Forensic Medical Autopsy Research Articles

Morphology of the mural and commissural atrioventricular junction of the mitral valve

ObjectiveThis study investigates mitral annular disjunctions (MAD) in the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures.MethodsWe examined 224 adult human hearts (21.9% females, 47.9±17.6 years)...

Prediction of criminal profiles based on forensic medical investigations in Banda Aceh, Indonesia

Background: Criminal profiles are also often referred to as psychological profiles or engagement profiles. Profile means a description the term profile to be discussed when discussing techniques and determining the possible characteristics of the debate about the results of research on crime itself. The following paper aims to present the case in predicting criminal profiles in Banda Aceh Indonesia based on forensic medical investigations. Case presentation: The victim is a male 16-year-old which is conducted a forensic medical examination. The result of forensic medical autopsy findings is the destruction of face-forming bones and skull fractures in the victim. According to the autopsy finding, the doctor concluded that the violence was carried out by someone who is powerful. The doctor states that the alleged criminal's profile consists of someone close to the victim, someone likely to be male, and someone who engaged in violence by using blunt objects. The police investigator is an Indonesian National Police in Banda Aceh district who has done the interview. The discussion with police investigators was conducted to predict the alleged perpetrator's profile. Based on the doctor's statement, the police conducted an investigation looking for the suspect, and the doctor's prediction was correct about the criminal profile of the perpetrator. During the trial, the panel of judges stated that the perpetrators used blunt objects to attack the victim. Conclusion: There is an association between the results of forensic medical examination, police investigations and facts at the trial in predicting the profiles of criminals.

Usefulness of computed tomography performed after forensic autopsy in the diagnosis of the battered child syndrome: a case report

Diagnostic imaging methods routinely used in clinical practice (mainly multi-slice computed tomography, CT) are increasingly entering forensic practice, also in Poland. Typically these exams are performed prior to an appropriate external examination and autopsy. The aim of the study is to present a case in which computed tomography examination performed only after forensic medical autopsy turned out to be useful in the diagnosis of an abused child syndrome. The CT examination showed, inter alia, nighstick injury/fracture of the ulna in its distal part, and deformation of the base of the phalanx of the distal finger of the fourth left hand, corresponding to a fracture/crush. Post-mortem imaging may be useful in the case of a suspected abused child syndrome.

THE FORENSIC SIGNIFICANCE OF THE BURN INJURY CRITERIA

In the modern world there is a constant increase in the number of fires in residential and industrial premises, transport, which leads to injuries and often fatalities [4,15]. According to data of the summary reports on activity of territorial bureaus of forensic-medical examination of the Russian Federation at fires from thermal traumas and carbon monoxide poisoning 15 918 persons were lost in 2000 and 16 416 - in 2008. It makes about 3 % from all forensic medical autopsies [5]. A similar situation is typical for the Republic of Tajikistan [11]. By now, the causes, pathogenesis, pathomorphosis [6, 12], clinical and morphological features [1, 10], epidemiology of thermal injuries [5], combined effects of thermal and carbon monoxide [7, 9], injuries caused by mechanical effects of falling parts of a burning building and various objects [14] have been studied in sufficient detail.

The Importance of Histological Examination in Forensic Medical Practice

Background: Histopathological examination plays a significant role in the precise determination of the cause ofdeath. Death scene investigation, full medical history of the patient, thoroughly performed macroscopic explorationof the bodyand its internal organs, supported by the results from a microscopic histological examination of thetissues, determine the forensic medical autopsy standards. These, as well as the skills and the experience of theforensic medical expert, guarantee an accurate forensic medical diagnosis for the medico-legal needs.Methods: In order to sustain our preposition, we present a case from our practice. A man died during a hospitaltreatment for anemia and an autopsy, requested by the relatives, was performed. It was concluded that the causeof death was a hypostatic pneumonia. During the autopsy a histological material was taken but no examinationwas made. Months later, following a prosecutor’s order a histological examination was performed and evidencefor a disseminated intravascular coagulation was found.Conclusion: This is one of many cases in which there is a difference between the macroscopic and the histologicaldiagnosis. Histopathological examination of the internal organs for the purpose of providing a medical cause ofdeath is essential for the forensic practice and it should be undertaken whenever there is a doubt in the macroscopicdiagnosis.

ACTUALIZACIÓN DEL DICTAMEN DE AUTOPSIA MÉDICO-FORENSE EN LA MORGUE JUDICIAL LA PAZ BOLIVIA

Listing clearly the basic components of an autopsy, in the form of a checklist, will enable technical procedures to adequately address forensic medical autopsy findings in those cases where the cause of death is under study or is unclear, in situations such as a traffic accident, falls, or other traumas of various or non-specific origins. In this sense, the present investigation focus on forensic autopsy reports, based on a comparison between the current forensic medical reports carried out in La Paz-Bolivia and the forensic medical reports used internationally such as the Minnesota Protocol and the Medical Autopsy Protocol of Veracruz-Mexico. Using a qualitative approach with a descriptive investigation and a documental research methodology, we proceeded to collect reports from the judicial morgue of La Paz-Bolivia and the Forensic Investigation Service of Veracruz -Mexico. Based on this documentation, a bibliographic-analytical matrix was elaborated, from which the authors concluded that the main deficiency of the judicial morgue of La Paz-Bolivia is that it does not have a standardized Protocol to carry out the forensic medical autopsy reports. Therefore, an update of the forensic autopsy report was proposed along with a forensic medical autopsy protocol that serves as a reference to improve the professional service and therefore of the entire judicial morgue of La Paz-Bolivia in terms of clarification of a death. Keywords: Report, Update, Forensic Medical Autopsy, Protocol.

Hepatic cirrhosis according to the forensic medical autopsy data from Moscow for the period of 2007-2016

Study purpose is to demonstrate the dynamics of mortality due to hepatic cirrhosis according to forensic medical autopsy data over the period from 2007 to 2016. Material and methods ― 268,139 protocols of forensic autopsies were studied to identify the number of deaths by hepatic cirrhosis over ten years between 2012 and 2016 and to determine the number of cases of liver failure associated with cirrhosis. To clarify the dynamics of mortality due to hepatic cirrhosis, a comparative analysis of two chronologically consecutive five-year periods, 2007-2011 and 2012-2016, has been conducted. The age of deceased by hepatic cirrhosis was studied. The number of cases with a histologically verified form of hepatic cirrhosis was specified. The average values and the percentage ratio of the number of examinations performed to the total number of all autopsies for non-violent death cases were calculated. Results ― Over ten years of study, death by hepatic cirrhosis was diagnosed 3,092 times, including 749 times with histologically confirmed liver failure. In 2009, there was an abrupt increase in mortality due to hepatic cirrhosis by the factor of 3.8, and the lowest mortality level was found in 2016. When comparing the mentioned two quinquennia, the first of them, 2007-2011, was characterized by an increase in the number of diagnosed hepatic cirrhosis. During the second one, 2012-2016, on the contrary, the dynamics of a decrease in the number of hepatic cirrhosis was revealed. At the average, the annual decrease in the number of hepatic cirrhosis diagnosed during the forensic medical examinations of corpses was 7.7%. The number of established cases of liver failure during the first five-year period compared with the data on the second one was significantly greater. In 2010, there were 109 such cases, in 2016 only 13. Among the histologically verified diagnoses, micronodular and mixed forms of hepatic cirrhosis prevailed. Most of the cases of hepatic cirrhosis were found in men aged within 31-40. Conclusion ― It has been found that over the past five years there has been a shift in the forensic-medical mortality values due to hepatic cirrhosis from the increasing trend to the decreasing one. If within the period of 2007-2011 an increase in diagnosed hepatic cirrhosis was observed, then during 2012-2016 a pronounced decreasing tendency in the number of such diagnoses was disclosed. During that time the number of histologically verified cases of hepatic failure decreased by 43.0%. As a cause of death, hepatic cirrhosis was more often recorded in men aged within 30–40.

Forensic medical assessment of morphological changes in the myocardium, affecting its contractile capacity in cases of death from alcoholic cardiomyopathy

A retrospective analysis of acts of forensic medical autopsies from the archive of BSME and a histological study of myocardial tissue in 180 cases (87 women and 93 men) were carried out with statistical processing of the obtained results for the purpose of studying and assessing the morphological changes in the main components of the histohematological barrier of myocardium, affecting the contractility of the cardiac muscle in cases of the death from alcoholic cardiomyopathy. As a result of the study, it was found that the occurrence of metabolic disturbances due to the toxic effects of ethanol and its metabolites contribute to the development of hypoxia of the heart muscle with the development of dystrophic and irreversible necrobiotic processes in it, which in its turn play a direct role in the formation of excitability processes, contractile function of myofibrils with the development of fatal rhythm disorders. The morphological changes in the contractile apparatus of the myocardium were discovered in the study in polarized light and can be used to diagnose alcohol damage to the heart. During the study of deaths from alcoholic cardiomyopathy in forensic medicine, it is recommended to use methods of polarization microscopy.

The significance of student competitions for the development of motivation for education and the acquisition of professional competences in the students the Department of Forensic Medical Expertise of the Sechenovsky University

Russia joined the Bologna process in 2003 and since that time has become integrated into the unified European educational space. The key element of the new form of the higher education process is the self-guided unsupervised work of the students. Motivation is needed to promote the involvement of the students in the educational process which implies the necessity of the goal-oriented initiative for the acquisition of professional knowledge and practical experience in the field of forensic medicine. To achieve this goal, the Department of Forensic Medicine of I.M. Sechenov First Moscow State Medical University places special emphasis on the experience with carrying out student competitions. Each such competition consists of several contests focused on the solution of a specific problem, e.g. the inspection of the place of occurrence under investigation with a gunshot or punctured-and-incised wound, forensic medical autopsy, problem studies, and intelligence tests. All the contests and problem studies are held in the form of an interactive game. The experience gained in the course of the student competitions gives practical evidence that the interdepartmental intelligence contests contribute to raising the interest of students in forensic medicine. The open competition provides a highly efficient tool for the popularization of scientific knowledge and the promotion of interest in the participation in the forensic medical research activities. Moreover, the student competitions facilitate formation of the earlier professional skills indispensable for team working and the development of abilities for making decisions under the extreme conditions. In addition, the contests teach the participants the art of public appearance. They improve the quality of vocational training in forensic medicine and help to establish the first professional contacts at the interinstitutional (including international) level.

The HIV-associated diseases encountered in the practice of forensic medical autopsies

The present article deals with the problems pertaining to the forensic medical diagnostics of the HIV-associated pathological conditions taking into consideration the materials available from the Moscow City Centre for AIDS Prophylaxis and Control with special reference to the number and structure of the diagnosed HIV-associated diseases. We undertook the analysis of co-morbid HIV/AIDS causes of violent and sudden deaths documented at the Bureau of Forensic Medical Expertise of the Moscow Health Department during the period from 2013 till 2016. The study revealed the tendency toward a rise in the number of deaths from the HIV-associated infections including tuberculosis, pneumonias, chronic immunodeficiency conditions refractory to the treatment, and from malignant neoplasms. A peculiar feature of the aforementioned period was the increased age of the deceased subjects. In the cases of violent deaths, the HIV-associated conditions were diagnosed as the concomitant diseases, with the markedly predominant ones being acute drug and alcohol intoxication, injures, and attempts at suicide. The available results of the studies give evidence of the necessity and importance of the cooperative work of the specialists for the further improvement of forensic medical diagnostics and monitoring of HIV-associated conditions.

Czy występowanie okrzemek w organach wewnętrznych zawsze świadczy o utonięciu?

Diatoms (Bacillariophyta) are unicellular algae inhabiting in aquatic ecosystems and marsh habitats on the entire Earth. This group of algae, variable in terms of species, comprises both cosmopolitan ones but also those whose occurrence is limited to specific environmental conditions, i.e. stenotopic species. Diatoms are distinguished by unique cell walls making so-called, frustules, whose structures constitute the bases for differentiation between species. Frustules are resistant to the majority of environmental conditions that destroy other algae. Due to the above characteristics diatoms have been incorporated in forensic investigations and they can be the conclusive component of the proceedings by indicating drowning as the cause of death. In those cases, it is important to answer the question whether finding diatoms in internal organs of corpses found in water always proves drowning. The publication uses reports from forensic medical examinations of corpses and reports from detecting presence of diatoms in internal organs performed in years 2013-2017 in the Institute of Forensic Medicine of Warsaw Medical University, which is presently the only centre in Poland that routinely performs the diatom test. It has been demonstrated that a positive result of the diatom test generally coincides with the conclusive indications of the cause of death in the forensic medical autopsy reports. Only in few individual well-explainable cases the results of the diatom tests did not confirm conclusions from the forensic autopsies, which excluded drowning as the cause of death.

Morphological characteristic and assessment of changesin the main structural components of the histohematological barrier of the thyroid tissue in cases of the sudden cardiac death from alcoholic cardiomyopathy

A retrospective analysis of acts of forensic medical autopsies from the archive of St. Petersburg GBUS BSME and a histological study of thyroid gland tissue in 188 cases (95 women and 93 men) were carried out with statistical processing of the obtained results for the purpose of studying and assessing the morphological changes in the main components of the histohematological barrier of thyroid gland tissue in cases of the sudden cardiac death from alcoholic cardiomyopathy. The decrease in the weight of the thyroid gland in the investigated cases and the revealed morphological signs, indicative of a decrease in the memory function of the thyroid gland were found and can be caused by the prolonged toxic effect of ethanol and its metabolites. Morphological changes in the endothelial lining of the vessels of the microcirculatory bed are caused both by the direct cytotoxic action of ethanol and its metabolites and by the action of mediators, the release of which occurs as a result of stimulation of the reactive cells, which leads to swelling, deformation and increased activity of endothelial cell membranes with the expansion of intercellular spaces and the development of increased permeability of the endothelial lining, which, in its turn, contributes to disruption of electrolyte transport and nutrients transport with changes trophism thyroid gland tissue, which is a substrate for the appearance of dystrophic and necrobiotic processes in main structural components of the histogematogenous barrier of the thyroid gland. The revealed morphological changes in thyroid gland tissue in cases of death from alcoholic cardiomyopathy have a non-specific nature and should be considered in conjunction with other visceral manifestations that are a reflection of alcohol intoxication during the chronic alcoholism.

The forensic medical evaluation of the changes in the cerebral tissue in the case of sudden death from alcoholic cardiomyopathy

This article presents the results of the retrospective analysis of the protocols of forensic medical autopsies and histological studies of the cerebral tissues together with the data obtained by their statistical treatment. The objective of present work was to study and evaluate the structural changes in the cerebral tissues associated with sudden cardiac death from alcoholic cardiomyopathy. It was shown that the morphological changes in the endothelial lining of the microcirculatory bed of the cerebral tissue can be a consequence of both the direct cytotoxic action of ethanol or its metabolites and the influence of cellular modulators liberation of which results in enhanced vascular permeability associated with trophic disturbances in the tissue. These changes provide a substrate for the development of the dystrophic and necrobiotic processes in the main structural components of the organ in question. The clustering of glial cells around atrophic neutrons or instead of the dead ones in the brain as well as around the microcysts of the cerebral tissue as a compensatory response to the lesion can be in its turn considered as a pathognomonic sign of chronic alcoholic intoxication. The severe dystrophic and destructive processes proceeding in the main components of the histohematological barrier revealed in the cerebral tissue as a result of the present analysis are believed to reflect the toxic action of ethanol and/or its metabolites that play an important role in the development of dyscirculatory disorders responsibly for cerebral tissue hypoxia.

Radio-visualization of non-specific postmortem changes in the cardiovascular system

This paper presents a review of the literature concerning radio-visualization of non-specific postmortem changes in the cardiovascular system during computed tomography and magnetic resonance imaging. The peculiar radiological characteristics of postmortem blood clots and cadaveric hypostases in the internal organs are described. It is emphasized that postmortem CT and MRI can not replace the pathological anatomical studies and forensic medical autopsy. Roentgenologists engaged in the postmortem examination of the bodies must have relevant knowledge of pathological anatomy and forensic medicine (namely, they must be aware of the non-specific postmortem changes) to be able to adequately interpret the tomograms obtained and correctly establish the diagnosis. It is recommended that the postmortem CT and MRI images should be used as an additional material for the traditional autopsy, e.g. as a preliminary 'guide' preceding the postmortem examination.

Forensic medical characteristic of the causes behind sudden death in the young subjects

The objective of the present study was to analyze the causes of sudden death in the general population and in the fraction of the young subjects (below 39 years of age). The results of the original retrospective study were obtained in the course of forensic medical autopsies of the subjects aged below 39 years that had been carried out during a period of 10 years. It was shown that one of the causes behind sudden death among the young subjects is cardiovascular disorders associated with the pre-existing pathological condition in the form of connective tissue dysplasia. The principal mechanism underlying sudden death among the young subjects has an arrhythmogenic nature. The development of terminal symptoms is promoted by a number of provocative factors including sporting activities, physical loading, psychoemotional stress, and alcohol consumption.

The morphological changes in the myocardial tissue after sudden cardiac death from alcoholic cardiomyopathy

This paper was designed to report the results of the retrospective analysis of the protocols of 180 forensic medical autopsy sections stored in the archives of Sankt-Petersburg Bureau of Forensic Medical Expertise and the data of the histological studies of myocardial tissues obtained after sudden cardiac death from alcoholic cardiomyopathy. The study revealed the following most pathognomonic histological criteria for alcoholic heart lesions: the alternation of hypertrophic and atrophic cardiomyocytes in the state of severe parenchymatous degeneration, pronounced mesenchymal fatty dystrophy in combination with pathological changes of the vascular walls (vascular wall plasmatization), sub-endothelial accumulation of the PAS-positive tissue compounds, microcirculatory disorders in the form of erythrocyte stasis with the manifestations of the blood "sludge" phenomenon, and precapillary fibrosis. The signs of severe parenchymatous and stromal vascular dystrophy of the myocardial histohematic barrier (HHB) are supposed to reflect the toxic effects of ethanol and its metabolites that are directly involved in the mechanisms underlying the disturbances of intracellular metabolism and dyscirculatory events leading to the development of heart muscle hypoxia.

Shame and Gender Differences in Paths to Youth Suicide: Parents' Perspective.

Risk factors, suicidal behavior, and help-seeking patterns differ between young women and men. We constructed a generic conceptual model of the processes underlying youth suicide, grounded in 78 interviews with parents in 52 consecutive cases of suicide (19 women, 33 men) identified at forensic medical autopsy and compared by sex. We found different forms of shame hidden behind gender-specific masks, as well as gender differences in their paths to suicide. Several interacting factors formed negative feedback loops. Finding no way out, the young persons looked for an "emergency exit." Signs and preparations could be observed at different times but recognized only in retrospect. Typically, the young persons and their parents asked for professional help but did not receive the help they needed. We discuss parents' experiences from the theoretical perspective on gender identity and developmental breakdown. Giving voice to the parents' tacit knowledge can contribute to better prevention and treatment.

Telocytes in human coronary arteries – scanning electron microscope study

Introduction: A telocyte is a novel type of interstitial cell in the stromal connective tissue of many animals and human organs. Morphologically, telocytes are composed of small cell bodies with telopodes – very long prolongations of uneven calibre. The existence of telopodes and the 3D network indicates that telocytes may function in intercellular communication and regulation. The presence of telocytes has been identified in human heart valves, atria, ventricles, but not yet in human coronary arteries. The pro-angiogenesis behaviour of telocytes and their close spatial relationships with newly formed blood vessels was outlined within the border zone of myocardial infarction. Objectives: To show visual evidence of the presence of telocytes within human coronary arteries. Materials and methods: Human coronary arteries were collected during routine forensic medical autopsies from people who did not have cardiovascular pathologies. The endothelial surface of human coronary arteries was examined and the images were captured using a scanning electron microscope. The study was approved by the Bioethical Committee of the Jagiellonian University Medical College. Results: Telocytes were present on the endothelial surface of human coronary arteries and had one to six long telopodes emerging from the small cell body (varying in shape depending on the number of telopodes). Telocytes seem to be adherent to the endothelial surface. They appear either singular or in groups and their density differs by region. Contacts between telopodes of two distinct adjacent telocytes were observed. Conclusions: We provide visual evidence for the presence of telocytes on the endothelial surface in human coronary arteries. It remains to be determined how telocytes support the ability of arteries to re-establish normal structure and function following injury and its impact on the regeneration of infarcted myocardium. Acknowledgements: Dr WieslawaKlimek-Piotrowska MD, PhD, for supervising this project.

The occurrence of acute subdural haematoma and diffuse axonal injury as two typical acceleration injuries

Closed head injuries have already been classified into contact injuries and acceleration–deceleration injuries. Two typical acceleration–deceleration injuries and at the same time, the two worst head injuries are acute subdural haematoma (ASDH) and diffuse axonal injury (DAI), and that is where they got their medico-legal importance. Using experiments, it has been shown that acceleration with an impact time of more than 20–25 min (which occurs in traffic accidents in real life) causes DAI, whereas an impact time of 5–10 min is more likely to produce acute subdural haematoma. The aim of this research is to show that not all, but some types of traffic accidents are more typical for the occurrence of DAI, as well as that the ASDH is not a common feature for all types of fall. The analysis conveyed covered 80 cases of closed head injuries (traffic accidents, falls and assaults) where a complete forensic medical autopsy has been undertaken, followed by a complete forensic–neuropathological examination. For the purpose of diagnosing DAI, immunohistochemistry using antibody against β-amyloid precursor protein has been involved. Results show that ASDH is more likely to occur in cases of simple fall, assaults and cyclists and DAI is more typical for vehicular traffic accidents and cases of falling from a considerable height. The paper also comprises discussion about some open questions regarding the diagnosis of DAI in the medico-legal practice.

Interrelationship between the concentrations of some elements in the organs of Japanese with special reference to selenium-heavy metal relationships

Multi-element analyses were conducted on internal organs (cerebrum, cerebellum, heart, spleen, liver and kidney) of Japanese obtained from 45 forensic medical autopsy cadavers. Elements analyzed and analytical methods were as follows: Ca, Cd, Cu, Fe, K, Mg, Na, P and Zn by inductively coupled plasma atomic emission spectrometry; total Hg (T-Hg) and inorganic Hg (I-Hg) by cold vapour atomic absorption spectrometry; methyl Hg (MeHg) by gas chromatography; and Se by fluorometry. A significantly positive correlation between Se and T-Hg was observed in kidney, liver, heart and spleen. The T-Hg/Se molar ratio was < 1 in all the organs examined. The correlation between Zn and Cd was significant in liver and kidney. Multiple regression analyses using Se as a dependent and I-Hg, MeHg, Zn, Cd, Cu as independent variables were conducted on each organ. Inorganic Hg was a significant independent variable in kidney, whereas in liver and spleen it was MeHg. Cadmium was significant in explaining the variations in Se in liver and kidney medulla, indicating CdSe co-accumulation in humans.