Dental Identification of the Putative Body of a Most Wanted Fugitive / 대한법의학회지

Dental identification was conducted on the putative body of a most wanted fugitive who was considered to be the de facto owner of the ferry MV Sewol. Postmortem examination showed many dental characteristics, including gold crowns, a porcelain-fused-to-metal crown, a gold fixed bridge, and resin restorations. The estimated age of the body was approximately 73 years. Antemortem data collected by the fugitive at private dentist showed that 10 teeth had dental features. When the antemortem data on the 10 teeth were compared with the corresponding teeth by using postmortem data, there was no discrepancy in the remaining teeth. The number of possible combinations was calculated, and the likelihood of this fugitive and any other person having the same dental features was one in 14 billion. Using the results of dental examination, the body was successfully identified.

A Statistical Analysis of Legal Autopsies Performed in Korea in 2014 / 대한법의학회지

Medicolegal autopsies are a vital tool for obtaining reliable injury mortality data. This study statistically analyzed the data obtained from medicolegal autopsies performed in Korea in 2014. A total of 5,324 deaths were analyzed by sex, age, manner of death, and cause of death. With respect to the manner of death, 56.3% were recorded as unnatural deaths, 38.4% were natural deaths, and 5.3% had unknown causes. Of the 2,998 unnatural deaths, 41.0% were determined to be accidental deaths; 28.1%, suicidal; 16.1%, homicidal; and 14.8%, undetermined. Of the total number of unnatural deaths, 38.8% were trauma-related, wherein falls accounted for 32.7%. Asphyxiation accounted for 16.3% of unnatural deaths; of these, the predominant cause was hanging (59.4%). In addition, 15.0% of the unnatural deaths were due to drowning; 14.8%, poisoning; 11.3%, thermal injuries; 2.5%, complications arising from medical procedures; and 0.4%, electrocution, starvation, or neglect. Among the 2,042 natural deaths, heart diseases accounted for 49.0% and vascular diseases accounted for 17.3%. Of the 170 deaths among children under the age of 10, 38.8% were recorded as unnatural deaths, 54.1% were natural deaths, and 7.1% had unknown causes.

The Statistical Analysis on Legal Autopsy Performed in Korea during 2013 Year / 대한법의학회지

Medicolegal autopsy is a vital tool for obtaining reliable injury mortality data. This study statistically analyzed data obtained from medicolegal autopsies performed in Korea in 2013. The aim of this study was to analyze various aspects of the 4,861 deaths that were categorized as unusual in Korea in 2013. A total of 4,861 deaths were analyzed by gender, age, manner of death, and cause of death. Of the 4,861 deaths, 3,542 (73.3%) were of men and 1,302 (26.7%) were of women. With respect to the manner of death, 54.4% were recorded as unnatural deaths, 38.8% were natural deaths, and 6.9% had unknown causes. Of the 2,642 unnatural deaths, 45.0% were determined to be accidental deaths, 26.3% suicidal, 16.9% homicidal, and 11.8% undetermined. Of the total number of unnatural deaths, 42.1% were trauma-related deaths, for which falling down accounted for 33.8%. Asphyxiation accounted for 16.0% of unnatural deaths, and of these, the predominant cause was hanging (58.8%). In addition, 14.4% of deaths were due to drowning, 12.9% poisoning, 11.0% thermal injuries, 1.8% complications arising from medical procedures, and 0.8% electrocution, starvation, or neglect. Among the 1,886 natural deaths, heart diseases accounted for 52.0% and vascular diseases accounted for 16.9%. Of the 196 deaths among children under the age of 10 years, 41.8% were recorded as unnatural deaths, 45.1% were natural deaths, and 1.5% had unknown causes.

A Forensic Autopsy Case of Lissencephaly for Evaluating the Possibility of Child Abuse / 대한법의학회지

A 9-year-old Korean boy with lissencephaly was found dead at home. He had previously been diagnosed with lissencephaly that presented with infantile spasm on the basis of magnetic resonance imaging and electroencephalogram results. Antemortem chromosomal banding revealed a normal karyotype. A legal autopsy was requested to eliminate the possibility of neglect or abuse by his parents. The autopsy findings revealed type I lissencephaly with the associated microcephaly. No external wounds or decubitus ulcers were noted. Postmortem fluorescence in situ hybridization for the LIS1 locus and nucleotide sequence analysis of the whole coding regions of the LIS1 gene did not reveal any deletions. The antemortem and postmortem findings revealed that lissencephaly syndrome was associated with isolated lissencephaly sequence. External causes of death were excluded by the full autopsy and toxicology test results. Because patients with mental retardation are frequently victimized and suffer neglect or abuse, thorough external and internal examinations should be conducted at the time of autopsy.

The Statistical Analysis on Legal Autopsy Performed in Korea during 2012 Year / 대한법의학회지

This statistical analysis of 4,709 legal autopsies performed in Korea in 2012 was conducted to obtain primary data about and related variables. The analysis revealed the following: 1. Of the total number of deaths, men accounted for and women, 26.8%. Evidently, the number of deaths among men was more than twice that among women. 2. With respect to mode of death, 54.8% were recorded as unnatural deaths, 39.2% were natural deaths, and 6.0% had unknown causes. Of the 2,581 unnatural deaths, 44.8% were accidental deaths; 27.2%, suicidal; 17.5%, homicidal; and 10.3%, undetermined. 3. Of the total number of unnatural deaths, 43.0% were trauma-related deaths, for which falling down was the leading cause, accounting for 33.5% cases. Asphyxiation was accounted for 17.2%, among which the predominant cause was hanging (55.3%). Moreover, 12.5% of deaths were due to drowning; 11.5%, poisoning; 11.2%, thermal injuries; 2.7%, complications in medical procedures; and 0.3%, electrocution, starvation, or neglect. 4. Among 1,847 natural deaths, heart diseases accounted for 50.2% and vascular diseases accounted for 16.7%. 5. There were 207 cases of deaths among children under the age of 10, of which 94 were unnatural and 49 were homicidal deaths. Of all cases, 9.2% had an unknown cause of death, and of these 67.6%, were putrefied or skeletonized bodies.

Sudden Infant Death Syndrome in Korea: A Retrospective Analysis of Autopsy-Diagnosed Cases

This study aimed to elucidate the demographic and sleeping environmental factors associated with sudden infant death syndrome (SIDS) in Korea. The autopsy reports of all SIDS cases reported to the National Forensic Service and Seoul National University College of Medicine between 1996 and 2008 were reviewed for data collection and analysis to identify the risk factors for SIDS. Analysis of the 355 SIDS cases reported within the study period revealed that of the 168 (47.3%) cases for which sleeping position before death had been reported, 75 (44.7%) cases had occurred after placement in prone or side position. Of the 204 (57.5%) cases for which bed-sharing situation had been reported, 121 (59.3%) deaths had occurred during bed-sharing, of which 54 (44.6%) infants were under 3 months of age, a significantly younger age than that of the non-bed-sharing cases (P = 0.0279). Analysis of the results indicated no tendency toward an increase or decrease in the use of a prone or side position. Rather, there was a statistically significant increasing trend for bed-sharing over the study period (OR, 1.087; 95% CI, 1.004-1.177; P = 0.04). These findings indicate the need for nationwide educational programs promoting a safe sleeping environment to enhance SIDS prevention.

Medicolegal Death Investigation System in America / 대한법의학회지

Medicolegal death investigations in the U.S. have become a critical part of crime investigations over the past several decades. additionally, the roles of medical examiners (MEs) and coroners have expanded beyond the field of criminal justice in recent years. despite the fact that these roles are becoming increasingly more important a systematic and comprehensive study of this complicated system is yet to be conducted. Since there is no national standard or federal system, medicolegal death investigations vary across states, districts, and counties in the U.S. In this paper, we attempted to classify the systems into three categories. We also examined the roles and work procedures that MEs and coroners commonly share across the country as well as the problems and challenges that the medicolegal death investigation system is facing today. In addition, we have also provided a brief summary of the Korean system in order to add a comparative perspective, since the Korean legal system differs substantially that of the U.S.

The Statistical Analysis of Legal Autopsies in 2011 (The Headquarters of National Forensic Service) / 대한법의학회지

This is a statistical analysis of the data obtained from legal autopsies performed at the headquarters of the National Forensic Service during 2011. This report aims to analyze 2,723 cases. 1. There were 1,995 (73.3%) cases involving mortalities among men and 707 (26.7%) among women; evidently, the number of deaths that occurred among men were twice as many as that among women. With respect to age, 694 (24.4%) deaths occurred in individuals aged in their forties and 658 (22.8%) among those in their fifties. 2. There were 1,437 (52.8%) cases of unnatural deaths, 1,159 (42.5%) cases of natural deaths, and 127 (4.7%) deaths from unknown causes. Among the 1,437 unnatural deaths, 483 (33.6%) were suicidal, 255 (17.7%) homicidal, 546 (38.0%) accidental, and 153 (10.6%) were of undetermined causes. 3. There were 618 cases of trauma-related death, accounting for 43.0% of the 1,437 unnatural deaths. Blunt trauma was the leading cause of trauma-related deaths, accounting for 174 (28.2%) cases. Deaths due to asphyxiation, among which hanging (187 cases, 64.7%) was the predominant cause, accounted for 289 cases. There were 192 (13.4%) deaths from poisoning, 151 (10.5%) from drowning, 139 (9.7%) from thermal injuries, 31 (2.2%) as a complication of medical procedures, and 14 (1.0%) from electrocutions. 4. Among the 1,159 natural deaths, heart diseases accounted for 600 (51.8%) deaths and vascular diseases accounted for 160 (13.8%) deaths. 5. There were 83 cases of death among children aged under 10; out of 33 unnatural deaths, 20 (24.1%) cases were homicidal.

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

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.

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

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.

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

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.

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

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.

The Statistical Analysis on Legal Autopsy in 2010 (The headquarters of National Forensic Service) / 대한법의학회지

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Forensic Service (NFS), requested by every kind of law enforcement agencies during the year of 2010. NFS is located in Seoul, Korea and has four branches throughout the country. The Seoul NFS covers all legal autopsies in Seoul, Incheon City and Gyeonggi Province and some cases referred from other regions. This report aims to analyze various aspects of 2,425 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 1,777 cases (73.3%) and that of female 648 (26.7%). Male was over twice more than female. The forties were 592 cases (24.4%), the fifties 552 (22.8%), and these two decades occupied 47.2%. 2. Unnatural deaths were 1,377 cases (56.8%), natural 875 (36.1%), and the unknown 173 (7.1%). Among 1,377 unnatural deaths, suicide was 411 (29.8%), homicide 260 (18.9%, accident 417 (30.3%), and the undetermined 289 (21.0%). Homicide occupied 34.7% of trauma, 61.2% of blunt force injury excluding traffic and fall-down injury, and 81.4% of sharp force injury. The homicide rate in asphyxia was 23.9%, but it went up to 60.9% excluding hanging. It showed only 1.3% of homicide in poisoning. 3. Traumatic deaths were 536 cases, occupying 38.9% of 1,377 unnatural deaths, followed by poisoning. Blunt trauma was 138 cases (25.0%) and the leading cause of death in traumatic death. Poisoning was 245 cases, among which the alcohols were dominant (54 cases). Thermal injuries were 119 cases, electrocution 10 cases, and starvation/neglect 2 cases. and 48 cases were directly due to medical procedures. 4. Among 875 natural deaths, heart diseases were 583 cases (66.6%), and vascular diseases 64 (7.3%), and these two categories were added up to 647 (73.9%). 5. Child deaths under the age of 10 were 102 cases. Homicide was 25 cases (65.8%) out of 38 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 73 cases (71.6%).

Utility of Postmortem Autopsy via Whole-Body Imaging: Initial Observations Comparing MDCT and 3.0T MRI Findings with Autopsy Findings

OBJECTIVE: We prospectively compared whole-body multidetector computed tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy findings. MATERIALS AND METHODS: Five cadavers were subjected to whole-body, 16-channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radiologist classified the MDCT and 3.0T MRI findings into major and minor findings, which were compared with autopsy findings. RESULTS: Most of the imaging findings, pertaining to head and neck, heart and vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to autopsy findings. The causes of death that were determined on the bases of MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direction of external force. MRI was effective in evaluating and tracing the route of a metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. CONCLUSION: A postmortem MDCT combined with MRI is a potentially powerful tool, providing noninvasive and objective measurements for forensic investigations.

Application of Korean Mechanical 3D Bone Model to the MADYMO(R) / 대한법의학회지

MADYMO(R) (Mathematical Dynamic Models) is a computer software with a multibody dynamics solver, which can be employed to reconstruct and interpret dynamic motions of the human body in impacts. The human model of the software is composed of many ellipsoidal structures, which makes it possible to interpret dynamic whole-body motions and calculate applied forces to human body parts. However, this model has some disadvantage to interpret injuries of the smaller body parts such as ribs, vertebral bodies or intervertebral discs. After achieving the finite element bone model produced by CT and software BIONIX BODYBUILDER(R) (finite element modeller), we tried to import this model into the MADYMO(R) and parts of the human bone model were successfully imported to it. Importing of the whole bone model was, however, impossible because of the numerous elements. The coming experiments need to reduce the number of elements in the whole human bone model and incorporate ligaments, tendons and muscles into each separated part of bone models.

Forensic Review of Bullet Embolism / 대한법의학회지

One unusual case of bullet embolism is reported. The deceased is a 65-year-old man with a non-penetrating gunshot wound to the right lateral portion of chest. The autopsy was performed and showed fatal gunshot wounds were observed in liver, pericardium and heart, but no bullet was found in the chest. A postmortem radiologic examination showed a bullet in the left femoral area. A careful dissection of the left femoral area was performed and the bullet was found in the left femoral artery. A discussion of forensic significance of bullet embolism is presented.

Preliminary Research for Applying Appraisal Techniques to Evaluate the Cause of Skin Injury / 대한법의학회지

In the field of the forensic medicine, deciding the cause of the injury is very important. Forensic doctors usually use their naked eyes, two dimensional photos, the characteristics and the distribution of the wounds for evaluating the cause of the injuries. After body release, forensic doctors not infrequently met the questions from the law enforcement whether the injuries were matched with the new facts or statements given through the progression of the investigation. In the face of answering this question, the information or evidence about the injury is insufficient. New technologies and instruments are being developed and will be helpful for getting the evidence from the human skin injuries. In this preliminary study, authors try to find the usefulness of appraisal techniques(3D scanner, trace evidence, TMDT, alternative light) that are already used for other purposes in forensic field. These techniques have their own merits for preserving the evidences from the injured skin. But further studies and systemic approaches are essential for more scientifically verified evaluation of the cause of the skin injury.

Homicidal Transorbital Intracranial Injury by a Metallic Chopstick: a Case Report / 대한법의학회지

The transorbital intracranial injury is a rare penetrating brain injury and few homicidal cases were reported. We report a case of 37 year-old man who died from a homicidal transorbital intracranial injury. The assailant was one of his friends, who pierced his left eye by a metallic chopstick. Despite the intensive care, he died one week after. Postmortem examination revealed only a small laceration with subcutaneous hematoma in left lower eyelid, fractures of medial orbital roof, body of sphenoid bone and sella turcica, diffuse cerebral edema, basal subarachnoid hematoma, focal subdural hematoma, and intraventricular hematoma in the right lateral ventricle.

The plausible practicality of modern high-tech medical imaging devices to forensic medicine and scientific crime investigation / 대한법의학회지

CT and MRI are high-tech devices for medical diagnosis. Their electromechanical function has leaped forward such a fast step, so that their image quality is improved and the time for a whole body scanning is shortened as little as only several minutes. These essential diagnostic tools are tried to apply for the field of forensic medicine in favor of their noninvasiveness and great resolution. These merits could make our postmortem investigation system improve in the aspect of practicality. This presenting study was done for the purpose of expecting what the field of forensic medicine could get or lose, what is needed technically, and what kind of supports are required. In our preliminary study, we gave injuries to the pigs' heads with weapons, scanned the wounds with high-tech devices, and embodied the injuries and the weapons three-dimensionally. These high-tech methods would be expected to play a role in forensic medicine and scientific crime investigation as a new and powerful testimony.

Unexpected Death due to Massive Nontraumatic Intraabdominal Hemorrhage in association with Liver Cirrhosis / 대한법의학회지

We reports a woman's death caused by massive intraabdominal hemorrhage, who was in chronic alcoholic state with advanced liver cirrhosis and found dead in her room. No macroscopic source for the bleeding was found in her intraabdomen and there was no circumstances of traumatic forces to the individual's body around the death. The presenting unsuspected death could be consistent with the forensic pathological cases described as sudden, unexpected death due to massive nontraumatic intraabdominal hemorrhage in association with liver cirrhosis by DiMaio in 1987.