Legal medicine
-
Comparative Study
Medicolegal death diagnosis in Tokyo Metropolis, Japan (2010): comparison of the results of death inquests by medical examiners and medical practitioners.
Japanese methods of death inquests are still in developmental stages and many problems have been uncovered since an inspection error was reported in 2007. In this study, we investigated the latest results of medicolegal deaths in the Tokyo Metropolis, which is composed of areas with and without the medical examiner system, and compared the results of inquests performed by official medical examiners with those by medical practitioners to re-evaluate the effectiveness of the medical examiner system for the Japanese death inquiry system. ⋯ The lower autopsy rate and the higher frequency of defects in death certificates in medical practitioner's cases likely led to the differences in the mortality statistics between the two groups. On the other hand, the medical examiner system leaves room for further improvement, such as in the autopsy rate. This study supports the necessity for implementation and improvement of the medical examiner system, and for reinforcement of under/postgraduate medicolegal education in Japan.
-
Traumatic lung herniation through the superior thoracic aperture rarely occurs. In this case report we present a motor vehicle accident of a 40 year old male victim with cervical lung herniation. After an enormous blunt trauma to the chest, the disrupted and lacerated lung tissue left the thoracic cavity and was pushed into the laryngeal and oral cavity. Extrathoracic post-traumatic lung herniation through the thoracic inlet and connective tissue spaces of the neck into the oral cavity is a unique complication of blunt trauma to the chest, and the post-mortem medico-legal investigations may collect more information about this phenomenon.
-
Creatine kinase-MB (CK-MB), cardiac troponin I (cTnI) and myoglobin (Mb) are biochemical markers of myocardial injury; however, Mb is more abundant in skeletal muscles. The present study involved analysis of these markers in pericardial and cerebrospinal fluids (PCF and CSF) from serial medicolegal autopsy cases (n=295, within 48h) to examine their efficacy in determining the cause of death. Although these markers showed a slight postmortem time-dependent elevation, except for CK-MB in CSF, the distribution depended on the cause of death. ⋯ PCF cTnI level was higher in acute pulmonary embolism without significant elevation of any other markers, whereas CSF CK-MB was higher in acute blunt brain injury death and methamphetamine abuse. In most cases of delayed brain injury death, hypothermia (cold exposure) and pneumonia, these markers were low or intermediate in both PCF and CSF; however, sudden cardiac death, asphyxiation and fire fatality cases showed few characteristic findings. These observations suggest that combined analyses of these markers in postmortem PCF and CSF, in addition to blood samples, are helpful for evaluating the severity of myocardial and/or skeletal muscle damage in death processes, in particular for investigating deaths due to hyperthermia, hypothermia, electrocution and intoxication.
-
Buckle rib fractures are incomplete fractures involving the inner cortex alone, and are rarely detected on routine chest X-ray or at autopsy. The characteristics of these fractures have not been well evaluated in situ although they are commonly observed on postmortem CT images especially following CPR. The postmortem CT findings in 42 cases showing buckle rib fractures caused by CPR were reviewed. ⋯ Over 97% of all CPR associated rib fractures are located in the anterior one third of the ribs based on a new measurement method utilizing oblique axial multiplanar reconstruction of the CT data. When recognition of incomplete or buckle rib fractures on postmortem CT is taken into account, detection of symmetry and continuity of rib fractures typically associated with CPR is improved compared with the detection of complete fractures alone. Recognition of buckle rib fractures and their characteristics on postmortem CT is of benefit to the forensic pathologist in evaluating the possibility of CPR and the differentiation of resuscitative artifact from forensically significant visceral injury observed at autopsy.
-
To investigate the occurrence of intravascular gas in the liver, kidneys, spleen, and pancreas by postmortem computed tomography (PMCT) in cases of non-traumatic in-hospital deaths and elucidate the relationship between the PMCT data and clinical information or autopsy results. ⋯ The present study was the first statistical analysis of intravascular gas in the liver, kidneys, spleen, and pancreas by using PMCT in non-traumatic in-hospital death cases. The results showed that PMCT in the presence and absence of CPR reveals differences in intraorgan gas distribution. In addition, the detection of intraorgan gas on PMCT cannot be used to predict time elapsed since death, and it is not affected by the administration of antibiotics, a history of bacteremia, and cause of death. Awareness of these postmortem changes is important for the accurate interpretation of PMCT results.