Ramalingam S

Missed injuries and delayed diagnosis are still common problems in the treatment of trauma patients especially, polytrauma. Diaphragmatic injuries are quite common and one of the most important missed injuries. It can result from either blunt or penetrating trauma. Traumatic diaphragmatic injuries (TDI) may go unnoticed initially and later present as life-threatening conditions. Here we present such a case of a fatal diaphragmatic injury, which was diagnosed during the autopsy.   Keywords: Missed injury, Traumatic diaphragmatic injury, Gastric perforation.

Deaths due to accidental ingestion, suicidal consumption and homicide poisoning with colchicine alkaloid containing extracts have been documented and reported in innumerable literature across the world. The lowest reported lethal dose of oral colchicine are 7-26 mg. Gloriosa superba, regionally known as Kodalikkizhangu is a highly poisonous flowering plant, seen wide spread in south and south East Asia. Colchicine is concentrated in the seeds and tubers of the plant. Colchicine content of Gloriosa tuber is 0.3%. These tubers are often mistaken as yams and accidentally ingested. Ingestion of tubers of Gloriosa results in colchicine poisoning. Toxicity of Gloriosa is due to the anti-mitotic effect of its toxic principle namely colchicine and Gloriosin on the rapidly proliferating cells such as stomach and oesophagus. Cardiac manifestation of Gloriosa poisoning is due to the impaired cardio myocyte conduction and contractility. Deaths in these cases are due to multi-organ failure. No specific antidote is available. A 71-year-old male who was a chronic alcoholic and known hypertensive got admitted in toxicology ward, with symptoms of acute gastroenteritis, 11 hours after alleged consumption of tubers of a wild plant. 24 hours after ingestion the patient succumbed to death and post-mortem was done to establish cause of death.   Keywords: Autopsy findings, Kodalikkizhangu, Colchicine, Poisoning.

Hanging is one of the commonest methods of committing suicide. In most cases of hanging, death occurs immediately, usually within 3 to 5 minutes and it is due to asphyxia, cerebral anoxia, vagal inhibition, venous congestion, or injury to the spinal cord. However, more number of cases have been reported in various literatures, in which death has occurred after a certain time period or the patients have been survived after initial resuscitative measures and later died after a prolonged period due to the complications such as aspiration, infections, HIE, etc., In this article, we present a case report of a 24-year old female in which she died three days after the incident due to one or more delayed complications including pneumomediastinum and pneumothorax (a rare finding). Keywords: Delayed death, Hanging, Pneumomediastinum, Pneumothorax

Ingestion of corrosive substances may cause severe to serious injuries of the upper aero-digestive tractand the poisoning can even result in death. Acute corrosive intoxications pose a major problem in clinical toxicology since the most commonly affected population are the young with psychic disorders, suicidal intent and alcohol addiction. In our case report, a 19-year-old male, 2year engineering student committed suicide by consuming a heavy metal salt available in his chemistry lab after leaving a suicidal note. He got treated in a private hospital for 2 days and later he succumbed due to poisoning. Though the findings of this heavy metal poisoning mimicks corrosive acid poisoning, it has to be viewed through the eye of forensic toxicology for a clear view in clinching the diagnosis in the earlier phase of treatment.   Keywords: Corrosive substances, Heavy metal poisoning, Mimicking, Forensic toxicology.

Angioedema related to deficiency of the C1- esterase inhibitor protein (C1-inh) is characterized by lack of response to therapies, which include antihistamines, steroids and epinephrine. In case of laryngeal edema, mortality rate is an estimated mammoth 30 percent. The first case of such acquired form of angioedema related to the deficiency in C1- esterase inhibitor was published in 1972. In the present case, we entail details of one such case., Keywords: C1­ esterase inhibitor, Sudden Death, Hereditary Angioedema, Hereditary Angioneurotic edema, Laryngeal edema

Foreign body aspiration (FBA) is an emergency condition and may be fatal. This condition is more common in children less than 3 years of age and male children are affected frequently. Among the foreign bodies inhaled, most of them are organic in nature and most commonly were lodged in right bronchus. Here we present a case report of an one and half year old male child who died of respiratory distress and found during autopsy that the cause for respiratory distress was foreign body aspiration. Keywords: Foreign body, Aspiration, Breathlessness, Asphyxia

The relationship between the trauma and the disease poses a biggest problem in interpretation, when a person who was either previously diseased dies after a trauma or who developed disease after sustaining injury. The importance of an autopsy in establishing the actual cause of death is most important in natural deaths, but it is even more important in the event of unnatural deaths. Here, we present a case report where the investigating agency booked the case under IPC S.304A and later the cause of death in the case is found to be a natural and the section was altered to IPC S.174.   Keywords: Autopsy, Trauma, Disease, IPC S174, IPC S304A.