Forensic Medicine: Concepts, Procedures, and Applications

Posted on May 12, 2024 in Medicine & Health

1. Concept of Forensic Medicine, Structure, and Development

Structure

  • 5 sections: Vilnius/Kaunas/Klaipeda/Siauliai/Panevezys
  • 5 subsections: Alytus/Jurbarkas/Marijampole
  • 5 Labs (NFMS) in Vilnius: Toxicology/Serology+DNA/Criminalist/Histology/Osteo

Expertises NFMS

  • Dead bodies
  • Living
  • Deontological
  • Toxicological
  • Serological
  • Cytological
  • DNA
  • Osteological
  • Criminalistic
  • Glucose [C]

Definition

1. Specialist

  • (special knowledge + skill for investigation, make conclusion)

2. Forensic Medical Examiner

  • (Human body, corpse, examination)

3. Forensic Expert

  • A person who has qualifications of forensic + LT forensic expert

4. Private Forensic Expert

2. Death Scene

  • Describe (Body/position/traces/Cloth/footwear)
  • (Appearance)
  • (External Injuries)

3. Real and Pseudo Death, Early and Late Postmortem Changes

PseudoReal
  • Immobile
  • Unconscious
  • 0 Reflex
  • 0 HR
  • 0 Breath
  • ECG 0
  • Brain death
  • Postmortem (cadaveric changes)
  • Incompatible with life
EarlyLate
  1. Postmortem hypostasis
  2. Stagnation: (2-4H) (No ATP)
  3. Dry Skin: (2-3H) (Liarsche spots)
  4. Cooling
  5. Supravitality
  1. Putrefaction
  2. Mummification (ventilated + warm) (6-12 M) (soft organs stiff, ↓ weight)
  3. Adipocere (glycerin + oleic acid melt) (wax-like substance formed) (1M start.. all body 10-12 M)
  4. Fixation in a turbary! (decomposition stops due to humic acid) (bones become elastic)

Rodent

  • Entomofauna (cycle takes 3-4 weeks)
  • Flies put eggs under the eyelids/nostrils
  • 1 day larva develops
  • 2 weeks: larvae move to dark space + pupa covered
  • New flies in 2 weeks

5. Methods and Application, Time of Death

MethodEstimation
  • Postmortem hypostasis
  • Stagnation
  • Ambient + corpse rectal temperature
  • Mompogram
  • Supravitality reactions
  • Potassium in vitreous
  • Entomofauna
  • Underwater changes
  • Late postpartum changes
  • >3 H = Warm + flaccid
  • 3-8H = Warm + Stiff
  • 8-36 = Cold + stiff
  • >36 = Cold and flaccid

8. Exhumation

General

  • Pretrial investigation for further examination

Classification

  1. Permitted (Pretrial exam) (scientific) (ID)
  2. Random
  3. Illegal (rob the grave/sex/mockery)

Causes

  • Suspect violent death
  • Defect in medical-legal investigation
  • New circumstances
  • Hidden by criminal

Stages

  • Pretrial investigation material
  • Medical or forensic documents
  • Determine cause of death/burial time
  • External investigation of the grave
  • Taking samples for additional tests (Hist/chemical/Criminalist)

Questions

  • Burial time
  • ID the person
  • Assessment of injuries
  • Cause of death

9. Osteological Examination

Skull

  • Bigger, rougher, irregular surface
  • Mandible heavier + branch more vertical (80-85g)
  • Occipital protuberance
  • Eyebrow ridge
  • Nasal bridge
  • Mastoid and styloid process
  • Mandible lighter (60-65g) + branch more horizontal
  • Frontal bone vertical

Pelvis

  • Pelvis 70-75 degrees
  • Pelvis, tall and narrow
  • Symphysis wider + shorter
  • Ischium further
  • Pubic bone 90-100 degrees
  • Pelvic bone thinner
  • Sacrum wider + shorter

10. Identifying the Individual, Unchanged and Changed Body

I. Corpse UnchangedII. Affected
  • General appearance
  • Clothing
  • Documentation
  • Things
  • Specific signs
  • Teeth
  • DNA
  • Fingerprints
  • Teeth condition
  • Comparison of skull
  • DNA examination
  • Reconstruction of face
  • X-ray

12. Types of Injuries

AbrasionContusionLaceration
  • Superficial layer of skin (epidermis)
  • Cause: friction, compression, stretching
  • Mechanism (tangential/crushing)
  • No bleeding
  • Types
  • Discoloration
  • Vessel damage + fluid leak = May be distal
  • Color types
  • Edema –> neutrophils –> macrophages
  • Tear in tissue
  • Produced by blunt force
  • May bleed
  • Area: bone + force

13. Sharp Wounds

General

  • Damage by weapons with pointed edges
  • Incise = Longer > Deep
  • Stab = Deep > Longer

Types

  • Study (not pointed, nail)
  • Cutting (sharp edge)
  • Stubby-cutting (knife)
  • Chopping (axe, sword)

I. Stab

  • Via thrust into a victim
  • Shape depends upon:
    1. Sharp weapon –> regular linear wound, no abraded margin
    2. Single edge –> blunt margin
    3. Both external skin –> V-shaped
    4. Scissors –> Z line
    5. Screwdriver –> circular wound
  • Angle of thrust
  • Blade movement
  • Langer lines
  • Tension/relaxation
  • Stab reflects the shape of the weapon

II. Incision + Slash Wound

  • Cutting/slicing
  • Longer than they are deep
  • Produce clean, sharply incised wounds
  • Lack bridging tissues
  • Dull weapon –> irregular incised wound
  • Defense wounds – arms and hands to protect the head

III. Self-Inflicted

  • Can self-access
  • Grouped in a single anatomical area
  • Contralateral side to handedness
  • Superficial/minor
  • Old healed scars in similar sites
  • Superficial injuries (hesitation)

IV. Healing

Early VascularCellularProliferative
  • Coagulation production of fibrin
  • Cytokines release
  • ↓ perfusion
  • ↑ vascular permeability
  • Neutrophils attracted
  • Macrophages later
  • Degrade RBC
  • Monocytes join
  • Fibroblasts
  • Collagen is laid down
  • New blood vessels

Sharp Object Injuries

  • Object with sharp/pointed edges
  • Incised – Longer > Deep
  • Stab – Deep > Long
StabIncisedSelf-Inflicted
  • Weapon @ victim
  • Shape (Sharp = Regular linear pattern)
  • (Both margins of external skin wound)
  • (Scissors linear Z)
  • (Screwdriver = circle)
  • Angle of thrust
  • Blade with wound movement
  • Langer lines
  • Cutting/slicing
  • Sharp edges weapons
  • Stab, with no ‘bridging tissue’
  • Defense wounds on arms & hands
  • Reachable area
  • Single anatomical region
  • Contralateral side
  • Superficial/minor
  • Hesitation/tentative injury

Healing Stages

  1. Early Vascular: Fibrin released, cytokines released, reduced tissue perfusion * enhanced vascular permeability
  2. Cellular Reaction: Neutrophils are attracted to the wound, followed later by macrophages
  3. Proliferative: Fibroblasts become very active, collagen laid down

15. Epidural and Subdural Hematoma

Intracranial hemorrhage (hematoma) <—- blunt trauma

Epidural HematomaSubdural Hematoma
  • Fall/vehicle accident
  • 95% fracture related
  • Meningeal artery bleeding
  • Death: displacement + herniation
  • Young or elderly
  • Symptoms: 4-8 hours
  • Shearing/tearing force acting upon parasagittal bridging veins
  • Ipsilateral/contralateral side
  • May be associated with skull fracture
  • Elderly/alcoholic
  • Acute symptoms: 72 hours
  • Subacute: 3 days – 2-3 weeks

16. Head (Scalp + Face) Soft Tissue Injury

Scalp InjurySkull Fracture
  • Incision <— bottle/knife
  • Blunt —-> laceration, abrasion, hematoma
  • Not life-threatening unless laceration
  • Depends on severity
  • Closed/open (compound)
  • Direct (parietal bone)
  • Indirect (blowout fracture)
  • Linear fracture –> vault, stellate fashion
  • Puppe rule

Le Fort Fractures

  • Le Fort I (Guerin Fracture): Premaxilla above apices of teeth, upper teeth mobile
  • Le Fort II (Pyramidal): Through maxilla, meeting in the middle of the nose
  • Le Fort III: Face sheared off, craniofacial separation, airway compromise, cause of death

17. Pectoral Injuries

  • Serious injuries may be caused by penetrating/blunt injury
  • Penetrating –> pneumothorax –> death due to damage to heart/great vessels = massive hemothorax
  • Blunt chest –> falls and motor vehicle collisions (rib fractures –> pneumothorax + damage to great vessels)

Types of Pectoral Injuries

  1. Sternal fracture (can cause myocardial injury)
  2. Rib fracture (few weeks to heal)
  3. Flail segment (3+ ribs in 2 places)
  4. Pneumothorax (punctured lung, connection between interpleural space + lung air space) (lung collapse)
  5. Aortic injury (transection of thoracic aorta)
  6. Sucking chest wound (significant defect due to gunshots)
  7. Myocardial injury (significant bleeding/cardiac tamponade) (blood in the pericardial cavity prevents heart refilling)

18. Abdominal Injury

Types of Abdominal Injuries

  1. Liver + spleen (risk of hemorrhage)
  2. Diaphragmatic rupture (respiratory compromise, stomach and spleen upward)
  3. Intestinal injury (risk of infection)
  4. Pancreatic injury (acute pancreatitis)
  5. Rectal injury (pelvic fracture associated)
  6. Pelvic fracture (bleeding/vertical shear/open book acetabular fractures)

19. Knee Injury

Mechanisms of Knee Injury

  • Varus flexion
  • Hyperflexion
  • Shearing force
  • Tearing force
  • Compression force

20. Seat Belt and Airbag Injuries

I. Seat Belt

  • Reduce deaths and serious injuries by 25%
  • (+) ↓ force: spreads deceleration forces at impact
  • (+) ↑ time of deceleration
  • (+) Restrains the body not to hit the window
  • (-) Fracture clavicle/sternum/ribs
  • (-) Rupture of mesentery, intestines, aorta
  • (-) Belt may slip

II. Airbag

  • Abrasion, contusion, laceration on face
  • Superficial burns to upper extremities, face, trunk
  • Eye injury * corneal abrasion, hyphema, lens

22. Main Types of Firearms

Main Types of Firearms

  • Shotguns (smooth barrel)
  • Rifles (grooved barrels) (projectile or bullets)

Shot Factors

  • Diagram of discharging firearm/small amount of flame at muzzle
  • Residual shot factors:
    1. Flame
    2. Cloud of smoke
    3. Particles of gunpowder
    4. Oil
    5. Small particles of metal
  • Contaminants follow projectile

23. Injuries by Smooth/Rifled Weapons

I. Smooth Bore Gun

ContactNear ContactIntermediateDistant
  • Circular defect
  • Regular, no individual pellet
  • Black tissue along wound
  • Muzzle mark
  • Similar wound appearance
  • No muzzle mark
  • Powder”tatto”
  • Wad in wound
  • 20cm-1m
  • Less circular skin defect
  • Satellite holes
  • Wad in wound
  • Black skin if < 30cm
  • Skin tattoo
  • 20-50m
  • Central defect < 10m

II. Gunshot Exit Wound

  • Small size, rarely completely penetrates through full length
  • Suicide – large defect (especially if from mouth)

III. Rifle Weapon

ContactClose Range (20cm)Longer Ranges (>1m)
  • Circular
  • Gas is common
  • May be muzzle on skin
  • Local burn
  • Smoke soiling
  • Skin + hair burn
  • Smaller defect
  • Skin inverted
  • Collar abrasion
  • No smoke soiling
  • Burning powder
  • Canal of a shot
  • Pulsatory cavity 1-2cm around the shot

25. Physical Injuries: Burns and Frostbite

Burns

  • I: Redness + swelling, weak inflammatory reaction
  • II: Burned skin
  • IIA: Superficial skin (ruptured epidermal blisters) (10-20 day healing)
  • IIB: Deep part of skin, visible necrosis, non-blistering
  • III: Skin, bones, muscle carbonized

Frostbite

  • I: Cyanosis, edema, paresthesia, itching
  • II: Blisters with serous content
  • III: Blisters + dark brown content + necrosis
  • IV: Necrosis of bone + soft tissue

26. Asphyxia

StageBreathingHeart RateBlood PressureSymptomsConsciousness
ILabored↓↓Cyanosis, weaknessConscious
IILabored↓↓Convulsions, sphincter relaxationLoss
IIIStopped↓↓RelaxedLoss
IVRareFluctuatingFluctuatingLoss
VNoNoNoRelaxedLoss
External SignsInternal Signs
  • Cyanosis + plethora
  • Petechiae (face + mucous membranes)
  • Relaxation of sphincters
  • Bright postmortem hypostasis
  • Dark liquid blood
  • Congested right heart
  • Anemic spleen
  • Petechiae pericardium

27. Strangulation Asphyxia, Its Types and Morphological Signs

StrangulationLigature StrangulationManual Strangulation
  • Ligature mark on neck
  • Hemorrhage in neck muscles
  • Protruding bitten tongue
  • Anisocoria
  • Bloody nose
  • Fracture of cervical vertebrae
  • Horizontal
  • Open
  • Fracture of lingual bone
  • General signs of asphyxia
  • Petechiae in eyes/face
  • Petechial hemorrhage
  • Abrasions + bruises
  • Wide hemorrhage in neck muscles

Sign of hanging = oblique strangulation mark on neck/unequal expressed in length

28. Obstructive Asphyxia

Gagging: External openings of airways (mouth/nostrils) are covered by palm or soft object

Signs of Gagging

  • General asphyxia
  • Subcutaneous hemorrhage, abrasions on face
  • Aspirated small foreign objects (feather, cotton, wool)
ChokingDrowning
  • Aspiration of foreign body
  • Aspiration of blood, powder
  • Aspiration of vomit

Water + liquid into airways

  • Submersion: body + head
  • Drowning = fatal

Signs of Choking

  • General asphyxia
  • Foreign body/vomit/blood in airways
  • Lungs are expanded (vomit + and uneven)

Signs of Drowning

External

  • Wet skin + clothing
  • Lake vegetation
  • Pale skin
  • Maceration of hands + feet
  • White foam

Internal

  • Bright, intensive purple hypostasis
  • Petechiae in eyes + pericardium
  • Hemolysis
  • Right heart full
  • Internal organs full of blood
  • Large amount of liquid in stomach
  • Liquid in sphenoid sinus

30. Poison

  • Natural/synthetic
  • Damages living tissue and may be fatal

Mechanism of Action (MOA)

  1. Local Action: (corrosive poison, irritant) inflammation of mucous membranes
  2. Remote Action: Systemic absorption, shock, pain
  3. Both Ways: (carbolic/oxalic acid)

General Symptoms

  • Sudden vomiting + diarrhea
  • Unexplained coma
  • Rapid peripheral neuropathy (wrist drop, GI symptoms)

31. Postmortem Intoxication

Toxicological Specimens

  1. Blood is preferable
  2. Urine for screening
  3. Vitreous is an excellent alternative to blood
  4. Bile (narcotics, benzodiazepines)
  5. Tissue specimens (muscle, lung, stomach, hair)

Types of Tests

  • Screen: Radioimmunoassay (RIA)/Enzyme immunoassay (EIA)/Fluorescent IA
  • Confirmatory: To determine substance concentration, HPLC, GC

32. Common Poisons

Ethanol (OH)

  • Most popular poison
  • Absorbed in duodenum + jejunum
  • Effects:
    1. Depressant/cortex
    2. High dose (-) subcortical neurons
    3. Respiratory paralysis + death if concentration 3.5-5%
  • Degrees of Intoxication:
    1. 41 mg/100ml (≤ 0.40 ‰) = no obvious effect
    2. 41 mg/100ml to 150 mg/100ml (0.41-1.50 ‰) – mild degree of drunkenness
    3. 151 mg/100ml to 250 mg/100ml (1.51-2.50 ‰) – moderate degree of drunkenness
    4. More than 250 mg/100ml (≥ 2.50 ‰) – severe degree of drunkenness
  • Methanol –> formaldehyde –> formic acid! Acidosis
  • Ingestion of 70-100ml can cause death
  • Isopropanol to acetone
  • 150mg/dl is lethal

Opiates

-Most popular X-Abs in duodenu+ Jejunum-Effect:1-depressent/cortex2-high Dose (-) subcortical neuron3-Repiratoryu paralyussis + death if [C] 3.5-5%-Degrees:1-41 mg/100ml (≤ 0,40 ‰) =no obvious effect, the person 2- 41 mg/100ml to 150 mg/100ml (0,41-1,50 ‰) – mild degree of drunkenness3- 151 mg/100ml to 250 mg/100ml (1,51-2,50 ‰) – moderate degree of drunkenness4- More than 250 mg/100ml (≥ 2,50 ‰) – severe degree of drunkennessMethyul Oh —–>Formaldehyde—->Formic acid!Acidocisingestion 70-100ml can cause deathISpopropanol to acetone150mg/dl is lethal-From poppy plants-Moprhin+codeine+ Heroin!-EffecT:1-CNS depressent via U1 Opiate receptos!2-Death due to pulmonaryu arrest3-Lab:Delay btwn adminsitaion+ rise in blood and urine-Morphine+ 6-mama appear minutes after injection!
CNS Stimulatns(amphematine.MDMA.cocain)Gases Intoxication(CO,CO2,H2S)
-Increase Dopamine [C]-Death is uncommon is used alone-No speicfic autpsy finding-MDMA death : hyperthernmia, Dehydration, Myocotylosuis!-Cocains: CVS stimulates ,HR (+) ,BP(+)-Increase Release of Catcholine-Cocain increaseM yocardian demand  and can cause MI-can cause accidental death-CO displace O2 from RBC,decrease the ability to delvierO@-CO Poison:1-Pink skin2-cherry pink organs3-Blood High levle of COhb!

***Corrosinve substance(alkali +acid)-Acid- STong minela-Alkali-Sodium Hydroxide!-Miscellanous substance-lysol/ Heacy metals!^^CF”-Difficulty swallowing-chest pain-abdominal pain-vommiting-difficuly breathing-chockingCorrosive—->destory surface in contactSkin injury—->due to acid/alkali!^^Internally:-esophageal, stomach and Small intestine damage if substance is swalled-GITperforation(chemical perititonisits)-Renal+ hepatic(-)***Health (-) Scale:^^def:-Faace+scale of health (-) also % of incapacity for work estiamted!-Loss of professionakl ability assed by Service of establishing disability and capacity for work^^concept:-HEalth(-)-Injury. ailement of person by breaking tissue/organs-Injury: violant of body tissue+organs by mechnial ,physical,chemical-Ailment- violeaiton of organism function by ….General ability: a person ability to do work without special knowledge/qualification!^^inflication of physical pain / low health (-):-conclusion about nfliction pain made by forensic exper-Low health (-) is assed when health impaired for 10 days of less-subcutanous bleeding,skin abrasion,wound healing-Teeth knockout!^^Simple Health (-):-injured or ailment impair health for 10 days -Injure lost small part >5% -Fractureo of small bone (Nose, forarm, hand bones)-Kocking out 3-5 teeth-10% -6+ teeth-25%^^High health(-):-Loss of hand from wrist/metacarpal 65%-spleen removed -30%-Loss of fetilization( sexual dysfunciton)-Loss of pregnancy-Open skull fracture-Open humour ,femur,ibial fracture41-Method of DNA investgation:-DNA expertise+examination- For spefici person-Idenityf DNA- Sturcture complianxe-STRshort tandem repeat)99.99%New method—->bone tissue+histology prepaionMitochondia DNA:Hair follicle-Biological material-Female Line!42-Criteria of quliaty heath care servies, innaporita medical servieceI-Deontological expertise:-deals with issues related to health care insituitionservies and their impact of pts stateor even deathII-Bythe law of patient Right + health damage compensation in LT republicIII-health care nsitution must compensate the dama caused to PTs on this situation^^Quality health Care:1-accordance with established health stadnards+laws!2-by person with medical license3- By intituiton which has licensce to provide health service!^^Law of medical practice in  LT”1-Medical practice mistkae-Doctor,did harm to pts health2-Rude medical practice- caused damage to pts health and potentially Death3-Staff fault if:(legal requirment regulating Tx were breache)(intentional damage or death casued by The Health provider)43-Deontology:^^Done according to:1-court order 2-Police task to perform it3- Deontological expertize+investifation NOT be pts Request!^^Objective of investigation:1-Case MAterial (Files)2-Original medical documents3-confirmed medical insuttion algotrythms4-Live person5-Dead body!Done by forensic experts!conclusion done by commitee unified opitionany different opinion can stand by its own^^Question :1-Correc+ timeline of Dx!2-undetected/late Disease or injuy3-Indication , timeliness4-NEcessity and timeliness of advisors5-correctness+ timeliness6-Mistake of pregnancy and childbirth care, anesthisea46-Pathoical exam Goal,structure, significant:^^Def:scice of disease /its Dx /Tx and prevention!^^Goals:ID  the cause to have succesful Tx and prevent Disease!^^Structure:-cellular px-Morbid anatomy-Chemical Px-Hemaotlogy-Genetic-immunology^^Significane:-Early Detection-Dc-Tx^^Role in Dx/Plan /Tx:-dx by applying Px methods-use for correctness of Tx!-TMN classsification!47-Pathology service in LT:-Ministry of health-consultatent -pathologist(1/2)-State Pathology center in Vilnuis-Clinic of pathology anatomy in KMU-Cardiac Pathology lab-Pathology Department in city -PAtholigst of LT^^Goal:-Correction/confirmation of Dx-Quality of Dx+ Tx in clinical dep-Increase thoeratical and practical qulification-Anatomical and cli8nical naalysis-Morphological based scientific investigation!49-Specific features of Biopsy:^^specifiment acquisition:-Contaimed with fixation solution!-Cntainer should be (R) to formalin solution, sufficient volume-Neck should be narrower to buttom-diff samples of same pts need diff container-Analyzes of specific zone^^Preparign and sending samples:-Most common fixatin material is 10% Formaline solution-volume 10x for biopsy 4x for surgical mateiral-diff samples in diff container^^Rules & regulation of 014-1A:-fill: name,surname,ID #,Address-Hx of morphological analysis-Precise Clinical Dx-Size of removed tissue/organ and iuts surrounding^^Mistake:LEaving clinical Dx mepty-Writing abbreviation51-Stages+ technology to prepare HistoPx exmination:`1-after tissue biopsy was done speicifc fixation with fixation material!(10% buffer foraline)(10x for biopsy )(4x for surgery material)2-Water is removed from sample in successive stage by (+) OH!3-Wax is added to casstte surroundign the sampe!4-tissue is sliced using a microtome to produce thin slice and placed on glass!5-tissue staineds with special staining (Most commonly is hematoxylin+ eosin)6-same is done for wwax paraffarin blocjks52-Pathology analysis and profile of their potentials:1-Histology:microscopic exmination of tissue2-CytologyL smear test3-Histochmistry:4-immunohistochemistry:”5(use of Ab to test certain antigen)6-Electron microscopyused to investigate ulterastructure of wide rand7-Fluorensen in situ hybridization(to detect RNA or DNA seuqence)8-PCR:(molecular biology to amplify a single copy)9-DNA sequnecing:-precise order of nucleotides within a DNA molecule!10-Virtual microscopy technologyu!53- Description of changes during histopathological exmination of biopsy and surgical specifmen:I-description of changfed determined durign HistopPx invetigation:Pathologist views the slides and writes a pathology report with:1-Types of cells!2-Arrangment3- If cells are abnormal4-other features!II-Diagnosis contruction based on observed changes + how the influence of tx strategy!:-Estalbishmen of Px Dx after microscopic analysis!-Several seperate samples are sent for analyss-Dx of Neoplasm is written to WHO classifciation!-some additional anaylisisIII-Presentation/trnasportation:-Macroscpic desctiion according to reocmmendation-Microscopic desciption -\Diagnosis/conluision of mporhopholical dataUrgent intraoperative morphological analysis ;15 – 30 min Urgent „one day biopsy “; 6 – 8 hours Small and needle biopsies; 3 – 4 days Surgical material; 4 – 6 days54-Rules and regulation for storage:-Macroscopic Autopsy  Archived till Dx/Epicrids!-Biopsy Least 1 M affter Dx+activation-Praffin blocks from autopsy kept till 5 years!-….Biopsy Not less 5 years-Autpsy Hx till 10 years-Biopsy Not less then 10-Px:Autopsy Doc/Body acceptance Doc/Death certificate/Form 0-1755-TMN :I-Goal:Stage+Spread of neoplasmII-(+):-Improves doctor communication-scietiffic reseach+survived prediction-Neoplasm of anatomical sitIII-TMN:1-primary +adjuvant Tx2-Result evaluation3-Change Tx4-Prognosis5-Help cancer research!CPRA(TMN)56-Disease Classification principle :Intenrational statistics^^Goals:-ensure systemic Registration /analysis/Interpretation-Used for Dx+Px into letter-ICD: 3 digit systemI-ICD-0:Tumour registration-topography-Histology

Topography-Anatomic terms:T28K- lungT-32KHEartT-51K=Mouth
M-Morphology-chances in cell, tissue, organs!M-40K inflammationM-44K GranulomaM-547K-inarned
L-(living organism) bacteria and viruses
C-(chemical)-DrugsBufferin Analgesic tablet/Caplets
F-(Function) Signs + SxFeverJ(occupation)-Terms that describe the occupation!
59- principles of contruction Epicarsis-Pathoanatomical conclusion based upon :micrscopic/hisotlogical-Dx: Preliminary( after Autopsy and discussion)-Final(afterl all exams 1-2 M)^^Dx PRocess:1-Main Disease (why pts died)2-Adjacent disease|(Disease aggravating the main disease)3-Intercurrent Disease(Aggravating the main disease)4-Latrogenic Disease( Caused by Dx or Tx)5-Complication (additional Processes elated to disease)^^clinical anatomical epicrises:1-Biograph data of Dead2-MAin Disease, and duration3- when and where Dx is Made( evaluation)4-Main complication5-qulaity of lcinical Dx6-PRimary cause of death7-Adjacent Disease8-Px concerte proposals!60-Principle of Priperin and formulating Px Dx anatomical epicrises+death cericitifcate(SAME as 59)+Death Certificate:-Can be fileld by : Pgysiian/PathologistForensic Pathologist-1st part is Biographycaical -2nd part is medialMedical PArt:I-A-Primary cause of DeathB- Intemrdiate cause of DeathC-Intermediate cause of DeathD-Main DiseaseII-Adjacent +other disease62- Ana,lysius,presentation+ discusion of Px investigation:-Px Does comparison to evalute the Quality of Dx+ Tx!-If Dx differed ” Diagnosis discepancy”-discrepancies : Nosological/localization/ Px Process!-Nosological discrepancy of Main Disease!-every clincial department recives copeis of Dx!-Final repors about autopsied cases yearlt!interesting, Dx idfficult!-Director assign a chairman , previous prss phyusician ,onsultate and other investigation-conference makes proposals and various concluision!