Death from Naphthalene Poisoning Manifesting as Toxic Hepatitis: An Autopsy Case / 대한법의학회지

Suicide through naphthalene poisoning is rare. Prolonged hemolytic anemia and hemoglobinuria are typical symptoms of naphthalene poisoning. We report an unusual case of naphthalene poisoning. The decedent was an 87-year-old female who intentionally ingested over 5 g of naphthalene. After more than 5 hours, she was found in a drowsy state. During initial examination, hemoglobin level and urine test results were normal. Aspartate aminotransferase and alanine aminotransferase levels were elevated (854 and 1,197 U/L, respectively). Metabolic acidosis was found on arterial blood gas analysis. The patient was treated conservatively by administration of activated charcoal, calcium gluconate, insulin, and glucose. However, the patient died after 1 day of hospital admission. On autopsy, the liver showed toxic hepatitis with confluent necrosis. Naphthalene concentrations in the blood and gastric contents were 5.4 and 5.8 mg/L, respectively. In conclusion, the decedent ingested naphthalene and died due to liver failure without hemolysis.

Hemorrhagic Infarction of the Small Intestine due to Transmesenteric Hernia in an Adolescent: A Case Report / 대한법의학회지

Transmesenteric hernia is so infrequent that sudden unexpected death due to this condition is a very rare occurrence. Because the disease usually occurs in pediatric populations, it is a very rarely observed in adolescents or adults. We report an autopsy case of transmesenteric hernia diagnosed postmortem in an 18-year-old boy who died suddenly after complaining of acute abdominal pains with nausea. Physical examinations, simple abdominal radiographs, and abdominal CT scans failed to provide a clear diagnosis of the illness for 37 h in the hospital. At autopsy, a small round defect of the small bowel mesentery was found, through which a long segment of the small intestine herniated, accompanied by hemorrhagic infarction induced by strangulation obstruction. We would like to present and review this rare autopsy case with medicolegal viewpoints.

Death due to Cardiac Metastasis after Treatment of Oral Squamous Cell Carcinoma: An Autopsy Case / 대한법의학회지

A 60-year-old man presented with electrocardiographic abnormalities after treatment for oral squamous cell carcinoma with surgical resection and radiation therapy 7 months ago. The patient died within 2 h without response to CPR after sudden arrest. Electrocardiographic changes 9 h before death included low QRS voltage and sinus tachycardia. Autopsy revealed cardiac metastasis with chronic active fibrinoid pericarditis accompanied by tumor cell infiltration. Although the frequency of cardiac metastasis in patients with oral cancer is reportedly low, clinicians should be aware that cardiac metastasis may exist if there are electrocardiographic changes in patients receiving follow-up care for primary malignancy. We report a rare medicolegal case of cardiac metastasis-related sudden death.

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.

Homicidal Fall from Height with 'Tram-line' Bruise at Buttocks / 대한법의학회지

A teenaged female was found dead in front of a three story building. Blunt force injuries were found mainly in the right upper-posterior part of the body. Autopsy findings revealed basal skull fracture, multiple rib fractures of the right thoracic cage, both scapular fractures and right iliac bone fracture. Additionally, typical so-called 'tramline'bruises were bilaterally noted at buttocks. The hymen was intact, but showed mucosal hemorrhage. After the personal identity was revealed, the police could find a witness who heard the detailed description of the criminal acts from one of the suspects. According to the witness, the deceased was pushed by two other teenaged girls from the concrete fence of the roof floor after the suspects molested the genitalia of the deceased and beat on the buttocks with a wooden stick. Mathematical estimation of the height of fall based on the severity of injuries correlates with that of the three story building. Authors suggest that a careful examination of injury patterns is required to differentiate homicidal falls from suicidal or accidental ones. Furthermore, application of mathematical model might be helpful to estimate the height of falls or correlate the assumed height of fall with severity of injuries.

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%).

Forensic Review of Bullet Embolism / 대한법의학회지

One unusual case of bullet embolism is reported. The deceased is a 65-year-old man with a non-penetrating gunshot wound to the right lateral portion of chest. The autopsy was performed and showed fatal gunshot wounds were observed in liver, pericardium and heart, but no bullet was found in the chest. A postmortem radiologic examination showed a bullet in the left femoral area. A careful dissection of the left femoral area was performed and the bullet was found in the left femoral artery. A discussion of forensic significance of bullet embolism is presented.

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.

The Characteristics of Incidental Pituitary Microadenomas in 120 Korean Forensic Autopsy Cases

To investigate the characteristics of incidental pituitary microadenomas, we examined 120 pituitary glands from Korean forensic autopsy cases, from which eight tumors were identified (incidence 6.7%). The average age of the affected subjects was 50 yr (range: 33-96 yr) with a female predominance. The maximum diameters of the tumors ranged from 0.4 to 5.4 mm (mean: 2.8 mm). Immunohistochemical analysis of pituitary hormones revealed three growth hormone-secreting adenomas, one prolactin-producing adenoma, one gonadotropin-producing adenoma, one plurihormonal adenoma, and two null cell adenomas. MIB-1 staining for Ki-67 antigen showed no positive expression. The microvessel density (MVD) of the pituitary microadenomas ranged from 2.3 to 11.6% (mean: 5.3%) and was significantly lower than that of nonneoplastic pituitary glands (11.9-20.1%, mean: 14.8%). Our study provides reference data on incidental pituitary microadenomas in the Korean population.

Forensic Review of the Medical Accidents Related to the Iatrogenic Injury of Neck Vessels: The report of four autopsy cases / 대한법의학회지

Four cases medical accidents related to the iatrogenic injury of neck vessels are reported. The first case was a 54-year-old woman. Under the diagnosis of the herniated cervical disc, the operation was performed. After five hours from starting the operation, respiratory difficulty, facial cyanosis and syncope were found, suddenly. The autopsy finding were large hematoma at the posterior portion of neck organ and perforation of right carotid artery. The second case was a 61-year-old woman. Under the diagnosis of the aneurysm of the anterior communicating artery, the coiling and embolization were performed. After one hour from removal of catheter of right carotid artery, respiratory difficulty, facial cyanosis and syncope associated with right neck hematoma were found, suddenly. Eventually, she died after 41 days due to hypoxic brain injury. The third case was a 55-year-old woman. Under the diagnosis of the thyroid cancer, total thyroidectomy was performed. After three hours from operation, respiratory difficulty, facial cyanosis and syncope associated with severe neck hematoma were found, suddenly. Eventually, she died after 25 days due to hypoxic brain injury. The last case was a 34-year-old man. He visited the hospital due to stab wound of left neck. The irrigation and simple suture were performed at the first visit. After he went home, respiratory difficulty and syncope were found, suddenly. He returned the hospital and cardiopulmonary resuscitation was performed. However, he died. The autopsy finding were large hematoma around the neck organ and stab wound of left carotid artery.

Histopathological Findings of Cardiac Conduction System of Korean / 대한법의학회지

One hundred and thirty three heart specimens were collected from the cases submitted fo autopsy in the Department of Forensic Medicine in the Central District Office of National Institute of Scientific Investigation in January 2003-March 2004 and April-November 2005. The cardiac conduction system(CCS) of these heart were examined in order to find out histopathological changes in the CCS of Korean people and their forensic pathological significance. There were 98 males and 35 females. Almost all age groups were included. The results revealed that in the most of the people the fibrosis and fatty infiltration in the CCS increased with aging. The pathologic findings that may be causing arrhythmia, include 10 cases of severe narrowing of the sinoatrial(SA) or atrioventricular(AV) artery by fibromuscular hyperplasia(FMH), 9 cases of anomalous conduction fibers arising from atrioventriular node or His bundle, 5 cases of focal myocarditis of CCS were identified in this study. The authors concluded that routine examination of the CCS is helpful for revealing disease of the CCS and improving the quality of forensic pathologic diagnosis.

A Statistical Analysis on Legal Autopsy in Chung-cheong Area of Korea in 2004: The Central District of National Institute of Scientific Investigation / 대한법의학회지

We reviewed forensic autopsies and scene examinations performed at Central District of National Institute of Scientific Investigation, requested by every kinds of law enforecement agencies in Chungcheong area of Korea during the year of 2004, and analysed the data of forensic autopsies and scene examinations according to the cause of death and the manner of death. The results are as follows ; 1. Scene examination on the spot was performed in 49 cases ; Among these cases, 36 cases(73.5%) were unnatural deaths and the most common cause of death was trauma(20 cases). Autopy was performed in 23 cases(46.9%). 2. The total number of forensic autopsy were 643 cases(437 males and 206 females). The number of the forties(156 cases) and the thirties(114 cases) occupied almost half(42.0%) of all cases of autopsy. 3. Unnatural deaths were 448 cases(69.7%), natural 169 cases(26.3%), and the unknown 26 cases(4.0%). In 448 cases of unnatural deaths, suicide was 133 cases(29.7%), homicide 180 cases(40.2%), accident 86 cases(19.2%), and the undetermined 49 cases(10.9%). Homicide occupied 70.2% of trauma, 65.2% of blunt force injury excluding traffic and fall-down injury, and 83.6% of sharp force injury. The homicide rate in asphyxia was 35.8%. It showed no case of homicide in poisoning. 4. In 448 cases of unnatural deaths, traumatic deaths were 198 cases(44.2%). Blunt trauma was 61 cases(30.8%) and the leading cause of death in traumatic death. Of remaining 250 cases of unnatural deaths, there were 67 cases(14.2%) of asphyxia, 63 cases(14.1%) of thermal injuries, 59 cases(13.2%) of drowning, 49 cases(10.9%) of poisoning, and 10 cases(2.2%) of medical procedures. 5. Among 169 natural deaths, cardiac diseases were 98 cases(56.0%) and the leading cause of death in natural deaths. 29 cases(17.2%) of diseases involving digestive system and 26 cases(15.4%) of disease involving vascular system were followed. 6. Child deaths under the age of 10 were 35 cases. Among these cases, unnatural deaths were 21 cases(60.0%) and most of them were homicide and accident.

Forensic Review of the Iatrogenic Injury of Carotid Artery: The Report of an Autopsy Case / 대한법의학회지

One case of the iatrogenic injury of carotid artery is reported. The deceased person was a 54-yearold woman. She visited a local clinic because she had the severe pain on back and neck and the radiating pain of left lower extremity. Under the diagnosis of the herniated cervical disc, the operation was performed. After five hours from starting the operation, respiratory difficulty, facial cyanosis and syncope were found, suddenly. Cardiopulmonary resuscitation was performed, however eventually she died. The autopsy was performed. In the neck, large hematoma at the posterior portion of neck organ and perforation of right carotid artery were noted.

Suicidal Strangulation by Ligature : Three Case Reports / 대한법의학회지

Suicidal strangulation by ligature (so-called self-strangulation) is distinctly uncommon. It is distinct from self-suspension in cases of hanging, the latter being a far more common form of suicide. Suicidal strangulation by ligature must be separated from homicidal strangulation by ligature. But clear distinction between the homicidal and suicidal strangulation by ligature is often impossible on the basis of the anatomical findings alone, although fractures of the larynx in suicidal strangulations are distinctly unusual. An accurate evaluation of circumstances, a thorough post-mortem examination, and inspection of the scene are extremely important in such cases. It is equally important to examine the type of noose and knot as well as the number of turns around the neck. We reports three cases of suicidal strangulation by ligature with brief review of literature.

Recommendation of the Guideline for Postmortem Inspection at Scene on Forensic Aspects / 대한법의학회지

Postmortem body inspection at scene and examination of the scene of death are very important in determination of the suspected cause of death, manner of death and interpretation of events leading death, nature of injuries, time of death etc. Actually these works must be performed by well-experienced forensic pathologists. And forensic pathologists should visit the scene of death before the body is removed. In Korea, attendance at scene of death by forensic pathologists is not performed effectively due to low faculty of forensic pathologists and the problem of medicolegal investigation system. But we try to overcome these problems and begin to the work of postmortem body inspection at scene and examination of the scene of body in area of Daejeon Metropolitan city since March, 2003. In this report we recommend the guideline for postmortem body inspection at scene on forensic aspects. We believe that sharing the experience and knowledge about scene investigation including postmortem body inspection at scene and examination of the scene of death is very important to improve and change the environment of medicolegal investigation system in the future.

Asphyxia Due to Oxygen Deficiency: The Report of Two Autopsy Cases / 대한법의학회지

Two autopsy cases of asphyxia due to oxygen deficiency are reported. The first case is that a 38-year-old man died in a storehouse. Many pears were stored in a storehouse and the its atmosphere was strictly controlled. The second case is that a 42-year-old man died in the boiler room of a fishing ship. Much amount of Freon gas escaped due to a defect of the refrigerator in the boiler room. The victim entered the boiler room because he repaired the refrigerator. But, the victim died when he entered the boiler room immediately. In this article, the autopsy findings and the contents of the investigation of scene of two cases are described.

A Statistical Analysis on Legal Autopsy in Chung-cheong Area of Korea in 2003: The Central District of National Institute of Scientific Investigation / 대한법의학회지

We reviewed forensic autopsies and scene examinations performed at Central District of National Institute of Scientific Investigation, requested by every kinds of law enforcement agencies in Chung-cheong area of Korea during the year of 2003, and analysed the data of forensic autopsies and scene examinations according to the cause of death and the manner of death. The results are as follows ; 1. Scene investigation on the spot was performed in 220 cases ; Among these cases, 161 cases (73.2%) were unnatural deaths and the most common cause of death was trauma (61 cases). Autopy was per-formed in 93 cases (42.3%). 2. The total number of forensic autopsy were 685 cases (452 males and 233 females). The number of the forties (215 cases) and the thirties (124 cases) occupied almost half (49.5%) of all cases of autopsy. 3. Unnatural deaths were 434 cases (63.3%), natural 204 cases (29.8%), and the unknown 47 cases (6.9%). In 434 cases of unnatural deaths, suicide was 84 cases (19.3%), homicide 115 cases (26.5%), acci-dent 186 cases (42.9%), and the undetermined 49 cases (11.3%). Homicide occupied 43.7% of trauma, 77.1% of blunt force injury excluding traffic and fall down injury, and 97.7% of sharp force injury. The homicide rate in asphyxia was 35.0%. It showed only 1 cases (1.9%) of homicide in poisoning. 4. In 434 cases of unnatural deaths, traumatic deaths were 229 cases (52.8%). Blunt trauma was 70 cases (30.6%) and the leading cause of death in traumatic death. Of remaining 205 cases of unnatural deaths, there were 52 cases (12.0%) of poisonings, 51 cases (11.8%) of thermal injuries, 41 cases (9.4%) of drowning, 40 cases (9.2%) of asphyxia, 19 cases (4.4%) of medical procedures, and 2 cases (0.5%) of electrocution. 5. Among 204 natural deaths, cardiovascular diseases were 106 cases (52.0%) and the leading cause of death in natural deaths. 36 cases (17.6%) of diseases involving vascular system were followed. 6. Child deaths under the age of 10 were 32 cases. Among these cases, unnatural deaths were 14 cases (43.8%) and most of them were accident.

Evaluation of Simplified Method of the Cardiac Conduction System Analysis and Sudden Death Resulting from the Cardiac Conduction System / 대한법의학회지

A simplified method of the cardiac conduction system (CCS) is evaluated by the study of 73 forensic cases. The sinoatrial node were observed in all cases (100.0%), atrioventricular node in 70 cases (95.9%) and penetrating bundle (His bundle) in 70 cases (95.9%). We divided the cases into three groups as the group of cardiac death (25 cases), non-cardiac death (24cases) and sudden unexpected death but undeterminable cause of death (24 cases) diagnosed after routine autopsy including routine cardiac examination and toxicological analysis and compared the type and incidence of CCS lesions in each groups. Narrowing of the sinoatrial (SA) or atrioventricular (AV) artery by fibromuscular hyperplasia (FMH) and fatty infiltration in SA or AV node were identified in all groups, lymphocytic infiltration in SA or AN node in cardiac and non-cardiac death group, hemorrhage and fibrosis of SA or AV node were identified in cardiac death group. FMH of the artery of SA or AN node occured more commonly in undeterminable cause of death group (45.1%) than in cardiac (16.0%) and non-cardiac group (20.8%) and severe narrowing (> or =75%) of the artery of SA or AV node was only present in undeterminable cause of death group (29.2%). The results led to the conclusion that this simple technique is very useful in detection of major abnor-malities of CCS with minimal effort and examination of the CCS in death which the routine autopsy and drug screen fail to provide a cause of death can yield a cause of death in a significant percentage of cases.

Review of Mechaincal Asphyxia of the Neck: Fatal Pressure on the Neck: The Central District of National Institute of Scientific Investigation / 대한법의학회지

Mechanical asphyxia of the neck(hanging, ligature strangulation, manual strangulation and combined deaths) provides one of the most complex and controversial areas of 'asphyxial' deaths. To better understand the presentation of such cases, we reviewed retrospectively forensic autopsy files of the Central District Office, National Institute of Scientific Investigation from June 1, 2000, through June 31, 2003 for all such cases. A total of 80 cases were found; hanging 37 cases(46.3%), ligature strangulation 9 cases(11.2%), manual strangulation 25 cases(31.3%) and combined deaths 9 cases(11.2%). Economic problem was one of most frequent motives. Petechiae were present in the conjunctivae and/or sclerae in 37.5% of hanging cases, 100.0% of ligature strangulation cases, 88.8% of manual strangulation cases and 88.9% of combined deaths cases; fractures of the hyoid and/or thyroid cartilage were most frequently present in manual strangulation(52.0%). All children under 10 years old were killed by their parents. Fifty-nine percent of the victims had been subjected to additional violence. Twenty-six percent of victims had blood alcohol.

A Statistical Analysis on Legal Autopsy in Chung-cheong Area of Korea in 2002: The Central District Office of National Institute of Scientific Investigation / 대한법의학회지

We reviewed forensic autopsies and scene examinations performed at Central District of National Institute of Scientific Investigation, requested by every kinds of law enforecement agencies in Chung-cheong area of Korea during the year of 2002, and analysed the data of forensic autopsies and scene examinations according to the cause of death and the maner of death. The results are as follows ; 1. Scene examination on the spot was performed in 18 cases ; Among these cases, 17 cases were unnatural deaths and the most common cause of death was thermal injury. Autopy was performed in all 18 cases. 2. The total number of forensic autopsy were 590 cases (399 males and 191 females). The number of the thirties (155 cases) and the forties (118 cases) occupied almost half (46.3%) of all cases of autopsy. 3. Unnatural deaths were 378 cases (64.1%), natural 177 cases (30.0%), and the unknown 35 cases (5.9%). In 378 cases of unnatural deaths, suicide was 63 cases (16.7%), homicide 135 cases (35.7%), accident 94 cases (24.9%), and the undetermined 86 cases (22.7%). Homicide occupied 60.1% of trauma, 65.0% of blunt force injury excluding traffic and fall-down injury, and 91.4% of sharp force injury. The homicide rate in asphyxia was 61.0%, but it went up to 89.3% excluding hanging. It showed only 1 cases (2.0%) of homicide in poisoning. 4. In 378 cases of unnatural deaths, traumatic deaths were 167 cases(44.2%). Blunt trauma was 60 cases (35.9%) and the leading cause of death in traumatic death. Of remaining 211 cases of unnatural deaths, there were 61 cases (16.1%) of thermal injuries, 49 cases (13.0%) of poisonings, 46 cases (13.0%) of drowning, 41 cases (10.8%) of asphyxia, 9 cases (2.3%) of medical procedures, 4 cases (1.1%) of electrocution, and one case of neglect. 5. Among 177 natural deaths, cardiovascular diseases were 113 cases(63.8%) and the leading cause of death in natural deaths. 30 cases(16.9%) of diseases involving digestive system were followed. 6. Child deaths under the age of 10 were 45 cases. Among these cases, homicide were 24 cases(53.4%) and most of them occurred in the preschool period.