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PubMed1989

Forensic pathology then and now. Retrospect and reflections.

The past half-century has witnessed significant progress and multiple, meaningful changes in the day-to-day practice of forensic pathology as it has in all other branches of laboratory and clinical medicine. Associated with the welcome advancing "scientific" aspects of our work have been gratifying changes in the professional status of our much misunderstood area of medical activity, the latter most vividly and convincingly represented by American Board of Pathology certification in Forensic Pathology and the appearance of such growing, vital, national professional organizations as the American Academy of Forensic Sciences and our National Association of Medical Examiners and the creation of such highly respected periodicals as the Journal of Forensic Sciences and our American Journal of Forensic Medicine and Pathology. Objective assessment of the foregoing accomplishments leads to the inescapable conclusion that forensic pathology has emerged from its previous role as the "invisible profession" and become a respected and productive branch of laboratory medicine.

Forensic Medicine↗
PubMed2002

Forensic pathology on the threshold of the 21st century and the need for harmonization of current practice and training: the Greek concept.

Our era is characterized by the globalization of crime. This poses to all democratic countries the urgent need to reform their systems to fight crime more effectively. Forensic sciences remain an integral part of the system against crime. This scientific field can also offer valuable knowledge regarding the causes of death. From an epidemiologic point of view, this can result in better organization of prevention measures for the best interests of the community. Harmonization and collaboration in the operation of the various forensic systems that presently exist around the world is of paramount importance if effective prevention of crime and other causes of death in contemporary reality is to be achieved. In addition, revision of training in forensic pathology and forensic sciences is essential if harmonizing the forensic systems is to succeed. This report provides an overview of the wide variation in the operation of forensic systems and training. Emphasis is given to the importance of their harmonization, and an attempt is made to explore principles that may contribute along these lines. Finally, the authors provide proposals for revision of the training system in forensic pathology in Greece.

Forensic Medicine↗
PubMed2004

[Pathophysiochemistry of acute death: an approach to evidence-based assessment in forensic pathology].

The essential social and academic task of legal medicine is to devote itself to a multidisciplinary approach to problems at the interface of medicine and law. It includes forensic medical activity, in which one of the social concerns is to investigate the fatal mechanisms, survival time and physical activity, especially in traumatic and unexpected sudden death, by means of forensic pathological procedures. To meet the social requirements through reliable interpretation of those issues, systematic practical investigations are necessary, establishing the evidence-based assessment in forensic pathology. For that purpose, an approach based on the pathophysiochemistry of fatal mechanisms may be useful to aid or support pathomorphological observations. Essential markers in forensic pathophysiochemistry are the indicators of systemic responses involving acute phase reaction to traumas, i.e., circulatory, respiratory and central nervous system (CNS) functions. A comprehensive study based on previous investigations is necessary to establish practical markers and to promote their use in routine forensic casework. In the present paper, reviewing the literature, our data in routine casework are summarized. Routine forensic casework at our institute includes biochemistry on automated analyzer systems, immunohistochemistry using commercial kits and molecular biology by means of RT-PCR: 1) blood and urine biochemistry in general, 2) oxymetry, 3) serum and pericardial myocardial markers (creatine kinase MB, troponin I and T), 4) serum pulmonary surfactants (SP-A and -D), 5) other serum markers including C-reactive protein, neopterin, catecholamines, cortisol, erythropoietin and S-100 protein, 6) pericardial natriuretic peptides, 7) urinary myoglobin, 8) immunohistochemistry of a pulmonary surfactant (SP-A) in the lungs, ubiquitin, S-100 protein and ssDNA in the brain, and 9) RT-PCR for a pulmonary surfactant (SP-A) in the lungs, ischemia- and hypoxia-related factors (hypoxia-inducible factor 1A, vascular endothelial growth factor and erythropoietin) in the brain, heart and kidneys. Further accumulation of practical data may be essentially important to establish evidence for medico-legal assessment in individual cases and to renew forensic pathology in response to potential social requirements.

Acute-Phase Reaction↗
PubMed2003

[The expression of Bcl-2 protein on acute myocardial ischemia/reperfusion and the significance in forensic pathology].

OBJECTIVE: To search the objective morphologic evidence for the forensic pathological diagnosis on the acute myocardial ischemia/reperfusion. METHODS: The expression of Bcl-2 protein in the early stage of acute myocardial ischemia/reperfusion(I/R) in rats were studyed with immunohistochemistry. RESULTS: There was no expression of Bcl-2 protein in control group. The expression of Bcl-2 protein began to increase in myocytes 0.5 h after I/R in the ischemic areas and the expression of Bcl-2 protein in inner layer was stronger than in outer layer. The expression of Bcl-2 protein appears firstly in the inner layer of myocardium and extended gradually toward the outer layer 1 h after I/R. It was found that the expression of Bcl-2 protein in outer layer was stronger than in inner layer, then the expression of Bcl-2 protein became weaken gradually. CONCLUSION: Bcl-2 gene may be an important regulative gene in the process of apoptosis and the changes observed in this paper might be useful for the forensic pathological diagnosis on the early myocardial ischemia.

Animals↗
PubMed1995

Forensic pathological expertise of medical tangle analysis of 139 autopsy cases.

In this article, we report 139 autopsy cases of medical tangle, which were examined by the Department of Forensic Pathology, Faculty of Medicine, Tongji Medical University from Jan. 1972 to Dec. 1992. The emphasis is put on analyses of the status of medical tangle autopsy in forensic pathology, involved medical departments, distribution of victim's age and sex, differences between clinical diagnosis and autoptical conclusion, the composition and causes of medical tangle. The associated problems in forensic pathological autopsy are also discussed.

Adult↗
PubMed1998

Differences in forensic pathology practice between Scotland and England.

Scotland and England are part of the United Kingdom but have separate legal systems. These legal differences have a substantial effect on forensic pathology practice, and are probably best appreciated by those pathologists who have worked on both sides of the border. This paper seeks to highlight the differences in forensic pathology practice between Scotland and England, discussing the investigation of death in both countries. It concludes that a knowledge of the Scottish procurator fiscal system of death investigation may be beneficial to those contemplating changes to the coroner system. All three authors have practised forensic pathology in Scotland and England or Wales.

Autopsy↗
PubMed2004

Three-dimensional computer visualization of forensic pathology data.

Despite a decade of use in US courtrooms, it is only recently that forensic computer animations have become an increasingly important form of communication in legal spheres within the United Kingdom. Aims Research at the University of Nottingham has been influential in the critical investigation of forensic computer graphics reconstruction methodologies and techniques and in raising the profile of this novel form of data visualization within the United Kingdom. The case study presented demonstrates research undertaken by Aims Research and the Department of Forensic Pathology at the University of Sheffield, which aims to apply, evaluate, and develop novel 3-dimensional computer graphics (CG) visualization and virtual reality (VR) techniques in the presentation and investigation of forensic information concerning the human body. The inclusion of such visualizations within other CG or VR environments may ultimately provide the potential for alternative exploratory directions, processes, and results within forensic pathology investigations.

Adult↗
PubMed2003

A comprehensive analysis of forensic science training in forensic pathology fellowship programs.

The purpose of this study is to assess the current nature and extent of forensic science training in the nation's 43 Accreditation Council for Graduate Medical Education (ACGME)-accredited forensic pathology fellowship programs. This manuscript describes the results of a survey of training program directors performed as a project for the College of American Pathologists (CAP) Forensic Identity Committee. The results show a considerable diversity in the forensic sciences training in forensic pathology programs, ranging from one to ten weeks, with an average of 4.1 weeks. However, almost one half of programs provide no training in at least one of the surveyed disciplines. Only 58.1% of responding programs meet the ACGME requirements for forensic science training, and a similar percentage (56.0%) currently provides the duration of forensic science training recommended by the National Association of Medical Examiners (NAME). The deficit in the NAME training recommendations, surprisingly, was strictly in the field of toxicology.

Accreditation↗
PubMed2000

[Forensic pathological significance of iNOS with regard to brain and myocardial damage].

Inducible nitric oxide synthase (iNOS) does not express within cells under normal conditions. But, it is induced by inflammatory cytokines and the activity of iNOS is independent of elevated Ca2+. It is implied that nitric oxide (NO) produced by iNOS has a close relation with pathological conditions as a mediator of cell damages. We aimed at the crucial property of iNOS, therefore we have searched the expression of iNOS for the purpose to establish forensic pathological significance in the cases with damages of neuronal cells or cardiomyocytes. At first, we examined induction and expression of iNOS in the human brains whose causes of death was traumatic brain injury (TBI). These findings demonstrated prolonged induction of iNOS in neutrophils, microglia/macrophages, and vascular smooth muscle cells in traumatized brain. Such a response may indicate that iNOS could play a crucial role on cerebrovascular disturbances and secondary brain injury subsequent to TBI. Secondly, we evaluated the induction and expression of iNOS in the human hearts with myocardial cell damage. The expressions of iNOS were localized to the following areas, the cardiomyocytes in the zone adjacent to the infarcted area, the preserved cytoplasm of infarcted cardiomyocytes, the endothelial cells in arteriolar walls and macrophages in viable myocardium. These findings have led to the speculation that the NO might play a significant role during myocardial ischemia and reperfusion. Furthermore, representative expression of iNOS was identified in coronary artery, that is the portion of shoulder and broken part of coronary atherosclerotic plaque. These findings may indicate that the iNOS might have a close relation to the coronary atherosclerotic lesion. The physiopathological mechanism of iNOS might involve in the close relation with inflammatory cytokines. The precise elucidation of this participation may make it possible to explicate the presumed time of injury in an earlier stage, and to clarify the forensic pathological significance of these inflammatory factors.

Brain↗
PubMed1986

Forensic pathology--Catch 22. A no-win situation(?).

The practice of forensic pathology finds itself in the unenviable position of existing in a political environment, the existence of which depends upon compromise. The professional pathologist cannot compromise ethically, morally, or legally. As a practical fact of life, most of us find ourselves in the compromising position and with the compromising attitude of "you get what you pay for." The end result all too often is tragedy for those who depend on our observations, our conclusions, our practice of medicine. What has not been widely recognized apparently is the all too common consequence of the personal jeopardy that the forensic pathologist is placed in--defenseless, friendless, disgraced, and left with a severely tarnished professional reputation.

Ethics, Medical↗
PubMed2000

Audit in forensic pathology.

Autopsy numbers in Australian hospitals have declined markedly during the past decade despite evidence of a relatively static rate of demonstrable clinical misdiagnosis during this time. The reason for this decrease in autopsy numbers is multifactorial and may include a general lack of clinical and pathologic interest in the autopsy with a possible decline in autopsy standard, a lack of clinicopathologic correlation after autopsies, and an increased emphasis on surgical biopsy reporting within hospital pathology departments. Although forensic autopsies are currently maintaining their numbers, it is incumbent on forensic pathologists to demonstrate the wealth of important information a carefully performed postmortem examination can reveal. To this end, the Pathology Division of the Victorian Institute of Forensic Medicine has instituted a program of minimum standards in varied types of coroner cases and commenced a system of internal and external audit. The minimum standard for a routine, sudden, presumed natural death is presented and the audit system is discussed.

Autopsy↗
PubMed2026

A profile of deaths in children at the Diepkloof Forensic Pathology Services mortuary in Gauteng, South Africa from 1 January 2019 to 31 December 2020.

This retrospective study was conducted to address the scarcity of knowledge regarding unnatural child deaths in South Africa. This was done by analysing cases admitted to the Diepkloof Forensic Pathology Services mortuary between 1 January 2019 and 31 December 2020. Data from FPS death registers and FPS case files were used to profile: (1) the incidence, causes and manner of death, circumstances of death, and ancillary investigations performed at autopsy; and (2) to assess the impact of the COVID-19 pandemic on trauma-related child deaths. Of 4 704 decedents, 535 (11.4%) were children, predominantly male (55.5%) and Black (94.8%). Accidental deaths were the most common manner of death (42.6%), primarily due to road traffic accidents, burns, and aspiration. Homicides accounted for 6.5% of all deaths in children, most frequently involving sharp force or gunshot injuries. Cranio-cerebral injuries predominated in trauma-related deaths. In 2020, compared to preceding years, with the implementation of the COVID-19 restrictions, there was a decrease in trauma-related child fatalities. These findings suggest that many child deaths are potentially preventable through government implementation of improved safety interventions and community education.

Humans↗
PubMed2005

Forensic pathology services and autopsy law of Qatar.

This work presents information about the current practice of medico-legal services including forensic pathology services in the Islamic state of Qatar from the author's personal experience gained during a consultation visit to Hamad Medical Corporation Hospital of Qatar. Qatar enacted a comprehensive autopsy law (Law No. 8 of 2003) on the basis of tenets of Islam, incorporating modern trends and opinion. This deals with performance of hospital/clinical, forensic post-mortems and dissection of dead bodies for educational purposes.

Autopsy↗
PubMed1978

Lactate dehydrogenase and glutamic oxalic transaminase isozymes in heart muscle of forensic pathological cases.

LDH and GOT isozyme patterns in the heart muscle of forensic pathological cases were investigated to find out the relationship between their changes and the causes of death. In most cases of death by violence, natural causes, poisoning and cold, the sum of LDH-1 and LDH-2 averaged about 80-90% of the total LDH, and GOTs was equal to or slightly lower than GOTm. In about two thirds of cases of asphyxia and drowning, LDH-1 and LDH-2 decreased and LDH-3, LDH-4 and LDH-5 increased. The activity of GOTs decreased and the ratio of GOTs/GOTm diminished. In neonate, LDH-3 showed the highest activity, followed by LDH-2 and LDH-1. GOTm was much less than GOTs. In most cases of cardiac death from unknown cause and cot death, LDH-3 increased remarkably, though it was less than LDH-1 and LDH-2, and GOTm became much less than GOTs. These findings revealed that there were some similarities in the LDH and GOT isozyme patterns in the heart muscle of the cardiac death from unknown cause and cot death and that of neonate.

Aspartate Aminotransferases↗
PubMed1985

Forensic pathology and related sciences. A model for teaching medical students.

Recently, awareness of the importance of forensic pathology and related sciences in the United States has grown. At our medical center, we developed a concise and systematic program on this subject and offered it as an elective in pathology to level II medical students. The course was very successful and rated highly by the medical students.

Adolescent↗
PubMed2026

A profile of firearm-related fatalities admitted to the Diepkloof Forensic Pathology Service Soweto medico-legal mortuary during the COVID-19 and post COVID-19 periods.

This retrospective descriptive study examined firearm-related fatalities during (April-December 2020; n&#x2009;=&#x2009;241) and after (April-December 2023; n&#x2009;=&#x2009;299) COVID-19 lockdowns using 540 cases from the Diepkloof Forensic Pathology Service, Soweto, South Africa. Data was obtained from autopsy reports, forensic records, police statements, and death scene documentation. Firearm violence affected young adult Black males (22-43&#x2009;years), with only minor demographic shifts post-pandemic. The overall burden and core patterns of violence remained stable, with criminal activity - primarily robbery and interpersonal violence - persisting as the leading contexts, and homicide the dominant manner of death. Post-COVID-19 findings demonstrated contextual shifts, including increased incidents in public and social environments, reflecting greater mobility and resumption of social activity. A significant rise in mean blood alcohol concentration (0.09&#x2009;g/100&#x2009;mL vs 0.14&#x2009;g/100&#x2009;mL; p&#x2009;<&#x2009;0.0001) suggests increased alcohol involvement following easing of restrictions. Unfortunately, persistent information gaps, noted particularly in circumstantial history, incident location, firearm type, highlighting the need for improved data provision and capture systems. While the epidemiology of firearm-related fatalities remained unchanged, the post-COVID-19 period was characterised by increased alcohol involvement, shifts toward public-space violence, and fewer gunshot wounds per victim, suggesting changes in situational and behavioural dynamics rather than underlying drivers of violence.

Humans↗