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PubMed2006

Expression of heat-shock protein 70 (Hsp70) in the respiratory tract and lungs of fire victims.

Immunohistochemical investigation of the respiratory tract and lungs of 63 fire victims revealed a statistically significant enhanced expression of heat-shock protein 70 (Hsp70) in the epiglottis, the trachea, and the main and the peripheral bronchi compared with a control group. In the fire victims, a strong expression of Hsp70 was discernible not only particularly in the vessels but also in seromucous secretory cells, ciliated epithelial cells, smooth muscle cells, and alveolar cells. The results suggest a vital or supravital reaction due to the inhalation of hot fire fumes.

Adolescent↗
PubMed2006

Sudden death due to undiagnosed acute promyelocytic leukemia: a case report.

Acute promyelocytic leukemia (APL) is associated with severe hemorrhagic coagulopathy induced by the release of procoagulant, plasminogen, and protease from leukemic cells. The case described in this report is of a 15-year-old male who unexpectedly died due to a cerebral hemorrhage caused by underlying APL within 12 h after presentation. This case suggests that underlying APL should be considered as a differential diagnosis when sudden death occurs with a fatal spontaneous hemorrhage, although it is rare.

Adolescent↗
PubMed2006

Cutting crime: the analysis of the "uniqueness" of saw marks on bone.

Witness marks produced on bone by the use of saws have traditionally been examined using stereomicroscopy. The marks are typically found on the kerf wall or floor and give important information about the implement that made them. This paper describes a new approach to the analysis of witness marks left on kerf walls and floors from crimes involving dismemberment. Previously, two types of marks have been identified: deep furrows formed during the pull stroke and fine striations formed on the push stroke. These types of striation allow the class of saw to be identified, but not an individual saw. With the advent of environmental scanning electron microscopy (ESEM), insulating materials can now be examined without the need for conductive coatings to be applied. This allows materials to be examined at higher magnifications than those available with stereomicroscopy. Here we report on a new, third type of striation that is visible at higher magnifications on ESEM images. These striations are formed from the imperfections on the cutting teeth of saws and give real possibilities of uniquely identifying whether or not a particular saw was used to cause the mark. In blind trials conducted on sawing of nylon 6.6, different individual saws could be successfully identified even if different people used the saw. We discuss ways in which these results can be extended to bone and how this may assist in the investigation of the act of dismemberment.

Aged↗
PubMed2006

Hypoxic changes in Purkinje cells of the human cerebellum.

The significance of both Purkinje cell numbers and various neuronal changes for the diagnosis and timing of hypoxic-induced brain lesions was investigated in tissue samples from the cerebellar cortex of 52 individuals with a history of acute or prolonged cerebral hypoxia/ischemia before death. Furthermore, the area of the Purkinje cell somata (PC size) was measured using an automatic image processing and analysis system (LEICA QWin). Significantly reduced numbers of Purkinje cells (<6 cells/unit length of 1 mm) and a decreased portion (<50%) of intact Purkinje cells could be detected in individuals with a period of resuscitation of at least 2 h after acute circulatory arrest. Average cell numbers of less than 4 cells/unit were found in individuals who suffered from diffuse brain swelling and were ventilated for at least 3 days, as well as in individuals who died of brain death. Moreover, the Purkinje cells in these cases exhibited shrunken somata compared to the controls. Specimens that were stored at room temperature up to 30 h after removal at autopsy showed no significant autolytic changes of the Purkinje cells. After 46 h, however, reduced Purkinje cell numbers and shrunken cell bodies were found.

Adult↗
PubMed2006

Neuronal and glial apoptosis in human traumatic brain injury.

To establish reliable methods to aid the timing of brain damage after traumatic brain injury (TBI), brain tissue from 56 autopsy cases with TBI and known survival times, ranging from a few minutes to 126 days, were tested for apoptotic changes to the neuronal and glial cells. Apoptosis was established using the TdT-mediated dUTP nick end labelling (TUNEL) method of in-situ labelling and immunohistochemical reaction of caspase 3. In addition, cellular reaction and astroglial cell differentiation were investigated using histological and immunohistochemical markers. From a survival time of 120 min up to 12 days, TUNEL-positive apoptotic neuronal cells were frequently detected in the contusion zone. The earliest positive caspase 3 reaction in cortical neurons was evident after a posttraumatic interval of 80 min. Detection of apoptotic glial cells using the TUNEL technique showed that as in the case of neuronal cells, the earliest positive TUNEL reaction was obtained after 110 min. In cases of survival times of 120 min up to 4 days, apoptotic glial cells could frequently be detected. However, the first caspase 3-positive glial cells appeared 5 h after injury. Cerebral apoptosis was significantly associated with TBI cases as compared to control cases (P<0.001). The reference histological findings of neutrophilic granulocytes, CD3-positive T-lymphocytes, CD68-positive activated microglial cells/macrophages and TUNEL-positive neuronal cells increases the degree of certainty in determining the probable age of traumatic brain injury to 87.5%.

Adolescent↗
PubMed2007

Postmortem determination of concentrations of stress hormones in various body fluids--is there a dependency between adrenaline/noradrenaline quotient, cause of death and agony time?

To find out whether a certain cause of death or a certain length of an agonal period shows specific adrenaline or noradrenaline profiles, heart blood, femoral vein blood, liquor, urine and vitreous humour were taken from corpses (n = 98) at the Medical School Hannover, and noradrenaline and adrenaline were determined using high-performance liquid chromatography (HPLC). Corpses were classified according to the following five categories: short agony, long agony, state after hanging, state after asphyxiation and state after CPR with documented administration of epinephrine. Once results were collected the adrenaline/noradrenaline quotient was determined. It became clear that there were no significant differences regarding the concentration of adrenaline and noradrenaline in the various body fluids in relation to the above-mentioned categories. The means adrenaline/noradrenaline quotients in femoral vein blood were 0.21 +/- 0.29 for hanged persons, 0.38 +/- 0.47 for asphyxiated persons, 0.17 +/- 0.19 for those with short agony and 0.42 +/- 0.43 for those with long agony, significantly below 1 (p < 0.001; p = 0.001; p = 0.003). For condition after CPR we found an adrenaline/noradrenaline quotient of 2.81 +/- 5.8. In liquor the adrenaline/noradrenaline quotients for short agony was 0.17 +/- 0.17, for hanged persons 0.18 +/- 0.19 and for asphyxiated ones 0.30 +/- 0.38, significantly lower than 1 (p < 0.001). In urine the adrenaline/noradrenaline quotients for all categories are lower than 1 (p < 0.001); short agony (0.13 +/- 0.09), long agony (0.21 +/- 0.16), hanged (0.15 +/- 0.16), asphyxiated (0.14 +/- 0.08) and CPR (0.14 +/- 0.06). In vitreous humour the quotients for short agony (0.14 +/- 0.28), long agony (0.13 +/- 0.12), hanged (0.07 +/- 0.09) and asphyxiated (0.09 +/- 0.11) are lower than 1 (p < 0.001). The spread of data for the adrenaline/noradrenaline quotient did not allow for any conclusions about cause of death and length of agony in individual cases.

Asphyxia↗
PubMed2005

Morphology of puparia of Megaselia scalaris (Diptera: Phoridae), a fly species of medical and forensic importance.

Megaselia scalaris (Loew), a scuttle fly, is a fly species of medical and forensic importance. For use in forensic investigation, fly specimens found to associate with human corpses have to be identified at species level. Herein, we present the morphology of the puparia of the above fly species using scanning electron microscopy. The characteristic of the intersegmental spines along the dorsal and lateral segments and sculpture of the pupal respiratory horn of this puparia may be useful in future studies, to distinguish it from other closely related species.

Animals↗
PubMed2006

Postmortem orbital findings in shaken baby syndrome.

PURPOSE: To compare postmortem orbital findings in pediatric accidental head injury to Shaken Baby Syndrome (SBS). DESIGN: Retrospective study. METHODS SETTING: Institutional. STUDY POPULATION: Thirty-six patients underwent postmortem modified exenteration with sectioning of the orbital contents; 18 victims of SBS and 18 cases of fatal accidental head trauma. OBSERVATION PROCEDURE: In all cases of children who died from accidental head trauma, the orbital tissues were separated to expose the optic nerve sheath. Patients with gross evidence of hemorrhage within the sheath were included. All cases of SBS were included. After accidental head injury, exenteration was performed only if optic nerve sheath hemorrhage was suspected on gross examination. All children younger than 18 years old with head injury as primary cause of death were included. SBS is defined as having at least two of the following: (1) typical abnormal findings on neuroimaging, (2) typical skeletal injury, (3) retinal hemorrhages, (4) history of abusive shaking with or without blunt head trauma, or (5) an inadequate history to explain the observed injuries. MAIN OUTCOME MEASURE: Presence or absence of orbital hemorrhage. RESULTS: Orbital tissue injury is more common in SBS than accidental head trauma without orbital fracture. In addition, optic nerve sheath and optic nerve intradural hemorrhage are also significantly more common in SBS (P < .0001). CONCLUSIONS: Our study reports new evidence of injury to orbital tissues in SBS and supports the concept that these finding are due to unique acceleration-deceleration forces of this type of abusive head injury.

Child, Preschool↗
PubMed2006

Criminal poisoning: medical murderers.

It is impossible to determine the true incidence of homicides that occur within health care facilities. Over the years there have been numerous documented examples of health care providers preying on helpless patients. For several reasons, the health care system has been inadequate in its response. This article reviews some of those cases, the hospitals' responses, and the outcome of investigations,to reveal the common factors that can identify the warning signs of these tragic events.

Forensic Pathology↗
PubMed2006

Criminal poisoning: Munchausen by proxy.

The diagnosis and subsequent prosecution of Munchausen by proxy (MBP) cases require the collaborative teamwork of health care teams, laboratory personnel, law enforcement, and social services. Poisoning occurs in a significant number of the MBP cases with a diverse variety of agents used. To aid laboratory professionals in determining the appropriate toxicology tests to perform in such criminal cases, health care professionals must focus their testing requests on substances that correspond to the victim's signs, symptoms, and ancillary test values. This article reviews MBP, with particular focus on poisoning agents that have been used in past reported cases.

Forensic Pathology↗
PubMed2005

Pathogenesis of conjunctival petechiae.

Conjunctival petechiae from 15 cases (cause of death: different natural and unnatural) were analysed using confocal laser scanning microscopy (CLSM) in order to visualize the kind of the damage within the vessel wall (diapedesis versus rhexis). The pathomorphological findings with multiple ruptures of vessels appearing to be filled to bursting point define the conjunctival petechiae as a rhexis-haemorrhage.

Adult↗
PubMed2004

Malpractice--role of the forensic pathologist in Germany.

Medicolegal malpractice assessments have been an important part of the work of forensic pathologists. Not only botchers are concerned but also physicians of all clinical subjects, especially malpractice charges claiming a malpractice leading to death. Single long articles and book chapters have been published about malpractice assessments since the end of the 17th century by forensic pathologists. After World War II systematic studies of malpractice charges first were published in the 1960s. Meanwhile the attention focuses more and more on the role of forensic pathologists to help in prevention of malpractice.

Forensic Pathology↗
PubMed2005

A coronary artery crossed embolism of bone-marrow origin: proof of connections between pulmonary arteries and veins.

The paper describes a case of exceptionally rare crossed embolism of the coronary artery. The embolus material originated in bone-marrow released from rib fractures which occurred during resuscitation attempts. Autopsy did not reveal any anatomical abnormalities of the circulatory system, nor any disease-related changes, which could explain the occurrence of this embolism type, and therefore the only possible explanation is the presence of direct connections between pulmonary arteries and veins. The confirmation of this theory is the bone-marrow embolism of the pulmonary vein detected in the second case.

Aged↗
PubMed2004

Neuropathological examination in forensic context.

Different diseases of and trauma to the central nervous system (CNS), as well as their consequences are common causes of death and therefore it is important to examine the CNS appropriately in forensic autopsy, bearing in mind that the site of the disease is often as crucial as its nature. The CNS is a complex organ and its examination requires special methods and knowledge and often consultation with a neuropathologist. The prerequisite for the proper examination is correct handling and processing of the CNS. Because of its soft consistency fixation of the CNS in toto before detailed macroscopic analysis is recommended but guidance for an expedited limited examination is also given. The key features to which attention should be paid during the removal and later macroscopic examination of the CNS are described. Processing CNS for microscopy also requires special techniques and in addition to the routine stains both special histological and selected immunohistochemical stainings are often needed to reach the correct diagnosis.

Antibodies↗
PubMed2004

Gunshot injuries to the head and brain caused by low-velocity handguns and rifles. A review.

OBJECTIVES: Reconstruction of brain injuries is a basic task of forensic neuropathology. For better understanding of the wound ballistics of gunshot injuries to the brain caused by low-velocity firearms (E(o) < 550 J), we reviewed the respective contributions of: (1) biomechanical reconstruction by postmortem imaging techniques, (2) biometry of the extent of very early microscopic tissue destruction, and (3) microscopic studies on the type and extent of early microscopic reactions around the permanent missile track. MATERIAL AND METHODS: A selected case material of 47 victims of lethal gunshot wounding to the brain was studied. (1) Computed tomography (CT) and magnetic resonance imaging (MRI) techniques were compared with macroscopic findings in 17 cases. (2) Morphometric evaluation of the zones of cellular and axonal destruction around the permanent track was performed in 20 cases (survival time: <90 min). (3) Microscopic studies of the emigration of leukocytes and macrophages plus axonal expression of beta-amyloid precursor protein (beta-APP) were conducted in 10 cases (survival time: >90 min). RESULTS AND CONCLUSIONS: (1) Imaging procedures provided valuable information on entrance and exit wounds, the missile track and secondary changes. (2) Biometry revealed a destruction zone of ca. 3.6 cm around the permanent track corresponding to the "temporary cavity". (3) Microscopic studies of reactive changes demonstrated axonal injury at sites remote from the permanent cavity that could explain the very early respiratory arrest following low-velocity gunshot injury.

Amyloid beta-Protein Precursor↗
PubMed2004

Non-traumatic forensic neuropathology.

The practicing Forensic Pathologist is likely to encounter case material in which either the cause of death or a major contribution to the cause of death is underlying damage to or disease of the central nervous system. While it is good practice in many instances to have a working relationship with a Department of Neuropathology, from which advice and practical help can be sought, there may be instances when the Forensic Pathologist needs to proceed on a basis of a working knowledge of Forensic Neuropathology up to and including how to examine the specimen and take tissue blocks for processing and subsequent histological examination. Some of the more common conditions of the central nervous system such as damage consequent to hypoxia-ischaemia, hypoglycemia and epilepsy, the encephalopathies associated with altered sodium concentration, deficiency due to Vitamin B(1) and various neurodegenerative diseases that manifest as dementia and include Alzheimer's disease, cortical Lewy body disease and the prion disorders, are outlined in this article.

Brain↗