Forensic Science, Medicine and Pathology最新文献

Fatal skull stabs are rare. In the case reported here, a 28-year-old man sustained an isolated penetrating skull injury from a knife and died two days later. The bone shard with the stab puncture, which was neurosurgically removed before death, later allowed the reproducible exact assignment of the murder knife found at the scene to the stab as well as the estimation of the length of the intracranial stab channel. This, together with the findings of the formalin-fixed brain, allowed forensic reconstruction.

Background: Diagnostic uncertainty is a well-recognized concept in clinical practice, encompassing both technical perspectives and the subjective perceptions of physicians. Post-mortem diagnostics (PMD), which involves all post-mortem investigations to assess diseases and injuries and determine the cause of death, shares this inherent uncertainty due to the complexity and multidisciplinary nature of autopsies.

Methods: A comprehensive literature review was conducted to uncover relevant publications focusing on diagnostic uncertainty in PMD. An expert panel evaluated expressions and sources of diagnostic uncertainty to identify factors influencing PMD uncertainty.

Results:  Literature specifically addressing PMD uncertainty is sparse, though implicit and explicit references exist. This article illustrates the presence of uncertainty in PMD by drawing upon both literature and pathology practice. We introduce the definition of PMD uncertainty as "the inability to determine the exact cause of death and/or the precise significance of certain autopsy findings". PMD uncertainty can stem from a pathologist's subjective perception, but often results from several objective factors. Six factors inherent to the PMD setting were identified as contributing to this uncertainty. To systematically express the certainty of cause-of-death determinations, we developed a new Post-Mortem Diagnostic Certainty Scale (PMDCS) featuring eight categories, distinguishing between assignable and non-assignable causes of death.

Conclusion: Understanding and applying the concept of PMD uncertainty will enhance comprehension of the importance of certain post-mortem findings and improve the accuracy of autopsy result interpretation. While eliminating PMD uncertainty entirely is not feasible, standardizing investigations can reduce uncertainty, and using the PMDCS can improve the clarity of autopsy reports.

Because pulmonary thromboembolism (PTE) has an inherent high risk of sudden and unexpected death, this condition is a classic entity in forensic casework. The purpose of this study was to elucidate the characteristics surrounding deaths from PTE. We conducted a retrospective study from 2010 to 2019 at the Department of Forensic Medicine in Aarhus, Denmark. We recorded demographic characteristics, risk factors, comorbidities, and autopsy findings, including BMI. Furthermore, we contextualized the role of forensic autopsy in terms of determining the correct cause of death (COD).Among the 3,572 autopsies, 58 had PTE as the main COD (1.6%), whereas only 0.3% of the deaths in the Danish COD registry were attributed to PTE in the same period. The decedents had a mean age of 52 years (range 19-87), and although the majority had preexisting comorbidities, approximately one-third died suddenly and unexpectedly. Additionally, more than half (35/58) of the decedents died in an out-of-hospital setting, and only a few of these (6/35) reported symptoms prior to death, underscoring the insidiousness of the condition. We identified a mean BMI of 32.7 among the decedents, with more than half of them (30/58) having a BMI ≥ 30.In conclusion, obesity is a major risk factor for fatal PTE. The blurred clinical presentation of PTE underscores the importance of an autopsy to determine the correct COD, and with an increased autopsy rate, the true prevalence may well be higher.

Death by collision with an incoming train is common in countries where a railroad network exists. In such cases, when there is severe pelvic trauma, the penis may be partially degloved and turned inside out. The inverted penile skin may then resemble a vulva and the scrotum may mimic labia majora, causing the injured male genitalia to strongly resemble female genitalia. Forensic pathologists should be aware of this possibility when they are called to such a scene of death and are asked by the police to immediately determine the sex of the victim. In the challenging circumstances of a chaotic on-site railway death investigation, an inexperienced doctor might easily mistake male genitals for female genitals and thus delay correct identification of the victim by the police.

A 24-year-old woman was brought to the emergency department after suffering dog bites, as reported by a witness. Autopsy revealed 21 deep wounds of the neck, along with unclear injuries to both carotid arteries, extensive damage to neck muscles, a wound to the larynx, and the right lobe of the thyroid gland had been avulsed. The forensic pathologist initially concluded that the cause of death was asphyxia and haemorrhagic syndrome. Furthermore, due to the nature of some wounds resembling stab wounds, as well as facial injuries and marks consistent with gripping, the death was initially considered a possible homicide rather than attributing it to dog bites. Following these findings, the investigation took a drastic turn, resulting in the arrest of the witness. Three years later, our team was consulted for a second opinion. Reviewing the medical records confirmed dissection of both carotid and vertebral arteries without complete section, and fractures of cervical transverse processes, with the left and right vertebral arteries occluded by a bone fragment as seen on a CT scan from the emergency department. The second forensic expert supported the conclusion that the cervical injuries were consistent with dog bites, particularly due to the torn appearance of the muscle masses and soft tissue avulsion. Additionally, the vascular dissections and cervical fractures were attributed to hyperextension and/or compression of the neck, consistent with the dynamics of a dog attack involving shaking or grabbing the neck. Similar types of injuries have been documented in the scientific literature in cases of dog attacks. Furthermore, instances of wounds resembling stab wounds following dog bites have also been reported. The experts conclude that death was secondary to cerebral anoxia resulting from multiple dissections of neck vessels, aggravated by blood spoliation and asphyxia related to the laryngeal wound. All of the wounds were consistent with dog bites, leading to the release of the defendant.

Forensic autopsies remain indispensable for accurately determining the cause and manner of death. However, pathologists face significant challenges inherent to the complex process of postmortem diagnostics (PMD), including the potential for diagnostic errors. The implementation of quality assurance (QA) mechanisms is crucial for minimizing these errors. Nonetheless, the lack of QA programs, specifically tailored for forensic pathology, continues to pose a significant obstacle. This article explores the enhancement of PMD after the adoption of ISO 17020 accreditation at a Belgian forensic institute in 2010. Drawing on over a decade of experience, it details on the development and implementation of label-specific standard operating procedures (SOPs) designed to address the various types of deaths in forensic practice. Additionally, it underscores the necessity of adapting international directives from leading organizations into effective local protocols, aiming to standardize practices and improve efficacy. Through a comparative review of existing international guidelines, this study provides forensic pathologists and institutions worldwide with practical strategies for qualitative standardization and improving their PMD.

In Japan, the Medical Treatment and Supervision Act (MTSA) was enacted in 2005 to provide intensive interventions aimed at reintegrating forensic psychiatric patients into society. However, these individuals face challenges with social reintegration and have an elevated risk of suicide. Therefore, identifying the risk factors for suicide among forensic psychiatric patients is essential. We compiled an extensive database spanning 12 years of data on Japanese forensic outpatients. Using a generalized linear model (GLM), we explored the relationship between suicidal behaviors-both attempted and completed suicides-and several variables, including outpatient pathways defined by law, histories of psychiatric outpatient/inpatient treatment, diagnoses of schizophrenia or mood disorders, types of crimes committed, and the types of victims involved. Our analysis included data from 2,263 Japanese forensic outpatients. Suicidal behaviors were observed in 6.9% of patients, with 1.5% completing suicide. Risk factors for suicidal behavior included being a direct outpatient (odds ratio [OR] = 1.63, 95% confidence interval [CI]: 1.14-2.34), having a history of outpatient treatment (OR = 1.92, 95% CI: 1.07-3.48), and being arrested for arson (OR = 2.24, 95% CI: 1.33-3.76). Conversely, a diagnosis of schizophrenia was associated with a reduced risk of suicidal behavior (OR = 0.61, 95% CI: 0.39-0.95). Forensic psychiatric patients are at a higher risk of suicide compared to the general population. It is essential to account for both risk and protective factors when planning interventions for these individuals.

Blue toe syndrome, also referred to as cholesterol crystal embolism is characterized by the distal embolization of cholesterol crystals originating from ruptured atherosclerotic plaques. This condition commonly arises in the context of cardiovascular procedures. Emboli from the thoracoabdominal aorta primarily affect the downstream extremities and intra-abdominal viscera, often resulting in fatal atheroembolic renal failure. Owing to its insidious and delayed onset, antemortem diagnosis of cholesterol crystal embolism is often underrecognized. Two cases of blue toe syndrome secondary to cardiovascular procedures are presented. In Case 1, the patient died 35 days after coronary angioplasty, whereas in Case 2, the patient developed toe necrosis 95 days after endovascular aortic repair, leading to progressive renal failure over the following five years. A comprehensive forensic autopsy included external examination, skin biopsy, histopathological examination of major organs, and serum biochemical evaluation of renal function parameters. Two cases of blue toe syndrome secondary to cardiovascular procedures are presented. In Case 1, the patient died 35 days after coronary angioplasty, whereas in Case 2, the patient developed toe necrosis 95 days after endovascular aortic repair, leading to progressive renal failure over the following five years. A comprehensive forensic autopsy included external examination, skin biopsy, histopathological examination of major organs, and serum biochemical evaluation of renal function parameters. This report underscores the importance of including systemic cholesterol crystal embolism in the differential diagnosis of blue toe syndrome, particularly in patients with a history of cardiovascular procedures. Fingertips serve as reliable indicators of impaired blood perfusion. To assess blue toe syndrome accurately, we highlight the value of focusing on the toe tips where cholesterol crystal embolism can be consistently detected.

Post mortem damage by predators varies with geography, climate, and location of cadavers. Frequently encountered facultatively parasitic terrestrial organisms include fly larvae (maggots), ants and beetles. This report describes for the first time opportunistic post mortem damage caused by the terrestrial flatworm Platydemus manokwari de Beauchamp,1963 (New Guinea Flatworm) (phylum Platyhelminthes: order Tricladida: suborder Continenticola: family Geoplanidae) to exposed skin of a body located in a tropical urban location. Several flatworms were attached to the body associated with areas of skin loss. Microscopy showed epidermal damage with no vital reaction and the presence of PAS-positive granules consistent with flatworm secretions. No human DNA profile was recovered with genetic testing of two of the flatworms. This case extends the range of potential post mortem predators to include flatworms, albeit opportunistically.

Traumatic brain injury (TBI) is a significant global health concern and frequently encountered in medico-legal autopsies. Previous studies suggest that certain TBI subtypes are more likely to co-occur than others. Therefore, we aimed to explore the potential of latent class analysis (LCA) to identify and characterize primary head injury combinations in neuropathologically examined medico-legal autopsy cases. The dataset comprised 78 cases from the Forensic Medicine Unit of the Finnish Institute for Health and Welfare over the period of 2016-2022. Data on background and circumstantial characteristics as well as primary and secondary head and brain injuries were collected from police documents, medical records, general autopsy reports and neuropathology reports. Latent class solutions with two to five classes were explored to identify clustering of primary head injuries among the sample. The dataset comprised 69.2% males and the median age was 49 years. In LCA, the solutions appeared reasonable, and each class appeared to represent a distinct TBI profile. The two-class solution was found to fit the present dataset best. Class 1 was characterized by older age, presence of an underlying CNS disease, and less diverse primary head injuries; these were interpreted as suggestive of lower traumatic forces. Class 2 was characterized by male sex and assaults as a prominent injury circumstance; subarachnoid and intracerebral/ventricular haemorrhages and contusions were classified exclusively into this class. In conclusion, this study identified two distinct subgroups of primary head injuries. Understanding typical injury combinations related to distinct circumstances could assist not only forensic pathologists but also clinicians treating TBI patients. However, the present latent class solution should not be interpreted as "ground truth", but instead further research is needed.