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PubMed1997

A national survey of autopsy cost and workload.

We mailed survey questionnaires to a random sample of medicolegal offices throughout the USA. The survey asked how many forensic pathologists were used, their American Board of Pathology forensic examination (Board) status, how many autopsies they performed, and, if payment were fee-for-service, what fees were paid for medicolegal autopsies. Response rate was 61%, with 188 offices returning questionnaires. The average fee, was $518 with a standard error of $27. The number of fee-for-service autopsies was split evenly between Board qualified and Board ineligible pathologists, accounting for about one-third of medicolegal autopsies nationwide. Although smaller offices used more pathologists ineligible for forensic Boards, they paid a premium for such qualification. Larger offices used more forensic Board qualified pathologists, but paid them less than those ineligible to take the examination! Overall there was no significant premium paid for Board qualification. The average fee paid is far less than the published estimates of the cost of an autopsy. The low fees paid may reflect: (1) the value of the teaching experience supplied to medical students and/or residents; (2) pathologists performing medico-legal examinations as community service; and (3) the lower marginal cost of additional autopsies.

Autopsy↗

PubMed2005

Strangulation signs: initial correlation of MRI, MSCT, and forensic neck findings.

PURPOSE: To evaluate multislice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) findings in hanging and manual strangulation cases and compare them with forensic autopsy results. MATERIALS AND METHODS: Postmortem MSCT and MRI of nine persons who died from hanging or manual strangulation were performed. The neck findings were compared with those discovered during forensic autopsy. In addition, two living patients underwent imaging and clinical examination following severe manual strangulation and near-hanging, respectively. For evaluation, the findings were divided into "primary" (strangulation mark and subcutaneous desiccation (i.e., soft-tissue thinning as a result of tissue fluids being driven out by mechanical compression) in hanging, and subcutaneous and intramuscular hemorrhage in manual strangulation) and "collateral" signs. The Wilcoxon two-tailed test was used for statistical analysis of the lymph node and salivary gland findings. RESULTS: In hanging, the primary and most frequent collateral signs were revealed by imaging. In manual strangulation, the primary findings were accurately depicted, with the exception of one slight hemorrhage. Apart from a vocal cord hemorrhage, all frequent collateral signs could be diagnosed radiologically. Traumatic lymph node hemorrhage (P = 0.031) was found in all of the manual strangulation cases. CONCLUSION: MSCT and MRI revealed strangulation signs concordantly with forensic pathology findings. Imaging offers a great potential for the forensic examination of lesions due to strangulation in both clinical and postmortem settings.

Adult↗

PubMed2003

Pathologic features of suicidal deaths caused by explosives.

Suicidal explosions that lack a terrorist background are only rarely encountered in the field of forensic pathology. The investigation of explosion-related fatalities can be a substantial challenge in medicolegal casework. Determining whether the manner of death is suicide, homicide, or accident in such cases can present an especially difficult task to the forensic pathologist. This study considers the pathologic features of suicidal deaths caused by explosives without a terrorist background. The modus operandi of the decedents reflected familiarity and proficiency, or at least a degree of specialized knowledge, with the construction and use of explosive devices. All explosions were set off in confined spaces. The injury patterns consisted of a combination of primary blast injuries (e.g. decapitation, traumatic amputation of limbs, gross lacerations of the body surface, blast injuries of gas-containing and hollow organs), secondary blast injuries (e.g. splinter-induced penetrating trauma), tertiary blast injuries (e.g. abrasions and contusions), and burn injuries (mostly of the flash type). The previously described symmetric distribution pattern of injuries in suicidal explosions was apparent only to a certain degree in the present series. Our observation of superficially sharp-edged wound margins with bridging in the depths of the lesion in blast-induced lacerations of the skin should deserve further attention in forthcoming cases of explosion-related fatalities because this finding is a diagnostic possibility that may support the theory of an explosion-related fatality under special circumstances, e.g. when the body has been dumped away from the place of death. Because a terrorist attack may be initially suspected in each case of suicide involving explosives, the importance of a joint inquiry based on expertise from police investigators, bomb experts, and forensic pathologists is evident.

Adult↗

PubMed1981

Sudden unexpected death caused by neuroepithelial (colloid) cyst of the third ventricle.

Sudden unexpected death caused by a colloid cyst of the third ventricle in young apparently healthy persons is an uncommon phenomenon that nevertheless occurs regularly in medical examiner's cases and may occur in general hospital pathology practice. This entity has not received proper attention in the general or forensic pathology literature in spite of the fact that sudden death has been appreciated in the clinical literature for many years. We report four cases of sudden unexpected death in young persons whose only major previous complaint was that the chronic relapsing headaches. Because of the sudden and unexpected nature of their deaths, these cases came to the attention of the medical examiner and the colloid cysts were discovered at autopsy. The history of the lesion, its histogenesis, its pathological physiology, and the experiences of others are reviewed.

Adolescent↗

PubMed2002

[The applying and foreground of quantifying DNA content by image analysis technique in determining postmortem interval].

Image Analysis Technique(IAT) was developed at 1950's, which quantifies the changing all the part of image by sampling, processing, quantifying, computing, analyzing the information of image. And now it has become a normal quantifying technique in biology and medicine research. In the present paper, we reviewed briefly the principium of quantifying the DNA content by IAT, the law of degradation of DNA in nucleus and the foreground of this method in determining PMI in forensic pathology.

DNA↗

PubMed1984

X-ray microanalysis: identification and quantification of elements in normal and pathologically altered cells.

It is apparent that advanced technology in X-ray microanalysis is rapidly becoming applicable to experimental cellular pathology. Additionally, it has already proven to be of significant value in diagnostic human pathology and clinical research, especially in the areas of environmental toxicology and forensic pathology. Like routine electron microscopy, X-ray microanalysis will soon be a necessary technology for any major medical center practicing 'state-of-the-art' medicine.

Calcinosis↗

PubMed1997

The impact of homicide trials on the forensic pathologist's time--the Fulton County experience.

Subpoenas received for criminal trials related to homicides in Fulton County (Atlanta) Georgia were tracked in a computer database for an 18 month period in order to determine the proportion of forensic pathologist worktime required for testimony in homicide cases. The number of subpoenas received annually amounted to 64% of the average number of homicides occurring annually. Testimony was required in about 33% of cases in which a subpoena was received, and, therefore, the number of testimony appearances per year was about 21% of the average annual number of homicides. Assuming a 40 hour work week for 52 weeks per year and an average of 3 hours of time preparing for, traveling to, and testifying in court, the time required of the forensic pathologist to testify in homicide trials amounted to about 2% of a full-time-equivalent. Although the time required for testimony in homicide cases may vary among jurisdictions because of the nature of its homicides, distance and travel time to court, and other factors, the data presented here may be used to estimate the impact of homicide trial court time on forensic pathology practice.

Coroners and Medical Examiners↗

PubMed1992

A pathological study of sudden coronary death in China: report of 89 autopsy cases.

This paper reports the results of a forensic pathological study of 89 autopsy cases of Sudden Coronary Death (SCD). Of 89 cases, 63 (52 male, 11 female) were narrowed by 76-100% in cross-sectional area (XSA) of the coronary artery (CA) and 26 (22 male, 4 female), by 51-75%. Atherosclerotic plaques in the CA were serious and extensive, especially in the left anterior descending and often involved several branches of CA at the same time. Recent thrombosis was found in 18 cases, haemorrhage in plaques in 17 cases. Only 2 cases had visible acute myocardial infarction. Inflammatory cell infiltration was found in coronary plaques in 36 cases. Myocardial fibrosis or small scar formation was detected in 51 cases. It is suggested that although the incidence of coronary heart disease (CHD) is low in China, SCD is the commonest mode of Sudden Unexpected Death. The majority of SCD (52%) were middle aged males (30-49 years old). Most of the cases died suddenly during sleep without any clear precipitating factors. The characteristics of occurrence and pathological changes in the CA and myocardium and the pathological diagnosis of SCD are also analysed and discussed.

Adult↗

PubMed2001

Bite injuries: pathophysiology, forensic analysis, and management.

Bites are serious injuries that constitute 1 percent of all emergency-department visits in the United States of America. Human bite injuries may lead to loss of function, infection, and gross disfigurement, and often are associated with interpersonal and sexual violence, and child abuse. Issues with infection from oral contaminants, tissue damage, and difficult surgical reconstruction make the management of human bite injuries a challenge. The unique nature of teeth and the bite marks they produce are invaluable in forensic pathology. A systematic and detailed evaluation of bite injuries should be performed by a forensic odontologist in order to provide the necessary information for forensic purposes. Management of human bite injuries includes wound debridement, surgery to repair or replace damaged tissue, and long-term antibiotic therapy.

Age Distribution↗

PubMed2006

Pigmentation of articular surfaces of bones as an identification factor: a unique case report.

One of the classic problems of forensic pathology, the identification of a skeletal remains, involves techniques and expertise that span a number of disciplines. This forensic endeavor offers a more challenging and creative exercise because identification with medical and legal certainty often requires thinking beyond routine workups. Identification workups are creative in developing features that are unique as presented by an individual decedent. In this case report, a rare pathologic condition, ochronosis, has helped in the accurate identification of an individual from a systematic skeletal remains examination.

Bone and Bones↗

PubMed1980

The general pathologist's role in forensic medicine: the Massachusetts scene.

The Commonwealth of Massachusetts medicolegal system is discussed. The current situation necessitates active participation by general pathologists. The rudimentary skills needed in forensic pathology are delineated. It is emphasized that since medicolegal cases are nationally increasing and since recent comprehensive studies confirm the present shortage of full time forensic pathologists, it is imperative that general pathologists become more involved.

Autopsy↗

PubMed2000

Coronary arteritis diagnosed at autopsy: three case reports and review of the literature.

Coronary arteritis is rare but can be fatal either by itself or in conjunction with other diseases. The authors report cases of three men in whom coronary arteritis was an interesting finding that may have caused or contributed to death. One 45-year-old man collapsed at work, another 56-year-old man was found dead in his parked car, and one 80-year-old man had a recent cerebrovascular accident. All three men had coronary arteritis, arteriosclerotic cardiovascular disease, some form of myocardial disease, and fatty liver change. Two had different lung diseases. The findings suggest that coronary arteritis may be an independent cause of death, part of a systemic disease, or, as these three cases illustrate, part of a constellation of cardiac and cardiovascular pathologies with a possible relation to other medical conditions. Coronary arteritis is an important finding in forensic pathology and merits consideration in a case of unexplained death.

Aged↗

PubMed2003

Age estimation using radiographic analysis of laryngeal cartilage.

The laryngeal cartilages undergo age changes, including mineralization and ossification. Keen and Wainwright defined, in male and female subjects, recognizable stages of radiopacity of the thyroid, cricoid, and arytenoid cartilages. The present study analyzed quantitatively the degree of laryngeal radiopacity to determine whether radiography of the larynx can be used routinely in forensic pathology to estimate age at death. In each of 82 subjects, the larynx was removed during forensic autopsy and subjected to radiography in an anteroposterior orientation. Each radiograph was independently scored by two observers. For each case, the degree of laryngeal radiopacity was evaluated according to the classification of Keen and Wainwright. There was a positive correlation between the total score of laryngeal radiopacity and age (correlation coefficient = 0.74). It was concluded that this method is simple, fast, and nondestructive and has a good reproducibility between observers. Because there was a wide interindividual variability in the same age class, this method must be associated with more accurate methods.

Adolescent↗

PubMed2000

[The dynamics of cytokines and their related substances in skin wounds].

Molecular-pathological study on cytokines and their related substances in skin wound healing was performed from the view points of forensic pathology; 1. The dynamics of inflammatory cytokines such as interleukin (IL)-1 alpha, IL-1 beta, IL-6 and tumor necrosis factor-alpha (TNF alpha) during murine wound healing was examined at the levels of protein and mRNA. As for the results, the production of those inflammatory cytokines could be considered as one of the local vital reactions after wounding, and it was clarified that those inflammatory cytokines were one of the biological markers for forensic wound age determination. Practically, our immunohistochemical and morphometrical study with human skin wounds with different wound ages suggested that the ratios of IL-1 alpha-positive cells, considerably exceeding 30%, indicated a postinfliction interval of 1 day or less. 2. In mouse skin incision, a significant increase in IL-10 mRNA occurred between 30 and 180 min. The increased expression of IL-10 mRNA could be considered a vital reaction in skin wounds. Furthermore, it was clarified that IL-10 may have an important regulatory role in limiting the extent and duration of inflammatory response during skin wound healing. 3. Fas and Fas ligand (Fas L) were immunohistochemically detectable on macrophages and fibroblasts in skin wound healing process. Morphometrically, the number of cell expressing Fas and/or Fas L reached a peak at 6 days after wounding. Therefore, it is considered that apoptosis through Fas and Fas L may play an important role for reducing the cellularity during proliferative phase of wound healing in mice.

Animals↗

PubMed1994

Photography in forensic medicine.

Forensic photography, although similar to medical photography, has different aims, and different objectives. The main consideration is that the images are taken primarily for legal reasons, therefore the results must be accurate and detailed, and of use in court. The photographer must have an understanding of the technical requirements as well as the related medical and legal requirements. Autopsy photography must produce the minimum delay to the autopsy as well as being extremely reliable, as the images are not repeatable. This requires a combination of easily portable equipment and additional technical support. A good photograph clearly demonstrates the required information and minimizes distortion and misleading information. Factors to consider include identification, backgrounds, lighting, colour, scale, perspective, orientation and cropping. The requirements for the effective photographic documentation of forensic subjects are discussed, with reference to the current practices of a specialist forensic pathology service in South Melbourne, Victoria, Australia.

Autopsy↗

PubMedDate not supplied

[Forensic medicine experiences in Kosovo].

In summer 1999, a German forensic team of CID officers and forensic pathologists was sent to Kosovo on request of the International Criminal Tribunal for the former Yugoslavia (ICTY) to investigate possible war crimes. For this purpose, witnesses had to be found and interrogated and graves of victims had to be located and the bodies exhumed and examined forensically. Roughly 200 bodies have been found and examined during the campaign that were predominantly of male sex and showed mainly gunshot wounds. A high percentage of all bodies could be identified. The article deals with different forensic-pathologic aspects of such an investigation.

Autopsy↗

PubMedDate not supplied

VIRTOPSY: minimally invasive, imaging-guided virtual autopsy.

Invasive "body-opening" autopsy represents the traditional means of postmortem investigation in humans. However, modern cross-sectional imaging techniques can supplement and may even partially replace traditional autopsy. Computed tomography (CT) is the imaging modality of choice for two- and three-dimensional documentation and analysis of autopsy findings including fracture systems, pathologic gas collections (eg, air embolism, subcutaneous emphysema after trauma, hyperbaric trauma, decomposition effects), and gross tissue injury. Various postprocessing techniques can provide strong forensic evidence for use in legal proceedings. Magnetic resonance (MR) imaging has had a greater impact in demonstrating soft-tissue injury, organ trauma, and nontraumatic conditions. However, the differences in morphologic features and signal intensity characteristics seen at antemortem versus postmortem MR imaging have not yet been studied systematically. The documentation and analysis of postmortem findings with CT and MR imaging and postprocessing techniques ("virtopsy") is investigator independent, objective, and noninvasive and will lead to qualitative improvements in forensic pathologic investigation. Future applications of this approach include the assessment of morbidity and mortality in the general population and, perhaps, routine screening of bodies prior to burial.

Autopsy↗

PubMed1997

Continuing education in forensic medicine: an exercise in distance learning.

Distance education and its application to postgraduate clinical medicine and continuing education in medicine is a recent development. Given the increasing requirement of the courts for forensic experts to engage in ongoing education, a continuing education programme (CEP) was developed in the field of clinical forensic medicine. This programme is the first programme available in clinical forensic medicine. Due to the interest expressed by forensic pathologists, the CEP has been modified to include cases of forensic pathology interest and the programme is now subscribed to by both clinicians and pathologists. The programme is reflective of the types of cases experienced in forensic medicine and is designed for individual practitioners working alone.

Journal Article↗