Skin changes following defibrillation. The effect of high voltage direct current

Previously, electrical injuries have been suggested caused only by the concomitant heat developed during the passage of an electrical current. Recent experimental studies on fully anesthetized pigs and the study of one human case have, however, shown typical electrical alterations. The purpose of the present study was further to evaluate the histology of electrically induced changes in the skin in humans. In addition, supplementary in vivo methods for evaluation of skin changes as high-frequency ultrasound and Raman spectroscopy were used. The skin of 11 patients treated with a defibrillation of the heart was examined for macroscopic changes, the skin of eight of them also for histologic changes and for changes observable via supplementary methods. Immediately and 7 days after the defibrillation, fractions of a narrow red ring were observed along the periphery of the tin-foil electrode. Epidermis showed signs previously observed following electrical influence: segmental alterations often related to the openings of sweat ducts, darkstaining or "empty" nuclei and homogeneous cytoplasm, eosinophilic or pale. Dermis did not show the specific sign of electrical influence: deposits of calcium salts on dermal fibres, neither via histologic examination nor via high-frequency ultrasonography and Raman spectroscopy. Fractions of a narrow red ring along the periphery of the electrode showing histological signs of electric influence in epidermis thus appear to be characteristic of high voltage electrical injury.     

微束X射线荧光光谱法检测电流损伤皮肤金属化

目的建立微束X射线荧光光谱（μ-probe X-ray fluorescence,μ-XRF）检测电流损伤皮肤金属化的方法。方法新西兰大白兔32只,随机分为黄铜电击组、紫铜电击组、铁电击组、铝合金电击组,每组8只。电极一极固定于左后腿中部,另一极固定于左前腿,建立电击模型。提取左后腿触电部位皮肤,以及对侧右后腿相应部位皮肤作为对照,应用μ-XRF光谱仪对电流损伤皮肤内金属元素进行测定。结果正常对照组皮肤中检测出磷、氯、钾、钙元素成分;在电击组皮肤中,除正常皮肤检出的元素外,黄铜电击组检测出铜、锌元素,紫铜电击组检出铜元素,铁电击组检出铁元素,铝合金电击组检出铝元素。渗透到电流损伤皮肤内的金属元素呈不均匀分布。结论μ-XRF光谱法检测皮肤金属化可作为诊断电流损伤的特征性指标,并可为触电材料的推断提供依据。     

Application of atomic absorption spectroscopy for detection of multimetal traces in low-voltage electrical marks

Application of atomic absorption spectroscopy to detect multimetal traces in injured skin is a promising tool for investigation of fatalities caused by electrocution. The present paper is aimed at testing the reliability of this method for metal traces detection in electric current marks and is focused on study of peculiarities of metal penetration into the skin exposed to a current impact. Bare aluminum wire, tin-lead coated copper multistrand wire, and zinc-plated steel rope were used to make electrical marks on pig skin. It is demonstrated that amount of copper, zinc, lead, and iron may serve as statistically reliable indicators for the type of wire, which caused the electrical mark, in spite of the background content of these metals in the skin without injury. Different penetration rates for different metals contained in the wire inflicting an electrical mark were observed.     

Electrical and thermal injuries in pig skin — Evaluated and compared by light microscopy

The morphology of pig skin after electrical (el) and thermal exposure was studied in order to find methods applicable for disclosing electrical torture.Biopsies from pig skin exposed 24 hours earlier to either heat or electrical current under general anesthesia were studied by light microscopy. The amount of energy used of either type ranged from about 6 to about 100 joule deposited on two circular areas of the skin measuring 12 mm in diameter.In sections stained with hematoxylin and eosin alterations were found in heat-influenced specimens following the administration of moderate and large doses of energy. Changes were observed in el-influenced specimens also after the administration of low amounts of energy, which did not lead to macroscopical changes in the skin. The two types of energy induced different patterns of alterations inside the epidermis. The most characteristic change following heat exposure was the presence of a granular or fibrillar eosinophilic cytoplasm and subepidermal clefts, while el-expoure often produced white homogeneous cytoplasm and shadowy nuclei (“white necrosis”) in the attached epidermis. The individual changes could be produced by both types of injury, but to a highly different degree. However, the alteration classified as “vesicular nuclei” was only observed in el-damaged skin. The dermis from the more severely injured skin of both groups showed a homogeneous appearance (“necrosis”). While the changes of epidermis and dermis in response to heat were diffusely distributed, the changes created by electrical injury were often present in segments. By electrical damage homogeneous areas with loss of stainability and shadowy nuclei were occasionally observed in sweat glands, hair sheaths and in vessel walls, structures which are suggested to serve as conductors for the electrical current. “Vesicular nuclei” were observed in similar structures.Some of the findings may be associated with differences in intensity of energy during exposure to heat and electricity. Furthermore, the existence of different biological patterns following the two types of exposure should be considered. The studies are being continued to elucidate these basic questions, and to study further the medical diagnostic potential of examining skin biopsies from tortured individuals.     

电烧伤皮肤金属元素的测定

本实验系用220V交流电源和直径2.0mm紫铜线为接触电极,在新鲜尸体腹部皮肤上做电烧伤实验。用原子吸收分光光度计对电烧伤皮肤中铜元素含量进行测定。结果表明电烧伤皮肤铜元素含量最高可达137.90μg/g。经10%福尔马林溶液固定40天以上的电烧伤皮肤铜元素含量有昕降低,但仍较正常皮肤含量为高。电烧伤皮肤铜元素含量以电流斑处为最高。本实验为电烧伤皮肤金属元素的定性与定量分析,检材的提取和处理,提供了一个较好的方法,有利于判定案件的性质和确定接触电极的金属种类。     

甲醛溶液固定对ICP-MS检测电流损伤皮肤金属化的影响

目的探讨应用电感耦合等离子体质谱（inductively coupled plasma-mass spectrometry ICP-MS）技术检测甲醛溶液固定后电流损伤皮肤中金属元素。方法利用黄铜、铁电极材料以220V交流电电击兔子后肢,电损伤皮肤分别进行甲醛溶液固定1周、6个月后,应用ICP-MS对电流损伤皮肤中金属元素进行测定。结果与对照组皮肤比较,黄铜电击组皮肤中检测出Cr、Ni、Cu、Zn、Pb含量升高（P〈0.05）;固定1周、6个月后仍可检测出Cr、Ni、Cu、Zn、Pb成分,其中Cr、Cu、Zn、Pb含量电击组与固定组差异无统计学意义。与对照组比较,铁电击后皮肤中检测出Fe、Cr、Mn、Ni元素含量升高（P〈0.05）;固定组（1周和6个月）后Fe、Cr、Ni元素含量与电击组差异无统计学意义。结论 ICP-MS可作为检测电流损伤皮肤中金属元素的有效方法,甲醛溶液固定后触电皮肤仍可进行沉积的金属元素检测,且固定对皮肤金属元素的含量影响较小,该方法仍可为电流损伤诊断提供依据。     

Electrocution--autopsy study with emphasis on "electrical petechiae"

Fatalities caused by electrocution (n = 37) were re-examined on the basis of the autopsy records, the police reports and the technical expertise. Accidents including two lightning deaths caused 2/3rd and suicides 1/4th of the fatalities and there were two homicides. Carelessness or ignorance were a major reason for accidental deaths while technical defects could be verified in five cases only. Low-voltage ac and male victims predominated. Electrical burns or current marks were detected in 81% including all high voltage electrocutions. The seven victims lacking burns were electrocuted in a wet environment including six cases of suicide in the bathtub with a hair drier. Petechial haemorrhages were present in 74% of the cases and the favourite sites were the skin of the eyelids, conjunctivae, visceral pleura, and the epicard. The presence of petechiae did not depend on the voltage or the current pathway relative to the heart. It is, therefore, suggested that the petechiae are not caused by asphyxia but by a combination of venous congestion due to cardiac arrest and a sudden rise in blood pressure induced by muscle contractions. Consequently, "electrical petechiae" represent a non-specific but typical finding in electrocution irrespective of the mechanism leading to death. Unlike electrical burns, petechiae also indicate the vital origin of the events. The relevance of this typical morphological sign in the examination of possible electrocution fatalities is therefore emphasised.     

大鼠电击死心脑肺及皮肤超微结构的改变

目的 观察电击致死大鼠的心、脑、肺、皮肤超微结构形态学改变，寻找电击死的法医学鉴定依据。方法 大鼠12只，其中电击致死6只，另6只对照；取心、脑、肺、皮肤，用戊二醛固定、锇酸染色后透射电镜观察。结果 所取组织细胞均见明显细胞凋亡样改变，其中红细胞肿胀变形，充填整个毛细血管管腔。结论 心、脑、肺、皮肤组织细胞与血管内皮细胞的超微结构形态改变对鉴定电流死有参考价值。     

Prevalence of potential risk factors in victims of electrocution.

OBJECTIVE: To identify risk factors of fatal arrhythmia following electrical shock, by comparing the prevalence of transthoracic current, tetany, decreased skin resistance because of wet extremities, skin burns and heart disease in victims of electrocution with instant as opposed to delayed death. DESIGN: Retrospective case-control study, based on the charts from the coroner's office. RESULTS: A total of 124 deaths from electrocution occurred between 1987 and 1992. One victim presumably died from delayed arrhythmia and was excluded from the study. Twenty victims had decreased skin resistance because of wet extremities and five had tetany. Autopsy revealed coronary heart disease in 21 cases, and burns in 109; 10 did not have any skin lesion. There was no difference in risk factors between those who died instantly presumably from arrhythmia (n=114) and those who died later from other causes (n=9). CONCLUSION: No differences in risk factors were found between victims who died immediately from arrhythmia following electrical shock and those died later from other causes.     

电感耦合等离子体质谱法检测电流损伤皮肤中金属元素

目的探讨应用电感耦合等离子体质谱(inductively coupled plasma mass spectrometry,ICP-MS)技术检测电流损伤皮肤中金属元素的可行性,建立检测电流损伤皮肤中金属元素的方法。方法用黄铜、紫铜、铝、铁电极材料以220V交流电电击家兔后肢,ICP-MS对电流损伤皮肤中金属元素进行检测。结果与对照组比较:黄铜电击组皮肤中的Cr、Ni、Cu、Zn、Pb含量升高(P0.05),紫铜电击组皮肤中的Cr、Cu、Pb含量升高(P0.05),铝电击组皮肤中的Al、Cr、Mn、Co、Ni、Cu、Pb含量升高(P0.05),铁电击组皮肤中的Cr、Mn、Fe、Ni含量升高(P0.05)。不同电极材料电击后皮肤中元素种类及含量也存在明显差异。结论ICP-MS可作为检测电流损伤皮肤中金属元素的有效方法,且可应用于触电材料的推断。     

Rupture of an intracranial aneurysm--unusual complication of an electric shock.

Here we report about a 35-year-old electrical engineer who was found dead in his study. Postmortem examination revealed that death resulted because of subarachnoid and intraventricular hemorrhage caused by the rupture of an intracranial aneurysm. Right hand and left cheek revealed electrical marks with metallizations on skin, an electric shock was diagnosed to have preceded death. The close temporal correlation suggests that a sudden rise in blood pressure was caused by the electric current and was thus responsible for the rupture of the aneurysm.     

First report of nonpsychotic self-cannibalism (autophagy), tongue splitting, and scar patterns (scarification) as an extreme form of cultural body modification in a western civilization.

As part of her current lifestyle, a 28-year-old Caucasian woman routinely injures and allows subsequent healing of her skin and other tissues. Her body modifications include a "split tongue" (a tongue split to the base), which does not interfere with speaking and eating. Other modifications include large scarification patterns produced by branding and cutting. This woman has been known to eat parts of her skin that were previously cut out of her body. She also performs "needle play" by allowing medical syringe needles to be lodged temporarily under her skin. The patient had a normal childhood, is currently employed full-time as an office manager, and is psychologically stable. Although one other case of self-induced penoscrotal hypospadias is known, this is the only report of extensive, nonpsychotic, autodestructive behavior. However, this may not be the case in the future as an increasing number of young individuals have become interested in body modifications.     

The effect of lethal electrical shock on postmortem serum myoglobin concentrations

Postmortem serum myoglobin concentrations in blood from the femoral vein (peripheral withdrawal) and the heart (central withdrawal) of nine electrical fatalities were compared with those of 74 individuals who had died of other causes. Independent of the cause of death or topographical site, serum myoglobin concentrations rose dramatically with the passage of postmortem time (maximum concentrations in the control group: 975,100 micrograms/l). In 59% of the total sample (electrical fatalities plus controls), serum myoglobin concentrations were higher in the central blood, in the other 41% the concentrations were higher in the peripheral blood. The differences in concentrations between the peripheral and the central withdrawal area correlated with neither the postmortem interval nor the cause of death. Up to the second day postmortem there was a statistically significant difference in serum myoglobin concentrations between electrical fatalities and controls. The individual values within each group, however, varied widely and overlapped between groups. Controls who had also suffered muscle injury (polytrauma, myocardial infarction) did not have significantly higher serum myoglobin concentrations than controls without muscle injury. Myoglobin concentrations appear to be greatly influenced by the extent and duration of the muscle cramps induced by the electrical current. Correct interpretation of serum myoglobin concentrations depends on the knowledge of events surrounding the lethal electrical shock. Postmortem determination of serum myoglobin concentrations alone is, therefore, not sufficient to establish intravital exposure to electrical current and can aid the diagnosis only in special cases.     

A preliminary study of skin electrical injury with computerized image analysis

This paper reports the application of computerized image analysis to a quantitative study of skin electrical injury in order to provide an objective and quantitative standard for identifying the electrical mark. The differences between antemortem and postmortem electrical injuries were also studied. In normal and electrically-injured human skin, the long/short axes ratio of nuclei were measured. The mean of epithelial basal cells was 1.4344 and 5.9325, respectively, the mean of hair follicle cells was 1.6193 and 4.5988, respectively, and the mean of capillary endothelial cells was 4.0229 and 4.3593, respectively. In rat specimens, the long/short axes ratio of nuclei of normal skin, at 15 and 5 min ante-mortem and at 5 min postmortem injury, the mean epithelial basal cells was 1.4124, 4.5417, 5.2282 and 5.0447, respectively. The mean of hair follicle cells was 1.4140, 4.4863, 4.1146 and 4.4522, respectively, while the mean of capillary endothelial cells was 2.8398, 3.7514, 3.6159 and 3.6977, respectively. The results indicate that the differences between electrical injuries and normal skin with respect to the ratios of long/short axes of the epithelial basal cell nuclei and hair follicle cell nuclei are of remarkable significance. On the other hand, no significant difference could be found between antemortem and postmortem injuries, nor between electrical injury and normal skin, concerning the long/short axes ratios of capillary endothelial cell nuclei. This result provides a preliminary objective standard for the changes of electrical skin injury.     

水、油污中无电流斑电击死大鼠皮肤和心肌的病变

目的探讨水中、油污中无电流斑电击死法医学鉴定的病理形态学依据。方法 SD大鼠28只,分为水中、油污中无电流斑电击死各1组,典型电流斑组、正常对照组、死后电击组、死后水中、油污中电击各1组共7组。采用肉眼、光镜及投射电镜观察水中、油污中无电流斑电击死大鼠皮肤和心肌组织病理学改变,并与其它各组进行比较。结果采用肉眼观察,生前水中、油污中无电流斑电击死大鼠皮肤未见明显电流斑。普通光镜观察,可见电击中心部位表皮变性坏死、脱落,表皮细胞变薄、致密,表皮细胞或/和毛囊、汗腺、皮脂腺发生极性化改变。电镜观察,透明层和角质层分离脱落,基底细胞肿胀、细胞器减少、核固缩,汗腺导管上皮肿胀,棘细胞中粗面内质网扩张融合成泡状,线粒体肿胀空泡化;但光镜与电镜的变化与生前电击死比较不明显、典型。而死后电击组皮肤则无明显病理学改变。实验各组大鼠心肌的改变与皮肤改变类同。结论采用光镜和投透射电镜观察在潮湿环境中电击死的组织病理学改变,可为无电流斑电击死提供依据。     

The morphogenesis of electrically and heat-induced dermal changes in pig skin

In order to establish pathological evidence in dermis for distinguishing between sequelae of electrical torture and those of other superficial injuries, the skin of eleven fully anaesthetized Danish Landrace pigs have been exposed to heat and electrical energy from either 50 Hz alternating current (a.c.) or direct current (d.c.) via 12 mm large contact knobs or via a pointed 0.5 mm large electrode (only 50 Hz a.c.). The lesions have been examined from 1 to 126 days after the injury. While heat lesions exposed to energy lower than 60 joule only gave minor changes, heat lesions exposed to more than 60 joule showed changes in both collagen fibres (basophilic or eosinophilic fibres without any birefringence or coarse cross-striation in polarized light, respectively) and dermal cells (granular cytoplasm). Areas exposed to 50 Hz a.c. via 0.5 mm. electrode showed basophilic collagen fibres and in a few biopsies on day 7 calcium salts on collagen fibres. Using 12 mm large electrodes the changes were minor, but basophilic and eosinophilic collagen fibres with no birefringence or with fine/coarse cross-striation respectively were seen. Even cells with 'vesicular nuclei' were seen on day 1 and 2 after the injury. The changes in the anode area showed resemblance to that of heat lesions (basophilic collagen fibres). Eosinophilic collagen fibres with fine densely spaced cross-striation in polarized light and 'vesicular nuclei' as well as collagen fibres with calcium salts were seen in the cathode lesions. It is concluded that the dermal changes in the cathode area are specific for electrical injury from day 1 to 14. However, earlier studies have demonstrated dermal changes specific for electrical injury at day 0 and the presence of calcified collagen fibres up to 2 months after injury. The dermal changes in anode lesions were non specific and could not be differentiated from those found in heat lesions. Alternating current lesions (50 Hz) were specific from day 1 to day 7, when the pointed electrode was used, but only in a few days when the energy was transferred via the 12-mm electrodes.     

Histopathological differentiation of skin lesions caused by electrocution, flame burns and abrasion

The aim of this study was to reveal histopathological features for differential diagnosis of skin lesions caused by electrocution, flames and abrasions. Based on the causes of the lesions, cases were assigned into three groups. Group 1 included 30 deaths from electric shock. Group 2 included 30 individuals with flame burns who died in the fires. Group 3 included 30 deaths from traffic accidents, from which the individuals had abrasions. Data from the crime scene investigations and macroscopic and microscopic findings from the autopsies allowed determination of the cause of death in all cases. The features of the lesions examined under the light microscope were intraepidermal separation, subepidermal (dermoepidermal) separation, coagulation necrosis in the epidermis, nuclear elongation in the epidermis, dark-staining epidermal nucleus, depth of homogenization in the dermis, and nuclear elongation in the epithelium of hair follicles. A significantly high rate of electrical lesions had intraepidermal separation. The rate of subepidermal separation was slightly more significant in flame burns. A significantly higher rate of electrical lesions had both intraepidermal and subepidermal separation. The rate of coagulation necrosis in the epidermis was significantly the highest in electrical lesions. Although the severity of nuclear elongation was the most significant in electrical lesions, varying degrees of nuclear elongation in the epidermis were present in all three groups. Dark staining of the epidermal nuclei was present in all lesions except for one electrical lesion, though the severity of staining was significant in the abrasion group. The depth of homogenization was slightly more significant in the abrasion group. The rate of nuclear elongation in the epithelium of the hair follicles was significantly lower in the abrasion group. The results of this study revealed that certain morphological changes determined under a light microscope could help the differential diagnoses of electrical lesions, flame burns and abrasions.     

Diagnosis of electrical skin injuries. A review and a description of a case.

This paper presents a brief review of the results of research in the area of electrical skin injuries. It also includes a case report of a 5-year-old girl noted on her admission to the hospital to have injuries to the skin of her chest and left arm. Histological examinations demonstrated that the skin lesions were segmental and showed necrosis and inflammation. Deposits of calcium salts distinctly located to collagen fibers were observed below the regenerated epidermis at the periphery of two skin lesions of the chest wall, in the lower part of dermis at the periphery of a skin lesion of the left arm, and within connective tissue adjacent to elastic arteries and peripheral nerves from the thoracic cavity. The pattern of calcification localized to collagen fibers and situated both superficially and deeply in the skin in a zone of viable tissue close to necrotic tissue is characteristic of electrically induced lesions. Although there have been reports of deposition of calcium salts on collagen fibers after application of calcium salts in high concentration at the skin surface, the collagen calcification in the pattern observed in this patient is probably diagnostic of electrical injury.     

Lightning Deaths: A Retrospective Review of New Mexico's Cases, 1977–2009

To better understand lightning deaths, a retrospective review of electronic records from New Mexico's Office of the Medical Investigator database was performed between 1977 and 2009 to update and assess current risk factors. Information on demographics, circumstances, autopsy, and death certificates were collected and analyzed. Fifty‐four decedents were identified, ages 2–71 years old (mean 34 years old), 42 males and 12 females. Common racial/ethnic groups were non‐Hispanic Whites and American Indians (together comprising 72% of all cases). Physical findings were often related to the heat carried by the electrical current including clothing alterations (29.6%) and burning of skin (53.7%). Most deaths occurred on weekend afternoons in summer months, associated with recreational activities or agricultural work, and rural locations (77.8%). Utilizing the demographic information, clustered events, and associated outdoor activities will assist in creating public awareness and provide a framework to support targeted warnings in an attempt to prevent future deaths.     

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。