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PubMed2004

Estimation of postmortem metabolic changes in porcine brain tissue using 1H-MR spectroscopy--preliminary results.

To investigate the potential for estimating the time since death by monitoring the evolution of different metabolites in brain tissue by (1)H-MRS, an animal model using pig heads was established. The maximum examination interval was 3 weeks. Within this time interval spectra revealed different compositions of metabolites, including metabolites observed in the normal brain and as products of bacterial decomposition processes (N-acetyl-aspartate 0-130 h, creatine 0-170 h, bound trimethylammonium, e. g. choline compounds, during the whole time course with fluctuating intensities, lactate 0-200 h, alanine and acetate during the whole time course, succinate and free trimethylammonium after approx. 100 h postmortem). The proposed approach may offer a new method to estimate later postmortem intervals although these observations have to be confirmed by further studies.

Acetates↗
PubMed2004

Heat stroke in an incubator: an immunohistochemical study in a fatal case.

The authors report the unique case of an 8-day-old infant succumbing to heat stroke caused by an abnormal increase of the environmental temperature in an incubator. At postmortem examination, second-degree burns were detected, and macroscopic and microscopic findings were typical for a heat-related death. An immunohistochemical study was performed. At the same time, a detailed examination of the incubator was conducted, revealing a malfunctioning of the temperature and relative humidity control system. We suggest that the diagnosis of heat stroke has to be confirmed on the basis of a detailed postmortem examination and a complete immunohistochemical investigation of heat shock proteins, molecules produced acutely in response to heat stress.

Antibodies, Monoclonal↗
PubMed2005

Postmortem multislice computed tomography and magnetic resonance imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema.

Non-invasive imaging methods are increasingly entering the field of forensic medicine. Facing the intricacies of classical neck dissection techniques, postmortem imaging might provide new diagnostic possibilities which could also improve forensic reconstruction. The aim of this study was to determine the value of postmortem neck imaging in comparison to forensic autopsy regarding the evaluation of the cause of death and the analysis of biomechanical aspects of neck trauma. For this purpose, 5 deceased persons (1 female and 4 male, mean age 49.8 years, range 20-80 years) who had suffered odontoid fractures or atlantoaxial distractions with or without medullary injuries, were studied using multislice computed tomography (MSCT), magnetic resonance imaging (MRI) and subsequent forensic autopsy. Evaluation of the findings was performed by radiologists, forensic pathologists and neuropathologists. The cause of death could be established radiologically in three of the five cases. MRI data were insufficient due to metal artefacts in one case, and in another, ascending medullary edema as the cause of delayed death was only detected by histological analysis. Regarding forensic reconstruction, the imaging methods were superior to autopsy neck exploration in all cases due to the post-processing possibilities of viewing the imaging data. In living patients who suffer medullary injury, follow-up MRI should be considered to exclude ascending medullary edema.

Adult↗
PubMed2005

The examination and reporting of war crimes-an example from Finnish history.

We present a historical example of forensic investigation of civilian victims of an armed conflict. During the Civil War in Finland in 1918, 77 external examinations with photographic documentation and 10 forensic autopsies were carried out. However, incorrect conclusions concerning post-mortem changes made by non-medical persons led into erroneous interpretations of the events. Post-mortem changes were considered to be signs of torture and post-mortem mutilation. This example demonstrates how political purposes may falsify results of a forensic investigation.

Deception↗
PubMed2005

Value of morphological parameters for grading of brain swelling.

This study investigated the value of both gross features and histological findings for grading of brain swelling. For this purpose, the grooving of the temporal gyri (unci) as well as the extension of the cones at the basal part of the cerebellum were measured in 42 brains obtained at autopsy. Furthermore, the distension of perivascular spaces in tissue samples from seven different regions of the brains was evaluated histologically, assisted by an automatic image processing and analysis system. In each individual, the normal range of brain weight was calculated on the basis of the body height, using the formulae by Röthig and Schaarschmidt. The difference between this calculated (normal) value and the brain weight evaluated at autopsy was considered as a reliable criterion for the grade of brain swelling. There was no statistical evidence of a positive correlation between the various parameters. Hence, it can be concluded that both gross section and histological findings are of minimal significance for grading of brain swelling.

Adolescent↗
PubMed2005

Postmortem imaging of blood and its characteristics using MSCT and MRI.

The rapid development of computed tomography (CT) and magnetic resonance imaging (MRI) led to the introduction and establishment in postmortem investigations. The objectives of this preliminary study were to describe the imaging appearances of the early postmortem changes of blood after cessation of the circulation, such as sedimentation, postmortem clotting, and internal livores, and to give a few first suggestions on how to differentiate them from other forensic findings. In the Virtopsy project, 95 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy and therefore 44 cases have been investigated in this study. Postmortem alterations as well as the forensic relevant findings of the blood, such as internal or subcutaneous bleedings, are presented on the basis of their imaging appearances in multislice CT and MRI.

Aorta↗
PubMed2005

Early increase in TNF-alpha-containing mast cells in skin lesions.

We have evaluated the numbers and immunohistochemical positivity for tumor necrosis factor (TNF) alpha of the mast cells in (a) 40 skin samples collected at autopsy from subjects who had survived for a few seconds to 1 h, (b) 10 samples of post-mortem skin lesions and (c) 10 surgical biopsies of healthy skin. Sections were treated with fluoresceinated avidin, to tag mast cell granules, followed by indirect immunohistochemistry for TNF-alpha with polyclonal primary and rhodaminated secondary antibodies. We could confirm a progressive increase in mast cell numbers, which became significant 1 h after trauma. More important, the fraction of mast cells positive for TNF-alpha increased progressively in the same time period and became significantly higher than controls in specimens collected more than 15 min after trauma. Samples from post-mortem lesions had significantly fewer mast cells and fewer TNF-alpha-positive cells than any other group of samples. The results suggest that mast cells are quickly recruited to an injured site in response to trauma and upregulate their TNF-alpha content, which can play an early role in directing tissue response to injury. The forensic pathologist can take advantage from this behavior of mast cells for the evaluation of the timing of early vital lesions.

Adult↗
PubMed2005

Sudden death in childhood due to varicella pneumonia: a forensic case report with clinical implications.

Varicella (chickenpox) is one of the most frequent highly infectious diseases in childhood. It is caused by varicella-zoster virus. Lethal complications are rare. Focused on histological findings, we present a case of a sudden unexpected death of an otherwise healthy 18-month-old girl due to varicella-induced pneumonia. The histological and immunohistochemical investigations of the lung tissue revealed typical findings of a varicella pneumonia: haemorrhagic and necrotic nodules, intra-alveolar fibrin, numerous neutrophilic granulocytes, lymphocytes, plasmacells, macrophages, multinucleated giant cells and hyaline membranes. Varicella-related deaths are preventable by vaccine. To prevent complications and lethal outcome of varicella as reported here, the recommendations concerning vaccination against varicella must be taken into account in paediatric practice.

Adolescent↗
PubMed2005

The human brain and its neural stem cells postmortem: from dead brains to live therapy.

Contrary to the traditional dogma of being a relatively invariable and quiescent organ lacking the capability to regenerate, there is now widespread evidence that the human brain harbors multipotent neural stem cells, possibly throughout senescence. These cells can divide and give rise to neuroectodermal progeny in vivo and are now regarded as powerful prospective candidates for repairing or enhancing the functional capability of neural tissue in trauma or diseases associated with degeneration or malperfusion. Hopes primarily rest upon techniques to either recruit endogenous stem cells or to utilize exogenous donor-derived material for transplantation. In the search for suitable human cell sources, embryonic, fetal, and adult stem cells appear highly controversial, as they are accompanied by various still-unresolved moral and legal challenges. Fascinatingly, however, recent reports indicate the successful isolation and expansion of viable neural stem cells from the rodent and human brain within a considerable postmortem interval, suggesting that postmortem neural stem cells could potentially become an acceptable alternative cellular resource. This article will provide a brief overview about neural stem cells, their prominent features, and prospects for a cellular therapy, and will furthermore illuminate the cells in particular with respect to their newly discovered postmortem provenience, their advantage as a potential cell source, and several unfolding forensic considerations. Also, important ethical, social, and legal implications arising from this hitherto unpracticed cellular harvest of brain tissue from the deceased are outlined.

Animals↗
PubMed2005

Does imaging technology overcome problems of conventional postmortem examination? A trial of computed tomography imaging for postmortem examination.

We used a mobile computed tomography (CT) unit for postmortem examinations of deceased subjects to see how many mistakes on cause-of-death diagnoses were made in Japan. In 5 of 20 cases, the cause of death determined by CT was different from the diagnosis made by superficial postmortem examination. In one case, the superficial examination suggested no trauma, whereas a subdural hematoma was found on cranial CT images. We concluded that postmortem examinations in Japan were not effective when screening for crimes or accidents. Using a mobile CT scanner in postmortem examination may be a viable method of screening for causes of deaths, although it cannot be used as a substitute for autopsy.

Adult↗
PubMed2005

An unusual case of homicidal near drowning followed by electrocution.

A young woman was found dead in a bath-tub with her facial orifices under water and current burn marks at the right big toe and at the neck near the hairline. Initial police investigations assumed an accidental electric shock due to a radio falling into the water. The forensic autopsy was followed by extensive histology and immunohistochemistry of the internal organs and skin marks. Intensive vital reactions of a near-drowning were detected that suggested a survival period of at least 20 min. Furthermore, an energy dispersive x-ray spectroscopy analysis on the current burn marks and on possible current applicators was performed, as well as reconstruction experiments with a cadaver of a pig that had been slaughtered shortly before. The results of all investigations revealed a two-step procedure with a primary near-drowning and a final current application with consecutive cardiac arrest.

Adult↗
PubMed2006

Cardiac arrhythmias and sudden death in infancy: implication for the medicolegal investigation.

Genetically transmitted diseases are an important cause of juvenile sudden cardiac death (SCD). In a considerable proportion of individuals in which a medicolegal investigation is performed, structural heart disease is absent, and the medical examiner fails to discover an adequate cause of death. In such cases, an inherited arrhythmogenic disease should be considered, which manifests with life-threatening ventricular tachycardia or SCD. Molecular diagnosis is progressively becoming an important tool for these questions. Therefore, postmortem genetic testing ("molecular autopsy") should be considered as a part of the comprehensive medicolegal investigation in SCD cases without apparent structural heart disease. It will have implications not only for the deceased individual but also for living family members in preventing (further) cardiac events by expert counseling, appropriate lifestyle adjustment, and adequate treatment, if available.

Arrhythmias, Cardiac↗
PubMed2005

Usefulness of serum mast cell-specific chymase levels for postmortem diagnosis of anaphylaxis.

Chymase, a serine protease, is stored mainly in secretory granules of human mast cells. Serum chymase concentration was examined in 8 autopsy cases with anaphylaxis as well as in 104 control cases without anaphylaxis. It was detected in all 8 cases with anaphylaxis (range 3-380 ng/ml, mean 89.8 ng/ml), while it was detected in only 2 of the 104 controls and was below a detectable level (<3 ng/ml) in the other 102. Serum tryptase levels are known to be a diagnostic indicator of anaphylaxis, therefore the relationship between serum chymase and tryptase levels was investigated in the 8 cases of anaphylactic death; a significant positive correlation was found (r=0.826, p=0.011). Furthermore, chymase was shown to be quite stable in serum. These results showed that measurement of serum chymase levels might be an additional tool for postmortem diagnosis of anaphylaxis.

Aged↗
PubMed2006

Postmortem cytokine levels and severity of traumatic injuries.

The relationship between postmortem serum cytokine levels and severity of traumatic injuries was studied. The postmortem serum levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) of 131 victims who died from traumatic injury were measured by an enzyme-linked immunosorbent assay method and compared with scores of total abbreviated injury scale (total AIS) and injury severity score (ISS) calculated from detailed autopsy reports. A significant positive correlation was observed between IL-6 and total AIS (rs=0.4508, p<0.0001), between IL-6 and ISS (rs=0.3337, p<0.0001), between IL-8 and total AIS (rs=0.6593, p<0.0001), and between IL-8 and ISS (rs=0.5305, p<0.0001). The significant correlation between cytokine levels and anatomical traumatic severity indicated that the cytokine levels are useful objective indexes of traumatic severity. In addition, the total AIS is a suitable marker to evaluate traumatic severity as the coefficient of correlation between the cytokine levels and the total AIS was higher than that for the ISS values.

Abbreviated Injury Scale↗
PubMed2006

Perforation of the pulmonary artery by a bronchial wall stent.

Implantation of stents into the bronchial walls is a newly developed method to treat lung emphysema, which is now being tested clinically. During this procedure, a bronchoscope carrying a Doppler ultrasonography head is placed into a segmental bronchus and the blood vessels running in parallel to the bronchus are localized. Once a safe location without blood vessels is found, the bronchial wall is perforated and a stent is placed within the wall to improve the expiratory volume of these "bypasses" to the adjacent lung parenchyma. We observed a fatal complication with this method in a 60-year-old man. The bronchial wall and the pulmonary artery were perforated by one of the stents inducing massive bleeding, which could not be stopped. The patient died due to aspiration of blood in combination with massive loss of blood. The general risk to perforate the pulmonary artery during this procedure cannot be estimated from this single observation but should be considered regarding the legal and clinical aspects.

Bronchi↗
PubMed2006

Effects of rounding errors on postmortem temperature measurements caused by thermometer resolution.

Beginning 7 h after death, a datalogger was used to measure the temperature in the external auditory canal of an adult male body placed in a refrigerated room. The sequence of measured values approximated a single exponential function with a correlation coefficient of 0.998475. This suggests that the starting time of body cooling in the refrigerated room under constant temperature can be calculated with less error using any two data points recorded by the datalogger. However, the results of such calculations varied widely and longer postmortem intervals demonstrated greater calculation errors. Periodic errors also appeared. Mathematical simulations showed that this variation was caused by rounding errors, which represent the difference between the thermometer readings and the true temperature. The resolution of the thermometer was 0.1 degrees C, a normal specification; however, even this led to noticeable rounding errors. Therefore, significant errors may influence postmortem interval estimations using other body temperatures. When body temperatures are used to determine the time of death, a method that minimizes rounding errors should be considered.

Body Temperature↗
PubMed2006

Sudden death due to giant cell coronary arteritis.

An 89-year-old woman was found dead lying in her bed. Autopsy demonstrated a pronounced thickening of all coronary arteries except for the first 2-4 cm. Death was due to a recent myocardial infarction. Microscopically, the coronary arteries showed a substantial concentric thickening of all three layers with 90% narrowing. There was a dense transmural inflammatory infiltration with lymphocytes, macrophages, and numerous multinucleated giant cells. The CD68 positive giant cells were mostly located at the media-intima border in the vicinity of fragmented fibers of the lamina elastica interna. The aorta and its major branches including the carotid arteries, however, were free of inflammation and thickening. The findings were characteristic for giant cell arteritis, the equivalent of temporal Horton arteritis, but isolated involvement of the coronary arteries is exceptional.

Aged, 80 and over↗
PubMed2006

Mast cell tryptase in postmortem serum-reference values and confounders.

We have investigated the effects of some factors suspected of inducing spuriously increased tryptase concentrations, specifically sampling site, conjunctival petechial bleeding and prone position at the time of death as indicators of premortem asphyxia, and resuscitation efforts by external cardiac massage. Tryptase was measured in blood from the femoral vein in 60 deaths: 39 control cases who died rapidly (within minutes) from natural causes (sudden cardiac death and acute aortic dissection), 16 with death caused by prolonged asphyxia (traumatic compression of the chest and suffocation due to body position or smothering), and five anaphylactic deaths. In 44 of these cases, tryptase was measured in both heart and femoral blood. Mast cell tryptase was analyzed with a commercial FEIA method (Pharmacia Diagnostics AB, Uppsala, Sweden) measuring both alpha- and beta-tryptase. Assuming that tryptase values in the control group were gamma distributed, we calculated the upper normal limits for tryptase concentrations in femoral blood. It was found that 95% of the controls had values below 44.3 mug/l (femoral blood), SD 5.27 mug/l. All but one of the anaphylactic deaths had tryptase concentrations exceeding that limit. Tryptase was significantly elevated in femoral blood from anaphylactic deaths (p<0.007), compared with the controls. Also, in the cases where death had occurred due to asphyxia tryptase was elevated in femoral blood (p<0.04). A significant difference in tryptase concentrations was seen between blood from the heart and the femoral vessels (p<0.02) in the whole material (n=44). Tryptase concentrations in femoral blood were not influenced by prone position at death, or resuscitation efforts. It is concluded that asphyxia premortem seems to affect tryptase concentrations, that postmortem tryptase measurements should be done in serum from femoral blood, and that the normal upper limit, covering 95%, is 44.3 microg/l.

Adolescent↗