2011년도 법의부검에 대한 통계적 고찰 (국립과학수사연구원 본원)

나주영,박종필,최민성,이한영,최영식,정낙은,박혜진,전석훈,김유훈,최병하,서중석 대한법의학회 2012 대한법의학회지 Vol.36 No.2

This is a statistical analysis of the data obtained from legal autopsies performed at the headquarters of the National Forensic Service during 2011. This report aims to analyze 2,723 cases. 1. There were 1,995 (73.3%) cases involving mortalities among men and 707(26.7%) among women; evidently, the number of deaths that occurred among men were twice as many as that among women. With respect to age, 694(24.4%) deaths occurred in individuals aged in their forties and 658 (22.8%)among those in their fifties. 2. There were 1,437 (52.8%) cases of unnatural deaths, 1,159 (42.5%) cases of natural deaths, and 127 (4.7%) deaths from unknown causes. Among the 1,437unnatural deaths, 483 (33.6%) were suicidal, 255 (17.7%) homicidal, 546 (38.0%)accidental, and 153 (10.6%) were of undetermined causes. 3. There were 618 cases of trauma-related death, accounting for 43.0% of the 1,437 unnatural deaths. Blunt trauma was the leading cause of trauma-related deaths, accounting for 174 (28.2%) cases. Deaths due to asphyxiation, among which hanging (187 cases, 64.7%) was the predominant cause, accounted for 289 cases. There were 192 (13.4%) deaths from poisoning, 151 (10.5%) from drowning, 139 (9.7%) from thermal injuries, 31 (2.2%) as a complication of medical procedures, and 14 (1.0%) from electrocutions. 4. Among the 1,159 natural deaths, heart diseases accounted for 600 (51.8%)deaths and vascular diseases accounted for 160 (13.8%) deaths. 5. There were 83 cases of death among children aged under 10; out of 33 unnatural deaths, 20 (24.1%) cases were homicidal. This is a statistical analysis of the data obtained from legal autopsies performed at the headquarters of the National Forensic Service during 2011. This report aims to analyze 2,723 cases. 1. There were 1,995 (73.3%) cases involving mortalities among men and 707(26.7%) among women; evidently, the number of deaths that occurred among men were twice as many as that among women. With respect to age, 694(24.4%) deaths occurred in individuals aged in their forties and 658 (22.8%)among those in their fifties. 2. There were 1,437 (52.8%) cases of unnatural deaths, 1,159 (42.5%) cases of natural deaths, and 127 (4.7%) deaths from unknown causes. Among the 1,437unnatural deaths, 483 (33.6%) were suicidal, 255 (17.7%) homicidal, 546 (38.0%)accidental, and 153 (10.6%) were of undetermined causes. 3. There were 618 cases of trauma-related death, accounting for 43.0% of the 1,437 unnatural deaths. Blunt trauma was the leading cause of trauma-related deaths, accounting for 174 (28.2%) cases. Deaths due to asphyxiation, among which hanging (187 cases, 64.7%) was the predominant cause, accounted for 289 cases. There were 192 (13.4%) deaths from poisoning, 151 (10.5%) from drowning, 139 (9.7%) from thermal injuries, 31 (2.2%) as a complication of medical procedures, and 14 (1.0%) from electrocutions. 4. Among the 1,159 natural deaths, heart diseases accounted for 600 (51.8%)deaths and vascular diseases accounted for 160 (13.8%) deaths. 5. There were 83 cases of death among children aged under 10; out of 33 unnatural deaths, 20 (24.1%) cases were homicidal.

광주, 전남 일부 지역에서 이루어진 법의부검 중 알코올과 관련된 사망의 통계적 분석

나주영,민병우,이영직,김형석,박종태 대한법의학회 2010 대한법의학회지 Vol.34 No.1

Alcohol is very popular and readily available among the population but is also known to be a toxic substance. Excessive alcohol ingestion can lead to death induced by acute intoxication. In addition, chronic alcohol ingestion can cause many diseases such as alcoholic liver disease and cardiomyopathy. Alcohol consumption is associated with many social incidents. For example, traffic accidents, murders, incendiary crimes and so on. Hence, alcohol should be considered as a significant and socially relevant substance. However, there is currently no statistical analysis about deaths associated with alcohol consumption in forensic autopsy cases. We analyzed forensic autopsy cases involving alcohol during 2007 to 2009 in Gwangju city and Jeollanamdo province, Korea. The following is the summary of the results. 1. The number of total cases in our department from 2007 to 2009 was 329. 2. Among the 329 cases, 314 cases were checked to have alcohol concentration levels. Alcohol related deaths were 118 cases (35.9%). 3. Among 118 cases, natural deaths were 27 (22.9%) and unnatural deaths were 91 cases (77.1%). 4. Deaths caused by alcohol intoxication were 9 cases (7.6%). The remaining 82cases of unnatural deaths were as follows: suicides (18 cases, 22.0%), homicides (32 cases, 39.0%), accidents (24 cases, 29.3%), and undetermined (8cases, 9.8%). 2007-2009년 동안 본 기관에서 시행한 부검은 329예이었으며, 이 중 부패로 인해 알코올이 검출된 2예를 제외하고 알코올 농도가 측정된 312예 중에서 알코올 농도가 0.05% 이상 측정된 경우는 93예(29.8%)로 약 30%에 해당되었고, 40대와50대에서 가장 많았다. 알코올과 관련된 사망 중 내인사는 27예로 전체 329예 중에서 8.2%였고, 외인사는 91예로 27.7%였다. 과거 통계와 비교할 때, 본 기관에서 이루어진 사법 부검 중 자연사의 약 1/5, 외인사의 약 1/2는 알코올과 관련된 사망으로 판단되었다. 알코올과 관련된 사망은 주정 중독에 의한 사망(Code A.),알코올 섭취와 관련된 내인사(Code B.), 알코올과 관련된 자살, 타살, 사고사, 불상 등 외인사(Code C.)로 각각 코드화 하여 분석한 결과 알코올과 관련된 사망은 전체 329예 중에서118예로 35.9%였으며, 이 중 주정중독에 의한 사망은 9예로7.6%였다. 내인사 27예 중에서는 남성이 24명으로 많았으며,이 중 40대 남성이 13명(48.1%)으로 가장 많았다. 사인은 주로 심혈관 질환이 많았으며, 이러한 결과는 심혈관계 질환으로 인한 사망 중 많은 부분은 알코올에 의한 사망의 가능성이 있으며, 알코올에 의한 사망이 저 평가 되어 있을 가능성이 있다는 과거의 보고와 일치하는 결과로 판단되었다. 알코올과 관련된 자살은 18예이었으며, 특히 20대의 경우 여성이 남성보다많다는 점과 20대 여성의 자살의 경우 알코올과 관련성이 높다는 것이 특징적이었다. 알코올과 관련된 타살의 경우 32예가있었으나, 이러한 결과는 피해자 뿐 아니라 가해자에 대한 자료 조사가 부족하였다는 점에서 실제보다 적게 계수되었을 가능성이 있는 것으로 판단되었다. 알코올과 관련된 사고사는 24예 있었고, 다른 연령에 비하여 고령이 많았다는 점이 특징적이었다. 기타 불상은 8예가 있었으며, 불상 중에서는 화재사가4예로 가장 많았다. 본 연구는 몇 가지 제한 점이 있으나, 알코올 섭취와 관련된사망을 전반적으로 포함하여 분석하였다는 점과, 법의 부검이시행된 사망에서 알코올과 관련된 사망을 처음으로 통계적 고찰하여 그 특징을 분석하였다는 점에서 의의가 있다고 생각된다.

Analysis of Cisternal Puncture Results during a Postmortem Examination

나주영,박지혜,오연호,오세민,김형석,박종태 대한법의학회 2016 대한법의학회지 Vol.40 No.2

Examination of cerebrospinal fluid (CSF) samples is important in postmortem examinations. CSF samples can be collected by performing lumbar or cisternal punctures. Additionally, if bloody fluid is aspirated during a spinal puncture, intracranial hemorrhage could be diagnosed. However, vascular injury and hemorrhage can occur during these procedures. The authors performed cisternal punctures during routine autopsies; further, to evaluate the usefulness of the former, the results were analyzed. Out of 50 cases, bloody fluid was aspirated in CSF samples of 20, while CSF samples of the other 30 were clear. Cases in which bloody fluid was aspirated were divided into blood-tinged and blood aspiration groups according to hemoglobin levels in the aspirated fluids. Cisternal punctures were characterized by high specificity and sensitivity; further, positive and negative predictive values were obtained that enabled detection of head and neck injuries including non-traumatic basal subarachnoid hemorrhage. Main head and neck injuries in blood aspiration group were skull base fracture, cervical fracture, and dislocation.

V1과 V2 피부분절에 국한된 감각저하를 보인 다리뇌출혈

나주영,김명국,유봉구 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Pontine tegmental hemorrhage involving the trigeminal tract, the medial lemniscus, and the spinothalamic tract frequently give rise to various sensory dysfunctions. However, isolated hypesthesia confined to certain parts of trigeminal sensory dermatomes is very rare. We experienced a case of impairment of pain and temperature sense over the unilateral ophthalmic (V1) and maxillary (V2) nerve distribution. Brain CT and gradient echo MRI showed a small hemorrhage in the right dorsomedial midpons. The segmental sensory impairment may explain by somatotopic representation of trigeminal nucleus and tract in the ventral to dorsal and cranio-caudal direction

A Comparative Study of Postmortem Bacterial Culture and Identification Methods

나주영,박지혜,함석훈,김형석,박종태 대한법의학회 2016 대한법의학회지 Vol.40 No.2

Postmortem bacterial culture can be valuable for investigating deaths and determining the cause of death. However, there are many concerns regarding postmortem bacterial culture such as postmortem transmigration and agonal spread of bacteria. The two main methods for identification of the bacteria are biochemical and genetic methods. In Korea, the genetic method has been used for postmortem bacterial culture and identification in forensic medicine. However, there is a lack of consensus on the method to be used for postmortem bacterial culture and identification. Herein, we compared the genetic and biochemical methods of postmortem bacterial culture in autopsy practice. Both analyses were performed on the same samples. Bacteria were identified in 28 of the 34 cases (82.4%). Of the 74 comparable samples, only 28 (37.8%) showed consistent results by both methods. In addition, the biochemical method had a shorter reporting time and was more sensitive. In conclusion, we analyzed the causes of the inconsistency between the two methods and provided appropriate conditions and protocols for postmortem bacterial culture and identification.

루드비히 앙기나 부검 증례

나주영,함석훈,오연호,이성수,김형석,박종태 대한법의학회 2015 대한법의학회지 Vol.39 No.4

Ludwig’s angina is a progressive gangrenous cellulitis and edema of the soft tissues of the neck and floor of the mouth. Ludwig’s angina can be fatal as a result of progressive swelling of the soft tissues of the neck and elevation and posterior displacement of the tongue, resulting in airway obstruction. We report the case of a 77-yearold man who was admitted to the dental hospital with a toothache and headache. He was diagnosed with left submandibular space abscess. Four days post-admission, the submandibular and submental abscess was incised and drained. After the operation, the patient suddenly developed dyspnea and suffered cardiopulmonary arrest and died. An autopsy was performed, and exploration of the neck revealed a submental and submandibular abscess with massive inflammation, edema, and an abscess in multiple layers of the cervical subcutaneous tissue. After autopsy, the cause of death was confirmed as Ludwig’s angina with a deep neck abscess. Ludwig’s angina is a rapidly progressive cellulitis that often results in death by asphyxia or sepsis and is rarely seen in a forensic autopsy practice. Here in we report a case of Ludwig’s angina and present a review of the literature.

The Significance of Ventricular Volume in the Evaluation of Secondary Cardiomyopathy at Autopsy

나주영,민병우,김영희,정승현,이영직,김형석,박종태 대한병리학회 2011 Journal of Pathology and Translational Medicine Vol.45 No.4

Background: The weight, shape and consistency of the heart, and the thickness of the ventricular wall are used as parameters for evaluating postmortem heart and diagnosing cardiomyopathy at autopsy. Methods: The weight and volume of the ventricles and the thickness of the left ventricular wall of 58 hearts were measured and analyzed. Results: In the group of dilated hearts, the ventricular weight, ventricular volume, ventricular volume/ventricular weight, and left ventricular volume/right ventricular volume increased, whereas ventricular wall thickness decreased. In the group of hypertrophied hearts, the ventricular weight, ventricular volume, and thickness of the ventricular wall increased but ventricular volume/ventricular weight and left ventricular volume/right ventricular volume did not change significantly. In the group of undetermined hearts, it was later found that four of the cases should have been included in the dilated heart group and another two cases in the hypertrophied heart group. Conclusions: In addition to conventional methods, the measuring ventricular volume is useful for evaluating a postmortem heart and may suggest postmortem differential diagnoses of dilated or hypertrophied forms of secondary cardiomyopathies.

고립폐동정맥루와 동반된 모순뇌색전증

나주영,김경진,이대승,김명국,유봉구 대한신경과학회 2014 대한신경과학회지 Vol.32 No.2

현훈과 실조보행만을 보인 가쪽 연수경색

나주영,이지현,김민정,김명국,유봉구 고신대학교(의대) 고신대학교 의과대학 학술지 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Isolated vertigo and gait ataxia without other symptoms and signs have rarely been reported as manifestations of lateral medullary infarction. We report a patient with lateral medullary infarction who presented with vertigo and gait ataxia as only symptoms. Brain MRI showed a small infarction involving the most dorsolateral part of the right lateral medulla that corresponds to the vestibulocerebellar pathway. This unusual presentation seems to be related to a selective involvement of the far dorsolateral portion of the lateral medulla that corresponds to the central vestibular pathway.

코로나바이러스감염증-19 관련 검안 지침: 대한법의학회

나주영,노상재,최민성,박종필 대한법의학회 2020 대한법의학회지 Vol.44 No.2

Coronavirus disease-19 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerged in Wuhan, China, in late 2019. It resulted in a worldwide pandemic, and spread through community transmission in the Republic of Korea (ROK). In the ROK, SARS-CoV-2 is categorized as a first-degree infectious disease of the legal communicable disease present. The Korean Society for Legal Medicine (KSLM) is the sole official academic association of forensic professionals in the ROK. As such, this society has played an important role in forensic medicine and science in the ROK. Therefore, KSLM suggests a standard operating procedure for the postmortem inspection in a focus on COVID-19. This article includes the background of this suggested standard operation procedure, basic principles for postmortem inspections of individuals suggested of having an infectious disease, and specific procedures according to the probability level of SARSCoV-2 infection.