1
|
Keller T, Desgraz B, Lossois M, Baccino E, Casadesus JM, Tuchtan L, Piercecchi MD, Klinguer P, Zarattin M, Gassend JL, Varlet V. Multicentric case series of scuba diving fatalities: The role of intracardiac gaseous carbon dioxide in the forensic diagnosis. Forensic Sci Int 2023; 352:111845. [PMID: 37757648 DOI: 10.1016/j.forsciint.2023.111845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
Scuba diving fatalities post-mortem diagnosis presents a higher level of forensic complexity because of their occurrence in a non-natural human life environment. Scuba divers are equipped with diving gas to breathe underwater. It is essential for them to be fully trained in order to be able to manage their dive safely despite the varying increase of ambient pressure and temperature decrease. Throughout the dive, the inhaled diving gas is dissolved in the diver's tissues during the descent and if the decompression steps are not respected during the ascent, the balance between the dissolved gas and the tissues (including blood) is disrupted, leading to a gaseous release in the organism. Depending on the magnitude of this gaseous release, free gas can occur in blood and tissue. Venous or arterial gas embolism can also occur as a consequence of decompression sickness or barotraumatism. It can also induce drowsiness that consequently leads to drowning. As a result, the occurrence of gas in dead scuba divers is very complex to interpret, as is the difficulty to distinguish it from resuscitation maneuver artifacts or body decomposition. Although the literature is scarce in this domain, significant work has been done to provide a precise intracadaveric gas sampling method to enlighten the cause and circumstances of death during the dive. The aim of this study is to obtain higher statistical significance by collecting a number of cases to confirm the gas sampling protocol and analysis and gain more information about the cause of death and the events surrounding the fatality through the establishment of clear management guidelines.
Collapse
Affiliation(s)
- T Keller
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - B Desgraz
- Universitary Centre of Hyperbaric Medicine (CURMedHyp), Lausanne, Geneva, Switzerland
| | - M Lossois
- Legal Medicine Department, Lapeyronie Hospital, Montpellier, France
| | - E Baccino
- Legal Medicine Department, Lapeyronie Hospital, Montpellier, France
| | - J M Casadesus
- Institute of Legal Medicine and Forensic Sciences of Catalonia, (Division of Girona, Spain), Spain; Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain
| | - L Tuchtan
- Legal Medicine Department, Marseille La Timone University Hospital, Marseille, France
| | - M D Piercecchi
- Legal Medicine Department, Marseille La Timone University Hospital, Marseille, France
| | - P Klinguer
- Forensic pathology unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Zarattin
- Forensic pathology unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - J L Gassend
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Forensic pathology unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - V Varlet
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
2
|
Hagita T, Shiotani S, Toyama N, Tominaga N, Miyazaki H, Ogasawara N. Positive cardiac gas on immediate postmortem CT indicates severe hyperammonemia and hypercapnia. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2020.200428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
3
|
Hagita T, Shiotani S, Toyama N, Tominaga N, Miyazaki H, Ogasawara N. Administration of sodium bicarbonate during cardiopulmonary resuscitation increases the frequency of cardiac gas on postmortem CT estimated to be CO2. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
4
|
Giorgetti A, Pelletti G, Barone R, Garagnani M, Rossi F, Guadagnini G, Fais P, Pelotti S. Deaths related to nitrogen inhalation: Analytical challenges. Forensic Sci Int 2020; 317:110548. [PMID: 33129047 DOI: 10.1016/j.forsciint.2020.110548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 02/04/2023]
Abstract
Dinitrogen (N2) has been increasingly connected to suicidal deaths. The analysis of N2 in post-mortem cases still represents a major challenge in forensic toxicology and circumstantial data has so far played a major role for the determination of the cause of death. In this paper, after presenting a review of cases of N2 intoxication described in forensic literature, we report the application of two approaches in order to quantify an excess of N2 in post-mortem whole blood collected from a case of suicide by nitrogen inhalation. N2 analyses were performed by GC-MS on the suicidal case and on controls taken from 10 autopsy cases with similar PMI (5 traumatic deaths and 5 deaths by asphyxia). The percentage of N2 was estimated by building a five-point N2 peak area calibration curve (0, 15.6 %, 62.4 % 78.1 %, 100 %) and through an external QC, assessing linearity, accuracy and precision, LLOQ, specificity and stability of N2 in the sample vial. Percentage of N2 of the case was significantly higher than the post-mortem controls (p<0.05). The N2/O2 ratio of the case and controls was also calculated as an additional indicator, and was significantly higher in the case (p<0.05). The strengths and the limitation of both methods are reported in the paper. Toxicological confirmation for N2 are rarely performed when the cause of death is evident, probably due to the lack of validated methods and the complexity of the interpretation of N2 concentration in biological fluids. The presented methods can be rapidly and profitably applied with instrumentation normally available in forensic laboratories.
Collapse
Affiliation(s)
- Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Gianni Guadagnini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| |
Collapse
|
5
|
Tsujita A, Nagasaka A, Okazaki H, Ogawa S, Gohda A, Matsui T. Quantitative Determination of H 2 in Human Blood by 22Ne-aided Gas Chromatography-Mass Spectrometry Using a Single Quadrupole Instrument. ANAL SCI 2020; 36:1231-1235. [PMID: 32475892 DOI: 10.2116/analsci.20p042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/16/2020] [Indexed: 08/09/2023]
Abstract
Here, we present a quantitative method for H2 detection by gas chromatography-selected ion monitoring-mass spectrometry (GC-SIM-MS) using a single quadrupole instrument. Additionally, the developed method was applied to the detection of H2 in human blood by GC-SIM-MS analysis using the existing 22Ne in air as an internal standard (IS). H2 was analyzed by GC-SIM-MS using a single quadrupole instrument with double TC-Molsieve 5A capillary columns for the separation of permanent gases. The detections of H2 (analyte) and 22Ne (IS) were performed at m/z 2 and 22, respectively, by GC-SIM-MS. The analyte and IS were separated using He as the carrier gas. The ratio of the peak area of H2 to 22Ne was employed to obtain a calibration curve for H2 determination in the gas phase. The proposed GC-SIM-MS method exhibited high sensitivity in terms of the limits of detection (LOD) (1.7 ppm) and quantitation (LOQ) (5.8 ppm) for H2 analysis. The developed quantitative assay of H2 in the headspace of blood samples achieved high repeatability with a relative standard deviation (RSD) of 1.4 - 4.7%. We successfully detected and quantified H2 in the headspaces of vacuum blood-collection tubes containing whole blood from 11 deceased individuals with several causes of death by employing the developed GC-SIM-MS method. The quantitative value of H2 ranged from 5 to 905 ppm. The proposed GC-SIM-MS method was applicable to the quantitative assay of H2 in biological samples without tedious pretreatment requirements.
Collapse
Affiliation(s)
- Akira Tsujita
- Forensic Science Laboratory, Fukuoka Prefectural Police Headquarters, 7-7 Higashikoen, Fukuoka 812-8576, Japan.
- Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School of Kyushu University, 744 Motooka, Fukuoka, 819-0395, Japan.
| | - Asami Nagasaka
- Forensic Science Laboratory, Fukuoka Prefectural Police Headquarters, 7-7 Higashikoen, Fukuoka 812-8576, Japan
| | - Hidehiko Okazaki
- Forensic Science Laboratory, Fukuoka Prefectural Police Headquarters, 7-7 Higashikoen, Fukuoka 812-8576, Japan
| | - Shin Ogawa
- Forensic Science Laboratory, Fukuoka Prefectural Police Headquarters, 7-7 Higashikoen, Fukuoka 812-8576, Japan
| | - Akinaga Gohda
- Forensic Science Laboratory, Fukuoka Prefectural Police Headquarters, 7-7 Higashikoen, Fukuoka 812-8576, Japan
| | - Toshiro Matsui
- Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School of Kyushu University, 744 Motooka, Fukuoka, 819-0395, Japan
| |
Collapse
|
6
|
Revolution in death sciences: body farms and taphonomics blooming. A review investigating the advantages, ethical and legal aspects in a Swiss context. Int J Legal Med 2020; 134:1875-1895. [DOI: 10.1007/s00414-020-02272-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
|
7
|
Correlation between blood gas analysis and cardiac gas on immediate postmortem computed tomography after cardiopulmonary resuscitation. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions. Forensic Sci Med Pathol 2020; 16:3-11. [PMID: 31463781 PMCID: PMC7069893 DOI: 10.1007/s12024-019-00162-x] [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] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
The detection of intracranial gas (ICG) in people who died due to trauma became possible once postmortem computed tomography (PMCT) became available in addition to traditional post-mortem examinations. The aim of this study was to determine the importance of ICG in the context of medico-legal opinions. We assessed 159 cases of trauma-induced death. Cadavers with pronounced signs of decomposition, open skull fractures, and after neurosurgical operations were excluded. Both PMCT findings and data from autopsy reports were analyzed. ICG was found in 38.99% (n = 62) of the cadavers, 96.77% (n = 60) of which presented with pneumocephalus (PNC) and 40.23% (n = 25) with intravascular gas (IVG). There was a strong correlation between ICG and skull fractures/brain injuries, as well as chest injuries, especially lung injuries. In 13 cases, ICG presented without skull fractures; three of these cases died as a result of stab and incised wounds to the neck and chest. The mean time between trauma and death was significantly longer in the non-ICG group than the ICG group at 2.94 days (0–48 days) and 0.01 day (0–1 day), respectively (p < 0.0001). The presence of ICG is a result of severe neck and chest injuries, including stab and incised wounds. The victims die in a very short amount of time after suffering trauma resulting in ICG. The ability to demonstrate ICG on PMCT scans can be of significance in forming medico-legal opinions.
Collapse
|
9
|
Michaud K, Genet P, Sabatasso S, Grabherr S. Postmortem imaging as a complementary tool for the investigation of cardiac death. Forensic Sci Res 2019; 4:211-222. [PMID: 31489387 PMCID: PMC6713140 DOI: 10.1080/20961790.2019.1630944] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/26/2022] Open
Abstract
In the past 2 decades, modern radiological methods, such as multiple detector computed tomography (MDCT), MDCT-angiography, and cardiac magnetic resonance imaging (MRI) were introduced into postmortem practice for investigation of sudden death (SD), including cases of sudden cardiac death (SCD). In forensic cases, the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause. There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques. This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination, especially in cases of SCD. In SCD cases, postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves, as well as to identify and locate cardiovascular devices. Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them, especially regarding the extent and location of stenosis and obstruction. In postsurgical cases, it allows verification and documentation of the patency of stents and bypass grafts before opening the body. Postmortem MRI is used to investigate soft tissues such as the myocardium, but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects, especially of the ischemic myocardium. In postsurgery cases, the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes. The implementation of new imaging methods into routine postmortem practice is challenging, as it requires not only an investment in equipment but, more importantly, investment in the expertise of interpreting the images. Once those requirements are implemented, however, they bring great advantages in investigating cases of SCD, as they allow documentation of the body, orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography.Key pointsThere are no established guidelines for the interpretation of postmortem imaging examination of the heartAt present, postmortem imaging methods are considered as less accurate than the autopsy for cardiac deathsPostmortem imaging is useful as a complementary tool for cardiac deathsThere is still a need to validate postmortem imaging in cardiac deaths by comparing with autopsy findings.
Collapse
Affiliation(s)
- Katarzyna Michaud
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Pia Genet
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
- Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Sara Sabatasso
- Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Silke Grabherr
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
- Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| |
Collapse
|
10
|
Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies. Radiol Med 2019; 124:1018-1027. [PMID: 31254219 DOI: 10.1007/s11547-019-01052-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study is to report radiological findings and features in advanced decomposed bodies obtained by post-mortem computed tomography (PMCT) with autopsy correlation. MATERIALS AND METHODS This retrospective descriptive multicentric study included 41 forensic cases examined between May 2013 and November 2016. All the bodies were PMCT-scanned prior to autopsy, and internal putrefactive state was determined using the radiological alteration index (RAI) by a radiologist with expertise in forensic radiology and a forensic pathologist trained in forensic imaging. After PMCT scans, grade of external putrefaction (GEP) was assigned during the external examination and the complete autopsy was performed by forensic pathologists. RESULTS The PMCT images evaluation revealed that the RAI index was > 61 in all bodies, corresponding to a moderate-massive presence of putrefactive gas. The gas grade was > II in correspondence of the major vessels, heart cavities, liver parenchyma, vertebra L3 and subcutaneous pectoral tissues, and varied from I to III in correspondence of the kidney. Cadaveric external examination revealed the presence of advanced transformative phenomena, with a GEP3 and GEP4 in most of the cases, with body swelling, eyes and tongue protrusion, body fluids expulsion and fat liquefaction. CONCLUSION Radiological imaging by PMCT as an adjunct to autopsy in advanced decomposed bodies represents a useful tool in detecting post-mortem gas, even in very small amounts. A correct interpretation process of the PMCT data is essential to avoid images pitfalls, due to natural decomposition that can be mistaken for pathologic processes.
Collapse
|
11
|
|
12
|
Helium poisoning: new procedure for sampling and analysis. Int J Legal Med 2019; 133:1809-1818. [DOI: 10.1007/s00414-019-02014-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
|
13
|
Gas embolism as a potential cause of death by helium poisoning – Postmortem computed tomography changes in two cases of suicidal helium inhalation. Leg Med (Tokyo) 2018; 31:59-65. [DOI: 10.1016/j.legalmed.2018.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/13/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
|
14
|
Casadesús JM, Aguirre F, Carrera A, Boadas-Vaello P, Serrando MT, Reina F. Diagnosis of arterial gas embolism in SCUBA diving: modification suggestion of autopsy techniques and experience in eight cases. Forensic Sci Med Pathol 2018; 14:18-25. [PMID: 29460254 DOI: 10.1007/s12024-018-9951-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to suggest modifications of autopsy techniques in order to improve post-mortem diagnosis of arterial gas embolism (AGE) based on multidisciplinary investigation of SCUBA diving fatalities. Five adult human cadavers from the voluntary donation program of the Human Anatomy Laboratory, and eight judicial autopsied bodies of SCUBA divers from the Forensic Pathology Service were assessed. Before performing any autopsies, we accessed the diving plan and the divers' profiles for each case. We then introduced a new dissection procedure that included identification, isolation, and manipulation of carotid, vertebral and thoracic arterial systems. The dissected vascular structures that allowed optimall isolation of the systemic arterial circulation were identified and ligated. In three of the eight judicial cases, we had a strongly suggestive history of arterial gas embolism following pulmonary barotrauma (PBt/AGE). In these cases, the additional arterial dissection allowed us to clearly diagnose AGE in one of them. The autopsy of the rest of the cases showed other causes of death such as asphyxia by drowning and heart attack. In all cases we were able to reject decompression sickness, and in some of them we showed the presence of artefacts secondary to decomposition and resuscitation maneuvers. These results allow us to suggest a specific autopsy technique divided into four steps, aimed at confirming or excluding some evidence of dysbaric disorders according to a re-enactment of the incident. We have demonstrated the presence of large volumes of intravascular air, which is typical of PBt/AGE.
Collapse
Affiliation(s)
- Josep M Casadesús
- Institute of Legal Medicine and Forensic Sciences of Catalonia, (Division of Girona, Spain), Av. Ramón Folch, 4-6, 17001, Girona, Spain. .,Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain. .,Department of Medical Sciences, Faculty of Medicine, University of Girona (Spain), Av. Emili Grahit 77, 17003, Girona, Spain.
| | - Fernando Aguirre
- Special Group for Underwater Activities (GEAS) of the Spanish Civil Guard, C/Torroella s/n, 17258, Estartit, Spain
| | - Ana Carrera
- Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona (Spain), Av. Emili Grahit 77, 17003, Girona, Spain
| | - Pere Boadas-Vaello
- Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona (Spain), Av. Emili Grahit 77, 17003, Girona, Spain
| | - Maria T Serrando
- Department of Medical Sciences, Faculty of Medicine, University of Girona (Spain), Av. Emili Grahit 77, 17003, Girona, Spain.,ICS-IAS Girona Clinical Laboratory, Av. Dr. Castany s/n, 17190, Salt, Spain
| | - Francisco Reina
- Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona (Spain), Av. Emili Grahit 77, 17003, Girona, Spain
| |
Collapse
|
15
|
Romolo FS, di Luca NM, Ciallella C, Bottoni E, Fiore PA, Cappelletti S, Giuliani N, Augsburger M, Varlet V. Volatile lipophilic substances management in case of fatal sniffing. J Forensic Leg Med 2017; 52:35-39. [DOI: 10.1016/j.jflm.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/25/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022]
|
16
|
Abstract
Diving air-breathing vertebrates have long been considered protected against decompression sickness (DCS) through anatomical, physiological, and behavioural adaptations. However, an acute systemic gas and fat embolic syndrome similar to DCS in human divers was described in beaked whales that stranded in temporal and spatial association with military exercises involving high-powered sonar. More recently, DCS has been diagnosed in bycaught sea turtles. Both cases were linked to human activities. Two Risso's dolphin (Grampus griseus) out of 493 necropsied cetaceans stranded in the Canary Islands in a 16-year period (2000-2015), had a severe acute decompression sickness supported by pathological findings and gas analysis. Deadly systemic, inflammatory, infectious, or neoplastic diseases, ship collision, military sonar, fisheries interaction or other type of lethal inducing associated trauma were ruled out. Struggling with a squid during hunting is discussed as the most likely cause of DCS.
Collapse
|
17
|
Sapienza D, Bottari A, Gualniera P, Asmundo A, Perri F, Gaeta M. Post mortem CT of intrahepatic gas distribution in twenty-seven victims of a flood: Patterns and timing. Leg Med (Tokyo) 2017; 29:18-21. [PMID: 28964984 DOI: 10.1016/j.legalmed.2017.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/09/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
Abstract
We reported the results of post mortem computed tomography of the liver in 27 subjects dead simultaneously during a flood. The aim of our work was to identify the different patterns of post mortem intrahepatic gas distribution and the timing of its appearance. Although post mortem CT is the method of choice for the evaluation of gas distribution, controversies exist about the first site of appearance of intrahepatic gas (portal veins versus hepatic veins) as well as the timing and steps of intrahepatic gas spreading. In each subject we performed thin slice CT scanner (Somatom Definition, Siemens) and post processing of native CT images with Minimum Intensity Projection technique. Our results show that the first site of appearance of intrahepatic gas is portal veins. Gas in hepatic veins was never seen without the presence of the gas in portal vein. Gaseous cysts in hepatic parenchyma represent a further and usually more tardive pattern of intrahepatic gas distribution. In addition, we demonstrated that differences in timing of gas spreading was statistically significative for exclusive presence of portal veins gas before 48h as well as for complete substitution of hepatic parenchyma by cysts 64h after death. In conclusion, our work shows that the CT study of postmortem intrahepatic gas distribution could be a useful complementary tool both in demonstrating the mechanism of intrahepatic gas spreading and in estimating post mortem interval.
Collapse
Affiliation(s)
- Daniela Sapienza
- Department of Biomedical Sciences, Dental and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy.
| | - Antonio Bottari
- Department of Biomedical Sciences, Dental and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Italy
| | - Patrizia Gualniera
- Department of Biomedical Sciences, Dental and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Alessio Asmundo
- Department of Biomedical Sciences, Dental and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Fabrizio Perri
- Department of Biomedical Sciences, Dental and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Michele Gaeta
- Department of Biomedical Sciences, Dental and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Italy
| |
Collapse
|
18
|
Varlet V, Dominguez A, Augsburger M, Lossois M, Egger C, Palmiere C, Vilarino R, Grabherr S. Understanding scuba diving fatalities: carbon dioxide concentrations in intra-cardiac gas. Diving Hyperb Med 2017. [PMID: 28641319 DOI: 10.28920/dhm47.2.75-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Important developments in the diagnosis of scuba diving fatalities have been made thanks to forensic imaging tool improvements. Multi-detector computed tomography (MDCT) permits reliable interpretation of the overall gaseous distribution in the cadaver. However, due to post-mortem delay, the radiological interpretation is often doubtful because the distinction between gas related to the dive and post-mortem decomposition artifactual gases becomes less obvious. METHODS We present six cases of fatal scuba diving showing gas in the heart and other vasculature. Carbon dioxide (CO₂) in cardiac gas measured by gas chromatography coupled to thermal conductivity detection were employed to distinguish decomposition from embolism based on the detection of decomposition gases (hydrogen, hydrogen sulfide and methane) and to confirm arterial gas embolism (AGE) or post-mortem offgasing diagnoses. A Radiological Alteration Index (RAI) was calculated from the scan. RESULTS Based on the dive history, the intra-cadaveric gas was diagnosed as deriving from decomposition (one case, minimal RAI of 61), post-mortem decompression artifacts (two cases, intermediate RAI between 60 and 85) and barotrauma/AGE (three cases, maximal RAI between 85 and 100), illustrating a large distribution inside the bodies. CONCLUSION MDCT scans should be interpreted simultaneously with compositional analysis of intra-cadaveric gases. Intra-cadaveric gas sampling and analysis may become useful tools for understanding and diagnosing scuba diving fatalities. In cases with short post-mortem delays, the CO₂ concentration of the cardiac gas provides relevant information about the circumstances and cause of death when this parameter is interpreted in combination with the diving profile.
Collapse
Affiliation(s)
- Vincent Varlet
- Forensic Chemistry and Toxicology Unit, University Centre of Legal Medicine CH-1011 Lausanne, Switzerland,
| | - Alejandro Dominguez
- Forensic Imaging Unit, University Centre of Legal Medicine Lausanne - Geneva, Switzerland
| | - Marc Augsburger
- Forensic Chemistry and Toxicology Unit, University Centre of Legal Medicine CH-1011 Lausanne, Switzerland
| | - Maisy Lossois
- Forensic Medicine Unit, University Center of Legal Medicine Lausanne - Geneva, Switzerland
| | - Coraline Egger
- Forensic Imaging Unit, University Centre of Legal Medicine Lausanne - Geneva, Switzerland.,Forensic Medicine Unit, University Center of Legal Medicine Lausanne - Geneva, Switzerland
| | - Cristian Palmiere
- Forensic Medicine Unit, University Center of Legal Medicine Lausanne - Geneva, Switzerland
| | - Raquel Vilarino
- Forensic Imaging Unit, University Centre of Legal Medicine Lausanne - Geneva, Switzerland.,Forensic Medicine Unit, University Center of Legal Medicine Lausanne - Geneva, Switzerland
| | - Silke Grabherr
- Forensic Imaging Unit, University Centre of Legal Medicine Lausanne - Geneva, Switzerland.,Forensic Medicine Unit, University Center of Legal Medicine Lausanne - Geneva, Switzerland
| |
Collapse
|
19
|
A minimally-invasive method for profiling volatile organic compounds within postmortem internal gas reservoirs. Int J Legal Med 2017; 131:1271-1281. [DOI: 10.1007/s00414-017-1621-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
|
20
|
Grabherr S, Egger C, Vilarino R, Campana L, Jotterand M, Dedouit F. Modern post-mortem imaging: an update on recent developments. Forensic Sci Res 2017; 2:52-64. [PMID: 30483621 PMCID: PMC6197109 DOI: 10.1080/20961790.2017.1330738] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022] Open
Abstract
Modern post-mortem investigations use an increasing number of digital imaging methods, which can be collected under the term "post-mortem imaging". Most methods of forensic imaging are from the radiology field and are therefore techniques that show the interior of the body with technologies such as X-ray or magnetic resonance imaging. To digitally image the surface of the body, other techniques are regularly applied, e.g. three-dimensional (3D) surface scanning (3DSS) or photogrammetry. Today's most frequently used techniques include post-mortem computed tomography (PMCT), post-mortem magnetic resonance imaging (PMMR), post-mortem computed tomographic angiography (PMCTA) and 3DSS or photogrammetry. Each of these methods has specific advantages and limitations. Therefore, the indications for using each method are different. While PMCT gives a rapid overview of the interior of the body and depicts the skeletal system and radiopaque foreign bodies, PMMR allows investigation of soft tissues and parenchymal organs. PMCTA is the method of choice for viewing the vascular system and detecting sources of bleeding. However, none of those radiological methods allow a detailed digital view of the body's surface, which makes 3DSS the best choice for such a purpose. If 3D surface scanners are not available, photogrammetry is an alternative. This review article gives an overview of different imaging techniques and explains their applications, advantages and limitations. We hope it will improve understanding of the methods.
Collapse
Affiliation(s)
- Silke Grabherr
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Coraline Egger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Raquel Vilarino
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
- Service of Legal Medicine, Central Institute of Hospitals, Sion, Switzerland
| | - Lorenzo Campana
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Melissa Jotterand
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Fabrice Dedouit
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| |
Collapse
|
21
|
Comment L, Varlet V, Ducrot K, Grabherr S. A fatal case of oxygen embolism in a hospital. Forensic Sci Res 2017; 2:100-106. [PMID: 30483626 PMCID: PMC6197113 DOI: 10.1080/20961790.2017.1329695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/05/2017] [Indexed: 01/26/2023] Open
Abstract
This case reports on a 68-year-old man who was found dead in hospital next to his bed. Before this, he had been treated with intravenous antibiotics for pneumonia. The body was found with a peripheral venous catheter connected to a nasal cannula delivering oxygen (O2) from the wall. Extensive medico–legal examinations were performed, including post-mortem computed tomography (CT), complete conventional autopsy, histological and immunohistochemistry analysis, toxicological analysis and post-mortem chemistry. Additionally, CT-guided gas sampling was performed at multiple sites to collect samples for gas analysis. During the external examination, massive subcutaneous emphysema was visible over the entire surface of the body. The CT scan revealed the presence of gas throughout the vascular system, and in the subcutaneous and muscular tissues. The autopsy confirmed the presence of lobar pneumonia and multiple gas bubbles in the vascular system. The gas analysis results showed a subnormal concentration of oxygen, confirming the suspected pure O2 embolism. Moreover, the carbon dioxide (CO2) concentration in the gas sample from the heart was elevated to a level similar to those found in scuba diving fatalities. This could come from degassing of dissolved CO2 that accumulated and was trapped in the cardiac cavity. Based on the results of the different exams performed, and especially the gas analysis results, it was concluded that the cause of death was O2 embolism.
Collapse
Affiliation(s)
- Lionel Comment
- Forensic Medicine Unit, University Center of Legal Medicine, CHUV Hospital, Lausanne-Geneva, Switzerland
| | - Vincent Varlet
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine, CHUV Hospital, Lausanne-Geneva, Switzerland
| | - Kewin Ducrot
- Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, CHUV Hospital, Lausanne-Geneva, Switzerland
| | - Silke Grabherr
- Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, CHUV Hospital, Lausanne-Geneva, Switzerland
| |
Collapse
|
22
|
Ali Z, Bolster F, Goldberg E, Fowler D, Li L. Systemic air embolism complicating upper gastrointestinal endoscopy: a case report with post-mortem CT scan findings and review of literature. Forensic Sci Res 2017; 1:52-57. [PMID: 30483611 PMCID: PMC6197118 DOI: 10.1080/20961790.2016.1252898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/22/2016] [Indexed: 12/21/2022] Open
Abstract
Endoscopy of the gastrointestinal and biliary tract is a common procedure and is routinely performed for therapeutic and diagnostic purposes. Perforation, bleeding and infection are some of the more common reported side effects. Air embolism on the other hand, is a rare complication of gastrointestinal endoscopy. We report a 77-year-old African-American female with a history of pancreatic cancer, which was resected with a Whipple procedure. As part of diagnostic and therapeutic procedure, an endoscopic retrograde cholangiopancreatography was planned several months after the surgery. The patient's heart rate suddenly slowed to 40 bpm during the procedure and she became cyanotic and difficult to oxygenate after the endoscope was introduced and CO2 gas was insufflated. A forensic autopsy was performed with post-mortem computed tomography (PMCT) and revealed extensive systemic air embolism. The detailed PMCT and autopsy findings are presented and current literature is reviewed.
Collapse
Affiliation(s)
- Zabiullah Ali
- Office of the Chief Medical Examiner, State of Maryland, Baltimore, MD, USA.,Sino-US Forensic Evidence Science Research Center, Collaborative Innovation Center of Judicial Civilization, China University of Political Science and Law, Beijing, China.,Division of Forensic Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ferdia Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Eric Goldberg
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David Fowler
- Office of the Chief Medical Examiner, State of Maryland, Baltimore, MD, USA.,Sino-US Forensic Evidence Science Research Center, Collaborative Innovation Center of Judicial Civilization, China University of Political Science and Law, Beijing, China.,Division of Forensic Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ling Li
- Office of the Chief Medical Examiner, State of Maryland, Baltimore, MD, USA.,Sino-US Forensic Evidence Science Research Center, Collaborative Innovation Center of Judicial Civilization, China University of Political Science and Law, Beijing, China.,Division of Forensic Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
23
|
|
24
|
Bernaldo de Quirós Y, Saavedra P, Møllerløkken A, Brubakk AO, Jørgensen A, González-Díaz O, Martín-Barrasa JL, Fernández A. Differentiation at necropsy between in vivo gas embolism and putrefaction using a gas score. Res Vet Sci 2016; 106:48-55. [PMID: 27234535 DOI: 10.1016/j.rvsc.2016.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 11/18/2022]
Abstract
Gas bubble lesions consistent with decompression sickness in marine mammals were described for the first time in beaked whales stranded in temporal and spatial association with military exercises. Putrefaction gas is a post-mortem artifact, which hinders the interpretation of gas found at necropsy. Gas analyses have been proven to help differentiating putrefaction gases from gases formed after hyperbaric exposures. Unfortunately, chemical analysis cannot always be performed. Post-mortem computed tomography is used to study gas collections, but many different logistical obstacles and obvious challenges, like the size of the animal or the transport of the animal from the stranding location to the scanner, limit its use in stranded marine mammals. In this study, we tested the diagnostic value of an index-based method for characterizing the amount and topography of gas found grossly during necropsies. For this purpose, putrefaction gases, intravenously infused atmospheric air, and gases produced by decompression were evaluated at necropsy with increased post-mortem time in New Zealand White Rabbits using a gas score index. Statistical differences (P<0.001) were found between the three experimental models immediately after death. Differences in gas score between in vivo gas embolism and putrefaction gases were found significant (P<0.05) throughout the 67h post-mortem. The gas score-index is a new and simple method that can be used by all stranding networks, which has been shown through this study to be a valid diagnostic tool to distinguish between fatal decompression, iatrogenic air embolism and putrefaction gases at autopsies.
Collapse
Affiliation(s)
- Yara Bernaldo de Quirós
- Veterinary Histology and Pathology, Department of Morphology, Institute of Animal Health, Veterinary School, University of Las Palmas de Gran Canaria (ULPGC), Trasmontaña s/n, 35416 Arucas, Las Palmas, Spain.
| | - Pedro Saavedra
- Department of Mathematics, University of Las Palmas de Gran Canaria (ULPGC), Campus de Tafira s/n, 35017, Las Palmas, Spain.
| | - Andreas Møllerløkken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Alf O Brubakk
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arve Jørgensen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Diagnostic Imaging, St. Olavs University Hospital, Trondheim, Norway.
| | - Oscar González-Díaz
- Physical and Chemical Instrumental Center for the Development of Applied Research Technology and Scientific estate, Edificio Polivalente 1, University of Las Palmas de Gran Canaria (ULPGC), Campus de Tafira s/n, 35017, Las Palmas, Spain.
| | - Jose L Martín-Barrasa
- Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario de Gran Canaria, Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain; Infectious Diseases and Fish Pathology, Institute of Animal Health, Veterinary School, University of Las Palmas de Gran Canaria (ULPGC), Trasmontaña s/n, 35416 Arucas, Las Palmas, Spain.
| | - Antonio Fernández
- Veterinary Histology and Pathology, Department of Morphology, Institute of Animal Health, Veterinary School, University of Las Palmas de Gran Canaria (ULPGC), Trasmontaña s/n, 35416 Arucas, Las Palmas, Spain.
| |
Collapse
|