Postmortem Biochemistry (I) : Cardiac Markers / 대한법의학회지

In cases of atherosclerotic occlusion of coronary artery, is it appropriate to conclude that myocardial infarction is the true cause of death? More sensitive and specific diagnostic methods for the postmortem diagnosis of myocardial infarction are sometimes necessary because macroscopic or microscopic changes associated with early-phase acute myocardial injuries or myocardial infarct are sometimes absent in sudden cardiac death. Postmortem biochemical assessment of cardiac markers may help to evaluate the pathological cardiac status in sudden unexpected death without obvious cause. However, forensic pathologists are generally interested only in the macroscopic and microscopic findings for postmortem diagnosis of myocardial diseases and hesitate to use postmortem biochemical data because of the risk of postmortem changes. There are several clinically useful cardiac markers antemortem cardiac events such as myocardial injuries, infarct, or heart failure and postmortem data on cardiac markers in autopsy cases of sudden death have been reported. This review of postmortem data on cardiac markers in blood, other body fluids, and myocardial tissue will serve to introduce the recent international research trends and provide a foundation for a new field in postmortem biochemistry.

Discrepant Causes of Death between Medical Death Certificates and Autopsy Reports (II) / 대한법의학회지

The postmortem examination certificate and death certificate provide proof of death and supply important data used to establish health statistics. However, the format of the form and the accuracy of postmortem examination and death certificates yield errors that must be corrected by comparison with postmortem studies. We reviewed 401 autopsies performed in the Department of Forensic Medicine of Chonnam National University Medical School from January 1, 2009 to December 31, 2011 and compared the reports with their postmortem examination certificates and death certificates. Of the 252 cases submitted with death certifications, 60 cases were concordant with the cause of death on the autopsy report. Eighty-nine cases had clear descriptions of the cause of death. Of these cases, 47 were from postmortem examination, 42 were from death certificates; 17 were natural deaths, 72 were unnatural. Concordance in each group was 59.6% (28/47 cases), 76.2% (32/42 cases), 41.2% (7/17 cases), and 73.6% (53/72 cases). We thus identified various types of errors in postmortem examination and death certificates. This study reveals a high rate of discrepancy between causes of death reported on death certificates and postmortem examination certificates. There are a few useful death certificate and postmortem examination certificates that can be used as a model, based on which we propose several remedies to increase the accuracy of death and postmortem examination certificates.

The Statistical Analysis on the Legal Autopsy Cases in Gwang-ju and Chonnam Area of Korea in 2009 and 2010 / 대한법의학회지

Analyzing the data associated with the causes and manners of death in each region is important to make policies for the national public health, because it can be basis for prevention of future crimes and treatment of diseases. To establish regional basic data of the 245 autopsy cases performed at the department of Forensic Medicine of Chonnam National University Medical School in 2009 and 2010, each case was statistically analyzed according to the causes of death and the manners of death. The results are as follows; 1) the total number of legal autopsy was 245 (178 males and 67 females). The number of the 5th decade (64 cases) and the 6th decade (51 cases) occupied near 50 percent (46.9%) of total cases. 2) unnatural deaths were 154 cases (62.9%), and natural deaths were 91 cases (37.1%). In 154 cases of unnatural deaths, suicides were 27 cases (11.0%), homicides were 52 cases (21.2%), accidental deaths were 43 cases (17.6%), and undetermined deaths were 32 cases (13.1%). 3) Among 91 natural deaths, deaths of cardiac origin were 57 cases (62.6%) and it was a leading cause of death in natural deaths. Deaths due to disease of cerebral vascular system were 11 cases (12.1%), deaths due to respiratory system were 9 cases (9.9%). 4) Child deaths under the age of 10 were 9 cases (3.6%). Four cases were homicide, 2 cases were accident, and 3 cases were natural deaths. Conclusively, in these area victims between thirties and forties are taking the most proportion, unnatural deaths are more than natural deaths. In unnatural deaths, the order of frequency is homicide, accidental death, suicide, in natural death, neurocardiovacular disease is predominant.

Differences in Expression of VEGF-A, VEGFR-1, VEGFR-2 and Microvessel Density in Colorectal Cancer with Liver Metastasis

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignant neoplasms and is a leading cause of mortality worldwide. Metastasis to the liver is a frequent event in patients with CRC. An essential step in the metastatic cascade is angiogenesis. METHODS: This study included 45 patients who underwent a partial colectomy with hepatic resection for CRC with hepatic metastases. Immunohistochemistry was performed using vascular endothelial growth factor (VEGF)-A, VEGF receptor (VEGFR)-1, VEGFR-2, and CD34 antibodies to examine the relationship between CRC with liver metastases and angiogenesis. RESULTS: CRC showed significantly stronger expression of VEGF-A, VEGFR-1, and VEGFR-2 than liver metastases (p < 0.05). Microvessel density was also higher in CRC than in liver metastases (p < 0.05). CONCLUSIONS: Compared with previous studies, we found a higher expression of VEGF-A, VEGFR-1, VEGFR-2, and microvessel density in CRC than in liver metastases, which could be ascribed to a difference in vessel distribution and blood supply in each organ. Given its profuse blood supply and distinct cell populations, the liver might provide a rich milieu for tumor cell growth with less expression of angiogenesis-inducing agents.