Ultrasonography on the non-living. Current approaches.

The vast majority of clinicians associate diagnostic ultrasound with a tool that is designed for the living patient. However, it is of course possible to apply this imaging technology to evaluate the recently deceased patient for postmortem diagnosis, or even just examine postmortem tissue. We describe several cases in which ultrasound-enabled providers obtain answers in postmortem examinations and discuss potential future strategies and applications. In addition, we will also illustrate the use of sonography in minimally invasive post-mortem tissue sampling (MITS), an approach that can be used in post-mortem minimally invasive autopsies as well as for establishing ultrasound diagnostic parameters in new medical fields such as periodontal and dental implant specialties.

Study of Sexual Dimorphism in the Closure of Sagittal Suture – A Postmortem Study

Background: Performing identity is a prime task in medicolegal and postmortem examinations. Age is the first parameter that has to be determined followed by sex. There are several techniques through which sex can be determined. As well there are different anatomical, physiological and pathological parameters determination of sex. Aim: To determine the sexual dimorphism in the cranial sagittal suture closure macroscopically. Methods: All the cases for this purpose had been selected from those brought for autopsy in the Department of Forensic Medicine and Toxicology, King Edward Medical University Lahore during the year 2016. Results: The statistical analysis revealed early closure in males than in females both ectocranially and endocranially with advancing age in the sagittal suture of cranial vault. The p value was found significant being less than 0.05 thereby establishing the fact that sexual dimorphism in the cranial sagittal suture exists. Conclusion: Conclusively the determination of sex is possible from the pattern of Cranial Sutures closure on autopsy table. Key words: Sex, Sagittal, Suture, Cranial

Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce. To distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts. 84.1% (n = 618) were classified as COVID-19 deaths, 6.4% (n = 47) as non-COVID-19 deaths, 9.5% (n = 70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n = 283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n = 187). Thromboses were found in 39.2% (n = 62/158 cases), pulmonary embolism in 22.1% (n = 56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n = 618) represented COVID-19 deaths. Our study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

Technical aspects of minimally invasive percutaneous approach for local complications of acute pancreatitis

Aim. To improve the results of treatment for patients with acute pancreatitis by optimizing the technique of performing percutaneous methods of drainage and sequestrectomy.Material and methods. We have considered experience of treating pancreatic necrosis in 257 patients, confirmed by computed tomography, intraoperatively, and postmortem examinations. Moderate severity pancreatitis was detected in 159 (61.9%) patients, severe – in 98 (38.1%) cases.Results. Small focal pancreatic necrosis was detected in 99 (62.3%) patients with moderate pancreatitis, large focal pancreatitis – in 60 (37.7%). Small-focal pancreatic necrosis was in 23 (23.5%) patients, large-focal – in 43 (43.9%), subtotal – in 29 (29.6%), total – in 3 (3.1%) among patients with severe acute pancreatitis. Percutaneous approach was used in combination with transluminal and open surgery in 59 (23%) patients. Infected necrosis was detected in 6 (3.8%) patients with acute moderate pancreatitis and in 44 (44.9%) patients with severe pancreatitis, sepsis – in 12 (12.2%) patients. 27 (10.5%) patient have died from septic shock in the first phase of pancreatitis, included 14 (5.4%) cases after surgery. Overall 41 (16%) patients with pancreatic necrosis have died.Conclusion. Compliance of stages in surgical treatment technology allows optimally combine it with transluminal sequestrectomy, reduces surgical trauma, eliminates additional risks of open approach associated with complications and deaths.

Polymelia, vent duplex, cloacal bursa duplex and triple caeca in a broiler chick

Congenital abnormalities are common among avian and mammalian species. They could be partial or total drift from the normal structural organization of the organ-systems. This article is aimed at reporting the occurrence of multiple abnormalities in a 3-week-old broiler chick. Ante mortem, post-mortem, radiological and osteological investigations were carried out, to ascertain the number and form of abnormalities present in the chick. A total of four different congenital abnormalities were discovered in this chick. These include: polymelia (presence of supernumerary or accessory limb which is usually malformed); double vents (vent duplex); double cloacal bursae (bursa duplex) and triple caeca. Radiological and postmortem examinations revealed the attachment of the accessory limb to the caudal depressor muscle as a form of synsarcosis, via a tendon that originated from the deep fossa of the modified femoral head of the accessory limb. The right vent was patent whereas the left was not. The two cloacal bursae were almost the same size, while the three caeca showed slight variation in length but typical features of the avian caecum (base, middle (body) and apex) were clearly visible. However, most cases of congenital anomalies in the avian species occur as multiple defects, with the most common being polymelia. The latest finding in this report is the discovery of double cloacal bursae (bursae of Fabricius), which has not been reported in the avian species.

Atrazine intoxication in cattle, confirmed by gas chromatography–mass spectrometry

Ten of 40 cows died within 48 h of gaining access to a barn in which various chemicals were stored. Some of the surviving cows exhibited drooling, muscle tremors, and agitation. Postmortem examinations of 2 cows were performed in the field, and revealed nonspecific, moderate-to-severe pulmonary congestion. Liver and rumen contents, each from a different cow, were analyzed using a qualitative, multi-residue GC-MS method validated for the detection of pesticides and other chemical analytes. Using this method, extracts from the liver and rumen content samples were compared to atrazine (neat standard) and matrix-matched, control samples fortified with atrazine. GC-MS analysis detected atrazine at 215 m/z (NIST match >97%) with a retention time of ~13 min in liver and rumen content samples from our case. Detection of atrazine in the samples from the cows in this herd, combined with the clinical history, indicate that atrazine toxicity was the likely cause of clinical signs and death observed in this herd.

Dying From Or With SARS-CoV-2 – Prospective Postmortem Evaluation of 735 Consecutive Death Cases –

BackgroundCoronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce.MethodsTo distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts.Findings84.1% (n=618) were classified as COVID-19 deaths, 6.4% (n=47) as non-COVID-19 deaths, 9.5% (n=70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n=283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n=187). Thromboses were found in 39.2% (n=62/158 cases), pulmonary embolism in 22.1% (n=56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n=618) represented COVID-19 deaths.InterpretationOur study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

Microscopic analysis of compression injury over neck: One-year prospective study

The present study was conducted in Department of Forensic Medicine and Toxicology of a Government Medical College and Hospital in year 2017. Total 2781 postmortem examinations were conducted in 2017. Out of that total 2781 cases, 176 compression of neck cases came for postmortem and amongst these 105 cases were studied in detail as per inclusion criteria. Out of 105 cases of compression around neck, which were studied, there were 93 cases of hanging, 10 cases of ligature strangulation, 01 case of manual strangulation and 01 case of accidental strangulation studied. On gross in total 11 cases of strangulation hemorrhage in subcutaneous tissue, strap muscle and sternocleidomastoid muscle observed and in only 20 cases of hanging there was hemorrhage observed in subcutaneous tissue and no hemorrhage observed in strap and sternocleidomastoid muscle in hanging cases. In this present study on histopathology vascular congestion and extravasation of red blood cells observed in 28 cases of compression of neck. These findings indicate the importance of histopathology of underlying neck structure in neck compression cases in documenting antemortem nature of hanging and strangulation in doubtful cases.

How to set up a postmortem facility in a farm animal practice

Postmortem examinations can be a useful diagnostic tool in farm animal medicine; however, they are often avoided in general practice because of a lack of appropriate facilities and expertise/familiarity with techniques. This article describes the setting up of a basic facility to allow general practitioners to perform postmortem examinations of calves, small ruminants and other small animals, e.g. poultry.

The Vital Role of Thanatochemistry in the Postmortem Diagnostic of Diabetic Ketoacidosis—Case Report

Diabetic ketoacidosis (DKA) is a lethal acute hyperglycemic complication of diabetes mellitus (DM) and it represents the initial manifestation of DM in about 15–20% of cases in adults and about 30–40% of cases in children. Postmortem diagnosis of DKA can only be made by applying thanatochemistry. Biochemistry applied postmortem is viewed with skepticism by many practitioners in the forensic field, completely lacking in many forensic services around the world, and especially in the national ones. This article aims to underline the importance of the postmortem application of biochemistry by reviewing the case of a person in the third decade of life who died suddenly at home due to diabetic ketoacidosis (DKA), whose autopsy was performed at an early PMI of approximately 24 h. Routine postmortem examinations (macroscopic, anatomopathological, and toxicological) could not establish a clear cause of death. When attention was turned to biochemical determinations (i.e., determination of glycated hemoglobin, glucose and ketone bodies (acetone, beta-hydroxybutyrate) in the blood, vitreous humor, and cerebrospinal fluid), the identified values clarified the thanatogenic mechanisms by establishing the diagnosis of DKA.