Legal Medicine最新文献

{"title":"Preventing vasovagal reactions during forensic autopsies: an analysis of risk factors and educational strategies for police officers","authors":"Mami Nakamura,&nbsp;Marin Takaso,&nbsp;Misa Tojo,&nbsp;Akari Uno,&nbsp;Masahito Hitosugi","doi":"10.1016/j.legalmed.2026.102898","DOIUrl":"10.1016/j.legalmed.2026.102898","url":null,"abstract":"<div><div>Police officers attending forensic autopsies may experience physical distress, often triggered by the vasovagal reflex. This study investigated the incidence and risk factors to establish effective preventive strategies. We surveyed demographic and personal factors of attendees in Shiga Prefecture, Japan. Environmental factors (weather data and autopsy room temperature/humidity records) and case factors (decomposition and injury severity) were also evaluated. The overall incidence of physical distress was 1.5% (20/1361 participants), which was lower than previously reported in medical students. Although the incidence was higher in female officers (12.5%) than in male officers (2.0%), logistic regression analysis showed that only shorter employment duration and limited attendance experience were independent risk factors; gender was not significant. The incidence was highest among officers in their second to fifth years and first-time attendee. Regarding case factors, severe injury was associated with higher distress rates, whereas the degree of decomposition had no significant effect. The incidence also increased during the summer months, in parallel with higher environmental temperatures. Overall, lack of experience appears to be the primary risk factor, whereas the observed gender difference likely reflects a confounding effect. Autopsy practitioners should recognize these risks and provide attendees with practical coping strategies. Such education can promote psychological safety, reduce severe distress and secondary injuries, and help maintain a safe working environment.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"84 ","pages":"Article 102898"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden death from non-traumatic right atrial appendage rupture: an autopsy case","authors":"Kie Horioka,&nbsp;Kumiko Asakura,&nbsp;Satoko Kimura,&nbsp;Aya Takada,&nbsp;Kazuyuki Saito,&nbsp;Maki Ohtani,&nbsp;Yuhei Matsuo,&nbsp;Akira Hayakawa","doi":"10.1016/j.legalmed.2026.102893","DOIUrl":"10.1016/j.legalmed.2026.102893","url":null,"abstract":"<div><div>Myocardial rupture most often involves the ventricles following acute myocardial infarction, whereas non-traumatic atrial rupture is extremely uncommon, and typically confirmed histologically. Isolated atrial infarction is rare and diagnostically challenging, requiring careful distinction from traumatic causes in forensic practice. We report a fatal case of non-traumatic rupture of the right atrial appendage (RAA). The patient was a 43-year-old woman with systemic lupus erythematosus. Postmortem computed tomography revealed high-density areas within the pericardial space. Autopsy demonstrated a 250 mL pericardial hematoma. The rupture site was identified at the apex of the RAA, located directly above the tricuspid valve in the inflow tract of the right atrial vestibule. Localized hemorrhage was present around the rupture site, and thrombus attachment was observed at this location. Histological examination of the RAA revealed wavy myocardial fibers with early coagulative necrosis surrounding the rupture site. Some fibers exhibited eosinophilia, thinning, loss of striation, and band necrosis. The right coronary artery adjacent to the rupture site showed atherosclerotic stenosis with a platelet thrombus. Based on these findings, the cause of death was determined to be endogenous rupture of the RAA secondary to atrial infarction. Although non-traumatic rupture of the RAA is extremely rare, distinguishing it from traumatic rupture in forensic practice is critically important and requires recognition of its characteristic histological features.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"84 ","pages":"Article 102893"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing postmortem interval estimation through PMCT brain decomposition metrics","authors":"Weihao Cheng ,&nbsp;Hangyu Zhu","doi":"10.1016/j.legalmed.2026.102860","DOIUrl":"10.1016/j.legalmed.2026.102860","url":null,"abstract":"","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"83 ","pages":"Article 102860"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When forensic evidence meets legislation: The Italian femicide law and the role of forensic pathology","authors":"Rossana Cecchi ,&nbsp;Jessika Camatti ,&nbsp;Anna Laura Santunione","doi":"10.1016/j.legalmed.2026.102858","DOIUrl":"10.1016/j.legalmed.2026.102858","url":null,"abstract":"","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"83 ","pages":"Article 102858"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147851439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child abuse, comparative analysis of national and European models and case studies","authors":"Argo Antonina,&nbsp;Malta Ginevra,&nbsp;Bilello Alessandra,&nbsp;Puntarello Maria,&nbsp;Midiri Mauro,&nbsp;Albano Giuseppe Davide,&nbsp;Piro Ettore,&nbsp;Zerbo Stefania","doi":"10.1016/j.legalmed.2026.102846","DOIUrl":"10.1016/j.legalmed.2026.102846","url":null,"abstract":"<div><h3>Background</h3><div>Child Abuse is described as a major public health problem, requiring a standardized and multidisciplinary approach.</div></div><div><h3>Objective</h3><div>The aim of the study is to evaluate the application of the operative protocols that have been used in the management of suspected cases of child abuse, provided by PDTA (Diagnostic–Therapeutic Care Pathway) of Palermo, and their conformity to the scientific literature (“Royal College of Pediatrics and Child Health” and “Adams’s classification”).</div></div><div><h3>Participants and setting</h3><div>The study was conducted on a clinical-legal database of 55 patients, which have been followed from 2013 until 2025, evaluating demographic variables, modality of the abuse and the mode of access (urgent vs scheduled).</div></div><div><h3>Methods</h3><div>We proceeded with a process of data normalization, terminological cleaning and removal of outliers to ensure consistency in the analysis and the validity of statistical analyses and epidemiological interpretations.</div></div><div><h3>Results</h3><div>The explorative analyses of the database highlighted a significant prevalence in the female gender (62,2%), of intra-familial cases (where the most frequent perpetrator is the father), of recurrent cases, and a bimodal distribution of the age with two peaks (3–6, 11–14 years with mean age 8.3 years). The 79,5% of the consultations were carried out on a scheduled basis, suggesting delays in activating the diagnostic-therapeutic pathway; in fact, a greater clinical-legal plausibility of abuse was observed in cases assessed urgently (p = 0.38).</div></div><div><h3>Conclusions</h3><div>Most cases were managed on a scheduled basis despite higher clinical-legal plausibility in urgent assessments; cases predominated in females, showed bimodal age peaks (3–6 and 11–14 years), and were largely intra-familial with fathers most frequently implicated. Findings support earlier activation of the pathway and standardized data capture across services.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"83 ","pages":"Article 102846"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147851437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-mortem microbiology (PMM) as diagnostic tool in sudden unexpected childhood deaths","authors":"Federica Cascone ,&nbsp;Gaetano Di Donna ,&nbsp;Alessandro Feola ,&nbsp;Emanuele Capasso ,&nbsp;Andrea Ronchi ,&nbsp;Massimo Niola ,&nbsp;Carlo Pietro Campobasso","doi":"10.1016/j.legalmed.2026.102859","DOIUrl":"10.1016/j.legalmed.2026.102859","url":null,"abstract":"<div><div>Post-mortem microbiology (PMM) is a significant diagnostic tool to identify infectious agents, unfortunately not always applied in forensic context. Two cases of meningo-encephalitis in juvenile females are reported. The first case involved an 8-year-old girl found dead in her bed, after a three-months clinical history of shortness of breath, coughing, vomiting, headache and purulent discharge from the ear canal. A diagnosis of adenoidal hypertrophy was made by pediatricians. At autopsy, acute and chronic multifocal inflammatory infiltrates were found at the brain, lungs, thymus and adenoidal tissue. The microbiological analysis performed on cerebrospinal fluid (CSF) was positive for Human Herpesvirus 6 (HHV-6). The cause of death was assessed as meningo-encephalitis based both on histological findings and PMM results. Based on the clinical history, medical malpractice issues were assessed. The second case is related to an 11-year-old girl’s death, who showed a rapid neurological decline with cerebral edema and decompressive craniotomy, after a prompt diagnosis of otitis media and mastoiditis. Microbiological tests performed on samples taken before death and on formalin-fixed tissues taken after death, showed negative results. The cause of death was assessed as acute meningo-encephalitis based on the histological findings. They were mostly represented by wide inflammatory infiltrates within the cerebral parenchyma and subpial regions. Comparison of these two cases shows the strengths and limitations of PMM in the identification of the etiological agents. This issue can be crucial in the evaluation of infectious diseases and medical malpractice. In this regard, a reliable PMM requires that recommended sampling protocols be applied to biological fluids and soft tissues.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"83 ","pages":"Article 102859"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On an alleged case of euthanasia by pentobarbital administration","authors":"P. Basilicata,&nbsp;A. Simonelli,&nbsp;M. Marisei,&nbsp;A. Silvestre,&nbsp;R. Guadagni,&nbsp;M. Pieri","doi":"10.1016/j.legalmed.2026.102857","DOIUrl":"10.1016/j.legalmed.2026.102857","url":null,"abstract":"<div><div>The delivery of healthcare services within hospital facilities and the management of those services by a team of health professionals fundamentally changed the intrinsic characteristics of professional responsibility in the medical field. It is crucial to carefully evaluate the connection between the alleged cause and the alleged effect when proving the potential existence of medical professional liability profiles. It is imperative to emphasize that a sanitary expert cannot be held accountable for the outcomes of difficulties that are not directly linked to technical misconduct. To illustrate the critical role that forensic toxicology plays in determining the veracity of the evidence to support or refute a claim of professional responsibility in psychiatric context, the case of a claimed pentobarbital administration for euthanasic purposes is provided.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"83 ","pages":"Article 102857"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmortem MRI detection of a dentate nucleus lesion of uncertain significance in a death with suspected heat exposure","authors":"Hideki Hyodoh ,&nbsp;Kotaro Matoba ,&nbsp;Khin Khin Tha ,&nbsp;Akiko Takeuchi ,&nbsp;Shogo Shimbashi ,&nbsp;Tomoko Matoba ,&nbsp;Takayuki Kiuchi ,&nbsp;Shigeki Jin","doi":"10.1016/j.legalmed.2026.102853","DOIUrl":"10.1016/j.legalmed.2026.102853","url":null,"abstract":"<div><div>The forensic diagnosis of heat-related death remains challenging when objective pathological indicators are absent. We report a case in which circumstantial and environmental investigative information raised suspicion of heat exposure, although classical autopsy findings associated with heatstroke, such as marked elevation of rectal temperature or renal myoglobin casts, were not identified.</div><div>Postmortem computed tomography revealed no apparent intracranial abnormalities. In contrast, postmortem magnetic resonance imaging demonstrated a focal abnormality surrounding the cerebellar dentate nucleus that was not detectable on CT.</div><div>Histopathological examination of the corresponding region revealed the presence of hemosiderin-laden macrophages.</div><div>The temporal relationship and etiological significance of this lesion could not be determined, and a causal association with heat exposure could not be established. Nevertheless, the discrepancy between postmortem CT and MRI findings in this case indicates that certain cerebellar abnormalities may only be recognizable by MRI. These findings underscore the complementary role of postmortem MRI in forensic investigations, particularly for documenting subtle intracranial changes in cases where the cause of death remains uncertain.</div><div>Further accumulation of similar cases is necessary to clarify the forensic relevance of dentate nucleus abnormalities and to determine whether such findings have diagnostic or supportive value in suspected heat-related deaths.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"83 ","pages":"Article 102853"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147799315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury as a silent witness: forensic medicine’s role in the legal qualification of an explosive case","authors":"Francesco Calabrò ,&nbsp;Francesco Saverio Romolo ,&nbsp;Beatrice Defraia ,&nbsp;Valentina Bugelli","doi":"10.1016/j.legalmed.2026.102845","DOIUrl":"10.1016/j.legalmed.2026.102845","url":null,"abstract":"<div><div>In forensic practice, the reconstruction of criminal behavior and charge determination are often entrusted solely to law enforcement, with forensic medicine playing a marginal, confirmatory role. Nonetheless, accurate injury analysis remains fundamental and, in specific contexts, may be decisive.</div><div>The authors present a case that underscores the crucial role of interdisciplinary forensic collaboration − particularly between forensic pathologist and ballistics expert − in the reconstruction of the event dynamics and in supporting judicial decision-making aimed at the accurate charge determination of the event. On the shutter of a bookstore a ticking object wrapped in white cloth was discovered. A bomb disposal technician intervened to neutralize the device. During the operation, the device exploded, causing the amputation of the left hand, loss of the right eye and bilateral thigh lacerations with retained foreign bodies. The technician claimed the explosion occurred spontaneously. Based on this, charges included mass murder, considering the alleged explosive power. A multidisciplinary forensic analysis integrating crime scene investigation, injury pattern review, radiological imaging and explosive residue testing was conducted. A detailed injury analysis and technical assessment of the device disproved this version, redefining the victim’s position at the time of detonation and substantially reducing the inferred explosive capacity. This led to the reclassification of some criminal charges.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"83 ","pages":"Article 102845"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between menstruation and spermatozoa persistence in sexual assault victims: a medicolegal case–control study in Southeast Sulawesi, Indonesia","authors":"Raja Al Fath Widya Iswara ,&nbsp;Beta Ahlam Gizela ,&nbsp;Intarniati Nur Rohmah ,&nbsp;Tuntas Dhanardhono","doi":"10.1016/j.legalmed.2026.102856","DOIUrl":"10.1016/j.legalmed.2026.102856","url":null,"abstract":"<div><h3>Background</h3><div>Spermatozoa detection is an important component of forensic examination in sexual assault cases. Spermatozoa persistence in the vaginal environment is influenced by physiological factors, including menstruation. However, the effect of menstruation on spermatozoa detectability during medicolegal examinations remains insufficiently explored. This study aimed to evaluate the association between menstruation and spermatozoa persistence among sexual assault victims undergoing medicolegal examination in Southeast Sulawesi, Indonesia.</div></div><div><h3>Methods</h3><div>A case–control study was conducted involving 240 female sexual assault victims examined within five days after the alleged assault. Cases consisted of victims examined during menstruation (n = 120), while controls were victims examined outside the menstrual period (n = 120). Bivariate analysis and multivariate logistic regression were performed to identify factors associated with spermatozoa detection.</div></div><div><h3>Results</h3><div>Spermatozoa were detected in 64.2% of menstruating victims and 47.5% of non-menstruating victims. Menstruation was significantly associated with increased odds of spermatozoa detection (adjusted OR 1.82, 95% CI 1.05–3.16; p = 0.032). Early examination (&lt;24 h) was the strongest predictor (adjusted OR 2.70, 95% CI 1.50–4.86; p = 0.001). Age was not significantly associated with spermatozoa detection. A significant interaction between menstruation and time since assault was observed (adjusted OR 2.11, 95% CI 1.14–3.89; p = 0.018), indicating a stronger effect of menstruation in delayed examinations. Sensitivity analyses confirmed the robustness of these findings.</div></div><div><h3>Conclusion</h3><div>Menstruation is associated with increased spermatozoa detection and appears to influence spermatozoa persistence in a time-dependent manner. These findings highlight the importance of considering menstrual status in the forensic interpretation of spermatozoa evidence.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"83 ","pages":"Article 102856"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}