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Death due to Cardiac Metastasis after Treatment of Oral Squamous Cell Carcinoma: An Autopsy Case.

Hyoung Joong KIM ; Seok Hoon JEON ; Joong Seok SEO

Korean Journal of Legal Medicine.2012;36(1):115-118. doi:10.7580/KoreanJLegMed.2012.36.1.115

A 60-year-old man presented with electrocardiographic abnormalities after treatment for oral squamous cell carcinoma with surgical resection and radiation therapy 7 months ago. The patient died within 2 h without response to CPR after sudden arrest. Electrocardiographic changes 9 h before death included low QRS voltage and sinus tachycardia. Autopsy revealed cardiac metastasis with chronic active fibrinoid pericarditis accompanied by tumor cell infiltration. Although the frequency of cardiac metastasis in patients with oral cancer is reportedly low, clinicians should be aware that cardiac metastasis may exist if there are electrocardiographic changes in patients receiving follow-up care for primary malignancy. We report a rare medicolegal case of cardiac metastasis-related sudden death.
Autopsy ; Carcinoma, Squamous Cell ; Cardiopulmonary Resuscitation ; Death, Sudden ; Electrocardiography ; Follow-Up Studies ; Humans ; Middle Aged ; Mouth Neoplasms ; Neoplasm Metastasis ; Pericarditis ; Tachycardia, Sinus

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Fatal Rectal Bleeding after Prostate Biopsy.

Min Jung KIM ; Jae Hong PARK ; Byung Ha CHOI ; Nak Eun CHUNG

Korean Journal of Legal Medicine.2012;36(1):111-114. doi:10.7580/KoreanJLegMed.2012.36.1.111

Transrectal ultrasound (TRUS)-guided biopsy of the prostate is a common outpatient procedure for diagnosing prostatic cancer. It is a relatively noninvasive, safe, and effective method, as the majority of post-biopsy complications are mild and self-limiting. Fatal complications including infection or massive hemorrhage are rare, but can be life threatening. We herein present an autopsy case of fatal rectal bleeding after prostate biopsy and an analysis of similar cases.
Autopsy ; Biopsy ; Hemorrhage ; Humans ; Outpatients ; Prostate ; Prostatic Neoplasms

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Hemoperitoneum Resulting From Injuries to Liver with a Benign Vascular Tumor During Acupuncture: A Case Report.

Sohyung PARK ; Han Young LEE

Korean Journal of Legal Medicine.2012;36(1):107-110. doi:10.7580/KoreanJLegMed.2012.36.1.107

Various complications following acupuncture have been reported. In most cases, complications occur from the close apposition of vital organs and acupuncture sites. These complications can be avoided if acupuncturists are trained in appropriate medical science such as anatomy. However, our case is somewhat different from the norm. The deceased received acupuncture on the abdomen, provided by an acupuncturist. Unexpected symptoms occurred suddenly and she was transported to a hospital where she died of hemoperitoneum. On the postmortem examination, a well-defined vascular tumor was identified on the front of the liver, which was also cirrhotic; a few localized injuries were identified on the cystic wall of the tumor and surrounding liver parenchyma. We assumed these injuries were complications of acupuncture. Therefore, we present this case to suggest that acupuncturists should be educated to be vigilant for complications following treatment to reduce the risk of these tragedies.
Abdomen ; Acupuncture ; Autopsy ; Hemoperitoneum ; Liver

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Hemorrhagic Infarction of the Small Intestine due to Transmesenteric Hernia in an Adolescent: A Case Report.

Minsung CHOI ; Jong Hyeok PARK ; Seok Hoon JEON ; Han Young LEE ; Joong Seok SEO ; Hyoung Joong KIM

Korean Journal of Legal Medicine.2012;36(1):102-106. doi:10.7580/KoreanJLegMed.2012.36.1.102

Transmesenteric hernia is so infrequent that sudden unexpected death due to this condition is a very rare occurrence. Because the disease usually occurs in pediatric populations, it is a very rarely observed in adolescents or adults. We report an autopsy case of transmesenteric hernia diagnosed postmortem in an 18-year-old boy who died suddenly after complaining of acute abdominal pains with nausea. Physical examinations, simple abdominal radiographs, and abdominal CT scans failed to provide a clear diagnosis of the illness for 37 h in the hospital. At autopsy, a small round defect of the small bowel mesentery was found, through which a long segment of the small intestine herniated, accompanied by hemorrhagic infarction induced by strangulation obstruction. We would like to present and review this rare autopsy case with medicolegal viewpoints.
Abdominal Pain ; Adolescent ; Adult ; Autopsy ; Death, Sudden ; Hernia ; Humans ; Infarction ; Intestine, Small ; Mesentery ; Nausea ; Physical Examination

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Alveolar Siderophages : A Precipitating Factor in a Fatal Scuba Diving Accident?: An Autopsy Case.

Youn Shin KIM

Korean Journal of Legal Medicine.2012;36(1):97-101. doi:10.7580/KoreanJLegMed.2012.36.1.97

The author report the case of a 40-year-old male leisure scuba diver (height, 176 cm; weight, 73 kg) who died from asphyxiation by aspiration of gastric content, allegedly triggered by pulmonary hemosiderosis and/or full stomach. On the first dive of the day, the deceased complained of difficulty in descent and tried to descend several times but finally gave up and separated from his companions. After several minutes of separation, he was found dead, face down position on the sea surface, by the captain of the boat carrying the diving party. On autopsy, the lungs showed foreign bodies from stomach, intra-alveolar hemorrhage, and siderophages in the alveolar sac. A small amount of air bubbles was noted in the mesenteric vein, iliac artery, right ventricle and pulmonary artery. The cause of death was asphyxiation by aspiration of gastric content and pulmonary hemosiderosis, which probably provoked the event. Alveolar hemosiderosis may be a causal factor in fatal scuba diving accident.
Adult ; Autopsy ; Cause of Death ; Diving ; Divorce ; Foreign Bodies ; Friends ; Heart Ventricles ; Hemorrhage ; Hemosiderosis ; Humans ; Iliac Artery ; Leisure Activities ; Lifting ; Lung ; Lung Diseases ; Male ; Mesenteric Veins ; Precipitating Factors ; Pulmonary Artery ; Ships ; Stomach

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Application of 3D Surface Scanners in Forensic Science and Medicine ( I ): Digital Storage of Human Skeletons and Development of Appraisal Methods for Incident Scenes.

Nak Eun CHUNG ; Hyung Nam KOO ; Hyun Moo KANG ; Sang Seob LEE ; Hye Jin PARK ; Hyung Joong KIM ; Kyung Rak LEE ; Ik Jo CHUNG ; Dae Yeol KIM ; Dal Won KIM ; Sang Beom LIM ; Saebomi LEE ; Han Soo HAN ; Jung LEE ; Jun Suk KIM ; Ki Woong MOON ; Byong Hyun KIM ; Kyun Woo CHO ; Jin Pyeo KIM ; Yeo Soo KIM ; Sung Ho KIM ; In Soo SEO ; Dae Kyun PARK ; Jae Kwang CHUNG ; Yi Suk KIM ; Seong Kyu CHOI ; U Young LEE ; Hoon LEE ; Chae Keun KIM ; In Soo LEE ; Hoon KANG ; Won Seob KIM ; Dong Kyu KIM ; Dong Soo KIM ; Hyeong Jin CHOI ; Dong Il PARK ; Hong Soon CHOI ; Si Ro KIM ; Yong Seok HEO

Korean Journal of Legal Medicine.2012;36(1):85-96. doi:10.7580/KoreanJLegMed.2012.36.1.85

The aim of this project was to use 3D scanning data collected at incident scenes and various evidence to 1) develop surveying methods based on 3D data consisting of overall and detailed scene evidence, captured by long-range and micros-canner, which can be shared by personnel working in different fields such as forensic medicine, video analysis, physical analysis, traffic engineering, and fire investigation; 2) create digital storage for human skeletons and set the foundation for virtual anthropology; and 3) improve the credibility of 3D evidence by virtual remodeling and simulation of incident scenes and evidence to provide a basis for advanced and high-tech scientific investigation. Two complete skeletons of male and female were scanned using 3D micro-scanner. Each bone was successfully reproduced and assembled in virtual space. In addition, recreating evidence scheduled for invasive examination by creating RP (rapid prototype) was possible. These outcomes could play an important role in setting up the new field of virtual anthropology. Case-specific surveying methods were developed through analysis of 3D scanning data collected by long-range surface scanners at the scenes of vehicular accidents, falls, shootings, and violent crimes. A technique and recording method was also developed for detecting forged seals by micro-scanning the pressure exerted on the seal. Appraisal methods developed in this project could be utilized to secure 3D data of human skeletal remains and incident scenes, create a standard for application, and increase objectivity, reproducibility, and accuracy of scanning methods. We plan to develop case-specific 3D data analysis techniques to improve the credibility of analysis at the NFS and to establish a 3D data collection and analysis team.
Crime ; Data Collection ; Female ; Fires ; Forensic Medicine ; Forensic Sciences ; Humans ; Male ; Skeleton ; Statistics as Topic

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DNA-Based Identification of Necrophagous Fly Species Using Abdominal-B (Abd-B) Homeobox Sequence.

Hu Guo PIAO ; Ukhee CHUNG ; Shang Eon SHIN ; Kwang Soo KO ; Juck Joon HWANG

Korean Journal of Legal Medicine.2012;36(1):74-84. doi:10.7580/KoreanJLegMed.2012.36.1.74

In medicolegal investigations, correct identification of the necrophagous fly species collected around and on the corpse is an essential step for estimating the postmortem interval (PMI). Therefore, forensic pathologists and entomologists investigating deaths due to violent crimes need a rapid, easy-to-use protocol to identify fly species found on corpses. A rapid and robust DNA-based tool that can distinguish between various immature and mature species from the Calliphoridae, Muscidae, and Sarcophagidae families would be ideal for such investigations. To date, the DNA barcode initiative is the best approach for identifying species-specific nucleotide sequences. We have developed 3 sequence-characterized amplified region (SCAR)-based identification systems derived from the Abdominal-B homeobox sequences of 17 fly species belonging to the Muscidae and Sarcophagidae. The flies used in this study were collected in Korea. These assay systems can classify 17 forensically important fly species into the dipteran family group and reliably distinguish them from inter- and intraspecific fly species through a 2-step multiplex PCR. This novel approach may also be used as an alternative to conventional DNA-based identification methods.
Base Sequence ; Cadaver ; Crime ; Diptera ; DNA ; Genes, Homeobox ; Humans ; Korea ; Multiplex Polymerase Chain Reaction ; Muscidae ; Sarcophagidae

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Legal Features of Mental Disorders among Sexual Offenders without Paraphilia.

Sang Hun SHIN ; Mi Kyung RYU ; Sun Bum KIM ; Jin Young LEE ; Mi Ji LEE ; Dae Youn KIM

Korean Journal of Legal Medicine.2012;36(1):68-73. doi:10.7580/KoreanJLegMed.2012.36.1.68

The aim of this study was to evaluate the legal features of sexual offenders with mental disorders without paraphilia. Patients admitted to Korea Forensic Hospital from 1994 to 2012 (n = 193) were reviewed for diagnosis, crime, legal responsibility, readmission (number of admissions), hospitalizations, criminal record, and education level. Psychotic subjects were often declared not guilty because of insanity and avoided legal responsibility, but had long admission periods and fewer criminal records. Mentally retarded subjects also had long admission periods and fewer criminal records, but commited more sexual offenses against victims aged 13 and younger. The substance abuse group had extensive criminal records, shorter admission periods, and frequent admissions. Subjects with personality disorders and others committed relatively more violent crime with injuries, rather than simple sexual offenses. Treatment and social concerns suitable to each diagnosis are required to address sexual offenses associated with diverse legal characteristics.
Aged ; Crime ; Criminals ; Hospitalization ; Humans ; Korea ; Mental Disorders ; Mentally Disabled Persons ; Paraphilic Disorders ; Personality Disorders ; Substance-Related Disorders

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Correlation of Alcohol intake with Suicide in Cases confirmed by Legal autopsy.

Hosun CHOI ; Joong Seok SEO ; Ju Yeon PYO ; Yun Hee PARK

Korean Journal of Legal Medicine.2012;36(1):63-67. doi:10.7580/KoreanJLegMed.2012.36.1.63

The purpose of this study is to provide a fundamental basis for defining measures to prevent suicide by specifically examining the relationship between suicide and alcohol consumption, which is thought to be a key factor in suicide. This study reviewed 426 suicide autopsies diagnosed by the department of forensic medicine, National Forensic Service (2007-2009) and analyzed the preliminary data on variables such as gender, age, and cause of death, with particular focus on the relationship between these variables and blood alcohol concentration. The relationship between each variable and alcohol consumption was as follows. First, alcohol was present in 48.4% of suicides. Second, blood alcohol concentration wrere twice as high in women as in men. Third, the relationship between suicide and alcohol consumption was greater in people in their 30s and 40s. The correlation between suicide and alcohol intake was evident this age group. These results are more specific and practical than the results of previous studies on the correlation between suicide and alcohol intake. The results of this study will help define measures to facilitate suicide prevention as an important reference and may eventually help lower the suicide rate in Korea.
Alcohol Drinking ; Autopsy ; Cause of Death ; Drinking ; Female ; Forensic Medicine ; Humans ; Korea ; Male ; Suicide

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Medicolegal Review of Deaths Related to Propofol Administration: Analysis of 36 Autopsied Cases.

Jong Hyeok PARK ; Hyoung Joong KIM ; Joong Seok SEO

Korean Journal of Legal Medicine.2012;36(1):56-62. doi:10.7580/KoreanJLegMed.2012.36.1.56

Propofol is a widely used anesthetic in anesthesia and sedation. Recent cases of propofol-induced death have been associated with adverse effects, abuse, or intoxication. However, there are few forensic reports of propofol-associated death. We reviewed and analyzed 36 cases of death related to propofol administration recorded by the National Forensic Service in 2000-2011. The number of women was 28 (77.8%). Subjects in their 20s and 30s accounted for 61.1% of cases. Cause included medical accidents, 16 (44.4%); suicides, 2 (5.6%); and undetermined, 18 (50%; suicide/accident). Of the 16 medical accidents, 8 were internal medicine cases (conscious sedation endoscopy), 3 surgical cases, 3 plastic surgery cases, 1 urology case, and 1 obstetrics and gynecology case. In 20 cases of suicide or undetermined (suicide/accident), the victims were nurses (9 cases), doctors (4 cases), hospital administrators (2 cases), homemakers (2 cases), bar hostesses (2 cases) and an office worker (1 case). The doctor included 2 plastic surgeons, an internist, and a resident anesthesiologist. The autopsy findings were nonspecific; congested parenchymal organs (34 cases), pulmonary edema (8 cases), cerebral edema (2 cases), pulmonary and cerebral edema (2 cases), putrefaction (2 cases), mucosal petechiae in the interior of the larynx (1 case), and cerebral ischemic necrosis and pneumonia (1 case). The blood propofol concentrations ranged between 0.007 mg/L (cardiopulmonary resuscitation) or 0.23 mg/L (no cardiopulmonary resuscitation) and 4.38 mg/L in medical accident cases, and from 0.12 mg/L to 108.3 mg/L in suicide or undetermined (suicide/accident) cases. Other drugs were detected in 17 cases and alcohol was detected in only 2 cases. Blood concentrations in cases of medical accident were lower than in cases of undetermined cause.
Anesthesia ; Autopsy ; Brain Edema ; Estrogens, Conjugated (USP) ; Female ; Gynecology ; Hospital Administrators ; Humans ; Internal Medicine ; Larynx ; Necrosis ; Obstetrics ; Pneumonia ; Propofol ; Pulmonary Edema ; Purpura ; Suicide ; Surgery, Plastic ; Urology

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