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Tyr A, Zilg B, Gelius T, Möllby R, Heldring N. Postmortem CT analysis of paranasal sinuses using an experimental model of drowning. Int J Legal Med 2024; 138:1401-1409. [PMID: 38351206 PMCID: PMC11164805 DOI: 10.1007/s00414-024-03173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/22/2024] [Indexed: 06/12/2024]
Abstract
Fluid-filled paranasal sinuses are suggested to be a valuable tool to distinguish between drowning and non-drowning postmortem, yet the mechanisms governing fluid entry remains unknown. We investigate if fluid-filled paranasal sinuses are caused by a passive influx from submersion or an active aspiration mechanism during drowning. The ovine nasal cavity and maxillary sinuses are remarkably similar anatomically to humans, and have been used for endoscopic surgical training in recent decades. We submerged 15 decapitated ovine heads from agricultural waste at a depth of 2 m in flowing water for 1, 8, and 24 h and 7 days. Paranasal sinuses were CT imaged and compared pre- and post-submersion to non-submerged controls. Furthermore, we examined the paranasal sinuses of a single homicide case of a non-drowned submerged subject. Results demonstrate that fluid passively enters the maxillary sinus postmortem in the non-drowned ovine heads following 1 h of submersion. Fluid volume was independent of submersion time and influenced by time out of water as well as handling, since volume was reduced between consecutive CT scans. In contrast to our hypothesis, the filling of the paranasal sinuses is due to passive influx of fluid from submersion rather than an active aspiration during drowning. The observation that paranasal sinuses were fluid-filled in a single medico-legal case of postmortem submersion supports the finding of passive influx. Consequently, careful interpretation of fluid-filled paranasal sinuses is required when bodies are found in water, as the finding cannot distinguish between postmortem submersion and drowning.
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Affiliation(s)
- Alexander Tyr
- Swedish National Board of Forensic Medicine, Retzius v. 5, 171 65, Stockholm, Sweden.
| | - Brita Zilg
- Swedish National Board of Forensic Medicine, Retzius v. 5, 171 65, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Retzius v. 3, 171 77, Stockholm, Sweden
| | - Tobias Gelius
- Swedish National Board of Forensic Medicine, Retzius v. 5, 171 65, Stockholm, Sweden
| | - Rasmus Möllby
- Swedish National Board of Forensic Medicine, Retzius v. 5, 171 65, Stockholm, Sweden
| | - Nina Heldring
- Swedish National Board of Forensic Medicine, Retzius v. 5, 171 65, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Retzius v. 3, 171 77, Stockholm, Sweden
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2
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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:biomedicines10102542. [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.
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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
- Correspondence:
| | - 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
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Takasu S, Matsumoto S, Kodama S, Sakamoto K, Shimmura S, Iwadate K. Accuracy of Urea Nitrogen and Creatinine Measurements in Postmortem Serum and Pericardial Fluid Compared With Antemortem Data. Am J Forensic Med Pathol 2022; 43:33-39. [PMID: 34608022 DOI: 10.1097/paf.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although several studies have measured urea nitrogen (UN) and creatinine (Cr) concentrations in postmortem serum and pericardial fluid, no recent antemortem biochemical data have been available for forensic autopsy, thereby making the evaluation of the accuracy of postmortem data difficult. This study compared antemortem (from emergency room results before the declaration of death) and postmortem serum UN and Cr concentrations, as well as postmortem serum and pericardial fluid values, in 51 forensic autopsy cases (postmortem interval within 87 hours). Postmortem UN concentrations were strongly correlated with antemortem data. Moreover, no significant difference between pericardial fluid UN concentrations and antemortem data was observed. Postmortem serum and pericardial fluid Cr values were also correlated with antemortem data, although postmortem values were significantly higher than antemortem ones. Given our observation of early postmortem elevation in Cr concentrations, such an elevation was attributed to rigor mortis. In conclusion, the current study demonstrated the utility of postmortem UN and Cr concentrations, in particular of those measured in the pericardial fluid.
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Affiliation(s)
- Shojiro Takasu
- From the Department of Forensic Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Wang N, Chen Z, Guo X, Cheng H, Wang P, Wang T, Wang L, Tash D, Ren P, Zhu B, Guan D, Zhang G, Zhao R. Sudden Death Due to Severe Ovarian Hyperstimulation Syndrome: An Autopsy-Centric Case Report. Am J Forensic Med Pathol 2021; 42:88-91. [PMID: 33186129 DOI: 10.1097/paf.0000000000000601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic disorder associated with controlled ovarian stimulation during assisted reproductive technology. Severe OHSS may impose serious complications, including pleural effusion, acute renal insufficiency, venous thrombosis, and even death, although lethal outcomes are rare in forensic practice. The reported incidence of severe OHSS ranges from 0.008% to 10%. Herein, we present the case of a 29-year-old woman who diagnosed with polycystic ovary syndrome and infertility chose to undergo assisted reproduction. She received leuprorelin acetate and follicle stimulating hormone prior to egg retrieval. Three days after the retrieval procedure, she developed abdominal pain and distension. Later that same day, she died unexpectedly. The subsequent autopsy revealed turbid effusions of pleural and peritoneal cavities, abnormal ovarian enlargement, and duskiness of multiple organ surfaces. Microscopic examination disclosed edema and hemorrhage in follicles of both ovaries, thrombosis within the myocardial matrix, and massive pulmonary edema. Routine toxicology screening was negative. The death was attributed to severe OHSS. This case provides a morphologic reference for clinical and forensic work. Autopsy findings in instances of severe OHSS provide valuable insight into the mechanisms and pathogenesis of this disease.
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Affiliation(s)
- Ning Wang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Ziyuan Chen
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Xiangshen Guo
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Hao Cheng
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Pengfei Wang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Tianqi Wang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Linlin Wang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Dilichati Tash
- Kizilsu Kirgiz Autonomous Prefecture Public Security Bureau, Xinjiang Uygur Autonomous Region, China
| | - Peng Ren
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Baoli Zhu
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Dawei Guan
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Guohua Zhang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Rui Zhao
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
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Takasu S, Matsumoto S, Kodama S, Sakamoto K, Iwadate K. Comparison of C-reactive protein levels between antemortem serum and postmortem serum and pericardial fluid. J Forensic Leg Med 2020; 73:101968. [PMID: 32442115 DOI: 10.1016/j.jflm.2020.101968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/01/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022]
Abstract
Biochemical markers undergo postmortem changes that complicate diagnostic measurement. C-reactive protein (CRP) is one marker that is known to be useful in postmortem specimens, with high levels reported in forensic cases of sepsis, trauma, and ketoacidosis. In the present study, we included 30 cases (17 males and 13 females) that underwent forensic autopsy within 80 h of death and had a CRP result from two postmortem specimens (serum from cardiac blood and pericardial fluid) and an emergency room specimen. Antemortem results were taken at a time near to cardiopulmonary arrest and the declaration of death. CRP levels in postmortem serum and pericardial fluid correlated with those in antemortem serum. Although no significant difference was observed between the antemortem and postmortem serum levels, the pericardial level was significantly low and five false negatives were observed. We conclude that postmortem serum is suitable for use in CRP measurement, and in cases with high antemortem CRP levels, postmortem pericardial fluid may be an appropriate alternative.
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Affiliation(s)
- Shojiro Takasu
- Department of Forensic Medicine, The Jikei University School of Medicine, Department of Forensic Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Sari Matsumoto
- Department of Forensic Medicine, The Jikei University School of Medicine, Department of Forensic Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Saki Kodama
- Department of Forensic Medicine, The Jikei University School of Medicine, Department of Forensic Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kana Sakamoto
- Department of Forensic Medicine, The Jikei University School of Medicine, Department of Forensic Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kimiharu Iwadate
- Department of Forensic Medicine, The Jikei University School of Medicine, Department of Forensic Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Takasu S, Matsumoto S, Kanto Y, Kodama S, Iwadate K. Postmortem urine concentration of N-terminal pro-brain natriuretic peptide in relation to the cause of death. Forensic Sci Int 2020; 306:110079. [DOI: 10.1016/j.forsciint.2019.110079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/19/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
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Post-mortem diagnosis of kidney impairment: An experimental study. Forensic Sci Int 2019; 301:271-277. [DOI: 10.1016/j.forsciint.2019.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/04/2019] [Accepted: 05/17/2019] [Indexed: 11/20/2022]
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Srettabunjong S, Thongphap W, Chittamma A. Urea, Uric Acid, and Creatinine in Postmortem Blood, Vitreous Humor, and Synovial Fluid: A Comparative and Correlation Study,. J Forensic Sci 2019; 65:128-133. [DOI: 10.1111/1556-4029.14138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/15/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Supawon Srettabunjong
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand
| | - Wantawanop Thongphap
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand
| | - Anchalee Chittamma
- Division of Clinical Chemistry, Department of Pathology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok 10400 Thailand
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Zhang K, Wang Q, Liu R, Wei X, Li Z, Fan S, Wang Z. Evaluating the effects of causes of death on postmortem interval estimation by ATR-FTIR spectroscopy. Int J Legal Med 2019; 134:565-574. [PMID: 30911838 DOI: 10.1007/s00414-019-02042-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 03/08/2019] [Indexed: 12/25/2022]
Abstract
Estimating postmortem interval (PMI) is one of the most challenging tasks in forensic practice due to the effects of many factors. Here, attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy combined with chemometrics was utilized to evaluate the effects of causes of death when estimating PMI and to establish a partial least square (PLS) regression model, which can precisely predict PMI under different causes of death. First, the sensitivities to causes of death (brainstem injury, mechanical asphyxia, and hemorrhage shock) of seven kinds of organs were evaluated based on their degrees of cohesion and separation. Then, the liver was selected as the most sensitive organ to establish a PMI estimation model to compare the predicted deviations from different causes of death. It turns out that the cause of death has no significant effect on estimating PMI. Next, a PLS regression model was built with kidney tissues, which have the lowest sensitivity, and this model showed a satisfactory predictive ability and wide applicability. This study demonstrates the feasibility of using ATR-FTIR spectroscopy in conjunction with chemometrics as a powerful alternative for detecting changes in biochemistry and estimating PMI. A new perspective was also provided for evaluating the effect of causes of death when predicting PMI.
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Affiliation(s)
- Kai Zhang
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Qi Wang
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ruina Liu
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Xin Wei
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Zhouru Li
- Department of Forensic Medicine, Xuzhou Medical University, Xuzhou, 221004, People's Republic of China
| | - Shuanliang Fan
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
| | - Zhenyuan Wang
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
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11
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Li Y, Shen R, Ding R, Wen G, Du A, Dong Z, Ren X, Yao H, Zhu B, Li R, Lu Y, Wu X. A fatal case of hypothermia caused by dog bites. MEDICINE, SCIENCE, AND THE LAW 2017; 57:130-133. [PMID: 28587535 DOI: 10.1177/0025802417712882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Death from hypothermia usually *We presented a fatal case of hypothermia after being bitten by dog in this article. occurs among people exposed to cold and humid environmental conditions when they are homeless, aged, suffering from natural or psychiatric diseases and drug or alcohol intoxication. A normal healthy person dying from hypothermia due to dog bites is unusual and rare. Here, we present a fatal case of hypothermia following dog bites causing blood loss and multiple wounds on the body. A 56-year-old man was found dead in a remote roadside puddle of a small village, early in the morning. He was naked, and his body trunk and limbs had multiple irregular wounds. Gray animal hairs could be seen in parts of the wound cavities and surrounding areas. In addition, there was a kennel near the scene. Family members argued that the deceased was bitten to death by a dog. However, autopsy revealed several findings which were strongly supportive of fatal hypothermia. Moreover, we saw no obvious changes caused by blood loss, either on the body surface or internal organs. Accordingly, we concluded the true cause of his death was fatal hypothermia; bites from a dog was a necessary causative factor.
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Affiliation(s)
- Yanning Li
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Ruipeng Shen
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
- 2 Wujiang District Branch of Suzhou Public Security Bureau, Suzhou, PR China
| | - Runtao Ding
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Gehua Wen
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Ao Du
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Zhibin Dong
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Xinghua Ren
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Hui Yao
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Baoli Zhu
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Rubo Li
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Yan Lu
- 3 Key Laboratory of Health Ministry in Congenital Malformation, the Affiliated Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Xu Wu
- 1 Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
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The experimental design of postmortem studies: the effect size and statistical power. Forensic Sci Med Pathol 2016; 12:343-9. [PMID: 27412160 PMCID: PMC4967085 DOI: 10.1007/s12024-016-9793-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 01/06/2023]
Abstract
Purpose The aim is of this study was to show the poor statistical power of postmortem studies. Further, this study aimed to find an estimate of the effect size for postmortem studies in order to show the importance of this parameter. This can be an aid in performing power analysis to determine a minimal sample size. Methods GPower was used to perform calculations on sample size, effect size, and statistical power. The minimal significance (α) and statistical power (1 − β) were set at 0.05 and 0.80 respectively. Calculations were performed for two groups (Student’s t-distribution) and multiple groups (one-way ANOVA; F-distribution). Results In this study, an average effect size of 0.46 was found (n = 22; SD = 0.30). Using this value to calculate the statistical power of another group of postmortem studies (n = 5) revealed that the average statistical power of these studies was poor (1 − β < 0.80). Conclusion The probability of a type-II error in postmortem studies is considerable. In order to enhance statistical power of postmortem studies, power analysis should be performed in which the effect size found in this study can be used as a guideline.
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Renal markers cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) in postmortem samples. Forensic Sci Med Pathol 2016; 12:189-92. [PMID: 26972903 DOI: 10.1007/s12024-016-9760-6] [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] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Renal markers may provide valuable information for cause of death (CoD) investigation when assessing the influence of impaired kidney function. A commonly used marker, creatinine (Cr), increases due to kidney injury and is known to be reasonably stable in postmortem (PM) samples. More sensitive markers are needed, as the increase of serum Cr level only occurs after relatively severe renal damage. We evaluated two markers, cystatin C and neutrophil gelatinase-associated lipocalin (NGAL), in addition to Cr. To the best of our knowledge this was the first study to investigate cystatin C and NGAL in a postmortem (PM) context. METHODS Cr, cystatin C, and NGAL were measured from PM blood in 39 autopsy cases. NGAL was also measured from urine in 16 cases. Cystatin C and NGAL were analyzed using ELISA, Cr measurements were performed with Jaffe method. Correlations of these markers were evaluated. RESULTS AND CONCLUSIONS Both, blood cystatin C and NGAL, levels showed significant correlation with Cr (p = 0.05 and p = 0.01, respectively). Cystatin C and NGAL in blood are promising markers for further studies with PM samples.
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Abstract
Diabetes mellitus has become a major cause of death worldwide and diabetic ketoacidosis is the most common cause of death in children and adolescents with type 1 diabetes. Acute complications of diabetes mellitus as causes of death may be difficult to diagnose due to missing characteristic macroscopic and microscopic findings. Biochemical analyses, including vitreous glucose, blood (or alternative specimen) beta-hydroxybutyrate, and blood glycated hemoglobin determination, may complement postmortem investigations and provide useful information for determining the cause of death even in corpses with advanced decompositional changes. In this article, we performed a review of the literature pertaining to the diagnostic performance of classical and novel biochemical parameters that may be used in the forensic casework to identify disorders in glucose metabolism. We also present a review focusing on the usefulness of traditional and alternative specimens that can be sampled and subsequently analyzed to diagnose acute complications of diabetes mellitus as causes of death.
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Affiliation(s)
- Cristian Palmiere
- Cristian Palmiere, CURML, Centre Universitaire Romand De Medecine Legale, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland,
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Changes in Surface Charge Density of Blood Cells in Fatal Accidental Hypothermia. J Membr Biol 2015; 248:1175-80. [PMID: 26364031 PMCID: PMC4611003 DOI: 10.1007/s00232-015-9838-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/04/2015] [Indexed: 10/28/2022]
Abstract
The objective of this research was to evaluate postmortem changes concerning electric charge of human erythrocytes and thrombocytes in fatal accidental hypothermia. The surface charge density values were determined on the basis of the electrophoretic mobility measurements of the cells conducted at various pH values of electrolyte solution. The surface charge of erythrocyte membranes after fatal accidental hypothermia increased compared to the control group within whole range of experimental pH values. Moreover, a slight shift of the isoelectric point of erythrocyte membranes towards high pH values was observed. The surface charge of thrombocyte membranes in fatal accidental hypothermia decreased at low pH compared to the control group. However, at pH range 4-9, the values increased compared to the control group. The isoelectric point of thrombocyte membranes after fatal accidental hypothermia was slightly shifted towards low pH values compared to the control group. The observed changes are probably connected with the partial destruction and functional changes of the blood cell structure.
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Palmiere C, Mangin P. Urea nitrogen, creatinine, and uric acid levels in postmortem serum, vitreous humor, and pericardial fluid. Int J Legal Med 2014; 129:301-5. [PMID: 25194712 DOI: 10.1007/s00414-014-1076-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/28/2014] [Indexed: 01/19/2023]
Abstract
Urea nitrogen, creatinine, and uric acid are relatively stable in postmortem serum and may, therefore, be used for diagnostic purposes when chronic kidney disease and end-stage renal failure are investigated as causes of death. Nevertheless, uncertainties remain in defining the best alternative to postmortem serum for the identification and assessment of significantly decreased kidney function. In this study, we investigated urea nitrogen, creatinine, and uric acid levels in postmortem serum, pericardial fluid, and vitreous humor in a series of medico-legal cases (500 autopsies) with various causes of death. No postmortem interval-related differences were observed in any of the investigated fluids for any analyzed parameter, confirming the biochemical stability of all compounds after death. Data analysis failed to reveal statistically significant differences between postmortem serum and pericardial fluid urea nitrogen, creatinine, and uric acid concentrations. Conversely, statistically significant differences were observed in all analyzed biomarkers between postmortem serum and vitreous humor levels, with lower concentrations of all markers measured in vitreous. The results of this study suggest that, in order to estimate as accurately as possible blood analyte concentrations at the time of death, pericardial fluid should be preferred to vitreous humor.
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Affiliation(s)
- Cristian Palmiere
- University Centre of Legal Medicine, Rue du Bugnon 21, 1011, Lausanne, Switzerland,
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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]
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18
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Kawamoto O, Michiue T, Ishikawa T, Maeda H. Comprehensive evaluation of pericardial biochemical markers in death investigation. Forensic Sci Int 2013. [DOI: 10.1016/j.forsciint.2012.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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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]
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20
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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]
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21
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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]
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22
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Procalcitonin and C-reactive protein in pericardial fluid for postmortem diagnosis of sepsis. Int J Legal Med 2012; 126:567-72. [DOI: 10.1007/s00414-012-0692-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/13/2012] [Indexed: 11/26/2022]
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23
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Palmiere C, Mangin P. Postmortem chemistry update part I. Int J Legal Med 2011; 126:187-98. [PMID: 21947676 DOI: 10.1007/s00414-011-0625-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/09/2011] [Indexed: 11/30/2022]
Abstract
Postmortem chemistry is becoming increasingly essential in the forensic pathology routine and considerable progress has been made over the past years. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine may provide significant information in determining the cause of death or in elucidating forensic cases. Postmortem chemistry may essentially contribute in the determination of the cause of death when the pathophysiological changes involved in the death process cannot be detected by morphological methods (e.g. diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders). It can also provide significant information and useful support in other forensic situations, including anaphylaxis, hypothermia, sepsis and hormonal disturbances. In this article, we present a review of the literature that covers this vast topic and we report the results of our observations. We have focused our attention on glucose metabolism, renal function and electrolytic disorders.
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Affiliation(s)
- Cristian Palmiere
- University Centre of Legal Medicine, Lausanne-Geneva, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
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24
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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]
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25
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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]
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26
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Maeda H, Zhu BL, Ishikawa T, Quan L, Michiue T. Significance of postmortem biochemistry in determining the cause of death. Leg Med (Tokyo) 2009; 11 Suppl 1:S46-9. [DOI: 10.1016/j.legalmed.2009.01.048] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 01/08/2009] [Indexed: 12/27/2022]
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27
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Comparative evaluation of postmortem serum concentrations of neopterin and C-reactive protein. Forensic Sci Int 2008; 179:135-43. [DOI: 10.1016/j.forsciint.2008.04.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 04/30/2008] [Accepted: 04/30/2008] [Indexed: 11/22/2022]
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28
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Tissue-specific differences in mRNA quantification of glucose transporter 1 and vascular endothelial growth factor with special regard to death investigations of fatal injuries. Forensic Sci Int 2008; 177:176-83. [DOI: 10.1016/j.forsciint.2007.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 10/17/2007] [Accepted: 12/10/2007] [Indexed: 12/31/2022]
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29
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Maeda H, Zhu BL, Bessho Y, Ishikawa T, Quan L, Michiue T, Zhao D, Li DR, Komatsu A. Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia. Forensic Sci Med Pathol 2008; 4:175-80. [DOI: 10.1007/s12024-008-9029-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 09/26/2007] [Indexed: 02/03/2023]
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30
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Quan L, Oritani S, Bessho Y, Maeda H. Postmortem serum catecholamine levels in relation to the cause of death. Forensic Sci Int 2007; 173:122-9. [PMID: 17395415 DOI: 10.1016/j.forsciint.2007.02.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 02/08/2007] [Accepted: 02/12/2007] [Indexed: 11/17/2022]
Abstract
Catecholamines are major humoral factors and neurotransmitters that contribute to various stress responses. However, they have been considered unstable due to agony, terminal medical care and postmortem interference. The present study was a comprehensive investigation of postmortem serum levels of adrenaline (Adr), noradrenaline (Nad) and dopamine (DA) with regard to the cause of death in serial medicolegal autopsy cases (n=542) including fatalities from various traumas and diseases. There was a slight tendency toward postmortem increases of Nad and DA in cardiac blood as well as Adr and Nad in peripheral blood, a slight age-dependent decrease in Adr and DA in right heart blood, and a marked increase in serum DA due to administration during critical medical care. When these factors were taken into consideration, significantly higher cardiac blood levels were observed for Adr and Nad in injury and asphyxiation cases and for Adr in fatal methamphetamine (MA) abuse and other poisoning cases, whereas those levels were lower in fatal hypothermia. Drowning, fire fatality, acute cardiac death and cerebrovascular disease showed intermediate Adr and Nad levels. The DA level was elevated in cases of injury, hyperthermia, MA fatality and other poisoning. Topographical analyses suggested that the major sources of increased serum catecholamines in cases of injury was abdominal viscera including adrenal glands, and that in cases of asphyxiation, drowning, fire fatality, hyperthermia, MA fatality, other poisoning, acute cardiac death and cerebrovascular disease was the extremities in addition to abdominal viscera. However, there was in part a large case-to-case difference in each marker related to individual causes of death. These findings differed markedly from clinical observations and suggest that the postmortem serum catecholamine levels may reflect the magnitude of physical stress responses during the process of death in individual cases.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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31
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Inouye DS, Kickertz K, Wong LL. Methamphetamine use in deceased kidney donors impairs one-yr graft function. Clin Transplant 2007; 21:643-50. [PMID: 17845640 DOI: 10.1111/j.1399-0012.2007.00703.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Methamphetamine (MA) has cumulative deleterious effects on multiple organ systems. A history of MA exposure in kidney donors may affect adversely graft function in recipients. METHODS Between September 2000 and March 2004, all deceased kidney donors were identified from the local registry (97 donors). Twenty donors (21%) with any MA exposure through history or toxicology were selected. Donors that did not fulfill UNOS standard criteria were excluded. Donor characteristics and subsequent recipient characteristics were retrospectively compared with a control group without MA exposure histories. The main outcome measure was mean serum creatinine at one-yr post-transplant (Cr365). Secondary outcome measures of delayed graft function and rejection episodes were reviewed. RESULTS Baseline serum creatinine at seven d post-transplant were equivalent between groups (Cr7 = 2.5 +/- 2.0 vs. 2.8 +/- 3.4, p = 0.75). At one yr, Cr365 was significantly elevated in recipients of MA exposed kidneys compared with controls (1.9 +/- 1.0 vs. 1.4 +/- 0.4, p = 0.028). When adjusted for confounding variables, MA exposure lost its statistical significance (p = 0.07-0.09) as an independent predictor of increased Cr365. CONCLUSION Donor MA exposure may be associated with increased Cr365 in recipients. Transplant centers can expect to encounter donors with MA use histories at rates higher that regional use rates. Larger studies may demonstrate MA exposure as an independent predictor of impaired graft function.
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Affiliation(s)
- David S Inouye
- Department of Surgery, University of Hawaii School of Medicine, Hawaii, USA
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32
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Guilbeau-Frugier C, Rambaud C, Dedouit F, Telmon N, Rougé D, Delisle MB. [Interest of post mortem analysis in diagnosis and etiopathogeny of ischemic myocardial infarction]. Ann Pathol 2007; 26:427-34. [PMID: 17255902 DOI: 10.1016/s0242-6498(06)70751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The discovery of an ischaemic myocardial infarction during forensic or scientific autopsy is sometimes surprising when found in a young subject. It is therefore important to find out the etiology of vascular lesions to take preventive measures in the family. In post mortem, some complementary analysis can be performed to determine the diagnosis of ischaemic myocardial infarction and its etiopathogeny. Such analyses, routinely made in forensic practice, are rarely used by pathologists during scientific autopsy. Some biological mediums are stable enough to be used for biological, biochemical and even genetical analyses. We will study the different post mortem analyses, and see their interest and reliability.
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Affiliation(s)
- Céline Guilbeau-Frugier
- Service d'Anatomie Pathologique, CHU Rangueil, Av du Professeur J. Poulhès, 31059 Toulouse cedex 9.
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Zhu BL, Ishikawa T, Michiue T, Tanaka S, Zhao D, Li DR, Quan L, Oritani S, Maeda H. Differences in postmortem urea nitrogen, creatinine and uric acid levels between blood and pericardial fluid in acute death. Leg Med (Tokyo) 2007; 9:115-22. [PMID: 17197225 DOI: 10.1016/j.legalmed.2006.10.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 10/13/2006] [Accepted: 10/16/2006] [Indexed: 11/30/2022]
Abstract
Previous studies showed significant differences in postmortem urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels in heart blood depending on the causes of death, including acute death. In addition, the levels in pericardial fluid approximated the clinical serum reference ranges, and their elevations may be assessed based on clinical criteria. The present study investigated difference between blood and pericardial levels of these markers. Medicolegal autopsy cases (n=556, within 48h postmortem) of the following causes of death were examined: injury (n=136), asphyxiation (n=50), drowning (n=39), fire fatalities (n=99), hyperthermia (n=11), hypothermia (n=8), poisoning (n=26), delayed traumatic death (n=44) and natural diseases (n=143). When serum UN, Cr and UA levels were compared with the pericardial levels, there was an equivalency for delayed traumatic death and chronic renal failure, although each level was markedly elevated. Parallel increases in serum and pericardial UA and/or Cr levels were also observed for hypothermia and gastrointestinal bleeding. However, in drowning cases, the left cardiac and pericardial UN levels were lower than the right cardiac and peripheral levels, suggesting the influence of water aspiration. Significant elevations in serum and pericardial Cr and UA levels with a higher serum/pericardial UA ratio for fatal methamphetamine intoxication suggest progressive skeletal muscle damage due to advanced hypoxia/acidosis. Similar findings were often observed for other acute and subacute deaths. These findings suggest that a comparison between blood and pericardial nitrogenous compounds would be useful for investigating the cause and process of death.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Zhao D, Zhu BL, Ishikawa T, Li DR, Michiue T, Maeda H. Quantitative RT-PCR assays of hypoxia-inducible factor‐1α, erythropoietin and vascular endothelial growth factor mRNA transcripts in the kidneys with regard to the cause of death in medicolegal autopsy. Leg Med (Tokyo) 2006; 8:258-63. [PMID: 16963303 DOI: 10.1016/j.legalmed.2006.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 04/06/2006] [Accepted: 05/11/2006] [Indexed: 11/19/2022]
Abstract
Accumulating studies demonstrate that the expressions of hypoxia-inducible factor 1 (HIF-1), erythropoietin (EPO) and vascular endothelial growth factor (VEGF) depend on cellular oxygen tension, which is involved in the pathological process of tissue hypoxia and/or ischemia. The present study investigated hypoxia-inducible factor-1alpha (HIF-1alpha), EPO and VEGF mRNA expressions in the kidney with regard to the cause of death in medicolegal autopsy. Relative quantifications of HIF-1alpha, EPO and VEGF mRNAs, based on real-time TaqMan reverse transcription-polymerase chain reaction (RT-PCR), were performed on tissue specimens obtained from consistent sites of the bilateral renal cortices. The cases (total, n=245, 6-48h postmortem) included fatal blunt/sharp instrument injuries (n=53/31), asphyxia (n=28: aspiration, n=8; strangulation/hanging, n=20), drowning (n=27), fire fatality (n=62), acute myocardial infarction/ischemia (AMI, n=39), and gastrointestinal hemorrhage (n=5). Both HIF-1alpha and EPO mRNA levels were significantly lower in drowning cases. More characteristic findings were found for VEGF mRNA: it showed higher expression levels for AMI, acute blunt/sharp instrument injury, and aspiration, whereas it was lower for neck compression (strangulation/hanging), drowning, fire fatality with higher blood carboxyhemoglobin (COHb) levels (>60%), peracute blunt injury, and gastrointestinal hemorrhage. Quantitative assays of renal HIF-1alpha, EPO and VEGF mRNA transcripts are potentially useful for investigating the pathophysiology of death, and VEGF mRNA may be especially useful as an indication of acute circulatory failure.
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Affiliation(s)
- Dong Zhao
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
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de la Grandmaison GL, Leterreux M, Lasseuguette K, Alvarez JC, de Mazancourt P, Durigon M. Study of the diagnostic value of iron in fresh water drowning. Forensic Sci Int 2006; 157:117-20. [PMID: 16280220 DOI: 10.1016/j.forsciint.2005.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Accepted: 03/21/2005] [Indexed: 11/17/2022]
Abstract
The aim of our study was to test the diagnostic value of iron (Fe) in fresh water drowning by investigating the postmortem levels of hemodilution in drowning cases compared to control cases. Twenty-six typical fresh water drowning cases were selected from 128 immersion cases autopsied in our Department of Forensic Pathology between 1998 and 2004. The exclusion criteria were a long postmortem interval and other causes of death than drowning. For all selected cases, the diagnosis of drowning was based on the presence of autopsy findings and positive diatom test. A control population of 12 cases was also selected. For each drowning and control case, iron blood levels were measured in the left ventricle (LV) and right ventricle (RV) of the heart. The mean difference of iron concentration (RVFe-LVFe) between the drowning group and the control group was statistically compared. Furthermore, iron measurements were performed in 19 drowning cases showing advanced putrefaction. The mean difference of iron concentration was significantly higher in the drowning cases compared with controls (P<0.001). All drowning cases showed hemodilution. No overlap was found in the RVFe-LVFe levels between the two groups. Resuscitation attempts seemed to have no effect on the results. In cases of drowning showing advanced putrefaction, the iron test was not reliable because biochemical iron measurement was often prevented by no sufficient blood in the heart or postmortem clots. In conclusion, according to our results, iron seems to be a good biochemical marker in fresh water drowning with a short postmortem interval.
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Affiliation(s)
- Geoffroy Lorin de la Grandmaison
- Department of Pathology and Forensic Medicine, Raymond Poincaré Hospital, Paris-Ouest Medical University, 104 Boulevard Raymond Poincaré, F-92380 Garches, France.
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