Legal Medicine RSS feed: Current Issue. Legal Medicine provides an international forum for the publication of original articles, reviews and correspondence on subjects that cover practical and theoretical areas of interest relating to the wide range of legal medicine. Subjects covered include forensic pathology, toxicology, odontology, anthropology, criminalistics, immunochemistry, hemogenetics and forensic aspects of biological science with emphasis on DNA analysis and molecular biology. Submissions dealing with medicolegal problems such as malpractice, insurance, child abuse or ethics in medical practice are also acceptable. http://www.legalmedicinejournal.com/?rss=yesElsevier Inc.en © 2012 Elsevier Ireland Ltd. All rights reserved. Legal Medicine1344-6223143May 2012 © 2012 Elsevier Ireland Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.legalmedicinejournal.com/article/PIIS1344622312000454/abstract?rss=yesEditorial Board10.1016/S1344-6223(12)00045-4Legal Medicine 14, 3 (2012)2012-05-01Legal Medicine2012-05-01143S1344-6223(12)X0003-8IFCIFChttp://www.legalmedicinejournal.com/article/PIIS1344622312000090/abstract?rss=yesAbstract: Malaria inflicts a huge health care burden in terms of mortality and morbidity worldwide. There has been evidence in the literature where many unexpected/unexplained deaths turned out to be related to malaria on autopsy. The aim of this study is to review autopsy diagnosed malaria related deaths in the literature with due stress to its biologic and forensic aspects. A meticulous literature search was performed for “sudden malaria death”, “malaria death postmortem diagnosis” and “unexplained death malaria” across PubMed, SCOPUS, Cochrane Database of Systematic Reviews, Allied and Complementary Medicine, British Nursing Index, CINAHL, EMBASE, Ovid-MEDLINE and Google Scholar. All the literature was thoroughly reviewed and analyzed with reference to the type of study, location, travel history, age, gender, circumstance of death, method of diagnosis, species involved, chemoprophylaxis usage and take home message from the particular study. Plasmodium falciparum was responsible in most of the cases. The symptoms mimicked influenza in most of the case reports. Travel to endemic areas was common to most of the victims. The travelers were from all over the world including USA, France, Switzerland, Spain, Portugal, Germany and Asia (China and Japan). Vascular congestion with the presence of malarial pigment laden RBCs in capillaries of various organs was the major histopathology finding. Such lesions were found in the brains of all subjects (100%), liver of 78% of the cases, spleen in 67%, lungs in 56% and myocardium in 43% of the cases. Peripheral smear and rapid diagnostic test was of great aid to the autopsy in many cases. PCR was used for diagnosis as well as exclusion of possibility of co-infection with other species in case of Plasmodium knowlesi related death. The postmortem and histopathology findings in this case were similar to P. falciparum except for the fact that brain sections were negative for intracellular adhesion molecule-1. Chemoprophylaxis was not taken by the victims except for two in whom history of chloroquine based chemoprophylaxis was mentioned. Given the worldwide prevalence of the disease, increasing international travel and rapidly developing drug resistance, malaria will continue to be an important disease and should be considered in all cases of unexpected deaths particularly in malaria endemic regions or in presence of travel history to endemic regions.Autopsy discoveries of death from malariaRitesh G. Menezes, Sadip Pant, Magdy A. Kharoshah, Subramanian Senthilkumaran, M. Arun, K.R. Nagesh, Nishanth B. Bhat, D.R. Mahadeshwara Prasad, Raj Kumar Karki, S.H. Subba, Abul Fazil10.1016/j.legalmed.2012.01.007Legal Medicine 14, 3 (2012)2012-02-27Legal Medicine2012-02-27143S1344-6223(12)X0003-8Review Article111115http://www.legalmedicinejournal.com/article/PIIS1344622312000028/abstract?rss=yesAbstract: Aims: The objective of this study was to explore the perception of the legal authorities regarding different report types and visualization techniques for post-mortem radiological findings.Methods: A standardized digital questionnaire was developed and the district attorneys in the catchment area of the affiliated Forensic Institute were requested to evaluate four different types of forensic imaging reports based on four cases examples. Each case was described in four different report types (short written report only, gray-scale CT image with figure caption, color-coded CT image with figure caption, 3D-reconstruction with figure caption). The survey participants were asked to evaluate those types of reports regarding understandability, cost effectiveness and overall appropriateness for the courtroom.Results and conclusion: 3D reconstructions and color-coded CT images accompanied by written report were preferred regarding understandability and cost/effectiveness. 3D reconstructions of the forensic findings reviewed as most adequate for court.Format preferences of district attorneys for post-mortem medical imaging reports: Understandability, cost effectiveness, and suitability for the courtroom: A questionnaire based studyGaryfalia Ampanozi, David Zimmermann, Gary M. Hatch, Thomas D. Ruder, Steffen Ross, Patricia M. Flach, Michael J. Thali, Lars C. Ebert10.1016/j.legalmed.2011.12.008Legal Medicine 14, 3 (2012)2012-02-20Legal Medicine2012-02-20143S1344-6223(12)X0003-8Original Articles116120http://www.legalmedicinejournal.com/article/PIIS134462231200003X/abstract?rss=yesAbstract: In criminal investigations, usually it is necessary to identify whether blood spots found at crime scenes are from humans or not. Nowadays, immunohistochemical methods and DNA analysis are usually used for this purpose. However, such methods and DNA analysis are labor intensive and expensive, and require highly trained skilled technicians. Recently, the genome profiling method (GP method) was developed. However, its use as a human DNA analysis method has not been reported. In this report, an attempt was made to differentiate human blood samples from animal blood samples using the GP method for forensic purposes.DNA extracted from a rat, squirrel, cat, dog, cow, and antelope along with human blood samples were analyzed. Following cluster analysis the human samples clustered into a single group separate from the animal samples. Therefore, although the number of samples was small the results suggest that the GP method might enable us to differentiate human samples from various animal samples. It may become a powerful tool in the field of forensic science.Human blood identification using the genome profiling methodNagisa Suwa, Hiroshi Ikegaya, Tomokazu Takasaka, Koichi Nishigaki, Koichi Sakurada10.1016/j.legalmed.2012.01.001Legal Medicine 14, 3 (2012)2012-01-30Legal Medicine2012-01-30143S1344-6223(12)X0003-8Original Articles121125http://www.legalmedicinejournal.com/article/PIIS1344622312000089/abstract?rss=yesAbstract: A liquid chromatography–tandem mass spectrometry method was developed and validated for simultaneous determination of four aconitines (aconitine, mesaconitine, hypaconitine, jesaconitine) and seven of their hydrolysis products (benzoylmesaconine, benzoylhypaconine, 14-O-anisoylaconine, benzoylaconine, aconine, mesaconine, hypaconine) in human serum and urine samples. Extraction was undertaken using a mixed-mode cation-exchange cartridge (OASIS MCX), and D5-aconitine was used as an internal standard. Separation of aconitum alkaloids was carried out using an L-column ODS with the mobile phase consisting of 10mM ammonium formate and methanol. The intra- and inter-day precisions were 0.3% to 9.9% and 3.2% to 12.8%, respectively. Intra- and inter-day accuracies were −14.1% to 7.3%, and −10.6% to 8.3%, respectively. The limit of detection and limit of quantification of analytes were 0.04–0.38ng/mL and 0.12–1.15ng/mL respectively. This method was applied in an autopsy case and successfully detected aconitines and their metabolites as well as some anti-psychiatric drugs.Simultaneous determination of 11 aconitum alkaloids in human serum and urine using liquid chromatography–tandem mass spectrometryKiyotaka Usui, Yoshie Hayashizaki, Masaki Hashiyada, Anri Nakano, Masato Funayama10.1016/j.legalmed.2012.01.006Legal Medicine 14, 3 (2012)2012-02-17Legal Medicine2012-02-17143S1344-6223(12)X0003-8Original Articles126133http://www.legalmedicinejournal.com/article/PIIS1344622312000107/abstract?rss=yesAbstract: We measured concentrations of sodium (Na), chloride (Cl), calcium (Ca), and magnesium (Mg) in pleural effusion from forensic autopsy cases to examine whether they were useful for a diagnosis of drowning. We analyzed a total of 51 cases (15 seawater drowning, 10 freshwater drowning, and 26 non-drowning), and determined the following reference values. If the concentration of Na or Cl is under 65mEq/l, a diagnosis of freshwater drowning can be made. If the concentration of Na is higher than 175mEq/l, or that of Cl is higher than 155mEq/l, or that of Ca is higher than 16mg/dl, or that of Mg is higher than 15mg/dl, a diagnosis of seawater drowning can be made. We recommend that pleural effusion from the left and the right thoracic cavities should be collected and analyzed separately because large differences may be observed between each side in the case of drowning. If one side corresponds to the reference value for seawater or freshwater drowning and the other side does not, a diagnosis of drowning can still be made according to the obtained value.Application of electrolyte analysis of pleural effusion to diagnosis of drowningKotaro Matoba, Manabu Murakami, Akira Hayakawa, Koichi Terazawa10.1016/j.legalmed.2012.01.008Legal Medicine 14, 3 (2012)2012-02-27Legal Medicine2012-02-27143S1344-6223(12)X0003-8Original Articles134139http://www.legalmedicinejournal.com/article/PIIS1344622312000119/abstract?rss=yesAbstract: C-reactive protein (CRP) is a widely used acute phase protein that reacts to various tissue-destroying stimuli. Its forensic applications have been established in prior studies. We show that CRP can be successfully measured even after a long postmortem period, up to 18days, which has not previously been reported. Information on elevated CRP levels can be very valuable for the forensic pathologist in autopsy cases with scarce findings. The interpretation of results can be very challenging, as the elevation can originate from many different reasons, and due to the biochemical changes in cadavers. One less studied possible reason for elevated CRP is ketoacidosis. Here, we present a study on the effect of both alcoholic and diabetic ketoacidosis on blood CRP elevation in forensic autopsy material. Our results imply that ketoacidosis itself can cause a rise in CRP without other underlying causes, such as infection or trauma. However, more comprehensive studies are required to confirm the relationship between ketoacidosis and CRP level elevation.Postmortem measurement of C-reactive protein and interpretation of results in ketoacidosisKatarina Lindroos-Jokinen, Terhi Keltanen, Teija Vanhala, Tiina Valonen, Antti Sajantila10.1016/j.legalmed.2012.01.009Legal Medicine 14, 3 (2012)2012-02-27Legal Medicine2012-02-27143S1344-6223(12)X0003-8Original Articles140146http://www.legalmedicinejournal.com/article/PIIS1344622312000338/abstract?rss=yesAbstract: The aim of this study was to investigate the difference between the pharmacokinetics of haloperidol in normal rats and in rats with fatty liver disease. A therapeutic dosage (0.1mg/kg) and a toxic dose (15mg/kg) of haloperidol were administrated to normal 9-week-old male rats or those with severe fatty liver disease, and the blood concentration of haloperidol was determined 15min, 1, 2, and 3h following haloperidol administration. The concentration of haloperidol in the organs was determined 1, 2, and 3h after the haloperidol administration. Additionally, the volume of the portal vein blood flow was measured 3h after haloperidol administration. When given at the therapeutic dosage, the concentrations of haloperidol in both the blood and organs of the rats with fatty liver disease were significantly higher than those in the normal rats. However, when given at the toxic level, the blood and organ haloperidol concentrations 1h after administration tended to be lower in the rats with fatty liver disease than those in the normal rats; these lower haloperidol levels returned to be the levels in the normal rats 3h after the administration of haloperidol. The volume of the portal vein blood flow significantly increased following the toxic haloperidol dose as compared with the volume pre-administration and following the therapeutic haloperidol dose in the normal rats. However, the volume did not change after the toxic or the therapeutic dose of haloperidol compared with pre-administration in rats with severe fatty liver disease, although it was significantly higher than in the normal rats. The pathway for haloperidol metabolism might have been saturated before the administration of haloperidol in rats with fatty liver disease; thus, it is possible that the blood concentration of haloperidol tends to be much higher in individuals with severe fatty liver disease than in those with normal livers in an inverse proportion to the dosage of haloperidol.The blood concentration and organ distribution of haloperidol at therapeutic and toxic doses in severe fatty liver diseaseMayumi Ikemura, Yasuhisa Nakagawa, Kotaro Shinone, Hiromasa Inoue, Masayuki Nata10.1016/j.legalmed.2012.01.012Legal Medicine 14, 3 (2012)2012-02-27Legal Medicine2012-02-27143S1344-6223(12)X0003-8Original Articles147153http://www.legalmedicinejournal.com/article/PIIS1344622312000053/abstract?rss=yesAbstract: The case of a female in the latter half of her teens found dead in her father’s apartment is reported. A glass containing liquid and plant remnants was found at the death scene. There were no indications of any intervention or the application of force by a third party.Autopsy showed unremarkable findings. Toxicological investigations revealed lethal doses of aconitine, a highly poisonous alkaloid and the major active compound of Aconitum napellus, in all specimens. Plant remnants were identified as A. napellus leaves by a botanist and toxicological examination of the liquid in the glass on site showed extremely high concentrations of aconitine.Additionally, laboratory results revealed that the young female was suffering from thyrotoxicosis factitia, an uncommon form of hyperthyroidism caused by misuse or overdosing of thyroid hormones in order to loose weight. A rare but serious and often fatal complication of hyperthyroidism is thyroid storm.Eventually the condition of thyroid storm due to thyrotoxicosis factitia could have contributed to the woman’s death from aconitine poisoning.Fatal aconitine intoxication or thyroid storm? A case reportE.M. Arlt, T. Keller, H. Wittmann, F. Monticelli10.1016/j.legalmed.2012.01.003Legal Medicine 14, 3 (2012)2012-02-17Legal Medicine2012-02-17143S1344-6223(12)X0003-8Case Reports154156http://www.legalmedicinejournal.com/article/PIIS1344622312000120/abstract?rss=yesAbstract: Transmesenteric hernias are internal hernias caused by a congenital defect in the mesentery. They are rare causes of intestinal obstruction, but most commonly affect the small bowel. We report an unexpected death of an infant with a bowel obstruction caused by a congenital mesenteric defect, which was undiagnosed despite visits to three different hospitals. Mesenteric defects are usually 2–3cm in diameter. At autopsy, we found an oval, 14×7cm congenital defect in the ileal mesentery through which the small bowel had herniated. Diagnosis of such defects remains difficult, even with currently available imaging techniques. Diagnosis is particularly difficult in infants who usually have nonspecific symptoms. Therefore, it is important that sudden unexpected deaths in children undergo full forensic evaluation to establish the precise cause of death. It is also important for forensic physicians to inform clinicians of the risk of such diseases, particularly in emergency situations.Sudden death of a child because of an intestinal obstruction caused by a large congenital mesenteric defectTakako Sato, Shuntaro Abe, Kento Tsuboi, Misa Iwata, Akiyoshi Tamura, Hitoshi Tsuchihashi, Hajime Nishio, Koichi Suzuki10.1016/j.legalmed.2012.01.010Legal Medicine 14, 3 (2012)2012-03-01Legal Medicine2012-03-01143S1344-6223(12)X0003-8Case Reports157159http://www.legalmedicinejournal.com/article/PIIS1344622312000077/abstract?rss=yesAbstract: To preliminarily evaluate the applicability of bacterial DNA as a marker for the forensic identification of vaginal fluid, we developed and performed PCR-based detection of 16S ribosomal RNA genes of Lactobacillus spp. dominating the vagina and of bacterial vaginosis-related bacteria from DNA extracted from body fluids and stains. As a result, 16S ribosomal RNA genes of Lactobacillus crispatus, Lactobacillus jensenii and Atopobium vaginae were specifically detected in vaginal fluid and female urine samples. Bacterial genes detected in female urine might have originated from contaminated vaginal fluid. In addition, those of Lactobacillus iners, Lactobacillus gasseri and Gardnerella vaginalis were also detected in non-vaginal body fluids such as semen. Because bacterial genes were successfully amplified in DNA samples extracted by using the general procedure for animal tissues without any optional treatments, DNA samples prepared for the identification of vaginal fluid can also be used for personal identification. In conclusion, 16S ribosomal RNA genes of L. crispatus, L. jensenii and A. vaginae could be effective markers for forensic identification of vaginal fluid.Detection of bacterial 16S ribosomal RNA genes for forensic identification of vaginal fluidTomoko Akutsu, Hisako Motani, Ken Watanabe, Hirotaro Iwase, Koichi Sakurada10.1016/j.legalmed.2012.01.005Legal Medicine 14, 3 (2012)2012-02-10Legal Medicine2012-02-10143S1344-6223(12)X0003-8Brief Communication160162http://www.legalmedicinejournal.com/article/PIIS1344622312000065/abstract?rss=yesAbstract: Allele frequencies and forensic parameters were estimated for 11 X chromosome STRs (DXS9898, DXS7424, DXS981, DXS8377, DXS9895, DXS10161, DXS10164, DXS6800, DXS6801, DXS9902 and DXS7423) from 749 samples of unrelated male individuals belonging to eleven populations of India.Population genetic data for 11 X-STR loci in eleven populations of IndiaSanjukta Mukerjee, Meeta Mukherjee, Tania Ghosh, D. Kalpana, Anil Kumar Sharma10.1016/j.legalmed.2012.01.004Legal Medicine 14, 3 (2012)2012-02-10Legal Medicine2012-02-10143S1344-6223(12)X0003-8Announcement of Population Data163165