The Predictive Ratios of Intoxicated Deaths by Police's Death Scene Investigation and Doctor's Death Certificates in South Korea / 대한법의학회지

Forensic autopsies were performed on 1,821 cases in 2014 and 2,024 cases in 2015 at the National Forensic Service Seoul Institute. Based on the autopsy reports, 103 cases (5.7%) in 2014 and 130 cases (6.4%) in 2015 were selected as unnatural deaths caused by fatal intoxication. The cases were divided into five groups. The first group had ethanol intoxication, the second had drug intoxication, the third had agrochemical intoxication, the fourth had cyanide intoxication, and the fifth had miscellaneous intoxications. Of the 233 cases, 202 had death certificates. Of these 202 cases, 169 (83.7%) had an undetermined manner of death (MOD); 17 (8.4%) had an unnatrual MOD and intoxication was the cause of death (COD); nine (4.5%) had an unnatural MOD, but the COD was not intoxication; seven (3.5%) had a natural MOD and disease as a COD. The predictive ratios of intoxication as a COD were compared with the death certificates and the police death scene investigation results. The death certificates and the police investigation results showed predictive ratios of 8.4% and 55.2%, respectively, for intoxication as a COD. The discrepance in these predictive ratios and relatively low predictive ratio of police investigation results mean that intoxicated deaths have been underevaluated; thus, some homicides or intentional deaths were probably missed under South Korea's death investigation system. Doctors who specialize in forensic medicine need to supervise the entire postmortem examination process and emergency blood toxicological analysis should be performed in South Korea.

A Statistical Analysis on Forensic Autopsies Performed in Korea in 2015 / 대한법의학회지

The statistical analysis of forensic autopsies provides basic data for the postmortem investigation system and is the foundation of the statistics used in the analysis of the causes of death. A statistical analysis was performed on national forensic autopsy data collected in the Republic of Korea during 2015 to overcome regional limitations and limitations from the number of unusual deaths in the current forensic autopsy research. A total of 6,610 cases were categorized based on the region, requested Police Agency or Coast Guard, gender, age, manner of death, and cause of death. Analysis of the manner of death revealed that 3,326 cases (50.3%) were unnatural death, 2,754 cases (41.7%) were natural death, and 530 cases (8.0%) were of unknown. Of the 3,326 cases of unnatural death, the majority (1,275 cases, 38.3%) were accidents, 1,040 cases (31.3%) were suicide, 481 cases (14.5%) were homicide, and 530 cases (15.9%) were undetermined death. Among the unnatural death, the majority (1,330 cases, 40.0%) were trauma, followed by 588 cases (17.7%) of asphyxia and 566 cases (17.0%) of poisoning. Fall down were the major cause of death by trauma (538 cases, 40.5%). On the basis of a previous study, there were 588 cases of asphyxia; strangulation was the major cause, with 472 cases (80.3%). Of the 2,754 cases of natural death, heart disease was the major cause (1,417 cases, 51.5%), followed by vascular disease (503 cases, 18.3%).

A Statistical Analysis of Legal Autopsies Performed in Korea in 2014 / 대한법의학회지

Medicolegal autopsies are a vital tool for obtaining reliable injury mortality data. This study statistically analyzed the data obtained from medicolegal autopsies performed in Korea in 2014. A total of 5,324 deaths were analyzed by sex, age, manner of death, and cause of death. With respect to the manner of death, 56.3% were recorded as unnatural deaths, 38.4% were natural deaths, and 5.3% had unknown causes. Of the 2,998 unnatural deaths, 41.0% were determined to be accidental deaths; 28.1%, suicidal; 16.1%, homicidal; and 14.8%, undetermined. Of the total number of unnatural deaths, 38.8% were trauma-related, wherein falls accounted for 32.7%. Asphyxiation accounted for 16.3% of unnatural deaths; of these, the predominant cause was hanging (59.4%). In addition, 15.0% of the unnatural deaths were due to drowning; 14.8%, poisoning; 11.3%, thermal injuries; 2.5%, complications arising from medical procedures; and 0.4%, electrocution, starvation, or neglect. Among the 2,042 natural deaths, heart diseases accounted for 49.0% and vascular diseases accounted for 17.3%. Of the 170 deaths among children under the age of 10, 38.8% were recorded as unnatural deaths, 54.1% were natural deaths, and 7.1% had unknown causes.

A Classification of Asphyxia Autopsy Cases of the Korea in 2012 according to New Classification of Asphyxia / 대한법의학회지

No accepted standard currently exists to classify asphyxia and define its subtypes. Sauvageau and Boghossian proposed an asphyxia classification system in 2010 that divided asphyxia into suffocation, strangulation, mechanical asphyxia, and drowning. Here, we present a modification of this classification system. We propose to classify asphyxia into four main categories: suffocation, strangulation, mechanical asphyxia, and complicated asphyxia. Suffocation includes smothering and choking as well as confined spaces, entrapment, and vitiated atmosphere. Strangulation is subdivided into hanging, ligature strangulation, manual strangulation, and other unspecified strangulation. Mechanical asphyxia includes positional and traumatic asphyxia. Finally, complicated asphyxia is defined as cases with two or more identifiable mechanisms of asphyxia. In this study, we review autopsy cases from 2012 diagnosed as asphyxia and classify them according to our proposed asphyxia classification system. In 24.7% of cases, the age range was 40-49 years, and 51.9% were men. The most common method of asphyxia was hanging (245 cases, 55.1%), followed by ligature or manual strangulation (53 cases, 11.9%). Most hangings were suicides; smothering, ligature, and manual strangulation were usually homicides. Eighteen cases were complicated asphyxia. This classification provides a simplified, unified, and useful tool to classify and understand deaths due to asphyxia.

Acute Necrotizing Esophagitis: An Autopsy Case Report and Literature Review / 대한법의학회지

Acute necrotizing esophagitis (AEN), also called "black esophagus," is a rare disorder with an unknown pathogenesis. Endoscopic findings generally show black pigmentation throughout the esophagus. This case also offered rare views of the gross anatomy of this disorder. Histological examination revealed that the mucosal and submucosal layers of the esophagus were involved in the severe necrotizing inflammation. The chief manifestation of this disease is hematemesis from hemorrhage of the upper gastrointestinal tract with a typically multifactorial etiology. AEN is also characterized by a clear boundary at the gastroesophageal junction where the necrosis stops. In this study, we report an autopsy case of a 61-year-old man with necrotizing inflammation throughout the esophagus and esophageal necrosis from the laryngopharynx to the gastroesophageal junction. The patient was a disabled person with a history of alcohol abuse who was also diagnosed with mild coronary arteriosclerosis and fatty liver on the basis of the underlying diseases. In this case, the main etiology for poor perfusion from the distal esophageal area was likely underlying illness, history of alcoholism, and malnutrition.

The Statistical Analysis on Legal Autopsy Performed in Korea during 2013 Year / 대한법의학회지

Medicolegal autopsy is a vital tool for obtaining reliable injury mortality data. This study statistically analyzed data obtained from medicolegal autopsies performed in Korea in 2013. The aim of this study was to analyze various aspects of the 4,861 deaths that were categorized as unusual in Korea in 2013. A total of 4,861 deaths were analyzed by gender, age, manner of death, and cause of death. Of the 4,861 deaths, 3,542 (73.3%) were of men and 1,302 (26.7%) were of women. With respect to the manner of death, 54.4% were recorded as unnatural deaths, 38.8% were natural deaths, and 6.9% had unknown causes. Of the 2,642 unnatural deaths, 45.0% were determined to be accidental deaths, 26.3% suicidal, 16.9% homicidal, and 11.8% undetermined. Of the total number of unnatural deaths, 42.1% were trauma-related deaths, for which falling down accounted for 33.8%. Asphyxiation accounted for 16.0% of unnatural deaths, and of these, the predominant cause was hanging (58.8%). In addition, 14.4% of deaths were due to drowning, 12.9% poisoning, 11.0% thermal injuries, 1.8% complications arising from medical procedures, and 0.8% electrocution, starvation, or neglect. Among the 1,886 natural deaths, heart diseases accounted for 52.0% and vascular diseases accounted for 16.9%. Of the 196 deaths among children under the age of 10 years, 41.8% were recorded as unnatural deaths, 45.1% were natural deaths, and 1.5% had unknown causes.

Cheese-like Material in the Heart: An Autopsy Case Report of Severe Hypertriglyceridemia in Diabetic Ketoacidosis Patient / 대한법의학회지

Here we report an autopsy case of diabetic ketoacidosis (DKA) with severe hypertriglyceridemia (12,900 mg/dl). A 29-year-old woman with a history of type 1 diabetes was found dead at a motel. There was no injury on external inspection, but a lump of cheese-like material was noted in the heart at autopsy and peripheral blood plasma had a creamy appearance. After postmortem biochemical analysis, we made a diagnosis of DKA with severe hypertriglyceridemia and concluded that these unusual autopsy findings were caused by DKA and postmortem change. Uncontrolled diabetes often causes DKA and hypertriglyceridemia. To the best of our knowledge, this is the first report in Korea of DKA with severe hypertriglyceridemia diagnosed by autopsy.

Application of 3D Surface Scanners in Forensic Science and Medicine ( I ): Digital Storage of Human Skeletons and Development of Appraisal Methods for Incident Scenes / 대한법의학회지

The aim of this project was to use 3D scanning data collected at incident scenes and various evidence to 1) develop surveying methods based on 3D data consisting of overall and detailed scene evidence, captured by long-range and micros-canner, which can be shared by personnel working in different fields such as forensic medicine, video analysis, physical analysis, traffic engineering, and fire investigation; 2) create digital storage for human skeletons and set the foundation for virtual anthropology; and 3) improve the credibility of 3D evidence by virtual remodeling and simulation of incident scenes and evidence to provide a basis for advanced and high-tech scientific investigation. Two complete skeletons of male and female were scanned using 3D micro-scanner. Each bone was successfully reproduced and assembled in virtual space. In addition, recreating evidence scheduled for invasive examination by creating RP (rapid prototype) was possible. These outcomes could play an important role in setting up the new field of virtual anthropology. Case-specific surveying methods were developed through analysis of 3D scanning data collected by long-range surface scanners at the scenes of vehicular accidents, falls, shootings, and violent crimes. A technique and recording method was also developed for detecting forged seals by micro-scanning the pressure exerted on the seal. Appraisal methods developed in this project could be utilized to secure 3D data of human skeletal remains and incident scenes, create a standard for application, and increase objectivity, reproducibility, and accuracy of scanning methods. We plan to develop case-specific 3D data analysis techniques to improve the credibility of analysis at the NFS and to establish a 3D data collection and analysis team.

Fatal Rectal Bleeding after Prostate Biopsy / 대한법의학회지

Transrectal ultrasound (TRUS)-guided biopsy of the prostate is a common outpatient procedure for diagnosing prostatic cancer. It is a relatively noninvasive, safe, and effective method, as the majority of post-biopsy complications are mild and self-limiting. Fatal complications including infection or massive hemorrhage are rare, but can be life threatening. We herein present an autopsy case of fatal rectal bleeding after prostate biopsy and an analysis of similar cases.

The Statistical Analysis of Legal Autopsies in 2011 (The Headquarters of National Forensic Service) / 대한법의학회지

This is a statistical analysis of the data obtained from legal autopsies performed at the headquarters of the National Forensic Service during 2011. This report aims to analyze 2,723 cases. 1. There were 1,995 (73.3%) cases involving mortalities among men and 707 (26.7%) among women; evidently, the number of deaths that occurred among men were twice as many as that among women. With respect to age, 694 (24.4%) deaths occurred in individuals aged in their forties and 658 (22.8%) among those in their fifties. 2. There were 1,437 (52.8%) cases of unnatural deaths, 1,159 (42.5%) cases of natural deaths, and 127 (4.7%) deaths from unknown causes. Among the 1,437 unnatural deaths, 483 (33.6%) were suicidal, 255 (17.7%) homicidal, 546 (38.0%) accidental, and 153 (10.6%) were of undetermined causes. 3. There were 618 cases of trauma-related death, accounting for 43.0% of the 1,437 unnatural deaths. Blunt trauma was the leading cause of trauma-related deaths, accounting for 174 (28.2%) cases. Deaths due to asphyxiation, among which hanging (187 cases, 64.7%) was the predominant cause, accounted for 289 cases. There were 192 (13.4%) deaths from poisoning, 151 (10.5%) from drowning, 139 (9.7%) from thermal injuries, 31 (2.2%) as a complication of medical procedures, and 14 (1.0%) from electrocutions. 4. Among the 1,159 natural deaths, heart diseases accounted for 600 (51.8%) deaths and vascular diseases accounted for 160 (13.8%) deaths. 5. There were 83 cases of death among children aged under 10; out of 33 unnatural deaths, 20 (24.1%) cases were homicidal.

Stercoral Colitis Leading to Fatal Peritonitis and Systemic Inflammatory Response Syndrome / 대한법의학회지

The stercoral colitis is an inflammatory process involving the colonic wall related to fecal impaction. This rare condition usually has a poor prognosis. We experienced a death case where an 84 years old woman died of stercoral colitis complications after total knee arthroplasty surgery. The fatal complications were peritonitis with systemic inflammatory response syndrome, not accompanying bowel perforations. We would like to show the autopsy case of stercoral colitis and suggest the importance of early suspicion and treatment.

Gastric Necrosis after Gastric Dilatation in a Patient with Bulimia / 대한법의학회지

Acute gastric dilatation leading to gastric necrosis is rare but potentially fatal condition that can occur in patients with bulimia. It usually develops after a bulimic episode and it is not diagnosed with sufficient rapidity it may lead to gastric perforation followed by peritonitis, sepsis, shock, and death. Because of the rarity of this condition and the patients in whom it occurs, the clinician must maintain a high degree of suspicion when treating patients with eating disorders who present with abdominal pain after a binge. This case report describes a 24-year old woman with acute gastric dilatation due to binge eating, who had the gastrotomy and died of complications such as gastric necrosis and disseminated intravascular coagulation.

Sudden Death Related to Left Anterior Descending Coronary Artery Fistula Draining to the Left Ventricle: A Case Report with Review of the Literature / 대한법의학회지

Coronary artery fistula (CAF) is a rare congenital malformation, comprising less than 1% of all congenital heart disease. Most fistulas drain into the right-sided heart chambers or pulmonary artery, and termination in left heart chambers is an uncommon finding. Clinical presentation mainly depends on the severity of the left-to-right shunt, and adult patients usually do not develop any symptom. There are few case reports relating CAF manifested as an exceptional form of sudden unexpected death. We experienced a case of a 62-year-old male with a single CAF arising from left main coronary artery which drains into the left ventricle, and reported with review of the related articles.

The Statistical Analysis on Legal Autopsy in 2010 (The headquarters of National Forensic Service) / 대한법의학회지

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Forensic Service (NFS), requested by every kind of law enforcement agencies during the year of 2010. NFS is located in Seoul, Korea and has four branches throughout the country. The Seoul NFS covers all legal autopsies in Seoul, Incheon City and Gyeonggi Province and some cases referred from other regions. This report aims to analyze various aspects of 2,425 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 1,777 cases (73.3%) and that of female 648 (26.7%). Male was over twice more than female. The forties were 592 cases (24.4%), the fifties 552 (22.8%), and these two decades occupied 47.2%. 2. Unnatural deaths were 1,377 cases (56.8%), natural 875 (36.1%), and the unknown 173 (7.1%). Among 1,377 unnatural deaths, suicide was 411 (29.8%), homicide 260 (18.9%, accident 417 (30.3%), and the undetermined 289 (21.0%). Homicide occupied 34.7% of trauma, 61.2% of blunt force injury excluding traffic and fall-down injury, and 81.4% of sharp force injury. The homicide rate in asphyxia was 23.9%, but it went up to 60.9% excluding hanging. It showed only 1.3% of homicide in poisoning. 3. Traumatic deaths were 536 cases, occupying 38.9% of 1,377 unnatural deaths, followed by poisoning. Blunt trauma was 138 cases (25.0%) and the leading cause of death in traumatic death. Poisoning was 245 cases, among which the alcohols were dominant (54 cases). Thermal injuries were 119 cases, electrocution 10 cases, and starvation/neglect 2 cases. and 48 cases were directly due to medical procedures. 4. Among 875 natural deaths, heart diseases were 583 cases (66.6%), and vascular diseases 64 (7.3%), and these two categories were added up to 647 (73.9%). 5. Child deaths under the age of 10 were 102 cases. Homicide was 25 cases (65.8%) out of 38 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 73 cases (71.6%).

Null and Duplicated Alleles of 17 Y-STR Haplotypes in Koreans and Considerations for Forensic Application / 대한법의학회지

The analysis of Y chromosome polymorphisms has become common place for the identification of male component in forensic cases. In male/female mixtures of many rape cases, Y-STRs are also very useful for the determination of contributors' number. During the analyses of 17 Y-STR haplotypes for forensic applications using the AmpFlSTR(R) Yfiler(TM) system, a number of null and duplicated alleles (40 out of 2144 subjects) were discovered. Interestingly, two haplotypes should focus the attention on forensic interpretation of Y-STR haplotype profiles, because multiple mutational events at various loci can be interpreted as a wrong mixed or allele drop-out profile.

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.

Application of Korean Mechanical 3D Bone Model to the MADYMO(R) / 대한법의학회지

MADYMO(R) (Mathematical Dynamic Models) is a computer software with a multibody dynamics solver, which can be employed to reconstruct and interpret dynamic motions of the human body in impacts. The human model of the software is composed of many ellipsoidal structures, which makes it possible to interpret dynamic whole-body motions and calculate applied forces to human body parts. However, this model has some disadvantage to interpret injuries of the smaller body parts such as ribs, vertebral bodies or intervertebral discs. After achieving the finite element bone model produced by CT and software BIONIX BODYBUILDER(R) (finite element modeller), we tried to import this model into the MADYMO(R) and parts of the human bone model were successfully imported to it. Importing of the whole bone model was, however, impossible because of the numerous elements. The coming experiments need to reduce the number of elements in the whole human bone model and incorporate ligaments, tendons and muscles into each separated part of bone models.

Media Operations and Family Assistance in Mass Disaster / 대한법의학회지

The level of initial media response will depend on the type of incident and the location of occurrence. Mass fatality incidents that occur in easily accessed areas will probably attract more and longer media visibility than an incident that occurs in a remote and possibly inhospitable climate. The actions the participates take should be based on doing what is right regardless of who is watching. However, we prepared for the problems the media can cause and have the ability to solve them. Many agencies have learned the hard way that no matter how well they managed the response to an incident, if the media coverage is unfavorable, the perception will be that they did a poor job. Having a good media-management plan is also something that does not just happen. Pre-incident coordination is key, as well as having trained spokespersons who can get along with the media and understand the media's role. The quality of our response will in large part be judge by the public's perception of our actions. No matter the cause of the incident or the size of the response force, the success of any incident response will depend on how well the families were cared for. So, the family assistance operations are very important. The quality of our overall response will, in large part, be judged by our response to the families. Mistakes should not happen, but when they do, we cannot undo them. Therefore, it is critical to listen to the families, provide them with what we can, and do our best.

Preliminary Research for Applying Appraisal Techniques to Evaluate the Cause of Skin Injury / 대한법의학회지

In the field of the forensic medicine, deciding the cause of the injury is very important. Forensic doctors usually use their naked eyes, two dimensional photos, the characteristics and the distribution of the wounds for evaluating the cause of the injuries. After body release, forensic doctors not infrequently met the questions from the law enforcement whether the injuries were matched with the new facts or statements given through the progression of the investigation. In the face of answering this question, the information or evidence about the injury is insufficient. New technologies and instruments are being developed and will be helpful for getting the evidence from the human skin injuries. In this preliminary study, authors try to find the usefulness of appraisal techniques(3D scanner, trace evidence, TMDT, alternative light) that are already used for other purposes in forensic field. These techniques have their own merits for preserving the evidences from the injured skin. But further studies and systemic approaches are essential for more scientifically verified evaluation of the cause of the skin injury.

Preparation of Bone Slide for Histomorphometry in Forensic Anthropology / 대한법의학회지

Microscopic analysis of bone is very useful method for estimating age at death of individual identification, diagnosing metabolic disorder or dietary deficiency in bone tissue, and differentiating human bone or not when applied to fragmentary skeletal remains. The purpose of this study was to establish a systematic method for preparing bone tissues by manual grinding method and offer help in application of related histomorphometric field such as estimating age at death. For this, human bone tissues of rib and femur from cadavers were prepared and considered histomorphological variations of osteon with light microscope. As results of this study, Type II osteons, smaller versions of Intact osteons (Type I) that form by radial remodeling of a preexisting Haversian canal, were distinguished from double-zonal osteons, one of the osteons that exhibit hypercalcified ring within their concentric lamellae, by the lack of an internal reversal line and the parallel contours of lamellae, and it is possible to suggest metric basis for drifting osteons as counting one osteon with the exception of size measurement. By applying this method of present study, one could easily make a bone tissue all oneself that would be helpful for establishing basic data in physical and forensic anthropology.