Postmortem skeletal lesions

Postmortem bone alterations are very frequent and can raise the issue of their nature (antemortem, perimortem or postmortem defects). The aim of this work is to study various aspects of defects which were not assessed as perimortem trauma, from a series of 50 defects examined, resulting from 24 forensic cases. This study emphasizes the variability of size, shape and number of postmortem defects. Usually the diagnosis of antemortem defects is helped by a careful examination of some characteristics as the edges of the defects, the areas of discoloration of the edges and of the whole bone. Elsewhere it appears very difficult to know the true nature (antemortem, postmortem, or perimortem alterations) of the bone.     

Distinguishing antemortem from postmortem injuries by LTB4 quantification

Leukotriene B₄ (LTB₄) in skin samples from seven forensic cases was detected by HPLC to distinguish their antemortem or postmortem origin. In total, there were thirteen antemortem and seven postmortem specimens. The results showed that LTB₄ was found in all antemortem wound specimens which were either fresh, or refrigerated or fixed in formalin for less than 10 days. In contrast, LTB₄ could not be detected in postmortem wound specimens. These results suggested that detecting the content of LTB₄ is a useful method for distinguishing antemortem from postmortem injuries.     

The extent of postmortem drug redistribution in a rat model.

The aim of this study was to investigate the postmortem redistribution of several drugs in a rat model and to examine if any of the pharmacological properties was related to the extent of this phenomenon. One of the following drugs: phenobarbital (phenobarbitone), acetaminophen (paracetamol), carbamazepine, codeine, verapamil, amphetamine, mianserin, trimeprazine (alimemazine) or chloroquine was administered together with nortriptyline orally to rats 90 min prior to sacrifice. Heart blood was sampled immediately before sacrifice and after 2 h postmortem, as it has previously been shown that this is sufficient time for postmortem concentration changes to occur in heart blood. Blood was also sampled from the clamped abdominal inferior vena cava (representing peripheral blood) and tissue samples were taken from lungs, myocardium, liver, kidney, thigh muscle, forebrain, and vitreous humor together with a specimen from the minced carcass. Drugs were analyzed by high performance liquid or gas chromatography. For phenobarbital, acetaminophen and carbamazepine the postmortem to antemortem blood drug concentration ratios were close to 1.0 and tissue concentrations were low. The postmortem to antemortem heart blood drug concentration ratio for chloroquine (6.9 +/- 1.5) was higher than for nortriptyline (3.5 +/- 0.3), and the remaining drugs (codeine, verapamil, amphetamine, mianserin, and trimeprazine) showed ratios of the same magnitude as nortriptyline. The postmortem to antemortem blood drug concentration ratios for both heart blood and blood from the vena cava and also the lung to antemortem blood drug concentration ratio were closely related to the apparent volume of distribution for the drugs studied (p < 0.001). Accordingly, an apparent volume of distribution of more than 3-4 L/kg is a good predictor that a drug is liable to undergo postmortem redistribution with significant increments in blood levels. The postmortem drug concentration in blood from vena cava was closely related to the antemortem blood level, confirming that among the postmortem samples, the peripheral blood sample was the most representative for the antemortem blood concentration.     

Postmortem Changes of Female External Genitalia and Their Importance in Suspected Sexual Abuse

Examination of the female external genitalia to assess for sexual abuse is performed in living individuals, and the interpretation of the findings is based on evidence-based studies. However, in the deceased, no such studies are available, and postmortem changes could present as suspicious findings that can be mistaken for trauma. Patches of discoloration in the hymen were reported previously in one case as hypostasis (i.e., livor and lividity), and based on this finding, it was listed as a finding that is not associated with trauma. This was a retrospective study that was conducted in the Center of Forensic and Legal Medicine in Dammam, Saudi Arabia over a 4-year period. The study included 30 deceased women in whom photographic documentation of their external genitalia was assessed for postmortem changes. The postmortem interval ranged from less than 24 h to more than 100 days, and the ages of these deceased women were in the 20–40 year-old age group. In cases where the hymen, vagina, and/or fossa navicularis were clearly visible, none of these areas showed any hypostatic discoloration. A comparison between antemortem and postmortem appearance of the hymen in one case clearly showed the absence of hypostatic changes in the hymen. In conclusion, any discoloration of the external genitalia that is detected in a female decedent requires serious consideration.     

枪弹创纤维蛋白形成能力的免疫组化研究

采用免疫组化PAP染色法，对57例人体枪弹创标本的纤维蛋白形成能力进行检测。结果发现，所有生前枪弹创均有纤维蛋白形成祖创缘邻近皮肤组织内毛细血管内皮细胞以及血管内充盈的红细胞膜上亦呈棕色阳性染色；死后30min内形成的枪弹创均有纤维蛋白形成；死后37min后形成的枪弹创无纤维蛋白形成，说明死后30min，纤维蛋白形成能力仍存在。作者认为，仅根据损伤局部有纤维蛋白形成即判断为生前伤是不恰当的，尚应结合损伤部位、损伤程度、损伤类型以及其它生活反应综合评定，不宜单凭纤维蛋白判断。     

Study of elastic fiber changes of human skin in distinction between antemortem and postmortem wounds

Elastic fiber changes of volunteers' antemortem and postmortem skin wounds of various time were observed in order to find possible differences between them. These sections of the wounds were stained by Hart's modification of Weigert's elastic tissue stain.. However, this study showed that there were no differences in the nature and distribution of the elastic fibers in the dermis of volunteers' antemortem and postmortem human skin wounds. Therefore, this suggests that the appearances of the elastic fibers in the dermis should not be as a means of differentiating antemortem skin wounds from postmortem wounds in forensic identification.     

大鼠皮肤切创后E-选择素表达及稳定性研究

目的探讨大鼠皮肤切创后E-选择素表达规律及法医学意义。方法健康SD大鼠90只,随机分成4组：正常对照组、活体切创组（30min～7d12个时间点）、死后切创组（30min～3h3个时间点）、死后稳定性组（-20％6h-7d9个时间点,25％6h～3d5个时间点）。在大鼠头部建立皮肤切创模型,按设定的时间点取皮肤检材,运用免疫组化和图像分析技术,检测血管内皮E-选择素的表达规律。结果在活体切创组中,伤后1hE-选择素在血管内皮细胞内即呈阳性表达,持续至伤后7d,且随时间变化呈规律性表达。在正常对照及死后切创组未见阳性表达。死后-20％稳定性组各时间点E-选择素表达与死后即刻比较无显著性差异（P〉0．05）。25％各时间点与死后即刻比较有显著性差异（P〈0．01）。结论E-选择素在创伤后血管内皮细胞内特异性的表达具有时序性规律,且低温条件下稳定性较好。     

扫描电镜下缢沟的形态特征

作者用光镜和扫描电镜对縊沟进行对比观察,得出如下结论:(1)扫描电镜下縊沟组织的改变具有较恒定的特征,出血及纤维蛋白检出率远较光镜为高;(2)在光镜下生活反应不明显的生前缢沟,在扫描电镜下其表面及断面均可见红细胞及纤维蛋白形成,并包裹红细胞。縊沟部位胶原纤维之间可见散在大小不等的圆球形脂肪样小滴。缢沟部位肥大细胞的形态改变,有助于生前与死后缢沟的鉴别诊断。     

Localization and quantification of the nonspecific esterase in injured skin for timing of wounds.

Histochemical quantification of the nonspecific esterase (NSE) in injured skin was performed using histochemical demonstration of the enzyme and a microspectrophotometric scanning technique on specimens taken from 32 Hartley guinea-pigs and 8 cases of human skin wounds. In all antemortem incisions and lacerations, including those made at the agonal stage, NSE activity could be observed in the dermal tissue of the wound edge. The enzyme activity increases with the antemortem duration of the injuries. Both total content and mean concentration of NSE in the wound edge between antemortem and postmortem wound groups differ significantly (less than 0.01). Multiple range test shows that significant differences (P less than 0.05 or P less than 0.01) of total content of NSE in the wound edge also exist in 0-5 min, 15-30 min, 1-h, 2-h and 4-h antemortem incised wound groups and in 0-min, 5-min, 15-30 min, 1-h and 4-h antemortem laceration groups. The positive NSE reactions in 8 cases of human skin wounds were similar. The study indicates that histochemical quantification of NSE in injured skin is very useful in timing wounds and is exactly applicable in medicolegal practice. According to the different influences of inhibitors on enzymes, it was inferred that the enzyme activity in wound edges was due to B-esterase.     

兔皮肤钝器伤IL-1β、COX-2和MCP-1 mRNA表达与法医学应用

目的应用荧光定量PCR技术检测兔皮肤钝器伤后IL-1β、COX-2和MCP-1mRNA的时序性表达规律,分析其与损伤时间的关系。方法分别在兔耳皮肤钝器伤后<0.5h,0.5h,1h,2h,3h,4h,5h,6h,8h,12h,24h,1d,3d,7d和死后10min,0.5h,1h取材,一步法提取组织总RNA,逆转录合成cDNA第一条链,荧光定量PCR检测IL-1β、COX-2和MCP-1mRNA逆转录合成第一条cDNA链的拷贝数,作统计学分析。结果IL-1βmRNA在钝器伤后<0.5h表达显著增强(P<0.001),0.5h达到峰值,至第2d降至基本水平;COX-2mRNA于创伤后0.5h表达显著增强(P<0.05)并持续强表达至24h开始下降,第2d降至正常;MCP-1 mRNA在钝器伤后于1h表达显著增强(P<0.05),于3h出现表达峰,至第3d降至正常;3个指标在死后各时间组与正常对照无明显表达差异。结论检测皮肤IL-1β、COX-2和MCP-1mRNA可对早期损伤时间的推断提供帮助,并且这三个指标都可以鉴别生前伤和死后伤。     

大鼠原发性脑干损伤早期脑干的免疫组织化学研究

用自制的簧片打击装置弹击大鼠枕骨结节，造成严重颅脑损伤或原发性脑干伤，取其脑干（中脑、桥脑及延髓）常规包埋、制片后作LSAB－FN染色。结果表明，在严重颅脑损伤及原发性脑干伤，可见FN沉积于血管周围间质、部分神经纤维内及一些神经细胞内，且随着损伤时间的延长，FN沉积量增加、范围增大。LSAB－FN法可用于生前原发性脑干伤与死后伤的鉴别和推断在3小时内损伤经过时间。     

人体皮肤索沟局部肥大细胞脱颗粒率的观察

本文观察人体皮肤索沟局部肥大细胞脱颗粒率变化。发现生前皮肤损伤局部脱颗粒率在皮肤受在处及距受压边缘０～１．０ｍｍ区域明显升高（＞４９％），与死后皮肤索沟有显著差异（Ｐ＜０．００１）。作者认为损伤局部肥大细胞脱颗粒率明显升高（＞４９％）可作为人体生前索沟的诊断依据。     

Postmortem Aortic Dissection: An Artifact of the Embalming Process

Aortic dissection (AD) is a serious condition that affects 3/100,000 individuals a year. Recently, a case report was published describing an embalmed patient with an aortic dissection. The purpose of this study was to examine the frequency of AD among 80 embalmed cadavers and confirm the AD with histopathologic evaluation. In seven cases of grossly identified AD, six were determined to be due to the embalming procedure and only one case of true antemortem AD was confirmed. These results suggest that aortic morphology can be altered by administration of the embalming fluid and that alterations can mimic AD, not only on gross inspection but also on postmortem imaging. Awareness of this embalming artifact may prevent misdiagnosis of an aortic dissection in an embalmed patient, a point particularly useful for autopsy pathology that may include postmortem examination of an embalmed patient.     

Localization and quantification of histamine in injured skin as parameters for the timing of wounds.

Localization and estimation of the histamine (HA) content in skin wound edges in 86 Sprague-Dawley rats and three cases of human injuries were carried out by a microfluorimetric method specific for this amine which forms a complex with o-phthalaldehyde (OPT). Distribution and density of the mast cells in the same areas were observed at the same time by toluidine blue stain. In all skin specimens with antemortem wounds, both the epidermis and upper dermis exhibit extracellular yellowish fluorescence of the HA-OPT complex. The fluorescent zone spreads in the wound edges with the lapse of time in vital injuries. The HA content increases gradually up to 30 min and then the yellow histamine fluorescence in areas 0-200 microns from the wound edge decreases. None of these features can be observed in normal skin and postmortem-injured skin. Mast cell degranulation can be demonstrated in all antemortem-injured skin. No statistical relationship exists between the number of mast cells and the HA-OPT fluorescence in either ante- or postmortem-injured groups. This study indicates that skin HA microfluorimetry by the OPT method is of practical value for distinguishing ante- from the postmortem wounds and for timing antemortem wounds.     

Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues,

Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes—so-called bone marrow edema—may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI—particularly the T1W sequence—can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.     

用RT-PCR法区别生前与死后伤

12只SD大鼠随机分为生前伤、死后伤、麻醉伤和正常对照四组，损伤时间为15min，取创缘皮肤为检材；IL－6引物为寡聚核着酸引物（27hP），内对照引物为Tx基因（20hP），用TRIZOLTMTotalRNA提取试剂盒抽据总RNA，AMV逆转录酶使mRNA逆转录成cDNA，PCR扩增得出：在生前伤、麻醉伤以及正常皮肤中均能扩增出IL－6cDNA片段（590hp）和内对照Tx基因片段（188b），在死后伤组只能扩增出Tx基因片段；图像分析凝胶灰度扫描；生前损伤组与麻醉组无显著性差异，而二者与正常皮肤组有统计学差异。藉此，运用RT－PCR法可以准确区别大鼠实验性损伤的生前伤与死后伤。     

Timely antemortem and postmortem concentrations in a fatal carbamazepine overdose.

There are no published reports that include both timely antemortem and postmortem carbamazepine concentrations after massive overdose. We report a fatal overdose of carbamazepine with both timely antemortem and postmortem carbamazepine concentrations. Carbamazepine concentrations were 47.7 mcg/mL 2 h antemortem and 53 mcg/mL at 9 h postmortem. The slight rise in drug concentration may reflect continued absorption of the drug in the last 2 h before death. Postmortem carbamazepine concentrations drawn from a peripheral vessel in this patient appeared to reflect drug concentrations at the time of death.     

Determination of deslanoside in antemortem and postmortem specimens. Unusual case report

One case of the erroneous administration of deslanoside and high level of drug in antemortem plasma and postmortem specimens has been reported owing to the unusual surrounding circumstances. Deslanoside in antemortem plasma was determined by FPIA and the analysis was done by HPLC in the postmortem tissue samples. The analytical results and methods used in the examinations are discussed in the following paper.     

Quantitation of nucleotides,nucleosides and bases in antemortem and postmortem bloodstains by high-performance liquid chromatography

Ante- and post-mortem bloodstains prepared from the blood of volunteers and corpses were analysed for ATP and its related compounds by reversed-phase high-performance liquid chromatography (HPLC). The results showed that (1) ATP was present in a large amount in antemortem bloodstains but not in postmortem stains, (2) AMP, adenosine, inosine, hypoxanthine, xanthine and uracil either were not detected or were detected in smaller amounts in antemortem than in postmortem bloodstains, and (3) ADP was present in both ante- and postmortem bloodstains. These differences suggest that quantitation of these compounds may be useful in identifying whether bloodstains are ante- or post-mortem.     

大鼠皮肤降钙素基因相关肽表达与损伤时间的相关性

目的探讨创伤皮肤组织降钙素基因相关肽(CGRP)的时间相关性表达,为损伤时间推断提供实验依据。方法应用免疫组化技术、图像分析技术和原位分子杂交技术检测不同损伤时间大鼠皮肤组织生前及死后CGRP表达。结果生前组大鼠损伤后皮肤组织内CGRP在神经纤维中表达明显高于对照组(P<0.05)。死后组皮肤组织中CGRP表达与正常对照组比较无明显变化(P>0.05)。生前组中CGRP表达在损伤后1h明显增多,4h达到高峰,以后恢复到正常。结论损伤组织神经纤维中CGRP表达具有规律性且有较好的时间相关性,可成为法医学损伤时间推断的指标。