| 1. |
- Beer, Torfinn, et al.
(författare)
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Cardiac enlargement in a medicolegal autopsy setting
- 2023
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Ingår i: American Journal of Forensic Medicine and Pathology. - : Wolters Kluwer. - 0195-7910 .- 1533-404X. ; 44:4, s. 267-272
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Tidskriftsartikel (refereegranskat)abstract
- A key element for diagnosing cardiac enlargement in an autopsy setting is relevant heart weight references. However, most available references are to a large extent not representative of a medicolegal autopsy population, implying that reference weights are likely lower than those in the relevant population.To establish more applicable heart weight references in a medicolegal autopsy population, we designed a heart weight model that accounts for undiagnosed cardiac enlargement using data from 11,897 nontraumatic Swedish medicolegal autopsy cases autopsied between 2010 and 2019. The model was validated in 296 nonobese young adult suicidal hanging cases.For a decedent of average height (174 cm), the evidence that a heart weight was enlarged reached weak support at approximately 430 g, substantial support at approximately 480 g, and strong support at 520 g. The modeled prevalence of cardiac enlargement was very high among elderly and obese decedents.We believe that our model is more applicable in a medicolegal setting than those previously published. The presented quantification of the degree of uncertainty regarding diagnosis can help the pathologist in diagnosing cardiac enlargement. To facilitate the use of this model, we also made it available through a simple online tool (https://formedum.shinyapps.io/HeartWeightCalc/).
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| 2. |
- Druid, Henrik, et al.
(författare)
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Incomplete shored exit wounds : A report of three cases
- 2000
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Ingår i: American Journal of Forensic Medicine and Pathology. - : Ovid Technologies (Wolters Kluwer Health). - 0195-7910 .- 1533-404X. ; 21:3, s. 220-224
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Tidskriftsartikel (refereegranskat)abstract
- Typical and atypical exit wounds are well described in the forensic literature. Included in the descriptions of atypical exit wounds are perforating, 'shored' exit wounds, in which the perforation of the skin is associated with an abrasion, whether or not the bullet fully exits the body. The authors describe an atypical, incomplete, shored exit wound in which the skin was abraded by supporting material at the site the bullet was recovered, but there was no associated perforation of the skin. Recognition of this injury pattern can be important in reconstruction of the crime scene in relation to the victim at the time of the shooting.
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| 3. |
- Edston, Erik, 1948-, et al.
(författare)
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Postmortem measurements of thyroid hormones in blood and vitreous humor combined with histology
- 2001
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Ingår i: American Journal of Forensic Medicine and Pathology. - : Ovid Technologies (Wolters Kluwer Health). - 0195-7910 .- 1533-404X. ; 22:1, s. 78-83
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate whether clinical reference premortem values can be used to assess postmortem concentrations of thyroxine, triiodothyronine, and thyroid stimulating hormone (TSH), to compare the postmortem concentrations in blood and vitreous humor, and to study the possibility of diagnosing hyperthyroidism by comparing thyroid histologic appearance and postmortem hormone values. Biochemical analyses of free thyroxine (FT4), free triiodothyronine (FT3), and TSH in femoral blood and vitreous humor were made in 38 cases. In 40 cases, the hormones and thyroid histologic appearance were studied, 22 had no significant pathologic changes, and 18 showed focal hyperplasia of the follicular epithelium. A positive correlation was seen between the femoral blood and vitreous humor concentrations of FT4 (R = 0.66) but not between the corresponding concentrations of FT3 and TSH. A positive correlation was also seen between FT3 and FT4 in femoral blood (R = 0.74). In cases with normal thyroid histologic appearance, 58% were found to have FT4 values >24 pmol/L (clinical reference interval 9-24 pmol/L), mean value 27.5 ▒ 9.4 pmol/L), which did not differ from the FT4 values in the cases with hyperplasia, 31.6 ▒ 15 pmol/L. Only 5% of the T3 measurements in the group with normal histologic appearance were >9 pmol/L (clinical reference interval 3-9 pmol/L). The mean value of FT3 in cases with normal histologic appearance was 3.4 ▒ 1.3 pmol/L, and in the group with hyperplasia 8.6 ▒ 6.1 pmol/L. The difference was statistically significant P < .005). It is concluded that postmortem values of FT3 and FT4 in femoral blood are fairly comparable to premortem clinical reference values, but the upper normal limit, especially for T4. has to be adjusted upward. Analysis of vitreous humor cannot be used post mortem to assess thyroid function. Histologically, hyperplastic changes correlate well with elevated FT3 in femoral blood.
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| 4. |
- Edston, Erik
(författare)
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The earlobe crease, coronary artery disease, and sudden cardiac death : An autopsy study of 520 individuals
- 2006
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Ingår i: American Journal of Forensic Medicine and Pathology. - : Ovid Technologies (Wolters Kluwer Health). - 0195-7910 .- 1533-404X. ; 27:2, s. 129-133
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Tidskriftsartikel (refereegranskat)abstract
- The majority of previous studies have demonstrated a correlation between diagonal earlobe creases (ELC) and coronary artery disease (CAD).In this study of 520 forensic autopsy cases, the earlobes were studied and photographed before autopsy, and the existence of a diagonal ELC was noted in 55%. The cause of death, the degree of coronary atherosclerosis, aortosclerosis, and cerebrosclerosis, as well as heart, kidney, and spleen weights, were noted in each case. The body mass index (BMI), thickness of abdominal fat, baldness, and excessive hair in the meatus externa of the external ears were also assessed. Nonparametric methods were used in the statistical calculations.It was found that ELC was strongly correlated with CAD in both men and women (P < 0.0001) but with sudden cardiac death (SCD) only in men (P < 0.04). The sensitivity of the ELC sign was 75% and the positive predictive value (ppv) was 68%. In individuals below 40 years, the ppv was as high as 80%. Using multiple logistic regression analysis, ELC was found to be the strongest independent risk factor for CAD and SCD apart from age and BMI (both genders), as well as baldness and hair in the meatus externa (in males).It is concluded that in a patient population similar to that in the present study the ELC sign could be especially useful in screening for premature CAD in younger individuals. Copyright © 2006 by Lippincott Williams & Wilkins.
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| 5. |
- Edston, Erik
(författare)
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Thymus Involution and Intravenous Drug Abuse
- 2020
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Ingår i: American Journal of Forensic Medicine and Pathology. - : LIPPINCOTT WILLIAMS & WILKINS. - 0195-7910 .- 1533-404X. ; 41:1, s. 32-34
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Tidskriftsartikel (refereegranskat)abstract
- Thymus glands from 283 autopsy cases were sampled and evaluated with histochemical and immunohistochemical methods. A subpopulation of 41 intravenous drug addicts were compared with age-matched control cases. It was found that an accelerated involution of the thymus occurred in the 20- to 25-year interval and thereafter with a steady pace of 5% per year. Also the size of Hassall bodies declined successively. In drug addicts, an increased dystrophic calcification of the Hassall bodies and a significant difference in thymus size (atrophy) compared with controls were seen. Moreover, a difference was seen in the relative numbers of CD4 and CD8 lymphocytes where CD4+ cells were reduced in drug addicts. It is hypothesized that signs of hepatitis C virus infection that was found in the majority of drug addicts and the reduced number of functionally intact Hassall corpuscles could explain the reduction of CD4+ lymphocytes and thymic hypotrophy in this population.
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| 6. |
- Finnberg, Amanda, et al.
(författare)
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Homicide by Poisoning
- 2013
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Ingår i: American Journal of Forensic Medicine and Pathology. - 0195-7910 .- 1533-404X. ; 34:1, s. 38-42
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Tidskriftsartikel (refereegranskat)abstract
- By studying the number and method of homicidal poisoning in Miami-Dade County, Florida; New York City, NY; Oakland County, Michigan; and Sweden, we have confirmed that this is an infrequently established crime. Several difficulties come with the detection of homicidal poisonings. Presenting symptoms and signs are often misdiagnosed as natural disease, especially if the crime is committed in a hospital environment, suggesting that an unknown number of homicides go undetected. In the reported cases analyzed, the lethal agent of choice has changed over the years. In earlier years, traditional poisons such as arsenic, cyanide, and parathion were frequently used. Such poisonings are nowadays rare, and instead, narcotics are more commonly detected in victims of this crime.
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| 7. |
- Khoshnood, Ardavan, et al.
(författare)
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Nineteen Victims of Homicide and Attempted Homicide in Sweden—Their Injuries, Cause of Death, and Offender Relationship
- 2017
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Ingår i: American Journal of Forensic Medicine and Pathology. - : Lippincott Williams & Wilkins. - 0195-7910 .- 1533-404X. ; 38:3, s. 241-248
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Victims of homicide and attempted homicide are not uncommon in Sweden. We therefore aimed to study these victims to understand their injuries, their cause of death, and their relationship to the offender. All cases during five years in a district court in Sweden, where an offender had been convicted for homicide or attempted homicide, were identified and the court documents reviewed. Nineteen victims were identified; 14 males and five females, with an average age of 39.1 years. Although knife/sharp weapon was the most common weapon used, the use of firearm caused more deaths. Our study shows higher rates of firearm use than many other countries. The most common anatomical site to be injured by knife/sharp weapon and firearm was the thorax followed by the head. The most common cause of death was hypovolemia, followed by intracranial injuries. The high rate of firearm use shows that firearms are common modus operandi in Sweden often causing lethal injuries, if the offender intends to kill the victim. Our results support other studies showing that it is foremost injuries to the vessels, intracranial injuries, and injuries to intrathoracic organs, which causes a victimʼs death when assaulted with knife/sharp weapon or firearm.
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| 8. |
- Rajs, J., et al.
(författare)
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Death related to coronary artery fistula after rupture of an aneurysm to the coronary sinus
- 2001
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Ingår i: American Journal of Forensic Medicine and Pathology. - : Ovid Technologies (Wolters Kluwer Health). - 0195-7910 .- 1533-404X. ; 22:1, s. 58-61
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Tidskriftsartikel (refereegranskat)abstract
- Large coronary fistulas are considered to cause myocardial ischemia due to diversion of the coronary blood flow. In this case the authors report the reverse effect-the spontaneous closure of a large fistulation between the left circumflex artery and the coronary sinus evoked angina pectoris in a middle aged man, who died several years later. Postmortem examination revealed a coronary aneurysm that had ruptured and dissected into the coronary sinus and finally thrombosed. The origin of the aneurysm could be congenital but perhaps also represents a healed stage of Kawasaki disease.
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| 9. |
- Rodhe, Axel, et al.
(författare)
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Sauna deaths in Sweden, 1992-2003.
- 2008
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Ingår i: American Journal of Forensic Medicine and Pathology. - 0195-7910 .- 1533-404X. ; 29:1, s. 27-31
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Tidskriftsartikel (refereegranskat)abstract
- Deaths from 1992 through 2003 related to sauna bathing in Sweden were collected from a national computer data base comprising all medicolegal autopsies, generating 77 cases included in this study. Of all deaths, 82% were men, most of them middle-aged. The geographic distribution seemed to be roughly related to the population density. Most bathers died on a weekend, and 84% were found dead in a sauna. In 69 cases, the blood alcohol concentration was determined; 49 (71%) of these tested positive, often with high concentrations. In 65 cases, a major disease/state that could explain death was identified; 34 (44%) of these deaths were related to alcohol and 18 (23%) cardiovascular. Other causes of death were drowning, CO poisoning, O2 deprivation, amphetamine intoxication, and burn injuries. In 13 cases, the cause of death remained undetermined. The results indicate that sauna habits in Sweden are similar to those in Finland but probably less common. The most important risk group is middle-aged men, especially those with heavy alcohol consumption. Among the cases found dead in a sauna, all but 2 were found alone. Obviously, bathing alone is a risk factor that can easily be avoided and should perhaps be emphasized more.
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| 10. |
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