MyMedR

Displaying publications 1 - 20 of 39 in total

Abstract:

Sort:

Progressive gas formation in a deceased person during mortuary storage demonstrated on computed tomography

Singh MK, O'Donnell C, Woodford NW

Forensic Sci Med Pathol, 2009;5(3):236-42.
PMID: 19669956 DOI: 10.1007/s12024-009-9103-y

We report the case of an 82-year-old woman with a past history of diabetes mellitus who died following blunt head injury sustained in a fall resulting in an acute subdural hematoma. Serial postmortem CT scans of the chest and abdomen performed over a 3-day period demonstrated progressive intra-hepatic and intra-cardiac gas formation whilst the deceased was stored in a standard mortuary refrigerator at a nominated temperature of 4 degrees C. Measured mortuary refrigerator temperatures over a 7 day period showed statistically significant day to day variability in temperatures above 4 degrees C as well as variations in temperature depending on location within the refrigerator space. In the absence of other known factors associated with such gas formation, putrefaction seems the likely cause despite a lack of obvious external features. This phenomenon must therefore be taken into account when interpreting the presence of visceral gas on postmortem CT and relating such gas to the cause of death.

Matched MeSH terms: Forensic Pathology
Choking on food: a rare case of alexander leukodystrophy and choking

Murty OP, Mun K, Gopinath N, Wong KT

Am J Forensic Med Pathol, 2008 Dec;29(4):364-7.
PMID: 19259028 DOI: 10.1097/PAF.0b013e3181859ff7

Every body has to eat to survive but it becomes a matter of great concern, when the life provider food becomes an asphyxiating agent. In this case, a 60-year-old woman choked herself while swallowing biscuits. On autopsy examination, biscuits were found lodged in larygo-pharynx. Brain showed marked dystrophy and loosened lusterless white matter. On histopathologic examination, brain tissue had numerous eosinophilic globules representing astrocytic processes called "Rosenthal fibers"; hence, it was diagnosed as a case of Alexander dystrophy. It is a disease of white matter, where there is a progressive degeneration of the white matter of the brain because of imperfect growth or development of the myelin sheath. The histopathology of brain showed Rosenthal fibers in abundance. This is one of the rarest disease in which choking can occur because of lack of nervous and muscular coordination and weakness. Its specific relation to choking is documented in this report.

Matched MeSH terms: Forensic Pathology
The post-mortem resilience of facial creases and the possibility for use in identification of the dead

Hadi H, Wilkinson CM

Forensic Sci Int, 2014 Apr;237:149.e1-149.e7.
PMID: 24613011 DOI: 10.1016/j.forsciint.2013.12.014

The post-mortem resilience of facial creases was studied using donated bodies in order to establish the efficacy of crease analysis for identification of the dead. Creases were studied on normal (pre-embalmed) and bloated (embalmed) cadavers at the Centre for Anatomy and Human Identification (CAHID) to establish whether facial bloating would affect facial crease visibility. Embalming was chosen to simulate the effects produced by post-mortem bloating. The results suggested that creases are resilient and changes were only detected for creases located on the periphery of the face, particularly at areas where the skin is thick, such as at the cheeks. Two new creases not previously classified were identified; these creases were called the vertical superciliary arch line and the lateral nose crease. This research suggests that facial creases may be resilient enough after death to be utilised for human identification.

Matched MeSH terms: Forensic Pathology
Growth of Chrysomya megacephala (Fabricius) maggots in a morgue cooler

Thevan K, Ahmad AH, Rawi CS, Singh B

J Forensic Sci, 2010 Nov;55(6):1656-8.
PMID: 20579228 DOI: 10.1111/j.1556-4029.2010.01485.x

In estimating the postmortem interval (PMI) using maggots obtained during autopsy, the forensic entomologist makes decisions regarding the effects of low-temperature storage of the body on the insects. In this case report, a corpse was found in an abandoned house in the residential area of Bukit Mertajam, Penang, Malaysia. The maggots were found to be alive inside the mouth of the deceased although the corpse had been in the morgue cooler for 12 days. The maggots were reared and identified as Chrysomya megacephala (Fabricius). The emerged adult flies were kept as a stock colony, and the duration of development under the indoor fluctuating temperature regime was studied. The total duration of developmental process of this species was 9.5 ± 0.5 days, and the PMI estimated was 3.2 ± 0.6 days. This case report demonstrates the survival of Ch. megacephala maggots for 12 days and their growth inside the morgue cooler.

Matched MeSH terms: Forensic Pathology
Post mortem computed tomography (PMCT) guided lung biopsy: A preliminary case report

Abdul Hadi D, Mansharan Kaur CS, Effat O, Siew SF

Trop Biomed, 2019 Dec 01;36(4):850-854.
PMID: 33597457

Tuberculosis (TB) is a highly infectious disease on the rise caused by the organism Mycobacterium tuberculosis and health care workers working in emergency departments, medical wards and autopsy rooms are in danger of contacting this disease. We present a case of a 42 year old man found dead under a pedestrian bridge with no medical history available. Post mortem computed tomography showed multiple cavities involving upper lobes of both lungs and areas of consolidation in both lung fields raising the suspicion of pulmonary tuberculosis. This was followed by a computed tomography guided lung biopsy and a limited conventional autopsy done in situ in a special high risk autopsy suite with appropriate ventilation. This case highlights the importance of cross sectional imaging which can be coupled with image guided biopsy in cases of infectious disease to reduce the risk of transmission to health care workers.

Matched MeSH terms: Forensic Pathology
Thoracic aortic dissection. Death may not always be due to rupture with haemorrhage. Unusual complications which can be missed at autopsy

Subramaniam K, Sheppard MN

J Forensic Leg Med, 2018 Feb;54:127-129.
PMID: 29413954 DOI: 10.1016/j.jflm.2018.01.005

OBJECTIVES: Aortic dissection (AD) can be a challenging diagnosis. At autopsy, the aorta may not be dilated and intimal tears may be missed or found without obvious rupture or haemorrhage. We report our experience of AD at a tertiary referral centre with review of 32 cases and discuss 2 unusual complications.
METHODS/RESULTS: 32 cases of which 12 females and 20 male and 18 out of 32 cases were aged below 40. All of the cases were examined macroscopically and microscopically. 30 out of 32 cases (93%) died due to rupture associated with the AD. Two unusual complications were proximal extension of AD into left coronary artery (CA) with intramural haematoma blocking the vessel and AD involving the ostium of the right CA resulting in avulsion of the right CA from the aorta. Mode of death in both these cases were myocardial ischemia. Sections of the aorta in all cases confirmed extensive cystic medial degeneration with disorganisation, fragmentation and disappearance of the elastin fibres with increased collagen and smooth muscle nuclear degeneration.
CONCLUSION: Pathologists should be thorough when examining the aorta, the aortic valve and root in AD. When a rupture site cannot be found it is important to look for unusual complications involving the CAs. Histology plays an important role to corroborate the cause of death.

Matched MeSH terms: Forensic Pathology
Motor vehicle-assisted ligature strangulation causing complete decapitation: an autopsy report

Samberkar PN

Am J Forensic Med Pathol, 2012 Mar;33(1):86-7.
PMID: 21455053 DOI: 10.1097/PAF.0b013e3182186d72

The victim, a 63-year-old prosperous businessman from Labasa, of the Northern Island (Vanua Levu) of Fiji Islands, was found completely decapitated in the early hours of morning in 2004. Initial police investigation did not reveal any history of any medical or family calamity. Further inquiry by the police revealed that on the previous day the deceased had visited all his friends and relatives, and his behavior was not out of the ordinary. The police suspected it to be a case of homicide. On visit to the scene, a completely decapitated body was found in a van on a downhill road. Tire marks were found on the road. A nylon rope was used for ligature strangulation. At autopsy, the decapitation wound of the head and the torso articulated well. The face was congested, and there was tongue bite. Wound margins were clear-cut, with well-demarcated abrasion and multiple imprints of the nylon rope on the neck. The upper one third of the larynx was attached to the head. No other injuries were found on the body. From the findings, it was obvious that asphyxiation was involved in the death before decapitation.

Matched MeSH terms: Forensic Pathology
Correlation and assessment of coronary artery luminal stenosis: Post-mortem computed tomography angiogram versus histopathology

Chainchel Singh MK, Abdul Rashid SN, Abdul Hamid S, Mahmood MS, Feng SS, Mohd Nawawi H, et al.

Forensic Sci Int, 2020 Mar;308:110171.
PMID: 32032870 DOI: 10.1016/j.forsciint.2020.110171

BACKGROUND: Post-mortem Computed Tomography (PMCT) allows non-invasive or minimally invasive detection of findings that may or may not be visible during conventional autopsy, however, it does not allow the investigator to draw any conclusions regarding patency of the vessel's lumen. To address this deficiency, Post-mortem Computed Tomography Angiography (PMCTA) utilizing different contrast media and techniques have been introduced with various studies looking at the correlation between PMCTA, autopsy (gross) findings and coronary artery histology in diagnosing coronary artery disease.
OBJECTIVES: The aim of this study is to investigate the sensitivity and specificity of PMCTA in diagnosing coronary artery stenosis using water-based contrast media introduced though the vessels of the neck, compared to the gold standard of diagnosis i.e. gross and histological evaluation of the coronary artery.
METHOD: This was a cross sectional study of 158 arterial sections involving 37 subjects recruited from the National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur (HKL). An unenhanced PMCT was performed followed by PMCTA using water-based contrast media introduced though the vessels of the neck. Coronary artery stenosis was determined using multiplanar reconstructionD while the degree of stenosis was determined by calculating the percentage of luminal diameter divided by the diameter of the vessel internal elastic.
RESULTS: The analysis of PMCTA and histopathology examinations revealed a sensitivity of 61.5%, specificity of 91.7%; positive predictive value (PPV) of 40.0% and negative predictive value (NPV) of 96.4%.
CONCLUSION: PMCTA utilizing water-based contrast introduced though the vessels of the neck yielded similar results as other methods and techniques of PMCTA. We would therefore conclude that PMCTA utilizing this technique could be used to assess the degree of calcification and the presence of significant stenosis.

Matched MeSH terms: Forensic Pathology
Lethal hemorrhage from a ureteric-arterial-enteric fistula diagnosed by postmortem CT angiography

Rashid SN, Bouwer H, O'Donnell C

Forensic Sci Med Pathol, 2012 Dec;8(4):430-5.
PMID: 22477359 DOI: 10.1007/s12024-012-9332-3

Fistula formation following pelvic surgery and radiotherapy, including ureteric-arterial fistulas (UAF), is well documented, however, ureteric-arterial-enteric fistula is extremely rare. Conventional autopsy is usually required for the definitive diagnosis of pelvic vascular fistulas although an accurate diagnosis can still be complicated and challenging. The role of post-mortem computed tomography (PMCT) as an adjunct to conventional autopsy is well documented in the literature. One of the limitations of PMCT is the diagnosis of vascular conditions. Post-mortem computed tomography angiography (PMCTA) is a recently introduced technique that can assist in detecting such pathology. We present a case of post-radiotherapy ureteric-arterial-enteric fistula presenting as massive rectal and vaginal bleeding diagnosed prior to autopsy on PMCTA. The role of PMCTA in the diagnosis of such a UAF has not previously been reported in the literature.

Matched MeSH terms: Forensic Pathology
Fulltext Post mortem changes in relation to different types of clothing

Teo CH, Pawita AH, Khairul O, Atiah Ayunni AG, Noor Hazfalinda H

Malays J Pathol, 2013 Jun;35(1):77-85.
PMID: 23817398 MyJurnal

Post mortem changes are important in estimating post mortem interval (PMI). This project's aim was to study the effect of burial and type of clothing on rate of decomposition, which can contribute to estimating PMI for victims. 12 rabbits (Oryctolagus cuniculus) carcasses were separated into 3 groups: no clothing, light clothing and heavy clothing. Control subjects were placed on the ground surface while test subjects were buried at 30 cm depth graves. Soil samples prior and after decomposition were collected for soil pH and moisture analysis. Post mortem change was assessed using a Total Body Score system. The head, neck and limb regions were found to decay faster than the body trunk region. Mummifi cation occurred on body parts that were exposed directly to the atmosphere while adipocere formed on some buried subjects. Burial delayed decomposition due to lower insect activity and lower soil temperature. The soil layer also blocked the accessibility of majority of the arthropods, causing further delay in decomposition. Clothing enhanced decay for bodies on ground surface because it provided protection for maggots and retained moisture on tissues. However, clothing delayed decomposition in buried bodies because it physically separated the bodies from soil and arthropods. Higher sun exposure and repetitive exhumation showed acceleration of decomposition. The decomposition process increased soil pH and moisture percentage values. Soil pH initially increased until pH 8.0-8.4 followed by a slight decrease while soil moisture percentage changed inconsistently. Burial was significant in affecting post mortem change, F(1,11)=12.991, p<0.05 while type of clothing was not significant, F(2,9)=0.022, p=0.978 and combination of both type of clothing and burial factors were also not significant, F(2,3)=0.429, p=0.686. For validation, an accuracy of 83.33% was achieved based on soil pH and soil moisture percentage analysis.

Matched MeSH terms: Forensic Pathology
Effectiveness of bone cleaning process using chemical and entomology approaches: time and cost

Lai PS, Khoo LS, Mohd Hilmi S, Ahmad Hafizam H, Mohd Shah M, Nurliza A, et al.

Malays J Pathol, 2015 Aug;37(2):123-35.
PMID: 26277669 MyJurnal

Skeletal examination is an important aspect of forensic pathology practice, requiring effective bone cleaning with minimal artefact. This study was conducted to compare between chemical and entomology methods of bone cleaning. Ten subjects between 20 and 40 years old who underwent uncomplicated medico-legal autopsies at the Institute of Forensic Medicine Malaysia were randomly chosen for this descriptive cross sectional study. The sternum bone was divided into 4 parts, each part subjected to a different cleaning method, being two chemical approaches i.e. laundry detergent and a combination of 6% hydrogen peroxide and powder sodium bicarbonate and two entomology approaches using 2nd instar maggots of Chrysomyia rufifacies and Ophyra spinigera. A scoring system for grading the outcome of cleaning was used. The effectiveness of the methods was evaluated based on average weight reduction per day and median number of days to achieve the average score of less than 1.5 within 12 days of the bone cleaning process. Using maggots was the most time-effective and costeffective method, achieving an average weight reduction of 1.4 gm per day, a median of 11.3 days to achieve the desired score and an average cost of MYR 4.10 per case to reach the desired score within 12 days. This conclusion was supported by blind validation by forensic specialists achieving a 77.8% preference for maggots. Emission scanning electron microscopy evaluation also revealed that maggots especially Chrysomyia rufifacies preserved the original condition of the bones better allowing improved elucidation of bone injuries in future real cases.

Matched MeSH terms: Forensic Pathology/economics; Forensic Pathology/methods*
Cystic tumor of papillary muscle of heart: a rare finding in sudden death

Murty OP

Am J Forensic Med Pathol, 2009 Jun;30(2):201-3.
PMID: 19465820 DOI: 10.1097/PAF.0b013e31819d9af5

Primary cystic tumors of papillary muscles of the heart are extremely rare. Here, one case of unusual cystic tumor in papillary muscle of the heart in a 37-year-old Myanmar migrant worker has been reported. He came to Malaysia 2 weeks before and one morning was found dead in sleep. Autopsy revealed cystic lesion in the papillary muscle of the mitral valve of heart, which was prolapsing into ventricular cavity. The cyst had white-jelly like sticky mucus material. The cyst was present in papillary muscle with slight invasion in septum area; it was lined by cuboidal-columnar epithelium and contained mucinous contents. There was no evidence of an inflammatory reaction in the cyst and in cardiac muscles. In addition to cystic neoplasm, the deceased also had histoplasmosis of the lungs. The case is presented with macroscopic and microscopic photographs of the cyst and histoplasmosis of the lungs. This case is reported because of its rarity, unique position, and unusual appearance.

Matched MeSH terms: Forensic Pathology
Tyre-blast injuries

Murty OP

J Forensic Leg Med, 2009 May;16(4):224-7.
PMID: 19329081 DOI: 10.1016/j.jflm.2008.12.027

A teenager college student was fatally injured by burst tyre air pressure while waiting on a public bus stand to catch a bus to reach her college at Kuala Lumpur. She accidentally came near the wheel while boarding when tube and tyre got burst .The air pressure had blown the girl in the air and she subsequently fell on a rough surface. The iron-locking rim of the wheel acted as a missile and hit the girl. She died on her way to the hospital. A medico-legal autopsy was performed which showed extensive injuries in the cranial and chest cavity. Head had large scalp laceration with diffuse separation and gaping from in the vault region; skull bones were fractured. Chest cavity had extensive rib fractures, lacerated lungs and haemo-thorax while externally there was no obvious injury. It requires intensive care management and screening of the victims. Tyre-blast injuries are not so common. This case exposes the hazard due to burst tyre.

Matched MeSH terms: Forensic Pathology
Diabetic artefacts in forensic practice

Murty OP

J Forensic Leg Med, 2009 May;16(4):218-23.
PMID: 19329080 DOI: 10.1016/j.jflm.2008.07.010

A case is presented where confusion arose about skin lesions and whether they were diabetic or electrical in origin. The deceased was a known diabetic and hypertensive man. A middle-aged person in early fifties was found unconscious in the cell and judicial autopsy was performed. He was facing trial for capital punishment of being allegedly involved in drug trafficking and money laundering. He had few marks over his fingers and foot which were considered to be electric marks produced in electric torture. also had fracture of skull and ischemic necrosis of right side of cerebrum; and contrecoup lesions. Findings are documented with photographs of the lesions. The article also depicts photographs of the scene where the victim had fallen and sustained skull fracture.

Matched MeSH terms: Forensic Pathology
Lightning fatality with blast, flame, heat and current effects: a macroscopic and microscopic view

Murty OP

J Forensic Leg Med, 2009 Apr;16(3):162-7.
PMID: 19239970 DOI: 10.1016/j.jflm.2008.07.009

A case is presented of a fatal environmental accidental injuries of lightning. A pedestrian was struck by lightning. The macroscopic and microscopic lightning injuries are reviewed.

Matched MeSH terms: Forensic Pathology
Giant cell myocarditis with cardiac tamponade: a rare combination

Murty OP

Am J Forensic Med Pathol, 2008 Sep;29(3):245-8.
PMID: 18725781 DOI: 10.1097/PAF.0b013e318183d55f

Giant cell myocarditis (GCM) is a rare but fatal disease of idiopathic origin. It results in focal necrosis of myocardium. This is a case report of middle aged Malaysian Indian female who died due to cardiac tamponade due to rupture myocardium and tear in the root of aorta. On naked eye examination, it simply resembled as recent as well as old fibrotic areas of myocardial infarction. She was clinically diagnosed as a case of obstructive cardiomyopathy with atrioventricular block, and was on pace maker. There was subendocardial fibrosis and left ventricular transmural infarction in the left ventricle. On histopathology, this was diagnosed as GCM, there were widespread areas of inflammatory cellular infiltration within the myocardium with multinucleated giant cells and granulomas interspersed with lymphocytes. Microscopic field showed up to 10 multinucleated giant cells. In this case, there were focal areas at multiple locations and caused uneven thickness in the left ventricle wall. Idiopathic GCM is very rare and causation of hemopericardium is the unique feature of this case. In this case the direct link of GCM with aortitis and rupture of left ventricle wall resulting in hemopericardium is shown. This case is documented through macroscopic as well as microscopic photographs in H&E, Ziel-Nelson, and GMS staining.

Matched MeSH terms: Forensic Pathology
Unusual self-electrocution simulating judicial electrocution by an adolescent

Murty OP

Am J Forensic Med Pathol, 2008 Jun;29(2):167-9.
PMID: 18520487 DOI: 10.1097/PAF.0b013e318177ea88

Electrocution is one of the rarest modes of suicide. In this case, one school going adolescent committed suicide by electrocution using bare electric wire. This is a rare case of suicidal death by applying live wires around the wrists, simulating the act of judicial electrocution. He positioned himself on armed chair and placed the nude wire loops from a cable around both wrists and switched on the current by plugging in to nearest socket by foot. There were linear electric contact wounds completely encircling around the both wrists. In addition to these linear electric burns all around wrists, there were electrical burns over both hands. This death highlights the need of supervision and close watch on children for self-destructing activities and behavior. This case also highlights unusual method adopted by adolescent to end his life.

Matched MeSH terms: Forensic Pathology
Male genital ornaments: penis pearls

Murty OP

J Forensic Leg Med, 2008 Feb;15(2):96-100.
PMID: 18206825 DOI: 10.1016/j.jflm.2007.01.005

In this article, five cases with pearls in penile skin are discussed. These cases were viewed from multiple angles as number, colour, position of pearls, socio-economic status, occupation, sexual behaviour, and the background of the individuals. The number of pearls varied from one to five in these cases. The penile skin examination revealed old healed scar marks indicating that probably some had even more pearls. Three persons were directly or indirectly associated with drugs. One of the victim was HIV positive. Two of the cases were of homicide; one died in police custody; one died due to ischemic heart disease; and one had died in accident. The article also discusses the common beliefs behind this practice with review of the literature.

Matched MeSH terms: Forensic Pathology
Dramatic lightning injury with exit wound

Murty OP

J Forensic Leg Med, 2007 May;14(4):225-7.
PMID: 16914357

This is a case report of an environmental accident due to lightning where one school boy sustained current, blast, and flame effects of it. A bolt of lightning directly struck the pole of a football ground and the scatter struck the child. In addition to burn injuries, he showed an exit wound of lightning in left foot. The exit wound of lightning current is a very rare finding. The body of victim had flame and heat effect of atmospheric electricity on head and neck, face, and trunk. In this incidence of lightning other team mates of the victim were safe. The patient survived the attack.

Matched MeSH terms: Forensic Pathology
Fatal lightning strikes in Malaysia

Murty OP, Kian CK, Ari Husin MH, Nanta Kumar RK, Mohammed Yusuf WY

Am J Forensic Med Pathol, 2009 Sep;30(3):246-51.
PMID: 19704405 DOI: 10.1097/PAF.0b013e31819d20a4

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the important causes of deaths from environmental phenomena. Almost every organ system may be affected as lightning current passes through the human body taking the shortest pathways between the contact points. A 10 years retrospective study (1996-2005) was conducted at University Hospital Kuala Lumpur (20 cases) also including cases during last 3 years from Hospital Tengku Ampuan Rahimah, Klang (7 cases) from the autopsy reports at Forensic Pathology Units of these 2 hospitals. Both these hospitals are attached to University of Malaya. There were 27 fatal cases of lightning strike with male preponderance(92.59%) and male to female ratio of 12.5:1. Majority of victims of lightning strike were from the age group between 30 and 39 years old. Most of the victims were foreign workers. Indonesians workers contributed to 59.26% of overall cases. Majority of them were construction workers who attributed i.e.11 of 27 cases (40.74%). Most of the victims were brought in dead (37.04%). In majority of the cases the lightning incidence occurred in the evenings, with the frequency of 15 of 27 cases (62.5%). The month of December represented with the highest number of cases (5 cases of 23 cases); 2004 had the highest incidence of lightning strike which was 5 (19.23%). Lightning strike incidence occurred when victims had taken shelter (25.9%) under trees or shades. Lightning strike in open areas occurred in 10 of 27 cases (37.0%). Head and neck were the most commonly affected sites with the incidence of 77.78% and 74% respectively in all the victims. Only 29.63% of the cases presented with ear bleeding.

Matched MeSH terms: Forensic Pathology

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links