Immunohistochemical investigations to demonstrate vital direct traumatic damage of skeletal muscle

Intramuscular hemorrhages in the pathway of an electric current through the body - two case reports

Intramuscular hemorrhages at autopsy can have a variety of traumatic as well as non-traumatic causes, but their recognition in electrical deaths is almost a rarity. We report on two autopsy cases of electrical fatalities, the first relating to a portion of the right upper human extremity, consisting (only) of the forearm and hand, while the other case relates to a female child who died after a high voltage electrical shock. In both cases, layered dissection of the upper limb revealed fresh intramuscular hemorrhages in the skeletal muscles that could be topographically related to the path taken by the current through the body. Externally visible electric marks were present in both cases. The hemorrhages were most likely caused by current-induced tetanic muscle contractions, producing an internal muscle trauma with rupture of fibers and bleedings. In complex situations, such as inconspicuous marks or a complete lack of visible signs on the body, the finding may be helpful in solving the case in consideration of the case history and circumstances. The vitality, topography, and pattern of the hemorrhages are discussed in the light of the available literature.

Histopathological muscle findings may be essential for a definitive diagnosis of suspected sharp trauma associated with ship strikes in stranded cetaceans

Ship strikes are a major issue for the conservation of may cetacean species. Certain gross and microscopic criteria have been previously reported for establishing a diagnosis of death due to ship strikes in these animals. However, some ship-strike injuries may be masked by advanced carcass decomposition and may be undetectable due to restricted access to the animals. In this report we describe histopathological muscular findings in 13 cetaceans with sharp trauma from ship strikes as the cause of death. Skeletal muscle samples were taken from the incision site and from the main locomotor muscle, the longissimus dorsi, in areas not directly affected by the sharp injury. The microscopic findings in tissues from both sites mainly consisted of haemorrhages; oedema; flocculent, granular or/and hyalinised segmentary degeneration; contraction band necrosis; and discoid degeneration or fragmentation of myofibres. We propose that skeletal muscle histopathology provides evidence of ante-mortem injuries even if the sample was taken elsewhere in the carcass and not only within or adjacent to the sharp trauma site and despite the advanced decomposition of some of the carcasses. This method helps to establish the diagnosis of ship strike as the cause of death.

Capture myopathy in live-stranded cetaceans

A group of 51 cetaceans that had been stranded alive on the coasts of the Canary Islands, experienced human capture/rescue interactions and then died, were necropsied over a 12-year period. Of these cetaceans, 25 had haemodynamic lesions indicative of multiorganic vascular shock, degenerative muscle lesions affecting both skeletal and cardiac muscles and myoglobinuric nephrosis typical of capture myopathy (CM). Because macroscopic lesions in muscles and kidneys were not always obvious, a standard protocol was developed where the longissimus dorsi muscle was examined histologically for segmental hypercontraction, contraction band necrosis and segmental muscular degeneration and cardiomyocytes studied for hypereosinophilic wavy fibres, sarcolemmal and perinuclear vacuolation and contraction band necrosis. Light microscopic skeletal and cardiac muscle lesions in all CM animals were confirmed as ante mortem by immunohistochemical assay for myoglobin loss from and fibrinogen entry into affected myofibres. All animals had tubular nephrosis with casts and tubular myoglobin. The oxidative stress-related marker HSP70 was demonstrated immunohistochemically in tubular epithelium. Although the syndrome related to death of live-stranded cetaceans is multifactorial, this study documents that a clinicopathological syndrome comparable to CM of terrestrial wildlife has a role in stranding outcomes.

Haemorrhages into the back and auxiliary breathing muscles after death by hanging

We describe and discuss haemorrhages discovered in the back and auxiliary breathing muscles of a population of cases of suicidal death by hanging. Intramuscular haemorrhages were present in approximately 30% of the cases. Pre-existing illnesses with an increased tendency to bleed or an anticoagulant medication did not exist; corresponding skin and subcutaneous fatty tissue structures were intact in each case. In cases of death by hanging, the occurrence of muscle haemorrhages of this type may be explained pathophysiologically by the occurrence of increased respiratory exertions and/or seizures during the hanging process. Although the results of our study do not indicate an obligatory autopsy finding, evidence of internal haemorrhaging into the back and auxiliary breathing muscles may be called upon following consideration of differential diagnostic aspects as a further diagnostic indication of vital hanging.

Fatal trauma to the neck: immunohistochemical study of local injuries

As fatal trauma to the neck is often associated with short survival times, proof of vitality may often be difficult using standard histochemical techniques. Soft tissue neck injuries resulting from strangulation by ligature or manual strangulation were examined immunohistochemically using antibodies to myoglobin, fibronectin, C5b-9 and MRP14, and compared to controls consisting of accidental soft tissue neck injuries as well as undamaged neck soft tissue. Although survival times in the study and control groups were unknown and certainly some individual variation may be expected in the time course of normal wound development, both the study and control groups demonstrated similar time courses in the immunohistochemical detection of antigen. Myoglobin was always found in those samples in which only one antigen was shown to be involved in an injury-specific pattern; myoglobin and fibronectin were found in samples with dual antigen involvement. Samples involving three antigens always included C5b-9 in addition to myoglobin and fibronectin. The single positive MRP14 sample in the study and control groups was simultaneously positive for the other markers used. Myoglobin, fibronectin, C5b-9 and MRP14 are therefore suitable for immunohistochemical detection of vital reactions and estimation of temporal relationships in the early posttraumatic period after neck trauma.

Light microscopical investigations on structural changes of skeletal muscle as artifacts after postmortem stimulation

Samples of skeletal muscle were taken from 20 human corpses where mechanical or electrical stimulation had been carried out up to 8h postmortem (hpm) in order to estimate the time since death. The stimulation had caused an idiomuscular bulge or tetanic contraction of the muscle tissue at this location. The muscle samples were examined for structural changes of the fibers by light microscopy. A comparison with control muscle samples taken contralaterally from the same corpse, showed that the findings previously interpreted as being of intravital origin, e.g. destruction of fiber integrity, invagination and contraction bands, could also be due to postmortem alterations. It is hypothesized that structural changes to the muscle fibers can, in general, be produced as long as the manifestation time is shorter than the supravital phase after the time of force impact.

Advances in the diagnosis of wound vitality: a review

The diagnosis of the vital origin of wounds in many cases remains an unsolved problem for the forensic pathologist. Practical experience enables the expert to diagnose the vital or postmortem origin of wounds on the basis of macroscopic examination. In some cases, optic microscopy is used to confirm the diagnosis. In many other cases, additional more sensitive and specific markers of vitality are required. In the past 50 years, comprehensive research on this topic has resulted in a better understanding of the acute inflammatory reaction. The development and application of sensitive and specific markers through research in the areas of histochemistry, enzymology, and biochemistry has provided a partial solution to the problems involved in wound vitality diagnosis. A review of this challenging area of forensic pathology, including an explanation of these methods and markers, is presented in this paper.

Adam (MDMA) and Eve (MDEA) misuse: an immunohistochemical study on three fatal cases

Three fatal cases of MDMA/MDEA misuse have been examined. These referred to white males between 19 and 20 years of age, in which post-mortem toxicology showed the presence of MDMA (in one case), MDEA (in one case) and both (in one case). The clinical data were analysed and the histopathological findings were studied following immunohistochemical investigations. A complete immunohistochemical study has made it possible to demonstrate rhabdomyolysis and myoglobinuria with alterations of the organs typical of a DIC. Clinical, histopathological and toxicological data suggest that severe or fatal complications following ecstasy ingestion could be related to idiosyncratic response.

Morphological changes in traumatized skeletal muscle: the appearance of 'opaque fibers' of cervical muscles as evidence of compression of the neck

Cervical muscles of 15 cases of compression of the neck and the other traumatized skeletal muscles from 54 autopsy cases were examined histologically and immunohistochemically. Round and thick fibers, that is, opaque fibers were observed in the muscles beneath the compression marks on the neck, whereas in areas where no force had been applied, such fibers did not exist. Furthermore, opaque changes appeared around cavities, which formed within severely compressed injured muscle tissue. The pattern of appearance of opaque fibers in the cases of compression of the neck were mainly divided into two types, 'diffuse' pattern and 'focal' pattern. In both blunt and sharp force injuries, the production of opaque fibers were common in the area directly where damage had been inflicted. In stab wounds especially, the appearance of opaque fibers and wavelike fibers, which fanned out and showed a different color from the other areas, was limited to the marginal zone. These results suggest that there is a close relationship between opaque changes and force. Opaque fibers are probably produced by damage to muscles due to extremely applied force. The high incidence of opaque fibers beneath compression marks on the neck should be regarded as a useful indication of strangulation and/or hanging. Furthermore, the distribution and direction of force to the neck might be presumed by the pattern of opaque fibers in cervical muscles, to a certain extent.

Distribution of biochemical markers in biologic fluids: application to the postmortem diagnosis of myocardial infarction

We evaluated the usefulness of postmortem determination of biochemical markers and the ratio of their concentrations in pericardial fluid and serum to diagnose acute myocardial necrosis. One hundred cadavers from routine necropsies were studied. Cases were allocated in diagnostic groups according to the cause of death. Myoglobin and myosin heavy chain concentrations and creatine kinase MB isoenzymes (CK-MB) activities were measured in serum and pericardial fluid. Ratios of the concentrations obtained in these fluids were calculated. Hematoxylin and eosin (H&E) and acridine orange stains were used for microscopy studies. Pericardial fluid-serum ratios of the concentrations of biochemical markers were significantly different. The ratio of the concentrations of myosin is the best indicator of wide-spread muscle damage or cardiac necrosis.

Typical homicide ritual of the Italian Mafia (incaprettamento)

Certain methods of homicide used by the Italian Mafia are intended to have an admonitory significance. One such method is the so-called "incaprettamento." This study analyzes 18 cases of homicidal ligature strangulation in which the body was found in this typical position. The circumstances of the crime and the macroscopic and microscopic evidence were evaluated to determine whether or not the ligatures on the wrists and ankles were placed antemortem or postmortem.

Identification of human skeletal muscle from a tissue fragment by detection of human myoglobin using a double-sandwich ELISA

A method for identifying human skeletal muscle by detection of human myoglobin using a double-sandwich ELISA was developed. When an extract was prepared from 0.1 g skeletal muscle homogenized with 10 ml PBS, this method was able to detect human myoglobin in extracts diluted 10(4)-fold. There was no difference in the detection limit between individuals or sites of origin of skeletal muscles. Species specificity was good and no cross reaction occurred with skeletal muscle from other animals except the gorilla. Our method could also discriminate between skeletal muscle and other organs or tissues except the heart. Human myoglobin could be detected in skeletal muscles under the following conditions: putrefied at room temperature for 5 months, dried at room temperature for 11 months, heated at 100 degrees C for 72 h and immersed in fresh water at room temperature for 6 days. Two practical cases to which this method was applied are presented.

Usefulness of myosin in the postmortem diagnosis of myocardial damage

In some situations the postmortem diagnosis of myocardial infarction is made difficult by the brief course of the fatal episode or by interferences caused by autolysis. In such cases, biochemical indices may provide a useful adjunct to morphological studies. Myosin is the main component of the contractile apparatus of muscle cells, so its determination may well be useful to evaluate myocardial injury. The purpose of the present study was to establish the diagnostic efficacy of postmortem myosin heavy chain determinations using monoclonal antibodies and to compare this data with structural findings used to diagnose acute myocardial ischaemia. We studied 105 cadavers with a mean age of 61.63 +/- 2.21 years. Cases were allocated to 1 of 7 diagnostic groups depending on the probable intensity of myocardial damage and cause of death. The highest serum and pericardial fluid values of myosin heavy chains were seen in subjects who showed morphological evidence of myocardial ischaemia. Mean pericardial fluid/serum ratios differed significantly between subjects with and without observable signs of heart damage.

Immunohistochemical alterations after muscle trauma

The proteins fibrin, fibrinogen, fibronectin and complement C5b-9 were investigated in mechanically damaged skeletal muscle. An accumulation of fibrin, fibrinogen and fibronectin could be observed immediately after intra-vital trauma in damaged fibre zones, later an accumulation at the torn edges of the fibres. The accumulation of complement C5b-9 began one hour after trauma. After post mortem trauma no positive reactions could be observed for any of the proteins. The degree of expression of these proteins can therefore be used to differentiate between vital and postmortem muscle damage as well as the estimation of wound age in the early antemortem time period.