pH24h postmortem). However, postmortem pH after 24 h (pH24h or ultimate pH) had a high negative correlation with pH change, pHc24, CIE L*, and protein content. Initial temperature postmortem (T1h ) was positively associated with a change in temperature from 45 min to 24 h postmortem (Tc24) and cooking loss, but negatively correlated with water holding capacity. Temperature at 24 h postmortem (T24h) was negatively associated with Tc24. Collectively, these results indicate that higher initial pH was associated with higher pHc24, T1h, and Tc24. However, higher initial pH was associated with a reduction in carcass weight, backfat thickness, CIE a* and b*, water holding capacity, collagen and fat content, drip loss, and cooking loss as well as decreased shear force. In contrast, CIE a* and b*, drip loss, cooking loss, and shear force in higher ultimate pH was showed by a similar pattern to higher initial pH, whereas pHc24, carcass weight, backfat thickness, water holding capacity, fat content, moisture content, protein content, T1h, T24h, and Tc24 were exhibited by completely differential patterns (p<0.05). Therefore, we suggest that initial pH, ultimate pH, and temperatures postmortem are important factors in determining the meat quality of pork. PMID:27499661

  8. Padova Charter on personal injury and damage under civil-tort law : Medico-legal guidelines on methods of ascertainment and criteria of evaluation.

    PubMed

    Ferrara, Santo Davide; Baccino, Eric; Boscolo-Berto, Rafael; Comandè, Giovanni; Domenici, Ranieri; Hernandez-Cueto, Claudio; Gulmen, Mete Korkut; Mendelson, George; Montisci, Massimo; Norelli, Gian Aristide; Pinchi, Vilma; Ranavaya, Mohammed; Shokry, Dina A; Sterzik, Vera; Vermylen, Yvo; Vieira, Duarte Nuno; Viel, Guido; Zoja, Riccardo

    2016-01-01

    Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first "International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law". This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM). PMID:26342285

  9. Biochemistry of postmortem muscle - lessons on mechanisms of meat tenderization.

    PubMed

    Huff Lonergan, Elisabeth; Zhang, Wangang; Lonergan, Steven M

    2010-09-01

    It is certain that meat tenderness is a highly valued consumer trait and thus definition of the multiple processes that influence meat tenderness will provide clues toward improving meat quality and value. The natural process by which meat becomes tender is complex. Tenderness development is dependent on the architecture and the integrity of the skeletal muscle cell and on events that modify those proteins and their interaction. Specifically protein degradation and protein oxidation have been identified as processes that modify proteins as well as the tenderness of meat. The intracellular environment is a major factor that controls these events. Ultimately, the interplay between these events determines the rate and extent of tenderization. Given the intricacy of the structure of the muscle cell, coupled with the complexity of the regulation of protein modification and the ever-changing intracellular environment it is not surprising that this area of research is a very dynamic field. Just as the overall integrity and function of muscle cells does not depend on a single protein, but rather on the coordinated interaction of several proteins, the structural weakening of muscle cells during postmortem aging also must not depend on the degradation of a single myofibrillar or other cytoskeletal protein. The proteins mentioned in this review are located in different regions of the muscle cell, and most have been implicated in some manner as being important in maintaining the structure and function of the muscle cell. Oxidation of myosin heavy chain, a predominant protein in the myofibril, is known to promote aggregation and toughening of meat. Degradation of proteins such as desmin, filamin, dystrophin, and talin (all located at the periphery of the Z-line) may disrupt the lateral register and integrity of the myofibril themselves as well as the attachments of the peripheral layer of myofibril to the sarcolemma. Degradation of the proteins within the myofibril that are

  10. Popliteal Vein Blood Sampling and the Postmortem Redistribution of Diazepam, Methadone, and Morphine.

    PubMed

    Lemaire, Eric; Schmidt, Carl; Denooz, Raphael; Charlier, Corinne; Boxho, Philippe

    2016-07-01

    Postmortem redistribution (PMR) refers to the site- and time-related blood drug concentration variations after death. We compared central blood (cardiac and subclavian) with peripheral blood (femoral and popliteal) concentrations of diazepam, methadone, and morphine. To our knowledge, popliteal blood has never been compared with other sites. Intracardiac blood (ICB), subclavian blood (SB), femoral blood (FB), and popliteal blood (PB) were sampled in 30 cases. To assess PMR, mean concentrations and ratios were compared. Influence of postmortem interval on mean ratios was also assessed. Results show that popliteal mean concentrations were lower than those for other sites for all three drugs, even lower than femoral blood; mean ratios suggested that the popliteal site was less subject to PMR, and estimated postmortem interval did not influence ratios except for diazepam and methadone FB/PB. In conclusion, our study is the first to explore the popliteal site and suggests that popliteal blood is less prone to postmortem redistribution. PMID:27364283

  11. Postmortem changes of ingested thinner components in tissues.

    PubMed

    Kimura, K; Nagata, T; Kato, K; Kudo, K; Imamura, T

    1991-06-01

    Postmortem changes of thinner components in body tissues were examined in rats, orally given 1 ml of standard thinner solution, which was prepared by mixing toluene, ethyl acetate and isobutanol in the proportion of 8:1:1. Analysis was made by gas chromatography combined with the head space method. Three thinner components and ethanol, a metabolite of ethyl acetate, were detected in the gastric contents of all rats up until 48 hours after death. An increase in the concentration of toluene was found in the blood, lung, kidney, liver, brain and abdominal muscle with the lapse of time. On the other hand, no changes were observed in the thigh muscle throughout the 48-hour period. Isobutanol showed a similar increasing pattern to toluene, with little or no changes in the brain or in the thigh muscle. Ethyl acetate was not detected in any tissues throughout the study but it was found in the gastric contents. The results indicate that every thinner component ingested, gradually diffuses into the surrounding tissues through the stomach wall after death, and that only muscle tissue remote from the abdominal cavity, together with the gastric contents, should be analyzed for a correct diagnosis of thinner ingestion. PMID:1920928

  12. [Detection of dengue virus antigen in post-mortem tissues].

    PubMed

    Rivera, Jorge; Neira, Marcela; Parra, Edgar; Méndez, Jairo; Sarmiento, Ladys; Caldas, María Leonor

    2014-01-01

    The epidemiological situation of dengue has worsened over the last decade. The difficulties in preventing its transmission and the absence of a vaccine or specific treatment have made dengue a serious risk to public health, health centers and research systems at different levels. Currently, most studies on the pathogenesis of dengue infection focus on the T-cell immune response almost exclusively in secondary infections and are aimed at identifying the mechanisms involved in the development of vascular permeability and bleeding events that accompany the infection. This report describes the case of a baby girl less than 45 days of age with clinical signs of severe dengue, whose diagnosis was confirmed by reverse transcription polymerase chain reaction in post-mortem tissue samples and by the ancillary diagnostic use of immunohistochemistry, which detected viral antigens in all organs obtained at autopsy. This case highlights the importance of studying primary infections associated with severe dengue, particularly in children, who are more likely to develop the severe form of the disease without previous infection, and it further stresses the importance of a diagnosis that should not be based solely on the examination of liver tissue samples when studying the pathogenesis of the viral infection. PMID:25504239

  13. Post-mortem cytogenomic investigations in patients with congenital malformations.

    PubMed

    Dias, Alexandre Torchio; Zanardo, Évelin Aline; Dutra, Roberta Lelis; Piazzon, Flavia Balbo; Novo-Filho, Gil Monteiro; Montenegro, Marilia Moreira; Nascimento, Amom Mendes; Rocha, Mariana; Madia, Fabricia Andreia Rosa; Costa, Thais Virgínia Moura Machado; Milani, Cintia; Schultz, Regina; Gonçalves, Fernanda Toledo; Fridman, Cintia; Yamamoto, Guilherme Lopes; Bertola, Débora Romeo; Kim, Chong Ae; Kulikowski, Leslie Domenici

    2016-08-01

    Congenital anomalies are the second highest cause of infant deaths, and, in most cases, diagnosis is a challenge. In this study, we characterize patterns of DNA copy number aberrations in different samples of post-mortem tissues from patients with congenital malformations. Twenty-eight patients undergoing autopsy were cytogenomically evaluated using several methods, specifically, Multiplex Ligation-dependent Probe Amplification (MLPA), microsatellite marker analysis with a MiniFiler kit, FISH, a cytogenomic array technique and bidirectional Sanger sequencing, which were performed on samples of different tissues (brain, heart, liver, skin and diaphragm) preserved in RNAlater, in formaldehyde or by paraffin-embedding. The results identified 13 patients with pathogenic copy number variations (CNVs). Of these, eight presented aneuploidies involving chromosomes 13, 18, 21, X and Y (two presented inter- and intra-tissue mosaicism). In addition, other abnormalities were found, including duplication of the TYMS gene (18p11.32); deletion of the CHL1 gene (3p26.3); deletion of the HIC1 gene (17p13.3); and deletion of the TOM1L2 gene (17p11.2). One patient had a pathogenic missense mutation of g.8535C>G (c.746C>G) in exon 7 of the FGFR3 gene consistent with Thanatophoric Dysplasia type I. Cytogenomic techniques were reliable for the analysis of autopsy material and allowed the identification of inter- and intra-tissue mosaicism and a better understanding of the pathogenesis of congenital malformations. PMID:27450648

  14. Postmortem and perimortem cesarean section: historical, religious and ethical considerations.

    PubMed

    Fadel, Hossam E

    2011-12-01

    Guillimeau was the first to use the term cesarean section (CS) in 1598, but this name became universal only in the 20th century. The many theories of the origin of this name will be discussed. This surgery has been reported to be performed in all cultures dating to ancient times. In the past, it was mainly done to deliver a live baby from a dead mother, hence the name postmortem CS (PMCS). Many heroes are reported to have been delivered this way. Old Jewish sacred books have made references to abdominal delivery. It was especially encouraged and often mandated in Catholicism. There is evidence that the operation was done in Muslim countries in the middle ages. Islamic rulings support the performance of PMCS. Now that most maternal deaths occur in the hospital, perimortem CS (PRMCS) is recommended for the delivery of a fetus after 24 weeks from a pregnant woman with cardiac arrest. It is believed that emergent delivery within four minutes of initiation of cardiopulmonary resuscitation (CPR) improves the chances of success of maternal resuscitation and survival and increases the chance of delivering a neurologically intact neonate. It is agreed that physicians are not to be held legally liable for the performance of PMCS and PRMCS regardless of the outcome. The ethical aspects of these operations are also discussed including a discussion about PMCS for the delivery of women who have been declared brain dead. PMID:23610509

  15. Postmortem computed tomography (PMCT) and disaster victim identification.

    PubMed

    Brough, A L; Morgan, B; Rutty, G N

    2015-09-01

    Radiography has been used for identification since 1927, and established a role in mass fatality investigations in 1949. More recently, postmortem computed tomography (PMCT) has been used for disaster victim identification (DVI). PMCT offers several advantages compared with fluoroscopy, plain film and dental X-rays, including: speed, reducing the number of on-site personnel and imaging modalities required, making it potentially more efficient. However, there are limitations that inhibit the international adoption of PMCT into routine practice. One particular problem is that due to the fact that forensic radiology is a relatively new sub-speciality, there are no internationally established standards for image acquisition, image interpretation and archiving. This is reflected by the current INTERPOL DVI form, which does not contain a PMCT section. The DVI working group of the International Society of Forensic Radiology and Imaging supports the use of imaging in mass fatality response and has published positional statements in this area. This review will discuss forensic radiology, PMCT, and its role in disaster victim identification. PMID:26108152

  16. Postmortem and Perimortem Cesarean Section: Historical, Religious and Ethical Considerations

    PubMed Central

    Fadel, Hossam E.

    2012-01-01

    Guillimeau was the first to use the term cesarean section (CS) in 1598, but this name became universal only in the 20th century. The many theories of the origin of this name will be discussed. This surgery has been reported to be performed in all cultures dating to ancient times. In the past, it was mainly done to deliver a live baby from a dead mother, hence the name postmortem CS (PMCS). Many heroes are reported to have been delivered this way. Old Jewish sacred books have made references to abdominal delivery. It was especially encouraged and often mandated in Catholicism. There is evidence that the operation was done in Muslim countries in the middle ages. Islamic rulings support the performance of PMCS. Now that most maternal deaths occur in the hospital, perimortem CS (PRMCS) is recommended for the delivery of a fetus after 24 weeks from a pregnant woman with cardiac arrest. It is believed that emergent delivery within four minutes of initiation of cardiopulmonary resuscitation (CPR) improves the chances of success of maternal resuscitation and survival and increases the chance of delivering a neurologically intact neonate. It is agreed that physicians are not to be held legally liable for the performance of PMCS and PRMCS regardless of the outcome. The ethical aspects of these operations are also discussed including a discussion about PMCS for the delivery of women who have been declared brain dead. PMID:23610509

  17. Disaster victim identification: new applications for postmortem computed tomography.

    PubMed

    Blau, Soren; Robertson, Shelley; Johnstone, Marnie

    2008-07-01

    Mass fatalities can present the forensic anthropologist and forensic pathologist with a different set of challenges to those presented by a single fatality. To date radiography has played an important role in the disaster victim identification (DVI) process. The aim of this paper is to highlight the benefits of applying computed tomography (CT) technology to the DVI process. The paper begins by reviewing the extent to which sophisticated imaging techniques, specifically CT, have been increasingly used to assist in the analysis of deceased individuals. A small scale case study is then presented which describes aspects of the DVI process following a recent Australian aviation disaster involving two individuals. Having grided the scene of the disaster, a total of 41 bags of heavily disrupted human remains were collected. A postmortem examination was subsequently undertaken. Analysis of the CT images of all body parts (n = 162) made it possible not only to identify and side differentially preserved skeletal elements which were anatomically unrecognizable in the heavily disrupted body masses, but also to observe and record useful identifying features such as surgical implants. In this case the role of the forensic anthropologist and CT technology were paramount in facilitating a quick identification, and subsequently, an effective and timely reconciliation, of body parts. Although this case study is small scale, it illustrates the enormous potential for CT imaging to complement the existing DVI process. PMID:18547358

  18. An acute gabapentin fatality: a case report with postmortem concentrations.

    PubMed

    Cantrell, F Lee; Mena, Othon; Gary, Ray D; McIntyre, Iain M

    2015-07-01

    Gabapentin (GBP) (Neurontin®, Horizant®, Gralise®) is a widely prescribed medication used primarily for the treatment of epilepsy and neuropathic pain. GBP has a favorable adverse effect profile in therapeutic dosing with the most common reported effects being dizziness, fatigue, drowsiness, weight gain, and peripheral edema. Even with intentional GBP self-poisonings, serious effects are rare. A 47-year-old female was found dead at work with her daughter's bottle of GBP 600 mg. There were 26 tablets missing and the decedent's only known medication was hydrocodone/acetaminophen. Following initial detection by an alkaline drug screen (GC-MS), analysis utilizing specific liquid chromatography-mass spectrometry revealed an elevated postmortem GBP peripheral blood concentration of 37 mg/L, central blood 32 mg/L, liver 26 mg/kg, vitreous 32 mg/L, and gastric contents 6 mg. Screening for volatiles, drugs of abuse, alkaline compounds, and acid/neutral compounds was negative with the exception of ibuprofen (<2 mg/L) detected in peripheral blood. This report presents a fatality that appears to be associated with an isolated and acute GBP ingestion. PMID:25904080

  19. Histological assessment of cellular changes in postmortem gingival specimens for estimation of time since death.

    PubMed

    Yadav, Achla Bharti; Angadi, Punnya V; Kale, Alka D; Yadav, Sumit Kumar

    2015-07-01

    Estimating the time after death is an important aspect of the role of a forensic expert. After death, the body undergoes substantial changes in its chemical and physical composition which can prove useful in providing an indication of the post-mortem interval. The most accurate estimate of the time of death is best achieved early in the post-mortem interval before the many environmental variables are able to affect the result. Whilst dependence on macroscopic observations was the foundation of the past practice, the application of histological techniques is proving to be an increasingly valuable tool in forensic research. The present study was conducted to evaluate the histologic post-mortem changes that take place in human gingival tissues and to correlate these changes with the time interval after death. Thirty one samples of post-mortem human gingival tissues were obtained from a pool of decedents at varied post-mortem intervals (0-8 hrs, 8-16 hrs, 16-24 hrs). Ante-mortem samples of gingival tissues for comparison were obtained from patients undergoing crown lengthening procedure. Histological changes in the epithelium (cytoplasmic and nuclear) and connective tissue were assessed. The initial epithelial changes observed were homogenization and eosinophilia while cytoplasmic vacuolation and other alterations, including shredding of the epithelium, ballooning, loss of nuclei and suprabasilar split were noticed in late post-mortem interval (16-24 hrs). Nuclear changes such as vacuolation, karyorrhexis, pyknosis and karyolysis became increasingly apparent with lengthening post-mortem intervals. Homogenizations of collagen and fibroblast vacuolation were also observed. To conclude; the initiation of decomposition at cellular level appeared within 24 hours of death and other features of decomposition were observed subsequently. Against this background, histological changes in the gingival tissues may be useful in estimating the time of death in the early post-mortem

  20. [Methodics and aspects of postmortem forensic psychiatric expertise in a civil law suit].

    PubMed

    Ileĭko, V R

    2002-01-01

    With the purpose of studying issues concerning conducting a postmortem forensic psychiatric examination (FPE) in a lawsuit, getting an expert opinion, an analysis was performed of 55 cases of postmortem FPE with respect to those subjects with mental disturbances secondary to vascular affection of the brain (cerebral atherosclerosis and relevant complications), having been within the competence of experts. Measures are submitted designed to do away with the disadvantages spotted. PMID:12587300

  1. Rapid alteration of protein phosphorylation during postmortem: implication in the study of protein phosphorylation.

    PubMed

    Wang, Yifan; Zhang, Yanchong; Hu, Wen; Xie, Shutao; Gong, Cheng-Xin; Iqbal, Khalid; Liu, Fei

    2015-01-01

    Protein phosphorylation is an important post-translational modification of proteins. Postmortem tissues are widely being utilized in the biomedical studies, but the effects of postmortem on protein phosphorylation have not been received enough attention. In the present study, we found here that most proteins in mouse brain, heart, liver, and kidney were rapidly dephosphorylated to various degrees during 20 sec to 10 min postmortem. Phosphorylation of tau at Thr212 and glycogen synthase kinase 3β (GSK-3β) at Ser9 was reduced by 50% in the brain with 40 sec postmortem, a regular time for tissue processing. During postmortem, phosphorylation of cAMP-dependent protein kinase (PKA) and AMP activated kinase (AMPK) was increased in the brain, but not in other organs. Perfusion of the brain with cold or room temperature phosphate-buffered saline (PBS) also caused significant alteration of protein phosphorylation. Cooling down and maintaining mouse brains in the ice-cold buffer prevented the alteration effectively. This study suggests that phosphorylation of proteins is rapidly changed during postmortem. Thus, immediate processing of tissues followed by cooling down in ice-cold buffer is vitally important and perfusion has to be avoided when protein phosphorylation is to be studied. PMID:26511732

  2. Adverse events, toxicity and post-mortem data on duloxetine: case reports and literature survey.

    PubMed

    Vey, Eric L; Kovelman, Inna

    2010-05-01

    Duloxetine, a dual acting norepinephrine serotonin reuptake inhibitor, is a relatively new pharmacologic agent utilized in the treatment of depression, as well as diabetic neuropathic pain, fibromyalgia, and female stress urinary incontinence. This expanding scope of usage will inevitably lead to its eventual appearance during routine post-mortem toxicologic assays. Currently there is a paucity of post-mortem toxicologic data concerning duloxetine. The current report provides six additional case reports of post-mortem duloxetine levels, along with a review of duloxetine's pharmacokinetics, and the toxicologic manifestations which have been reported in the literature. The post-mortem levels reported, including the highest level recorded to date, are integrated with previously published reports to generate a foundation for a nascent guide to the interpretation of post-mortem duloxetine levels that could be encountered during routine post-mortem toxicologic analyses, and establish a basis upon which the establishment of toxic and lethal thresholds for this compound can be further elucidated with greater clarity. PMID:20382351

  3. Running a postmortem service--a business case and clinical experience.

    PubMed

    Cohen, Marta C; Whitby, Elspeth; Fink, Michelle A; Collett, Jacquelene M; Offiah, Amaka C

    2015-04-01

    The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia. PMID:25828353

  4. Rapid alteration of protein phosphorylation during postmortem: implication in the study of protein phosphorylation

    PubMed Central

    Wang, Yifan; Zhang, Yanchong; Hu, Wen; Xie, Shutao; Gong, Cheng-Xin; Iqbal, Khalid; Liu, Fei

    2015-01-01

    Protein phosphorylation is an important post-translational modification of proteins. Postmortem tissues are widely being utilized in the biomedical studies, but the effects of postmortem on protein phosphorylation have not been received enough attention. In the present study, we found here that most proteins in mouse brain, heart, liver, and kidney were rapidly dephosphorylated to various degrees during 20 sec to 10 min postmortem. Phosphorylation of tau at Thr212 and glycogen synthase kinase 3β (GSK-3β) at Ser9 was reduced by 50% in the brain with 40 sec postmortem, a regular time for tissue processing. During postmortem, phosphorylation of cAMP-dependent protein kinase (PKA) and AMP activated kinase (AMPK) was increased in the brain, but not in other organs. Perfusion of the brain with cold or room temperature phosphate-buffered saline (PBS) also caused significant alteration of protein phosphorylation. Cooling down and maintaining mouse brains in the ice-cold buffer prevented the alteration effectively. This study suggests that phosphorylation of proteins is rapidly changed during postmortem. Thus, immediate processing of tissues followed by cooling down in ice-cold buffer is vitally important and perfusion has to be avoided when protein phosphorylation is to be studied. PMID:26511732

  5. [Pelvic and genital injuries in children. Sexual injuries of young girls. Management in a medico-legal context].

    PubMed

    Soutoul, J H; Robert, M; Pierre, F

    1988-01-01

    In the emergency care of a young girl presumed to be a victim of sexual assault and the treatment of the lesions discovered in the perineum and vulvo-vaginal tract, the paediatric surgeon must take into consideration the medico-legal aspects of the file right from the first approach to this young victim. It would actually be damaging to her if a paediatric surgeon reconstituted the perineal tissues, vulva and vagina "ad integrum" without carefully describing the lesions observed and without, whenever possible, taking good quality photographs to be kept in the case file to support the evidence of sexual assault, if a criminal procedure is filed. Similarly, as a complement to this assessment of the initial lesions, the surgeon must be able to establish an anatomical and functional assessment of the vulvo-vaginal tract after healing, to enable the experts appointed by the court to determine the basis for compensation of bodily damages related to the sexual assault and the expenses entailed by further plastic operations required by the sequelae of the genital lesions. The bases for a pretium doloris, future aesthetic, sexual and obstetric damages should also be indicated in any certificate given to the patient's family or to the court experts. Thus, if the surgeon participates indirectly in demonstrating evidence of the crime subject to penal sanction, he can help the victim in her parallel civil court action for compensation of her bodily damages before the repressive jurisdiction. PMID:3168089

  6. The medico-legal aspects of road traffic deaths in children under 5 years of age.

    PubMed

    Terranova, Claudio

    2015-11-01

    The family tragedy that results from a child who dies in a road traffic accident may be exacerbated by judicial consequences for the adult/parent driving the vehicle, carrying the child, or responsible for properly immobilising the child in the safety device that was used. The author presents two court cases of the road traffic accident deaths of two children under the age of five years. The two cases are presented using a methodological approach, which integrates competencies in other fields into the medico-legal aspects. An analysis of the two cases provides the opportunity to discuss the driver's responsibility to properly use child safety seat and to analyse and evaluate the efficacy and limits of child restraint systems. In the two cases, the responsibility for the application of a child safety device was excluded. It was confirmed that child protective devices are not always sufficient to avoid lesions or death in road accidents that occur with significant speed or other specific dynamics. PMID:26462201

  7. Medicolegal aspects of complex behaviours arising from the sleep period: a review and guide for the practising sleep physician.

    PubMed

    Morrison, Ian; Rumbold, John M M; Riha, Renata L

    2014-06-01

    This review is aimed at summarizing the current state of knowledge regarding parasomnias, which have been implicated in medicolegal cases as well as providing guidance to those working within common-law jurisdictions regarding the technical aspects of the law. Sleepwalking and sexsomnia as a defence are being raised more frequently in criminal cases and there has been public debate on their validity. Unfortunately, expert evidence on forensic sleep disorders continues to be heavily opinion-based with the potential for miscarriages of justice seen in recent highly publicized cases. There is an apparent inertia in research into violent sleep disorders. We review the current state of forensic sleep science in the United Kingdom (UK) and abroad and discuss the need to formulate guidelines based on available evidence. We also highlight the pressing necessity for more research in this area as well as the need to reform the law, which is the subject of a recent Criminal Law Commission report in the United Kingdom. In time, this will facilitate the efficient, proportionate, and just disposal of violence arising from sleep, thus benefitting both society and the individual sufferer. PMID:24095310

  8. Breast tissue decomposition with spectral distortion correction: A postmortem study

    PubMed Central

    Ding, Huanjun; Zhao, Bo; Baturin, Pavlo; Behroozi, Farnaz; Molloi, Sabee

    2014-01-01

    Purpose: To investigate the feasibility of an accurate measurement of water, lipid, and protein composition of breast tissue using a photon-counting spectral computed tomography (CT) with spectral distortion corrections. Methods: Thirty-eight postmortem breasts were imaged with a cadmium-zinc-telluride-based photon-counting spectral CT system at 100 kV. The energy-resolving capability of the photon-counting detector was used to separate photons into low and high energy bins with a splitting energy of 42 keV. The estimated mean glandular dose for each breast ranged from 1.8 to 2.2 mGy. Two spectral distortion correction techniques were implemented, respectively, on the raw images to correct the nonlinear detector response due to pulse pileup and charge-sharing artifacts. Dual energy decomposition was then used to characterize each breast in terms of water, lipid, and protein content. In the meantime, the breasts were chemically decomposed into their respective water, lipid, and protein components to provide a gold standard for comparison with dual energy decomposition results. Results: The accuracy of the tissue compositional measurement with spectral CT was determined by comparing to the reference standard from chemical analysis. The averaged root-mean-square error in percentage composition was reduced from 15.5% to 2.8% after spectral distortion corrections. Conclusions: The results indicate that spectral CT can be used to quantify the water, lipid, and protein content in breast tissue. The accuracy of the compositional analysis depends on the applied spectral distortion correction technique. PMID:25281953

  9. Can postmortem computed tomography detect antemortem hypoxic-ischemic encephalopathy?

    PubMed

    Shirota, Go; Ishida, Masanori; Shintani, Yukako; Abe, Hiroyuki; Ikemura, Masako; Fukayama, Masashi; Gonoi, Wataru

    2016-09-01

    The purpose of this study was to evaluate the usefulness of brain postmortem computed tomography (PMCT) findings for the detection of global hypoxia or hypoperfusion leading to hypoxic-ischemic encephalopathy (HIE) prior to death. Cadavers of individuals who died from non-traumatic causes were subjected to PMCT and pathological autopsy. Cases with an episode of cardiopulmonary arrest, hypoxia, or hypoperfusion that required intensive respiratory management at least 24 h before death and exhibited findings of HIE in conventional autopsy (HIE group, n = 6) were compared with those without such episodes prior to death (control group; overall, n = 37; age-matched, n = 8) with regard to four parameters: (1) width of the central sulcus (CS), (2) attenuation difference at the basal ganglia (BG) level, (3) attenuation difference between cerebral gray matter (GM) and cerebral white matter (WM), and (4) attenuation difference between cerebellar GM and cerebral GM. The results revealed significant differences in the width of the CS (P < 0.001), attenuation difference at the BG level (P < 0.001), and attenuation difference between cerebral GM and cerebral WM (P = 0.009) between the HIE group and the overall control group. When the age-matched control group and the HIE group were compared, there was a significant difference in the width of the CS (P = 0.026) and attenuation difference at the BG level (P < 0.001). Our results suggest that effacement of the sulcus of the cerebral hemisphere and the loss of contrast at the BG level on brain PMCT indicate the existence of HIE prior to death. PMID:27342771

  10. Evidential value of postmortem MRI in forensic pathology

    NASA Astrophysics Data System (ADS)

    Schweitzer, Wolf; Schaepman, Michael E.; Ith, Michael; Bruegger, Karin; Thali, Michael J.; Doernhofer, Tanya; Tiefenthaler, Kathrin; Scheurer, Eva; Vock, Peter; Boesch, Chris; Dirnhofer, Richard

    2001-05-01

    We currently evaluate MRI as add-on to dissection. Cases can only build on high evidential values of morphological findings as estimated using Bayesian likelihood-ratios. These values may vary among different cases depending on the quality of the morphology and the discrete hypotheses to be discerned. After scanning 20 bodies using MRI admitted to our institute for autopsy, we reconstructed selected imaging findings from a couple of illustrative cases according to a geometrical model ('Pink Box') designed as an object oriented bridging protocol to enable comparison of autopsy and MRI data. Although it appears obvious that 'three-dimensional imaging yields relevant diagnoses,' comparison of selected findings suggests, that the real evidential value of a postmortem scan depends on basic geometrical features of tissue structures examined. (1) Tissue surfaces are difficult to examine in MRI, including surface features of contact wounds in firearm injuries, lacerations of the pleura, or skin needle marks. (2) Specificity and sensitivity of solid tissue block data depend on contrast and resolution. (3) Tunnels or tubes, such as coronary arteries, linear wound tracks or the aorta offer more degrees of freedom for reconstruction, including spatial reconstruction or cross sectioning in different directions. (4) Three-dimensional rendering of complex objects results in spectacular images. Their evidential value is dependent on the way thresholding of 2D slices is validated. We present illustrative examples which suggest that a possible integration of non-invasive imaging methods into Forensic Pathology in fact need to take basic geometry into consideration when discussing evidential value.

  11. Breast tissue decomposition with spectral distortion correction: A postmortem study

    SciTech Connect

    Ding, Huanjun; Zhao, Bo; Baturin, Pavlo; Behroozi, Farnaz; Molloi, Sabee

    2014-10-15

    Purpose: To investigate the feasibility of an accurate measurement of water, lipid, and protein composition of breast tissue using a photon-counting spectral computed tomography (CT) with spectral distortion corrections. Methods: Thirty-eight postmortem breasts were imaged with a cadmium-zinc-telluride-based photon-counting spectral CT system at 100 kV. The energy-resolving capability of the photon-counting detector was used to separate photons into low and high energy bins with a splitting energy of 42 keV. The estimated mean glandular dose for each breast ranged from 1.8 to 2.2 mGy. Two spectral distortion correction techniques were implemented, respectively, on the raw images to correct the nonlinear detector response due to pulse pileup and charge-sharing artifacts. Dual energy decomposition was then used to characterize each breast in terms of water, lipid, and protein content. In the meantime, the breasts were chemically decomposed into their respective water, lipid, and protein components to provide a gold standard for comparison with dual energy decomposition results. Results: The accuracy of the tissue compositional measurement with spectral CT was determined by comparing to the reference standard from chemical analysis. The averaged root-mean-square error in percentage composition was reduced from 15.5% to 2.8% after spectral distortion corrections. Conclusions: The results indicate that spectral CT can be used to quantify the water, lipid, and protein content in breast tissue. The accuracy of the compositional analysis depends on the applied spectral distortion correction technique.

  12. Deuterium inventory in Tore Supra: reconciling particle balance and post-mortem analysis

    NASA Astrophysics Data System (ADS)

    Tsitrone, E.; Brosset, C.; Pégourié, B.; Gauthier, E.; Bouvet, J.; Bucalossi, J.; Carpentier, S.; Corre, Y.; Delchambre, E.; Desgranges, L.; Dittmar, T.; Douai, D.; Ekedahl, A.; Escarguel, A.; Ghendrih, Ph.; Grisolia, C.; Grosman, A.; Gunn, J.; Hong, S. H.; Jacob, W.; Kazarian, F.; Kocan, M.; Khodja, H.; Linez, F.; Loarer, T.; Marandet, Y.; Martinez, A.; Mayer, M.; Meyer, O.; Monier Garbet, P.; Moreau, P.; Pascal, J. Y.; Pasquet, B.; Rimini, F.; Roche, H.; Roure, I.; Rosanvallon, S.; Roubin, P.; Roth, J.; Saint-Laurent, F.; Samaille, F.; Vartanian, S.

    2009-07-01

    Fuel retention, a crucial issue for next step devices, is assessed in present-day tokamaks using two methods: particle balance performed during shots and post-mortem analysis carried out during shutdowns between experimental campaigns. Post-mortem analysis generally gives lower estimates of fuel retention than integrated particle balance. In order to understand the discrepancy between these two methods, a dedicated experimental campaign has been performed in Tore Supra to load the vessel walls with deuterium (D) and monitor the trapped D inventory through particle balance. The campaign was followed by an extensive post-mortem analysis phase of the Tore Supra limiter. This paper presents the status of the analysis phase, including the assessment of the D content in the castellated tile structure of the limiter. Indeed, using combined surface analysis techniques, it was possible to derive the relative contributions of different zones of interest on the limiter (erosion, thick deposits, thin deposits), showing that the post-mortem inventory is mainly due to codeposition (90% of the total), in particular due to gap deposits. However, deuterium was also evidenced deep into the material in erosion zones (10% of the total). At the present stage of the analysis, 50% of the inventory deduced from particle balance has been found through post-mortem analysis, a significant progress with respect to previous studies (factor 8-10 discrepancy). This shows that post-mortem analysis can be consistent with particle balance provided specific procedures are implemented (dedicated campaign followed by extensive post-mortem analysis). Both techniques are needed for a reliable assessment of fuel retention in tokamaks, giving complementary information on how much and where fuel is retained in the vessel walls.

  13. Medicolegal liability in surgical pathology: a consideration of underlying causes and selected pertinent concepts.

    PubMed

    Wick, Mark R

    2007-05-01

    Malpractice actions against surgical pathologists are still relatively uncommon, but they have increased in frequency over time and are associated with sizable indemnity figures. This discussion categorizes areas of liability in surgical pathology into three groups: those that represent health system flaws (problems with specimen identification, or transportation, or both; lack of clinical information or erroneous information; sampling effects and defects; and poorly reproducible or poorly defined diagnostic or prognostic criteria), others that exist at the interface between the system and individuals (allowing clinicians to bypass pathologic review of referred specimens; acceding to clinical demands for inadvisable procedures; and working in a disruptive environment), and truly individual errors by pathologists (lapses in reasoning; deficiencies concerning continuity in the laboratory; invalid assumptions regarding recipients of surgical pathology reports; over-reliance on the results of "special" tests; and problems with peer consultation). Finally, two important topic areas are discussed that commonly enter into lawsuits filed against surgical pathologists; namely, "delay in diagnosis" of malignant neoplasms and "failure to provide adequate prognostic information." Based on a review of the pertinent literature, we conclude that the clinical courses of most common malignancies are not affected in a significant manner by delays in diagnosis. Moreover, the practice of using "personalized external validity" for supposedly prognostic tests is examined, with the resulting opinion that prognostication of tumor behavior in individual patients is not reliable using anything but anatomic staging systems. PMID:17633350

  14. Postmortem diffusion of n-butane and i-butane used for anticontagious plugging spray.

    PubMed

    Okuda, Katsuhiro; Maseda, Chikatoshi; Asari, Masaru; Isozaki, Shotaro; Kiya, Hiroshi; Yajima, Daisuke; Shiono, Hiroshi; Shimizu, Keiko

    2016-03-01

    Blood and tissue samples from a forensic autopsy of a man in his late 60s, who developed dementia and died of multiple head traumas due to a fall from a moving vehicle, contained certain amounts of n-butane and i-butane. The concentration of n-butane was in the range of 0.48-70.5 μL/g, which would be considered as toxic or lethal levels. We had to distinguish whether the cause of his unexplained behavior was due to his pre-existing condition (dementia), or from a confused state induced by butane abuse. No traces of butane use were found at the scene. Police investigation revealed that a propellant used in an anticontagious plugging spray had been administered to him during a postmortem treatment in the emergency hospital. In order to prove the postmortem butane diffusion had resulted from the spray administration and to estimate the diffused concentration, experimental simulation was conducted by using rats. As a result of postmortem treatment with the spray, n-butane at concentrations of 0.54-15.5 μL/mL or g were found in the rat blood and tissues. In this case, we provided further evidence that the postmortem butane diffusion, caused by using the anticontagious plugging spray containing butane gas as a propellant administered to a cadaver during a postmortem procedure prior to forensic autopsy, should be distinguished from cases of actual butane poisoning. PMID:26318540

  15. Influence of porcine circovirus type 2 vaccination on the probability and severity of pneumonia detected postmortem

    PubMed Central

    Raith, J.; Kuchling, S.; Schleicher, C.; Schobesberger, H.; Köfer, J.

    2015-01-01

    To evaluate the influence of porcine circovirus type 2 vaccination (PCV-2) on the probability and severity of pneumonia, postmortem findings of 247,505 pigs slaughtered between 2008 and 2011 were analysed by applying a cumulative link mixed model. Three major effects could be observed: (1) PCV-2 vaccination significantly (P<0.01) reduced the odds (coefficient: −0.05) of postmortem findings of mild, moderate and severe pneumonia for vaccinated pigs. (2) Pigs from fattening farms were less likely (coefficient: −0.44; P<0.05) to exhibit signs of pneumonia at slaughter than pigs from farrow-to-finish farms. (3) When vaccinated, the odds of detecting postmortem signs showed an even more pronounced reduction (coefficient: −0.19; P<0.001) for pigs from fattening farms. Combining PCV-2 vaccination, farm type and interaction effects between these two factors, a pig vaccinated against PCV-2 from a fattening farm had only half the chance (OR 0.51) of pneumonia being detected at postmortem than a non-vaccinated pig from a farrow-to-finish farm. The study demonstrates the benefit of a vaccination programme against PCV-2 as an important tool to reduce the risk of postmortem pneumonia findings and the severity of pneumonia in pigs at slaughter. PMID:25413158

  16. Postmortem MRI of Human Brain Hemispheres: T2 Relaxation Times during Formaldehyde Fixation

    PubMed Central

    Dawe, Robert J.; Bennett, David A.; Schneider, Julie A.; Vasireddi, Sunil K.; Arfanakis, Konstantinos

    2009-01-01

    Unlike in vivo imaging, postmortem MRI allows for invasive examination of the tissue specimen immediately following the MR scan. However, natural tissue decomposition and chemical fixation cause the postmortem tissue’s MRI properties to be different from those found in vivo. Moreover, these properties change as postmortem fixation time elapses. The goal of this study was to characterize the T2 relaxation changes that occur over time in cadaveric human brain hemispheres during fixation. Five hemispheres immersed in formaldehyde solution were scanned on a weekly basis for three months postmortem, and once again at six months postmortem. The T2 relaxation times were measured throughout the hemispheres. Over time, T2 values near the edges of the hemispheres decreased rapidly after death, while T2 values of deep tissue decreased more slowly. This difference is likely due to the relatively large distance from the hemisphere surface, and other barriers limiting diffusion of formaldehyde molecules to deep tissues. In addition, T2 values in deep tissue did not continuously decay to a plateau, but instead reached a minimum and then increased to a plateau. This final increase may be due to the effects of prolonged tissue decomposition, a hypothesis that is supported by numerical simulations of the fixation process. PMID:19189294

  17. Postmortem serum endotoxin level in relation to the causes of death.

    PubMed

    Zhu, Bao-Li; Ishikawa, Takaki; Michiue, Tomomi; Quan, Li; Maeda, Hitoshi

    2005-03-01

    Serum endotoxin is a clinical marker of sepsis. However, it is vulnerable to bacterial contamination, and the postmortem stability has not been established. In the present study, to evaluate the forensic pathological significance of postmortem endotoxemia in relation to the causes of death, we investigated a series of 111 autopsy cases (postmortem interval<48 h), in part, using bacteriological investigations. Systemic endotoxemia involving both the cardiac and peripheral blood was observed in some specific causes of death, including pneumonia (n=1/3), peritonitis (n=2/5), delayed traumatic death with severe secondary infection (n=7/33), drownings (freshwater, n=3/9; saltwater, n=3/16), fire deaths (n=3/16), and also in protracted deaths under critical medical care (n=2). Most cases of fatal blunt injury (n=4/5) showed sporadic endotoxemia in cardiac or peripheral blood, whereas there was no elevation of serum endotoxin in acute hemorrhagic death from sharp instrument injury (n=6). The bacteriological investigation showed some characteristic profiles in infections and drownings. These observations suggested that, although endotoxin is a vulnerable serum marker to ante and postmortem interference, systemic postmortem endotoxemia involving peripheral blood may be a possible indicator of antemortem bacteremia related to some specific causes of death accompanied by advanced infection or pulmonary alveolar damage in the dying process especially due to drownings and fires. PMID:15708333

  18. [Opium alcaloids in toxicological medico-legal practice of Department of Forensic Medicine, Jagiellonian University Medical College].

    PubMed

    Kłys, Małgorzata; Rojek, Sebastian; Maciów-Głab, Martyna; Kula, Karol

    2013-01-01

    Most likely, opium was the first narcotic substance discovered at the dawn of mankind. Contemporary drug abuse predominantly poses a social and clinical problem and encompasses among other aspects emergency procedures in cases of intoxication and treatment of addictions. On the other hand, this is also a problem of the judicial system, which implements the rule of apt punishment in criminal cases (rapes, robberies, drivers, production and trade in narcotic substances) and of the necessity of monitoring drug-associates deaths. In all drug-associated cases, investigative capabilities have increased with the introduction of extremely sensitive and specific analytical methods (GC-MS, LC/MS, HPLC/DAD) allowing for detection and identification of multi-component mixtures of xenobiotics found at low concentration levels in complex biological matrices. The history of the Krakow Department of Forensic Medicine dates back to the year 1877, since archival materials have been kept since that time. Isolated deaths resulting from morphine poisoning, mostly involving individuals employed in the health care sector, constituted the subject of medico-legal expert opinions starting at the beginning of the 20th century, but only the eighties did bring the need for multidirectional toxicological examinations of opiates and their metabolites in diversified biological and non-biological materials. The present report, in addition to the historical background of opiate addiction, discusses selected problems derived from published by Department reports on opiates, including cases of fatal intoxication, hair analysis of drug addicts in its various aspects, interactions in cases of poisoning and others. PMID:24847643

  19. Clinical profile of medicolegal cases presenting to the eye casualty in a tertiary care center in India

    PubMed Central

    Tripathy, Koushik; Chawla, Rohan; Venkatesh, Pradeep; Vohra, Rajpal; Sharma, Yog Raj

    2016-01-01

    Purpose: The purpose of this study was to analyze the clinical profile of medicolegal cases (MLCs) presenting to the eye casualty in a tertiary care hospital. Materials and Methods: Retrospective review of records. The cases were grouped according to the Ocular Trauma Classification Group classification system. Results: Out of 188 MLCs, 164 (87.2%) were male. Mean age (±standard deviation) was 31.6 (±12.7) years. Age ranged from 7 to 75 years. Twenty-six (13.8%) patients had bilateral involvement. The fist was the most common mode of injury, which was seen in 109 (58%) cases. A total of 27 (14.3%) patients had associated extraocular injury. No evidence of ocular or orbital trauma (malingering) could be found in 13 (7%) patients. Mechanical trauma was present in 169 (90%) patients with injury to globe in 129 (69%) patients and injury to lid or orbit without damage to the globe in 40 (21%) patients. Chemical injury was observed in 6 (3%) patients. Closed globe injury (CGI) was seen in 116 eyes and open globe injury (OGI) was noted in 29 eyes. The most common type of injury, zone, pupil, and grade of injury in CGI were Type A or contusion (79%), Zone I (72%), Pupil B (absence of relative afferent pupillary defect) in 95%, and Grade A [visual acuity (VA) ≥20/40] in 68% of the eyes, respectively. The most common type of injury, zone, pupil, and grade of injury in OGI were Type B or penetrating (48%), Zone II (38%), Pupil B (59%), and Grade D (VA 4/200-light perception) (42%), respectively. Conclusions: The most common form and mode of ocular injury in MLC were closed globe injury and fist, respectively. The most common type of injury in CGI and OGI was contusion and penetrating injury, respectively. PMID:27488149

  20. Interpersonal violence in road rage. Cases from the Medico-Legal Center for Victims of Violence in Hamburg.

    PubMed

    Pfeiffer, Joost-Levin; Pueschel, Klaus; Seifert, Dragana

    2016-04-01

    Aggressive behavior in traffic is a widespread phenomenon. Up to 90% of the population are involved in mild forms such as shouting or gesturing. More dramatic cases with injury to individuals affect at least 1100 people in the US annually. Certain factors such as a male sex, a young age and an urban residency have been identified to contribute to the likelihood of road rage. Central to this analysis is the determination of specific features regarding the conflicting parties, the crime scene and the injury pattern in violent offenses related to traffic. In a retrospective study spanning 10 years, cases of road rage-linked injuries were identified amongst patients at the Medico-Legal Center of the Institute of Legal Medicine in Hamburg, Germany. The data were digitized and then analyzed using descriptive statistics via SPSS. There are disproportionately large numbers of males (85.7%) and motorists (61.2%) amongst road rage perpetrators. Usually the conflicting parties have no prior relationship (89.7%). In 68.1% of the cases, the violence applied was exclusively physical. Objects were utilized in 31.0% of all cases, and in more than half (55.6%) of these cases the vehicle was used as a weapon. The resulting trauma in road rage is mostly blunt and applied to the face and the extremities. There are characteristic features regarding the demographics, time and place of incident, as well as severity and pattern of injury in road rage associated offenses. Identifying these factors may lead to appropriate measures in the reduction of road rage. PMID:26817969

  1. Comparison of injuries due to lethal weapons during and after civil strife in Sri Lanka: A medico-legal study

    PubMed Central

    Vidanapathirana, Muditha; Ruwanpura, Rohan P; Amararatne, Sriyantha RRG; Ratnaweera, Ajith RHI

    2016-01-01

    Background and Aims: “Injuries due to lethal weapons” has emerged as a subject of public discussion in Sri Lanka. This study was conducted to describe the nature and characteristics of injuries due to lethal weapons during civil strife and to compare those with injuries after civil strife. Methods: A cross-sectional study was conducted on patients reported with injuries caused by lethal weapons from 2004 to 2014. Periods before and after May 19, 2009 were considered as during and after civil strife periods, respectively. A total of 21,210 medico-legal examination forms were studied. Results: There were 358 (1.7%) injuries caused by lethal weapons. Of them, 41% (n = 148) were during and 59% (n = 210) were after the civil strife. During civil strife, 63% occurred during daytime (P < 0.05). Types of lethal weapons that caused injuries were sharp weapons (n = 282), explosives (n = 49), and firearms (n = 27). Of them, 32% of during and 01% of after civil strife were explosive injuries (P < 0.01). Regarding severity, 73% of during and 57% of after civil strife injuries were severe (P < 0.05). During civil strife, 34% injuries were in lower limbs (P < 0.01) and after civil strife, 37% were in upper limbs (P < 0.05). Conclusions: The presence of many similarities indicated that both groups learnt their basis in a society that breeds violence. During civil strife, more injuries occurred during daytime, to lower limbs by explosive weapons and after the civil strife during nighttime, to upper limbs by nonexplosive weapons. Nonexplosive lethal weapon use after civil strife needs further investigation to develop evidence-based interventions. PMID:27127743

  2. Usefulness and limitations of postmortem computed tomography in forensic analysis of gunshot injuries: Three case reports.

    PubMed

    Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Kozakai, Masataka; Saito, Haruo; Funayama, Masato

    2016-01-01

    Gunshot injury has always been an important field of investigation in postmortem forensic radiology. The localization and retrieval of the bullet and of potentially important fragments are vital to these cases. Using postmortem multidetector-row computed tomography (MDCT) prior to forensic autopsy, we sought to illustrate the importance of this modality in the noninvasive characterization of gunshot wounds. We obtained and analyzed MDCT images in three cases of gunshot wounds (accidental close-range shotgun shooting, suicidal contact gunshot to the head and accidental long-range buckshot shooting). We discuss the value of postmortem MDCT findings in gunshot wound cases by comparing with forensic autopsy findings in Japan, a developing country with miserably low autopsy rate. PMID:26832386

  3. Evaluation of Virulence Factors and Antifungal Susceptibility in Yeast Isolates from Postmortem Specimens.

    PubMed

    Yagmur, Gulhan; Sav, Hafize; Ziyade, Nihan; Elgormus, Neval; Sen, Sumeyye; Akkoyun Bilgi, Esma; Atan, Yusuf; Buyuk, Yalcin; Kiraz, Nuri

    2016-07-01

    Invasive fungal infections are a leading cause of morbidity and mortality in immunocompromised patients, especially in cases requiring a prolonged stay in the intensive care unit. A total of 99 yeast strains were isolated from 42 postmortem cases. In this study, virulence factors and antifungal susceptibility of these species were evaluated. The isolates were identified as Candida albicans (54), C. tropicalis (15), C. glabrata (12), C. parapsilosis (6), C. lipolytica (3), C. utilis (3), C. krusei (2), C. kefyr (1), and Cryptococcus neoformans (3). The most commonly isolated species was C. albicans, and no resistant species were determined. Despite the equal number of specimens, no secretion of significant virulence factors was associated with the postmortem specimen in the Candida species. Postmortem fungal investigations in forensic autopsies are useful in explaining cause of death in such cases, also may lead to protocols for the treatment of fungal infections and contribute to fungal pathogenesis and epidemiological data. PMID:27364280

  4. Hyperdensity of the Basilar Artery on Postmortem CT: A Potential Indicator for Basilar Artery Thrombosis.

    PubMed

    Garland, Jack; Tse, Rexson; Beh, Raymond J; Lyons, Timothy J; Cala, Allan D

    2016-06-01

    Basilar artery thrombosis constitutes 1% of all types of stroke, carries a mortality rate of up to 90%, and is one of the rarer causes of sudden death. It leads to brain stem ischemia and commonly presents with impaired consciousness, cranial nerve palsy, hemiplegia or quadriplegia, and sudden collapse. Clinically, the diagnosis of basilar artery thrombosis is made on clinical symptoms, along with a hyperdense basilar artery in antemortem computed tomography (CT) scan. To our knowledge, whether a hyperdense basilar artery indicates basilar artery thrombosis on postmortem CT scan is not documented in the literature. We present a case report of a 55-year-old man who on postmortem CT scan showed a hyperdense basilar artery and was subsequently confirmed to be a fatal basilar artery thrombosis. We suggest that a hyperdense basilar artery on postmortem CT should prompt the pathologist to consider basilar artery thrombosis. PMID:27049662

  5. Postmortem drug concentration intervals for the non-intoxicated state - A review.

    PubMed

    Linnet, Kristian

    2012-07-01

    In postmortem toxicology, it is important to know what the usual drug level is in blood under ordinary therapy to make correct interpretations with regard to the possible occurrence of poisoning. A commonly used source is The International Association of Forensic Toxicologists (TIAFT) list of drug concentrations providing therapeutic drug levels, usually measured in serum. In this article, published postmortem-derived blood drug reference concentration intervals were related to therapeutic serum levels of drugs from the TIAFT list to assess agreement or discrepancies with focus on the importance of postmortem redistribution. The ratio between the upper limits was evaluated. This ratio ranged from 0.13 to 11.3 for 57 compounds with a median value of 1.5. For about a third of the compounds the ratio exceeded three. There was a tendency that for highly water-soluble drugs with a low propensity for redistribution, the ratio was generally low. For example, for pentobarbital, carisoprodol, meprobamate, carbamazepine, phenazone and theophylline, the ratio ranged from 0.14 to 1.1 with a median of 0.4. For the 15 antidepressants considered, on the other hand, the ratio was relatively high, ranging from 0.6 to 4.7 (median 2.4). For antipsychotics, the ratio ranged from 0.2 to 11.3 with a median of 1.4. In conclusion, there were generally wide discrepancies between serum-based intervals as presented in the TIAFT list and published postmortem blood-based drug reference intervals. More focus on postmortem-derived intervals is encouraged, so that those that have been estimated are cited in reference publications and so that further intervals are estimated. Ultimately, a reliable database of postmortem blood-based drug reference intervals for use by the forensic community is desirable. PMID:22687764

  6. Postmortem redistribution of the heroin metabolites morphine and morphine-3-glucuronide in rabbits over 24 h.

    PubMed

    Maskell, Peter D; Albeishy, Mohammed; De Paoli, Giorgia; Wilson, Nathan E; Seetohul, L Nitin

    2016-03-01

    The interpretation of postmortem drug levels is complicated by changes in drug blood levels in the postmortem period, a phenomena known as postmortem drug redistribution. We investigated the postmortem redistribution of the heroin metabolites morphine and morphine-3-glucuronide in a rabbit model. Heroin (1 mg/kg) was injected into anesthetised rabbit; after 1 h, an auricular vein blood sample was taken and the rabbit was euthanised. Following death rabbits were placed in a supine position at room temperature and divided into three groups namely (1) immediate autopsy, (2) autopsy after 30 minutes and (3) autopsy 24 h after death. Various samples which included femoral blood, cardiac blood, lung, liver, kidney, vitreous humour, subcutaneous and abdominal fat, liver, bone marrow and skeletal muscle were taken. The samples were analysed with a validated LC-MS/MS method. It was observed that within minutes there was a significant increase in free morphine postmortem femoral blood concentration compared to the antemortem sample (0.01 ± 0.01 to 0.05 ± 0.02 mg/L).Various other changes in free morphine and metabolite concentrations were observed during the course of the experiment in various tissues. Principal component analysis was used to investigate possible correlations between free morphine in the various samples. Some correlations were observed but gave poor predictions (>20 % error) when back calculating. The results suggest that rabbits are a good model for further studies of postmortem redistribution but that further study and understanding of the phenomena is required before accurate predictions of the blood concentration at the time of death are possible. PMID:25863436

  7. Effects of probiotics feeding on meat quality of chicken breast during postmortem storage.

    PubMed

    Kim, H W; Yan, F F; Hu, J Y; Cheng, H W; Kim, Y H B

    2016-06-01

    This study evaluated the effects of dietary probiotic supplement and postmortem storage on meat quality of chicken breast during retail display. A total of 35 birds were randomly obtained from 3 feeding groups (control without probiotic supplement, 250 ppm Sporulin, and 500 ppm PoultryStar). The probiotic supplement had no influence on feed conversion ratio and body weight gain, as well as body weight at 29 and 44 d (P > 0.05). After slaughter, each side of the breast muscles (M. Pectoralis major) was assigned to either one d or 5 d of postmortem storage. Probiotic supplement had no influence on the rate of pH decline of chicken breast muscles during the initial 6 h postmortem (P > 0.05). No interactions between probiotic supplement and postmortem storage on meat quality were found (P > 0.05). Postmortem storage decreased drip loss from 25.30 to 18.05% (P < 0.05). Probiotics-fed chicken groups, particularly PoultryStar treatment, had a higher myofibrillar fragmentation index than the control group (P < 0.05). However, shear force values were not affected by the probiotic treatments. Decreases in color and lipid stabilities of breast muscles were found during display (P < 0.05), but were not affected by the probiotic supplement (P > 0.05). Our result suggests that probiotic supplement had no adverse impacts on proteolysis and oxidative changes during 5 d postmortem display storage. PMID:26944974

  8. Postmortem sperm retrieval in context of developing countries of Indian subcontinent.

    PubMed

    Sikary, Asit Kumar; Murty, O P; Bardale, Rajesh V

    2016-01-01

    There was a request for postmortem sperm retrieval (PMSR) from the wife of a deceased, but we had to decline. We have no guideline in place for the procedure in such cases. When we explored the international scenario on the issue of PMSR, we found that most of the developed countries have their guidelines about it, whether to allow or not to. There is not guideline available in developing countries, as such, for the procedure and various medical, legal, and social issues related thereto. In this article, we have explored the status of postmortem retrieval and feasibility of the procedure in developing countries of Indian subcontinent. PMID:27382231

  9. Investigation of Post-mortem Tissue Effects Using Long-time Decorrelation Ultrasound

    NASA Astrophysics Data System (ADS)

    Csány, Gergely; Balogh, Lajos; Gyöngy, Miklós

    Decorrelation ultrasound is being increasingly used to investigate long-term biological phenomena. In the current work, ultrasound image sequences of mice who did not survive anesthesia (in a separate investigation) were analyzed and post-mortem tissue effects were observed via decorrelation calculation. A method was developed to obtain a quantitative parameter characterizing the rate of decorrelation. The results show that ultrasound decorrelation imaging is an effective method of observing post-mortem tissue effects and point to further studies elucidating the mechanism behind these effects.

  10. Postmortem sperm retrieval in context of developing countries of Indian subcontinent

    PubMed Central

    Sikary, Asit Kumar; Murty, O. P.; Bardale, Rajesh V.

    2016-01-01

    There was a request for postmortem sperm retrieval (PMSR) from the wife of a deceased, but we had to decline. We have no guideline in place for the procedure in such cases. When we explored the international scenario on the issue of PMSR, we found that most of the developed countries have their guidelines about it, whether to allow or not to. There is not guideline available in developing countries, as such, for the procedure and various medical, legal, and social issues related thereto. In this article, we have explored the status of postmortem retrieval and feasibility of the procedure in developing countries of Indian subcontinent. PMID:27382231