Medicolegal Autopsy Cases Report

, Jai Kwan Suh

Case report

Korean Journal of Legal Medicine 1994;18(2):49-54.

National Institute of Scientific Investigation, Seoul, Korea

Abstract

Case I: Silicon embolism (46-year-old woman) Silicon(poly-dimethy1-si1oxane) is a polymer with a minimal tissue reaction and a high degree of thermal stability. So it is widely used for medical purpose, especially in the correction of minor contour defects. Illegal injections of silicon in human beings, however, have been associated with many adverse effects, including migration of the silicone, skin hypopigmentation, granulomatous hepatitis, mastitis, sclerosis, and human autoimmune diseases. Silicon may migrate thr ough the subcutaneous tissue to areas as far away as the parenchymal organs such as lungs. Now, a lung embolism is reported in a case involving death following repeated injections of liquid silicone for vaginal wall reconstruction(vaginoplasty). Case II: Choking by hen egg (17-year-old girl) Choking is suffocation due to obstruction of the air passages by a foreign body which is not unusual for a large piece of food hastily swallowed, often in drunkenness, to lodge in the upper pharynx, there become impacted, compressing the epiglottis and the entrance of the larynx. This condition is referred to as “cafe-coronary” because it mimicks a heart at tack. Food aspiration following suppression of the gag reflex by tranquilizing drugs is a common phenomenon in mental institutione. A 17-year old girl inhaled the piece of hen egg during her breakfast time in mental hospital. She lapsed into unconsciousness and became cyanosis in front of nurse. At autopsy her blood alcohol level was negative, and she was not under the influence of medication. Case III: Ven om intoxication (56-yea r-old woman ) Snake venoms are slightly viscid fluids, usually pale yellow to amber. Numerous enzymes have been identified in snake venoms. Hyaluronidases which present in most venoms, Proteases which cause local inflammation, necrosis and damage to vascular epithelium, Phospholipase A, which is most toxic, alters membrane permeability and releases histamine, thus contributing to hemorrhage and shock, Phosphodiesterase which may be responsible for same of the hypotensive effect of venoms and Esterases which liberate bradykinin. Clinically, anticoagulant activity of venoms is more important and may result from destruction of fibrinogen or prothrombin, or in vivo defibrination with formation of minute fibrin emboli. The clinical symptoms are severe local pain, edema spreading from the bite, painful lymphadenopathy, and local ecchymosis. Systemic manifestations include nausea and vomiting, thirst, sweating and fever. Therapy in snakebite has five aims: ①retarding absorption of venom and removing as much as possible by mechanical means. ②neutralization of venom by immune serum. ③counteracting specific pharmacologic activities of the venom. ④relief of symptoms and ⑤prevention of complications. This case represents the death due to venom intoxication who is bited by snake while working in her peanut field.