Emedinews:Insights on Medicolegal Issues:Sudden death due to cardiac origin–autopsy

Right coronary artery supplies blood to electrical area of heart

The most common cause of sudden cardiac death in adults over the age of 40 was coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in AIIMS mortuary.

• The most common finding at postmortem examination is chronic high–grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply.
• A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
• In 75 cases out of hundreds, the clots were seen in right coronary artery supplying the electrical area of heart.
• Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall, which induces a ventricular arrhythmia/fibrillation and no changes in the myocardium are seen during postmortem examination.
• The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
• Chronic high–grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
• Ventricular arrhythmias may arise from a myocardium, which has been previously scarred by episodes of ischemia.

Emedinews:Insights on Medicolegal Issues:Reconstitution of the body following an autopsy

An important component of the autopsy is the reconstitution of the body such that it can be viewed as normal following the autopsy procedure.

• After the conduction of postmortem examination, the body has an open and empty chest cavity with chest flaps open on both sides, the top of the skull is missing, and the skull flaps are pulled over the face and neck. All organs and tissue must be returned to the body unless permission is given by the family to retain any tissue for further investigation.
• Normally the internal body cavity is lined with cotton wool or an appropriate material; the organs are then placed into a plastic bag to prevent leakage and returned to the body cavity. The chest flaps are then closed and sewn back together and the skull cap is sewed back in place.
• The cases of mutilation/dismembered corpse must be surgically repaired into a normal anatomical position.
• Then the body must be properly sutured and reconstructed by the doctor conducting the autopsy with a cosmetic and parlor touch and then only it should be handed over to the relative of deceased as a regard of human corpse for ritual cremation

Emedinews:Insights on MEdicolegal Issues:Autopsy in death due to adverse events following immunization (AEFI)

Autopsy in death due to adverse events following immunization (AEFI)

The doctor conducting the autopsy is duty bound to take samples for toxicological screening and send them to Forensic Laboratory for toxicological/chemical examination

• The injection site and the tissues underneath up to 2–3 cms (button size) with dermis and epidermis of the sight of injection prick should be excised out. It should be preserved in a glass jar which should be filled two–thirds with saturated saline water. The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further toxicological/chemical examination.
• Viscera for toxicological/chemical examination: The following viscera specimen/biological samples should be collected for toxicological/chemical examination (80-100 gms of liver, 80-100 gms of brain with meninges, whole of the stomach with gastric contents (If no gastric contents, a section of stomach should be sent), upper part of small intestine about 30cm long with its contents, fragments from both adrenal glands, half of transverse section of kidneys, half of spleen, blood (100 ml ideal/minimum 10 ml) and urine (100 ml/minimum 10 ml).
• All the visceral specimens should be collected in separate container a wide-mouthed bottle as prescribed and saturated saline should be added as preservatives. The quantitative of the saline should be sufficient to cover all the pieces of specimen viscera in bottle.
• The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further chemical examination in a forensic lab.