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1.
Repert.Med.Cir ; 30(3): 214-218, 2021.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1362924

ABSTRACT

La patología y la salud pública son disciplinas que se complementan en múltiples formas, desde la información que aportan mutuamente a niveles individual y poblacional, hasta la elaboración de políticas públicas en salud y la gestión de la información en los biobancos, así como la articulación para respuesta en emergencias y brotes. En revisión no sistemática resaltamos que los dos campos de mayor colaboración con la salud pública son la patología forense (comprendiendo muertes violentas y no violentas) y la patología molecular, realizando aportes significativos a la planeación de los servicios de salud, la calidad de la información epidemiológica, la salud pública basada en la evidencia que permite una mejor toma de decisiones, y la gestión de la salud comunitaria y poblacional. A partir de la revisión realizada se identificaron como puntos de mejora el uso de los sistemas de información, la necesidad de un enfoque interdisciplinario más tangible, y la urgente transformación educativa que subyace a esta colaboración.


Pathology and public health are disciplines that complement each other in many ways, from the information they provide to each other at the individual and population levels, to the development of public health policies and the management of information in biobanks, as well as articulation in responding to emergencies and outbreaks. Our non-systematic review highlights that the two most relevant fields which collaborate with public health are forensic pathology (including violent and non-violent deaths) and molecular pathology, making significant contributions to health care planning, the quality of epidemiological information, evidence-based public health that enables better decision-making, and community and population health management. This review identified the use of information systems, the need for a more tangible interdisciplinary approach, and the urgent educational transformation that underlies this collaboration, as areas for improvement.


Subject(s)
Public Health , Health Policy , Pathology, Clinical , Autopsy , Forensic Pathology , Pathology, Molecular
2.
Article in Spanish | LILACS | ID: biblio-1150965

ABSTRACT

Justificación:La autopsia es el procedimiento fundamental para determinar las causas de muerte, provee información crítica para ser correlacionada con la clínica, epidemiología y fisiopatolología de enfermedades con altas tasas de mortandad. Los hallazgos patológicos delas autopsias deben confirmar el diagnóstico clínico y determinar los efectos del tratamiento para fundamentar terapias eficaces. La infección por SARS-Cov-2 al tratarse de una enfermedad nueva con implicaciones sin precedentes para la humanidad, ha generado múltiples trabajos científicos para entenderla desde diferentes puntos de vista.Objetivos:Los propósitos de la revisión fueron: analizar la literatura disponible sobre autopsiasde pacientes con infección porSARS-CoV-2, identificar los principales hallazgos patológicos reportados y determinar las condiciones técnicas en que se hicieron esos procedimientos. Metodología:Se utilizaron los buscadores bibliográficos (PubMed, Google Scholar, Dialnet, Scielo), usando las palabras Autopsia, Postmortem y COVID-19,para localizar la literatura sobre las autopsias de pacientes con infección por SARS-CoV-2. Resultados:Se obtuvieron 16 artículos científicos que cumplieron los criterios de búsqueda, en siete se reportaron 83autopsias de 54 varones y 16mujeres, con edad promedio de 60,91 años. El análisis anatomopatológico se enfocó especialmente enlos pulmones, que macroscópicamenteestaban pesados por edema y congestión. Microscópicamente había daño alveolar difuso (membranas hialinas o de organización con angiogénesis y microtrombos) e infiltración linfocitaria intersticial. En 18 autopsias también analizaron otros órganos como corazón, hígado, riñón y bazo. Conclusión:A pesar del incremento de trabajos de investigación sobre la enfermedad,Covid-19los estudios basados en autopsia son muy escasos y limitados. Un aumento en el número de autopsias realizadas a los fallecidos por COVID-19 proveería mayor conocimiento de las características de la enfermedad, la causa de la muerte, la extensión de la misma y efectos del tratamiento...(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Autopsy , Coronavirus Infections/mortality , Databases, Bibliographic , Periodical , Forensic Pathology
3.
Med. leg. Costa Rica ; 36(2): 127-165, sep.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1040453

ABSTRACT

Resumen Desde la década de los sesenta del siglo anterior, el esfuerzo del Dr. Adolfo Acosta Guzmán, dio sus frutos para que Costa Rica emprendiera el entretejimiento del derecho con la medicina, instaurando formalmente la Medicina Legal de manera institucional y educativa. En la actualidad los Departamentos de Medicina Legal y Ciencias Forenses se encuentran ubicados en la Ciudad Judicial, San Joaquín de Flores, en Heredia; con descentralización de sus servicios por medio de casi veinte Unidades Médico Legales en todo el país. Es importante destacar que en nuestro país, la Medicina Legal funciona en un departamento distinto al Departamento de Ciencias Forenses, toda vez que ambos tienen un Jefe Departamental con independencia uno de otro, y que se deben ambos a la Dirección General del Organismo de Investigación Judicial. La mística y profesionalismo de más de cien profesionales en medicina legal y disciplinas afines ha permitido un sólido sistema para la diaria valoración de pericias en áreas como valoración de daño corporal en materia penal y laboral, delitos sexuales, violencia doméstica, patología forense, psiquiatría forense, odontología forense, antropología forense y muchas otras. Este artículo aborda la historia y actualidad de la Medicina Legal en Costa Rica, sus alcances y proyecciones.


Abstract Since the sixties of the previous century, the efforts of Dr. Adolfo Acosta Guzmán, paid off for Costa Rica to undertake the interweaving of law with medicine, formally establishing Legal Medicine in an institutional and educational way. At present, the Departments of Legal Medicine and Forensic Sciences are located in a place named Ciudad Judicial, San Joaquin de Flores, in Heredia; with decentralization of its services through almost twenty Legal Medical Units throughout the country. It is important to note that in our country, Legal Medicine works in a Department other than the Department of Forensic Sciences, both have a Departmental Chief independently of each other, and that both are due to the General Directorate of the Judicial Investigation Agency . The mysticism and professionalism of more than one hundred professionals in legal medicine and related disciplines has allowed a solid system for the daily assessment of expertise in areas such as assessment of permanent impairment in criminal and labor matters, sexual assault crimes, domestic violence, forensic pathology, forensic psychiatry, forensic dentistry, forensic anthropology and many others. This article addresses the history and current affairs of Legal Medicine in Costa Rica, its scope and projections.


Subject(s)
Humans , Costa Rica , Forensic Sciences , Forensic Pathology , Forensic Medicine , History of Medicine
5.
Article in English | WPRIM | ID: wpr-759874

ABSTRACT

We present the case of a 48-year-old woman who complained of sustained dyspnea and newly developed dyspnea, who then suddenly and unexpectedly expired during bronchoscopy. On postmortem examination, the deceased had advanced gastric cancer as a primary tumor. Frequent lymphatic tumor emboli were observed with some pulmonary lymphangitic carcinomatosis (PLC), and pulmonary tumor thrombotic microangiopathy (PTMA). PLC and PTMA are lethal forms of pulmonary metastasis, and PTMA can lead to sudden death. The characteristic findings of PLC and PTMA in the deceased were not predominant, however, and the clinical manifestation was not acutely deteriorating. These findings are, therefore, insufficient to explain the deceased's sudden death. Clinically, the deceased manifested hypoxemia, bradycardia and cardiac arrest during bronchoscopy and then soon expired, suggesting the possibility of cardiovascular complication related to bronchoscopy. Despite several limitations, we assumed that the sudden unexpected death might have been induced by cardiovascular complications related to bronchoscopy and due to the underlying pathologic condition by PLC and PTMA.


Subject(s)
Hypoxia , Autopsy , Bradycardia , Bronchoscopy , Carcinoma , Death, Sudden , Dyspnea , Female , Forensic Pathology , Heart Arrest , Humans , Middle Aged , Neoplasm Metastasis , Stomach Neoplasms , Thrombotic Microangiopathies
6.
Article in English | WPRIM | ID: wpr-740693

ABSTRACT

We present the case of a 23-year-old man who suddenly collapsed during a physical altercation with his friends while in a drunken state. The post-mortem computed tomography (CT) with angiography revealed acute basal subarachnoid hemorrhage with rupture of the left middle cerebral artery. On autopsy, the head, face, mandible and neck showed multifocal hemorrhages with fracture of the hyoid bone, and the pathologic findings of the brain was consistent with CT findings. However, the vascular rupture site was not observed macroscopically. On histologic examination, a microscopic focal rupture was identified at the proximal portion of the middle cerebral artery, and possibility of arteriopathy was considered. This case illustrates that other parts of intracerebral arteries (other than the vertebral arteries) can be the culprit of rupture in the case of traumatic basal subarachnoid hemorrhage, and the post-mortem angiographic findings can be helpful in targeting the site of vascular injury. Furthermore, meticulous sampling of intracranial vessels could help find the vascular rupture site and identify any histologic findings suspicious of arteriopathy. Therefore, we suggest that post-mortem angiography can be an effective and adjunctive tool for a tailored approach in finding the vascular injury, and that histologic examination of both the intracranial and extracranial arteries be important to medicolegally ensure the death of traumatic basal subarachnoid hemorrhage and to examine presence of arteriopathy as a predisposing factor.


Subject(s)
Angiography , Arteries , Autopsy , Brain , Causality , Forensic Pathology , Friends , Head , Hemorrhage , Humans , Hyoid Bone , Mandible , Middle Cerebral Artery , Neck , Rupture , Subarachnoid Hemorrhage , Subarachnoid Hemorrhage, Traumatic , Vascular System Injuries , Young Adult
7.
Saúde Soc ; 27(2): 311-325, abr.-jun. 2018.
Article in Portuguese | LILACS | ID: biblio-962588

ABSTRACT

Resumo O artigo analisa as condições de formação do conceito psiquiátrico de "perversão" e mais especificamente a maneira como, a partir dos anos 1820, se constrói uma oposição fundamental e estruturante entre "perversão" e "perversidade" que se evidencia tanto no campo jurídico como no médico-legal. Compreender esse jogo de oposição e de poder entre ambos os conceitos permite entender alguns conflitos profissionais entre médicos e juristas, mas também algumas disputas políticas.


Abstract The article analyzes the conditions of formation of the psychiatric concept of "perversion" and, more specifically, the way in which, from the 1820s, a fundamental structuring opposition between "perversion" and "perversity" in juridical and medical-legal fields was constructed. Understanding this game of opposition and power between both concepts allows assimilating some professional conflicts between doctors and jurists, as well as some political disputes.


Subject(s)
Humans , Male , Female , Philology , Psychiatry , Psychological Phenomena , Enacted Statutes , Forensic Pathology , Psychiatry in Literature , France
8.
Med. leg. Costa Rica ; 35(1): 102-114, ene.-mar. 2018. tab
Article in Spanish | LILACS | ID: biblio-894343

ABSTRACT

Resumen El análisis científico de la escena del crimen es de trascendental importancia en la investigación judicial. Es función de un equipo, del cual el médico forense es parte obligatoria. El conocimiento de las circunstancias y antecedentes del hecho investigado, junto con el estudio del lugar y del cadáver, constituyen elementos indispensables para el correcto abordaje del cuerpo en la necropsia; de esta manera, se cumplirá con el objetivo primordial del trabajo pericial médico forense: contribuir al esclarecimiento de la comisión de un hecho delictivo con resultado de muerte. En este artículo se ofrece una actualización del tema de la participación del médico forense en la escena del crimen, considerando la realidad de la práctica pericial médico legal en Panamá.


Abstract The scientific analysis of the crime scene is of transcendental importance in the judicial investigation. It is a function of a team, of which the forensic physician is an indispensable part. Knowledge of the circumstances and background of the researched fact, together with the study of the place and the corpse, constitute essential elements for the correct approach to the body at postmortem examination; in this way, the primary objective of the forensic medical expert work: contribute to the elucidation of the commission of a criminal act resulting in death, will be accomplished. This article offers an update of the theme of the participation of the forensic physician at the scene of the crime, considering the reality of the medicolegal practice in Panamá.


Subject(s)
Panama , Coroners and Medical Examiners , Crime , Forensic Pathology , Expert Testimony , Forensic Medicine
9.
Med. leg. Costa Rica ; 35(1): 152-159, ene.-mar. 2018. graf
Article in Spanish | LILACS | ID: biblio-894347

ABSTRACT

Resumen El hallazgo de un cadáver con signos de suspensión y en circunstancias dudosas plantea la posibilidad de que la muerte esté relacionada a la intervención de terceros. Presentamos el caso de un varón de 36 años que fue encontrado muerto, con una compresión cervical mecánica extrínseca, en una vía pública, sin testigos del hecho. Inicialmente, se investigó el caso como un homicidio, con diagnóstico diferencial de suicidio. El estudio exhaustivo del sitio de la muerte, más el examen post-mórtem completo, incluyendo: autopsia, histopatología y toxicología, permitió descartar la posibilidad de la acción de terceros y confirmar la hipótesis diagnóstica de una estrangulación autoinducida, de ubicación atípica, ejecutada con lazo.


Abstract Finding a suspended body in doubtful circumstances raises the possibility that the manner of death is homicide. We present the case of a 36 years-old male who was found dead, with extrinsic mechanical cervical compression, on a public place, there were no witnesses of the fact. Initially, the case was investigated as a homicide, with differential diagnosis of suicide. The comprehensive analysis of the scene and a complete post-mortem examination: including autopsy, histopathology and toxicology results, allowed us to rule out the possibility of the action of third parties and confirm the hypothesis of a self-induced atypical strangulation.


Subject(s)
Humans , Male , Adult , Autopsy , Suicide , Cause of Death , Coroners and Medical Examiners , Forensic Pathology , Esophageal Stenosis , Forensic Medicine
10.
Article in Chinese | WPRIM | ID: wpr-772132

ABSTRACT

OBJECTIVE@#To analyze the morphological features and forensic pathological characteristics of cardiac ruptures of different causes for their differential diagnosis.@*METHODS@#We analyzed the data of 44 autopsy cases of cardiac rupture from 2014 to 2017 in our institute, including 11 cases caused by blunt violence with intact pericardium, 4 caused by cardiopulmonary resuscitation (CPR), 9 by myocardial infarction, and 20 by aorta dissection rupture.The gross features and histopathological characteristics of cardiac rupture and pericardial effusion were analyzed and compared.@*RESULTS@#Cardiac ruptures caused by blunt violence varied in both morphology and locations, and multiple ruptures could be found, often accompanied with rib or sternum fractures; the volume of pericardial effusion was variable in a wide range; microscopically, hemorrhage and contraction band necrosis could be observed in the cardiac tissue surrounding the rupture.Cardiac ruptures caused by CPR occurred typically near the apex of the right ventricular anterior wall, and the laceration was often parallel to the interventricular septum with frequent rib and sternum fractures; the volume of pericardial blood was small without blood clots; microscopic examination only revealed a few hemorrhages around the ruptured cardiac muscular fibers.Cardiac ruptures due to myocardial infarction caused massive pericardial blood with blood clots, and the blood volume was significantly greater than that found in cases of CPR-induced cardiac rupture ( < 0.05);lacerations were confined in the left ventricular anterior wall, and the microscopic findings included myocardial necrosis, inflammatory cell infiltration, and mural thrombus.Cardiac tamponade resulting from aorta dissection rupture was featured by massive pericardial blood with blood clots, and the blood volume was much greater than that in cases of cardiac ruptures caused by blunt violence, myocardial infarction and CPR ( < 0.05).@*CONCLUSIONS@#Hemorrhage, inflammatory cell infiltration, and lateral thrombi around the cardiac rupture, along with pericardial blood clots, are all evidences of antemortem injuries.


Subject(s)
Aneurysm, Dissecting , Aortic Aneurysm , Cardiopulmonary Resuscitation , Forensic Pathology , Heart Rupture , Pathology , Heart Rupture, Post-Infarction , Pathology , Humans , Myocardial Contusions
11.
Article in English | WPRIM | ID: wpr-740678

ABSTRACT

Popliteal venous aneurysms can be a cause of fatal pulmonary thromboembolism. We report a case of a 47-year-old woman who suddenly died of fatal pulmonary thromboembolism. Deep vein thrombosis was not observed, but a venous aneurysm with intraluminal thrombi formation was identified on the left popliteal vein. This case illustrates that venous aneurysms can be presented as fatal pulmonary thromboembolism, and that they should be considered as a rare cause of pulmonary thromboembolism.


Subject(s)
Aneurysm , Female , Forensic Pathology , Humans , Middle Aged , Popliteal Vein , Pulmonary Embolism , Venous Thrombosis
12.
Article in English | WPRIM | ID: wpr-740670

ABSTRACT

Venipuncture is a routine and relatively safe and painless medical procedure, necessary for accurate diagnosis and treatment. However, given that pain related to medical procedures may have adverse effects for children, could venipuncture cause deaths in infants and children? We analyzed our cases of unexpected death after venipuncture and conducted a literature review on them. A vasovagal response to noxious stimuli may explain such a sudden death immediately after venipuncture, commonly presented as needle phobia, breath-holding spell, and reflex anoxic seizure in the literature, despite the fact that the current medical evidence is not enough to prove their casual relationship. In addition, pain prevention and management during medical procedure is incorporated in clinical guidelines for pediatric patients, because painful medical procedures negatively affect child development. Thus, prevention and management of pain related to medical procedure may be helpful to avoid an adverse vasovagal response to noxious stimuli from occurring.


Subject(s)
Autopsy , Child , Child Development , Death, Sudden , Diagnosis , Forensic Pathology , Humans , Infant , Infant Death , Needles , Phlebotomy , Phobic Disorders , Reflex , Seizures
13.
Article in English | WPRIM | ID: wpr-714135

ABSTRACT

BACKGROUND: The diagnostic criteria for bathtub drownings are not standardized, and the risk factors associated with bath-related deaths are unclear. METHODS: We analyzed a Korean nationwide database of bath-related deaths that occurred between January 2008 and December 2015. Eighty-four cases were enrolled after reviewing 31,123 autopsy records. RESULTS: The subjects' ages ranged from 18 to 91 years, with a mean age ± standard deviation of 61.3 ± 16.0 years. Bath-related deaths in the winter were approximately 4.6-fold greater than those in the summer. Of the 84 subjects, the primary cause of death in 57 (67.9%) was drowning in the bath; 24 (28.6%) drowned of other causes such as natural diseases, and 3 (3.6%) died of acute alcohol intoxication. We analyzed water-inhalation signs to establish criteria for bathtub drowning diagnosis. There were significantly higher incidences of hyperinflated lungs, water in the sphenoid sinus and stomach/duodenal contents, and Paltauf's spots (subpleural hemorrhage) in bathtub-drowned subjects compared to non-drowned individuals (P < 0.01). Multiple signs of water inhalation were significantly associated with bathtub drowning (P < 0.01). The two leading contributory causes of bath-related death were cardiovascular diseases and alcohol intoxication (binge drinking before bathing). CONCLUSION: The diagnosis of bath-related deaths could present considerable medico-legal problems; therefore, a comprehensive autopsy with a thorough scene investigation can clarify the cause of death in these situations. Preventive strategies for reducing such deaths should target alcohol drinking before bathing and long soaking times in bathtubs, especially among elderly individuals with preexisting cardiovascular diseases.


Subject(s)
Aged , Alcohol Drinking , Autopsy , Baths , Cardiovascular Diseases , Cause of Death , Diagnosis , Drinking , Drowning , Forensic Pathology , Humans , Incidence , Inhalation , Korea , Lung , Risk Factors , Sphenoid Sinus , Water
14.
West Afr. j. radiol ; 25(1): 1-8, 2018.
Article in English | AIM | ID: biblio-1273542

ABSTRACT

Background: Traditional autopsy (TA) is employed towards determining the cause and manner of death. Over the last decade, virtual autopsy (VA), involving the application of forensic imaging techniques have gained prominence and, with great precision in developed countries. Aim: This is to compare the findings at post-mortem using forensic imaging techniques and, those of TA. Materials and Methods: Post-mortem CT-Scan and MRI techniques were employed in the present case and for the first time in Nigeria, to identify the fatal injuries and determine their causation. The examination was done prior to the TA; the latter was done by a team of pathologists without the prior knowledge of the imaging findings. The results, using both methods, were subsequently compared. Results: Most of the VA and TA findings were the same except for the areas that were not readily accessible to the pathology team because of prior embalmment of the body. The inexperience of the radiologist in the area of post-mortem forensic imaging also contributed to the few discrepancies. Conclusion: This is the first virtopsy to be conducted in Nigeria and, with impressive results. The findings compare favourably with those of TA and, have the added advantage of identifying minor injuries that might easily be missed using TA method. Success is however hinged on the expertise of the forensic radiologist and forensic pathologist. While VA can be employed to solve the problems of religious opposition to TA, the cost of the former is astronomical


Subject(s)
Autopsy/methods , Cause of Death , Forensic Pathology , Lakes , Nigeria
15.
Article in Spanish | LILACS, BIMENA | ID: biblio-1348776

ABSTRACT

La Universidad Nacional Autónoma de Honduras tiene en su oferta académica los posgrados en Anatomía Patológica y en Medicina Legal y Forense, al formar profesionales que investigan la causa de muerte haciendo énfasis desde perspectivas distintas, es recomendable que ambos posgrados se vinculen académicamente para que los estudiantes desarrollen las competencias que permitan analizar integralmente las causas de muerte...(AU)


Subject(s)
Humans , Forensic Pathology , Pathologists , Autopsy/methods , Information Storage and Retrieval
19.
Med. leg. Costa Rica ; 34(1): 279-286, ene.-mar. 2017. tab
Article in Spanish | LILACS | ID: biblio-841454

ABSTRACT

ResumenLas alteraciones del sodio son un factor primordial o agravante que podrían condicionar o causar la muerte tanto en personas conocidas sanas como que en aquellas que presentan algún tipo de patología ya sea aguda o crónica. Dichas alteraciones en muchas ocasiones podrían pasar desapercibidas, dado su grandísima complejidad de detección, de tratamiento y en ocasiones de manejo clínico. Siendo estos factores que vuelven a dichas alteraciones un eje de la medicina clínica olvidada en muchas ocasiones por parte de los peritos encargados de realizar autopsias tanto clínicas como aquellas en las que priva algún interés de índole médico legal.


AbstractSodium alterations are a primary or aggravating factor that could cause death in both well-known and wellknown people, as well as those that present some type of pathology, either acute or chronic. These alterations in many occasions could go unnoticed, given their great complexity of detection, treatment and sometimes clinical management. These factors make these alterations an axis of clinical medicine often forgotten by experts in charge of performing clinical autopsies as well as those in which it deprives some interest of a legal medical nature


Subject(s)
Humans , Osmotic Fragility , Sodium , Cause of Death , Myelinolysis, Central Pontine , Forensic Pathology , Forensic Medicine , Hypernatremia , Hyponatremia
20.
Article in English | WPRIM | ID: wpr-67293

ABSTRACT

Acute fatty liver of pregnancy (AFLP) is one of the sudden unexpected causes in pregnancy and maternal deaths. It has been considered as a potential fatal disease in pregnancy, but the postmortem findings of AFLP is not well known. Because an unexpected maternal death may lead to a legal dispute, forensic pathologists should be aware of clinical presentations and postmortem findings of AFLP. Therefore, we presented our case and reviewed with literatures.


Subject(s)
Autopsy , Dissent and Disputes , Fatty Liver , Forensic Pathology , Maternal Death , Pregnancy
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