Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.
Agrochemicals ; Alcoholism ; Autopsy ; Cardiovascular Diseases ; Cause of Death ; Korea ; Liver Diseases

BACKGROUND: It is well known that a lacunar infarction has characteristic clinical features and a relatively good prognosis. However, the significance of lesions in the parent artery of patients with lacunar syndrome as regard to the prognosis remains unsettled. METHODS: Using the data of consecutive patients with their first ischemic stroke and were followed longer than 1 year, were divided the patients by their clinical features and the results of the work-up was as follows; (1) mismatching [MM] group; lacunar syndrome and the presence of parent arterial lesion, (2) large artery artherosclerosis [LAD]; non-lacunar syndrome and the presence of parent arterial lesion, (3) no determined etiology [NE]; non-lacunar syndrome without parent arterial lesion, and (4) small artery disease [SAD]; lacunar syndrome without parent arterial lesion. Patients with a potential source of embolism were excluded from this study. The prognosis and recurrence rate of patients with the MM group were compared with those of other groups. RESULTS: A total of 176 patients were included; 56 LAD, 62 SAD, 22 MM and 36 NE groups. An unstable hospital course was more frequently found in LAD than in the other groups. The recurrence rate of the MM group (23%) was significantly higher than that of SAD (2%), but was similar to that of patients with non-lacunar syndrome (LAD 16%, NE 28%). CONCLUSIONS: Among patients with lacunar syndrome, the prognosis of those with parent arterial lesions was different from those without lesions. Therefore, a systematic work up of the stroke mechanism may be important in patients with lacunar syndrome.
Arteries ; Embolism ; Humans ; Parents* ; Prognosis ; Recurrence ; Stroke ; Stroke, Lacunar*

Suicidal smothering is distinctly uncommon, especially when caused by winding strips of adhesive tape around the head to cover the nose and mouth. The authors report a very unusual case in which the deceased, a 43-year-old woman, was found with gray adhesive tape wrapped 8 times around the head and strictly obstructed nose and mouse and 2 times around neck. Clear distinction between the homicidal and suicidal smothering by means of multiple loops of adhesive tape is often impossible on the basis of the anatomical findings alone. An accurate evaluation of circumstances, a thorough post-mortem examination, inspection of the scene are extremely important in such cases. We reports a case of suicidal smothering by means of multiple loops of adhesive tape with brief review of literature.
Adhesives* ; Adult ; Animals ; Autopsy ; Female ; Head ; Humans ; Mice ; Mouth ; Neck ; Nose ; Suicide ; Wind

Carbon monoxide poisoning is probably one of the most common toxic condition to be met with the routine forensic practice. Carbon monoxide is colorless, odorless, tasteless, non-irritating gas whose relative density is a little less than that of air. The most common source of carbon monoxide in death are fires, automobile exhaust, defected heaters, and incomplete combustion of burning products, such as charcoal briquets. Suicidal deaths caused by carbon monoxide are mostly involve inhalation of automobile exhaust and rarely incomplete combustion of charcoal briquets. We recently experienced three cases of suicidal carbon monoxide death by using the carbon monoxide produced by incomplete combustion of charcoal briquets. These deaths were subsequently occurred after forensic medical expert's announcement of accidental carbon monoxide death occurred at shellfish grill restaurant through the television. And we presents four cases of carbon monoxide death with considering of the social effects of forensic medical expert's announcement through the mass media.
Burns ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Charcoal* ; Fires ; Inhalation ; Mass Media* ; Public Health* ; Restaurants ; Shellfish ; Specific Gravity ; Suicide ; Television ; Vehicle Emissions

No abstract available.
Appointments and Schedules* ; Hepatitis B Vaccines* ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Infant, Newborn* ; Vaccination*

Hypopharyngeal perforation associated with traffic accident is a rare occurrence, which can cause serious morbidity and mortality if not diagnosed and treated early. We report an autopsy case of hypopharyngeal perforation following a traffic accident. A 32-year-old man hits his chin when his car hits highway guardrail. He complained continuous neck pain and died 5 days after the accident. Autopsy was performed, and death was due to undiagnosed retropharyngeal abscess with sepsis.
Accidents, Traffic ; Adult ; Autopsy ; Chin ; Humans ; Hypopharynx ; Neck Pain ; Retropharyngeal Abscess ; Sepsis

The incidence of sudden death due to undiagnosed primary intracranial tumor is very low in forensic autopsy practice. The ganglioglioma is a well differentiated, slow growing primary brain tumor that is encountered predominantly in childhood. We report a sudden, unexpected death in a 6-year-old girl from a ganglioglioma. On autopsy, there was an intraventricular tumor with recent hemorrhage, occupying the anterior aspect of the lateral ventricle and resulting in hydrocephalus. Acute intratumoral hemorrhage appears to be the mechanism of sudden death.
Autopsy ; Brain Neoplasms ; Child ; Death, Sudden ; Ganglioglioma ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Lateral Ventricles

BACKGROUND: Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome, which typically occurs after large perisylvian lesions involving both the Broca's and Wernicke's areas. This study localized the lesions and examined the pathogenic mechanism in Korean patients with GAWH. METHODS: Twelve patients were diagnosed with aphasia using the Western Aphasia Battery. To identify decreased perfusion, which might be functionally relevant to aphasia but not detected by diffusion weighted imaging (DWI), single photon emission tomography (SPECT) was performed in six patients. To uncover the possible pathogenic mechanisms of ischemic stroke, vascular and cardiologic work-ups were performed in all of the patients. RESULTS: The lesions seen on DWI varied, and included: both inferior frontal and superior temporal (four), isolated inferior frontal (four), superior temporal (one), subcortical (two), and even parieto-occipital (one) lesions. Brain SPECT did not reveal any extensive lesions of the peri-sylvian area outside the DWI lesion in any of the patients, except in one patient with subcortical lesions. CONCLUSIONS: Our results indicate that a single lesion of the left inferior frontal area, or a superior temporal lesion in different locations may produce GAWH, and the lesion profile and stroke mechanism in GAWH are heterogeneous, suggesting that lesions to an area of complex functional anatomy result in aphasia.
Aphasia* ; Brain ; Diffusion ; Humans ; Paresis* ; Perfusion ; Stroke ; Tomography, Emission-Computed, Single-Photon

Spontaneous coronary artery dissection (SCAD) is a rare disease that occurs most commonly in young people, especially in peripartum or postpartum women without traditional risk factors for coronary artery disease. We describe the case of a 30-year-old woman who suddenly died approximately 2 weeks postpartum period. She was otherwise healthy with no cardiac risk factors. On autopsy, the coronary artery showed 4cm long segment of dissection, starting from the left main artery to anterior descending branch. Microscopic finding of the dissection revealed a tear between tunica media and adventitia, creating an intramural hematoma. The left ventricle showed multifocal areas of acute myocardial infarction with reperfusion injury. SCAD should be considered in the differential diagnosis of any young person sustaining an acute myocardial infarction, especially women in the postpartum state.
Adult ; Adventitia ; Arteries ; Autopsy ; Coronary Artery Disease ; Coronary Vessels* ; Death, Sudden* ; Diagnosis, Differential ; Female ; Heart Ventricles ; Hematoma ; Humans ; Myocardial Infarction ; Peripartum Period ; Postpartum Period* ; Rare Diseases ; Reperfusion Injury ; Risk Factors ; Tunica Media

The optimum timing of surgery for ruptured intracranial aneurysms still remains controversial. In order to compare the total management outcome between early and late surgery a retrospective analysis was carried out. Of 159 patients, 97 patients were selected according to the entry criteria and were divided into two groups ; group I(46pts.) was early surgery planned patients and group II(51 pts.) was late surgery planned patients. The results obtained are as follows ; 1) The incidence of a good recovery for the early surgery planned group was 74%, and that of the late surgery planned group was 67%, but there was no statistically significant difference between two groups. 2) The incidence of a delayed ischemic deficit was 24% for the early surgery planned group, and 29% for the late surgery planned group, with no statistically significant difference. But, the incidence of rebleeding was 2% for the early surgery group, and 14% for the late surgery planned group, so there was a statistically significant difference here. 3) The total management outcome of the early and late surgery planned group was similar, but early surgery was advantageous for the prevention of rebleeding.
Aneurysm, Ruptured ; Humans ; Incidence ; Intracranial Aneurysm* ; Retrospective Studies ; Subarachnoid Hemorrhage