Republication: Sudden Postpartum Death from Pulmonary Arterial Hypertension / 대한법의학회지

We present here a brief literature review and a case study of postpartum pulmonary arterial hypertension, a rare and progressive disease with a high maternal mortality rate. The patient, a 32-year-old woman, presented with dyspnea and shivering immediately following an uncomplicated vaginal delivery. The patient had no remarkable individual or familial history. She died 4 hours after her delivery, and an autopsy revealed atherosclerosis of the main pulmonary arteries and characteristic plexiform lesions on the lung. The remaining organs showed no remarkable pathology. We reported pulmonary arterial hypertension associated with pregnancy as the cause of death.

Differences in the Determination of Cause and Manner of 127 Natural Death Cases by Postmortem Inspection and Autopsy / 대한법의학회지

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.

Asphyxial Death Using Plastic Bag / 대한법의학회지

Asphyxia due to plastic bag is not common. The manner of death may be accidental, suicidal or homicidal. We report an asphyxial death using plastic bag, giving us difficulty in determining the manner of death, suicidal or homicidal. A 32-year-old female was found dead in bathroom and her head was wrapped in a supermarket shopping bag sealed with adhesive tape around the neck. Strangely she was handcuffed behind the back of the victim. Because of no evidence of violence on the body and the presence of a suicide note at the scene, the manner of death was concluded as suicide. This case emphasizes that the interpretation of postmortem examination should be incorporated with the proper investigation of circumstances at the scene of death to determine the manner of death.

Autopsy case: Vibrio vulnificus sepsis confirmed by autopsy / 대한내과학회지

Vibrio vulnificus primary septicemia is a serious illness associated with high mortality rates and is caused by the ingestion of raw or undercooked shellfish. Most patients admitted with V. vulnificus infection are immunocompromised or have an underlying disease, such as liver cirrhosis or hemochromatosis. In contrast, the authors experienced an uncommon case in which a patient with no known underlying disease rapidly progressed to sepsis with hypotensive shock, followed by death within a few hours. Based on a postmortem examination, tissue cultures, and blood cultures, it was determined that the patient had been infected with V. vulnificus and had chronic liver disease. There are no reports in Korea on the clinicopathological findings of V. vulnificus infection. Here, we present the case of a patient with V. vulnificus septicemia and describe the associated clinical symptoms and clinicopathological findings discovered upon autopsy.

Sudden Death Due to a Ganglioglioma / 대한법의학회지

The incidence of sudden death due to undiagnosed primary intracranial tumor is very low in forensic autopsy practice. The ganglioglioma is a well differentiated, slow growing primary brain tumor that is encountered predominantly in childhood. We report a sudden, unexpected death in a 6-year-old girl from a ganglioglioma. On autopsy, there was an intraventricular tumor with recent hemorrhage, occupying the anterior aspect of the lateral ventricle and resulting in hydrocephalus. Acute intratumoral hemorrhage appears to be the mechanism of sudden death.

Pathogenesis of Sudden Manhood Death Syndrome / 대한법의학회지

Sudden manhood death syndrome (SMDS) is a disorder found in southeast Asia, particularly Thailand, Philippines and Japan, which causes sudden cardiac death during sleep. In Korea, SMDS cases have been occasionally encountered in forensic autopsy practice. However, the incidence and pathogenesis has been rarely studied. This study to review chronologically the proposed pathogenesis of SMDS; pathology of cardiac conduction system, sleeping and breathing disorder, K+ and thiamine deficiency, mental stress, testosterone, hyperlipidemia, and narrow circumference of coronary artery. Brugada syndrome and SMDS are phenotypically, genetically and functionally the same disorder and Brugada syndrome has been a subject of intensive study since its early description in 1992. While Brugada syndrome is an inherited cardiac disorder caused by mutations in the SCN5A gene encoding the cardiac sodium channel alpha-subunit. less than 20% of its patients are known to be associated with SCN5A mutations. Moreover, the postmortem molecular screening of SCN5A mutations on formalin fixed paraffin embbeded cardiac tissues from SMDS cases has not been rewarding due to technical problems. The role of structural heart disease and sodium channel dysfunction in the induction of electrical instability in SMDS and Brugada syndrome is still debatable.

Sudden Death due to Undiagnosed Intracranial Meningioma: A Case Report / 대한법의학회지

Since patients with intracranial neoplasms usually represent their neurological symptoms rather early in the course of the disease, sudden unexpected death due to intracranial neoplasms is an uncommon event seen only exceptionally in medicolegal autopsy practice. Although meningiom is one of the most common primary intracranial neoplasms, sudden death due to the tumor is an uncommon event. We report a sudden, unexpected death of a 56-year-old female with an undiagnosed olfactory groove meningioma. It is assumed that peritumoral edema is related to the sudden death among the several mechanisms.

Usefulness of Rapid Test for Cardiac Troponin T in Postmortem Diagnosis of Sudden Cardiac Death / 대한법의학회지

BACKGROUND/AIMS: Sudden cardiac death (SCD), mostly related to myocardial infarction is a common cause of death on forensic autopsy. It is known that the morphologic evidence can not be detected in the early stage of myocardial infarction. Cardiac troponin T (cTnT) is a specific marker of myocardial damage, which is clinically used for the diagnosis of ischemic heart disease with rapid test kit. This study was aimed to evaluate the usefulness of rapid test kit for cTnT in postmortem diagnosis of sudden cardiac death. METHODS: We performed the test on heart blood during autopsy on SCD (n=35) and control (n=10, 5 trauma-related and 5 non-trauma-related) groups, using TROPT(R) sensitive assay kit. RESULTS: 68.6% of SCD was positive, compared with 20.0% of control. There was a statistically significant difference between two groups. Among non-traumatic control, drug intoxication and asphyxia due to O2 deficiency were positive, while all trauma-related cases were negative. 76.2% of SCD within PMI 24 hours was positive, compared with 57.1% after PMI 24 hours. Negative results among SCD were found in the cases died very shortly after the event, with acute change in atheromatous plaque of coronary atherosclerosis. CONCLUSIONS: This rapid test for cTnT could be an adjuvant tool of postmortem diagnosis of SCD. However, the result of this test should be interpreted with caution, considering the duration of the event in SCD and the false positivity on non-traumatic cause of death.

Sudden Death 10 Hours after Birth Due to Congenital Pneumonia / 대한법의학회지

Congenital pneumonia is defined as pneumonia acquired transplacentally or perinatally. It is frequently associated with prolonged rupture of the membranes, chorioamnionitis, prolonged labor, premature labor, fetal distress, prematurity and meconium staining. It is one of the important causes of neonatal death. We report a case of congenital pneumonia of a full-term, female neonate who was born by cesarian section and died at 10th hours of her life. There were no maternal signs and symptoms of infection and amniotic fluid was not stained with meconium at birth. We insist that full physical examination and routine laboratory examinations including simple chest X ray are required even in grossly normal neonate without specific risk factors and that possibility of neonatal pneumonia should always be considered when the cause of death cannot be explained immediately by gross autopsy findings.

Anatomy in Disaster Victim Identification: Air China Crash near Kimhae Airport / 대한해부학회지

Positive identification of human remains is one of the most important tasks in mass disaster management. Intervention of highly trained anatomists is essential for the effective procedures. However, most anatomists have not so much chances and/or experiences in this field in Korea. Recently, there was an aircraft accident leaving 128 people dead or missing. Most of the bodies were severely fragmented and incinerated beyond recognition. We joined as a member of national identification team and supported identifying skeletal remains. Physical characteristics of the dead bodies were obtained through autopsies and X-ray. We also interviewed family members of the victims and collected antemortem medical and dental records. Collaboration between the different professional investigators involving anatomists, forensic pathologists, odontologists, and other scientists resulted in rapid resolution and identified 126 of the 128 victims in 26 days. This article represents diverse methods that were used and the results including DNA typing, dental records and specific anatomical or X-ray findings.

Medicolegal and Anthropological Investigations on Tattoo Marks in Korean / 대한법의학회지

Tattoo involves puncturing the skin with a sharp instrument and inserting pigment through the epidermis into the dermis. People around the world have been tattooing their bodies for ages. As widely recognized, tattoo marks are found on Egyptian and Nubian mummies dating from about 2000 B.C. The culture of tattooing has had diverse meanings in different cultures. It may include cosmetic, religious and magical origins and identification of a social class. In Korea, there was a record of tattooing on forearm as a commitment to the thieves in Korea dynasty (918-1392). From a medicolegal perspective, tattoos are often used as identification markers in unknown human bodies, and have been associated with several risk factors for lethality from both suicide and accidental death. In this article, we investigated tattoo marks among the 665 autopsies performed in the Southern division of National Institute of Scientific Investigation between August 2001 and December 2002.

An Autopsy Case of a Transsexual Woman / 대한법의학회지

Transsexualism is a variety and complexity of conditions to the desire for sex change and may require medical treatments over psychological evaluations in some patients. Consequently, there is a potential confusion in the determination of anatomical sex in transsexuals arising from administration of hormone and/or sex reassignment surgery. In this article, we represent a case of a 52-year-old "woman"found dead on the road-side. "She"was naked on the scene and supposed to be murdered by strangulation of he neck. Surprisingly, autopsy findings as well as DNA typing revealed that "she"was transsexual once a man. We discuss medicolegal problems posed by medico-surgical treatment in transsexuals.

Autoerotic Death in an Old Man / 대한법의학회지

Autoerotic death is an accident occurring during individual, usually solitary sexual activity in which a device or apparatus used to enhance the sexual stimulation. Although it is a well-known phenomenon described in many forensic medicine reports, cases are rare in Korea because of conservative tradition of the society and embarrassment of the victim 's family members. It may be far more common than realized. We present a case of the autoerotic accident involving a plastic bag asphyxia in a 67-year-old man. The death scene investigation and findings at autopsy will provide police officers and physicians with adequate knowledge about this phenomenon to make an accurate diagnosis.

Mass Disaster Operational System of an Aircraft Accident in Korea / 대한법의학회지

Mass disasters usually include transportation accidents (aircraft, train or bus), structural failures of bridges and buildings, structural fires and industrial accidents. These often result in extensive damage of property and the loss of life. For the effective restoration and management of the situation, a well-organized operational plan is essential. Such a plan must consider facilities, specified personnel, administrative assistance and law enforcement. Recently, we experienced an aircraft accident leaving 128 people dead or missing. KDMORT (Korea Disaster Mortuary Operational Team) was tasked to perform the medicolegal investigations and identification. Difficulties were encountered during the procedures. In this article, we discuss some problems in the mass disaster operational system of Korea.

Adult Polycystic Kidney Disease with Cardiovascular Assault / 대한법의학회지

Adult polycystic kidney disease is a genetic disease characterized by bilateral multiple renal cysts and is transmitted as an autosomal dominant traits. The disease usually manifests in the fourth decade of life. The affected patients usually die with end stage renal failure, cardiovascular assaults and infection etc. Cardiovascular assaults include ruptured berry aneurysm, spontaneous intracranial hemorrhage, acute myocardial infarction, dissecting aortic aneurysm and hypertensive heart failure. Fatal intracranial hemorrhage and hypertensive heart failure occur in 15% and 2% of patients, respectively. Genetically-determined structural weakness in the arterial wall have been suggested as a possible factor in the genesis of berry aneurysm. We have experienced three autopsy cases with cardiovascular causes of sudden death. Two cases have intracranial hemorrhage (1 berry aneurysm and 1 intracerebral hemorrhage) and the remaining one is dead with hypertensive cardiomyopathy. All of them are aged over 40 years and associated with polycystic liver disease. Histologically, myriad cysts of enlarged bilateral kidney are lined by single layer of cuboidal cells with focal hyperplastic epithelial configuration. Diffusely scattered liver cysts are also lined by flat to cuboidal epithelium and often associated with portal fibrosis.

Examination of Abdominal Organ in Forensic Autopsy / 대한법의학회지

The dissection in forensic case is basically similar to any other sutopsy, with variations according to the nature of the death and the needs of the particular investigation. There are a number of manuals devoted to the performance of an autopsy and here only an outline of the technique to examining abdominal organs and described some postmortem artefacts. There are many facets of the autopsy, and there are a number of associated matters. Thus procedure of the autopsy is properly operated according to the circumstances.