Legal medicine
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An autopsy case of fatal hyperthermia in a state of excited delirium is reported. On a hot summer night a 39-year-old man was suspected of being a rapist, and police officers and several men attempted to arrest him. He vigorously resisted, but after a 20-min struggle he was ultimately forced into a prone position on the ground with his arms and legs restrained by police officers. ⋯ The liver showed diffuse coarse-droplet fatty infiltration of hepatocytes. Neither addictive drugs nor alcohol were detected from the blood or urine. The suspect was concluded to have died of fatal hyperthermia in a state of excited delirium.
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Gunshot injuries detected by post-mortem multislice computed tomography (MSCT): a feasibility study.
Modern cross-sectional imaging techniques are being increasingly implemented in forensic pathology. These methods may serve as an adjuvant to classic forensic autopsies or even replace them altogether in the future. ⋯ The cardinal questions of the location of entrance and exit wounds, the detection of bullets and bullet fragments in the body, the bullet course, inflicted injuries and cause of death were addressed at MSCT and autopsy. The results of the two techniques revealed that post-mortem MSCT can answer these questions reliably and is therefore a useful tool in the assessment of such injuries.
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A motor scooter carrying two 15-year-old boys collided with the back of an open, parked truck. The tailgate of the truck was down and in a horizontal position. At the autopsy of the driver, horizontal tramline bruises were found on the anterior chest, but the thoracic cage was intact. ⋯ Therefore, it was obvious that cardiovascular collapse occurred immediately after the accident. Neither injuries nor diseases that would cause the instantaneous death were found on examination of the whole body. We determined that the driver died of commotio cordis due to blunt force to the anterior chest.
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This report documented three autopsy cases involving fatal shock during intravenous injection of therapeutic and diagnostic agents in a hospital setting. For postmortem diagnosis, clinical laboratory parameters for anaphylaxis, specificity of antibodies for allergens and mast cell numbers in tissue sections were examined. Elevated plasma tryptase levels were evident in the three adult males; two of the three victims displayed elevated IgE levels. ⋯ Double immuno-staining was performed employing anti-tryptase and anti-chymase monoclonal antibodies in order to count mast cells in lung sections. Increased numbers of mast cells were observed in anaphylactic tissues, which was particularly true for chymase-positive cells, in comparison with tissues associated with acute traumatic deaths. In addition to findings at autopsy, positive data obtained by laboratory examinations and immunohistochemical analyses indicated that fatal systemic anaphylaxis occurred during intravenous injection of clinical agents.
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The present study investigated the immunohistochemical distributions and mRNA expressions of myocardial hypoxia-inducible factor (HIF)-1 alpha and its downstream factors, erythropoietin (Epo) and vascular endothelial growth factor (VEGF), in cardiac deaths. Medico-legal autopsy cases (n=114, within 48-h postmortem) of cardiac deaths (n=58) and control cases (n=56) were examined. Immunohistochemical positivities of HIF-1 alpha, Epo and VEGF were patchily observed in cardiomyocytes in the acute ischemic lesions of myocardial infarction (n=37), showing a relationship to morphological cardiomyocyte damage: the staining was intense in the regions with early ischemic changes and weak in the necrotic regions. ⋯ The mRNA expressions were significantly lower in cases of drowning. These findings suggest that focal immunopositivities and increased mRNAs of these factors are indicative of short and substantial duration of myocardial ischemia, respectively. The combined analyses may not only be useful for investigating the site, phase and severity of acute myocardial ischemia and the severity of chronic ischemic stress, but also contribute to differentiating cardiac deaths from asphyxiation and drowning or interpreting the possible contribution of cardiac disease in traumatic death.