The wounding potential of assault rifles: analysis of the dimensions of entrance and exit wounds and comparison with conventional handguns. A multicentric study.

The appearance of a gunshot wound (GSW) is greatly influenced by the velocity of the projectile, where high-velocity projectiles (HVPs) are defined as ballistic agents reaching a muzzle velocity of > 600 m/s fired from assault rifles. The aim of the study is to present and explain the differences in the dimensions of entrance and exit wounds between the most used handguns and assault rifles and to propose a predictor of HVP, i.e., the ratio of exit and entrance wounds (EX/ENR). The surface area of entrance and exit GSWs and the EX/ENR were calculated. 66 perforating GSWs produced by NATO FMJ 7.62 × 52 mm and 5.56 × 42 mm fired from assault rifles were assigned to the HVP, while 64 lesions produced by conventional projectiles fired from revolvers and semi-automatic pistols were assigned to the low-velocity projectile (LVP) group. The dimensions of the exit wounds of the HVP group were significantly higher when compared to the LVP group (95% CI 0.9886-2.423, p < 0.05). The HVP group showed significantly higher values for the EX/ENR when compared to the LVP group (95% CI 2.617-7.173, p < 0.05). The evaluation of the EX/ENR can be considered an adequate tool to assess the type of weapon involved and to roughly estimate the associated wounding mechanisms, which can guide both the physician in the management and treatment of the patients affected by GSW, and the forensic pathologist in crime investigation.

Myocardial tissue embolism in lung due to gunshot wound to the chest.

Myocardial tissue embolism due to gunshot wound is a very rare event, as only a few cases of myocardial tissue embolization, occurring after cardiac surgery or myocardial infarction, have been reported. According to this study's referenced report from forensic autopsy, one case of myocardial tissue emboli to the lung has been found, in an Asian male, 22 years old, who died from a gunshot to the chest by a handgun. From the examination, myocardial tissue embolism was considered important forensic evidence, showing that the gunshot occurred while the victim was still alive, and that he also survived for some period of time after being shot.

Hanging Fatalities in Central Bangkok, Thailand: A 13-Year Retrospective Study.

Hanging is violent asphyxial death. The objective of this study is to assess the data of hanging cases. A descriptive-retrospective study was conducted. We studied 244 hanging cases autopsied in Forensic Division, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, between January 2001 and December 2013. The study included 197 men (80.7%) and 47 women (19.2%). Their age ranged from 14 to 93 years. Most of these cases were incomplete hanging (83.6%). Features of hanging victims, such as tongue protrusion; congestion of face; petechial hemorrhage of face, conjunctiva, and internal organs; and neck injuries, significantly correlated with complete hanging. The predominant occupation of hanging victims was in the service industry (63.1%). Suicides usually occurred in private homes or apartments (84.8%). A suicide note was found in 6.1% of cases. The most common ligature material used was nylon rope, found in 61.1% of cases. The most underlying diseases of the victims in hanging cases were tuberculosis and human immunodeficiency virus infection, 9 cases each. Blood ethanol levels of 29 cases (11.8%) were detected to be higher than 150 mg%. Methamphetamine and benzodiazepine were detected in 5.3% and 3.3% of cases, respectively. This study provides comprehensive baseline data of hanging cases in central Bangkok.

Entrance and exit wounds of high velocity bullet: An autopsy analysis in the event of dispersing the mass rally in Bangkok Thailand, May 2010.

Fatal mass casualties by high velocity bullets (HVBs) are rare events in peaceful countries. This study presents 27 forensic autopsy cases with 32 shots fired by 5.56×45mm. HVB (M-16 rifle bullets) during the dispersing the mass rally in Bangkok Thailand, May 2010. It was found that twenty-three (71.88%) typical entrance HVB wounds had round sizes less than the bullet diameters. Most entrance wounds had microtears but no collar abrasion since a HVB has a small streamlined spitzer tip and full metal jacket. For exit wounds, there were various sizes and shapes depending on which section of wound ballistics presented when the bullet exited the body. If a bullet exited in the section of temporally cavity formation, there would be a large size exit wound in accordance with the degree of bullet yaw. This is different from civilian bullets whereby the shape looks like a cylindrical round nose and at low velocity that causes entrance wounds with a similar size to the bullet diameter and is usually round or oval shape with collar abrasion. The temporary cavity is not as large as in a HVB so exit wounds are not quite as large and present a ragged border compared to a HVB. We also reported 9 out of 32 shots (28.13%) of atypical entrance wounds that had various characteristics depending on site of injury and destabilization of bullets. These findings may be helpful to forensic pathologists and to give physicians, who need to diagnose HVB wounds, more confidence.

The use of pilocarpine eye drops for estimating the time since death.

OBJECTIVE: The objective of this study was to estimate the time since death using pilocarpine eye drops. METHODS: In this study, 100 postmortem cases with known time of death were included. In each case, the left pupil was measured in millimeter units using a vernier caliper, and pilocarpine eye drops were applied. The pupil was measured again 10 min later, and statistical analysis was used to analyze the correlation between the time since death and the change in the pupil. RESULTS: The longest duration since death that the pupils showed reaction to pilocarpine was 15 h. The correlation between the change in the pupil and the postmortem interval was found (Spearman's rho, r = -0.304, p = 0.002), and the change in the pupil may be used to predict the postmortem interval by the following regression equation: postmortem interval (PMI) = 8.310-3.702 (Diff) ± 0.735 (PMI was postmortem interval in hours and Diff was the difference in the size of the pupil after administering pilocarpine in millimeter units). CONCLUSION: The present study showed that pilocarpine eye drops can be used to estimate the time since death.

Fatal firearm injuries in autopsy cases at central Bangkok, Thailand: a 10-year retrospective study.

Even though there have been previously published reports on firearm injuries in various countries, the incidence and pattern of death from firearm injuries in Thailand have not been studied before. In present study, 149 fatal firearm injuries from 2002 to 2011 were reviewed. At total of 7126 autopsies, fatal firearm injuries comprised of 2.09% (n = 149) of total autopsies cases. Among those victims, 136 were male (91.3%), 13 (8.7%) were female. The youngest age of victim was 10 years and the oldest was 79 years. Mean age of the victims was 33.79 years and median age was 30 years. Outdoor incident was the most common scene of crime. Night time incident (18:00 PM-05:59 AM) was higher than day time one. Most of the cases occurred in week ends (n = 52). Homicide (77.2%) was the most frequent manner of death. Head/face and chest were the most common sites of entrance. The autopsy report also study on entrance wound, range and types of projectiles. Blood alcohol concentration was examined in 122 cases and 38 victims showed positive results, 11 cases revealed using of illegal substances in blood and urine analysis. This study also included the association between manner of death and other factors. Age group, time of incidence, place of incidence, number of entrance wound and range showed statistically significant association with manner of death.

Committed suicide: forensic autopsy analysis at Ramathibodi Hospital during year 2001-2010.

BACKGROUND: Suicide is one of the most important causes of death in the world. To study the behaviors and risk factors may be helpful to prevent suicide. OBJECTIVE: To retrospectively study the factors that affected suicide in forensic postmortem cases at Ramathibodi Hospital, Bangkok, Thailand between 2001 and 2010. MATERIAL AND METHOD: Two hundred ninety suicidal cases from 7,102 forensic postmortem autopsies in Ramathibodi Hospital between 2001 and 2010 were descriptively retrospective studied. Study topics included sex, age, nationality, year, methods of suicide, and HIV. RESULTS: The suicide-rate in the present study varied between 2.53% and 6.91% (average 4.08%) of the forensic autopsy cases. The peak was found in 2003. Males had higher suicide rate than females [ratio of M:F of 4.3:1 (235 males and 55 females)]. The age varied from seven years to 91 years. Although the average age of suicide was 37.38 years, the peak was found in the young adult (age group of 21 to 30 years). Male, younger age, and foreigner were related to suicide with statistical significance. Hanging was the most frequent method of suicide followed by fall from height (62.1% and 17.2% respectively) and by firearm (in male) and toxic substance ingestion (in females). Of all the suicide, 5.1% were HIV seropositive, which is slightly more than non-HIV cases (4.0%) but this was not statistically significant. CONCLUSION: The suicidal cases among unusual death were related to varieties of factors. Male, younger age, and foreigner were significant related to suicide. Hanging and falling from height were the most frequent method of suicide.

Comparison between prostate specific antigen and acid phosphatase for detection of semen in vaginal swabs from raped women.

OBJECTIVE: To compare the effectiveness of the prostate specific antigen (PSA) test and the acid phosphatase (AP) test for semen detection in human vaginal samples. MATERIAL AND METHOD: The source materials were vaginal swabs that were tested at Ramathibodi Hospital between 2008 and 2010 from 2450 cases of raped women. Each swab was tested for semen by three methods: sperm detection by light microscopy, the AP enzymatic reaction, and the presence of PSA by using an immuno-chromatographic rapid kit test. The efficiencies of the AP and PSA tests were compared using the light microscopy result for the presence of sperm as the gold standard. RESULT: The specificities of the AP, the PSA and the combined AP-PSA tests were 96.4%, 92.3% and 91.9%, respectively, and the sensitivities were 65.5%, 80.4% and 84.5%, respectively. The receiver operating characteristic (ROC) area of the AP, PSA and combined AP-PSA tests were 0.8091, 0.8639 and 0.8823, respectively. The ROC area of the PSA test was significantly greater than that of the AP test (p < 0.0001), and the ROC area of the combined AP-PSA test was significantly greater than both the tests individually (p < 0.0001). DISCUSSION: Based on the ROC area, the PSA test was better than the AP test for semen detection in the vaginal swabs, and the combined results (AP + PSA) were better than the individual tests. The specificity of the AP test was higher than the PSA test in this study because a positive detection was made within only 15 s. While the PSA test was more convenient as it was available in a rapid test kit format, our recommendation is PSA detection should be done together with AP test and spermatozoa examination to identify evidence of rape. CONCLUSION: Using these three tests together (AP, PSA, and spermatozoa detection) was recommended as a forensic tool for investigations of vaginal swabs of the rape victims.

Aberrant abdominal umbilical arteries in VACTERL--association: a first case report.

A 38-week-gestational age male neonatal death from a 27-year-old-mother was reported. The autopsy found multiple congenital anomalies such as scoliosis of thoracic spine with 13 pairs of ribs, anal atresia, bilateral renal agenesis, and clubfeet. These anomalies were diagnosed VACTERL--association that must include at least three out of six principal anomalies of previously mentioned, e.g., (1) V--vertebral defects, (2) A--anal atresia, (3) C--cardiac anomalies, (4) TE--tracheo-esophageal fistula, (5) R--renal anomalies, and (6) L--limb abnormalities. In addition, other anomalies were also observed in this case, i.e., cryptorchidism both sides, jejunal diverticulum, and aberrant abdominal umbilical arteries.

Pathology of HIV seropositive: forensic autopsy study in a tertiary care hospital, Bangkok, Thailand.

OBJECTIVE: To retrospectively study the pathology of HIV seropositive in forensic autopsies. MATERIAL AND METHOD: Three hundred thirty five HIV seropositive cases, selected from 7,387 forensic postmortem inquests by law, were studied in Ramathibodi hospital between 2000 and 2010. The study topics were sex, age, cause of death, manner of death, and pathological features. Autopsies were done in 67 cases. The pathological features were classified into five groups, (a) HIV disease with infectious and parasitic diseases, (b) HIV disease with malignant neoplasms, (c) HIV disease with other specified diseases, (d) HIV disease with other conditions, and (e) HIV disease with unspecified pathology. RESULTS: The average prevalence of HIV seropositive cases was 4.5%. The peak was 10.0% in 2001 and gradually decreased until 1.8% in 2010. The ratio of male:female was 4:1. The most manner of death was natural death (83.6%). In unnatural death cases, the most frequently method was suicide by hanging. The prevalence of HIV group (a) to group (e) were 56.7%, 6.0%, 3.0%, 17.9%, and 16.4%, respectively. Pulmonary tuberculosis is the most common found in group (a) with frequency of 28.4%. Kaposi's sarcoma of skin, coronary atherosclerosis, and fatty change of liver were frequently observed in HIV group (b) to group (d), respectively. The pathology showed multiple pathological features in each group, i.e., group (a) pulmonary tuberculosis, pneumonia, disseminated fungal infection, brain abscess, and meningitis, group (b) Kaposi's sarcoma of skin and acute lymphoblastic leukemia, group (c) coronary atherosclerosis, chronic pyelonephritis, gastritis, and cirrhosis of the liver, and group (d) cardiomegaly, fatty change of liver; pulmonary edema, and splenomegaly. CONCLUSION: HIV disease causes pathology of various organs. The severities vary from severe to asymptomatic disease. Five pathological patterns of HIV were established in this study that showed interesting topics, i.e., pulmonary tuberculosis was the most frequent and occurred (28.4%) in HIV disease with infectious and parasitic diseases while Kaposi's sarcoma of skin frequently occurred in HIV disease with malignant neoplasms. The decreasing rate of HIV transmitted infection in forensic postmortem may reflect the success of using antiretroviral drug treatment in the National AIDS program during the ten-year period of this study

HELLP syndrome in pregnancy as a cause of sudden unexpected death and spontaneous hepatic rupture: A medico-legal autopsy case report.

This is the first reported medico-legal autopsy case in Thailand. It is a case of a 26-year-old Thai female with primigravida and 34 weeks gestational age that had sudden unexpected death. The laboratory investigations before death revealed evidence of hemolysis, which is decreased hematocrit, elevated lactate dehydrogenase (865 U/L), and low platelet count (8.7 x 10(9) cells/L). These findings were compatible with HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome. The autopsy findings showed two ruptures of the right lobe of the liver hepatic subcapsular hematoma, rupture of Glisson's capsule, and massive hemoperitoneum with abruptio placentae. Histological features of liver and kidneys revealed specific characteristics that can assist the forensic pathologist to diagnose HELLP syndrome when laboratory examinations are not available.

Left subclavian arterioesophageal fistula induced by chicken bone with upper gastrointestinal hemorrhage and unexpected death: report of a case.

Left subclavian arterioesophageal fistula resulting from chicken bone ingestion is a rare occurrence. The authors report the death of a 42-year-old Thai female with mental retardation who presented to the hospital with severe hematemesis and arrested Death occurred about 24 hours after laparotomy due to hypovolemic shock Postmortem examination revealed a chicken bone embedded in middle part of esophagus with fistula between the esophagus and the left subclavian artery.

Sudden unexpected deaths in different age groups at Ramathibodi Hospital, Bangkok, Thailand: a retrospective autopsy study during 2003-2007.

A sudden unexpected death is considered one type of medico-legal death in Thailand. In some studies, it comprises up to 50-60% of all medico-legal deaths. In this retrospective study, data were collected from 1,460 cases of sudden unexpected deaths, 39.9% of all deaths in which a medico-legal autopsy had been carried out. The study was conducted over a 5-year period from January 2003 to December 2007. There were 1,009 males and 451 females (M:F ratio = 2.2:1). The mean age was 55.3+/-0.98 years. The peak age group was the 46-60 years accounting for 28.2% of cases. The most common cause of death in all age groups was coronary atherosclerosis. Understanding epidemiological autopsy data is vital for determining the characteristics of the population involved.

Comparable between rapid one step immunochromatographic assay and ELISA in the detection of prostate specific antigen in vaginal specimens of raped women.

BACKGROUND: Rape is a crime found in Thailand nowadays. The crime is often lacking of eyewitnesses. Therefore, examination for forensic biological evidence becomes quite important, especially investigating sperm and semen in vaginal specimens of the victim. Acid phosphatase test for semen is commonly used in Thailand but is just a presumptive test. Recently, confirmatory kit tests became available in Thailand for detecting the prostate specific antigen (PSA) from semen. This test is simpler and cheaper than ELISA. OBJECTIVE: To compare the rapid one-step immunochromatographic assay with ELISA for the detection of prostate specific antigen in vaginal specimens of raped women. MATERIAL AND METHOD: A diagnostic test was conducted on the vaginal specimens of raped women that were sent to the laboratory of the Pathology Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University during April-August 2006. One hundred vaginal specimens were examined for prostate specific antigen by rapid one step immunochromatographic assay and compared with ELISA. RESULTS: There were 85% and 83% of sensitivity, 85% and 85% of specificity, 85% and 85% of accuracy, 89% and 89% of positive predictive value, and 79% and 77% of negative predictive value from rapid one-step test kit and ELISA respectively CONCLUSION: The result showed that there was no difference on specificity, accuracy and positive predictive value between the two methods but sensitivity and negative predictive value of rapid one-step test kit was better than ELISA. The research team recommends that rapid one-step test kit for prostate specific antigen should be routine service in vaginal specimens of raped women.

Normal internal organ weight of Thai adults correlated to body length and body weight.

OBJECTIVE: Examine the relationship between the internal organ weight with body weight and body length. MATERIAL AND METHOD: Analysis of data from 250 autopsies from the Ramathibodi Hospital from August 2003 to February 2005. The cases were from sudden unnatural death including accident, homicide and suicide and excluded decomposed bodies, fire related deaths and cases where medical treatment had been given. The age ranged from 15 to 88 years and there were 51 females and 199 males. Parson's correlation coefficient was used to examine the relationship between the internal organ weight with body weight and body length. RESULTS: The mean+/-standard deviation (SD) were represented by males and females respectively; Brain 1339+/-160/1165+/-184 gm, heart 311+/-66/278+/-160 gm, lung 910+/-347/675+/-255 gm, liver 1439+/-365/ 1214+/-275 gm, spleen 103+/-46/92.9+/-48 gm, kidney 260+/-68/230+/-42 gm. CONCLUSION: The relationship between internal organ weight and body weight showed each internal organ significantly correlated with body weight in males at p-value < 0.05, whereas in females it only correlated to liver, kidney and spleen at p-value < 0.05. For the correlation between internal organ weight and body length, it showed only brain, lung, liver and kidney correlated to the body length in males at p-value < 0. 05, but not in females.