Fatal spontaneous rupture of splenic artery aneurysm in third trimester pregnancy

@#Introduction: Unforeseen emergency in late pregnancy can be catastrophic and cause unexpected maternal and foetal demise. Moreover, lack of awareness and failure of prompt treatment raise mortality rate. Such fatalities warrant a forensic autopsy as it may raise redundant medico-legal concerns. Case Report: We report a case that revealed significant intra-abdominal haemorrhage at autopsy. The source of haemorrhage was at the spleen hilum and histology established rupture of splenic artery aneurysm. There was no associated obstetric cause found. Conclusion: Knowledge of spontaneous rupture of splenic artery aneurysm in late pregnancy is essential for monitoring maternal and foetal, morbidity and mortality. However, in the eventuality of death a comprehensive forensic autopsy is the only investigation to recognise such calamity and clear clinical confusion.

Evolución histórica de las autopsias y situación actual en Costa Rica / historical evolution of the autopsies and current situation in Costa Rica

A continuación se presenta un artículo de revisión en el que se desarrolla la evolución histórica de un acto médico poco valorado: la autopsia. Después de conocer su historia tanto internacional como en Costa Rica se entra a analizar la situación actual de este procedimiento en nuestro país, después de lo cual se concluye que, gracias a la adecuada formación y a la disciplina del personal a cargo, la autopsia médico legal y hospitalaria en Costa Rica están en un nivel de calidad igual al de un país desarrollado, con el mérito de que en nuestras instituciones se trabaja con un presupuesto mucho más limitado, siempre en aras de beneficiar a la sociedad costarricense, tanto en Administración de Justicia como en Salud Pública.

This is a review article about the historical evolution of a medical act poor valued now: the autopsy. After knowing his history both internationally and in Costa Rica, is hard to analyze the current situation of this procedure in our country, after which it is concluded that, with the proper training and discipline of staff in charge, forensic and clinical autopsies in Costa Rica are at a level of quality equal to a developed country, with the merit of our institutions are working with a much more limited economic resources; all this work always in the interest of benefiting the Costa Rican society, across administration of justice and public health.

Neumonía lipoidea por exposición laboral / Lipoid pneumonia due to occupational exposure

La neumonía lipoidea es una condición poco común que resulta de la presencia de lípidos en el interior del espacio alveolar. Según la fuente de los lípidos se ha clasificado en endógena y exógena y esta a su vez según la presentación en aguda y crónica. La neumonía lipoidea exógena se produce por aspiración o inhalación de sustancias oleosas, suele presentarse en pacientes con predisposición a broncoaspiración por alteraciones anatómicas o neurológicas, sin embargo se puede presentar en pacientes sanos que están expuestos a este tipo de sustancias y suele ser en el medio laboral. La fisiopatología es secundaria a una respuesta de cuerpo extraño que termina en fibrosis pulmonar. Los síntomas que produce al igual que manifestaciones al examen físico son inespecíficos y los hallazgos en los exámenes de laboratorio y gabinete también lo son, esto hace que sea una patología poco diagnosticada; sin embargo, haciendo una buena historia clínica e historia laboral se puede sospechar su diagnóstico en el caso de los médicos tratantes o establecer una relación de causalidad en el caso del médico forense. Presentación de caso: Se expone el caso de masculino de 34 años de edad referido por un caso de riesgo laboral, el mismo sin antecedentes patológicos conocidos, quien estuvo expuesto al humo del vehículo que conducía, posteriormente inicia con síntomas respiratorios inespecíficos y finalmente es diagnosticado con neumonía lipoidea.

The lipoid pneumonia is an uncommon condition that results from the presence of lipids within the alveolar space. According to the source of lipids has been classified into endogenous and exogenous, and this in turn according to the presentation in acute and chronic. Exogenous lipoid pneumonia is caused by inhalation or aspiration of oily substances, usually seen in patients predisposed to aspiration for anatomical or neurological disorders, but also can occur in healthy patients who are exposed to these substances and are usually cases of occupational exposure. The pathophysiology is secondary to a foreign body response that ends in pulmonary fibrosis. Symptoms and physical examinations findings are nonspecific as well as laboratory and cabinet tests, this makes it a disease underdiagnosed; however, doing a good history and labor history may suspect the diagnosis in the case of treating physicians or establish a causal link if the case of the forensic medical. Case presentation: Male 34 years of age are exposed, referred by a case of occupational risk, the same with no known medical history, who was exposed to the vehicle driven smoke then begins with nonspecific respiratory symptoms and finally is diagnosed with lipoid pneumonia.

Medicolegal Review of Deaths Related to Propofol Administration: Analysis of 36 Autopsied Cases / 대한법의학회지

Propofol is a widely used anesthetic in anesthesia and sedation. Recent cases of propofol-induced death have been associated with adverse effects, abuse, or intoxication. However, there are few forensic reports of propofol-associated death. We reviewed and analyzed 36 cases of death related to propofol administration recorded by the National Forensic Service in 2000-2011. The number of women was 28 (77.8%). Subjects in their 20s and 30s accounted for 61.1% of cases. Cause included medical accidents, 16 (44.4%); suicides, 2 (5.6%); and undetermined, 18 (50%; suicide/accident). Of the 16 medical accidents, 8 were internal medicine cases (conscious sedation endoscopy), 3 surgical cases, 3 plastic surgery cases, 1 urology case, and 1 obstetrics and gynecology case. In 20 cases of suicide or undetermined (suicide/accident), the victims were nurses (9 cases), doctors (4 cases), hospital administrators (2 cases), homemakers (2 cases), bar hostesses (2 cases) and an office worker (1 case). The doctor included 2 plastic surgeons, an internist, and a resident anesthesiologist. The autopsy findings were nonspecific; congested parenchymal organs (34 cases), pulmonary edema (8 cases), cerebral edema (2 cases), pulmonary and cerebral edema (2 cases), putrefaction (2 cases), mucosal petechiae in the interior of the larynx (1 case), and cerebral ischemic necrosis and pneumonia (1 case). The blood propofol concentrations ranged between 0.007 mg/L (cardiopulmonary resuscitation) or 0.23 mg/L (no cardiopulmonary resuscitation) and 4.38 mg/L in medical accident cases, and from 0.12 mg/L to 108.3 mg/L in suicide or undetermined (suicide/accident) cases. Other drugs were detected in 17 cases and alcohol was detected in only 2 cases. Blood concentrations in cases of medical accident were lower than in cases of undetermined cause.

Utility of Postmortem Autopsy via Whole-Body Imaging: Initial Observations Comparing MDCT and 3.0T MRI Findings with Autopsy Findings

OBJECTIVE: We prospectively compared whole-body multidetector computed tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy findings. MATERIALS AND METHODS: Five cadavers were subjected to whole-body, 16-channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radiologist classified the MDCT and 3.0T MRI findings into major and minor findings, which were compared with autopsy findings. RESULTS: Most of the imaging findings, pertaining to head and neck, heart and vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to autopsy findings. The causes of death that were determined on the bases of MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direction of external force. MRI was effective in evaluating and tracing the route of a metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. CONCLUSION: A postmortem MDCT combined with MRI is a potentially powerful tool, providing noninvasive and objective measurements for forensic investigations.

The Statistical Analysis of the Forensic Autopsy Cases of the Deaths Associated with Alcohol in Gwangju and Chonnam Area, Korea / 대한법의학회지

Alcohol is very popular and readily available among the population but is also known to be a toxic substance. Excessive alcohol ingestion can lead to death induced by acute intoxication. In addition, chronic alcohol ingestion can cause many diseases such as alcoholic liver disease and cardiomyopathy. Alcohol consumption is associated with many social incidents. For example, traffic accidents, murders, incendiary crimes and so on. Hence, alcohol should be considered as a significant and socially relevant substance. However, there is currently no statistical analysis about deaths associated with alcohol consumption in forensic autopsy cases. We analyzed forensic autopsy cases involving alcohol during 2007 to 2009 in Gwangju city and Jeollanamdo province, Korea. The following is the summary of the results. 1. The number of total cases in our department from 2007 to 2009 was 329. 2. Among the 329 cases, 314 cases were checked to have alcohol concentration levels. Alcohol related deaths were 118 cases (35.9%). 3. Among 118 cases, natural deaths were 27 (22.9%) and unnatural deaths were 91 cases (77.1%). 4. Deaths caused by alcohol intoxication were 9 cases (7.6%). The remaining 82 cases of unnatural deaths were as follows: suicides (18 cases, 22.0%), homicides (32 cases, 39.0%), accidents (24 cases, 29.3%), and undetermined (8 cases, 9.8%).

The Significance of Hemosiderin Deposition in the Lungs and Organs of the Mononucleated Macrophage Resorption System in Infants and Children

Hemosiderin deposition is not often recognized on routine examination with hematoxylin and eosin staining; however, iron stains may be helpful in the evaluation of hemosiderin deposition in infant autopsies. This report describes the data obtained from autopsy of 86 infants and children whose deaths were investigated at the Forensic Medicine Council Bursa Morgue Department from January 2000 to January 2003. A histochemical technique was used to identify hemosiderin in lung, liver and spleen specimens, which was correlated with other descriptive variables such as the reported cause of death, postmortem interval, trauma history, gender, and age. There was a weakly positive but significant correlation between lung and liver hemosiderin scores (Spearman's rank correlation coefficient, rho=0.348, p=0.001); i.e., given an increase in lung hemosiderin scores, an increase in liver hemosiderin scores was also observed. Similarly, a marked positive correlation between spleen and liver hemosiderin scores (Spearman's rank correlation coefficient, rho=0.335, p=0.002) was observed. The probability of spleen hemosiderin-positive cases belonging to the age group under 6 months was found to be 4.3 times greater than those who were hemosiderin-negative (95% confidence interval, 1.6-11.8). After the major differential diagnoses were ruled out, this study demonstrated, that depending on the statistically assessed morphometric grounds, the presence of hemosiderin deposits in the liver and spleen were significantly higher in the age group under 6 months.

A Statistical Analysis on Forensic Autopsy in Busan Area in 2006: The Institute of Forensic Medicine in Pusan National University / 대한법의학회지

This study was aimed to analyse the cause and manner of death on 297 cases of forensic autopsy performed at Institute of Forensic Medicine, Pusan National University School of Medicine, referred by law enforcement agencies in Busan and parts of Gyeongnam, Gyeongbuk from Mar. 2006 to Dec. 2006. In Busan, total 233 cases of autopsy was performed among 1,040 cases of postmortem inspection on the spot (autopsy rate: 22.4%). Among the total 297 cases, male was 197 cases (66.3%) and female 100 (33.7%). The age of forties and fifties occupied almost half (141 cases : 47.5%) of cases. By the manner of death, there were 216 cases of unnatural deaths (72.7%), 76 natural deaths (25.6%), and 5 unknown (1.7%). Among unnatural deaths, there were 35 cases of suicide (16.2%), 89 homicide (41.2%), 68 accident (31.5%), and 24 undetermined (11.1%). By the cause of death, unnatural deaths was classified as 117 cases of traumatic deaths (54.2%), 26 asphyxia (12.0%), 23 thermal injuries (10.6%), 18 medical procedures (8.3%), 15 poisoning (6.9%), 13 drowning (6.0%). Among 76 natural deaths, there were 49 cases of cardiac diseases (64.5%), 10 diseases involving vascular system (13.2%), and 6 diseases involving digestive system (7.9%).

Epidemiology of poisoning fatalities in Manipal.

A twelve year retrospective review of poisoning fatalities was undertaken in the tertiary care referral hospital of Kasturba Medical College, Manipal, South India. Of the 1917 cases of forensic autopsies conducted, 372 cases (79.4%) were due to poisoning deaths. There was an increasing trend observed in the number of poisoning deaths from the period 1993-94 to 1999-2000, followed by a declining trend during 2003-04. Ninety two percent of the fatalities were due to self-poisoning, with 77% due to pesticide consumption. Majority of the cases occurred in the rural areas during winter season. Many of the decedents were men (73.1%) in their 3rd decade of life. Suggestions are being offered on the basis of this study for the control of pesticide poisoning.

A university-based forensic pathology practice: The UPM-PGH experience (1996-2000)

Forensic Pathology is not a widely recognized field of medicine in the Philippines. Doctors involved in death investigation are often unskilled due to lack of formal training and their work is further hampered by insufficient support and material resources. Upon the authors return in 1995 from post-residency training in forensic pathology at a medical examiners office in the United States, she sought to establish a practice as a specialist based at the University of the Philippines Manila-Philippine General Hospital. This case review is the authors initial experience over the period 1996-2000. The procedures done and problems encountered are described, and recommendations on how the specialty can be professionalized are offered, Included are templates of actual worksheets for the guidance of local doctors doing forensic autopsies. (Author)