Exhumation: A 10-year retrospective study.

Exhumation is done for number of reason and includes establishment of identity, to know cause and manner of death, belated suspicion of an unnatural death or for medical insurance problems. It is infrequently done in India and due to cultural practice of cremation by burning to ashes the data are lacking. Compared with conventional autopsy done immediately after death, exhumation poses many problems. The present study was aimed to collect data regarding exhumation, to collect morphological findings in comparison with maximum postmortem interval and to analyze them in an attempt to formulate “catalogue of expectation” to supplement the published literature. Total 24 forensic exhumations performed at three centers of this region from 1999 to 2008 were evaluated retrospectively. Total 24 cases were analyzed and amongst them 12 were men and 12 were women and their age ranged from 3 years to 75 years (mean age 26.95). In the present series, the cause of death at exhumation could be clearly determined in 16 cases (66.6%). Amongst others, the burial practice and postmortem interval are major determining factors for possible outcome at exhumation.

Natural deaths in custody A 10 year mortality study.

Death in custody is usually associated with apprehension and community concern, and raises the suspicion of violation of human rights. Studies conducted in few countries have shown that people in custody have increased rate of morbidity and mortality than those not in custody. Many of these deaths are premature deaths and can be prevented with proper care and treatment. The present postmortem examination based retrospective study was undertaken to examine natural deaths in custody and provide mortality pattern in this population. A total 165 autopsies were performed during the 10 year period out of which 142 (86.06%) cases were of natural deaths. The study population consists of 138 (97.18%) males and 4 (2.81%) females and their age ranged from 21 to 78 years (mean age 46.80 years). It was noted that most common cause of death was diseases of the respiratory system (40.8%) followed by cardiovascular system (19.01%).

Issues related to non-heart-beating organ donation.

Since the enactment of the Transplantation of Human Organs Act, 1994, the brain dead person remains the primary source of organs legally obtained for transplantation purposes in India. With the increasing demand of organs for transplantation purposes, non-heart-beating donors can help meet this need. However, the process of retrieving organs in non-heart-beating donors is more complex and raises ethical and legal as well as medical issues. This essay discusses some of these concerns. Since the enactment of the Transplantation of Human Organs Act, 1994, the brain dead person remains the primary source of organs legally obtained for transplantation purposes in India. However, the demand for organs always been high and continues to grow, and potential donors are few, so the supply of organs remains limited. Therefore, alternative sources have been sought, including the retrieval of organs from individuals declared dead according to cardiopulmonary criteria, that is when cardiac function ceases. Such individuals are known as non-heart-beating donors (NHBD) (1). The NHBD is defined as one who sustains cardio-respiratory arrest and whose organs are retrieved after irreversible cessation of cardiac and respiratory function (2). In contrast, a conventional heart-beating donor is one who sustains irreversible brain insult and whose death is based on neurological criteria. The concept of NHBD is not new. When organ transplant programmes first started, all organs were retrieved from patients immediately after cardiorespiratory arrest (3). However, with the recognition of brain death, the use of NHBD has decreased considerably. The modified Maastricht classification of NHBD identified five categories of potential donors. A more practical classification may be “uncontrolled” or “controlled” NHBD depending on whether cardiopulmonary function ceases spontaneously or after medical therapy is withdrawn. Donors from categories 1, 2 and 5 have been classified as uncontrolled donors whereas those in categories 3 and 4 are described as controlled donors (3). It is proposed that NHBD could contribute to an increase in the number of solid organ and tissue donation for transplantation purposes. The solid organs that are suitable for transplantation purposes include the kidneys, liver, lungs and pancreas, and tissues such as corneas, bone marrow and pancreatic islet cells (1, 3-6). The results of transplantation of kidneys are encouraging (7, 8) and the recipients of NHBD kidneys have a five-year survival that is the same as those who received a conventional heart-beating donor kidney (2). It is estimated that the introduction of an NHBD programme would have the greatest impact on the cadaveric organ pool compared to cadaveric donations (9). However, the retrieval of organs for transplantation is more complex in NHBD due to time constraints, medical concerns about organ damage owing to “warm ischaemia” and the ethical and legal issues involved therein.

Fatal multiple painless intussusceptions: A case report.

Intussusception is an invagination of the intestine into another in the direction of peristalsis. Because of varied presentations and relative rarity, intussusception remains a difficult condition to diagnose and at times it may be missed altogether. It is a commonest cause of intestinal obstruction in infancy and childhood though morbidity and mortality rates from the condition have progressively declined in recent times, still avoidable deaths continues. Here we present a case of female child of 3 months brought for forensic autopsy after her death with history of fever and cough since 2 days and breathlessness since 1 day. Autopsy revealed three intussusceptions. Painless intussusceptions are deceitful in their presentations. The forensic pathologist should be aware of such condition. The current case report exhibits such diagnostic pitfall and highlights the importance of forensic autopsy in revealing the cause of death.

Electrocution: A six-year study of electrical fatalities.

A six-year study, from January 2001 to December 2006, was undertaken in an attempt to study the pattern of electrical injuries, the cause of death, manner of death and the importance of histopathological examination. The study was comprised of 86 cases brought with history of electrocution, consisting of 69 men and 17 women. Their age ranged from [3] year to [65] year. We had found 97.67% cases of accidental death and 2.32% cases of homicides. Accidental death was more common in age group 21 to 30 years. Of all cases, 45.34% cases were of electric contact, 31.39% cases were of contact and heat and 9.30% cases were of flash burns. In [6] cases no electric mark could be identified. With reference to occupation, 20.93% of deaths occurred in labor class. Considering the histopathological changes, nuclear streaming, dermo-epidermal separation and coagulative necrosis were amongst the commonest lesions.