No abstract

In infants, pulmonary haemosiderin has been put forward as a marker of previous asphyxic abuse and possible grounds for suspicion of homicide. Review of the available literature does not provide a strong enough evidence base to support this claim. Further research is needed before instigation of criminal proceedings can be justified on this pathological finding.

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Colonic fibrosarcoma is extremely rare. This is a report of a patient with fibrosarcoma of the transverse colon, manifesting as an obstructive lesion with local perforation and abscess formation.

Retrograde amnesia is a recognised neurological complication of carbon monoxide poisoning. This article describes the case of a female found dead in her bath where initial post-mortem findings and the surrounding circumstances raised strong suspicions of homicide, especially when there was contradictory evidence from her husband who was the only other person present. He was later diagnosed as having retrograde amnesia between his two visits to the bathroom to attend to his wife which caused him to merge them into one event, thus arousing suspicions of foul play. The discussion explores the current clinical views on non-fatal carbon monoxide poisoning as well as problems of interpretation of information derived from case work.

Tests to examine the resistance to cutting of several samples of post-mortem human skin have been conducted. The strength of the tissue is compared to that of a commonly used skin simulation, chamois leather. Several effects are noted relating to the physical behaviour of skin and skin simulations in sharp edge contacts likely to produce tissue damage. Particular reference is made to the minor trauma suffered as a consequence of head to windscreen contact in road traffic accidents.

Sudden unexpected death in infancy and childhood requires a 'full' post-mortem investigation. Guidance from the Royal College of Pathologists recommends sampling of all the major organs. However, the diaphragm does not feature in this or in most lists of routine histology. Our aim is to emphasize the importance of sampling the diaphragm for histological examination during autopsy. We describe three autopsy cases of clinically unexplained death in the perinatal and paediatric age group that showed significant pathology of the diaphragm. In Case 1, a previously healthy five-year-old girl collapsed suddenly and died four days later. In Case 2, an eight-month-old infant had repeated episodes of respiratory arrest that culminated in death. Autopsy demonstrated a predominantly diaphragmatic myositis. In Case 3 a female neonate had a respiratory arrest three days after birth and died less than a month later. Autopsy showed multiple large calcified necrotic fibres in the diaphragm. The diaphragm is seldom sampled at autopsy. In the first two cases a predominantly diaphragmatic myositis was either the direct or underlying cause of death. In the third case long-standing diaphragmatic pathology of uncertain cause may have contributed to the original respiratory arrest. Had the diaphragm not been examined histologically, the cause of death would have remained unascertained in these cases. In cases of sudden death in infancy and childhood, failure to reach a diagnosis may lead to undue suspicion falling upon the child's carers. This underscores the need for full histology at post-mortem in child deaths, including diaphragmatic sampling.