Comparative evaluation of postmortem serum concentrations of neopterin and C-reactive protein

The cellular immune response is accompanied by the release of neopterin. The level of neopterin in serum is increased in patients suffering from viral infections, autoimmune diseases, systemic inflammation, allograft rejection and malignant diseases, while that of C-reactive protein (CRP) is known to rise during inflammatory diseases and traumas. To investigate postmortem neopterin and CRP concentrations with regard to the cause of death, we examined cardiac and peripheral blood samples in 474 autopsy cases without advanced decomposition (0-96 years of age, 343 males and 131 females), 2.8 h to 3 days (median, 18.0 h) after death. Survival time was 0.1 h to 5 months (median, 3.0 h) for traumatic death, and 0.1-1, 440 h (median, 2.5 h) for natural death. In autopsied subjects, neopterin concentrations were higher than the clinical reference, independent of the time after death, and depended on the survival time. In cases of acute and subacute death due to trauma, the neopterin level in right heart blood was mildly to moderately elevated (about 50-200 nmol/l) except for sharp instrument injury, whereas the CRP concentration usually remained low (<1 mg/dl). However, a moderate rise in the CRP level (around 1-10 mg/dl) was observed in fatal cases of hypothermia (cold exposure). Markedly elevated serum CRP and neopterin levels (>10 mg/dl and >500 nmol/l, respectively) were detected in cases of delayed death due to trauma involving systemic inflammatory response syndrome (SIRS) and of fatal bacterial infections. For sepsis, the serum CRP level was markedly elevated but the neopterin level was low in some cases. Fatal viral infections usually resulted in a marked elevation in the serum neopterin level (>500 nmol/l) with a mild to moderate rise in the CRP level. Combined analyses of neopterin and CRP may be useful to investigate viral infections and delayed traumatic death involving SIRS to support pathological findings.     

氯氮平在家兔体内死后再分布规律研究

目的阐明死后48h内家兔体内氯氮平再分布规律,为相关法医鉴定工作提供借鉴。方法取家兔15只,随机分为5组,以氯氮平灌胃,分别于死后0、6、12、24、48h取心血、外周静脉血、尿液、肝组织检测氯氮平浓度。结果家兔死亡后心血、外周静脉血、肝脏氯氮平浓度不断升高,尿液氯氮平浓度不断降低;死后早期浓度变化率大于晚期浓度变化率。死后48h心血、外周静脉血、肝脏、尿液氯氮平浓度分别为死后0h各检材氯氮平浓度的418%、193%、154%和29%。结论死亡一段时间后,提取生物检材,检测出的氯氮平浓度并不能准确反映刚死时的实际浓度。     

死后血液流动对氯胺酮在家兔尸体内再分布的影响

目的观察分析静脉注射氯胺酮家兔死后血液流动对体内药物浓度再分布影响。方法雄性新西兰大白兔随机分为实验组2组（各24只）,对照组（8只）;实验组家兔经耳缘静脉注入40mg/kg氯胺酮,1.5h后处死,其中一组立即结扎主动脉,另一组不结扎;家兔尸体仰卧位室温下保存,分别于死后0、3、6、12、24、48、72和96h解剖并采取组织和体液样本;对照组静脉注射等量生理盐水,同样方法解剖取相同样本。所有样本采用GC/MS和GC-NPD法检测样品中氯胺酮含量。结果两个实验组家兔尸体放置96h内氯胺酮含量,除尿液各时间点与0h以及相邻时间点之间比较均有显著性差异（P〈0.05）外,两组家兔其余各类样本与0h以及相邻时间点比较均无显著性差异（P〉0.05）。除尿液外,各类样本两个实验组之间均无显著性差异（P〉0.05）;结扎组和不结扎组心血与外周血中氯胺酮含量比值分别为0.90~1.03和0.90~1.02。结论静脉注射氯胺酮家兔死后的血液流动不是体内氯胺酮发生再分布的主要机制。     

Biolog-Eco法检测尸体微生物群落的代谢功能变化

目的检测死后不同时间尸体上微生物群落功能多样性的变化并评估其在死亡时间推断中的应用价值。方法采用Biolog-Eco微平板对野外实验中来自于死后0~240 h猪和人尸体的肛门拭子进行微生物群体的培养,监测其引起的光密度值变化,结合法医病理学及蝇类演替,观察自然腐败尸体微生物群落的代谢特性及其变化。结果微生物代谢功能多样性与蛆虫数量变化呈负相关关系。冷冻在0 h对每孔颜色平均变化率影响最大,48 h后基本消失,192 h后尸体微生物群落多样性相对不稳定。主成分分析将31种碳源综合为5个主成分(累积贡献率90%)。碳源tsquare分析显示,N-乙酰-D-葡萄糖氨和L-丝氨酸是推断人和猪样品PMI(0~240 h)的优势碳源。结论 Biolog-Eco法能表现死亡后0~240 h尸体上微生物群落对部分碳源利用的代谢差异,有望为死亡时间推断提供新依据。     

Delta(9)-THC, 11-OH-Delta(9)-THC and Delta(9)-THCCOOH plasma or serum to whole blood concentrations distribution ratios in blood samples taken from living and dead people.

The recreational use and abuse of Cannabis is continuously increasing in Switzerland. Cannabinoids are very often detected alone or in combination with other drugs in biological samples taken from drivers suspected of driving under the influence of drugs. Moreover, they are also frequently found in blood specimens from people involved in various medico-legal events, e.g. muggings, murders, rapes and working accidents as well. In order to assess the influence of Cannabis exposure on man behavior and performances, it is often needed to estimate the time of Cannabis use. For that purpose two mathematical models have been set up by Huestis and coworkers. These models are based on cannabinoids concentrations in plasma. Because plasma samples are rarely available for forensic determinations in our laboratory, it could be useful to assess the time-laps since Cannabis use through these models from whole blood values. One prerequisite to the use of these models from whole blood values is the knowledge of the plasma to whole blood concentrations distribution ratios of cannabinoids. In this respect, the Delta(9)-THC, 11-OH-Delta(9)-THC and Delta(9)-THCCOOH concentrations were measured in plasma and whole blood taken from eight volunteers who smoke Cannabis on a regular basis. Cannabinoids levels were also determined in "serum" and whole blood samples taken from six corpses. The values of the plasma to whole blood distribution ratios were found to be very similar and their individual coefficient of variation relatively low suggesting that plasma levels could be calculated from whole blood concentrations taken into account a multiplying factor of 1.6. The data obtained postmortem suggest that the distribution of cannabinoids between whole blood and "serum" is scattered over a larger range of values than those determined from living people and that more cannabinoids (mean value of the serum/whole blood concentrations ratios=2.4) can be recovered from the "serum" fraction. The successful use of the mathematical models of Huestis and coworkers may, therefore, rely in part upon the selection of the appropriate blood sample, i.e. plasma. When plasma is not available, whole blood values could be considered with some caution taken into account a multiplying factor of 1.6 to calculate plasma concentrations from blood values. In the case of blood samples taken after death, the use of these models to assess the time of Cannabis use is not recommended.     

Determination of morphine in postmortem rabbit bone marrow and comparison with blood morphine concentrations

The aim of this study is to predict how long after time of death a buried body could be analyzed for opiates in soft tissues and to show the accessibility and suitability of bone marrow as a useful toxicological specimen from buried bodies. Morphine solutions were injected in nine albino rabbits. Doses ranged from 0.3 to 1.1 mg/kg with 0.1 mg/kg increments. One hour after the injections, the rabbits were sacrificed. Blood, urine and bone marrow samples were collected for analysis. After the whole bodies were buried, femur bone marrow specimens were collected on the seventh and fourteenth days. CEDIA was used to monitor morphine contents of the collected samples. All experimental cases showed that the increase in the given morphine doses correlated with the increase in blood and bone marrow morphine concentrations. High morphine concentrations were detected in urine samples, but there was no correlation between the urine and blood or urine and bone marrow morphine concentrations. Statistically meaningful increases in bone marrow morphine concentrations were found parallel to increase of blood morphine concentrations. Seventh and fourteenth day postmortem morphine concentrations also followed this correlation. Morphine concentrations in bone marrow at 7 and 14 day postmortem decreased consistently when compared with bone marrow morphine concentrations collected immediately after death. We conclude that in sudden death when other specimens are unavailable due to degradation, bone marrow can be a most useful specimen. Further experimental research in this area is required to validate bone marrow as an alternative tissue.     

Postmortem disposition of morphine in rats

The antemortem and postmortem distribution of morphine was studied in rats for the purpose of establishing whether drug distribution is altered after death. Samples were examined for free and total morphine concentration, pH and water content at 0-96 h after death. Morphine was administered antemortem at various intervals. All groups of rats studied showed a significant (P less than 0.05) increase in postmortem cardiac blood morphine concentrations. These changes, which are detectable within 5 min after death are likely to be related to an observed, rapid decrease in cardiac blood pH from 7.34 +/- 0.02 to 6.74 +/- 0.05. Significant increases in free morphine levels were, also, observed 24 and 96 h after death in liver, heart and forebrain while urine morphine levels decreased. The liver showed the greatest increase (20-fold) in free morphine levels 96 h after death, while hindbrain levels did not significantly change. Bacterial hydrolysis of morphine glucuronides accounted only in part for the observed increase in free morphine concentration. Postmortem fluid movement and pH-dependent drug partitioning was detected. It would appear that several mechanisms are responsible for postmortem drug distribution. Understanding the mechanisms and patterns responsible may eventually lead to better choices of postmortem tissue which may better represent antemortem drug levels.     

Role of alcohol in heroin overdose

The relationship between ethanol and risk of heroin overdosage was studied. Statistical processing of the results of forensic chemical analysis (460 expert evaluations) carried out in Chelyabinsk Regional Bureau of Forensic Medical Expert Evaluations in 2000 was carried out. The results of morphine and ethanol measurements in the blood and urine from corpses where deaths ensued from narcotic or ethanol poisoning, were analyzed. The concentrations of morphine in the blood and urine were measured on a gaseous chromatographer with mass-selective detector (Hewlett Packard HP 6890/HP-5972). Methods for measuring urinary and blood morphine are described. The results of statistical analysis demonstrated relationships between the age and ethanol concentrations in the blood and urine; blood ethanol and total urinary and blood morphine concentrations; blood concentration of free morphine and presence of 6-monoacetylmorphine in the blood. The authors conclude that the presence of ethanol in the blood together with morphine drastically augments the risk of rapid death from respiration arrest. It can also lead to a relatively high risk of overdosage in experienced narcomaniacs using heroin and ethanol.     

Distribution of ethyl glucuronide in rib bone marrow, other tissues and body liquids as proof of alcohol consumption before death

Postmortem ethyl glucuronide (EtG) concentrations in rib bone marrow, liver, muscle, fat tissue, urine, blood and bile have been determined by LC-MS/MS. Samples have been taken from twelve corpses during autopsies. In nine corpses EtG could be detected, corresponding blood ethanol concentrations (BAC) were 0.04-0.37 g%. In three cases, no EtG was found; two of these cases showed postmortem BACs - possibly due to putrefaction - of 0.01 and 0.1g%. In rib bone marrow, which is easily accessible during autopsy, EtG concentrations (0.77-9.36 microg/g) have been lower than in blood (2.24-20.46 microg/mL) in eight of nine cases and comparable or higher than in muscle tissue. Therefore, rib bone marrow has been found suitable as matrix for EtG determination. The highest EtG concentrations have been found in urine in all but one case, where the resorption of ethanol had been incomplete. Second highest EtG concentrations have been detected in liver samples. In two cases with putrefaction, EtG could not be detected. In these cases, the detectable ethanol might have been produced partially or in total by postmortem fermentation. However, instability of EtG during putrefaction cannot be totally excluded which might result in a total loss of EtG.     

Biochemical measurements of glucose metabolism in relation to cause of death and postmortem effects

This study was performed to examine the relationship between postmortem biochemical values and cause of death. The follow samples were taken from 399 corpses: cerebrospinal fluid (CSF; n = 376, suboccipital), blood (n = 158, femoral vein), and urine (n = 101, at autopsy). (See Table 1 for causes of death) All samples were stored at -80 degrees C. A further 100 samples of blood were later taken and stored at +4 degrees C before testing. Biochemical determinations made were: glucose in CSF, blood, and urine (hexokinase method); lactate (LDH/GPT) and free acetone (HS-gas chromatography) in CSF; hemoglobin A1 in blood (microcolumn technique). In 34 cases fatal diabetic coma was considered verified by morphological and chemical findings. One hundred cases of sudden cardiac death were chosen as the main control group. In 32 of the 34 cases defined above, the value of the formula of Traub (glucose + lactate in CSF) exceeded 415 mg/dl. It is not influenced significantly by hyperglycemia or hyperlactatemia due to factors other than diabetes (i.e., carbon monoxide, asphyxia). After death the value rose till the 30th hpm, then remained stable for at least 1 week. Fatal coma was defined as the ketoacidotic form if free acetone in CSF ranged above 21 mg/l. In these cases, CSF glucose and free acetone correlated positively. Hemoglobin A1 remained stable after death. Its amount was independent from postmortem blood glucose, postmortem interval and total hemoglobin. Furthermore, the manner of storage (-80 degrees or +4 degrees C) had no significant influence on its values. In 29 of 34 cases of fatal coma, Hb A1 exceeded 12.1%. Analysis of urine glucose showed elevated levels (over 500 mg/dl) in diabetic comas. On conclusion, fatal diabetic coma seems indicated as the cause of death if measured values of postmortem biochemistry exceed the following limits: CSF-Traub 415 mg/dl, free acetone (CSF) 21 mg/l; Hb A1 12.1%; urine glucose 500 mg/dl. Most important are the Traub formula and hemoglobin A1. Usually, in fatal coma both values are elevated. If both of them are normal, diabetic coma can nearly be excluded. Combined evaluation of all values is absolutely necessary. Morphology must also always be taken into account. Consequently, a diagnosis of fatal coma can be obtained by a process of elimination.     

Site-dependent production of gamma-hydroxybutyric acid in the early postmortem period

This study compared endogenous gamma-hydroxybutyric acid (GHB) concentrations in various postmortem fluid samples of 25 autopsy cases. All bodies were stored between 10-20 degrees C until autopsy, and the intervals between death and autopsy were less than 2 days (6-48 h). GHB concentrations were measured by headspace gas chromatography after GHB was converted to gamma-butyrolactone. Endogenous GHB concentrations were significantly higher in femoral venous blood (4.6+/-3.4 microg/ml, n=23) than in cerebrospinal fluid (1.8+/-1.5 microg/ml, n=9), vitreous humor (0.9+/-1.7 microg/ml, n=8), bile (1.0+/-1.1 microg/ml, n=9) and urine (0.6+/-1.2 microg/ml, n=12). GHB concentrations were similar in blood samples taken from different sites. Cut-off limits of 30 and 10 microg/ml are proposed for blood and urine, respectively, to discriminate between exogenous and endogenous GHB in decedents showing no or little putrefaction (postmortem intervals usually 48 h or less). The criterion established for endogenous GHB in postmortem urine may also be applicable to analytical results in cerebrospinal fluid, vitreous humor and bile from deceased persons.     

Interleukin-6 and C-reactive protein serum levels in sepsis-related fatalities during the early postmortem period

Postmortem interleukin-6 (IL-6) and C-reactive protein (CRP) serum levels were investigated prospectively in sepsis-related fatalities and non-septic fatalities by using a linear regression model. At least three blood samples were collected between 0.3 and 139 h postmortem from sepsis-related fatalities (n=8) and non-septic fatalities (n=16). In addition, one antemortem blood sample was collected shortly before death from the septic patients. Antemortem and postmortem IL-6 and CRP levels were highly elevated in all individuals included in the sepsis group. An excessive postmortem increase of IL-6 serum levels associated with progressive time after death was observed in five out of the eight septic patients. Both, IL-6 and CRP serum concentrations seem to be suitable biochemical postmortem markers of sepsis. The determination of IL-6 serum levels above 1500 pg/ml in peripheral venous blood obtained in the early postmortem interval can be considered as a diagnostic hint towards an underlying septic condition. A more precise postmortem discrimination between sepsis and non-septic underlying causes of death is provided by the postmortem measurement of serum CRP in peripheral venous blood: on condition that at least two postmortem CRP values have been determined at different time points postmortem, the CRP level of a deceased at the time of death can be calculated by using linear regression analysis. When assessing postmortem IL-6 and CRP concentrations as biochemical postmortem markers of sepsis, various clinical conditions, such as a preceding trauma or burn injury going along with elevated IL-6 and/or CRP levels prior to death as a result of the systemic inflammatory response syndrome (SIRS) should be taken into consideration, thus adding relevant information for the practical interpretation of the results.     

应用酶组织化学方法鉴定死亡时间的初步探讨

利用7例颅脑外伤死亡的健康青年尸体,在死后48h,环境温度18～24℃,空气相对湿度83～92％和实验湿度54～64％的条件下,检测肝脏、肾脏酶活性的变化。实验结果表明,肝脏乳酸脱氢酶(LDH)和L-苹果酸脱氢酶(MDH),随着死亡时间的延长,活性逐渐减低,48h近于阴性;而肾脏上述二种酶活性则在死亡后6h和24h出现高峰,36h开始下降;肝脏的酸性磷酸酶(ACP)亦于死后6h和24h出现高峰,36h开始下降。而肾脏此种酶在死后18～24h,有增高趋势。笔者认为上述酶活性的规律性变化有助于死亡时间的推断。应用二种以上酶活性的变化特点,能够较准确地判断死亡时间。     

Ethyl sulphate and ethyl glucuronide in vitreous humor as postmortem evidence marker for ethanol consumption prior to death

To clarify the circumstances of death, the degree of inebriation is of importance in many cases, but for several reasons the determination of the ethanol concentration in post-mortem samples can be challenging and the synopsis of ethanol and the direct consumption markers ethyl glucuronide (EtG) and ethyl sulphate (EtS) has proved to be useful. The use of a rather stable matrix like vitreous humor offers further advantages. The aim of this study was to determine the concentrations of ethanol and the biomarkers in the robust matrix of vitreous humor and to compare them with the respective levels in peripheral venous blood and urine. Samples of urine, blood from the femoral vein and vitreous humor were taken from 26 deceased with suspected ethanol consumption prior to death and analyzed for ethanol, EtS and EtG. In the urine samples creatinine was also determined. The personal data, the circumstances of death, the post-mortem interval and the information about ethanol consumption prior to death were recorded. EtG and EtS analysis in urine was performed by LC-ESI-MS/MS, creatinine concentration was determined using the Jaffé reaction and ethanol was detected by HS-GC-FID and by an ADH-based method. In general, the highest concentrations of the analytes were found in urine and showed statistical significance. The mean concentrations of EtG were 62.8mg/L (EtG100 206.5mg/L) in urine, 4.3mg/L in blood and 2.1mg/L in vitreous humor. EtS was found in the following mean concentrations: 54.6mg/L in urine (EtS100 123.1mg/L), 1.8mg/L in blood and 0.9mg/L in vitreous humor. Ethanol was detected in more vitreous humor samples (mean concentration 2.0g/kg) than in blood and urine (mean concentration 1.6g/kg and 2.1g/kg respectively). There was no correlation between the ethanol and the marker concentrations and no statistical conclusions could be drawn between the markers and matrices.     

Time of drug elimination in chronic drug abusers. Case study of 52 patients in a "low-step" detoxification ward

The elimination time of illicit drugs and their metabolites is of both clinical and forensic interest. In order to determine the elimination time for various drugs and their metabolites we recruited 52 volunteers in a protected, low-step detoxification program. Blood samples were taken from each volunteer for the first 7 days, daily, urine sample for the first 3 weeks, daily. Urine was analyzed using a fluorescence-polarization immunoassay (FPIA) and gas chromatography/mass spectrometry (GC/MS), serum using GC/MS. The elimination times of the drugs and/or their metabolites in urine and serum as well as the tolerance intervals/confidence intervals were determined. Due to the sometimes extremely high initial concentrations and low cut-off values, a few of the volunteers had markedly longer elimination times than those described in the literature. The cut-off values were as follows: barbiturates II (200ng/ml), cannabinoids (20ng/ml), cocaine metabolites (300ng/ml), opiates (200ng/ml). GC/MS detected the following maximum elimination times: total morphine in urine up to 270.3h, total morphine and free morphine in serum up to 121.3h, monoacetylmorphine in urine up to 34.5h, 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH) in urine up to 433.5h, THC-COOH in serum up to 74.3h, total codeine in urine up to 123h, free codeine in urine up to 97.5h, total codeine in serum up to 29h, free codeine in serum up to 6.3h, total dihydrocodeine (DHC) in urine up to 314.8h, free DHC in urine up to 273.3h, total and free DHC in serum up to 50.1h. Cocaine and its metabolites were largely undetectable in the present study.     

A screening radioimmunoassay for 1,4-benzodiazepines in human blood, serum, and urine using anti-oxazepam-hemisuccinate-antibodies (author's transl)]

A simple and specific radioimmunoassay (RIA) was developed for the determination of oxazepam and other 1,4-benzodiazepines in human blood serum and urine (e.g., diazepam, desmethyldiazepam, chlorazepate). For serum a 1:10 dilution, for urine a 1:100 dilution is recommended. Blood and hemolyzed samples need prior extraction by Amberlite XAD-2. The antisera were raised by immunizing "White New Zealand"-rabbits with an oxazepam-3-hemisuccinate bovine serum albumin conjugate. Using 0.1 ml serum dilution the sensitivity is 0.01 mg/l per tube. Especially higher concentrations show a tendency toward underestimation. Being not limited to a single 1,4-benzodiazepine derivative, the specificity of the antisera is also suitable for a screening analysis. Compared to thin-layer chromatographic analysis of urine this assay shows improved sensitivity (0.05--0.1 mg/l in 0.1 ml of a 1:100 dilution = 1 microliter of urine). For forensic investigations, an analysis in the sequence of urine-RIA, blood/serum-RIA, blood/serum-"electron-capture"-gas-liquid chromatography (ECD-GLC) seems to be a helpful approach. Blood levels of diazepam and desmethyldiazepam determined by RIA and GLC after extraction are in satisfactory agreement.     

Towards a "crime pollen calendar" - pollen analysis on corpses throughout one year

A palynological study was carried out on 28 corpses brought in one year (June 2003-May 2004) to the morgue of the Institute of Legal Medicine of Parma (Northern Italy). This preliminary research focuses on the date of death, which was known for all corpses examined. Pollen sampling and analyses were made with the first aim of comparing the pollen grains found on corpses with those diffused in the atmosphere in the region in the same season as the known date of death. Eyebrows, hair-line near the forehead, facial skin and nasal cavities were sampled. Most of the corpses had trapped pollen grains, with the exception of two December corpses. All pollen grains were found with cytoplasm and in a good state of preservation. In this way, a series of reference data was collected for the area where the deaths occurred, and we examined whether pollen grains on corpses could be an index of the season of death. To verify this hypothesis, the pollen analyses were compared with data reported in the airborne pollen calendars of Parma and the region around. Pollen calendars record pollen types and their concentrations in the air, month by month. The quantity of pollen recorded on corpses did not prove to be directly related to the quantity of pollen in the air. But qualitatively, many pollen types which are seasonal markers were found on corpses. Main corpse/air discrepancies were also observed due to the great influence that the local environmental conditions of the death scene have in determining the pollen trapped by a corpse. Qualitative plus quantitative pollen data from corpses appeared helpful in indicating the season of death. A preliminary sketch of a "crime pollen calendar" in a synthetic graphic form was made by grouping the corpse pollen records into three main seasons: A, winter/spring; B, spring/summer; C, summer/autumn. Trends match the general seasonal trend of pollen types in the air.     

对冻死尸体血糖变化的研究

用分光光度计对10具冻死尸体、50具非冻死尸体、50名健康体检人的血糖及5只家兔冻死前后的血糖分别进行测定,测得的数据用统计学“方差分析”方法处理,结果为健康人男、女的血糖浓度、健康人与非冻死尸体血糖的浓度差异无显著性;冻死与非冻死血糖的浓度、冻死与健康人血糖的浓度差异有高度显著性;家兔在冻前与冻死后血糖浓度的差异有高度的显著性。结论为冻死尸体血糖明显升高,可以做为法医确定冻死的佐证之一。     

152例火场尸体的法医学检验分析

目的 探讨火场尸体的法医学检验特点及其鉴定。方法 对86起火场中152例尸体的相关检验资料进行回顾性研究。结果 152例火场尸体,生前烧死109例,纵火焚尸38例,无明显高温作用的尸体5例。主要死因有“烧死综合征”100例,火场有毒气体中毒8例,机械性损伤32例(含高坠死4例),机械性窒息5例,电击、服毒各1例;不能确定死因5例。自杀5例,他杀40例,意外107例。在生前烧死尸体,87例呼吸道内有炭末沉着,71例皮肤局部烧伤边缘组织有红肿,46例检见水泡,17例有“闭眼反应”征象,大部分尸体血中HbCO浓度超过20％;纵火焚尸少见或不见上述改变。结论 检验火场尸体,根据烧死尸体征象和血中HbCO浓度检测,并结合火场勘验资料综合分析,其死因鉴定和死亡方式推断结论方能准确。     

Establishing the cause of death in finding a corpse on a flight of stairs

A total of 793 forensic medical conclusions concerning corpses found in vestibules are analyzed. The circumstances of death were unknown in the majority of cases. Causes other than injuries were responsible for the majority (72.4%) of deaths: coronary diseases, hanging, alcohol intoxication, or general hypothermia. Strikes with blunt objects and falling on the staircase or floor rank second among causes of death. Injuries caused by falling from staircase and cases with this cause suspected were responsible for 9.6% deaths. Murders with acute objects and guns were recorded in 6% cases. For facilitating differential diagnosis, a list of signs and injuries occurring as a result of falling from staircase and main causes of death in such injuries, made with consideration for the place where the corpses are found, is offered.