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Role of forensic doctors in Thailand's tsunami: experiences from Chulalongkorn Medical School.
Personal identification was the major task of forensic doctors in Thailand's Tsunami. Identification can be done by visual identification, circumstantial evidence and physical evidence. Among the physical evidences dental data is the most effective method of identification, followed by fingerprint and DNA. A disaster Identification team should be set up to handle the problems and plan for the future.
Sudden death due to primary intracranial neoplasms. A forensic autopsy study.
Although most fatal tumors are diagnosed well before a patient's death, occasionally forensic pathologists encounter cases in which the presence of a primary tumor of the central nervous system had not been suspected prior to death. A search for cases of sudden death due to intracranial tumors from a total of 1985 autopsies from the archives of the Department of Forensic Pathology, University of Ioannina, Greece, in the period 1998-2005, was undertaken. Two such cases in which a medico-legal autopsy had disclosed brain tumors were found. The first case was a 34-year-old man who had been found unconscious in bed, and died a few hours after hospitalization. His autopsy had revealed a 7-cm glioblastoma at the level of the third ventricle. The second case involved a 67-year-old man presenting with brain tumor, diagnosed 1.5 months previously. The patient had died after 16 hours of hospitalization. A 4-cm astrocytoma of the left temporal lobe had been found at autopsy. In both cases, the tumors may, directly or indirectly, have been the underlying cause of death. The importance of a thorough neuropathological examination in all cases of sudden death, in which no extracerebral cause had been found, is emphasized.
[Forensic-biochemical indices of serum amilase and cholinesterase activity in lethal poisoning with heroin].
The examination of the activity of serum amilase and cholinesterase in the blood from subjects who had died of heroin poisoning showed significant elevation of such activity. These findings allow experts to use the activity of the above enzymes as effective markers in detection of narcotic drugs in cadaveric blood, opiate narcotics, in particular.
Legal cases involving birds: the role of the veterinary surgeon.
Since the passing of the Wildlife and Countryside Act 1981, veterinary surgeons have had an increasingly important role to play in legal cases concerning wild animals, especially birds. This paper proposes guidelines for those who may be asked to investigate birds clinically, to carry out post mortem examinations or to perform laboratory tests. The importance of developing and using standard techniques is emphasised and attention is drawn to the need for more detailed research in the field of avian forensic pathology.
[Expert systems in forensic medicine. Pilot project in the differential diagnosis of death caused by hanging].
The special field of legal medicine represents a very heterogeneous science, which makes it impossible, that a forensic pathologist could be an "expert" in all areas. The most recent achievements of computer-technology have opened up the possibility of being able to use a PC to produce an "expert system", for with large computer programs are needed. Therefore we wanted to test in a pilot project, if it was possible to establish an expert system, which was suitable for supporting forensic pathological diagnosis. We confined ourselves to the differential diagnosis of "death by hanging" where a clear line between vital and postmortal events, respectively suicide, homicide and accident was drawn. The discrepancy between the relatively scanty amount of statistically reliable data on the one hand and the complexity of the manifestation of death by hanging on the other hand proved to be the main problem. Although we are not yet able to make an expert system available which meets all our requirements, we are convinced, that in the future computer-aided diagnosis may be of great use for work in legal medicine.
[The problem of the pathomorphological diagnosis "death by drowning"--case histories].
The paper describes pathomorphological findings in two dogs and one cat with the intention to clarify whether these animals died by drowning. The investigations are supplemented by experimental results of water instillation into the lung to induce signs of emphysema aquosum post mortem. Additionally, histopathology of the skin lesions due to water exposition after death are demonstrated by systematic investigations of four different localizations for 10 days. Critical evaluation of the results and literature references in human forensic pathology indicate that post mortem findings as described in this paper, especially those of the so called "drowning lung" can be attributed to death by drowning.
An unusual, deep lingual hemorrhage as a consequence of ligature strangulation.
During the course of the daily practice of forensic pathology, little or no attention is generally devoted to the tongue (if it is even removed at all during the autopsy examination) except in a handful of relatively well-defined situations. In some other instances, such as injuries involving the neck and laryngopharyngeal organs, the tongue may be removed, but examined in only a cursory manner, since the serious pathology which caused or contributed to death is most often located in adjacent structures. While the postmortem examination was being carried out on a victim of ligature strangulation who exhibited relatively sparse external and laryngeal findings of significance, a unique and apparently heretofore undescribed patterned hemorrhage was discovered within the deep musculature of the tongue, having an appearance and contour identical to that of the curved edge of the subjacent hyoid bone. In difficult cases where strangulation is suspected as well as other potentially medicolegal problems with trauma involving the neck organs, a detailed inspection of the tongue through an easily accomplished dissection technique may provide invaluable information as to the mechanism of injury.
Post-mortem examination of the heart in cases of sudden death.
Sudden unexpected death is an important topic of forensic medicine. Several papers have been published on the morphological changes of the coronary arteries and the myocardium in sudden cardiac death. Forensic pathology demands more and more accurate methods of postmortem diagnosis of early ischaemic lesions of the heart muscle that occur shortly before death and which, in the absence of other explanations, may presumably be related to the cause of death. The cause of death is often evident from post-mortem findings, still in a number of cases the diagnosis may be doubtful. The application of electron microscopy has increased rapidly over recent years and the electron microscopic investigation of post-mortem biopsy material may be useful in narrowing down the cause of death. This report presents the results of electron microscopic and cytochemical studies of the myocardium in cases when death had occurred at a precisely recorded time.
Fatal gliding accidents in the United Kingdom: 1960-1980.
For many years, the Department of Aviation and Forensic Pathology of the RAF Institute of Pathology and Tropical Medicine has assisted in the medical investigation of fatal military and civil aircraft accidents, both in the U.K. and overseas. These included 33 glider accidents involving 39 deaths over the period 1960-1980. They do not include all the fatal gliding accidents in the U.K. because there is no mandatory obligation to call in the department, but probably represent over 50%. The Department is primarily interested in the nature of fatal injuries, the performance of safety equipment and the presence or absence of pre-existing medical factors which might have affected or caused the accident. It also makes recommendations intended to improve flight safety, and is often involved in the discussions between the British Gliding Association, the Civil Aviation Authority, and the other organizations involved.
Sudden death due to coronary artery anomalies: a case report and clinical review.
Congenital anomalies of the coronary arteries are relatively uncommon conditions with an incidence of approximately 2% in the adult population. Although less common than acquired coronary artery disease, these anomalies may be associated with myocardial ischemia and its consequences; angina, arrhythmia, infarction, and sudden death. A 21-year-old female patient with no significant prior medical history was found dead at home. Postmortem examination revealed high take-off of the right coronary artery with acute down-ward angulation of the proximal right coronary artery and acute downward angulation of the left main coronary artery. Microscopic examination revealed global myocardial ischemia consistent with a terminal ventricular dysrhythmia. There was no evidence of any other disease processes. Detailed toxicological investigation was negative. The Regional Forensic Pathology Unit experience with sudden death due to congenital coronary artery anomalies is presented along with a review of the current literature.
Blunt traumatic rupture of the thoracic aorta: an epidemiological perspective.
A study was conducted from 1 July 1991 to 30 June 1994 to determine the incidence of blunt traumatic rupture of the thoracic aorta (RTA) in a defined area of inner-metropolitan Sydney. The study group consisted of 30 subjects with RTA following falls, rail or road accidents, who were taken by ambulance to the regional trauma centre or directly to forensic pathology. The incidence of RTA in the resident population of 330,000 was in the range 20-30/10(6)/year. There was one survivor in the series, with 24 scene deaths and five deaths en route to hospital. Road accidents were responsible for 57% of incidents. RTA was found in 36% of the fatalities that occurred as a result of car and motorbike accidents. This was 5 times more common than that observed in pedestrian deaths (P < 0.005). Twenty-seven subjects (90%) had at least one co-existent critical or lethal injury. Outcome may be improved by increasing awareness of the high prevalence of RTA in shocked car- and motor-bike-accident victims and stressing the importance of rapid transport of such cases to an appropriate hospital.
Continuous river monitoring of the diatoms in the diagnosis of drowning.
The diagnosis of drowning is one of the most difficult in forensic pathology. Diatom analysis has been proposed to provide supportive evidence of drowning but the reliability and applicability of quantitative and qualitative diatom analysis in the diagnosis of drowning is still disputed in the literature. In order to further examine such cases, the authors report the development of a water monitoring system based on algae performed each month at three aquatic locations where drowning victims are frequently found. Water samples and stones were taken from the surface and from the bed of the river. This protocol was performed during 1993 with analyses both on water samples and human tissue samples (30 bodies). The diatom profile of the drowning sites was compared with the tissue analysis. The extraction of diatoms from the tissues was performed with an enzymatic digestion method using Proteinase K. Results indicate that the monitoring of river diatom populations is an accurate method of generating profiles of the river flora, which can then be compared with the diatom genera found in tissues.
[Sudden death from hypoglycemia].
The sudden death by hypoglycemia is an aspect of the forensic pathology frequently neglected. Authors initially described the pathogenesis of different hypoglycemia forms, distinguishing the primary ones due to hyperinsulinism and the secondary ones due to functional insufficiency of other organs (hypophysis, thyroid, adrenal gland, liver); after that Authors described three cases of sudden death induced hypoglycemia by hyperinsulinism: two were unweaned with nesidioblastosis and one adolescent. In any form of hypoglycemia the central nervous system damage is present with evident neuronal degenerative-necrotic phenomena, widespread edema with microhemorrhage, swollen and dissociation of myelin sheath, glial cells hyperplasia. Death caused by primary hypoglycemia is histopathologically different from the secondary one because of the maintenance of hepatic glycogen content in the former, that increase in striated muscles, including the heart, in spite of the constant secretion of catecholamine from the adrenal medulla. Glycogen is depleted in secondary hypoglycemia. In the primary form, behind the adrenal medulla hyperfunction, the increased functional activity of the adrenal cortex is moderate, contrasting with the seriousness of the syndrome, due prevalently to inhibit the gluconeogenesis response conditioned by the persistence of stored glycogen in the liver, heart and striated muscles. The rare anoxic processes coming with resynthesis of hepatic glycogen have to be considered in the differential diagnosis. The primary hypoglycemic death, especially in unweaned, is frequently promoted by other processes inducing hypoxia (fetal asphyxia outcome, pneumonia, etc.) or worsening the hypoglycemia (hypothyroidism, etc.). The secondary hypoglycemias are characterized by the normality of exocrine pancreas and by organic alterations that cause glycogen depletion from the liver.
Techniques and criteria in pathologic and forensic-medical diagnostics in sudden unexpected infant and perinatal death.
For each case of sudden infant and perinatal death, a full review of clinical and epidemiologic data and a complete necropsy study were performed according to the necropsy protocol devised by the Institute of Pathology, University of Milan, Milan, Italy (available at: http://users.unimi.it/~pathol/sids_e.html). Histopathologic examination of unexpected late fetal and neonatal death and SIDS cases allowed us to identify frequent alterations, mainly congenital, of the autonomic nervous system, modulating respiratory, cardiovascular, arousal, and upper digestive activities. The data and arguments presented herein provide a brief survey tending to open, rather than conclude, a far-reaching subject and to motivate medicolegal specialists and pathologists to perform more in-depth study.
Safety in forensic science and pathology.
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[Experience of the interaction of forensic medical and pathological anatomy services].
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The relationship between traumatic experiences, dissociation, and borderline personality pathology among male forensic patients and prisoners.
In the present study the relationship between traumatic experiences, dissociation, and borderline personality disorder pathology is examined in a group of 39 male forensic patients and 192 male prisoners. Sexual and emotional abuse are significantly more common among forensic patients than among prisoners. Patients also report a broader range of different kinds of traumas. Prisoners report significantly more dissociative symptoms. Analyses of the relationship of type of trauma on the one hand and dissociation and borderline personality pathology on the other show that sexual abuse is significantly associated with borderline personality pathology but not with dissociation among the patients. In the prison sample these associations are found only for familial but not extrafamilial sexual abuse. When the subjects are grouped on account of presence or absence of a borderline personality disorder, highly significant differences on dissociation are found between both groups. The results from this study lend support to the hypothesis that sexual abuse is not related to dissociative symptoms but merely to borderline personality pathology. Because most subjects in this study are not patients, these findings are not likely to be confounded by false memories of traumatic events that are recovered by psychotherapy. Furthermore, dissociative symptoms are found to be related to borderline personality pathology and not to the experience of traumatic events.