Pub Date : 2026-02-01Epub Date: 2026-01-02DOI: 10.1016/j.legalmed.2026.102774
Mariko Kazuta, Toshihiko Aki, Kanako Noritake, Atsushi Yamada, Kana Unuma
Heavy metals, including arsenic, which are found in a wide range of environments, can disrupt cellular homeostasis in humans and even entire ecosystems. Metallothioneins (MTs) are well-known mediators of cellular defense against metal toxicity, while the STEAP family of metalloreductases has recently been attracting attention, especially in the field of cancer research. The aim of this study was to evaluate systematically the cellular responses of HT-29 cells (derived from human colorectal adenocarcinoma) exposed to As2O3 (0, 5, 10, 15 μM for 24 h). Transcriptome analysis identified the induction and suppression of the MT and STEAP genes, respectively. However, further evaluation of MT and STEAP gene responses to CdCl2, HgCl2, PbCl2, and ZnCl2 (0, 5, 10, 15 μM for 24 h) revealed that the expressions of the MT and STEAP genes were each regulated differently in a metal-specific manner, suggesting distinct cytotoxic mechanisms in response to each heavy metal. This study represents the first systematic investigation of MT and STEAP gene responses to heavy metals providing a new perspective for further research in metal toxicity assessment.
{"title":"Diversity and similarity of metallothionein and STEAP gene regulation by heavy metals in human colorectal cells","authors":"Mariko Kazuta, Toshihiko Aki, Kanako Noritake, Atsushi Yamada, Kana Unuma","doi":"10.1016/j.legalmed.2026.102774","DOIUrl":"10.1016/j.legalmed.2026.102774","url":null,"abstract":"<div><div>Heavy metals, including arsenic, which are found in a wide range of environments, can disrupt cellular homeostasis in humans and even entire ecosystems. Metallothioneins (MTs) are well-known mediators of cellular defense against metal toxicity, while the STEAP family of metalloreductases has recently been attracting attention, especially in the field of cancer research. The aim of this study was to evaluate systematically the cellular responses of HT-29 cells (derived from human colorectal adenocarcinoma) exposed to As<sub>2</sub>O<sub>3</sub> (0, 5, 10, 15 μM for 24 h). Transcriptome analysis identified the induction and suppression of the MT and STEAP genes, respectively. However, further evaluation of MT and STEAP gene responses to CdCl<sub>2</sub>, HgCl<sub>2</sub>, PbCl<sub>2</sub>, and ZnCl<sub>2</sub> (0, 5, 10, 15 μM for 24 h) revealed that the expressions of the MT and STEAP genes were each regulated differently in a metal-specific manner, suggesting distinct cytotoxic mechanisms in response to each heavy metal. This study represents the first systematic investigation of MT and STEAP gene responses to heavy metals providing a new perspective for further research in metal toxicity assessment.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"80 ","pages":"Article 102774"},"PeriodicalIF":1.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919008","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 : 2026-01-07DOI: 10.1016/j.legalmed.2026.102777
Ken Sato, Suzuka Shimmura, Takeki Nishi, Marie Inaba, Hisashi Akuzawa, Fujio Ishizawa, Yukiko Sugano, Yoichiro Takahashi
Determination of the cause of death is a fundamental task in forensic medicine. However, this becomes particularly challenging in cases of decomposition, where critical findings necessary for diagnosis are often obscured by putrefaction or insect activity. Here, we report a case of a man in his 70 s who went missing during a summer hike and was found approximately 10 m below a trail after four days, in a state of moderate decomposition with heavy maggot infestation. Postmortem computed tomography revealed no major traumatic injuries but identified a high-density, oval-shaped foreign body, measuring approximately 2 cm, in the oral cavity. Autopsy confirmed this as the pit of a pickled plum (umeboshi), retrieved from a cluster of maggots. The stomach contained plum paste, rice, and seaweed, which were typical components of a Japanese rice ball (onigiri). These findings suggested that the deceased died while eating onigiri, implying that the cause of death involved food aspiration-related choking, although decomposition prevented definitive identification of airway obstruction and other cause of death could not be evaded completely. In this case, postmortem computed tomography enabled detection of evidence that would likely have been missed or displaced without imaging, especially given the moderate postmortem changes. It was demonstrated that, even in decomposed bodies, persistent foreign materials such as an umeboshi pit could serve as useful circumstantial indicators in forensic investigations. This case illustrates the importance of integrating imaging and autopsy approaches in elucidating causes of death in complex forensic cases.
{"title":"Postmortem computed tomography identified indigestible umeboshi pit surrounded by maggot masses in oral cavity suggesting food-related choking in a decomposed body","authors":"Ken Sato, Suzuka Shimmura, Takeki Nishi, Marie Inaba, Hisashi Akuzawa, Fujio Ishizawa, Yukiko Sugano, Yoichiro Takahashi","doi":"10.1016/j.legalmed.2026.102777","DOIUrl":"10.1016/j.legalmed.2026.102777","url":null,"abstract":"<div><div>Determination of the cause of death is a fundamental task in forensic medicine. However, this becomes particularly challenging in cases of decomposition, where critical findings necessary for diagnosis are often obscured by putrefaction or insect activity. <em>Here</em>, we report a case of a man in his 70 s who went missing during a summer hike and was found approximately 10 m below a trail after four days, in a state of moderate decomposition with heavy maggot infestation. Postmortem computed tomography revealed no major traumatic injuries but identified a high-density, oval-shaped foreign body, measuring approximately 2 cm, in the oral cavity. Autopsy confirmed this as the pit of a pickled plum (<em>umeboshi</em>), retrieved from a cluster of maggots. The stomach contained plum paste, rice, and seaweed, which were typical components of a Japanese rice ball (<em>onigiri</em>). These findings suggested that the deceased died while eating <em>onigiri</em>, implying that the cause of death involved food aspiration-related choking, although decomposition prevented definitive identification of airway obstruction and other cause of death could not be evaded completely. In this case, postmortem computed tomography enabled detection of evidence that would likely have been missed or displaced without imaging, especially given the moderate postmortem changes. It was demonstrated that, even in decomposed bodies, persistent foreign materials such as an <em>umeboshi</em> pit could serve as useful circumstantial indicators in forensic investigations. This case illustrates the importance of integrating imaging and autopsy approaches in elucidating causes of death in complex forensic cases.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"80 ","pages":"Article 102777"},"PeriodicalIF":1.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924403","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}
Accurate detection and quantification of human nuclear DNA (nDNA), named the human accelerated region 1 (HAR1) assay, was developed to simultaneously prove the human origin of forensic biological samples and optimize nDNA input for PCR in human DNA profiling. The HAR1 assay, a TaqMan probe-based real-time PCR assay targeting HAR1 in nDNA, was exclusively specific to human DNA samples with no cross-reactivity across 23 vertebrate species (mammals including non-human primates, birds, reptiles, amphibians, and fishes). This assay is capable of proving the human origin of the samples from as little as the DNA content of a single somatic cell. Moreover, accurate quantification of human nDNA was achieved down to the minimum input concentration (33 pg/μL) recommended by commercial DNA profiling kits. Furthermore, it was confirmed that the presence of non-human DNA mixed with human DNA did not interfere with the accuracy of human nDNA quantification. Therefore, the HAR1 assay represents a valuable and practical tool for improving both the accuracy and efficiency of human DNA profiling, particularly in forensic casework where sample quantity and quality may be limited and the presence of non-human DNA can complicate analysis.
{"title":"Accurate Detection and Quantification of Human Nuclear DNA","authors":"Toshifumi Nakagawa , Masanori Doi , Kosuke Nishi , Takuya Sugahara","doi":"10.1016/j.legalmed.2025.102715","DOIUrl":"10.1016/j.legalmed.2025.102715","url":null,"abstract":"<div><div>Accurate detection and quantification of human nuclear DNA (nDNA), named the human accelerated region 1 (HAR1) assay, was developed to simultaneously prove the human origin of forensic biological samples and optimize nDNA input for PCR in human DNA profiling. The HAR1 assay, a TaqMan probe-based real-time PCR assay targeting HAR1 in nDNA, was exclusively specific to human DNA samples with no cross-reactivity across 23 vertebrate species (mammals including non-human primates, birds, reptiles, amphibians, and fishes). This assay is capable of proving the human origin of the samples from as little as the DNA content of a single somatic cell. Moreover, accurate quantification of human nDNA was achieved down to the minimum input concentration (33 pg/μL) recommended by commercial DNA profiling kits. Furthermore, it was confirmed that the presence of non-human DNA mixed with human DNA did not interfere with the accuracy of human nDNA quantification. Therefore, the HAR1 assay represents a valuable and practical tool for improving both the accuracy and efficiency of human DNA profiling, particularly in forensic casework where sample quantity and quality may be limited and the presence of non-human DNA can complicate analysis.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102715"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364467","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 : 2025-11-01Epub 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":"2025-11-01","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 : 2025-11-01Epub Date: 2025-10-22DOI: 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}
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":"2025-11-01","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 : 2025-11-01Epub 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":"2025-11-01","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}
Internal abdominal hernias (IAHs) are rare causes of intestinal obstruction and unexpected death, with transmesocolic hernias being particularly uncommon and typically diagnosed in children. Autopsy-confirmed congenital cases in the elderly are exceptionally rare.
Case presentation
An 89-year-old woman presented with a three-day history of abdominal pain and constipation. Despite supportive treatment, her condition rapidly deteriorated, leading to death within nine hours of hospital admission. Autopsy revealed a 180 cm segment of necrotic small intestine herniated through a 3 cm smooth-edged defect in the transverse mesocolon, consistent with a congenital transmesocolic hernia. No prior abdominal surgeries, trauma, or intra-abdominal inflammation were noted.
Discussion
Transmesocolic hernias are a rare subset of IAHs and can be life-threatening due to bowel strangulation and ischemia. Congenital mesenteric defects are typically identified in pediatric populations, making this elderly case highly unusual. The nonspecific clinical presentation often delays diagnosis, and imaging may fail to detect small mesenteric defects, contributing to high mortality rates.
Conclusion
This case represents the first reported autopsy-confirmed congenital transmesocolic hernia in an elderly individual. It emphasizes the importance of considering rare congenital anomalies in differential diagnoses of acute abdomen and unexplained sudden death, even in the absence of surgical or traumatic history.
{"title":"Congenital transmesocolic internal hernia as a cause of sudden death – autopsy case report","authors":"Veljko Milošević , Milenko Bogdanović , Milena Kontić-Žarčanin , Tijana Petrović , Bojana Radnić","doi":"10.1016/j.legalmed.2025.102732","DOIUrl":"10.1016/j.legalmed.2025.102732","url":null,"abstract":"<div><h3>Introduction</h3><div>Internal abdominal hernias (IAHs) are rare causes of intestinal obstruction and unexpected death, with transmesocolic hernias being particularly uncommon and typically diagnosed in children. Autopsy-confirmed congenital cases in the elderly are exceptionally rare.</div></div><div><h3>Case presentation</h3><div>An 89-year-old woman presented with a three-day history of abdominal pain and constipation. Despite supportive treatment, her condition rapidly deteriorated, leading to death within nine hours of hospital admission. Autopsy revealed a 180 cm segment of necrotic small intestine herniated through a 3 cm smooth-edged defect in the transverse mesocolon, consistent with a congenital transmesocolic hernia. No prior abdominal surgeries, trauma, or intra-abdominal inflammation were noted.</div></div><div><h3>Discussion</h3><div>Transmesocolic hernias are a rare subset of IAHs and can be life-threatening due to bowel strangulation and ischemia. Congenital mesenteric defects are typically identified in pediatric populations, making this elderly case highly unusual. The nonspecific clinical presentation often delays diagnosis, and imaging may fail to detect small mesenteric defects, contributing to high mortality rates.</div></div><div><h3>Conclusion</h3><div>This case represents the first reported autopsy-confirmed congenital transmesocolic hernia in an elderly individual. It emphasizes the importance of considering rare congenital anomalies in differential diagnoses of acute abdomen and unexplained sudden death, even in the absence of surgical or traumatic history.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102732"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145271308","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 : 2025-11-01Epub Date: 2025-10-29DOI: 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}
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}
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