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.

Autopsy study of fatal deliberate self harm.

A retrospective autopsy study of fatal deliberate self harm (FDSH) was undertaken in the mortuary of Kasturba Hospital, Manipal, Southern India over a period of 12 years (1993-2004). Out of 1917 cases autopsied, 21.2% were deaths due to deliberate self harm (DSH). The male sex (66.1%) and victims in the third decade of life (35.9%) predominated. More than two-thirds of the decedents were married. More fatalities were observed during the winter season (35.8%) and in the day time (62.2%). Dispair with life (61.9%) was the most common motive for FDSH. The majority of fatalities were due to poisoning (73.5%), where organophosphorous compounds topped the list (71.9%). About one-third of the victims survived for 18 to 24 hours after DSH.

Atypical fatal entry wound to the thigh--a case report.

Stab wounds encountered in medico-legal practice are caused by sharp or blunt pointed weapons such as a kitchen knife, dagger, screwdriver, iron rod, etc. Atypical entry wounds may result from elasticity of skin, relative movement of the victim or the offending weapon or both. These are often described in the literature. We report an unusual incised stab injury of the thigh where a single atypical entry wound resulted in injury to the femoral vessels. The precise causation of such a peculiar entry wound cannot be explained, though it can be considered within the dynamic processes involved between victim, assailant and the offending weapon. It is recorded because of its academic curiosity.

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.

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.

Wounds due to a modified shot gun (home-made): a case report.

In a case of firearm fatality, the autopsy surgeon is required to opine as to the range of fire in addition to the cause of death which will help in reconstruction of the events. Problems may arise in estimating the range of fire based on wound ballistics when there is an alteration or modification in the internal ballistics. We encountered such a case in the department of Forensic Medicine, Kasturba Medical College, Manipal, which is discussed.

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

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.

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.