Postmortem Analysis of Electrogram Records from an Implantable Cardioverter‐Defibrillator (ICD) in the Reconstruction of a Road Traffic Accident

The case of a 69‐year‐old man, equipped with an ICD and suffering from several chronic cardiac diseases, who died in a car accident, was presented. We analyzed electrogram records from the ICD explanted from the body during the autopsy, which showed that the driver had suffered from malignant ventricular arrhythmia—ventricular fibrillation (VF). A thorough analysis of the details of the accident, as well as the timing of VF and the rhythm observed after the discharge of the ICD showed that the direct cause of the accident was the episode of arrhythmia resulting in a loss of consciousness. Therefore, the presented case illustrates the usefulness of postmortem analysis of electrogram records from ICDs in the reconstruction of road traffic accidents. In such cases, if the victims are implanted with ICDs, it should be a routine procedure performed by forensic pathologists.     

Reasons for South Korean attitudes towards the death penalty: exploring the nexus between strong public support and history of misapplication

As of this writing, South Korea (officially, the Republic of Korea) is an abolitionist-in-practice nation; capital punishment is legal, but no death sentences have been carried out since a moratorium was enacted in 1997. Public support for the death penalty has decreased over time; however, the factors that determine support for or opposition to the death penalty of the South Korean general public are largely unknown. Using survey data from a nationwide sample of 416 respondents, this study examined the potential predictors for public attitudes towards capital punishment support. A majority of survey respondents (83%) supported the death penalty, a higher percentage than recent surveys of the South Korean general public. The deterrence and retribution perspectives were positively related to death penalty support, while crime severity, neighbourhood safety, the brutalisation effect, and innocence were negatively related. This study provides the first multivariate analysis of factors associated with South Korean attitudes towards the death penalty.     

Bone Area Histomorphometry

Quantifying the amount of cortical bone loss is one variable used in histological methods of adult age estimation. Measurements of cortical area tend to be subjective and additional information regarding bone loss is not captured considering cancellous bone is disregarded. We describe whether measuring bone area (cancellous + cortical area) rather than cortical area may improve histological age estimation for the sixth rib. Mid‐shaft rib cross‐sections (n = 114) with a skewed sex distribution were analyzed. Ages range from 16 to 87 years. Variables included: total cross‐sectional area, cortical area, bone area, relative bone area, relative cortical area, and endosteal area. Males have larger mean total cross‐sectional area, bone area, and cortical area than females. Females display a larger mean endosteal area and greater mean relative measure values. Relative bone area significantly correlates with age. The relative bone area variable will provide researchers with a less subjective and more accurate measure than cortical area.     

Comparative and Correlation Studies of Biochemical Substances in Vitreous Humor and Synovial Fluid

Vitreous humor (VH) and synovial fluid (SF) become optional postmortem samples for biochemistry investigation. However, few studies have explored SF as a potential source, and there is still controversy whether the biochemical concentrations in bilateral VH are the same. We explored the concentrations of biochemical substances in both VH and SF, and compared between both sides and between the fluids. We also correlated the biochemical concentrations in both fluids. All samples were centrifuged after collection and the supernatant fluids were used for the analysis. The results indicated no significant difference in the constituent concentrations between the fluids from both sides (p > 0.05). Sodium, potassium, chloride, and magnesium concentrations were significantly higher in the VH, but in vice versa for glucose, uric acid, and creatinine concentrations (p < 0.001). Sodium, potassium, glucose, lactate, urea, uric acid, and creatinine concentrations between both fluids showed significant correlation (p < 0.05), but not chloride and magnesium concentrations.     

Multiple Giant Coronary Artery Aneurysms: A Rare Cause of Sudden Cardiac Death

Multiple giant aneurysms involving the coronary arteries are uncommon and rarely reported. In the presented case, a 63‐year‐old man with poorly controlled hypertension died suddenly. Gross autopsy examination showed multiple giant thrombus‐filled coronary artery aneurysms, atherosclerotic coronary artery disease, and cardiomegaly. Histological sections of the coronary aneurysms showed atherosclerotic changes with both organized and fresh thrombus. Giant coronary aneurysm is defined as a segmental enlargement of a coronary artery with a diameter exceeding 20 mm or more. The main etiology of this nebulous entity is attributed to atherosclerosis and inflammatory or inherited connective tissue disorders with the remainder being congenital, infectious, or idiopathic. Before its cataclysmic presentation, when ruptured or thrombosed, giant coronary aneurysm usually has a silent clinical course. Sudden death owing to giant multiple coronary aneurysms is rare and mandates careful classification of the aneurysms and prudent search for autoimmune‐mediated or genetically based factors for subsequent ancillary autopsy studies.     

A Ten‐year Study of Suicides from a Rural/Suburban County

This study will discuss trends in suicide data compiled over 10 years in Dutchess County, NY, from 2004 to 2013. These data were based on reporting and examination standards recommended by the National Association of Medical Examiners and Department of Justice death investigation standards. Almost 300 cases were analyzed in terms of the deceased's gender, age, race, method of suicide, and weapon used. Results from this study agree with other reports showing significant differences for method of death both in terms of age and gender, with men more likely to choose firearms and women more likely to choose overdose. Furthermore, older persons were more likely to commit suicide by firearms, and the younger persons were more likely to commit suicide by overdose. However, other areas, such as method of suicide, differ from national statistics.     

Causes and Mechanisms of Death in Fatal Water Buffalo Attacks

Deaths due to buffalo attack have not been well described. A 72‐year‐old man was trampled by a water buffalo (Bubalus bubalis) while attempting to move the animal within an enclosed area at an abattoir. At autopsy, there were numerous injuries involving the chest, head, neck, and left upper arm. Blunt force injury had resulted in multiple rib fractures with a flail chest and fracture/dislocation of the mid‐cervical vertebrae caused either by physical crushing by the animal against the walls of the enclosure or by stomping. There was also evidence of crush asphyxia with bilateral conjunctival hemorrhages and petechial hemorrhages. In addition, there was a deep degloving injury of the upper left arm compatible with goring by one of the buffalo horns. While large animal attacks may result in death from multiple injuries, careful dissection and examination of specific injuries at autopsy may clarify the complex interaction of lethal mechanisms.     

Obesity,Body Mass Index,and Homicide

The body mass indexes (BMIs) of 100 randomly selected homicide cases from the files of Forensic Science SA were compared to the Australian and South Australian populations. There were 70 males and 30 females (M:F = 2.3:1; age range 18–84 years; mean 42.3 years). There was a substantially lower proportion of obese individuals in the homicide population compared to the general Australian and South Australian populations (19% [vs.] 27.9% and 30%, respectively). A second group of 144 randomly selected autopsy cases where the BMI was ≥40 kg/m² was analyzed. There were 77 males and 67 females (M:F = 1.2:1; age range 23–78 years; mean 46.7 years). The majority of deaths were natural (N = 108), with no homicides. A negative association between obesity and homicide has, therefore, been demonstrated. Reasons for the lower numbers of obese/morbidly obese individuals among homicide victims are unclear, but may include physical protection afforded by fat padding from sharp force injuries, and relative sociodemographic isolation.     

Dr. Death? Professionalism,Virtue, and U.S. Physician Participation in the Death Penalty

In the United States at present, the death penalty is a possible sentence in 31 out of 50 states, as well as within the military and for federal cases. In the U.S., numbers of executions are declining, in part due to moratoriums in place and challenges to execution by lethal injection. Participation by physicians in lethal injection executions has been steadfastly viewed by professional medical organizations as contrary to their ethical standards. However, physicians have participated in lethal injection executions, and the morality of the death penalty itself is a matter of intense social and political debate. Medical ethics commentators and professional organizations have typically held that the prohibition on physician participation in the death penalty is independent of the ethical status of the death penalty itself. This article argues that this view is untenable, and that it is tied to a view of professional role virtue that is similarly untenable. At the same time, it argues that, given the morally uncertain status of the death penalty, it is plausible that virtuous physicians may either refuse or choose to participate in some aspects of the death penalty.