Usefulness of Near-infrared Spectroscopy for Diagnosis of Traumatic Intracranial Hemorrhage in Postmortem Inspection

Near-infrared spectroscopy is a device used to determine whether traumatic intracranial hemorrhage has occurred and is primarily used for screening in emergency situations. In this study we examined the applicability of this equipment in postmortem inspection. This study included 124 autopsy cases and 59 postmortem inspection cases performed in the National Forensic Service from July 2017 to October 2018. We carried out the test using Infrascanner Model 2000 (Infrascan Inc.). Autopsy cases were divided into four groups (epidural hemorrhage or subdural hemorrhage group, traumatic subarachnoid hemorrhage or cerebral contusion group, nontraumatic intracerebral hemorrhage group, and control group) and analyzed. There was no difference in the test results according to the presence and type of intracranial hemorrhage. The possibility that variables related to postmortem change affected the test results was considered. In conclusion, this study confirmed that nearinfrared spectroscopy is not suitable for the detection of traumatic intracranial hemorrhage in postmortem inspection.ope

Evaluation of the Usefulness of Cardiac Enzyme Analysis for the Diagnosis of Acute Myocardial Infarction in Postmortem Inspection

Acute myocardial infarction is one of the most common causes of unexpected deaths, but there are limitations to its diagnosis in postmortem inspection. In this study, we aimed to investigate the usefulness of cardiac marker analysis for the diagnosis of acute myocardial infarction in postmortem inspection. This study was conducted on 30 postmortem inspection cases conducted by the National Forensic Service from 2016 to 2018. Tests for three myocardial enzymes (myoglobin, creatinine kinase-MB, and cardiac troponin I) were performed in each case, and the relationships between enzyme levels, cause of death, and factors affecting the postmortem tests were analyzed. Cardiac enzyme concentrations were not significantly different between the heart disease group and other disease groups, and the false-positive rate was increased due to postmortem changes. Therefore, we can conclude that it is not appropriate to use cardiac enzyme analysis for the diagnosis of acute myocardial infarction in postmortem inspection

Coronavirus Disease 2019 Diagnosed through a Forensic Autopsy: A Case Report

Despite the high mortality rate associated with coronavirus disease 2019 (COVID-19), no clinical autopsy has been reported among the deceased during the pandemic by the Korean quarantine authorities. Notably, since 2020, forensic autopsies are performed in suspected and confirmed cases of COVID-19 infection. The first case of death secondary to COVID-19 pneumonia in Korea was reported in November 2021. We recently performed a forensic autopsy of a couple (85-year-old man and 81-year-old woman) who were discovered dead at home. Gross examination showed lobar consolidation of lungs, and microscopic evaluation revealed diffuse alveolar injury in the acute phase and thrombi in small arterioles; these findings were consistent with those reported by previous studies that have described COVID-19 pneumonia. Based on the aforementioned findings, we concluded that the couple died of COVID-19, and our study is the second Korean study to report these findingsope

Evaluation of the Usefulness of Cardiac Marker Analysis for Postmortem Diagnosis of Acute Myocardial Infarction

Acute myocardial infarction is one of the main causes of unusual death. However, diagnosing acute myocardial infarction based on post-mortem examination may be difficult; notably, it cannot be diagnosed based on post-mortem inspection. In this study, we aimed to investigate the usefulness of cardiac marker analysis in the diagnosis of acute myocardial infarction and to review the possibility of its application in post-mortem inspections. This study included 69 autopsy cases, including 29 cases in which the post-mortem interval was ≤24 hours, performed at the National Forensic Service Seoul Institute from July to November 2018. Tests for three cardiac markers (myoglobin, creatinine kinase-MB, and cardiac troponin I) were performed in each case using portable equipment, Triage Meter. The reliability of the equipment enzyme levels according to cause of death, and factors affecting the postmortem test results were analyzed. Cardiac marker concentrations were not significantly different between the heart disease and other disease groups, and Triage Meter was not found to be suitable for postmortem examination. Therefore, we can conclude that using cardiac marker analysis in the diagnosis of acute myocardial infarction using portable equipment at the scene of postmortem inspection is inappropriate.ope

Secondary Publication] Standard Operating Procedure for Post-mortem Inspection in a Focus on Coronavirus Disease-19: the Korean Society for Legal Medicine

Coronavirus disease 2019 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerged in Wuhan, China, in late 2019. It resulted in a worldwide pandemic, and spread through community transmission in the Republic of Korea (ROK). In the ROK, SARS-CoV-2 is categorized as a first-degree infectious disease of the legal communicable disease present. The Korean Society for Legal Medicine (KSLM) is the sole official academic association of forensic professionals in the ROK. As such, this society has played an important role in forensic medicine and science in the ROK. Therefore, KSLM suggests a standard operating procedure for the postmortem inspection in a focus on COVID-19. This article includes the background of this suggested standard operation procedure, basic principles for postmortem inspections of individuals suggested of having an infectious disease, and specific procedures according to the probability level of SARS-CoV-2 infection.ope

Standard Operating Procedure for Postmortem Inspection in a Focus on Coronavirus Disease-19: The Korean Society for Legal Medicine

Coronavirus disease-19 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerged in Wuhan, China, in late 2019. It resulted in a worldwide pandemic, and spread through community transmission in the Republic of Korea (ROK). In the ROK, SARS-CoV-2 is categorized as a first-degree infectious disease of the legal communicable disease present. The Korean Society for Legal Medicine (KSLM) is the sole official academic association of forensic professionals in the ROK. As such, this society has played an important role in forensic medicine and science in the ROK. Therefore, KSLM suggests a standard operating procedure for the postmortem inspection in a focus on COVID-19. This article includes the background of this suggested standard operation procedure, basic principles for postmortem inspections of individuals suggested of having an infectious disease, and specific procedures according to the probability level of SARSCoV-2 infection.ope

Birth Year Estimation of Skeletal Remains by Radiocarbon Dating for Teeth

Identifying remains is an important role of forensic medicine. For identification, dating, i.e., estimating the birth year and death year, is expected as useful, however has not yet been practically applied. A dating method using radiocarbon analysis was recently introduced and related studies have been reported. In this study, we conducted radiocarbon analysis on teeth and aimed to develop a formula to estimate the birth year. Fifteen autopsy cases from the National Forensic Service, from December 2014 to December 2020, with known birth year were selected for inclusion. For each case, dentin of the first molar in mandible was taken, radiocarbon analysis was carried out and the corresponding estimated birth year were calculated using the bomb peak curve. The differences between the birth year and the teeth year were determined and analyzed on the influence of variables. A formula for estimating the birth year was developed and the applicability of the formula was determined. The difference between the birth year and the teeth year was 2.6 years on average for cases born before 1963, and 5.7 years for those born after 1963. The estimation formula of birth year was as follows: (Before 1963) Birth year=0.565×(Tooth year)-0.446×(Age)+875.001, (After 1963) Birth year=Tooth year-5.7. This study is meaningful in that it reduced the error by using only the first molars of the lower jaw as a sample, and presented an estimation formula of birth year that can be applied in practice through radiocarbon analysis of teeth.ope

Two cases of inflammatory myofibroblastic tumors of the Liver that resolved with conservative care

Inflammatory myofibroblastic tumor (IMT) is a rare benign disease that is characterized by pseudosarcomatous proliferation consisting of spindled myofibroblast cells admixed with various inflammatory cells. IMT may mimic malignancy, clinically and radiologically. Consequently, most IMTs in the liver are removed surgically by hepatic resection with a confirmative diagnosis made later. However, current reports indicate that a minimally invasive pathologic examination and medical therapy might be sufficient treatment. We report two cases of IMT of the liver diagnosed by ultrasonography (US)-guided biopsies. Case 1: A 26-year-old man presented with right upper quadrant pain, and abdominal computerized tomography (CT) showed multiple liver abscesses. He was diagnosed with IMT on an US-guided biopsy and treated with antibiotics. Case 2: A 47-year-old man presented with three target lesions in the right lobe of the liver on abdominal CT. An US-guided biopsy showed a myofibroblastic tumor that resolved with conservative therapy.ope

Postmortem Diagnosis of Anaphylactic Shock by Histopathological Examination of Mast Cell

An autopsy for a fatal anaphylactic shock (AS) is not rare; however, postmortem diagnosis of anaphylaxis can be very challenging due to nonspecific macroscopic findings and absence of diagnostic tests except serum mast cell tryptase analysis. We tried to review the usefulness of histopathologic examination as an alternative method for the postmortem diagnosis of AS in this study. Immunohistochemical staining was carried out for detection of mast cells in 27 autopsy cases, including 7 AS cases, 5 false-positive cases, and 15 control cases at the National Forensic Service from January 2013 to May 2015, and the differences of mast cell counts and staining pattern were analyzed. The results revealed no differences in the number of mast cells among the three groups; however, a characteristic mast cell degranulation staining pattern was observed in the AS group and false-positive group. It can be conclusively inferred that the histopathologic examination could prove helpful in the postmortem diagnosis of AS, but it should serve as an ancillary option.ope

A Study on the Usefulness of Postmortem Diabetes Mellitus-Related Tests

Diabetes mellitus (DM) is a group of metabolic disorders, that have become a major cause of death worldwide. This study aimed to determine the usefulness of diabetes-related laboratory tests for diagnosis of postmortem DM. From March to August 2018, among the autopsy cases investigated by the National Forensic Service, heart blood and vitreous humor samples from 253 cases that had not been decomposed were collected, and the data from 208 cases except 45 cases that were incapable of testing were analyzed for statistical significance and compared with the causes of death on autopsy reports. The levels of C-peptide, insulin, acetoacetate, β-hydroxybutyrate (β-HA), total ketone, and HbA1c were measured in the heart blood, and the levels of glucose, blood urea nitrogen, creatinine, and potassium were measured in the vitreous humor. The levels of glucose in the vitreous humor and HbA1c, β-HA, and total ketone in the heart blood were significantly correlated. C-peptide and insulin levels were lower than normal levels in most cases (C-peptide 92.3%, P=0.480, insulin 97.6%, P=0.589), and were not useful measures indicating diabetic complications. In the group with DM history, the average levels of HbA1c from the heart blood and glucose from the vitreous humor were higher than in those with no or unknown history of DM, indicating their usefulness as diagnostic tools. The results of this study suggest a postmortem DM diagnosis model. Therefore, postmortem DM-related tests can help diagnose the cause of death in forensic medicine.ope