Screening of milk aspiration in 105 infant death cases by immunostaining with anti-human alpha-lactalbumin antibody.

To determine the frequency and degree of milk aspiration in infant death cases, immunohistochemical examinations were performed on lung sections from 41 sudden death cases and 64 in-hospital death cases using anti-human alpha-lactalbumin antibody. Milk aspiration to some degree was detected in more than half of the sudden death cases and in about one-third of the in-hospital death cases. A semi-quantitative examination of the amount of aspirated milk was subsequently performed in the positive cases. The amount of aspirated milk in the sudden death cases was significantly higher than that in the in-hospital death cases. The frequency distribution of the amount of aspirated milk was similar in shape in both groups. In most cases, a very small amount of aspirated milk was detected. The aspirated milk was assumed to be a result of occasional gastroesophageal reflux or cardiopulmonary resuscitation. However, in five cases, much larger amounts of aspirated milk were found. In these cases, milk aspiration may have been an important part of the cause of death. We concluded that slight milk aspiration is not rare in infant death cases, and that in a few cases, the aspiration is lethal. An immunohistochemical screening test is available to perform a postmortem diagnosis in these cases.     

Retrograde blood aspiration: a vital reaction

Blood aspiration, which is based on an intact breathing activity, is one of the forensically most important vital reactions. On the example of 11 forensic cases it is shown that the aspiration of blood into the lung tissue is possible not only when the bleeding source is situated above the trachea or main bronchi, but also in a retrograde way, taking its origin from an injury of the peripheral lung tissue itself. Equally to 'classical' blood aspiration, the findings of retrograde blood aspiration are to be diagnosed by means of macroscopical and histological examination of the lung tissue. The lung tissue presents with roundish, reddish spots, which are situated close to, but separate from a lung contusion or other lung tissue injury, and microscopical examination reveals blood in the alveoli and the bronchioli. Retrograde blood aspiration may be a helpful vital sign in the forensic assessment of thorax trauma cases where no other vital reactions are present.     

Fatal Aspiration of Barium Sulfate in a Case of Myasthenia Gravis: A Case Report and Review of Literature

Barium contrast radiography is a usual procedure performed for detecting lesions of the digestive tract using barium sulfate on X-ray irradiation. The aspiration of barium contrast is an uncommon but well-documented complication occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Certain conditions that affect the anatomical and functional integrity of the oropharynx and esophagus can be predisposing factors. Barium is an inert material that can cause symptoms varying from an asymptomatic mechanical obstruction to severe respiratory distress that can result in death when aspirated. Sudden death due to aspiration of barium is rarely reported in the literature. We report a case of a 50-year-old female who suddenly developed difficulty in breathing, followed by loss of consciousness during barium swallow procedure due to aspiration of barium contrast. She could not be revived and died within a few minutes of the episode. The predisposing factor was the weakness of the muscles of deglutition due to myasthenia gravis. We also reviewed the literature available on cases resulting from the aspiration of barium sulfate during the barium study procedures. We considered the factors like the age, indications, the distribution of barium in the lungs, clinical presentation, the period of survival, and cause of death. We came across only four cases of death within 24 h following the aspiration of barium. This case report and review of literature emphasize the importance of consideration of predisposing factors before conducting barium contrast radiography and also the possibility of sudden death.     

Blood aspiration as a vital sign detected by postmortem computed tomography imaging

Blood aspiration is a significant forensic finding. In this study, we examined the value of postmortem computed tomography (CT) imaging in evaluating findings of blood aspiration. We selected 37 cases with autopsy evidence of blood in the lungs and/or in the airways previously submitted to total-body CT scanning. The CT-images were retrospectively analyzed. In one case with pulmonary blood aspiration, biopsy specimens were obtained under CT guide for histological examination. In six cases, CT detected pulmonary abnormalities suggestive of blood aspiration, not mentioned in the autopsy reports. CT reconstructions provided additional data about the distribution and extent of aspiration. In one needle-biopsied case, the pulmonary specimens showed blood in the alveoli. We suggest the use of CT imaging as a tool complementary to traditional techniques in cases of blood aspiration to avoid misdiagnosis, to guide the investigation of lung tissue, and to allow for more evidence-based inferences on the cause of death.     

Forensic medicine and morphologic aspects of fatal amniotic fluid aspiration

The massive aspiration of amniotic fluid as one cause of a fatal postpartal asphyxia will be demonstrated under the aspect of preliminary criminal law proceedings against physicians because of medical negligence. The pathomorphologically established diagnosis of a fatal aspiration of amniotic fluid supposes extensive and systematic quantitative histological examination of both lungs. The technique of histological cross sections through the entire lung combined with morphometry is a suitable method to exactly record the alterations of bronchi and lung parenchyma by aspiration of amniotic fluid and their complications, such as interstitial emphysema.     

An autopsy case of an infant with Joubert syndrome who died unexpectedly and a review of the literature

The present report describes the unexpected death of a 6-month-old female infant who had been clinically diagnosed with Joubert syndrome. This is a relatively rare congenital neurological disorder characterized by hypoplasia/aplasia of cerebellar vermis, which transmits information from the body to the cerebellum, and is associated with respiratory dysfunction, abnormal eye movements, and developmental delay. The infant was found dead in bed and the immediate cause of death was determined as aspiration of vomit which may have been induced by a neurological disorder related to hypoplasia of the cerebellar vermis. These findings, together with a review of previous clinical case reports, suggest that Joubert syndrome should be considered as a predisposition to sudden unexpected death in infants mainly due to aspiration or complicated infection.     

Suicidal shot in the mouth with an unmodified blank cartridge pistol

In the medicolegal literature reports of suicides with weapons designed for self-defence, especially gas pistols, are rare. We report on a suicide of a 54-year-old woman who fired a fatal shot in her mouth with an unmanipulated blank cartridge pistol, make R?hm RG 8, calibre 8 mm. The autopsy findings (lips and mucosa of the buccal vestibule without injuries, but extensive lesions of the tongue and the middle and rear third of the smooth palate) suggest that the shot was fired - as observed by a witness - with the barrel of the weapon inside the oral cavity. Both macroscopic inspection and histological investigations excluded the possibility that death was caused by an injury of the brain, in particular the brain stem. The immediate cause of death was deep aspiration of chyme with concurrent aspiration of blood.     

The Violence of Non-Violence: Law and War in Iraq

The article examines the relation between war making in Iraq and juridical reforms aimed at instituting democracy, or what the article coins juridico-democracy. It is argued that a certain aspiration for global peace, global security, and non-violence to be instituted by juridico-democracy accompanies the war against Iraq. Rather than leave this aspiration intact, the article examines the extent to which this aspiration itself is conducive to the war's violence. The associations between violence and non-violence, war and peace, conflict and security are examined not as oppositions, but as cycles, where nonviolence, peace, and security are performative of more violence.     

Unusual findings in a death caused by a car fire

Witnesses detected a burning car in the parking lot next to a discotheque in the early morning hours. After the fire had been extinguished, the charred body of the 23-year-old car owner was found in the driver's seat. The young man had been a guest of the discotheque the previous night and consumed plenty of alcoholic drinks. The traces left by the fire on the car suggested that the fire had started in the passenger compartment. At autopsy, greyish-brown discoloration and induration of the mucosa of the respiratory tract were found in addition to massive aspiration of soot and signs of soot swallowing. The macroscopic and histological findings pointed to a chemical burn of the airways probably caused by chlorine gases developing when the covering of the passenger compartment was burning. Chemical burns due to inhalation, aspiration and swallowing of soot are all signs of vitality, so that a smoldering fire must have gone on for a while inside the car with the windows closed. The most probable cause of the fire is that clothing or textile material in the car was set on fire by a burning cigarette.     

Aspiration of gastric contents in hanging with typical position of the strangulation cord and free suspension]

Among 193 cases of hanging from the years 1978 to 1991 examined in the institute of Forensic Medicine of the Freie Universit?t Berlin 8 cases with an aspiration of stomach contents had been reported. Herefrom 3 cases were hanging in a "typical" position (suspension point at the back of the head, free suspension of the hanging body) and did not undergo resuscitation. By free suspension of the hanging body the observed massive aspiration of gastric contents only can be explained by an at least partly open connecting passage between the laryngeal entry and the entrance of the oesophagus. The post mortem flowing in of stomach contents as well as a post mortem gastro-oesophageal peristalsis seem not to be able for explicating the findings. Differences in important parameters (e.g. gastric contents, alcoholization) to the cases of hanging without aspiration were not found. Even by free suspension of the body, running noose and point of suspension in the back of the neck sometimes the connection between larynx and oesophagus may stay open, especially when by emesis a high pressure is produced by the stomach.     

Mechanisms of unexpected and/or sudden death in Lafora disease

A 23-year-old male was found dead wedged between two chairs at his home address. His past history included a diagnosis of Lafora disease (a type of heritable progressive myoclonic epilepsy) at the age of 16 years. This had been characterised by the development of epilepsy and progressive motor impairment and mental deterioration. Diagnosis had been confirmed by demonstration of mutation in the EPM2A gene on chromosome 6q24. At autopsy, petechial haemorrhages were noted of the face and conjunctivae bilaterally. There were no other significant findings apart from gastric contents within the airways. Death was attributed to positional asphyxia complicated by aspiration of gastric contents. Although death in Lafora disease is usually predictable and often protracted, sudden and/or unexpected death may occur and involve status epilepticus, sudden unexpected epileptic death, choking, aspiration of gastric contents, and cardiac arrhythmias. In addition, the possibility exists of unnatural causes of death, such as accidents, provoked by epilepsy or physical inability of the victims to extricate themselves from dangerous situations, or homicides, provoked by difficulties in caring for individuals with significant and progressive disabilities.     

Therapy-related café coronary deaths: two case reports of rare asphyxial deaths in patients under supervised care

Café coronary deaths, as initially characterized, denote fatal occlusion of the upper airway by food substances. Such fatalities typically occur in individuals who either are clinically inebriated or have clinically significant neuromuscular dysfunction. Both conditions impair mastication and deglutition. The authors review the accidental deaths of two neurologically compromised patients under supervised care. Both subjects underwent complete medicolegal autopsy. In one case, ingestion of a prescribed emollient laxative precipitated death; in the other, death was attributable to aspiration of a contrast medium during a diagnostic radiographic procedure. These therapy-related deaths, which are regarded as a variation of the traditionally described café coronary fatalities summarized in the discussion, represent adverse events occurring during medical care. The adverse outcomes reviewed here are potentially avoidable and require special attentiveness by the clinicians directed to the particular condition of each patient. Such true aspiration-related deaths are confirmed on autopsy examination and are to be differentiated from the findings of agonal aspiration of gastric contents commonly encountered by the autopsy pathologist investigating deaths due to a great variety of natural and traumatic causes.     

Occult aspiration of a nut in an elderly patient: a case report

Occult foreign body aspiration is an uncommon but serious occurrence in the elderly population. A case is presented in which the foreign body, a nut, was uncovered only at autopsy.     

A heat gelatinized subdural hematoma in a burned cadaver as an indication of a vital accident

The autopsy of a carbonized male cadaver revealed a subdural hematoma which permitted by absence of soot aspiration and carbon monoxid intoxication to think of a crime with following fire setting. This was confirmed later by detective investigations. The most impressive finding of this case was a heat-gelatinized subdural hematoma highly resembling to a postmortem epidural burn hematoma, which could easily lead to an error conclusion. The problems in the diagnosis of the causes of death in carbonized bodies are discussed and the taking into account of crimes is accentuated.     

Suffocation death by occlusion of the airways with sand

Eleven cases are reported in which death occurred because of suffocation as a result of occlusion of the respiratory tract by sand (without thoracic compression: 3 cases) or being buried alive (8 cases). Two tables demonstrate the findings and circumstances in the events. Three cases are described in detail. A 22-year-old woman was manhandled by blows and kicks to the head and neck. She became unconscious and her head and neck were covered by a layer of sand so that she suffocated. A 42-year-old man was smothered, while unconscious, in a prone position with his face in the sand, after hard blows to the head by two culprits. A 17-year-old girl finally died by chocking. Previously the culprit had pressed her face into the ground, so that she aspirated particles of soil. The question of vital reactions during aspiration of sand was investigated by microscopic examination of the content of the air passage and by destroying parts of the lungs by sulphuric acid. Minimal aspiration of sand occurred in all cases. Although the postmortal remains were left in the ground, there was no postmortem penetration of sand into the air passage. Histological examinations were carried out to support the diagnosis of violent suffocation. In some cases, there were remarkable findings (mobilization of alveolar cells, hepatocelullar hydropic degeneration), but there were no typical or unanimous findings that pertained to all cases.     

Model experiments on breathing under sand

Remarkable autopsy findings in persons who had suffocated as a result of closure of the mouth and nose by sand (without the body being buried) induced us to investigate some aspects of this situation by means of a simple experiment. A barrel (diameter 36.7 cm) with a mouthpiece in the bottom was filled with sand to a depth of 15, 30, 60, or 90 cm. The subject tried to breathe as long as possible through the sand, while the amount of sand inspired was measured. Pressure and volume of the breath, as well as the O2 and CO2 content were also measured. A respiratory volume of up to 31 was possible, even when the depth was 90 cm. After about 1 min in all trials, the subject's shortness of breath forced us to stop the experiment. Measurement of O2 and CO2 concentrations proved that respiratory volume in and out of the sand shifts to atmospheric air without gas exchange, even when the sand depth is 15 cm. Sand aspiration depended on the moisture of the material: when the sand was dry, it was impossible to avoid aspiration. However, even a water content of only 5% prevented aspiration, although the sand seemed to be nearly dry.     

La justicia social y la globalización monetarista

The author analyzes the doctrinal concept of social justice, in light of the ILO at its 75th anniversary, in which he was questioned their future, like a universal postulate. Whither goes the job? Social justice as a principle and aspiration of the right amount of work trying to promote and preserve decent existence of the community by imposing human values to all speculative consideration, commercial or financial information, proposed by globalization.     

Longitudinal evaluation of immunohistochemical findings of milk aspiration: an experimental study using a murine model

To examine the longitudinal change of pathological findings of the lung and other organs in milk aspiration, an experimental study using a murine model was carried out. Either 0.5 or 1.0 ml cow's milk was instilled into the trachea of rats. From immediately after to 14 days after instillation, the animals were sacrificed, and the lungs, liver, kidneys, and spleen were removed. The results of immunostaining with anti-human α lactalbumin antibody indicated that not only the lung but also the kidney and spleen showed a positive reaction against the antibody over time. Experimentally aspirated milk was detectable in alveoli until 2 days after instillation. It was also detectable in renal tubules from 1 to 6h after instillation. Macrophages containing granules of aspirated milk were observed in splenic red pulp from 3h to 14 days after instillation. Detection of aspirated milk in other organs except the lung would be clear evidence of intravital milk aspiration and would suggest previous or recurrent milk aspiration.     

Adult sudden death caused by aspiration of chewing gum

A case of a fatal foreign material aspiration is presented in the following text. A 24-year-old white male died suddenly. A piece of chewing gum lodged in a pool of frothy fluid was revealed at autopsy. Microscopic examinations revealed atelectasia emphysema, eosinophilic exudate and empty spaces. Blood and urine samples were analyzed, for alcohol and drug use by fluorescence polarization immunoassay (FPIA) on an Abbott AXSYM system. No alcohol or other drugs were detected in blood or urine.