HIV-infection in forensic autopsy cases

Sudden and unexpected death and violent death of persons with a high risk of acquiring HIV-infections, especially homosexual males and intravenous drug abusers, have to be investigated by forensic autopsies. Therefore every forensic pathologist has to be aware of this infection and should try to make the proper diagnosis. Three typical cases are described: (1) suicide by hanging, (2) homicide by cutting the throat and (3) intravenous heroin overdose. Merely retrospectively it could be cleared up that the deceased were homosexual but did not manifestly suffer from AIDS. The morphological findings in the lymph nodes and the postmortem serological findings are described in detail.     

医疗纠纷处理中的法医病理尸检

医疗纠纷中最后需医疗事故鉴定委员会鉴定或向各级人民法院起诉的,绝大多数是导致死亡的医疗纠纷,如果处理不好可能影响正常的医疗秩序和社会安定.     

Investigating demodex in forensic autopsy cases

Demodex is an ectoparasite living in the skin as a nonpathogen or a pathogen. It is also known that demodex acts as a vector of pathogenic microorganisms. In this study, we have investigated the rate of occurrence and vitality of demodex in forensic autopsies that have a high risk of contamination by infected organisms. The study, which was cross-sectional, conducted on 100 autopsy cases: 77 of the bodies were male and 23 female. The average age was 41. The samples were taken from the forehead, nose, cheeks, eyelashes and the temporal areas using the standardized skin surface biopsy and hair epilation techniques that were modified for this study. The data obtained were assessed statistically. Demodex was determined in 10% of all the cases. The cases revealed that demodex increased in old age and was more frequently seen in people with fair complexion. It was most frequently found in the forehead and the cheek. The longest postmortem interval in the positive cases was 55 h. The relationship between the postmortem interval and the presence of demodex was not statistically significant. Considering the fact that demodex, which is transmitted from human to human through skin contact, acts as a vector of pathogenic organisms and can stay alive in dead bodies for a long time, we think that the personnel performing autopsies without taking the necessary precautions are under risk.     

眼内窥镜检查视网膜在法医学中的应用价值

目前对于不明原因的死亡主要是通过法医尸体检验明确死亡原因,然而在尸体解剖中由于某些原因几乎很少对视网膜进行检查,视网膜改变在法医学中的价值并未引起重视。眼内窥镜的出现和在尸体检验中的应用,使视网膜检查在确定死亡原因和推测死亡间隔时间方面的作用逐渐被法医所重视。     

Significance of inflammatory changes in the brainstem in forensic autopsy cases

Brain stem encephalitis is an uncommon disease. In order to assess the significance of inflammatory changes in the brain stem in a forensic autopsy material we reviewed the findings over a 12-year period. Between January 1st 1982-December 31st 1993, neuropathological examination of the brain was carried out in 29% of the autopsy cases from the Institute of Forensic Medicine, University of Oslo. Out of 4546 brains, 110 (2.2%) showed microglial nodules and perivascular lymphocytic cuffing in the lower brain stem. In 66 of the cases (60%), the abnormalities were limited to the nucleus and/or the spinal tract of the fifth cranial nerve. Only 16 of the 39 cases with more widespread changes, diagnosed as brain stem encephalitis, had a serious underlying or concomitant disease. Three particular cases of brain stem encephalitis are reported in more detail. In all three cases we suggest that the brain stem inflammatory changes may be either the direct or a contributory cause of death.     

Reform of forensic autopsy in the German Code of Criminal Procedure

The Federal Ministry of Justice has presented another proposal to rephrase the wording of Section 87 of the German Code of Criminal Procedure (StPO). The new version of Section 87 StPO is to be rejected as it would lead to a loss of institutional and professional standards. The bill is clearly influenced by a tendency towards privatisation for the benefit of a small group of specialists in forensic medicine mostly organised in limited liability companies and thus at the expense of institutes of legal medicine affiliated to universities or physicians working in the forensic service of regional courts. In the long run, this reform would not only jeopardize medicolegal research and teaching but also medical education and specialist medical training. For future severe negative consequences would have to be expected on the rule of law and legal certainty.     

Adult Hirschsprung's disease diagnosed during forensic autopsy

We report a case of fatal Hirschsprung's disease (HD) discovered at autopsy. A 20-year-old man collapsed at home. Emergency medical personnel found him in cardiac arrest and all resuscitative efforts failed. He had a past history of chronic constipation since infancy. Forensic autopsy revealed a megacolon full of gas and stools. Microscopic examination showed absence of ganglion cells in a short segment of the rectum and enterocolitis in the left and transverse colon. HD is rarely described in adults. In many cases, patients complained of constipation since infancy but the affection remained misdiagnosed. The relative good tolerance of the disease is usually due to a short aganglionic bowel segment. Enterocolitis is a frequent and severe complication of HD in children but is rarely described in adults. This case suggests the importance of HD diagnosis in childhood in order to avoid fatal complications with forensic consequences.     

Immunohistochemical distribution of C-reactive protein in the hepatic tissue in forensic autopsy

Previously, we examined the expression of C-reactive protein (CRP) in hepatic tissues in fatal injuries (injury deaths) immunohistochemically, and classified the CRP distribution into three patterns: diffuse (D-) pattern, diffuse with strong positivity in the hepatic lobules; periportal (PP-) pattern, characterized by positive cells in the periportal region of some lobules; focal (F-) pattern, showing small islands of positive cells in some lobules. There was a relationship between the CRP distribution and the survival time. In this study, we further analyzed the deaths including those due to other than fatal injuries (non-injury deaths), and a study of a total of 314 deaths from various causes was performed. Generally, non-injury deaths showed findings similar to those in injury deaths. PP- and/or F-patterns were observed in 43.7% of cases having a short survival time (<6 h), but found in only 3% of those surviving longer (>6 h), showing that such findings are suggestive of a short survival time. D-pattern was found more frequently in non-acute deaths (60.4%), than in acute deaths (10.9%). In acute deaths, D-pattern was found in some cases showing extensive tissue injuries, such as burns and polytrauma, and inflammative predisposition. Immunohistochemical findings also showed some correlation with the serum CRP level. Our data suggest that hepatic CRP immunohistochemistry may be a useful tool for elucidating the dying process.     

Evolution of forensic autopsy and current legal procedures in Turkey

The first documented forensic autopsy in Turkey was in 1843 during the Ottoman period. In this article, the evolution and current legal procedures regarding forensic autopsies with emphasis on current legal procedures following the declaration of Turkish Republic in 1923 are delineated.     

Healed fractures of the larynx and lingual bone in forensic autopsy]

Laryngohyoid fractures are a frequently investigated matter, especially in the forensic literature. On the other hand, there are only very few (old) forensic reports of such fractures in survived cases. However, healed fractures are not seldom found in forensic autopsies: In a personal series of 1160 forensic autopsies (adult persons) a careful dissection of the laryngohyoid complex was done by 1 investigator. Only a macroscopic examination of the cartilages was carried out; radiographs and histological slices were not regularly made. Therefore only a part of existing old fractures is detectable; for example, healed fissures are not visible with this simple method. Furthermore, asymmetries of the thyroid laminae cannot be declared as posttraumatic without additional examination, because this condition is described as possible anatomic anomaly. From that, the injury frequencies presented here only mark the lower threshold of the existence of such findings. Healed fractures of the upper thyroid horns and the major hyoid horns can be easily detected even in a routine examination, if healing resulted in a fixed dislocation or apposition of bone surrounding the former fracture site. In the present series, this was the predominant localization of old fractures: the upper thyroid horns (43 cases), followed by the hyoid cornua (12 cases), a combination of both sites (5) and cricoid fractures (5). Of the total 65 healed fractures (5.6%), 35 were found in the group of 290 chronic alcoholics (12.1%) and only 3.4% in non-alcoholics. In the subgroup of middle-aged alcoholics, the fracture rate increased up to 19%. However, this group did not present a higher rate of fresh laryngohyoid injuries (not related to strangulation) than the other cases. The old fractures probably resulted from minor "daily" injuries (like falls), which are common, especially in chronic alcoholics. The frequency of such findings should be in mind if an apparently fresh fracture, found in an actual autopsy, should be related to the cause of death: there is a real chance, that this fracture occurred prior, and without causal connection to the factors resulting in death. Therefore a histological examination of the age of this finding is necessary. Cricoid fractures are quite uncommon, except in serious external neck trauma. In 1 of our 5 cases, this fracture was caused by repeated cruelty, finally resulting in death.     

法医学高危尸检的风险识别与防护

高危尸检(High Risk Autopsy)是指对患有或者可能患有严重传染性疾病的尸体进行解剖检验,该传染性疾病可能传染给尸体解剖检验的法医及其他高危人群,从而导致严重疾病或引起死亡。本文对高危尸检中的感染风险、风险识别方面进行论述,在个人防护、解剖室防护、虚拟影像方面提出安全预防措施。     

法医尸检工作中常见的职业危害因素及预防措施

法医尸体解剖在解决民事、刑事案件中所涉及的死亡原因、死亡方式等问题中发挥重要作用,法医作为尸体检验工作的承担者,其在尸检过程中自身常面临多种危害因素,本文对法医实践中常见的职业性危害因素以及其可能危害机制进行总结分析,以期提高法医的自我保护意识并引起相关部门的重视.     

传染病疫情下法医学尸体解剖检验室建设展望

人群对新型冠状病毒肺炎普遍易感,在国内已造成数万人感染。由于现有的尸体解剖检验室不具备传染病患者或疑似传染病患者尸体解剖检验条件,公安机关法医人员在处理感染状态不清、疫情接触时不明的未知名尸体案事件时,面临着严峻的感染风险。为满足传染病患者或疑似传染病患者尸体解剖工作需要,确保法医人员身体健康安全,了解传染病患者的病理生理改变,完善法医学解剖检验室的建设十分必要。     

Use of forensic investigations in anti-doping

The fight against doping is mainly focused on direct detection, using analytical methods for the detection of doping agents in biological samples. However, the World Anti-Doping Code also defines doping as possession, administration or attempted administration of prohibited substances or methods, trafficking or attempted trafficking in any prohibited substance or methods. As these issues correspond to criminal investigation, a forensic approach can help assessing potential violation of these rules. In the context of a rowing competition, genetic analyses were conducted on biological samples collected in infusion apparatus, bags and tubing in order to obtain DNA profiles. As no database of athletes' DNA profiles was available, the use of information from the location detection as well as contextual information were key to determine a population of suspected athletes and to obtain reference DNA profiles for comparison. Analysis of samples from infusion systems provided 8 different DNA profiles. The comparison between these profiles and 8 reference profiles from suspected athletes could not be distinguished. This case-study is one of the first where a forensic approach was applied for anti-doping purposes. Based on this investigation, the International Rowing Federation authorities decided to ban not only the incriminated athletes, but also the coaches and officials for 2 years.     

A study of 44 forensic autopsy cases of adrenal hemorrhage

44 cases of adrenal hemorrhage (AH) were analyzed. The forensic autopsy showed that AH occurred mainly in male aged from 20 to 40 years old. The traumatic AH was more often seen in young men and the pathologic AH was mostly seen in elderly persons. AH were more likely found in bilateral adrenal corticomedullary junction. The pathological grade of AH was not related to the interval time of survival. The pathologic mechanism of AH was discussed as well.     

Use of orthopantomographs in forensic identification

Radiographs of the head region were used for identification of 17 victims during an 11-year period in the Department of Forensic Medicine, University of Turku, Finland. Examinations resulted in positive identification of 10 victims. Proof of identity of four people was based on exclusion identifications. In one case, comparable information supporting the identity was achieved. Due to insufficient ante- and postmortem material, two individuals remained unidentified by radiological methods. The use of orthopantomography in identification is recommended because it enables visualization of the structures of the jaws and related areas on a single radiograph.