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1.
Article in English | WPRIM (Western Pacific) | ID: wpr-1044690

ABSTRACT

Compressive asphyxia is generally defined as a type of asphyxia caused by chest or abdominal compression by a heavy object. It has also been reported that it could be caused by external compression caused by ligatures around the chest or abdomen. However, asphyxia caused by ligature around the thorax has not been reported in suicide cases. We present an unusual case of suicide in which the cause of death was attributed to asphyxia caused by a ligature around the thorax. The deceased was a 41-year-old woman who was found dead and suspended by a rope around the thorax from a rooftop railing on the twelfth floor of a building. On postmortem examination, a ‘C’ shaped ligature mark was identified around the thorax, with a pressure mark in the subcutis and focal intramuscular hemorrhages, which were consistent with the ligature mark. The cause of death was determined to be asphyxia due to external compression of the chest in a suspended position.

2.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-1044697

ABSTRACT

Positional asphyxia is a type of asphyxia where the position of an individual compromises the ability to breathe. It is commonly caused by accidents due to alcohol or drug intoxication, diseases, and/or being in a confined space. In this study, the authors reviewed autopsy cases at their institute over the past 5 years where positional asphyxia is suspected as a contributing factor or cause of death. The autopsy cases (n=24) were divided into three groups: positional asphyxia was the cause of death (n=15); unknown cause of death but positional asphyxia was considered (n=4); and positional asphyxia was suspected to be a contributing factor (n=5). All cases of group A included postures that could interfere with breathing, but the typical jackknife or head-down postures were seen in approximately half of the cases; “classic signs of asphyxia” were also observed in approximately half of the cases. They shared features such as high blood alcohol concentration, therapeutic levels of drugs, various disease, minor head trauma, and morbid obesity; however, no definite diagnostic criteria have been established for forensic practice. Positional asphyxia is a form of mechanical asphyxia which must be differentiated from traumatic asphyxia. In addition to a complete autopsy, thorough laboratory tests and understanding of the circumstances of the case and the situation at the death scene are required for diagnosis. Special attention is required for the diagnosis of special types of positional asphyxia such as death during institutional restraint or prone restraint.

3.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-1002271

ABSTRACT

This study highlights a new case of an infant death caused by mechanical asphyxia, who was found dead after being wrapped and pressed by a daycare center teacher with the body and beddings. Moreover, we present a comparative review of four similar previously reported cases and the implications for forensic pathologists in the management of such cases from the perspectives of judicial verdicts of the cases. The previous report commented that the four cases could be considered as overlaying as a type of accidental asphyxia. However, a contextual comprehensive review including the whole scenarios of the cases and negative postmortem findings concluded that all the cases were explicitly different from overlaying cases. Furthermore, we followed up the judicial processes and verdicts in all five cases, including the present case and the four previously reported cases. In the four cases, the defendants were incarcerated for violation of ‘Act on Special Cases Concerning the Punishment of Child Abuse Crimes.’ The ruling trend revealed that the prison sentence durations had been prolonged from 4 to 19 years. Therefore, for a pediatric death suspecting mechanical asphyxia involving a daycare center, contextual comprehensive approach is essential to determine the cause of death and to provide appropriate medicolegal interpretation.

4.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-938549

ABSTRACT

For the diagnosis of drowning in immersed bodies, the diatom test has been controversial due to false-negative and false-positive results. Causes of false positive results include antemortem penetration of diatoms, and postmortem contamination during the submersion or the diatom preparation process. Herein, we report a false-positive case in a 30-year-old woman who died from homicidal multiple stab wounds and was thrown into a shallow farm waterway approximately 10 days after her death. In addition, a discussion on the false-positive diatom test results in immersed bodies with penetrating wounds is provided.

5.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-926667

ABSTRACT

Esophageal foreign body impaction may be fatal secondary to occlusion of the glottis or external compression of the membranous portion of the trachea. A 14-year-old adolescent female was admitted to the emergency department for evaluation of sudden dyspnea and cyanosis after she swallowed a food bolus (a part of bachelor radish kimchi) without chewing. Unfortunately, the patient died despite cardiopulmonary resuscitation. Autopsy findings showed an ovoid, firm foreign body (3.5×2.5×2 cm) impacted in the proximal esophagus, with focal narrowing of the tracheal lumen secondary to external compression by esophageal foreign body impaction. Death was attributed to choking caused by an esophageal foreign body.

6.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-917815

ABSTRACT

Histiocytoid cardiomyopathy, an extremely rare heart disease in infants and children, usually occurring in girls under the age of 2 years, is characterized by cardiomegaly, ventricular arrhythmia, and sudden death. In the present study, we report a case of a 2-day-old female neonate who suddenly showed cyanosis and cardiac arrest in the neonatal unit and died without resuscitation. Autopsy revealed multifocal nodular lesions in the left ventricle wall and papillary muscles. Microscopically, these lesions were composed of discohesive round or polygonal cells with eosinophilic cytoplasm and were positive for desmin and negative for CD68. Electron microscopy findings displayed abnormal swollen mitochondria with disorganized cristae, dense granules, and diminished myofibrils in the periphery of the cytoplasm.

7.
Article | WPRIM (Western Pacific) | ID: wpr-836580

ABSTRACT

Sodium nitrite intoxication is a primary cause of severe methemoglobinemia, which may be fatal. In the past, nitrite-related deaths were rare, but cases of suicide with nitrite have been increasing in number in recent years. We analyzed 14 cases of fatal nitrite intoxication from January 2013 to February 2019. There was a different trend between the cases from the past and those from recent years. The former consisted of older individuals who ingested nitrite accidentally or intentionally, while the latter comprised younger individuals who used nitrite mostly for suicide. Most individuals showed dark purple or dark brown lividity and cherry-pink discoloration of the muscles. Postmortem methemoglobin levels, which were analyzed in 5 cases, were 30%-49%. Most nitrite and nitrate concentrations showed the highest concentration in the stomach contents, and it showed that the nitrite was converted into nitrate in the blood. To conclude, methemoglobin tests using a portable oximeter and quantitative tests of nitrite and nitrate, as well as a thorough investigation of the case and scene may help determine the cause of death.

8.
Article in English | WPRIM (Western Pacific) | ID: wpr-917791

ABSTRACT

The deceased was found in the basement staircase of a commercial building. He was drunk the night before his death. He went into the building at 00:45 am as per the security camera recording. He was found at 9:10 am in an inverted and jackknife position causing the hyperflexion of his torso and neck. Autopsy findings revealed facial congestion and conjunctival petechiae. No evidence of critical trauma was noted. Therefore, he can be diagnosed with positional asphyxia. He must have lost his body balance and fallen on his back while climbing up the basement staircase for unknown reasons. His lower body was found to be in the jackknife position due to inertia. The drunken state and the accident prevented movement and this position was sustained for an extended period.

9.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-917797

ABSTRACT

Most sharp force fatalities are attributed to homicide or suicide, with only a few accidental cases reported to date. Broken glass accounts for most of these accidental fatalities. We herein report an unusual accidental death caused by a broken glass cup. A 21-year-old woman was found dead on the floor of her studio apartment. The studio was a duplex consisting of one room and a bathroom, with a stepped drawer leading to the second floor. She was lying face down with her legs spread apart in a large pool of blood, surrounded by many pieces of broken glass. There was an oblique cut measuring 9 cm in length in the right sternocleidomastoid region just above the right clavicle. The surface of the cut wound showed irregular edges and the internal jugular vein was severed in the depth of the wound. She appeared to have fallen down the steps onto the ground floor and been fatally injured in the neck by a piece of broken glass.

10.
Article in English | WPRIM (Western Pacific) | ID: wpr-759867

ABSTRACT

The deceased was found in the basement staircase of a commercial building. He was drunk the night before his death. He went into the building at 00:45 am as per the security camera recording. He was found at 9:10 am in an inverted and jackknife position causing the hyperflexion of his torso and neck. Autopsy findings revealed facial congestion and conjunctival petechiae. No evidence of critical trauma was noted. Therefore, he can be diagnosed with positional asphyxia. He must have lost his body balance and fallen on his back while climbing up the basement staircase for unknown reasons. His lower body was found to be in the jackknife position due to inertia. The drunken state and the accident prevented movement and this position was sustained for an extended period.


Subject(s)
Accidental Falls , Asphyxia , Autopsy , Estrogens, Conjugated (USP) , Neck , Purpura , Torso
11.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-740692

ABSTRACT

Most sharp force fatalities are attributed to homicide or suicide, with only a few accidental cases reported to date. Broken glass accounts for most of these accidental fatalities. We herein report an unusual accidental death caused by a broken glass cup. A 21-year-old woman was found dead on the floor of her studio apartment. The studio was a duplex consisting of one room and a bathroom, with a stepped drawer leading to the second floor. She was lying face down with her legs spread apart in a large pool of blood, surrounded by many pieces of broken glass. There was an oblique cut measuring 9 cm in length in the right sternocleidomastoid region just above the right clavicle. The surface of the cut wound showed irregular edges and the internal jugular vein was severed in the depth of the wound. She appeared to have fallen down the steps onto the ground floor and been fatally injured in the neck by a piece of broken glass.


Subject(s)
Female , Humans , Young Adult , Clavicle , Deception , Glass , Homicide , Jugular Veins , Leg , Neck , Neck Injuries , Suicide , Wounds and Injuries
12.
Article in English | WPRIM (Western Pacific) | ID: wpr-917768

ABSTRACT

Popliteal venous aneurysms can be a cause of fatal pulmonary thromboembolism. We report a case of a 47-year-old woman who suddenly died of fatal pulmonary thromboembolism. Deep vein thrombosis was not observed, but a venous aneurysm with intraluminal thrombi formation was identified on the left popliteal vein. This case illustrates that venous aneurysms can be presented as fatal pulmonary thromboembolism, and that they should be considered as a rare cause of pulmonary thromboembolism.

13.
Article in English | WPRIM (Western Pacific) | ID: wpr-917775

ABSTRACT

Venipuncture is a routine and relatively safe and painless medical procedure, necessary for accurate diagnosis and treatment. However, given that pain related to medical procedures may have adverse effects for children, could venipuncture cause deaths in infants and children? We analyzed our cases of unexpected death after venipuncture and conducted a literature review on them. A vasovagal response to noxious stimuli may explain such a sudden death immediately after venipuncture, commonly presented as needle phobia, breath-holding spell, and reflex anoxic seizure in the literature, despite the fact that the current medical evidence is not enough to prove their casual relationship. In addition, pain prevention and management during medical procedure is incorporated in clinical guidelines for pediatric patients, because painful medical procedures negatively affect child development. Thus, prevention and management of pain related to medical procedure may be helpful to avoid an adverse vasovagal response to noxious stimuli from occurring.

14.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-917776

ABSTRACT

Recently, fatal nicotine intoxications with electronic cigarette liquid have increased in Korea, but various kinds of cigarettes and smoking cessation aids may also cause fatal poisoning. We report cases of fatal nicotine intoxications involving causes other than the use of liquid nicotine. A 29-year-old woman (case 1) found dead in a hotel room with about 70 patches (21 mg dose) of nicotine on her body. Blood nicotine levels were 7.68 mg/L (heart) and 3.25 mg/L (femoral). A toxic level of zolpidem was also detected. A 28-year-old Uzbekistan man (case 2) was found dead in his uncle's room with his face covered with chewing tobacco. Blood nicotine levels were 7.3 mg/L (heart) and 4.6 mg/L (femoral). Blood alcohol level was 0.139%. A 55-year-old man (case 3) bit his tongue. As he was taken to the hospital, his wife put tobacco powders in his mouth for hemostasis, and he died of cardiac arrest. Blood nicotine levels were 2.01 mg/L (heart) and 0.96 mg/L (femoral). Nicotine-related deaths can be caused by various types of administration including transdermal and transmucosal routes, and relatively small doses may cause death, so meticulous investigation should be taken when such deaths are suspected.

15.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-917783

ABSTRACT

In Korea, small octopus (Octopus minor) and webfoot octopus (Octopus ocellatus) are food items and fatal laryngeal choking due to ingestion of live octopus is not uncommon. We recently encountered two autopsy cases of accidental choking on small octopus and webfoot octopus. Case 1 involved a 58-year-old fisherman who ingested two live webfoot octopuses in his fishing boat and collapsed. He was immediately taken to the hospital but died. During autopsy, one of the webfoot octopuses was found between his pharynx and esophagus; it was obstructing the epiglottis and upper esophagus. His blood alcohol concentration was 0.140%. Case 2 involved a 55-year-old man who ingested an intact body part of a small octopus and was found dead in his house. He had a history of cerebral infarction and angina pectoris. During autopsy, an intact body part of the small octopus was found to be lodged in the laryngeal inlet.

16.
Article in English | WPRIM (Western Pacific) | ID: wpr-740670

ABSTRACT

Venipuncture is a routine and relatively safe and painless medical procedure, necessary for accurate diagnosis and treatment. However, given that pain related to medical procedures may have adverse effects for children, could venipuncture cause deaths in infants and children? We analyzed our cases of unexpected death after venipuncture and conducted a literature review on them. A vasovagal response to noxious stimuli may explain such a sudden death immediately after venipuncture, commonly presented as needle phobia, breath-holding spell, and reflex anoxic seizure in the literature, despite the fact that the current medical evidence is not enough to prove their casual relationship. In addition, pain prevention and management during medical procedure is incorporated in clinical guidelines for pediatric patients, because painful medical procedures negatively affect child development. Thus, prevention and management of pain related to medical procedure may be helpful to avoid an adverse vasovagal response to noxious stimuli from occurring.


Subject(s)
Child , Humans , Infant , Autopsy , Child Development , Death, Sudden , Diagnosis , Forensic Pathology , Infant Death , Needles , Phlebotomy , Phobic Disorders , Reflex , Seizures
17.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-740671

ABSTRACT

Recently, fatal nicotine intoxications with electronic cigarette liquid have increased in Korea, but various kinds of cigarettes and smoking cessation aids may also cause fatal poisoning. We report cases of fatal nicotine intoxications involving causes other than the use of liquid nicotine. A 29-year-old woman (case 1) found dead in a hotel room with about 70 patches (21 mg dose) of nicotine on her body. Blood nicotine levels were 7.68 mg/L (heart) and 3.25 mg/L (femoral). A toxic level of zolpidem was also detected. A 28-year-old Uzbekistan man (case 2) was found dead in his uncle's room with his face covered with chewing tobacco. Blood nicotine levels were 7.3 mg/L (heart) and 4.6 mg/L (femoral). Blood alcohol level was 0.139%. A 55-year-old man (case 3) bit his tongue. As he was taken to the hospital, his wife put tobacco powders in his mouth for hemostasis, and he died of cardiac arrest. Blood nicotine levels were 2.01 mg/L (heart) and 0.96 mg/L (femoral). Nicotine-related deaths can be caused by various types of administration including transdermal and transmucosal routes, and relatively small doses may cause death, so meticulous investigation should be taken when such deaths are suspected.


Subject(s)
Adult , Female , Humans , Middle Aged , Blood Alcohol Content , Electronic Nicotine Delivery Systems , Heart Arrest , Hemostasis , Korea , Mouth , Nicotine , Poisoning , Powders , Smoking Cessation , Spouses , Nicotiana , Tobacco Products , Tobacco Use Cessation Devices , Tobacco, Smokeless , Tongue , Uzbekistan
18.
Article in English | WPRIM (Western Pacific) | ID: wpr-740678

ABSTRACT

Popliteal venous aneurysms can be a cause of fatal pulmonary thromboembolism. We report a case of a 47-year-old woman who suddenly died of fatal pulmonary thromboembolism. Deep vein thrombosis was not observed, but a venous aneurysm with intraluminal thrombi formation was identified on the left popliteal vein. This case illustrates that venous aneurysms can be presented as fatal pulmonary thromboembolism, and that they should be considered as a rare cause of pulmonary thromboembolism.


Subject(s)
Female , Humans , Middle Aged , Aneurysm , Forensic Pathology , Popliteal Vein , Pulmonary Embolism , Venous Thrombosis
19.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-740683

ABSTRACT

In Korea, small octopus (Octopus minor) and webfoot octopus (Octopus ocellatus) are food items and fatal laryngeal choking due to ingestion of live octopus is not uncommon. We recently encountered two autopsy cases of accidental choking on small octopus and webfoot octopus. Case 1 involved a 58-year-old fisherman who ingested two live webfoot octopuses in his fishing boat and collapsed. He was immediately taken to the hospital but died. During autopsy, one of the webfoot octopuses was found between his pharynx and esophagus; it was obstructing the epiglottis and upper esophagus. His blood alcohol concentration was 0.140%. Case 2 involved a 55-year-old man who ingested an intact body part of a small octopus and was found dead in his house. He had a history of cerebral infarction and angina pectoris. During autopsy, an intact body part of the small octopus was found to be lodged in the laryngeal inlet.


Subject(s)
Humans , Middle Aged , Airway Obstruction , Angina Pectoris , Autopsy , Bays , Blood Alcohol Content , Cerebral Infarction , Eating , Epiglottis , Esophagus , Korea , Larynx , Octopodiformes , Pharynx , Ships
20.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-107261

ABSTRACT

Nitrous oxide is medically used as an anesthetic gas and as an additive in whipped cream production. Few cases of death from nitrous oxide intoxication have been reported in Korea. However, fatalities due to inhalation of pure nitrous oxide in an amount enough to cause death have been recently increasing. We report two cases of death related to nitrous oxide abuse with a review of literature focusing on the fact that nitrous oxide abuse can be considered as a possible cause of death if appliances with nitrous oxide contents were found during the investigation, and the autopsy and toxicological findings cannot be attributed to nitrous oxide intoxication.


Subject(s)
Autopsy , Cause of Death , Inhalant Abuse , Inhalation , Korea , Nitrous Oxide , Toxicology
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