An autopsy case of iatrogenic tracheoesophageal fistula secondary to tracheostomy.

Tracheoesophageal fistula (TEF) is an uncommon but life-threatening sequel of prolonged use of a cuffed tracheostomy tube. We describe a patient who developed a TEF after a tracheostomy done for management of head injury due to a road traffic mishap. The patient subsequently died of sepsis after bilateral bronchopneumonia. To the best of our knowledge, this is the first autopsy case of iatrogenic TEF after tracheal intubation reported in forensic literature.

Mesiodistal width of canines: a tool for sex determination.

Teeth, in the living as well as the dead, are the most useful objects in the field of forensic investigation. Their ability to survive in situations like mass disasters makes them important tools in victim identification. Though the morphology and structure is similar in both men and women, there are subtle differences. Variation in dental size can give a clue about differences between the sexes. Many authors have measured the crowns of teeth in both men and women and found certain variations. Canines, reported to survive air crash and hurricane disasters, are perhaps the most stable teeth in the oral cavity because of the labiolingual thickness of the crown and the root anchorage in the alveolar process of the jaws. Measurement of mesiodistal width of the mandibular and maxillary canines provides good evidence of sex identification due to dimorphism.

The Mangalore aircrash of 22 May 2010: practical problems related to identification of the dead in a populous developing country.

It was a sad and emotional moment for the citizens of Mangalore, India when the "Dubai to Mangalore" Air India Express Boeing 737-800 flight IX-812 crashed at the Mangalore International Airport on 22 May 2010, killing 158 people on board. Identification of the victims was difficult as most of the bodies were charred beyond easy recognition. The practical problems faced by the legal authorities in identifying the charred victims in a populous and developing country like India are discussed in this paper.

Blunt trauma to the chest--a case of delayed cardiac rupture.

Blunt traumatic cardiac rupture is a relatively uncommon diagnosis and is usually associated with a high mortality rate. A case of delayed cardiac rupture is described in an elderly person who sustained blunt chest trauma following a fall into a roadside ditch. In the case reported herein, the preliminary investigations at the time of admission did not show any evidence of haemopericardium. The patient deteriorated suddenly, possibly due to a delayed rupture of the right ventricle that was diagnosed postmortem. Acute cardiac tamponade resulting from rupture of the right ventricle is a serious and life threatening state. A high index of suspicion about the possibility of delayed cardiac rupture is required during the management of a case of polytrauma where significant cardiac findings can be masked by the presence of other injuries.

Estimation of stature from the length of the sternum in South Indian females.

Estimation of stature is one of the principal elements in practical forensic casework involving examination of skeletal remains. The present study was undertaken to estimate stature from the length of the sternum in South Indian females using a linear regression equation. The material for the present study consisted of intact sternums belonging to adult females of South Indian origin aged between 25 and 35 years of age obtained during medico-legal autopsies. The length of the sternum was measured as the combined length of the manubrium and the mesosternum (body of the sternum) from the incisura jugularis (central suprasternal notch) to the mesoxiphoid junction along the mid-sagittal plane using vernier calipers. A linear regression equation [Stature = 111.599 + (3.316 × Length of the sternum)] was derived to estimate stature from the length of the sternum. The correlation coefficient was 0.639. The standard error of the estimate was 4.11 cm. The present study concludes that the length of the sternum is a reliable predictor of stature in adult South Indian females and can be used as a tool for stature estimation when better predictors of stature like the long bones of the limbs are not available when examining skeletal remains.

Descending thoracic aortic aneurysm rupture during postpartum period.

Aortic aneurysm refers to the pathological dilatation of the normal aortic lumen involving one or several segments. Thoracic aortic aneurysms are much less common than aneurysms of the abdominal aorta. Descending thoracic aortic aneurysm leading to dissection and spontaneous rupture is a potentially catastrophic illness. Although rare, dissection and rupture of a preexisting aortic aneurysm have been reported during pregnancy and early puerperium. To the best of our knowledge, such cases among young pregnant women are rarely reported in literature. Herein, an autopsy case of spontaneous rupture of a clinically undiagnosed descending thoracic aortic aneurysm during early puerperium in a young woman is presented along with the review of relevant literature. The victim was found dead on her hospital bed on the seventh day of puerperium. Autopsy with ancillary investigations revealed that the young woman died because of hemothorax from a ruptured dissecting descending thoracic aortic aneurysm secondary to chronic aortitis.

Sexual dimorphism of the index to ring finger ratio in South Indian adolescents.

Sex determination from prepubertal human remains is a challenge for forensic experts and physical anthropologists worldwide as definitive sexual traits are not manifested until after the full development of secondary sexual characters that appear during puberty. The research was undertaken in 350 South Indian adolescents to investigate sexual dimorphism of the index and ring finger ratio. The index finger length (IFL) and the ring finger length (RFL) were measured in millimeters in each hand and the index and ring finger ratio was computed by dividing the index finger length by the ring finger length. Mean RFL was greater than mean IFL in both males and females. Mean RFL was significantly higher in males. The index and ring finger ratio showed a statistically significant difference between males and females (p

Death by attack from a domestic buffalo.

Attacks on humans by domestic animals causing fatal injuries are not uncommon in rural areas of India. But injuries due to buffalo gore are rarely observed in villages and are different from other casualties like stab injuries, road fatalities, etc. As the victims of buffalo attack are usually recovered from the fields or forest, the investigating officer could be mislead as to the nature of infliction of fatal injuries to a possible homicide. The injuries caused by the horns of buffaloes are of various shapes, sizes and directions. They are violent and goring in nature. The wound sustained may be contusions, lacerations, criss-cross wounds, penetration of body cavities, and sometimes fractures. In the absence of any eye witness, it becomes very difficult to believe the unsuspecting domestic water buffalo as attacker. This case is reported for its rarity, for the awareness of the possible injuries in such unnatural deaths, and factors predisposing to a buffalo attack.

Early adipocere formation: a case report and review of literature.

Adipocere has a long history of frightening and fascinating mankind, from so called "incorruptible saints" to the famous "iceman" and its formation on human remains has long been known and feared. Adipocere formation replaces the putrefactive changes, when the body lies buried in shallow, moist, clay, soiled grave or it is thrown into cess pools or submerged in water. As the progression of putrefaction is arrested, the facial features and wounds are preserved without much alteration, thereby aiding the identification and to certain extent, the cause of death. The time required for the formation of adipocere is a subject of controversy. Here we present a case of early adipocere formation within 3 days and the review of literature pertaining to it.

Fatal unintentional injuries among young children--a hospital based retrospective analysis.

Unintentional (accidental) injuries in childhood constitute a significant public health problem. Young children are extremely vulnerable to unintentional injuries that are vastly preventable. All cases of fatal unintentional injuries in children aged 10 years and below autopsied during 1994-2007 were retrospectively reviewed. Seventy five such cases were identified during the 14 year study period. Males accounted for 68% of cases with a male-female ratio of 2.1:1. Mean age of male and female victims was 5.3 and 4.9 years, respectively. Road traffic fatalities accounted for majority of the cases in this age group (52%), followed by those due to thermal injuries (22.7%). Flame was the cause of thermal injuries in 52.9% cases and scalds were observed in 47.1% cases. Traffic fatalities, fall and drowning were more common in school age children while toddlers and pre-school age children were relatively at a greater risk from domestic accidents (thermal injuries and poisoning). The most frequent victims of road traffic incidents were pedestrians (64.1%). Head injuries alone were the cause of fatalities in the majority of road traffic incidents (82.1%). The study highlights on the pattern of fatalities due to unintentional injuries among young children. To reduce the burden of unintentional childhood mortalities in this region, priorities for school age children are traffic injuries and for toddlers and pre-school children, thermal injuries.

Sudden death due to pulmonary aspergillosis.

Sudden death due to respiratory pathology is not uncommon and tuberculosis with its complications is well known to cause death. We report a case of a male, train passenger, who started coughing out blood and died on reaching the hospital. Medicolegal autopsy confirmed the sudden unexpected death to be due to pulmonary aspergillosis in the person with past medical history of tuberculosis.

Atypical wound of entry and unusual presentation in a fatal stab injury.

Stab wounds encountered in medico-legal autopsies are usually caused by sharp pointed weapons. Peculiarities of the wound of entry in stab wounds, for example due to the hilt of the weapon, movement of the weapon and sometimes by the hand of the assailant holding the weapon are often described in literature. We report an unusual presentation in a fatal stab injury wherein a single atypical external wound was associated with multiple internal injuries to the organs. The exact cause of such peculiarities can never be accurately determined, rather that can be speculated upon at the time of the autopsy and recorded for the purpose of academic interest.

Self-inflicted burns fatalities in Manipal, India.

Death due to burns is an important public health problem. Suicide by burning is uncommon in the Western world compared with Asian countries. This study presents retrospective research carried out in the tertiary care teaching hospital of Kasturba Medical College, Manipal, Southern India, between January 1993 to December 2003 (11 years). Out of a total of 343 burns deaths during the above-mentioned period, 39 were victims of suicide. The majority of deaths (46.1%) occurred in the 21-30 years age group, with a preponderance of the female sex (79.5%). Most of the victims belonged to the Hindu religion and the incident occurred mostly during the daytime. In the overwhelming majority of cases, the incident occurred at home (97.4%). In all cases kerosene was the accelerant and flame was the causative agent. In more than fifty per cent of cases, the total body surface area (TBSA) involved was more than 80%. Dowry demands and harassment were the reasons for committng suicide in 12 cases. More stringent laws and empowering female independence, both mentally and economically, will reduce suicidal burns in young women.