Review of the Determination of the Cause and Manner of Death, in Deaths Related to Medical Care / 대한법의학회지

A death certificate (DC) can be considered a legal document and in terms of societal use, it is a public document. A DC includes facts such as the time and place of death, as well as judgments as to the cause and manner of death. Whether it pertains to facts or judgments, recording false information results in a false DC. According to the National Association of Medical Examiners (NAME) in the United States, it is acknowledged that there are varying opinions and approaches when it comes to classifying the manner of death. Therefore, it may require a final judgment, including input from the legal system. Generally, deaths resulting from complications that occur during drug administration or medical procedures are classified as natural deaths, while deaths due to unforeseen complications that occur suddenly, are categorized as accidental deaths. Applying this classification by NAME to the principles and legal precedents related to the duty of explanation and medical lowas of the Korean Medical Association, it is reasonable to classify deaths resulting from complication, during medical care, as natural death. However, if the death occurs due to injury or poisoning during medical care, it falls under external causes, according to the principle of following the primary cause. In conclusion, it is considered reasonable to classify complications that occur during medical treatment as natural deaths when they are foreseeable and within the accepted range of complications determined by medical standards at that the time.

Sudden Cardiac Death from Acute Myocardial Infarction Caused by Unruptured Ascending Aortic Aneurysm Involving the Sinus of Valsalva: An Autopsy Case / 대한법의학회지

Ascending aortic aneurysm of the thorax is a condition characterized by an increase in the diameter of the ascending aorta between the aortic valve and the brachiocephalic artery. Most patients with ascending aortic aneurysm are asymptomatic and do not require treatment; the rates of dissection, rupture, and mortality are also low. In this report, we describe the autopsy findings in a case of sudden death due to acute myocardial infarction secondary to the previously asymptomatic, unruptured, and undissected aortic aneurysm of the thoracic ascending aorta extending to the sinus of Valsalva. The findings in this case emphasize the importance of preventive management of asymptomatic ascending aortic aneurysms, and possible mechanisms of sudden cardiac death in patients with uncomplicated ascending aortic aneurysm is also discussed.

Fat Embolism Syndrome after Femoral Fracture Fixation due to Pedestrian Injury / 대한법의학회지

Fat embolism syndrome (FES) is a rare but serious complication that primarily occurs in patients with long bone fractures. Herein, we report a case of sudden death due to FES, which was later confirmed by autopsy. The clinical course and pathological findings of the case are also presented. A 79-year-old male pedestrian was struck by a car while crossing a crosswalk, and due to the impact, he flew 4.5 meters away. He was admitted to the emergency room and diagnosed with an intertrochanteric fracture of the right femur. Upon admission, he had clear consciousness and normal vital signs. The patient died 27 hours after trauma during surgery for a right femur fracture. Histological examination revealed fat droplets in lung tissue. The diagnosis of FES was confirmed based on clinical and histological findings.

Sudden Cardiac Death from Coronary Arteriosclerosis and Coronary Artery Aneurysm in Childhood: An Autopsy Case / 대한법의학회지

Coronary artery disease in childhood is rare. However, coronary arteriosclerosis and coronary artery aneurysm may occur in childhood as congenital malformations, or as complications of vasculitis, other connective tissue disorders, and infections. Coronary arteriosclerosis and coronary artery aneurysm may manifest in varied ways, including silent ischemia, myocardial infarction and sudden cardiac death. In this report, we present a rare case of sudden death in 5-year-old child. Autopsy examination showed coronary arteriosclerosis and coronary artery aneurysm with myocardial fibrosis of the septal wall. Pathologic examination showed near total occlusion of the left anterior descending branch of the coronary artery and the aneurysm, with fibrosis and calcification of the right coronary artery.

Standard Operating Procedure for Postmortem Inspection in a Focus on Coronavirus Disease-19: The Korean Society for Legal Medicine / 대한법의학회지

Coronavirus disease-19 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerged in Wuhan, China, in late 2019. It resulted in a worldwide pandemic, and spread through community transmission in the Republic of Korea (ROK). In the ROK, SARS-CoV-2 is categorized as a first-degree infectious disease of the legal communicable disease present. The Korean Society for Legal Medicine (KSLM) is the sole official academic association of forensic professionals in the ROK. As such, this society has played an important role in forensic medicine and science in the ROK. Therefore, KSLM suggests a standard operating procedure for the postmortem inspection in a focus on COVID-19. This article includes the background of this suggested standard operation procedure, basic principles for postmortem inspections of individuals suggested of having an infectious disease, and specific procedures according to the probability level of SARSCoV- 2 infection.

Secondary Publication Standard Operating Procedure for Post-mortem Inspection in a Focus on Coronavirus Disease-19: the Korean Society for Legal Medicine

Coronavirus disease 2019 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerged in Wuhan, China, in late 2019. It resulted in a worldwide pandemic, and spread through community transmission in the Republic of Korea (ROK). In the ROK, SARS-CoV-2 is categorized as a first-degree infectious disease of the legal communicable disease present. The Korean Society for Legal Medicine (KSLM) is the sole official academic association of forensic professionals in the ROK. As such, this society has played an important role in forensic medicine and science in the ROK. Therefore, KSLM suggests a standard operating procedure for the postmortem inspection in a focus on COVID-19. This article includes the background of this suggested standard operation procedure, basic principles for postmortem inspections of individuals suggested of having an infectious disease, and specific procedures according to the probability level of SARS-CoV-2 infection.

Type A Aortic Dissection with Concomitant Acute Myocardial Infarction and Cardiac Tamponade: An Autopsy Case / 대한법의학회지

Aortic dissection is an uncommon, life-threatening medical emergency that is associated with a high mortality rate, and death from aortic dissection is mainly related to secondary complications, namely cardiac tamponade, severe aortic regurgitation, acute myocardial infarction, and abdominal organ vessel obstruction. Hence, prompt and accurate diagnosis followed by proper treatment is important for patient survival. Herein, we present a rare case of sudden death after aortic dissection with concomitant acute myocardial infarction and cardiac tamponade.

Type A Aortic Dissection with Concomitant Acute Myocardial Infarction and Cardiac Tamponade: An Autopsy Case / 대한법의학회지

Aortic dissection is an uncommon, life-threatening medical emergency that is associated with a high mortality rate, and death from aortic dissection is mainly related to secondary complications, namely cardiac tamponade, severe aortic regurgitation, acute myocardial infarction, and abdominal organ vessel obstruction. Hence, prompt and accurate diagnosis followed by proper treatment is important for patient survival. Herein, we present a rare case of sudden death after aortic dissection with concomitant acute myocardial infarction and cardiac tamponade.

Statistical Analysis of Legal Autopsy Cases Performed in the Jeollabuk-do Province of Korea in 2016 / 대한법의학회지

This study aimed to obtain basic regional data of legal autopsy cases observed in the Jeollabuk-do province concerning causes and manner of death. We investigated 170 autopsy cases (114 males [67.0%] and 56 females [33%]) performed at the Department of Forensic Medicine, Chonbuk National University Medical School, in 2016. Of these, seven (4.1%) were children aged <10 years. Regarding the manner of death, there were 95 unnatural deaths (55.9%), 69 natural deaths (40.6%), and six deaths from unknown causes (3.5%). Among the 95 unnatural deaths, 29 suicides (30.5%), 10 homicides (10.5%), 52 accidental deaths (54.7%), and four undetermined deaths (4.2%) were recorded. Concerning causes of unnatural death, there were 39 traumatic injury-related deaths (41.2%), 10 asphyxiations (10.5%), 25 poisonings (26.3%), 13 thermal injury-related deaths (13.7%), and eight deaths due to drowning (8.4%). The most common cause of unnatural death was injury from falls (n=15), followed by agrochemical poisoning (n=12), traffic injury (n=12), and death from fire (n=11). Of 69 natural deaths, 31 were from cardiac diseases (44.9%), eight from cerebral or vascular diseases (11.6%), 12 from digestive system diseases (17.4%), one from respiratory system disease (1.4%), five from endocrine/metabolic/nutritional disorders (7.2%), and nine due to causes of unknown origin (including sudden manhood and sudden infant death syndromes) (13.1%).

Immunohistochemical Expression and Clinical Significance of Suggested Stem Cell Markers in Hepatocellular Carcinoma

BACKGROUND: Increasing evidence has shown that tumor initiation and growth are nourished by a small subpopulation of cancer stem cells (CSCs) within the tumor mass. CSCs are posited to be responsible for tumor maintenance, growth, distant metastasis, and relapse after curative operation. We examined the expression of CSC markers in paraffin-embedded tissue sections of hepatocellular carcinoma (HCC) and correlated the results with clinicopathologic characteristics. METHODS: Immunohistochemical staining for the markers believed to be expressed in the CSCs, including epithelial cell adhesion molecule (EpCAM), keratin 19 (K19), CD133, and CD56, was performed in 82 HCC specimens. RESULTS: EpCAM expression was observed in 56% of the HCCs (46/82) and K19 in 6% (5/82). EpCAM expression in HCC significantly correlated with elevated alpha-fetoprotein level, microvessel invasion of tumor cells, and high histologic grade. In addition, EpCAM expression significantly correlated with K19 expression. The overall survival and relapsefree survival rates in patients with EpCAM-expressing HCC were relatively lower than those in patients with EpCAM-negative HCC. All but two of the 82 HCCs were negative for CD133 and CD56, respectively. CONCLUSIONS: Our results suggest that HCCs expressing EpCAM are associated with unfavorable prognostic factors and have a more aggressive clinical course than those not expressing EpCAM. Further, the expression of either CD133 or CD56 in paraffin-embedded HCC tissues appears to be rare.

Sudden Death from Acute Epiglottitis and Epiglottic Abscess in Adult / 대한법의학회지

Acute epiglottitis is an inflammation of the epiglottis and adjacent structures. Although the incidence is extremely rare, acute epiglottitis is a life-threatening medical emergency and can cause sudden respiratory obstruction. Herein, we describe two cases of sudden death from epiglottitis and epiglottic abscess. A 39-year-old man and 66-year-old man died after suffering from shortness of breath. Autopsies revealed diffuse swelling and abscess formation in the epiglottis and neighboring structures. These cases emphasize the medicolegal importance of sudden death from acute epiglottitis and epiglottic abscess in adults.

Malignant Fat-Forming Solitary Fibrous Tumor of the Thigh

No abstract available.

Multicystic Biliary Hamartoma of the Liver

Multicystic biliary hamartoma (MCBH) is a very rare hamartomatous cystic nodule of the liver, which has recently been described as a new entity of a hepatic nodular lesion. We report a unique case of MCBH with a review of the literatures. A hepatic multicystic mass of segment 3 was detected in a 52-year-old male by abdominal computed tomography, and resection of this lesion was performed. Macroscopic examination revealed a 2.7x2.0 cm nodular mass with a multicystic honeycomb cut surface. Histologically, this lesion consisted of multiple dilated cystic ducts lined by biliary type epithelial cells, periductal glands and connective tissue, which included small amounts of hepatic parenchyma and blood vessels. Recognition of this unusual lesion is essential to avoid confusion with other cystic tumors of the liver, and to learn more about its natural history and response to treatment.

Nesidioblastosis and Pancreatic Non-functioning Islet Cell Tumor in an Adult with Type 2 Diabetes Mellitus

No abstract available.

Mucinous Non-neoplastic Cyst of the Pancreas

No abstract available.

Exophytic combined hepatocellular carcinoma and cholangiocarcinoma

No abstract available.

Expressions of E-cadherin, Cortactin and MMP-9 in Pseudoepitheliomatous Hyperplasia and Squamous Cell Carcinoma of the Head and Neck: Their Relationships with Clinicopathologic Factors and Prognostic Implication

BACKGROUND: E-cadherin, cortactin, and matrix metalloproteinase (MMP)-9 have roles in tumor development or progression, but their expression has not been fully investigated in pseudoepitheliomatous hyperplasia (PEH) and squamous cell carcinoma (SCC) of the head and neck. METHODS: We evaluated the immunohistochemical expression of E-cadherin, cortactin, and MMP-9 in 29 cases of PEH and 97 cases of SCC. Additionally, we evaluated their relationship with clinicopathologic factors and prognostic implications in SCC. RESULTS: Thirty-five cases of SCC showed reduced expression of E-cadherin, whereas none of the PEH did. A total of 20 cases and 11 cases of SCC were immunoreactive for cortactin and MMP-9, respectively, whereas none of the PEH did. In SCC, reduced expression of E-cadherin was correlated with cortactin expression and invasion depth. Cortactin expression was correlated with differentiation, T classification, and recurrence and/or metastasis. MMP-9 expression was correlated with invasion depth. Cortactin expression was correlated with poor overall survival and relapse-free survival and it was an independent prognostic factor. CONCLUSIONS: The reduced expression of E-cadherin and the expression of cortactin may be helpful for the differential diagnosis of PEH and SCC. Furthermore, cortactin expression in association with reduced E-cadherin expression is correlated with poor prognosis in SCC.

Solitary necrotic nodule of the liver

No abstract available.

In Situ Follicular Lymphoma Developed after Hodgkin Lymphoma

In situ follicular lymphoma is a newly defined entity among the lymphoid neoplasms and is defined as architecturally normal-appearing lymph nodes and other lymphoid tissues that have one or more follicles that demonstrate bcl-2 overexpressing centrocytes and centroblasts, with or without a monomorphic cytologic appearance suggestive of follicular lymphoma. Here we present a case of in situ follicular lymphoma diagnosed during the follow-up after a complete response to the treatment of lymphocyte-rich classical Hodgkin's lymphoma. In our case, because only a few germinal centers contained bcl-2 overexpressing cells, we missed the diagnosis of in situ follicular lymphoma in the initial histological examination. We could establish the diagnosis only after performing bcl-2 immunostaining in the sequential biopsy. Therefore, we recommend that careful histological examination along with bcl-2 immunostaining is needed in patients with suspicious clinical findings.

The Prognostic Significance of the Tumor-Infiltrating FoxP3-Positive Regulatory T Cells in Gastric Carcinoma

BACKGROUND: Regulatory T cells (Tregs) are known to be key regulators of immune responses in patients with autoimmune disease and infection and also for attenuating antitumor immunity by the host. It has been reported that high numbers of tumor-infiltrating Tregs might be associated with poor clinical outcomes for several malignant tumors. Therefore, this study aimed to examine the impact of tumor-infiltrating Tregs on the prognosis of gastric carcinoma patients. METHODS: The immunohistochemical staining for anti-fork head Box P3 (FoxP3) antibody was performed by using a 3 mm core from the tumor specimens of each of the 173 gastric cancer patients for constructing a tissue microarray. FoxP3-positive Tregs were quantified by calculating the numbers of positive cells per 5 high-power fields on light microscopy. Thereafter, the 173 patients were subdivided into the low Tregs group ( 3/5 HPF, n = 132). RESULTS: The high Tregs group was significantly associated with a higher stage, more invasion depth and lymph node metastasis (p = 0.009, p = 0.036, p = 0.006, respectively). The high Tregs group showed significantly poorer overall survival and event-free survival (p = 0.004, p = 0.017, respectively) on the univariate analysis. The Tregs group and the tumor, node and metastasis stage were also independent prognostic factors that were significantly associated with overall survival (p = 0.025, p < 0.001, respectively) by multivariate analysis. CONCLUSIONS: Our results indicated that a high number of tumor-infiltrating FoxP3-positive Tregs could be an indicator of poor long term survival for gastric carcinoma patients.