Bland-Garland-White syndrome, or an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), is a rare congenital coronary anomaly that can cause myocardial ischemia, congestive heart failure, and sudden death. In this study, we aimed to present a case of sudden infant death caused by ALCAPA. Postmortem computed tomography (PMCT) showed a collapsed left lung, enlarged heart volume, and severe calcification of the left ventricular papillary muscles and posterior left ventricular wall. Macroscopic examination during the autopsy revealed marked cardiac hypertrophy and an anomalous left coronary artery originating from the pulmonary artery. Furthermore, microscopic examination showed significant myocardial fibrosis with severe left ventricular calcification. Histological findings revealed features of acute-on-chronic myocardial ischemia, including myocytolysis around fibrotic and calcified areas, contraction-band necrosis, and a characteristic wavy cardiomyocyte pattern. In this case, we suggest that localized myocardial calcification detected by PMCT, particularly following three-dimensional visualization, may be useful for the postmortem assessment of ALCAPA and other causes of chronic myocardial ischemia in infants.
{"title":"Myocardial calcification revealed by postmortem computed tomography in a case of infantile myocardial ischemia caused by anomalous origin of the left coronary artery from the pulmonary artery","authors":"Haruki Fukuda , Akira Hayakawa , Yoichiro Takahashi , Hiroyuki Tokue , Rie Sano","doi":"10.1016/j.legalmed.2025.102743","DOIUrl":"10.1016/j.legalmed.2025.102743","url":null,"abstract":"<div><div>Bland-Garland-White syndrome, or an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), is a rare congenital coronary anomaly that can cause myocardial ischemia, congestive heart failure, and sudden death. In this study, we aimed to present a case of sudden infant death caused by ALCAPA. Postmortem computed tomography (PMCT) showed a collapsed left lung, enlarged heart volume, and severe calcification of the left ventricular papillary muscles and posterior left ventricular wall. Macroscopic examination during the autopsy revealed marked cardiac hypertrophy and an anomalous left coronary artery originating from the pulmonary artery. Furthermore, microscopic examination showed significant myocardial fibrosis with severe left ventricular calcification. Histological findings revealed features of acute-on-chronic myocardial ischemia, including myocytolysis around fibrotic and calcified areas, contraction-band necrosis, and a characteristic wavy cardiomyocyte pattern. In this case, we suggest that localized myocardial calcification detected by PMCT, particularly following three-dimensional visualization, may be useful for the postmortem assessment of ALCAPA and other causes of chronic myocardial ischemia in infants.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"80 ","pages":"Article 102743"},"PeriodicalIF":1.4,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.legalmed.2025.102739
Meichen Pan , Huine Liu , Chuxiong Ma, Ying Dong, HongMei Dong
Background
Clarifying the cause of death of heat stroke (HS) is critical for judicial handling of related cases. Yet, postmortem diagnosis of HS remains challenging owing to the lack of specific morphology and biomarkers. Liver damage frequently acts as a direct cause in HS. This study aimed to explore the postmortem diagnosis of HS based on the protein biomarkers in liver by machine learning methods.
Methods
Electron microscopy was used to observe the morphological features of hepatocytes in HS. Five candidate protein biomarkers were selected based on the literature, the eletron microscopy observation, and the previously proteomics results. Western blotting and Immunohistochemistry were used to detect candidate proteins expression in both HS rat models and human cases. Lastly, a machine learning algorithm (eXtreme Gradient Boosting, XGBoost) was employed to detect the most discriminative biomarkers.
Results
The mitochondrial damage, autophagy could be observed in hepatocytes of HS. Five candidate protein biomarkers (LRPPRC, CPT2, GPX2, LATS1, and ULK2) were decreased in both HS rat models and HS human cases. The postmortem temporal changes of biomarkers showed that LATS1 and CPT2 were stable. XGBoost revealed LATS1 and CPT2 were the most discriminative biomarkers. The combination of LATS1 and CPT2 achieved optimal diagnostic efficiency, with a sensitivity of 90.91 % and a specificity of 100 %. A diagnostic software was constructed and was applied to five human cases, all of which were recognized.
Conclusion
This study provides a promising valid strategy for practical diagnosis of death from HS by integrating liver LATS1 and CPT2 protein biomarkers.
{"title":"Machine learning analysis facilitates the identification of liver biomarkers in postmortem diagnosis of heat stroke","authors":"Meichen Pan , Huine Liu , Chuxiong Ma, Ying Dong, HongMei Dong","doi":"10.1016/j.legalmed.2025.102739","DOIUrl":"10.1016/j.legalmed.2025.102739","url":null,"abstract":"<div><h3>Background</h3><div>Clarifying the cause of death of heat stroke (HS) is critical for judicial handling of related cases. Yet, postmortem diagnosis of HS remains challenging owing to the lack of specific morphology and biomarkers. Liver damage frequently acts as a direct cause in HS. This study aimed to explore the postmortem diagnosis of HS based on the protein biomarkers in liver by machine learning methods.</div></div><div><h3>Methods</h3><div>Electron microscopy was used to observe the morphological features of hepatocytes in HS. Five candidate protein biomarkers were selected based on the literature, the eletron microscopy observation, and the previously proteomics results. Western blotting and Immunohistochemistry were used to detect candidate proteins expression in both HS rat models and human cases. Lastly, a machine learning algorithm (eXtreme Gradient Boosting, XGBoost) was employed to detect the most discriminative biomarkers.</div></div><div><h3>Results</h3><div>The mitochondrial damage, autophagy could be observed in hepatocytes of HS. Five candidate protein biomarkers (LRPPRC, CPT2, GPX2, LATS1, and ULK2) were decreased in both HS rat models and HS human cases. The postmortem temporal changes of biomarkers showed that LATS1 and CPT2 were stable. XGBoost revealed LATS1 and CPT2 were the most discriminative biomarkers. The combination of LATS1 and CPT2 achieved optimal diagnostic efficiency, with a sensitivity of 90.91 % and a specificity of 100 %. A diagnostic software was constructed and was applied to five human cases, all of which were recognized.</div></div><div><h3>Conclusion</h3><div>This study provides a promising valid strategy for practical diagnosis of death from HS by integrating liver LATS1 and CPT2 protein biomarkers.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102739"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tuberculous myocarditis is a rare manifestation of disseminated tuberculosis that is often misdiagnosed. It may present with non-specific symptoms, or alternatively remain clinically silent, making diagnosis particularly challenging. We present in this paper a case report of a 49-year-old man with a medical history of diabetes, untreated hypertension, and dyslipidemia was found dead in his home. There was no specific symptom before death. A medico-legal autopsy was requested to determine the cause of death. At the internal examination, there were bilateral yellow-citrine pleural effusion, pulmonary edema with congestion, whitish areas in the left ventricular myocardium. Histopathological analysis showed granulomatous myocarditis associated with interstitial granulomatous pneumonitis suggestive of miliary tuberculosis. The cause of death was attributed to acute heart failure related to undiagnosed tuberculous myocarditis.
{"title":"Sudden death related to tuberculous myocarditis: An autopsy case report","authors":"Mariem Grayaa , Oumeima Bouzid , Asma Ben Mabrouk , Mohamed Amine Zaara , Taher Sakly , Abdelfattah Zakhama , Nidhal Haj Salem","doi":"10.1016/j.legalmed.2025.102741","DOIUrl":"10.1016/j.legalmed.2025.102741","url":null,"abstract":"<div><div>Tuberculous myocarditis is a rare manifestation of disseminated tuberculosis that is often misdiagnosed. It may present with non-specific symptoms, or alternatively remain clinically silent, making diagnosis particularly challenging. We present in this paper a case report of a 49-year-old man with a medical history of diabetes, untreated hypertension, and dyslipidemia was found dead in his home. There was no specific symptom before death. A medico-legal autopsy was requested to determine the cause of death. At the internal examination, there were bilateral yellow-citrine pleural effusion, pulmonary edema with congestion, whitish areas in the left ventricular myocardium. Histopathological analysis showed granulomatous myocarditis associated with interstitial granulomatous pneumonitis suggestive of miliary tuberculosis. The cause of death was attributed to acute heart failure related to undiagnosed tuberculous myocarditis.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102741"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.legalmed.2025.102740
Aytül Buğra , Hüseyin Çağrı Şahin , Beyza Keskin Öztürk , Kadriye Ebru Akar , Halit Çakır , Zekeriya Kul , Hızır Aslıyüksek
Background
Liposuction remains one of the most commonly performed cosmetic surgical procedures worldwide, yet fatal complications continue to occur despite advances in surgical techniques. This study aims to conduct forensic pathological analysis of liposuction-related deaths to identify specific complications, underlying causes, and patterns of fatal outcomes.
Methods
This retrospective study analyzed 35 fatal cases following liposuction procedures autopsied at the Council of Forensic Medicine, Turkey, between January 2022 and December 2024. Autopsy findings, histopathological examinations, demographic characteristics, and toxicological results were systematically evaluated.
Results
All cases were female with a mean age of 41.7 ± 9.5 years and mean BMI of 29.5 ± 3.7 kg/m2. Postoperative clinical deterioration occurred in 80.0 % of cases, requiring hospitalization in 62.9 %. Multiple surgical procedures were performed in 85.7 % of cases, with abdominoplasty (94.3 %), mammoplasty (57.1 %), and gluteal fat grafting (54.3 %) being most common. Pulmonary thromboembolism was the most frequent complication (65.7 %), followed by deep vein thrombosis (40.0 %). Histopathologically, pulmonary edema (71.4 %) and pulmonary fat embolism (68.6 %) were predominant findings. BMI was significantly higher in cases with pulmonary thromboembolism (p = 0.004). All five intraoperative deterioration cases involved gluteal fat injection.
Conclusion
Fatal liposuction complications have multifactorial etiology, with high BMI, multiple procedures, and gluteal fat transfer representing major risk factors. Comprehensive preoperative assessment, enhanced safety protocols, and close postoperative monitoring are essential for mortality reduction.
{"title":"Liposuction associated fatalities in Istanbul from a forensic perspective: An autopsy study","authors":"Aytül Buğra , Hüseyin Çağrı Şahin , Beyza Keskin Öztürk , Kadriye Ebru Akar , Halit Çakır , Zekeriya Kul , Hızır Aslıyüksek","doi":"10.1016/j.legalmed.2025.102740","DOIUrl":"10.1016/j.legalmed.2025.102740","url":null,"abstract":"<div><h3>Background</h3><div>Liposuction remains one of the most commonly performed cosmetic surgical procedures worldwide, yet fatal complications continue to occur despite advances in surgical techniques. This study aims to conduct forensic pathological analysis of liposuction-related deaths to identify specific complications, underlying causes, and patterns of fatal outcomes.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 35 fatal cases following liposuction procedures autopsied at the Council of Forensic Medicine, Turkey, between January 2022 and December 2024. Autopsy findings, histopathological examinations, demographic characteristics, and toxicological results were systematically evaluated.</div></div><div><h3>Results</h3><div>All cases were female with a mean age of 41.7 ± 9.5 years and mean BMI of 29.5 ± 3.7 kg/m<sup>2</sup>. Postoperative clinical deterioration occurred in 80.0 % of cases, requiring hospitalization in 62.9 %. Multiple surgical procedures were performed in 85.7 % of cases, with abdominoplasty (94.3 %), mammoplasty (57.1 %), and gluteal fat grafting (54.3 %) being most common. Pulmonary thromboembolism was the most frequent complication (65.7 %), followed by deep vein thrombosis (40.0 %). Histopathologically, pulmonary edema (71.4 %) and pulmonary fat embolism (68.6 %) were predominant findings. BMI was significantly higher in cases with pulmonary thromboembolism (p = 0.004). All five intraoperative deterioration cases involved gluteal fat injection.</div></div><div><h3>Conclusion</h3><div>Fatal liposuction complications have multifactorial etiology, with high BMI, multiple procedures, and gluteal fat transfer representing major risk factors. Comprehensive preoperative assessment, enhanced safety protocols, and close postoperative monitoring are essential for mortality reduction.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102740"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.legalmed.2025.102738
Norihiro Shinkawa, Eiji Kakizaki, Ai Sonoda, Nobuhiro Yukawa
Ingested alcohol (ethanol) is oxidized in the liver to acetic acid, which is then transferred to other organs where it is completely oxidized to carbon dioxide and water. However, to the best of our knowledge, no overall equation for this process has yet been described in the forensic literature, despite its physiological relevance. Here we present such an overall equation, derived by summing the reactions involved in the complete oxidation of ethanol: oxidation of ethanol to acetic acid by alcohol and aldehyde dehydrogenases, conversion to acetyl-coenzyme A, oxidation via the citric acid cycle, and utilization of the resulting reduced form of nicotinamide adenine dinucleotide and ubiquinol to fully reduce molecular oxygen. The overall equation is expressed as a pair of equations because inorganic phosphate takes two forms, H2PO4− and HPO42−, with a pKa of approximately 6.8. The pair of equations indicates that no H+ is generated if inorganic phosphate is present as H2PO4−, whereas one H+ is formed if inorganic phosphate is present as HPO42−. The actual ratio of [HPO42−]/[H2PO4−] is approximately 1, 1.6, and 2.5 at pH 6.8, 7.0, and 7.2, respectively, indicating that complete oxidation of one ethanol molecule forms approximately 0.6 (0.5–0.7) H+. Evidence of H+ formation contradicts the general notion that complete oxidation neither generates nor consumes H+. The implications of H+ generation merit clarification, particularly given the prevalence of metabolic acidosis in heavy drinkers.
{"title":"Overall equation for complete oxidation of ingested alcohol (ethanol) to carbon dioxide (CO2) and water (H2O)","authors":"Norihiro Shinkawa, Eiji Kakizaki, Ai Sonoda, Nobuhiro Yukawa","doi":"10.1016/j.legalmed.2025.102738","DOIUrl":"10.1016/j.legalmed.2025.102738","url":null,"abstract":"<div><div>Ingested alcohol (ethanol) is oxidized in the liver to acetic acid, which is then transferred to other organs where it is completely oxidized to carbon dioxide and water. However, to the best of our knowledge, no overall equation for this process has yet been described in the forensic literature, despite its physiological relevance. Here we present such an overall equation, derived by summing the reactions involved in the complete oxidation of ethanol: oxidation of ethanol to acetic acid by alcohol and aldehyde dehydrogenases, conversion to acetyl-coenzyme A, oxidation via the citric acid cycle, and utilization of the resulting reduced form of nicotinamide adenine dinucleotide and ubiquinol to fully reduce molecular oxygen. The overall equation is expressed as a pair of equations because inorganic phosphate takes two forms, H<sub>2</sub>PO<sub>4</sub><sup>−</sup> and HPO<sub>4</sub><sup>2−</sup>, with a pKa of approximately 6.8. The pair of equations indicates that no H<sup>+</sup> is generated if inorganic phosphate is present as H<sub>2</sub>PO<sub>4</sub><sup>−</sup>, whereas one H<sup>+</sup> is formed if inorganic phosphate is present as HPO<sub>4</sub><sup>2−</sup>. The actual ratio of [HPO<sub>4</sub><sup>2−</sup>]/[H<sub>2</sub>PO<sub>4</sub><sup>−</sup>] is approximately 1, 1.6, and 2.5 at pH 6.8, 7.0, and 7.2, respectively, indicating that complete oxidation of one ethanol molecule forms approximately 0.6 (0.5–0.7) H<sup>+</sup>. Evidence of H<sup>+</sup> formation contradicts the general notion that complete oxidation neither generates nor consumes H<sup>+</sup>. The implications of H<sup>+</sup> generation merit clarification, particularly given the prevalence of metabolic acidosis in heavy drinkers.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102738"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Venous air embolism (VAE) secondary to basilar skull fractures is rare but potentially fatal. While VAE is a known complication in central venous catheter management, traumatic VAE—particularly in forensic contexts—remains underreported. In forensic medicine, few case reports have detailed the use of postmortem computed tomography (PMCT) to diagnose VAE.
Case presentation
A man in his 30 s sustained a head injury at a construction site when his head was caught between a 500-kg steel plate and the ground. Despite resuscitation attempts, spontaneous circulation was not restored, and death was confirmed. PMCT performed 90 h postmortem revealed a basilar skull fracture, facial bone fractures, and approximately 430 mL of gas in the right heart and major systemic veins. Only mild decomposition was noted. Autopsy confirmed a rupture of the right sigmoid sinus and basal dura mater, a skull fracture extending from the right occipital bone to the anterior cranial fossa, and no trauma in the neck or chest. Subarachnoid hemorrhage was observed on the occipital lobes and cerebellar surface, without herniation or cerebral contusion. Brain sectioning showed only small hemorrhages in the brainstem and left basal ganglia. The cause of death was determined to be VAE due to air entry through the right sigmoid sinus.
Conclusion
We report a fatal case of VAE caused by air entry through a basilar skull fracture with confirmed rupture of the right sigmoid sinus. This condition may be overlooked without PMCT. Vigilance is essential in severe head trauma cases.
{"title":"Postmortem diagnosis of fatal venous air embolism due to sigmoid sinus rupture associated with a basilar skull fracture","authors":"Motoo Yoshimiya, Ikuto Takeuchi, Atsushi Ueda, Yu Kakimoto","doi":"10.1016/j.legalmed.2025.102734","DOIUrl":"10.1016/j.legalmed.2025.102734","url":null,"abstract":"<div><h3>Background</h3><div>Venous air embolism (VAE) secondary to basilar skull fractures is rare but potentially fatal. While VAE is a known complication in central venous catheter management, traumatic VAE—particularly in forensic contexts—remains underreported. In forensic medicine, few case reports have detailed the use of postmortem computed tomography (PMCT) to diagnose VAE.</div></div><div><h3>Case presentation</h3><div>A man in his 30 s sustained a head injury at a construction site when his head was caught between a 500-kg steel plate and the ground. Despite resuscitation attempts, spontaneous circulation was not restored, and death was confirmed. PMCT performed 90 h postmortem revealed a basilar skull fracture, facial bone fractures, and approximately 430 mL of gas in the right heart and major systemic veins. Only mild decomposition was noted. Autopsy confirmed a rupture of the right sigmoid sinus and basal dura mater, a skull fracture extending from the right occipital bone to the anterior cranial fossa, and no trauma in the neck or chest. Subarachnoid hemorrhage was observed on the occipital lobes and cerebellar surface, without herniation or cerebral contusion. Brain sectioning showed only small hemorrhages in the brainstem and left basal ganglia. The cause of death was determined to be VAE due to air entry through the right sigmoid sinus.</div></div><div><h3>Conclusion</h3><div>We report a fatal case of VAE caused by air entry through a basilar skull fracture with confirmed rupture of the right sigmoid sinus. This condition may be overlooked without PMCT. Vigilance is essential in severe head trauma cases.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102734"},"PeriodicalIF":1.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.legalmed.2025.102736
Brian Waters, Masayuki Kashiwagi, Aya Matsusue, Shin-ichi Kubo
This study investigates the postmortem tissue distribution of morphine, its main metabolites, and levetiracetam in a terminal cancer patient. A validated liquid chromatography-tandem mass spectroscopy method was developed and applied to blood and tissue samples collected during a forensic autopsy. Samples were processed using protein precipitation with acetonitrile and lipid removal cartridges. The analysis revealed peripheral blood concentrations of 0.220, 1.19, and 16.6 μg/mL for morphine, morphine-3-glucuronide/morphine-6-glucuronide, and levetiracetam, respectively. The highest concentrations of each drug were found in the urine. The concentration of free morphine in the blood was elevated, but higher levels have been reported in terminal cancer patients undergoing long periods of pain management with morphine. Levetiracetam blood levels were in the therapeutic range. The results align with existing literature on morphine’s postmortem redistribution and provide new insights into the tissue distribution of levetiracetam. These data can serve as a reference for future studies and contribute to the development of guidelines for the use of these medications in end-of-life care. The study concludes that while the drug concentrations were not high enough to solely attribute the cause of death to intoxication, the comprehensive tissue distribution analysis offers valuable information for forensic and clinical applications. To our knowledge, this is the first report to document the simultaneous analysis and tissue distribution of morphine and levetiracetam in postmortem samples.
{"title":"Tissue distribution of morphine and levetiracetam in a forensic autopsy case of a terminal cancer patient","authors":"Brian Waters, Masayuki Kashiwagi, Aya Matsusue, Shin-ichi Kubo","doi":"10.1016/j.legalmed.2025.102736","DOIUrl":"10.1016/j.legalmed.2025.102736","url":null,"abstract":"<div><div>This study investigates the postmortem tissue distribution of morphine, its main metabolites, and levetiracetam in a terminal cancer patient. A validated liquid chromatography-tandem mass spectroscopy method was developed and applied to blood and tissue samples collected during a forensic autopsy. Samples were processed using protein precipitation with acetonitrile and lipid removal cartridges. The analysis revealed peripheral blood concentrations of 0.220, 1.19, and 16.6 μg/mL for morphine, morphine-3-glucuronide/morphine-6-glucuronide, and levetiracetam, respectively. The highest concentrations of each drug were found in the urine. The concentration of free morphine in the blood was elevated, but higher levels have been reported in terminal cancer patients undergoing long periods of pain management with morphine. Levetiracetam blood levels were in the therapeutic range. The results align with existing literature on morphine’s postmortem redistribution and provide new insights into the tissue distribution of levetiracetam. These data can serve as a reference for future studies and contribute to the development of guidelines for the use of these medications in end-of-life care. The study concludes that while the drug concentrations were not high enough to solely attribute the cause of death to intoxication, the comprehensive tissue distribution analysis offers valuable information for forensic and clinical applications. To our knowledge, this is the first report to document the simultaneous analysis and tissue distribution of morphine and levetiracetam in postmortem samples.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102736"},"PeriodicalIF":1.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.legalmed.2025.102737
Huine Liu , Meichen Pan , Chuxiong Ma , Chenguang Yang , Hongmei Dong
The rupture of coronary artery plaque is a pathological mechanism leading to acute coronary syndrome, typically associated with severe atherosclerosis and high hemodynamic stress, while cases induced by blunt chest trauma (BCT) are exceedingly rare. This report presents an unusual case of a young male who died shortly after an informal basketball game. Postmortem examination revealed mild atherosclerotic plaque with a lacerated fibrous cap, along with complete thrombotic occlusion in the proximal left anterior descending (LAD) artery. Some areas of the thrombus were in direct contact with the lipid and necrotic components of the plaque. Witness testimony indicated the presence of BCT. Moreover, focal epicardial hemorrhage around the LAD artery, along with microscopically identified subcutaneous hemorrhage in the chest wall skin further supported the occurrence of BCT. Ultimately, the cause of death was determined to be BCT-related plaque rupture and the subsequent thrombus formation in the LAD artery. Given the rarity of this phenomenon, the association between BCT and plaque rupture requires careful clarification and may lead to forensic disputes. This report aims to remind forensic pathologists to consider the possibility of plaque rupture following BCT when faced with similar cases.
{"title":"Fatal plaque rupture of mild atherosclerotic coronary artery following basketball-related blunt chest trauma: A case report with forensic disputes","authors":"Huine Liu , Meichen Pan , Chuxiong Ma , Chenguang Yang , Hongmei Dong","doi":"10.1016/j.legalmed.2025.102737","DOIUrl":"10.1016/j.legalmed.2025.102737","url":null,"abstract":"<div><div>The rupture of coronary artery plaque is a pathological mechanism leading to acute coronary syndrome, typically associated with severe atherosclerosis and high hemodynamic stress, while cases induced by blunt chest trauma (BCT) are exceedingly rare. This report presents an unusual case of a young male who died shortly after an informal basketball game. Postmortem examination revealed mild atherosclerotic plaque with a lacerated fibrous cap, along with complete thrombotic occlusion in the proximal left anterior descending (LAD) artery. Some areas of the thrombus were in direct contact with the lipid and necrotic components of the plaque. Witness testimony indicated the presence of BCT. Moreover, focal epicardial hemorrhage around the LAD artery, along with microscopically identified subcutaneous hemorrhage in the chest wall skin further supported the occurrence of BCT. Ultimately, the cause of death was determined to be BCT-related plaque rupture and the subsequent thrombus formation in the LAD artery. Given the rarity of this phenomenon, the association between BCT and plaque rupture requires careful clarification and may lead to forensic disputes. This report aims to remind forensic pathologists to consider the possibility of plaque rupture following BCT when faced with similar cases.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102737"},"PeriodicalIF":1.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diatoms inhaled with a drowning medium are thought to reach closed organs, including the kidney and liver, through circulation; however, this is uncertain. Thus, to assess this doubt, we evaluated the relationship between resuscitation or decomposition and diatom concentration in closed organs (kidney and liver) (Cc).
Materials and methods
We retrospectively reviewed our diatom test results in 62 natural water- and five bathtub-water drowning consecutive forensic autopsies. Tukey’s honestly significant difference (HSD) test and multiple regression analysis were performed in natural water-drowning cases, to evaluate the relationship between Cc and three groups of post-mortem changes (PC): no or little, moderate, or severe PC. Furthermore, Welch’s t-test and multiple regression analyses were performed for natural water cases with no or little PC, to examine the effect of resuscitation on Cc. The Cc in natural and bathtub cases were compared using Welch’s t-test.
Results
Severe PC significantly increased the Cc in both analyses. Resuscitation caused no significant changes in Cc in either analysis. Natural water-drowning did not increase Cc compared with bathtub-drowning.
Conclusion
Our results suggest a post-mortem increase in Cc and diatom detection in non-drowning cases owing to natural load or laboratory contamination. Thus, the probability of Cc increasing during drowning or resuscitation was very low, Therefore, diatom testing of closed-organ samples should be carefully performed, and the results should be interpreted cautiously, especially in cases with severe post-mortem changes.
{"title":"Diatom testing for closed organs should be carefully performed and interpreted: the effect of post-mortem change and resuscitation","authors":"Shigeki Tsuneya , Makoto Nakajima , Yukiko Uemura , Suguru Torimitsu , Yui Takahagi , Go Inokuchi , Hirotaro Iwase , Yohsuke Makino","doi":"10.1016/j.legalmed.2025.102735","DOIUrl":"10.1016/j.legalmed.2025.102735","url":null,"abstract":"<div><h3>Introduction</h3><div>Diatoms inhaled with a drowning medium are thought to reach closed organs, including the kidney and liver, through circulation; however, this is uncertain. Thus, to assess this doubt, we evaluated the relationship between resuscitation or decomposition and diatom concentration in closed organs (kidney and liver) (Cc).</div></div><div><h3>Materials and methods</h3><div>We retrospectively reviewed our diatom test results in 62 natural water- and five bathtub-water drowning consecutive forensic autopsies. Tukey’s honestly significant difference (HSD) test and multiple regression analysis were performed in natural water-drowning cases, to evaluate the relationship between Cc and three groups of post-mortem changes (PC): no or little, moderate, or severe PC. Furthermore, Welch’s <em>t</em>-test and multiple regression analyses were performed for natural water cases with no or little PC, to examine the effect of resuscitation on Cc. The Cc in natural and bathtub cases were compared using Welch’s <em>t</em>-test.</div></div><div><h3>Results</h3><div>Severe PC significantly increased the Cc in both analyses. Resuscitation caused no significant changes in Cc in either analysis. Natural water-drowning did not increase Cc compared with bathtub-drowning.</div></div><div><h3>Conclusion</h3><div>Our results suggest a post-mortem increase in Cc and diatom detection in non-drowning cases owing to natural load or laboratory contamination. Thus, the probability of Cc increasing during drowning or resuscitation was very low, Therefore, diatom testing of closed-organ samples should be carefully performed, and the results should be interpreted cautiously, especially in cases with severe post-mortem changes.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102735"},"PeriodicalIF":1.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.legalmed.2025.102731
Laura Donato , Michele Treglia , Douglas H. Ubelaker , Margherita Pallocci , Chiara De Cagna , Anna Laura Santunione , Rossana Cecchi , Jessika Camatti , Pierluigi Passalacqua , Luigi Tonino Marsella
Age progression is increasingly applied in forensic practice to assist in the identification of long-term missing persons, yet its reliability requires systematic validation.
This study analysed childhood and adult photographs of an Italian family to assess the accuracy of the technique. Eight images were examined: five portraying the parents and three children at age 2, and three depicting the parents and daughter at age 30. A morphological analysis of facial features (face shape, eyebrows, eyelid folds, nasal bridge and tip, lips) was performed to identify hereditary traits. Age progressions of the two sons were generated to age 30 and subsequently adjusted to their current ages (45 and 43 years). Reconstructions were created using Adobe® Photoshop, combining low-resolution parental photographs with high-resolution reference images.
Results showed variable accuracy: the progression of Brother 2 closely resembled his current appearance, whereas discrepancies were noted for Brother 1, particularly in nasal morphology, largely due to poor source resolution. Overall, accuracy improved with higher image quality and a larger number of reference photographs.
This validation demonstrates that age progression can approximate the real appearance of missing persons but emphasizes image quality as a critical limitation. Expanding datasets and refining morphological protocols are essential to increase its reliability in forensic casework.
{"title":"Testing age progression technique: evaluation of reliability and accuracy","authors":"Laura Donato , Michele Treglia , Douglas H. Ubelaker , Margherita Pallocci , Chiara De Cagna , Anna Laura Santunione , Rossana Cecchi , Jessika Camatti , Pierluigi Passalacqua , Luigi Tonino Marsella","doi":"10.1016/j.legalmed.2025.102731","DOIUrl":"10.1016/j.legalmed.2025.102731","url":null,"abstract":"<div><div>Age progression is increasingly applied in forensic practice to assist in the identification of long-term missing persons, yet its reliability requires systematic validation.</div><div>This study analysed childhood and adult photographs of an Italian family to assess the accuracy of the technique. Eight images were examined: five portraying the parents and three children at age 2, and three depicting the parents and daughter at age 30. A morphological analysis of facial features (face shape, eyebrows, eyelid folds, nasal bridge and tip, lips) was performed to identify hereditary traits. Age progressions of the two sons were generated to age 30 and subsequently adjusted to their current ages (45 and 43 years). Reconstructions were created using Adobe® Photoshop, combining low-resolution parental photographs with high-resolution reference images.</div><div>Results showed variable accuracy: the progression of Brother 2 closely resembled his current appearance, whereas discrepancies were noted for Brother 1, particularly in nasal morphology, largely due to poor source resolution. Overall, accuracy improved with higher image quality and a larger number of reference photographs.</div><div>This validation demonstrates that age progression can approximate the real appearance of missing persons but emphasizes image quality as a critical limitation. Expanding datasets and refining morphological protocols are essential to increase its reliability in forensic casework.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102731"},"PeriodicalIF":1.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145248023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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