1
|
Hleșcu AA, Grigoraș A, Covatariu G, Moscalu M, Amalinei C. The Value of Myocardium and Kidney Histopathological and Immunohistochemical Findings in Accidental Hypothermia-Related Fatalities. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1507. [PMID: 36363464 PMCID: PMC9694447 DOI: 10.3390/medicina58111507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 08/30/2023]
Abstract
Background and Objectives: The post-mortem diagnosis of hypothermia is challenging in forensics. The aim of our study was to detect the kidney and heart histopathological changes that occurred in a group of hypothermia-related fatalities. Materials and Methods: The cohort included 107 cases identified in the database of our department between 2007 and 2021, which have been associated with extreme cold stress. Demographic and clinicopathological data were collected from the medico-legal reports. Archived tissue samples were evaluated to identify the histopathological features, in routine haematoxylin-eosin (H&E), Periodic acid-Schiff (PAS), and Masson's trichrome stainings, while cardiac sirtuin1 (SIRT1) and renal ubiquitin (Ub) immunostaining have been performed. Results: The majority of cases exposed to low temperatures were males (76%) from rural regions (68.2%) during the cold season. Paradoxical undressing was documented in 9.3% of cases. The common comorbidities included alcoholism (50.5%), neuropsychiatric diseases (10.3%), diabetes mellitus (3.7%), and lung tuberculosis (4.7%). The microscopic heart exam revealed areas of myocardial degeneration (100%), contraction bands (95.3%), fatty change (13.1%) and focal wavy contractile myocardial cells. Basal vacuolisation of renal tubular epithelial cells (Armanni-Ebstein lesions) (21.5%), focal tubular necrosis (7.5%), tubular renal cysts (7.5%), interstitial haemorrhages (5.6%), diabetic kidney disease (3.7%), background benign nephroangiosclerosis (42.1%), variable thickening of tubules and corpuscles basement membranes, capsular space amorphous material, and intratubular casts were identified in kidney tissue samples. Myocardial cells displayed SIRT1 weak expression, with a loss of immunopositivity correlated with areas with contraction bands, while a variable Ub expression was observed in renal corpuscles capsules, proximal, distal, and collecting renal tubules, Henle's loops, urothelium, and intratubular casts. Conclusions: In the context of the current concept that death associated with hypothermia is still a diagnosis of exclusion, our findings suggest that the microscopic exam provides relevant data that support the diagnosis of hypothermia-related fatalities in appropriate circumstances of death. A deeper insight into the histopathologic findings in hypothermic patients may lead to new therapeutic approaches in these cases.
Collapse
Affiliation(s)
- Andreea Alexandra Hleșcu
- Legal Medicine Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adriana Grigoraș
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Histopathology, Institute of Legal Medicine, 700455 Iasi, Romania
| | - Gabriela Covatariu
- Faculty of Civil Engineering and Building Services, “Gheorghe Asachi” Technical University, 700050 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cornelia Amalinei
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Histopathology, Institute of Legal Medicine, 700455 Iasi, Romania
| |
Collapse
|
2
|
Savioli G, Zanza C, Longhitano Y, Nardone A, Varesi A, Ceresa IF, Manetti AC, Volonnino G, Maiese A, La Russa R. Heat-Related Illness in Emergency and Critical Care: Recommendations for Recognition and Management with Medico-Legal Considerations. Biomedicines 2022; 10:2542. [PMID: 36289804 PMCID: PMC9599879 DOI: 10.3390/biomedicines10102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
Hyperthermia is an internal body temperature increase above 40.5 °C; normally internal body temperature is kept constant through natural homeostatic mechanisms. Heat-related illnesses occur due to exposure to high environmental temperatures in conditions in which an organism is unable to maintain adequate homeostasis. This can happen, for example, when the organism is unable to dissipate heat adequately. Heat dissipation occurs through evaporation, conduction, convection, and radiation. Heat disease exhibits a continuum of signs and symptoms ranging from minor to major clinical pictures. Minor clinical pictures include cramps, syncope, edema, tetany, and exhaustion. Major clinical pictures include heatstroke and life-threatening heat stroke and typically are expressed in the presence of an extremely high body temperature. There are also some categories of people at greater risk of developing these diseases, due to exposure in particular geographic areas (e.g., hot humid environments), to unchangeable predisposing conditions (e.g., advanced age, young age (i.e., children), diabetes, skin disease with reduced sweating), to modifiable risk factors (e.g., alcoholism, excessive exercise, infections), to partially modifiable risk factors (obesity), to certain types of professional activity (e.g., athletes, military personnel, and outdoor laborers) or to the effects of drug treatment (e.g., beta-blockers, anticholinergics, diuretics). Heat-related illness is largely preventable.
Collapse
Affiliation(s)
- Gabriele Savioli
- Emergency Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Doctoral Program Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Christian Zanza
- Foundation “Ospedale Alba-Bra”, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Yaroslava Longhitano
- Foundation “Ospedale Alba-Bra”, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Alba Nardone
- Department of Internal Medicine, Università degli Studi of Pavia, 27100 Pavia, Italy
| | - Angelica Varesi
- Department of Internal Medicine, Università degli Studi of Pavia, 27100 Pavia, Italy
| | | | - Alice Chiara Manetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| |
Collapse
|
3
|
Ibrahim MA, Mohammed SS, Tammam HG, Ibrahim Abdel-Karim R, Farag MM. Histopathological, histochemical and biochemical postmortem changes in induced fatal hypothermia in rats. Forensic Sci Res 2021; 7:211-227. [PMID: 35784407 PMCID: PMC9246044 DOI: 10.1080/20961790.2021.1886656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Reaching a postmortem diagnosis of hypothermia is challenging in forensic practice. Therefore, this study was conducted to detect the histopathological, histochemical and biochemical changes that occur in adult albino rats following exposure to induced fatal hypothermia. Twenty-four adult albino rats were divided into the negative control, moderate hypothermia, severe hypothermia and hypoxia groups. Rats in the control group were euthanized when those in the moderate hypothermic group died. Blood samples were collected via heart puncture, and the cerebrum, heart, suprarenal gland, kidney, liver and skeletal muscle were removed to investigate the biochemical, histochemical and histopathological changes. Postmortem assessment depicted significant changes in lipid peroxidation, represented by increased malondialdehyde levels in the studied organs of the rats in hypothermic and hypoxia groups. Histopathological examination of the rats’ organs revealed degeneration and necrosis in the hypothermia and hypoxia groups. Sections taken from the severe hypothermic rats revealed a loss of normal cardiac tissue architecture, necrotic changes in the pyramidal cells in the cerebral cortex, and massive necrosis, mainly in the tubules of the renal cortex and medulla. These findings suggest that histological changes might be used as biochemical markers for postmortem diagnosing of fatal hypothermia, particularly in severe hypothermic conditions.Key points Death by hypothermia is a serious public health problem worldwide. Confirming a diagnosis and determining the cause of death in cases of hypothermia are among the most difficult practices in forensic medicine. Death by hypothermia might be associated with structural abnormalities in various organs. Studies using different tissue staining techniques will enable an overall illustration of the role of histopathological changes in body organs as indicators of hypothermia.
Collapse
Affiliation(s)
- Mahrous Abdelbasset Ibrahim
- Forensic Medicine & Clinical Toxicology, College of Medicine, Jouf University, Sakakah, Saudi Arabia
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sally Salem Mohammed
- Histology and Cell Biology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hany Goda Tammam
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Rehab Ibrahim Abdel-Karim
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Medhat Mohammed Farag
- Medical biochemistry Department, College of Medicine, Shaqra University, Shaqraa, Saudi Arabia
- Medical Biochemistry & Molecular Biology Department, Faculty of Medicine, Benha University, Benha, Egypt
| |
Collapse
|
4
|
Natanti A, Mazzanti R, Palpacelli M, Turchi C, Tagliabracci A, Pesaresi M. Death following extreme temperature exposure: Histological, biochemical and immunohistochemical markers. MEDICINE, SCIENCE, AND THE LAW 2021; 61:36-41. [PMID: 33591877 DOI: 10.1177/0025802420942423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Defining extreme temperatures as the cause of death remains challenging. It is mostly based on circumstantial, macroscopic and microscopic features. METHODS We retrospectively compared groups of cases of fatal hypothermia, fatal hyperthermia and non-extreme temperature-related deaths. We analysed specific histological findings, focusing on samples from the liver, pancreas and kidney. RESULTS Between 1 January 2013 and 31 December 2016, 15 autopsies were performed for deaths related to extreme temperatures. They included 11 cases of fatal hypothermia (group A), four cases of fatal hyperthermia (group B) and eight controls (group C). Perinuclear hepatocyte vacuolisation was observed in seven cases of hypothermia, one case of hyperthermia and four controls. Pancreatic cytoarchitecture was well preserved in two cases of hypothermia, one case of hyperthermia and two controls. No particular microscopic feature was found in pancreatic samples. Renal epithelial tubular cell vacuolisation was observed in seven cases of hypothermia and one case of hyperthermia, while it was absent in all controls. Chromogranin A (CgA) was markedly positive in the pancreatic tissue of five cases of fatal hypothermia and one control, and mildly positive in one case of fatal hyperthermia. No significant p-values were observed for any comparisons (p > 0.05), except when hypothermia cases group were compared to the control group for the Armanni-Ebstein phenomenon test (p = 0.0078). CONCLUSIONS Although our study did not find a specific microscopic marker, hepatocyte vacuolisation, the Armanni-Ebstein phenomenon and pancreatic CgA positivity, taken together, may be useful tools to confirm hypo- and hyperthermia-related deaths, in addition to circumstantial and macroscopic findings.
Collapse
Affiliation(s)
- Alice Natanti
- Università Politecnica delle Marche, Dipartimento di Scienze Biomediche e Sanità Pubblica, Italy
| | - Roberta Mazzanti
- Università Politecnica delle Marche, Dipartimento di Scienze Biomediche e Sanità Pubblica, Italy
| | - Marco Palpacelli
- Università Politecnica delle Marche, Dipartimento di Scienze Biomediche e Sanità Pubblica, Italy
| | - Chiara Turchi
- Università Politecnica delle Marche, Dipartimento di Scienze Biomediche e Sanità Pubblica, Italy
| | - Adriano Tagliabracci
- Università Politecnica delle Marche, Dipartimento di Scienze Biomediche e Sanità Pubblica, Italy
| | - Mauro Pesaresi
- Università Politecnica delle Marche, Dipartimento di Scienze Biomediche e Sanità Pubblica, Italy
| |
Collapse
|
5
|
Shida A, Ikeda T, Tani N, Morioka F, Aoki Y, Ikeda K, Watanabe M, Ishikawa T. Cortisol levels after cold exposure are independent of adrenocorticotropic hormone stimulation. PLoS One 2020; 15:e0218910. [PMID: 32069307 PMCID: PMC7028257 DOI: 10.1371/journal.pone.0218910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/27/2020] [Indexed: 02/08/2023] Open
Abstract
We previously showed that postmortem serum levels of adrenocorticotropic hormone (ACTH) were significantly higher in cases of hypothermia (cold exposure) than other causes of death. This study examined how the human hypothalamic-pituitary-adrenal axis, and specifically cortisol, responds to hypothermia. Human samples: Autopsies on 205 subjects (147 men and 58 women; age 15-98 years, median 60 years) were performed within 3 days of death. Cause of death was classified as either hypothermia (cold exposure, n = 14) or non-cold exposure (controls; n = 191). Cortisol levels were determined in blood samples obtained from the left and right cardiac chambers and common iliac veins using a chemiluminescent enzyme immunoassay. Adrenal gland tissues samples were stained for cortisol using a rabbit anti-human polyclonal antibody. Cell culture: AtT20, a mouse ACTH secretory cell line, and Y-1, a corticosterone secretory cell line derived from a mouse adrenal tumor, were analyzed in mono-and co-culture, and times courses of ACTH (in AtT20) and corticosterone (in Y-1) secretion were assessed after low temperature exposure mimicking hypothermia and compared with data for samples collected postmortem for other cases of death. However, no correlation between ACTH concentration and cortisol levels was observed in hypothermia cases. Immunohistologic analyses of samples from hypothermia cases showed that cortisol staining was localized primarily to the nucleus rather than the cytoplasm of cells in the zona fasciculata of the adrenal gland. During both mono-culture and co-culture, AtT20 cells secreted high levels of ACTH after 10-15 minutes of cold exposure, whereas corticosterone secretion by Y-1 cells increased slowly during the first 15-20 minutes of cold exposure. Similar to autopsy results, no correlation was detected between ACTH levels and corticosterone secretion, either in mono-culture or co-culture experiments. These results suggested that ACTH-independent cortisol secretion may function as a stress response during cold exposure.
Collapse
Affiliation(s)
- Alissa Shida
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- * E-mail:
| | - Tomoya Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), Osaka, Japan
| | - Naoto Tani
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), Osaka, Japan
| | - Fumiya Morioka
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - Yayoi Aoki
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - Kei Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - Miho Watanabe
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Laboratory of Clinical Regenerative Medicine Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Health and Medical Science Innovation laboratory, Tsukuba City, Ibaraki, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), Osaka, Japan
| |
Collapse
|
6
|
Rousseau G, Reynier P, Jousset N, Rougé-Maillart C, Palmiere C. Updated review of postmortem biochemical exploration of hypothermia with a presentation of standard strategy of sampling and analyses. Clin Chem Lab Med 2019; 56:1819-1827. [PMID: 29715177 DOI: 10.1515/cclm-2018-0153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/03/2018] [Indexed: 11/15/2022]
Abstract
Hypothermia is defined as a core body temperature below 35°C and can be caused by environmental exposure, drug intoxication, metabolic or nervous system dysfunction. This lethal pathology with medico-legal implications is complex to diagnose because macroscopic and microscopic lesions observed at the autopsy and the histological analysis are suggestive but not pathognomonic. Postmortem biochemical explorations have been progressively developed through the study of several biomarkers to improve the diagnosis decision cluster. Here, we present an updated review with novel biomarkers (such as catecholamines O-methylated metabolites, thrombomodulin and the cardiac oxyhemoglobin ratio) as well as some propositional interpretative postmortem thresholds and, to the best of our knowledge, for the first time, we present the most adapted strategy of sampling and analyses to identify biomarkers of hypothermia. For our consideration, the most relevant identified biomarkers are urinary catecholamines and their O-methylated metabolites, urinary free cortisol, blood cortisol, as well as blood, vitreous humor and pericardial fluid for ketone bodies and blood free fatty acids. These biomarkers are increased in response either to cold-mediated stress or to bioenergetics ketogenesis crisis and significantly contribute to the diagnosis by exclusion of death by hypothermia.
Collapse
Affiliation(s)
- Guillaume Rousseau
- Département de Biochimie et Génétique, Centre Hospitalier Universitaire d'Angers, Angers, France
- Service de Médecine Légale et Pénitentiaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Pascal Reynier
- Département de Biochimie et Génétique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Nathalie Jousset
- Service de Médecine Légale et Pénitentiaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Clotilde Rougé-Maillart
- GEROM-LHEA, IRIS-IBS Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Cristian Palmiere
- CURML, Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| |
Collapse
|
7
|
Zhang Z, Lin H, Li Z, Luo Y, Wang L, Chen L, Huang P. Identification of fatal hypothermia via attenuated total reflection Fourier transform infrared spectroscopy of rabbit vitreous humour. AUST J FORENSIC SCI 2019. [DOI: 10.1080/00450618.2019.1629021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Zhong Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
- Department of Forensic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Hancheng Lin
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Zhengdong Li
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Yiwen Luo
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Lei Wang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Liqin Chen
- Department of Forensic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Ping Huang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| |
Collapse
|
8
|
The relationship between the intramuscular bleeding of the tongue and cause of death. J Forensic Leg Med 2018; 59:50-55. [PMID: 30142489 DOI: 10.1016/j.jflm.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 11/21/2022]
Abstract
Intramuscular bleeding of the tongue (ImBT) is occasionally found during post mortem examination. Despite its frequent reports, its cause has not yet been clarified. In this study, forensic autopsy data of 799 cadavers were examined and the relationship between ImBT and cause of death was investigated. A total of 74 cases showed ImBT (16 of 66 cases of fire fatality, 17 of 108 cases of drowning, 23 of 74 cases of asphyxiation, and 18 of 551 cases of other causes of death). The frequency of bleeding was significantly greater in cases with causes of death including fire fatality, drowning, and asphyxiation compared to those with other causes of death (p < 0.01). Among asphyxiation cases, ImBT was confirmed in two of five cases of typical hanging, three of 16 cases of atypical hanging, six of six cases of ligature strangulation, two of two cases of manual strangulation, eight of 38 cases of airway obstruction, and two of seven cases of oxygen deficiency. Among fire fatalities, the carboxyhemoglobin (CO-Hb) concentration of cases with ImBT was significantly lower than that in cases without ImBT (p < 0.01). In addition, the frequency of bleeding was significantly higher (p < 0.05) in cases where the blood cyanide concentration was 0.05 ppm or less. These observations suggested that ImBT during fire fatality occurs in a manner similar to that of ligature or manual strangulation, in which the flames cause the contraction and decrease in elasticity of the skin. Past reports indicated that bleeding frequency in cases of drowning did not significantly differ from that in cases with other causes of death. However, our cases showed a statistically higher incidence of bleeding compared to that in the other causes of death (p < 0.01). These results suggested that ImBT is a characteristic finding in cases of asphyxia and is an important evaluation for the diagnosis of death. When the relationship between ImBT and petechial hemorrhage was examined in three of the causes of death, no significant difference was observed between fire fatality and asphyxiation, but drowning was significantly different (p < 0.05). In cases without ImBT, the secretion of noradrenaline and adrenaline was significantly higher (p < 0.01). This finding suggests that it is unlikely that excessive secretion of catecholamine causes ImBT.
Collapse
|
9
|
Umehara T, Murase T, Abe Y, Yamashita H, Shibaike Y, Kagawa S, Yamamoto T, Ikematsu K. Identification of potential markers of fatal hypothermia by a body temperature-dependent gene expression assay. Int J Legal Med 2018; 133:335-345. [PMID: 29959558 DOI: 10.1007/s00414-018-1888-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022]
Abstract
Diagnosis of fatal hypothermia is considered to be difficult in forensic practice and even if findings due to cold exposure are evident, cold exposure is not necessarily a direct cause of death. Identification of useful molecular markers for the diagnosis of fatal hypothermia has not been successful. In this study, to identify novel molecular markers that inform the diagnosis of fatal hypothermia, we focused on skeletal muscle, which plays a role in cold-induced thermogenesis in mammals. We made rat models of mild, moderate, and severe hypothermia and performed body temperature-dependent gene expression analysis in the iliopsoas muscle using next-generation sequencing (NGS). NGS showed that after severe hypothermia, the expression levels of 91 mRNAs were more than double those in mild and moderate hypothermia and control animals. Gene ontology (GO) analysis indicated that these mRNAs are involved in a number of biological processes, including response to stress and lipids, and cellular response to hypoxia. The expression of four genes [connective tissue growth factor (Ctgf), JunB proto-oncogene, AP-1 transcription factor subunit (Junb), nuclear receptor subfamily 4, group A, member 1 (Nr4a1), and Syndecan 4 (Sdc4)] and the level of one protein (CTGF) were induced only by severe hypothermia. These genes and protein are involved in muscle regeneration, tissue repair, and lipid metabolism. These results indicate that heat production to maintain body temperature in a process leading to fatal hypothermia might be performed by the iliopsoas muscle, and that Ctgf, Junb, Nr4a1, and Sdc4 genes are potential diagnostic markers for fatal hypothermia.
Collapse
Affiliation(s)
- Takahiro Umehara
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan.
| | - Takehiko Murase
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Yuki Abe
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Hiromi Yamashita
- Center for Forensic Pathology and Science, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Yoshinori Shibaike
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Shinichiro Kagawa
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Takuma Yamamoto
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Kazuya Ikematsu
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| |
Collapse
|
10
|
Tani N, Ikeda T, Watanabe M, Toyomura J, Ohyama A, Ishikawa T. Prolactin selectively transported to cerebrospinal fluid from blood under hypoxic/ischemic conditions. PLoS One 2018; 13:e0198673. [PMID: 29949606 PMCID: PMC6021042 DOI: 10.1371/journal.pone.0198673] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/23/2018] [Indexed: 12/04/2022] Open
Abstract
Aim The aim of this study was to determine and to verify the correlation between the amount of prolactin (PRL) levels in the blood and in the cerebrospinal fluid (CSF) by various causes of death as an indicator for acute hypoxia in autopsy cases. It is to confirm the cause of the change in prolactin level in CSF by in vitro system. Materials and methods In autopsy materials, the PRL levels in blood from the right heart ventricle and in the CSF were measured by chemiluminescent enzyme immunoassay, and changes in the percentage of PRL-positive cells in the pituitary gland were examined using an immunohistochemical method. Furthermore, an inverted culture method was used as an in vitro model of the blood-CSF barrier using epithelial cells of the human choroid plexus (HIBCPP cell line) and SDR-P-1D5 or MSH-P3 (PRL-secreting cell line derived from miniature swine hypophysis) under normoxic or hypoxic (5% oxygen) conditions, and as an index of cell activity, we used Vascular Endothelial Growth Factor (VEGF). Results and discussion Serum PRL levels were not significantly different between hypoxia/ischemia cases and other causes of death. However, PRL levels in CSF were three times higher in cases of hypoxia/ischemia than in those of the other causes of death. In the cultured cell under the hypoxia condition, PRL and VEGF showed a high concentration at 10 min. We established a brain-CSF barrier model to clarify the mechanism of PRL transport to CSF from blood, the PRL concentrations from blood to CSF increased under hypoxic conditions from 5 min. These results suggested that PRL moves in CSF through choroidal epithelium from blood within a short time. PRL is hypothesized to protect the hypoxic/ischemic brain, and this may be because of the increased transportation of the choroid plexus epithelial cells.
Collapse
Affiliation(s)
- Naoto Tani
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Osaka, Japan
- * E-mail:
| | - Tomoya Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Osaka, Japan
| | - Miho Watanabe
- Department of NDU Life Sciences, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
- Field of Oral and Maxillofacial Surgery and System Medicine, Course of Clinical Science, Nippon Dental University, Graduate School of Life Dentistry at Niigata, Niigata, Japan
| | - Junko Toyomura
- Department of NDU Life Sciences, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
| | - Akihiro Ohyama
- Department of NDU Life Sciences, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
- Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Osaka, Japan
| |
Collapse
|
11
|
Expression of Hsp27 and Hsp70 and vacuolization in the pituitary glands in cases of fatal hypothermia. Forensic Sci Med Pathol 2017. [DOI: 10.1007/s12024-017-9884-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
12
|
Doberentz E, Madea B. Microscopic examination of pituitary glands in cases of fatal accidental hypothermia. Forensic Sci Res 2017; 2:132-138. [PMID: 30483631 PMCID: PMC6197093 DOI: 10.1080/20961790.2017.1330804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022] Open
Abstract
In cases of death caused by hypothermia, histological analysis can be used to determine the cause of death. Certain histological alterations of the pituitary glands in hypothermia have been reported in the literature, including haemorrhage, hyperaemia and cellular vacuolization of cells in the anterior lobe. In the present study, the validity of these morphological alterations as markers for fatal accidental hypothermia was investigated in autopsy material. A total of 34 pituitary glands in cases of verified fatal accidental hypothermia were examined histologically (haematoxylin and eosin, ferric, azan) and immunohistochemically (LCA, ACTH, C5b-9). The findings were compared with 61 cases in a control group. Hyperaemia was found in 50.0% of the study group cases and 59.0% of the control group cases. Cellular vacuolization was observed in one case (2.9%) in the study group and one case (1.6%) in the control group. Acute or recent haemorrhage in the glandular tissue was never detected. In our study, the histopathological characteristics described in the literature as pathognomonic for hypothermia could not be confirmed. Furthermore, histological differences in the pituitary glands between fatal hypothermia cases and control group cases were not observed.
Collapse
Affiliation(s)
- Elke Doberentz
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Burkhard Madea
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| |
Collapse
|
13
|
Caplan MJ. A Practical Forensic Approach to Fatal Pediatric Endocrinopathies. Acad Forensic Pathol 2016; 6:258-270. [PMID: 31239897 DOI: 10.23907/2016.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/08/2016] [Accepted: 04/30/2016] [Indexed: 11/12/2022]
Abstract
Of all of the organ systems in clinical medicine, the endocrine system is among the most difficult to master since it requires a detailed and knowledgeable integration of many of the body's separate systems. In forensic pathology, the evaluation of a sudden unexplained death can be challenging depending upon the particular disease processes and the organ systems that are affected. It is therefore not surprising that the investigation of sudden unexplained deaths involving the endocrine system can be particularly daunting. This review attempts to focus upon three of the major endocrine/metabolic conditions that may be potentially life-threatening and fatal in the pediatric population - hypoglycemia, adrenal insufficiency, and hyperthyroidism - and to provide forensic pathologists with a practical strategy for working up these cases. By adopting a more focused and selective approach to pediatric endocrine conditions rather than an exhaustive and comprehensive study of them, it is the intention of this review to make these disorders more manageable conceptually and to optimize the chance of arriving at a decisive and ultimately accurate postmortem diagnosis.
Collapse
Affiliation(s)
- Michael J Caplan
- Suffolk County Office of the Medical Examiner and Stony Brook University Health Sciences Center School of Medicine - Pathology
| |
Collapse
|
14
|
Belsey SL, Flanagan RJ. Postmortem biochemistry: Current applications. J Forensic Leg Med 2016; 41:49-57. [PMID: 27131037 DOI: 10.1016/j.jflm.2016.04.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/31/2016] [Accepted: 04/10/2016] [Indexed: 11/26/2022]
Abstract
The results of biochemical analyses in specimens obtained postmortem may aid death investigation when diabetic and alcoholic ketoacidosis is suspected, when death may have been the result of drowning, anaphylaxis, or involved a prolonged stress response such as hypothermia, and in the diagnosis of disease processes such as inflammation, early myocardial infarction, or sepsis. There is often cross-over with different disciplines, in particular with clinical and forensic toxicology, since some endogenous substances such as sodium chloride, potassium chloride, and insulin can be used as poisons. The interpretation of results is often complicated because of the likelihood of postmortem change in analyte concentration or activity, and proper interpretation must take into account all the available evidence. The unpredictability of postmortem changes means that use of biochemical measurements in time of death estimation has little value. The use of vitreous humour is beneficial for many analytes as the eye is in a physically protected environment, this medium may be less affected by autolysis or microbial metabolism than blood, and the assays can be performed with due precaution using standard clinical chemistry analysers. However, interpretation of results may not be straightforward because (i) defined reference ranges in life are often lacking, (ii) there is a dearth of knowledge regarding, for example, the speed of equilibration of many analytes between blood, vitreous humour, and other fluids that may be sampled, and (iii) the effects of post-mortem change are difficult to quantify because of the lack of control data. A major limitation is that postmortem vitreous glucose measurements are of no help in diagnosing antemortem hypoglycaemia.
Collapse
Affiliation(s)
- S L Belsey
- Toxicology Unit, Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK.
| | - R J Flanagan
- Toxicology Unit, Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK; Toxicology Unit, Dept of Pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| |
Collapse
|
15
|
Perich P, Tuchtan L, Bartoli C, Léonetti G, Piercecchi-Marti MD. Death from Hypothermia during a Training Course under "Extreme Conditions": Related to Two Cases. J Forensic Sci 2015; 61:562-565. [PMID: 26551786 DOI: 10.1111/1556-4029.12981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/01/2015] [Accepted: 04/18/2015] [Indexed: 02/02/2023]
Abstract
Death from hypothermia following exhaustion or from various complicated pathologies is no longer a frequent cause of death among combat troops. During a training course under "extreme conditions" in the French Alps, two young African officers died. Confronted with these two clinically confirmed cases of hypothermia, the unknown anatomopathological and biological specificities associated with death from hypothermia were highlighted. In these typical and clinically confirmed cases of death from subacute exhaustion hypothermia, none of the signs revealed by the autopsy were specific. Although some recent publications have addressed the utility of postmortem biochemical markers when establishing a diagnosis, with no anamnesis, with no knowledge or analysis of the circumstances of death, and without an in situ examination of the body, it appears difficult, if not impossible, to confirm that death was caused by hypothermia.
Collapse
Affiliation(s)
- Pierre Perich
- APHM, CHU Timone, Service de Médecine Légale et Droit de la Santé, 13385 Cedex 5, Marseille, France
| | - Lucile Tuchtan
- APHM, CHU Timone, Service de Médecine Légale et Droit de la Santé, 13385 Cedex 5, Marseille, France.,Aix Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France
| | - Christophe Bartoli
- APHM, CHU Timone, Service de Médecine Légale et Droit de la Santé, 13385 Cedex 5, Marseille, France.,Aix Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France
| | - Georges Léonetti
- APHM, CHU Timone, Service de Médecine Légale et Droit de la Santé, 13385 Cedex 5, Marseille, France.,Aix Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France
| | - Marie-Dominique Piercecchi-Marti
- APHM, CHU Timone, Service de Médecine Légale et Droit de la Santé, 13385 Cedex 5, Marseille, France.,Aix Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France
| |
Collapse
|
16
|
Chen JH, Michiue T, Inamori-Kawamoto O, Ikeda S, Ishikawa T, Maeda H. Comprehensive investigation of postmortem glucose levels in blood and body fluids with regard to the cause of death in forensic autopsy cases. Leg Med (Tokyo) 2015; 17:475-82. [PMID: 26593993 DOI: 10.1016/j.legalmed.2015.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 01/08/2023]
Abstract
The serum glucose level is regulated within a narrow range by multiple factors under physiological conditions, but is greatly modified in the death process and after death. The present study comprehensively investigated glucose levels in blood and body fluids, including pericardial fluid (PCF), cerebrospinal fluid (CSF) and vitreous humor, reviewing forensic autopsy cases (n=672). Right heart blood glucose level was often higher than at other sites, and the CSF glucose level was the lowest, showing greater dissociation in acute/subacute death cases. The glucose level was higher in the diabetic (high HbA1c) than in the non-diabetic (low HbA1c) group at each site (p<0.01-0.0001). Fatal diabetic ketoacidosis cases had evidently high glucose levels at each site; whereas in the non-diabetic group, blood glucose level was higher in fatal alcohol abuse, saltwater drowning, electrocution, cerebrovascular disease and sudden cardiac death due to ischemic heart disease. Fatal methamphetamine (MA) abuse, sepsis, malnutrition (starvation) and hypoglycemia due to antidiabetics showed markedly lower blood glucose levels. Ketones in bilateral cardiac blood and PCF were increased in diabetic ketoacidosis and fatal alcohol abuse as well as in most cases of hyperthermia (heatstroke), hypothermia (cold exposure) and malnutrition. These findings suggest that combined analysis of glucose, HbA1c and ketones in blood and body fluids is useful to investigate not only fatal diabetic metabolic disorders but also death processes due to other causes, including alcohol and MA abuse, as well as thermal disorders, sepsis and malnutrition.
Collapse
Affiliation(s)
- Jian-Hua Chen
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
| | - Tomomi Michiue
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Osamu Inamori-Kawamoto
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Sayuko Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Hitoshi Maeda
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| |
Collapse
|
17
|
Ishikawa T, Inamori-Kawamoto O, Quan L, Michiue T, Chen JH, Wang Q, Zhu BL, Maeda H. Postmortem urinary catecholamine levels with regard to the cause of death. Leg Med (Tokyo) 2014; 16:344-9. [DOI: 10.1016/j.legalmed.2014.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/25/2014] [Accepted: 07/21/2014] [Indexed: 01/15/2023]
|
18
|
Palmiere C, Teresiński G, Hejna P. Postmortem diagnosis of hypothermia. Int J Legal Med 2014; 128:607-14. [DOI: 10.1007/s00414-014-0977-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/04/2014] [Indexed: 11/24/2022]
|
19
|
Maeda H, Ishikawa T, Michiue T. Forensic molecular pathology: its impacts on routine work, education and training. Leg Med (Tokyo) 2014; 16:61-9. [PMID: 24480586 DOI: 10.1016/j.legalmed.2014.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 01/07/2014] [Indexed: 01/14/2023]
Abstract
The major role of forensic pathology is the investigation of human death in relevance to social risk management to determine the cause and process of death, especially in violent and unexpected sudden deaths, which involve social and medicolegal issues of ultimate, personal and public concerns. In addition to the identification of victims and biological materials, forensic molecular pathology contributes to general explanation of the human death process and assessment of individual death on the basis of biological molecular evidence, visualizing dynamic functional changes involved in the dying process that cannot be detected by morphology (pathophysiological or molecular biological vital reactions); the genetic background (genomics), dynamics of gene expression (up-/down-regulation: transcriptomics) and vital phenomena, involving activated biological mediators and degenerative products (proteomics) as well as metabolic deterioration (metabolomics), are detected by DNA analysis, relative quantification of mRNA transcripts using real-time reverse transcription-PCR (RT-PCR), and immunohisto-/immunocytochemistry combined with biochemistry, respectively. Thus, forensic molecular pathology involves the application of omic medical sciences to investigate the genetic basis, and cause and process of death at the biological molecular level in the context of forensic pathology, that is, 'advanced molecular autopsy'. These procedures can be incorporated into routine death investigations as well as guidance, education and training programs in forensic pathology for 'dynamic assessment of the cause and process of death' on the basis of autopsy and laboratory data. Postmortem human data can also contribute to understanding patients' critical conditions in clinical management.
Collapse
Affiliation(s)
- Hitoshi Maeda
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan; Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503 Tottori, Japan
| | - Tomomi Michiue
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan
| |
Collapse
|
20
|
Bańka K, Teresiński G, Buszewicz G. Free fatty acids as markers of death from hypothermia. Forensic Sci Int 2014; 234:79-85. [DOI: 10.1016/j.forsciint.2013.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
|
21
|
Ishikawa T, Quan L, Michiue T, Kawamoto O, Wang Q, Chen JH, Zhu BL, Maeda H. Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy. Forensic Sci Int 2013; 228:52-60. [DOI: 10.1016/j.forsciint.2013.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 01/30/2013] [Accepted: 02/04/2013] [Indexed: 01/19/2023]
|
22
|
Bańka K, Teresiński G, Buszewicz G, Mądro R. Glucocorticosteroids as markers of death from hypothermia. Forensic Sci Int 2013; 229:60-5. [PMID: 23683909 DOI: 10.1016/j.forsciint.2013.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 02/06/2023]
Abstract
In the course of hypothermia, biochemical changes occur that are associated with stimulation of protective thermogenic mechanisms as well as mobilization of internal energy resources mediated by the hormone system. The objective of the investigation was the assessment of validity of determinations of cortisol, cortisone and corticosterone as hypothermia markers in cases of fatal hypothermia combined with concomitant insobriety of the victims. The experimental group consisted of blood samples collected in the course of medico-legal autopsies of 23 hypothermia victims. The controls included blood samples originating from 34 victims of violent sudden deaths (deaths by hanging and traffic road accidents at the scene) and from ten individuals deceased after prolonged agony in consequence of post-traumatic subdural hematomas. In both groups, three subgroups were distinguished that included cases with ethanol levels within the following ranges: 0.0-0.99, 1.0-2.99 and ≥3.0‰. The comparison of determination results showed that irrespectively of blood ethanol concentration, cortisol, cortisone and corticosterone levels seen in hypothermia victims were significantly higher as compared to the controls (P<0.001).
Collapse
Affiliation(s)
- Krzysztof Bańka
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Jaczewskiego 8, Poland.
| | | | | | | |
Collapse
|
23
|
Biochemical markers of fatal hypothermia. Forensic Sci Int 2013; 226:54-61. [DOI: 10.1016/j.forsciint.2012.12.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 10/30/2012] [Accepted: 12/02/2012] [Indexed: 11/19/2022]
|
24
|
Postmortem biochemical investigations in hypothermia fatalities. Int J Legal Med 2012; 127:267-76. [DOI: 10.1007/s00414-012-0738-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
|
25
|
Molecular pathology of natriuretic peptides in the myocardium with special regard to fatal intoxication, hypothermia, and hyperthermia. Int J Legal Med 2012; 126:747-56. [DOI: 10.1007/s00414-012-0732-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 06/12/2012] [Indexed: 11/30/2022]
|
26
|
Palmiere C, Mangin P. Hyperthermia and postmortem biochemical investigations. Int J Legal Med 2012; 127:93-102. [DOI: 10.1007/s00414-012-0722-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/24/2012] [Indexed: 12/22/2022]
|
27
|
Wang Q, Ishikawa T, Michiue T, Zhu BL, Guan DW, Maeda H. Evaluation of human brain damage in fatalities due to extreme environmental temperature by quantification of basic fibroblast growth factor (bFGF), glial fibrillary acidic protein (GFAP), S100β and single-stranded DNA (ssDNA) immunoreactivities. Forensic Sci Int 2012; 219:259-64. [DOI: 10.1016/j.forsciint.2012.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/14/2011] [Accepted: 01/04/2012] [Indexed: 11/28/2022]
|
28
|
Miyazato T, Ishikawa T, Michiue T, Maeda H. Molecular pathology of pulmonary surfactants and cytokines in drowning compared with other asphyxiation and fatal hypothermia. Int J Legal Med 2012; 126:581-7. [PMID: 22552475 DOI: 10.1007/s00414-012-0698-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 04/16/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Takako Miyazato
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan
| | | | | | | |
Collapse
|
29
|
Palmiere C, Lesta MDM, Sabatasso S, Mangin P, Augsburger M, Sporkert F. Usefulness of postmortem biochemistry in forensic pathology: illustrative case reports. Leg Med (Tokyo) 2011; 14:27-35. [PMID: 22177826 DOI: 10.1016/j.legalmed.2011.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 11/17/2022]
Abstract
The aim of this work is to present some practical, postmortem biochemistry applications to illustrate the usefulness of this discipline and reassert the importance of carrying out biochemical investigations as an integral part of the autopsy process. Five case reports are presented pertaining to diabetic ketoacidosis in an adult who was not known to suffer from diabetes and in presence of multiple psychotropic substances; fatal flecainide intoxication in a poor metabolizer also presenting an impaired renal function; diabetic ketoacidosis showing severe postmortem changes; primary aldosteronism presented with intracranial hemorrhage and hypothermia showing severe postmortem changes. The cases herein presented can be considered representative examples of the importance of postmortem biochemistry investigations, which may provide significant information useful in determining the cause of death in routine forensic casework or contribute to understanding the pathophysiological mechanisms involved in the death process.
Collapse
Affiliation(s)
- Cristian Palmiere
- University Center of Legal Medicine, Lausanne-Geneva, Rue du Bugnon 21, 1011 Lausanne, Switzerland Rue Michel-Servet 1, 1211 Genève 4, Switzerland.
| | | | | | | | | | | |
Collapse
|
30
|
Postmortem chemistry update part II. Int J Legal Med 2011; 126:199-215. [DOI: 10.1007/s00414-011-0614-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 08/22/2011] [Indexed: 02/02/2023]
|
31
|
Pakanen L, Kortelainen ML, Särkioja T, Porvari K. Increased Adrenaline to Noradrenaline Ratio Is a Superior Indicator of Antemortem Hypothermia Compared with Separate Catecholamine Concentrations. J Forensic Sci 2011; 56:1213-8. [DOI: 10.1111/j.1556-4029.2011.01805.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Pathophysiologic changes due to TASER® devices versus excited delirium: Potential relevance to deaths-in-custody? J Forensic Leg Med 2011; 18:145-53. [PMID: 21550562 DOI: 10.1016/j.jflm.2011.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 01/13/2011] [Accepted: 01/26/2011] [Indexed: 11/21/2022]
|
33
|
Doberentz E, Preuss-Wössner J, Kuchelmeister K, Madea B. Histological examination of the pituitary glands in cases of fatal hypothermia. Forensic Sci Int 2011; 207:46-9. [DOI: 10.1016/j.forsciint.2010.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 07/22/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
|
34
|
Maeda H, Ishikawa T, Michiue T. Forensic biochemistry for functional investigation of death: Concept and practical application. Leg Med (Tokyo) 2011; 13:55-67. [DOI: 10.1016/j.legalmed.2010.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
|
35
|
Quan L, Ishikawa T, Hara J, Michiue T, Chen JH, Wang Q, Zhu BL, Maeda H. Postmortem serotonin levels in cerebrospinal and pericardial fluids with regard to the cause of death in medicolegal autopsy. Leg Med (Tokyo) 2011; 13:75-8. [DOI: 10.1016/j.legalmed.2010.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 11/24/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
|
36
|
Ishikawa T, Michiue T, Maeda H. Evaluation of postmortem serum and cerebrospinal fluid growth hormone levels in relation to the cause of death in forensic autopsy. Hum Cell 2011; 24:74-7. [DOI: 10.1007/s13577-011-0012-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/09/2010] [Indexed: 11/27/2022]
|
37
|
Maeda H, Zhu BL, Ishikawa T, Michiue T. Forensic molecular pathology of violent deaths. Forensic Sci Int 2010; 203:83-92. [DOI: 10.1016/j.forsciint.2010.07.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
38
|
Ishikawa T, Yoshida C, Michiue T, Perdekamp MG, Pollak S, Maeda H. Immunohistochemistry of catecholamines in the hypothalamic–pituitary–adrenal system with special regard to fatal hypothermia and hyperthermia. Leg Med (Tokyo) 2010; 12:121-7. [DOI: 10.1016/j.legalmed.2010.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 01/21/2010] [Accepted: 01/21/2010] [Indexed: 02/05/2023]
|
39
|
Piette MHA, Pieters SEP, De Letter EA. Evaluation of the agonal stress: can immunohistochemical detection of ubiquitin in the locus coeruleus be useful? Int J Legal Med 2010; 125:333-40. [PMID: 20396898 DOI: 10.1007/s00414-010-0434-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 02/19/2010] [Indexed: 11/25/2022]
Abstract
The determination of the survival time after a crime as well as the concomitant physical and mental load of the victim is an important task for the forensic pathologist. The heat shock protein, ubiquitin, exerts an essential role in the cellular response to stress. We aimed to investigate the usefulness of the ubiquitin expression in the locus coeruleus as a marker for the evaluation of agonal stress. Is the amount of ubiquitin in this brain locus an indication of the length and/or intensity of the agonal period following various causes of death? The immunohistochemical (IHC) expression of ubiquitin is examined in formalin-fixed, paraffin-embedded slides of the human locus coeruleus (n = 48). The evaluation of the IHC staining is blindly performed, prior to the study of the medico-legal files. According to the length of agony, a division into subgroups is made. Three possible IHC staining patterns are observed: a staining of the neuronal nucleus or the cytoplasm or both. In addition, the number of neurons with ubiquitin expression per μm(2) is calculated in each locus coeruleus. Significant differences in the number of ubiquitin-immunoreactive neurons are noticed with respect to the length of the agony: A higher density of positive neurons is seen in case of a pronounced and extended death struggle.
Collapse
Affiliation(s)
- Michel H A Piette
- Department of Forensic Medicine, Forensic Institute Ghent University, J. Kluyskensstraat 29, 9000, Ghent, Belgium.
| | | | | |
Collapse
|
40
|
|
41
|
Time-dependent organic changes of intravenous thrombi in stasis-induced deep vein thrombosis model and its application to thrombus age determination. Forensic Sci Int 2010; 195:143-7. [DOI: 10.1016/j.forsciint.2009.12.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 11/28/2009] [Accepted: 12/02/2009] [Indexed: 11/24/2022]
|
42
|
Nikolic S, Zivkovic M, Zivkovic V, Jukovic F. Hypothermia as the cause of death in forensic pathology: Autopsy study. SRP ARK CELOK LEK 2010; 138:467-72. [DOI: 10.2298/sarh1008467n] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. The body cooling process goes through few clinical phases. These are followed by some morphological thanatological changes such as frost erythema and Wischnewsky's spots, which are used in diagnosis of death due to hypothermia. In such cases there is no any specific autopsy finding. Objective. To establish the frequency of hypothermia as the cause of death for a ten-year-period, and to analyze the sample according to gender and age, risk factors and autopsy findings of subjects. Methods. A retrospective autopsy study was performed for a ten-year-period (total of 12,765 forensic autopsies). The relevant data were collected from autopsy records, police reports and heteroanamnestic interviews. The sample was analyzed according to gender, age, scene of death, blood alcohol concentration, risk factors, and autopsy findings of all observed subjects. Results. The sample included 67 subjects, 42 males and 25 females (?2=4.31; p<0.05), of average age 63.9?14.7 years (min=27, max=92; med=65, mod=55). Nineteen of subjects were found at in-door places. In 13 subjects blood alcohol concentration ranged from 0.50 to 3.32 promille (average 1.81?0.93). The younger the observed subject was, the higher the blood alcohol concentration (?=-0.251; p=0.04). One third of the observed subjects were chronic alcohol abusers. Thirteen persons had psychiatric diseases. In 43 observed subjects the concomitant appearance of frost erythema and Wischniewsky's spots were established (?2=49.59; df=3; p<0.001). Conclusion. In the analyzed ten-year period hypothermia was not often the cause of death; it was disclosed only in 0.5% of the total number of the studied autopsies. The most of the deceased were older males with cardiovascular problems found in unprotected open-air places. The most frequent thanatological findings in the analyzed subjects were frost erythema and Wischnewsky's spots.
Collapse
Affiliation(s)
- Slobodan Nikolic
- Institut za sudsku medicinu, Medicinski fakultet, Beograd%SR13-01.08.34
| | | | - Vladimir Zivkovic
- Institut za sudsku medicinu, Medicinski fakultet, Beograd%SR13-01.08.34
| | | |
Collapse
|
43
|
Yoshida C, Ishikawa T, Michiue T, Quan L, Maeda H. Postmortem biochemistry and immunohistochemistry of chromogranin A as a stress marker with special regard to fatal hypothermia and hyperthermia. Int J Legal Med 2009; 125:11-20. [DOI: 10.1007/s00414-009-0374-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 08/31/2009] [Indexed: 10/20/2022]
|
44
|
Morphological and functional alterations in the adenohypophysis in cases of brain death. Leg Med (Tokyo) 2009; 11 Suppl 1:S234-7. [DOI: 10.1016/j.legalmed.2009.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 02/23/2009] [Accepted: 03/05/2009] [Indexed: 11/22/2022]
|
45
|
Ishikawa T, Michiue T, Zhao D, Komatsu A, Azuma Y, Quan L, Hamel M, Maeda H. Evaluation of postmortem serum and cerebrospinal fluid levels of thyroid-stimulating hormone with special regard to fatal hypothermia. Leg Med (Tokyo) 2009; 11 Suppl 1:S228-30. [DOI: 10.1016/j.legalmed.2009.02.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 02/03/2009] [Accepted: 02/09/2009] [Indexed: 11/24/2022]
|