Frontal sinus pattern analysis for human identification using non-contrast computed tomography images: A Sri Lankan experience.

Objective: Morphometry of frontal sinuses has been studied extensively in many countries. However, these findings cannot be generalized due to genetic and environmental factors affecting the skeletal structure. The main aim of this study was to morphometrically analyze the frontal sinuses in patients who underwent non-contrast computed tomography (NCCT) skull imaging at Teaching Hospital Peradeniya and to assess its association with age and sex.

Trap gun: an unusual firearm, aimed at wild animals but causing a silent epidemic of human fatalities.

Among a variety of uncommon firearms of different origin used worldwide, the trap gun used in Sri Lanka is underreported. This is an illegal, locally made, smooth-bore, long-barreled, muzzle-loading firearm with a victim-activated simple trigger mechanism. It is mainly used to protect crops and livestock from the potential harm by wild animals.

Over-a-century-old death investigation system in Sri Lanka: an appraisal for reforms.

Although the death investigation systems in the world are divergent, the prime objective of each system is to certify the cause of death and manner of unnatural and unexplained deaths. In addition, it provides evidence for the purpose of fair administration of justice and data for health sector regulation. Many jurisdictions recently underwent considerable review and made changes to their death investigation systems in accordance with modern innovation in medicine and science.

The role of the Armanni-Ebstein lesion, hepatic steatosis, biochemical analysis and second generation anti-psychotic drugs in fatal diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) is an acute severe complication of diabetes and characterized by a complex disordered metabolic state due to an absolute or relative insulin deficiency, leads to hyperglycaemia, ketoacidosis and ketonuria. DKA can cause sudden unexpected death and often yields minimal and/or subtle autopsy findings or a negative autopsy and the diagnosis mainly depends upon biochemical analysis of body fluids. This communication highlights the role of Armanni-Ebstein lesion, hepatic steatosis, biochemical analysis and second generation anti-psychotic drugs in 25 adult cases of fatal diabetic ketoacidosis.

A death following hemopericardium due to rupture of a right ventricular aneurysm due to a congenital ventricular septal defect.

Right ventricular aneurysm (RVA) is a rare clinicopathological entity. Although it occurs as a consequence of a variety of conditions, congenital ventricular septal defect (VSD) as an etiology for the RVA has not been previously reported. A 42-year-old man without a significant family or past medical history was found dead in bed.

Fatal subarachnoid hemorrhage following traumatic rupture of the internal carotid artery.

Traumatic subarachnoid hemorrhage (TSAH) is a life-threatening intracranial bleed often associated with violent assault or motor vehicle accidents. The vast majority of TSAH is associated with rupture of the vertebral artery, although rare cases of traumatic aneurysm of the internal carotid artery (ICA) have been reported. A 27-year-old man was found bleeding and unresponsive following a violent altercation in which he received repeated blows to the head and neck.

Pericardium: an exceedingly rare site for a primary biphasic synovial sarcoma.

Pericardial neoplasms are rare. Among pericardial neoplasms, metastatic spread is more common and primary synovial sarcomas of the pericardium are exceedingly rare. A 61-year-old man was found dead in bed.

"Excited delirium syndrome": is it a cause of death?

Excited delirium syndrome (EDS) has become a controversial and vexing forensic issue due to its association with restraint and sudden unexpected death. Although some authorities and jurisdictions recognised EDS as a cause of death there is no consensus among the medical community in this regard. The overlapping nature of the spectrum of antemortem behaviours and signs with many natural disease processes complicates this issue further.

Practice of clinical forensic medicine in Sri Lanka: does it need a new era?

Clinical forensic medicine is a sub-specialty of forensic medicine and is intimately associated with the justice system of a country. Practice of clinical forensic medicine is evolving, but deviates from one jurisdiction to another. Most English-speaking countries practice clinical forensic medicine and forensic pathology separately while most non-English-speaking countries practice forensic medicine which includes clinical forensic medicine and forensic pathology.

Fatal pediatric head injury due to toppled television: does the injury pattern overlap with abusive head trauma?

Pediatric head injuries can occur from abusive head trauma (AHT) or accidents. Accidental pediatric head injuries caused by cathode-ray tube televisions (CRTT) toppling have become a 'silent epidemic'. Differentiation between a fatal case of AHT and CRTT toppling could be vexing when the historical and scene evidence are subtle.

Left-sided ventricular cardiomyopathy with minimal right ventricular involvement.

Left-sided ventricular arrhythmogenic cardiomyopathy is rare and represents a rather different expression of the arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC). Among sudden cardiac deaths, ARVC plays a significant role. ARVC is considered as a cardiomyopathy of unknown aetiology that primarily involves the right ventricle (RV) and is characterized by progressive replacement of myocytes by fibro-fatty tissue, complicating a spectrum of arrhythmias.

Strychnine in amoxicillin capsules: a means of homicide.

Fatal strychnine poisoning is uncommon. It is no longer used as a therapeutic drug and its availability to the public is controlled by legislations in various jurisdictions, but it is still in use as a rodenticide and an adulterant in street drugs. Homicide by strychnine is extremely rare.

Accidental hanging: a novel mobile suspension apparatus partially hidden inside the clothes.

Accidental hanging is uncommon. An immobile/fixed and exposed suspension apparatus is seen in almost all cases of hanging. A 50-year-old man, who was drunk, was trying to steal an iron rod by hiding it under his clothing.

Alcoholism and the Armanni-Ebstein lesion.

The Armanni-Ebstein lesion is a histological change in the kidney consisting of sub-nuclear vacuolation of the proximal tubules. It has been most associated with diabetic ketoacidosis. The vacuoles have been reported to contain glycogen.

Sudden unexpected death in epilepsy: a retrospective analysis of 24 adult cases.

Sudden unexpected death in epilepsy is a common form of seizure-related death but is poorly appreciated by the medical profession. A number of risk factors have been identified in this context including male gender, young adult age group (20-40 years), poor compliance with antiepileptic drugs, polytherapy, and presence of neuropathological lesions. In addition it has been noted that most of the victims sustained an unwitnessed collapse at home.

Accidental hanging by a T-shirt collar in a man with morphine intoxication: an unusual case.

Accidental hanging is rare across all age groups, and it is even rarer in the adult population except in autoerotic asphyxia. Few cases have been reported in the literature, which describe unusual patterns of accidental hanging. This article focuses on an unusual pattern of accidental hanging of a 25-year-old man, who was in a state of morphine-induced central nervous system depression and found dead in a sitting position with the collar of his T-shirt hanging off a jutting-out root of a tree.

Death due to hemorrhagic shock after delayed rupture of spleen: a rare phenomenon.

Delayed splenic rupture after blunt trauma is rare and contributes to a significant mortality rate. As this is accompanied by a period of clinical quiescence, a close clinical vigilance is required for early diagnosis and surgical intervention. A case report on death because of delayed rupture of healthy spleen after blunt trauma is presented.

Bilateral pulmonary artery aneurysms.

Pulmonary artery aneurysms are rare. The estimated incidence is 1 in 14,000 in autopsies. Bilateral main pulmonary artery aneurysms have not been previously reported in the literature.

Mechanisms of delayed splenic rupture: a new hypothesis.

A 46-year-old man was assaulted with a club to the face, chest and abdomen. On admission there were no signs of circulatory shock. The abdominal examination was unremarkable.