Daisley-Barton Syndrome is a rare but distinct systemic manifestation of paraquat poisoning, characterized by the development of spontaneous pneumothorax and/or pneumomediastinum. We report the case of an adult male in his 40 s, who presented with abdominal pain and vomiting following ingestion of approximately 200 mL of paraquat. Initial management included gastric lavage and supportive care. Over the following days, he developed mucosal ulcerations involving the lips, tongue, and oral cavity, along with progressive respiratory distress. Imaging revealed pneumothorax and pneumomediastinum. Despite intensive care, the patient died due to respiratory failure. Autopsy revealed extensive pulmonary hemorrhage, necrosis, and diffuse alveolar damage consistent with paraquat toxicity. A literature search was conducted using major databases, and relevant case reports describing Daisley-Barton Syndrome were identified. We compared clinical features, radiological findings, outcomes, and autopsy details, where available. Our case is unique in providing both detailed clinical and autopsy findings. The comparison reinforces the diagnostic significance of spontaneous pneumothorax and pneumomediastinum as hallmark features of the syndrome and highlights the variability in clinical course and outcomes. This report emphasizes the importance of early recognition and the role of autopsy in confirming diagnosis and understanding the underlying pathophysiology.
{"title":"Fatal case of Daisley-Barton Syndrome: A case report with Review of the literature","authors":"LN. Abisha Tino , Deepu Mathew , Vinod Ashok Chaudhari , P.Keerthi Kumaran , Sanjay Sriram , S. Santhakumar","doi":"10.1016/j.legalmed.2025.102704","DOIUrl":"10.1016/j.legalmed.2025.102704","url":null,"abstract":"<div><div>Daisley-Barton Syndrome is a rare but distinct systemic manifestation of paraquat poisoning, characterized by the development of spontaneous pneumothorax and/or pneumomediastinum. We report the case of an adult male in his 40 s, who presented with abdominal pain and vomiting following ingestion of approximately 200 mL of paraquat. Initial management included gastric lavage and supportive care. Over the following days, he developed mucosal ulcerations involving the lips, tongue, and oral cavity, along with progressive respiratory distress. Imaging revealed pneumothorax and pneumomediastinum. Despite intensive care, the patient died due to respiratory failure. Autopsy revealed extensive pulmonary hemorrhage, necrosis, and diffuse alveolar damage consistent with paraquat toxicity. A literature search was conducted using major databases, and relevant case reports describing Daisley-Barton Syndrome were identified. We compared clinical features, radiological findings, outcomes, and autopsy details, where available. Our case is unique in providing both detailed clinical and autopsy findings. The comparison reinforces the diagnostic significance of spontaneous pneumothorax and pneumomediastinum as hallmark features of the syndrome and highlights the variability in clinical course and outcomes. This report emphasizes the importance of early recognition and the role of autopsy in confirming diagnosis and understanding the underlying pathophysiology.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102704"},"PeriodicalIF":1.4,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049023","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}
The number of drowning deaths worldwide is increasing, and preventive measures are being developed on a global scale. However, unlike the global trend, elderly people account for most drowning deaths in Japan, which suggests that unique surveys and measures are required. In this study, we analyzed forensic autopsy cases of river drowning in a part of Japan to reveal the characteristics of the deaths and of finding of the deceased.
Methods
We retrospectively investigated river drowning cases for which a forensic autopsy was performed from 2012 to 2021 in Yamaguchi Prefecture, Japan. Various factors were examined statistically for comparison of accidents and suicides.
Results
The accident group tended to be older and many had cognitive impairments or reduced mobility, while the suicide group tended to be younger, with a higher proportion in their 50 s and 60 s. Many cases in both groups occurred within 6 h of the last confirmed contact. The suicide cases were reported as missing more frequently than the accident cases. The accident cases tended to occur in smaller, more familiar rivers, while suicide cases tended to occur in larger rivers further from home. Preventive measures such as guardrails or fences were present in 81.8 % of the suicide cases and 22.0 % of the accident cases.
Conclusions
This study highlights the importance of timely searches, innovative preventive measures, and societal awareness focused on people with mental and cognitive problems to address the underlying factors contributing to drowning in rivers due to accident and suicide in Japan.
{"title":"Differences between accidents and suicides in river drowning cases based on forensic autopsy information in a part of Japan","authors":"Kurumi Kokusho , Ayako Himemiya-Hakucho , Izumi Takase","doi":"10.1016/j.legalmed.2025.102705","DOIUrl":"10.1016/j.legalmed.2025.102705","url":null,"abstract":"<div><h3>Background</h3><div>The number of drowning deaths worldwide is increasing, and preventive measures are being developed on a global scale. However, unlike the global trend, elderly people account for most drowning deaths in Japan, which suggests that unique surveys and measures are required. In this study, we analyzed forensic autopsy cases of river drowning in a part of Japan to reveal the characteristics of the deaths and of finding of the deceased.</div></div><div><h3>Methods</h3><div>We retrospectively investigated river drowning cases for which a forensic autopsy was performed from 2012 to 2021 in Yamaguchi Prefecture, Japan. Various factors were examined statistically for comparison of accidents and suicides.</div></div><div><h3>Results</h3><div>The accident group tended to be older and many had cognitive impairments or reduced mobility, while the suicide group tended to be younger, with a higher proportion in their 50 s and 60 s. Many cases in both groups occurred within 6 h of the last confirmed contact. The suicide cases were reported as missing more frequently than the accident cases. The accident cases tended to occur in smaller, more familiar rivers, while suicide cases tended to occur in larger rivers further from home. Preventive measures such as guardrails or fences were present in 81.8 % of the suicide cases and 22.0 % of the accident cases.</div></div><div><h3>Conclusions</h3><div>This study highlights the importance of timely searches, innovative preventive measures, and societal awareness focused on people with mental and cognitive problems to address the underlying factors contributing to drowning in rivers due to accident and suicide in Japan.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102705"},"PeriodicalIF":1.4,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026693","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}
The number of suicides by children in Japan has increased over the past few years. We conducted this descriptive epidemiological study to identify aspects of this situation that must be improved. We summarize the observations based on our findings and describe effective approaches to decrease the number of suicides among children. We investigated and calculated the number of suicides and the percentage of ’unknown’ causes of/motives for suicide among the categories of causes of/motives for suicide among Japanese elementary, junior high school, and high school students (including separate analyses for male and female students) during the 3-year period 2022–2024 based on the numerical data published by Japan’s Ministry of Health, Labour and Welfare and the National Police Agency. The current problems with suicide statistics are explained, and potential approaches to dealing with these statistics are described. During the 3-year study period, 1,556 suicides by elementary, junior high school, and high school students were recorded in Japan. ’Unknown’ causes of/motives for suicide accounted for 11.8% of the suicides by the students overall during the 3-year period; the yearly percentage for these unknown causes was 10.1%–12.9%. Since Japan’s Status of Suicide report was revised in 2022, care is required when comparing suicide data with the data obtained before 2022. These issues must be addressed in collaborations by legal medicine and public health experts.
{"title":"Current major problems with the establishment of effective measures to prevent suicide among children in Japan: Collaborative studies between legal medicine and public health are needed to address these problems","authors":"Ken Inoue , Tadashi Takeshima , Takashi Yamauchi , Tsukasa Sasaki , Yuri Murayama , Sultana Razia , Haruo Takeshita , Noriyuki Kawano , Tatsushige Fukunaga","doi":"10.1016/j.legalmed.2025.102701","DOIUrl":"10.1016/j.legalmed.2025.102701","url":null,"abstract":"<div><div>The number of suicides by children in Japan has increased over the past few years. We conducted this descriptive epidemiological study to identify aspects of this situation that must be improved. We summarize the observations based on our findings and describe effective approaches to decrease the number of suicides among children. We investigated and calculated the number of suicides and the percentage of ’unknown’ causes of/motives for suicide among the categories of causes of/motives for suicide among Japanese elementary, junior high school, and high school students (including separate analyses for male and female students) during the 3-year period 2022–2024 based on the numerical data published by Japan’s Ministry of Health, Labour and Welfare and the National Police Agency. The current problems with suicide statistics are explained, and potential approaches to dealing with these statistics are described. During the 3-year study period, 1,556 suicides by elementary, junior high school, and high school students were recorded in Japan. ’Unknown’ causes of/motives for suicide accounted for 11.8% of the suicides by the students overall during the 3-year period; the yearly percentage for these unknown causes was 10.1%–12.9%. Since Japan’s Status of Suicide report was revised in 2022, care is required when comparing suicide data with the data obtained before 2022. These issues must be addressed in collaborations by legal medicine and public health experts.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102701"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004419","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}
An intramuscular hemorrhage in the back is considered a potential supportive finding with regard to diagnosing drowning; however, its detection traditionally requires autopsy. This study aimed to evaluate whether back muscle intramuscular hemorrhage can be reliably identified on postmortem computed tomography (PMCT). Here, we retrospectively reviewed 31 drowning cases for which autopsies had already been performed, comparing PMCT scans acquired before dissection with the subsequent autopsy findings. Intramuscular hemorrhage in 11 major back muscles was recorded and compared with the PMCT findings; furthermore, diagnostic accuracy (sensitivity, specificity, and F1 score) was calculated. Of the 682 muscles, 176 (25.8 %) showed hemorrhage on autopsy. Overall, the PMCT sensitivity was 21.6 %, specificity was 92.1 %, and F1 score was 0.299. ROC analysis showed that hemorrhages larger than certain size thresholds (6.0 and 4.5 cm in vertical and horizontal dimensions, respectively, with 16.0 cm2 area) were more likely to be detected. Detection improved with the increase in hemorrhage size; however, many smaller lesions were missed. While large hemorrhages can occasionally be recognized on PMCT, routine forensic applications for detecting back muscle hemorrhages remain limited. PMCT often underestimates the incidence of smaller intramuscular hemorrhages. Meticulous autopsy remains indispensable for the accurate diagnosis of intramuscular hemorrhage in drowning cases.
{"title":"Can intramuscular hemorrhage in the back be detected on postmortem CT? A forensic study in drowning cases","authors":"Shogo Shimbashi , Motoo Yoshimiya , Akiko Tashiro , Shunsuke Sakamoto , Hideki Hyodoh","doi":"10.1016/j.legalmed.2025.102702","DOIUrl":"10.1016/j.legalmed.2025.102702","url":null,"abstract":"<div><div>An intramuscular hemorrhage in the back is considered a potential supportive finding with regard to diagnosing drowning; however, its detection traditionally requires autopsy. This study aimed to evaluate whether back muscle intramuscular hemorrhage can be reliably identified on postmortem computed tomography (PMCT). Here, we retrospectively reviewed 31 drowning cases for which autopsies had already been performed, comparing PMCT scans acquired before dissection with the subsequent autopsy findings. Intramuscular hemorrhage in 11 major back muscles was recorded and compared with the PMCT findings; furthermore, diagnostic accuracy (sensitivity, specificity, and F1 score) was calculated. Of the 682 muscles, 176 (25.8 %) showed hemorrhage on autopsy. Overall, the PMCT sensitivity was 21.6 %, specificity was 92.1 %, and F1 score was 0.299. ROC analysis showed that hemorrhages larger than certain size thresholds (6.0 and 4.5 cm in vertical and horizontal dimensions, respectively, with 16.0 cm<sup>2</sup> area) were more likely to be detected. Detection improved with the increase in hemorrhage size; however, many smaller lesions were missed. While large hemorrhages can occasionally be recognized on PMCT, routine forensic applications for detecting back muscle hemorrhages remain limited. PMCT often underestimates the incidence of smaller intramuscular hemorrhages. Meticulous autopsy remains indispensable for the accurate diagnosis of intramuscular hemorrhage in drowning cases.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102702"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049022","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 : 2025-09-05DOI: 10.1016/j.legalmed.2025.102699
Koichi Saito, Tomonori Asanuma, Rie Ito
This study investigated headspace solid-phase microextraction (HS–SPME)–gas chromatography (GS)/mass spectrometry as a low-complexity method for accurate measurement of blood alcohol concentration (BAC) changes in humans over time following alcohol consumption. The aim was to develop an analytical method that would require as small blood samples as possible—smaller than that required for the conventional method—thereby reducing the burden on the subject. Polyethylene glycol (PEG) was used as the fiber material for SPME, and a DB-WAX capillary column was used for GC. For sample extraction via SPME, 50 µL of blood sample obtained via fingertip puncture was added to a vial already containing 3 mL of 20 % aqueous sodium chloride solution, following which an SPME fiber was inserted into the vapor phase (headspace) of the vial and heated at 70 ℃ for 20 min to sorb ethanol onto the fiber. The experiment for ethanol recovery in whole blood yielded recoveries of 71.1 % when spiked at 100 µg/mL and 95.1 % when spiked at 1000 µg/mL. Blood samples were obtained periodically with consent from a human volunteer who had actually consumed alcohol, and the BAC was shown to decrease with a peak 1.5 h after drinking, confirming the applicability of this method in BAC assessment when compared with the conventional Widmark method. Furthermore, the applicability of this method was also investigated in the case of saliva, which can be collected more easily and non-invasively than blood.
{"title":"Determination of alcohol concentration in a single drop blood obtained via fingertip using gas chromatography/mass spectrometry coupled with solid-phase microextraction","authors":"Koichi Saito, Tomonori Asanuma, Rie Ito","doi":"10.1016/j.legalmed.2025.102699","DOIUrl":"10.1016/j.legalmed.2025.102699","url":null,"abstract":"<div><div>This study investigated headspace solid-phase microextraction (HS–SPME)–gas chromatography (GS)/mass spectrometry as a low-complexity method for accurate measurement of blood alcohol concentration (BAC) changes in humans over time following alcohol consumption. The aim was to develop an analytical method that would require as small blood samples as possible—smaller than that required for the conventional method—thereby reducing the burden on the subject. Polyethylene glycol (PEG) was used as the fiber material for SPME, and a DB-WAX capillary column was used for GC. For sample extraction via SPME, 50 µL of blood sample obtained via fingertip puncture was added to a vial already containing 3 mL of 20 % aqueous sodium chloride solution, following which an SPME fiber was inserted into the vapor phase (headspace) of the vial and heated at 70 ℃ for 20 min to sorb ethanol onto the fiber. The experiment for ethanol recovery in whole blood yielded recoveries of 71.1 % when spiked at 100 µg/mL and 95.1 % when spiked at 1000 µg/mL. Blood samples were obtained periodically with consent from a human volunteer who had actually consumed alcohol, and the BAC was shown to decrease with a peak 1.5 h after drinking, confirming the applicability of this method in BAC assessment when compared with the conventional Widmark method. Furthermore, the applicability of this method was also investigated in the case of saliva, which can be collected more easily and non-invasively than blood.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102699"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010646","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 : 2025-09-05DOI: 10.1016/j.legalmed.2025.102703
Rossana Cecchi , Anna Laura Santunione , Jessika Camatti , Alice Buzzelli , Alessandra De Martina , Alessandra Sannella , Marco Vinceti , Graziamaria Corbi , Carlo Pietro Campobasso , Matilde Sassani , Giovanna Laura De Fazio , Paolo Fais , Susi Pelotti , Arianna Giorgetti , Elena Lacchè , Andrea Verzeletti , Bianca Beltrame , Riccardo Zoia , Lorenzo Franceschetti , Giulia Vignali , Raffaella Marino
Understanding the motives behind femicides is crucial to design effective prevention strategies and to support women’s self-determination, free from threats to their mental and physical integrity.
We conducted a retrospective, multicenter forensic study involving 27 Italian Institutes of Legal Medicine, analyzing 1238 female homicides (1950–2023). Cases were classified as femicide or non-femicide female homicide according to the medico-legal definition of femicide as the murder due to the failure to recognize women’s right to self-determination. Motives were categorized into 12 groups, and relevant anamnestic and circumstantial data were collected.
Of the 1238 cases, 410 were identified as femicides, 395 as non-femicides, and 433 were excluded for insufficient information. Femicides were most frequently driven by jealousy/rejection (n = 185; 45.1 %) and separation/divorce (n = 144; 35.1 %), often in the context of intimate partner violence or inability to accept the end of a relationship. Non-femicides were predominantly associated with the perpetrator’s psychiatric disorder and/or drug addiction (n = 126; 31.9 %), violent aggression without gender-related motive (n = 69; 17.5 %), victim’s illness (n = 63; 15.9 %), or economic reasons (n = 58; 14.7 %).
In the Italian context, most femicides stem from relational dynamics − particularly jealousy, rejection, and separation − whereas non-femicides are more often linked to psychiatric illness, substance abuse, or non-gender-related aggression. Incorporating these findings into clinical risk assessment protocols, especially in emergency and primary care settings, may help identify women at high risk and guide targeted prevention strategies.
{"title":"A nationwide forensic case-series of femicides in Italy – Part 1: Clues to the motives of the murder","authors":"Rossana Cecchi , Anna Laura Santunione , Jessika Camatti , Alice Buzzelli , Alessandra De Martina , Alessandra Sannella , Marco Vinceti , Graziamaria Corbi , Carlo Pietro Campobasso , Matilde Sassani , Giovanna Laura De Fazio , Paolo Fais , Susi Pelotti , Arianna Giorgetti , Elena Lacchè , Andrea Verzeletti , Bianca Beltrame , Riccardo Zoia , Lorenzo Franceschetti , Giulia Vignali , Raffaella Marino","doi":"10.1016/j.legalmed.2025.102703","DOIUrl":"10.1016/j.legalmed.2025.102703","url":null,"abstract":"<div><div>Understanding the motives behind femicides is crucial to design effective prevention strategies and to support women’s self-determination, free from threats to their mental and physical integrity.</div><div>We conducted a retrospective, multicenter forensic study involving 27 Italian Institutes of Legal Medicine, analyzing 1238 female homicides (1950–2023). Cases were classified as <em>femicide</em> or <em>non-femicide female homicide</em> according to the medico-legal definition of femicide as the murder due to the failure to recognize women’s right to self-determination. Motives were categorized into 12 groups, and relevant anamnestic and circumstantial data were collected.</div><div>Of the 1238 cases, 410 were identified as femicides, 395 as non-femicides, and 433 were excluded for insufficient information. Femicides were most frequently driven by jealousy/rejection (n = 185; 45.1 %) and separation/divorce (n = 144; 35.1 %), often in the context of intimate partner violence or inability to accept the end of a relationship. Non-femicides were predominantly associated with the perpetrator’s psychiatric disorder and/or drug addiction (n = 126; 31.9 %), violent aggression without gender-related motive (n = 69; 17.5 %), victim’s illness (n = 63; 15.9 %), or economic reasons (n = 58; 14.7 %).</div><div>In the Italian context, most femicides stem from relational dynamics − particularly jealousy, rejection, and separation − whereas non-femicides are more often linked to psychiatric illness, substance abuse, or non-gender-related aggression. Incorporating these findings into clinical risk assessment protocols, especially in emergency and primary care settings, may help identify women at high risk and guide targeted prevention strategies.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102703"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019576","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 : 2025-09-01Epub Date: 2025-08-07DOI: 10.1016/j.legalmed.2025.102682
Tadashi Ogawa, Kyoko Maebashi, Tomohito Matsuo, Masae Iwai, Kana Sakamoto, Mamiko Fukuta, Katsutoshi Kubo, Fumio Kondo, Hiroshi Seno
We developed a simultaneous analysis method for 13 neonicotinoids and related insecticides in whole blood by liquid chromatography-tandem mass spectrometry (LC-MS/MS) using a Novum simplified liquid extraction column. The extraction method, which employs an extraction solvent of 16% acetonitrile in ethyl acetate, demonstrated the best performance in terms of balancing phospholipid removal ability, recovery efficiency and matrix effects. Calibration curves showed good linear relationships, with r2 values exceeding 0.995. The intra- and inter-day accuracies and precisions were 85.5-108.8% and 0.2-13.0%, respectively. The recovery efficiencies were in the range of 52.7-92.7%. Matrix effects were between 60.6 and 201.0%; higher effects were seen for fipronil, which represents a significant challenge that resulted in substantial ion enhancement. Nevertheless, both the accuracy and precision of the method were enhanced by utilization of a stable isotopically-labeled internal standard followed by LC-MS/MS. The method was applied to a human postmortem blood sample collected during a forensic autopsy to demonstrate feasibility; results suggest that this method will be useful for forensic toxicological investigations.
{"title":"Development of a simultaneous analysis method for 13 neonicotinoids and related insecticides in whole blood by LC-MS/MS using a Novum simplified liquid extraction column.","authors":"Tadashi Ogawa, Kyoko Maebashi, Tomohito Matsuo, Masae Iwai, Kana Sakamoto, Mamiko Fukuta, Katsutoshi Kubo, Fumio Kondo, Hiroshi Seno","doi":"10.1016/j.legalmed.2025.102682","DOIUrl":"10.1016/j.legalmed.2025.102682","url":null,"abstract":"<p><p>We developed a simultaneous analysis method for 13 neonicotinoids and related insecticides in whole blood by liquid chromatography-tandem mass spectrometry (LC-MS/MS) using a Novum simplified liquid extraction column. The extraction method, which employs an extraction solvent of 16% acetonitrile in ethyl acetate, demonstrated the best performance in terms of balancing phospholipid removal ability, recovery efficiency and matrix effects. Calibration curves showed good linear relationships, with r<sup>2</sup> values exceeding 0.995. The intra- and inter-day accuracies and precisions were 85.5-108.8% and 0.2-13.0%, respectively. The recovery efficiencies were in the range of 52.7-92.7%. Matrix effects were between 60.6 and 201.0%; higher effects were seen for fipronil, which represents a significant challenge that resulted in substantial ion enhancement. Nevertheless, both the accuracy and precision of the method were enhanced by utilization of a stable isotopically-labeled internal standard followed by LC-MS/MS. The method was applied to a human postmortem blood sample collected during a forensic autopsy to demonstrate feasibility; results suggest that this method will be useful for forensic toxicological investigations.</p>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"77 ","pages":"102682"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812638","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}
We report a case of a minimally invasive autopsy using postmortem contrast-enhanced computed tomography (PMeCT) by direct large-vessel puncture combined with CT-guided myocardial biopsy as a novel method to determine the cause of death. The case involved a man in his 60 s who was found dead at his residence. Postmortem CT revealed a hematoma around the heart, suggesting the possibility of a post-myocardial infarction cardiac rupture or aortic dissection. PMeCT revealed contrast agent infiltration into the myocardium and leakage into the pericardium, indicating pericardial hematoma, likely due to cardiac rupture. A CT-guided percutaneous biopsy was performed on the area of contrast infiltration, and subacute myocardial infarction was observed 3-7 days after onset. Postmortem CT angiography provides detailed vascular images and is a valuable tool for evaluating pericardial hematomas and cardiac ruptures; however, the cost of the equipment and time constraints have limited its widespread use. To address these challenges, a relatively inexpensive technique called PMeCT by direct large-vessel puncture has been developed. To our knowledge, this is the first practical demonstration of combining PMeCT by direct large-vessel puncture with CT-guided myocardial biopsy in an actual forensic death investigation. This case illustrates how this minimally invasive approach can yield both radiological and histopathological insights, potentially offering a viable alternative in cases where a conventional autopsy is not feasible. As a supplementary report to our previous technical study, this case highlights the real-world applicability and diagnostic value of the technique, especially for identifying cardiac rupture.
{"title":"Diagnosis of cardiac rupture using PMeCT by direct large-vessel puncture and CT-guided biopsy: A case report.","authors":"Shogo Shimbashi, Motoo Yoshimiya, Sakon Noriki, Hideki Hyodoh","doi":"10.1016/j.legalmed.2025.102683","DOIUrl":"10.1016/j.legalmed.2025.102683","url":null,"abstract":"<p><p>We report a case of a minimally invasive autopsy using postmortem contrast-enhanced computed tomography (PMeCT) by direct large-vessel puncture combined with CT-guided myocardial biopsy as a novel method to determine the cause of death. The case involved a man in his 60 s who was found dead at his residence. Postmortem CT revealed a hematoma around the heart, suggesting the possibility of a post-myocardial infarction cardiac rupture or aortic dissection. PMeCT revealed contrast agent infiltration into the myocardium and leakage into the pericardium, indicating pericardial hematoma, likely due to cardiac rupture. A CT-guided percutaneous biopsy was performed on the area of contrast infiltration, and subacute myocardial infarction was observed 3-7 days after onset. Postmortem CT angiography provides detailed vascular images and is a valuable tool for evaluating pericardial hematomas and cardiac ruptures; however, the cost of the equipment and time constraints have limited its widespread use. To address these challenges, a relatively inexpensive technique called PMeCT by direct large-vessel puncture has been developed. To our knowledge, this is the first practical demonstration of combining PMeCT by direct large-vessel puncture with CT-guided myocardial biopsy in an actual forensic death investigation. This case illustrates how this minimally invasive approach can yield both radiological and histopathological insights, potentially offering a viable alternative in cases where a conventional autopsy is not feasible. As a supplementary report to our previous technical study, this case highlights the real-world applicability and diagnostic value of the technique, especially for identifying cardiac rupture.</p>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"77 ","pages":"102683"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812639","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 : 2025-08-30DOI: 10.1016/j.legalmed.2025.102698
Fabio De-Giorgio , Beatrice Benedetti , Matteo Mancino , Andrea Arcangeli , Luigi Carbone
Percutaneous transhepatic biliary drainage (PTBD) is a widely utilized procedure for managing biliary obstructions, particularly in patients with unresectable pancreatic cancer. While generally effective, PTBD carries a risk of complications, including hemobilia, intra-abdominal hemorrhage, catheter-related issues, and, rarely, vascular injuries.
We present the case of a 90-year-old woman with pancreatic cancer who underwent PTBD for biliary obstruction. Shortly after the procedure, she developed hypovolemic shock and succumbed within hours. A forensic autopsy revealed a massive hemoperitoneum (2.5 L) resulting from a rupture of the inferior vena cava (IVC), an exceedingly rare complication of PTBD.
To our knowledge, this is the first reported case of an IVC rupture directly associated with PTBD. This case underscores the critical importance of operator expertise and meticulous technique during PTBD, as well as the need for heightened awareness of potential, albeit rare, vascular complications. It also highlights the role of autopsy in elucidating unexpected causes of death and in assessing procedural outcomes.
{"title":"A rare and fatal injury to the retrohepatic inferior vena cava following percutaneous transhepatic biliary drainage","authors":"Fabio De-Giorgio , Beatrice Benedetti , Matteo Mancino , Andrea Arcangeli , Luigi Carbone","doi":"10.1016/j.legalmed.2025.102698","DOIUrl":"10.1016/j.legalmed.2025.102698","url":null,"abstract":"<div><div>Percutaneous transhepatic biliary drainage (PTBD) is a widely utilized procedure for managing biliary obstructions, particularly in patients with unresectable pancreatic cancer. While generally effective, PTBD carries a risk of complications, including hemobilia, intra-abdominal hemorrhage, catheter-related issues, and, rarely, vascular injuries.</div><div>We present the case of a 90-year-old woman with pancreatic cancer who underwent PTBD for biliary obstruction. Shortly after the procedure, she developed hypovolemic shock and succumbed within hours. A forensic autopsy revealed a massive hemoperitoneum (2.5 L) resulting from a rupture of the inferior vena cava (IVC), an exceedingly rare complication of PTBD.</div><div>To our knowledge, this is the first reported case of an IVC rupture directly associated with PTBD. This case underscores the critical importance of operator expertise and meticulous technique during PTBD, as well as the need for heightened awareness of potential, albeit rare, vascular complications. It also highlights the role of autopsy in elucidating unexpected causes of death and in assessing procedural outcomes.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102698"},"PeriodicalIF":1.4,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921741","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}
Reports on the quantification of fluvoxamine (FLV) in human tissues have been quite limited, although FLV has been used as an antidepressant since 1986. Fluvoxamine acid (FLA) was shown to be the major metabolite of FLV in human urine in 1983, but its quantification is also limited to only three works using human plasma. The existence of desmethyl fluvoxamine (FLD) in human specimens was recently reported in 2025; therefore, its quantification has not yet been performed. Therefore, the present work deals with the quantifications of FLV, FLD and FLA in the human samples of blood, cerebrospinal fluid, pericardial fluid, bile, urine, liver, kidney and cerebrum obtained from a human cadaver; for the quantification, the standard addition method was employed using liquid chromatography–tandem mass spectrometry (LC–MS/MS). The three top concentrations of FLV, FLD and FLA were observed in bile > liver > cerebrum, bile > liver > kidney and bile > kidney > urine, respectively. The three top relative ratios of FLD/FLA were observed in cerebrum > liver > bile, and the lowest ratio was observed in urine, and this may be one of the reasons why the previous work on FLV metabolites using urine in 1983 could not detect FLD. To our knowledge, this is the first report on the validated quantification of the new metabolite FLD by LC–MS/MS in the authentic human body fluids and solid tissues.
{"title":"Quantification of fluvoxamine, desmethyl fluvoxamine and fluvoxamine acid by LC–MS/MS in body fluids and solid tissues obtained from a deceased using the standard addition method","authors":"Hideki Nozawa , Kayoko Minakata , Itaru Yamagishi , Kenta Yuyama , Masako Suzuki , Osamu Suzuki , Takuya Kitamoto , Minako Kondo , Koutaro Hasegawa","doi":"10.1016/j.legalmed.2025.102684","DOIUrl":"10.1016/j.legalmed.2025.102684","url":null,"abstract":"<div><div>Reports on the quantification of fluvoxamine (FLV) in human tissues have been quite limited, although FLV has been used as an antidepressant since 1986. Fluvoxamine acid (FLA) was shown to be the major metabolite of FLV in human urine in 1983, but its quantification is also limited to only three works using human plasma. The existence of desmethyl fluvoxamine (FLD) in human specimens was recently reported in 2025; therefore, its quantification has not yet been performed. Therefore, the present work deals with the quantifications of FLV, FLD and FLA in the human samples of blood, cerebrospinal fluid, pericardial fluid, bile, urine, liver, kidney and cerebrum obtained from a human cadaver; for the quantification, the standard addition method was employed using liquid chromatography–tandem mass spectrometry (LC–MS/MS). The three top concentrations of FLV, FLD and FLA were observed in bile > liver > cerebrum, bile > liver > kidney and bile > kidney > urine, respectively. The three top relative ratios of FLD/FLA were observed in cerebrum > liver > bile, and the lowest ratio was observed in urine, and this may be one of the reasons why the previous work on FLV metabolites using urine in 1983 could not detect FLD. To our knowledge, this is the first report on the validated quantification of the new metabolite FLD by LC–MS/MS in the authentic human body fluids and solid tissues.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102684"},"PeriodicalIF":1.4,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019577","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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