Legal medicine
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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 present study focuses attention upon the relationship among postmortem mRNA levels of pulmonary glucose transporter (GLUT1) and vascular endothelial growth factor (VEGF) to lung weight to investigate pulmonary pathophysiology in the death process. Autopsy cases (n=173, within 48 h postmortem) of blunt injury, including head injury (brain contusions and acute subdural hemotoma) and non-head injury, sharp instrument injury, mechanical asphyxiation, drowning, acute myocardial infarction/ischemia (AMI) and idiopathic cerebral hemorrhage (ICH) were examined. GLUT1 and VEGF mRNAs were quantified by TaqMan real-time RT-PCR for the upper lobes of the bilateral lungs. ⋯ Such findings were not detected for other groups. These findings indicate parallel increases in hypoxia-induced responses and lung weight in ICH and brain contusions, suggesting different pulmonary hemodynamics with milder alveolar damage compared with other groups, including AMI and acute subdural hematoma. Different mechanisms might be involved in non-cardiogenic or neurogenic pulmonary congestion and edema for ICH/brain contusions and subdural hematoma.
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In cases of shock, the lung weight decreases due to massive hemorrhaging, but increases due to progressive congestion and edema caused by microvascular injury. To examine the relationship between postmortem lung weight and survival time, the present study investigated serial autopsy cases (n=904), including those with fatalities from blunt injury (n=328: head injury, n=191; others, n=137), sharp instrument injury (n=70), mechanical asphyxiation (n=80), intoxication (n=62), drowning (n=75), fire fatality (n=184), and acute myocardial infarction/ischemia (AMI, n=105). ⋯ The total lung weight showed a survival time-dependent increase for blunt and sharp instrument injuries, fire fatality, and mechanical asphyxiation; however, such a finding was not seen in the cases of AMI, drowning, or intoxication. These findings suggest that an increase in lung weight due to progressive congestion and edema and a heavier lung weight may indicate a longer survival time.
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To clarify drowning death, positive evidence for aspiration of the immersion medium and the subsequent fatal mechanism is necessary. This study investigated biochemical findings with regard to lung weight in drowning cases of adults (n=56, >18 years of age, <48 h postmortem: salt water, n=19; fresh water, n=21; brackish water, n=16), using acute cardiac death cases (n=240) as controls. The biochemical markers used in this study were urea nitrogen (UN), sodium (Na), chloride (Cl), calcium (Ca) and magnesium (Mg) in the blood and pericardial fluid (PCF). ⋯ Correlation of the left cardiac serum level with lung weight was positive for Na, Cl and Mg in saltwater and brackish water drowning, and was also positive for Ca in saltwater drowning. There was an inverse correlation with lung weight for PCF Na and Cl levels in freshwater drowning. These findings suggest that analyses of serum and pericardial markers in relation to lung weight are useful for evaluating the composition and amount of aspirated medium when investigating drowning death.
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Basic fibroblast growth factor (bFGF) is a highly conserved and ubiquitously distributed mitogen, and much is known at the molecular level. However the available information about in vivo distribution in human tissues and expression changes in relation to causes of death is not sufficient. The present study investigated 35 autopsy cases, comprising five cases for each cause of death: acute myocardial infarction/ischemia (AMI), mechanical asphyxiation, blunt brain injury, drowning, hypothermia, intoxication and sharp instrument injury. ⋯ High positivity in the brain was seen for intoxication, but AMI, mechanical asphyxiation and drowning showed lower positivity. For the heart, spleen and pancreas, there was no evident difference among the causes of death. These findings suggested that bFGF expression in the lung, liver, kidney and brain varies depending on the cause of death, and is useful for investigating deaths.