Legal medicine
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Case Reports
Chin-sternum-heart syndrome type of injury observed in a pedestrian victim of car traffic accident.
We report an autopsy case of a pedestrian victim of car traffic accident with the chin-sternum-heart syndrome type of injury. A drunken man who lay on the road was run over by a car. ⋯ Blood ethanol level was 2.92 mg/g. These findings indicate that there was hyperflexion of the neck and then the victim's heart was strongly compressed and ruptured by the collision of the chin with the sternal region of the chest.
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Previous studies have suggested the usefulness of postmortem serum calcium (Ca) and magnesium (Mg) for investigating cause of death. The present study investigated their levels in the pericardial fluid of serial autopsy cases of adults within 48 h postmortem (n=385), including fatalities from blunt injury (n=57), sharp instrument injury (n=9), mechanical asphyxiation (n=28), salt- and freshwater drowning (n=14 and n=61, respectively), fire fatality (n=35), intoxication (n=23), hypothermia (cold exposure, n=12), hyperthermia (heat stroke, n=7), acute cardiac death (ACD, n=86), pneumonia (n=9) and spontaneous cerebral hemorrhage (n=11). The pericardial Ca level was independent of the postmortem interval, showing a value similar to that of the clinical reference range in cases other than saltwater drowning, while the Mg level was higher than the clinical reference range and showed a mild postmortem time-dependent increase. ⋯ The Mg level was also significantly higher for saltwater drowning than the other groups, and showed a higher level for sharp instrument injury, but a lower level for hypothermia. The Mg/Ca ratio was higher for sharp instrument injury and saltwater drowning, but was lower for hypothermia. These findings suggest that postmortem pericardial Ca and Mg can be used to investigate the cause of death, especially for saltwater drowning, hypothermia and hyperthermia.
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The aim of the present study was to undertake, during routine forensic work, a comprehensive analysis of the serum and cerebrospinal fluid (CSF) levels of thyroid-stimulating hormone (TSH) and to examine hypophyseal TSH immunopositivity in relation to the cause of death, with particular regard to fatal hypothermia. Medicolegal autopsy cases (n=120; within 48 h postmortem; survival time, <24 h), including cases of blunt injury (n=9), sharp instrument injury (n=8), fire fatality (n=18), mechanical asphyxiation (n=10), drowning (n=21), poisoning (n=6), hypothermia (n=10), and acute ischemic heart disease (n=38), were examined. Serum and CSF TSH concentrations were measured using an electrochemiluminescence immunoassay. ⋯ Serum and CSF TSH levels were significantly lower in cases of hypothermia than in the other groups (p<0.05 and p<0.001, respectively). TSH immunopositivity in adenohypophysis was significantly lower in cases of hypothermia, but exhibited a large case-to-case variation for poisoning. These observations suggest that a decrease in serum and CSF TSH levels in hypothermia is related to hypothalamic adenohypophyseal dysfunction.