Lung histology in experimental drowning

Experiments were carried out on anesthetized rats which had to aspirate actively watery fluids of different osmolarities (range: freshwater--2.9% NaCl solution) by a tracheotomy tube. The cytologic and histological alterations which are to be found are mainly of osmotic origin. In aspiration of hypotonic solutions macroscopy shows the well-known emphysema aquosum. Corresponding to the structure of the respiratory system, the histological alterations show areolar limitations. The influx of fluids causes a wide range of reactions from the development of an alveolar-interstitial edema in combination with intracellular and intercellular vesiculation, karyolysis with swollen homogenized nuclei of the subendothelial, septal, and epithelial cells to a necrosis of all the cellular elements. A pronounced microangiopathy with edema of the vascular walls, a hydrops of the myocytes containing large vacuoles and perivascular edema with dilated lymphatic channels are likewise to be found. The alveolar macrophages are considerably increased. Sporadic ruptures of the alveolar walls and microhemorrhages occur. In salt water drowning alterations of the shape of both the erythrocytes (thorn-apple form) and the alveolar epithelium in combination with a striking of the pneumocytes and villous transformation prevail. Besides, these are capillary hyperemia and sludge. In a careful specimen analysis a differentiation of the findings between vital reactions and postmortem fluid impact is possible.     

Ultrastructural pathology of mechanical skeletal muscle damage

In continuation of previous light microscope investigations the question has been raised whether the criteria determined for vital muscle damage using light microscopy, could be verified and perhaps extended for the ultrastructural region. In addition to existing human pathological material taken early post mortem, muscle tissue obtained from animal experiments was also examined. The evaluation concentrated on the muscle cells, the cell organelles and the contractile apparatus. An evaluation of semi-thin-sections was carried out in parallel. The following reaction patterns could be defined as vital reactions: hypercontraction bands, zones of rupture in narrow topological relationship to organelle changes, microstructure changes with disintegration of the fibre structure, subsarcolemmic and interfibrillary oedema, decomposition of the sarcolemma. The earliest vital reactions were detectable after only a few minutes survival time. The comparison between the results of animal experiments and human pathology and the application of the results to forensic pathology will be discussed.     

溺死鉴定中硅藻检验的应用

在法医学检案中,溺死诊断以及入水地点的判定一直是重点和难点之一,硅藻检验被认为是一种相对可靠的诊断溺死的方法,而根据硅藻的群落特征推断其入水区域具有一定的可信度。对不同水域内硅藻进行研究,可为溺死鉴定及入水区域的判定提供参考。本文就硅藻相关的生物学特性、检验方法等相关的国内外研究进展进行综述,供法医学工作者在相关科研和检案实践中参考。     

溺死的法医学鉴定

溺死的鉴定一直是基层法医鉴定工作中的难点,这是由于大部分溺死案例的特征性尸检所见很少,同时国际上很多学者对溺死的实验室检验存有疑义。本文查阅了国内外相关文献并结合作者多年来对溺死案例的实际鉴定经验,对溺死的法医学鉴定作出较系统的综述。     

Neonatal freshwater drowning after birth in the bathroom

The macroscopic and microscopic findings in neonatal freshwater drowning are demonstrated on the basis of 3 exemplary cases of birth in the bathroom after concealed pregnancy. If the newborn is expelled under water and remains there until death, the lungs cannot be ventilated with air. In case of incomplete or only temporary submersion, aeration of the lungs may develop in the immediate postpartum period. The morphologic criteria of separate existence are critically discussed with respect to the presented findings.     

Scanning electron microscope study of the lung in drowning

The authors describe the results obtained using the scanning electron microscope (SEM) to study drowned lungs and control lungs. Results are compared with a previous study carried out using laboratory animals. The results from both studies are analogous, in the absence of chronic pulmonary emphysema. The diagnosis of chronic pulmonary emphysema is simple with the SEM even when dealing with autoptic material obtained 24 to 48 h after death, but the diagnosis of drowning becomes difficult in lungs with chronic emphysema.     

Neck and scleral hemorrhage in drowning

The determination of the cause and manner of death for a body recovered from the water can be difficult because of a lack of autopsy findings specific for drowning. This case report describes a 30-year-old man found submerged at the bottom of a hotel pool. An autopsy revealed scleral hemorrhages and fascial hemorrhages of multiple muscles of the anterior and posterior neck bilaterally. No evidence of traumatic injury was on the surface of the body. An investigation by law enforcement found no evidence of foul play. The occurrence of petechial and neck hemorrhage in a body recovered from the water is controversial, and a review of this literature will be given. We suggest that fascial hemorrhages of the muscles of the neck, as well as cephalic hemorrhages, can be explained by drowning-related elevated central venous pressure that is communicated to the head through the valveless veins of the neck.     

Suicidal drowning in south Florida.

Autopsy protocols at the office of the Chief Medical Examiner were reviewed with respect to suicidal drowning. Between July 1, 1994 and June 30, 1998, there were 267 drownings and 873 people committed suicide in Broward County, Florida. Of those, 25 were suicidal drownings, representing 2.86% of all suicides, and overall the 8th leading cause of suicidal death. When considering suicide in the age group of 65 years and older, (n = 239), which accounts for 19.8% of the population and 27.4%, of all suicides, drowning represents 6.7% of all suicidal deaths, and within females in this group represents the third most common form of suicidal death (13.8%). The presence of alcohol or other drugs is less usual in elderly suicide victims than younger victims. Of the 25 drowning suicides, there was a preference for swimming pools, canals, and lakes as the locations of choice. Additional drowning and suicide related criteria were evaluated including marital status, mental health, clothing worn, previous attempts or threats, suicide notes, and personal effects at the scene; with the intention of establishing a profile for drowning by suicide. Given the relative abundance of water, the suicidal drowning rate appears to be lower than what might otherwise be anticipated.     

Study of the diagnostic value of iron in fresh water drowning

The aim of our study was to test the diagnostic value of iron (Fe) in fresh water drowning by investigating the postmortem levels of hemodilution in drowning cases compared to control cases. Twenty-six typical fresh water drowning cases were selected from 128 immersion cases autopsied in our Department of Forensic Pathology between 1998 and 2004. The exclusion criteria were a long postmortem interval and other causes of death than drowning. For all selected cases, the diagnosis of drowning was based on the presence of autopsy findings and positive diatom test. A control population of 12 cases was also selected. For each drowning and control case, iron blood levels were measured in the left ventricle (LV) and right ventricle (RV) of the heart. The mean difference of iron concentration (RVFe-LVFe) between the drowning group and the control group was statistically compared. Furthermore, iron measurements were performed in 19 drowning cases showing advanced putrefaction. The mean difference of iron concentration was significantly higher in the drowning cases compared with controls (P<0.001). All drowning cases showed hemodilution. No overlap was found in the RVFe-LVFe levels between the two groups. Resuscitation attempts seemed to have no effect on the results. In cases of drowning showing advanced putrefaction, the iron test was not reliable because biochemical iron measurement was often prevented by no sufficient blood in the heart or postmortem clots. In conclusion, according to our results, iron seems to be a good biochemical marker in fresh water drowning with a short postmortem interval.     

医源性溺死1例分析

医源性溺死是指医疗行为中由于治疗不当引起液体进入气管、支气管和肺部,妨碍气体交换而导致窒息死亡.     

医源性溺死1例分析

医源性溺死是指医疗行为中由于治疗不当引起液体进入气管、支气管和肺部 ,妨碍气体交换而导致窒息死亡。在临床上因为洗胃直接导致的死亡较为鲜见 ,笔者曾遇一例因可疑鼠药中毒在医院用自动洗胃机洗胃过程中死亡的医疗纠纷案例。死者家属认为患儿的死亡是由于洗胃操作不当不慎所致 ,而院方则称患儿系鼠药中毒抢救无效死亡 ,与医院洗胃无关。为正确处理此案 ,卫生部门组织法医等有关专家对死者进行解剖检验发现洗胃液未进入胃内 ,毒化检验排除中毒 ,尸体外表征象及内部改变符合缺氧窒息死亡特点 ,病理检验结果提示肺脏兼有水肿和气肿两种特征…     

A promising microbiological test for the diagnosis of drowning

A number of biological and chemical tests have been developed over the years to determine whether a person was drowned. This study focuses on the potential of a microbiological test for detecting common bacterial markers of water faecal pollution such as faecal coliforms (FC) and faecal streptococci (FS) as possible indicators of drowning. A promising previous study was carried out on central and peripheral blood samples of 42 drowned victims (20 cases in saltwater and 22 cases in freshwater) and 30 not-drowned bodies. To improve the accuracy of our previous results and also in order to investigate a possible cause of a false positive due to pulmonary passive diffusion and subsequently endogenous or exogenous bacterial invasion of the blood in the post-mortem interval (PMI), the FC and FS test was applied to bodies submerged in water but died from causes other than drowning. In the present study, blood samples collected from the left ventricle (LV), right ventricle (RV), femoral artery (FA) and, femoral vein (FV) of 10 drowned victims (5 cases in freshwater and 5 cases in seawater) and 3 not-drowned individuals with bodies submerged in water for a while after death have been analysed. Preliminary results are in agreement with other reports dealing with diatoms and marine bacteria that suggest to exclude the hypothesis of a passive penetration of sufficient quantities of drowning medium into circulation after death or during the agonal period. Based on our results there is also no evidence of a relevant dissemination of endogenous micro-flora from the gastrointestinal tract affecting the FS and FC test. There are still several other factors that could influence the applicability of post-mortem FS and FC cultures for the diagnosis of drowning and they need further investigations. The present article provides only a glimpse of the potential of the FS and FC test as bacteriological method for the diagnosis of drowning.     

The significance of detecting serum fluorine level in the diagnosis of drowning

In view of the high content of fluorine in the water of a vast area of Guangdong Province, we detected the serum fluorine level in rabbits that died of drowning and compared them with those obtained from rabbits immersed in water after death from hanging. The fluorine content in water is about 15-fold higher than in the normal serum content. In drowned rabbits, the serum fluorine values are significantly higher than normal while in control cases the serum fluorine values are slightly lower than normal. The fluorine content in human serum is similar with that of rabbits. It suggests that detection of serum fluorine content might be a valuable method for the diagnosis of drowning in those areas where there are high water fluorine content.     

An original cause of drowning in an industrial environment

We describe an original case of drowning in a wax tank in an industrial setting. The causes of death were multiple, with the association of drowning, mechanical asphyxia, and extensive superficial burns. To our knowledge, it is the first report of drowning in wax, and only 7 previous related observations of drowning in industrial environments were reported in the international literature. These accidents are more often fatal, with multiple associated causes of death due to the incriminated media. Although exceptional, these serious accidents must be prevented in potentially risky industries.     

溺死法医学鉴定的研究新进展

综述了近年来在硅藻检验、水中浮游生物叶绿素（A）检测、血液化学和组织化学检验等方面的最新文献报道,并对各种溺死检验方法的优缺点进行了评价：在硅藻检验中,硝酸乙醇法、破机罐法及微波消解法,可缩短检验时间,提高办案效率;酶消化法及PCR法硅藻检出率高,适用于可疑水样中硅藻密度低等情况。早期器官组织中浮游生物叶绿素（A）、血液和组织中其他生化指标,可作为鉴定溺死的重要参考。微量元素锶检测可用于鉴定海水中溺死。另外,硅藻及其他浮游生物遗传多态性片断PCR,可望成为新的、灵敏的溺死检测方法。     

溺死相关浮游生物基因座的复合扩增体系

目的构建溺死相关浮游生物基因座的复合扩增体系,验证体系特异性并评估其在法医溺死诊断中的应用价值。方法针对溺死相关浮游生物同源基因序列,设计特异性引物,并用FAM、HEX、TAMRA、ROX、SIZ荧光染料分组标记,构建复合扩增体系;进行体系特异性验证;以16例实验猪样本评估体系检验效能;复合扩增体系、硅藻形态学MD-VF-Auto SEM检测法及硅藻rbc L基因PCR-CE检测法分别检测28例案件样本,比较分析应用效果。结果该复合扩增体系共包含14个基因座,可特异性扩增35种浮游藻类和3种浮游细菌,人、3种人体共生菌及8种浮游细菌均为阴性。以该体系检测溺死实验猪,阳性率为90%,非溺死实验猪均未检出;检测溺死案件样本,阳性率为96%,非溺死案件均未检出。复合扩增体系与MD-VF-Auto SEM法检测案件尸体肺、肝和肾的阳性率均不具有统计学差异(P>0.05),但其与硅藻rbcL基因PCR-CE法检测案件肝和肾的阳性率均具有统计学差异(P<0.05)。结论本文针对多种溺死相关浮游生物14个基因建立的复合扩增体系,具备多种靶物种的特异性遗传标记,且所需检材量小,提高了检测效能,在法医溺死鉴定中具有良好的应用前景。