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PubMedDate not supplied

Studies on the composition of gases in the post-mortem body: animal experiments and two autopsy cases.

The composition of gases was measured in a cadaver, particularly in the stomach, using gas chromatography. High concentrations of carbon dioxide (CO2) and hydrogen (H2) and a low concentration of methane (CH4) were found. At an environmental temperature of 25 degrees C, the concentrations of CO2 and H2 were approximately 80% and 10%, respectively, at an advanced stage of putrefaction, while at an environmental temperature of 15 degrees C the concentrations were approximately 60% and 35%, respectively. These gases were not produced until the fourth day at 15 degrees C, but after that the volume of gases was greater than that produced at 25 degrees C, the cadaver becoming greatly enlarged. Oxygen (O2) in air injected into a body disappeared during putrefaction. This study revealed that H2 was the main component of inflammable gas in a dead body. The mechanisms of production of the gases are also discussed.

Abdomen↗

PubMed1989

Postmortem stability of some markers of intra-vital wounds.

We have studied the diagnostic value of several markers of the intra-vital nature of wounds - cathepsin D (EC 3.4.23.5) and ions (Ca, Mg, Cu, Zn and Fe) - after the influence of putrefaction. For this purpose, we have inflicted vital wounds to six pigs, which were killed 20 min later. Ten minutes after death, wounds were excised with 5-6 cm of skin around the incision and maintained at three different temperatures (4, 18 and 28.5 +/- 13.4 degrees C). After varying periods of postmortem interval from 0 to 48 h, aliquots of each wound were taken and analyzed with atomic absorption spectrophotometry for ions and with UV-spectrophotometry for cathepsin D. Our results demonstrate that ions conserve their diagnostic ability to differentiate vital from postmortem wounds after the influence of putrefaction. Nevertheless, cathepsin D does not show this ability in these experimental conditions.

Animals↗

PubMed1993

Postmortem changes in blood tranylcypromine concentration: competing redistribution and degradation effects.

Site and temporal changes in tranylcypromine (TCP) and lithium concentrations in blood were studied in a human poisoning case. Blood samples from peripheral vessels and six central vessels were obtained at 0, 6, 24, 48 and 72 h after starting the autopsy. Nine tissue samples were obtained on completion. TCP showed preferential concentration in liver (2.21 micrograms/g) and brainstem (2.46 micrograms/g). There was a moderate post mortem redistribution phenomenon with TCP concentrations lowest in peripheral blood (0.17 micrograms/ml) at 0 h and highest in central vessels at 24 h (0.52 micrograms/ml). At 72 h blood TCP concentrations fell below those at 0 time but the samples showed marked putrefactive changes. Control blood samples spiked with TCP and incubated for 48 h at 37 degrees C showed a 58% fall in drug concentration. By contrast with TCP, lithium, which has a small Vd (0.8 l/kg) and is chemically stable, did not show this pattern of change in blood concentration. The site and temporal differences in TCP concentration in blood can be explained by the competing effects of post mortem redistribution and drug degradation. Redistribution is an early post mortem phenomenon characterised by diffusion, along a concentration gradient, from drug reservoirs in solid organs into adjacent blood vessels. Drug degradation is a later phenomenon associated with putrefactive change.

Drug Overdose↗

PubMed2004

Preanalytic aspects in postmortem toxicology.

The preanalytic phase has been recognized to have a substantial role for the quality and reliability of analytical results, which very much depend on the type and quality of specimens provided. There are several unique challenges to select and collect specimens for postmortem toxicology investigation. Postmortem specimens may be numerous, and sample quality may be quite variable. An overview is given on specimens routinely collected as well as on alternative specimens that may provide additional information on the route of administration, a long term or a recent use/exposure to a drug or poison. Autolytic and putrefactive changes limit the selection and utility of specimens. Some data from case reports as well as experimental investigations on drug degradation and/or formation during putrefaction are discussed. Diffusion processes as well as postmortem degradation or formation may influence ethanol concentration in autopsy specimens. Formalin fixation of specimens or embalmment of the corpse may cause considerable changes of initial drug levels. These changes are due to alterations of the biological matrix as well as to dilution of a sample, release or degradation of the drug or poison. Most important seems a conversion of desmethyl metabolites to the parent drug. Some general requirements for postmortem sampling are given based on references about specimen collection issues, for a harmonized protocol for sampling in suspected poisonings or drug-related deaths does not exist. The advantages and disadvantages of specimen preservation are shortly discussed. Storage stability is another important issue to be considered. Instability can either derive from physical, chemical or metabolic processes. The knowledge on degradation mechanisms may enable the forensic toxicologist to target the right substance, which may be a major break down product in the investigation of highly labile compounds. Although it is impossible to eliminate all interfering factors or influences occurring during the preanalytic phase, their consideration should facilitate the assessment of sample quality and the analytical result obtained from that sample.

Autolysis↗

PubMed2005

Virtopsy: postmortem imaging of the human heart in situ using MSCT and MRI.

The rapid further development of computed tomography (CT) and magnetic resonance imaging (MRI) induced the idea to use these techniques for postmortem documentation of forensic findings. Until now, only a few institutes of forensic medicine have acquired experience in postmortem cross-sectional imaging. Protocols, image interpretation and visualization have to be adapted to the postmortem conditions. Especially, postmortem alterations, such as putrefaction and livores, different temperature of the corpse and the loss of the circulation are a challenge for the imaging process and interpretation. Advantages of postmortem imaging are the higher exposure and resolution available in CT when there is no concern for biologic effects of ionizing radiation, and the lack of cardiac motion artifacts during scanning. CT and MRI may become useful tools for postmortem documentation in forensic medicine. In Bern, 80 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy until the month of August 2003. Here, we describe the imaging appearance of postmortem alterations--internal livores, putrefaction, postmortem clotting--and distinguish them from the forensic findings of the heart, such as calcification, endocarditis, myocardial infarction, myocardial scarring, injury and other morphological alterations.

Autopsy↗

PubMed2004

A novel approach in personal identification from tissue samples undergone different processes through STR typing.

Short tandem repeats (STRs) or microsatellites have been recognized worldwide as a powerful tool for human identification. They have become widely used in human identification especially in criminal cases and mass disasters. Police departments are often interested in cases where tissues are already decomposed and only do bones remain to let them perform laboratory analyses. Bone is the most resistant tissue in animal body to time depending degradation and putrefaction, but it is often hard to extract DNA from it because of its highly mineralized structure, which makes DNA extraction and/or amplification hard to carry out. We have performed human nuclear DNA extraction and STR typing in three different cases, on bones and bone fragments from long time dead persons found buried, in the sea, almost completely burnt and whose tissues were already decomposed. We report these caseworks as we would like to show how forensic scientists are improving their skill in identifying people whose corps have undergone several kinds of processes, even independently on the time passed and the level of putrefaction of their tissues.

Bone and Bones↗

PubMed2005

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.

Adolescent↗

PubMed2005

Effects of perimortem physical factors associated with death on exogenous ethanol concentrations in cardiac blood.

The purpose of this study was to determine whether perimortem physical factors associated with death affect exogenous ethanol concentrations in cardiac blood. Forty-one autopsies of alcohol-intoxicated decedents with no or little putrefaction were involved. Postmortem intervals ranged from 6 to 96 h at the time of autopsy. Our 41 cases consisted of 17 fire victims, 8 drowned persons, 3 blood-loss patients who underwent unsuccessful cardiopulmonary resuscitation (CPR) for 30-50 min, 3 blood-loss persons without CPR, three non-blood-loss patients who underwent unsuccessful CPR for 5-60 min, and seven people who died of other causes. Ethanol concentrations in right cardiac chamber blood ranged from 0.12 to 4.40 mg/g (mean 1.39 mg/g) in all cases. An excellent correlation was observed between ethanol concentrations in right cardiac chamber blood and femoral venous blood (y=1.01x-0.087, n=38, r2=0.990). The ratios of blood ethanol concentrations in the left to right cardiac chambers were significantly lower in blood-loss decedents with CPR (0.71+/-0.13) than other decedents (0.92+/-0.07-1.06+/-0.06). Two factors, blood-loss and prolonged chest compression under ventilation, might have caused a decrease in blood ethanol concentration in the left cardiac chambers. Postmortem cardiac blood ethanol concentration as well as postmortem femoral venous blood ethanol concentration may usually reflect blood ethanol levels at the time of death when putrefaction is not evident. However, special attention is required for cases that received CPR after massive bleeding.

Adult↗

PubMed2001

Association between oral malodor and adult periodontitis: a review.

BACKGROUND: Bad breath has a significant impact on our daily social life to those who suffer from it. The majority of bad breath originates within the oral cavity. However, it is also possible that it can come from other sources such as gastric-intestine imbalance. The term "oral malodor" is used to describe a foul or offensive odor emanating from the oral cavity, in which proteolysis, metabolic products of the desquamating cell, and bacterial putrefaction are involved. Recent evidence has demonstrated a link between oral malodor and adult periodontitis. The process of developing bad breath is similar to that noted in the progression of gingivitis/periodontitis. Oral malodor is mainly attributed to volatile sulfur compounds (VSC) such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide. The primary causative microbes are gram-negative, anaerobic bacteria that are similar to the bacteria causing periodontitis. These bacteria produce the VSC by metabolizing different cells/tissues (i.e., epithelial cells, leukocytes, etc.) located in saliva, dental plaque, and gingival crevicular fluid. Tongue surface is composed of blood components, nutrients, large amounts of desquamated epithelial cells and bacteria, suggesting that it has the proteolytic and putrefactive capacity to produce VSC. One of the challenges in dealing with oral malodor is to identify a reliable test for detecting bad breath. AIMS: The purposes of this review article were: (1) to correlate the relationship between oral malodor and adult periodontitis; (2) to analyze current malodor tests and discuss available treatment regimens.

Adult↗

PubMed1997

Effects of AvGard treatment on the microbiological flora of poultry carcases.

1. The efficiency of the AvGard (or Assur-Rince in the USA) trisodium phosphate poultry carcase decontamination process was evaluated during both manual and industrial trials against total aerobic mesophilic count (TAMC), thermotolerant coliforms, Pseudomonas, Enterobacteriaceae, Campylobacter, Listeria monocytogenes and Salmonella. 2. The TSP treatment proved to have significant effects on the bacterial decontamination of poultry neck skin, lowering the contamination by a factor of about 10 for TAMC and of 100 for Coliform and Pseudomonas. 3. Numeration of Salmonella with an innovative miniaturised most probable number method has proved that the effect upon these micro-organisms was also close to 2 log10 reduction. 4. The effect of TSP treatment on the ecological balance of psychrotrophic bacterial flora was also investigated to study the origin of the shelf-life flora of treated carcases (Pseudomonas being reduced to the limit of detection) and to ascertain whether L. monocytogenes might gain a competitive advantage. In fact AvGard reduced the number of L. monocytogenes on poultry carcases. 5. As a consequence of the virtual elimination of the Pseudomonas usually present, Brochothrix thermosphacta became the main species responsible for putrefaction. 6. Because the growth rate of Brochothrix thermosphacta was greater than that of L. monocytogenes at refrigeration temperature, it was considered that putrefaction would occur before the emergence of large numbers of L. monocytogenes.

Animals↗

PubMed1994

Postmortem changes in blood amitriptyline concentration.

Detailed toxicological studies were undertaken on two suicides by amitriptyline overdose, one with salicylate also. In the first case, 10 initial blood samples taken 21 h after body discovery and an estimated 28 1/2 h after overdose had drug concentration (mg/L) ranges of 2.5-12 for amitriptyline (AM), 0.7-3.1 for nortriptyline (NOR), and 81-244 for salicylate (SAL). Ten blood samples taken 42 h later showed corresponding ranges of 1-39 AM, 0.6-7.0 NOR, and 86-310 SAL. Sample haemoglobin concentrations (range, 8.7-23.5 g/dl) did not correlate with drug concentrations. Postmortem increase in pulmonary vein AM concentration occurred more rapidly than in the pulmonary artery, likely reflecting relative ease of diffusion across the vessel walls from lung (AM, 60 mg/kg). In nine tissue samples, drug concentrations (mg/kg) were highest in the liver: AM, 301; and SAL, 670. Considerable drug residue was present in gastric contents, duodenal contents, and seven sequential small bowel contents. In both cases, sanguineous putrefactive pleural fluid showed higher AM concentrations on the left than on the right (2.0 vs 1.4 and 23 vs 16), likely reflecting diffusion from gastric drug residue. The detailed case data illustrate the intensity and complexity of postmortem drug diffusion from reservoirs in solid organs, such as the lungs, and unabsorbed gastric residue, into the blood and putrefactive fluids.

Adult↗

PubMed1994

Postmortem redistribution and degradation of dothiepin. Human case studies and an animal model.

Two suicides took estimated maximum dothiepin doses of 765 and 1875 mg, respectively. Initial drug levels in nine and 12 blood samples were 0.26-1.85 and 4.08-23.98 mg/L, with highest concentrations in the pulmonary veins. Pulmonary artery concentrations rose markedly over 18 h: 0.32 rising to 0.9, and 6.54 rising to 19.53 mg/L. Peripheral blood concentrations were relatively stable. Concentrations in liver, heart, lung, and skeletal muscle were, for case 1, 4.3, 2.92, 18.6, and 1.1 mg/kg; and, for case 2, 52, 16.8, 73.9, and 8.98 mg/kg. New Zealand white female rabbits (2.4-3.2 kg) given 20 mg dothiepin hydrochloride intravenously were killed with pentobarbital after 1 h. Blood was sampled from the thorax, infra-renal inferior vena cava, and supra-renal inferior vena cava at 0, 1/2, 1, 4, 8, 12, and 24 h postmortem in paired animals. Liver, heart, lung, and skeletal muscle were sampled at 0 and 24 h. Mean dothiepin levels in thoracic blood rose from 0.43 mg/L at time 0 to 1.73 at 8 h and then fell to 0.61 at 12 h, likely reflecting initial redistribution from the lungs (63.4 mg/kg at time 0 and 27.3 mg/kg at 24 h) followed by putrefaction-associated bacterial degradation. Falls in blood drug levels associated with putrefaction were not seen in the human cases. Interpretation of postmortem dothiepin blood concentrations is complicated by pronounced interindividual variations in in vivo pharmacokinetics, the postmortem redistribution phenomenon, and variable drug degradation by bacteria.

Animals↗

PubMed2000

Morphine-3-D glucuronide stability in postmortem specimens exposed to bacterial enzymatic hydrolysis.

Medical examiners frequently rely on the finding of free morphine present in postmortem specimens to assist in certifying deaths associated with narcotics. In vitro hydrolysis of morphine-3-D glucuronide (M3DG) to free morphine was studied using variable specimen pH, initial degree of specimen putrefaction, storage temperature and time, and the effectiveness of sodium fluoride (NaF) preservation. Reagent M3DG was added to opiate-free fresh blood and urine and to autopsy-derived blood specimens. Reagent bovine glucuronidase was also added to certain specimens. Freshly collected and refrigerated NaF-preserved blood produced minimal free morphine, whereas four of five autopsy blood specimens produced free morphine from M3DG. Increased storage time, temperature, and initial degree of putrefaction resulted in greater free morphine generation despite the absence of viable bacteria. Hydrolysis occurring during specimen storage can generate free morphine from M3DG and may result in erroneous conclusions in certifying narcotic deaths.

Adolescent↗

PubMed2001

Venous air embolism in homicidal blunt impact head trauma. Case reports.

From 1992 through 1997, there were 41 deaths by homicidal blunt impact head trauma in Hillsborough County, Florida. Twenty-one cases were excluded from the study because of putrefaction or survival beyond the emergency department doors, leaving 20 cases for the study. One of the 15 nonputrefied victims found dead at the scene and 1 of the 5 victims pronounced dead in the emergency department had definite venous air embolism. Victim 1 was found dead, bludgeoned with a concrete block, and had open vault and comminuted basilar skull fractures. The dura forming the right sigmoid sinus at the jugular foramen was lacerated. A preautopsy chest radiograph and examination under water documented gas in the pulmonary artery and right ventricle. Victim 2 was bludgeoned with a steel stake and was pronounced dead on arrival in the emergency department. He had open comminuted vault fractures, a transverse basilar skull fracture, and lacerations of the brain. Direct examination and preautopsy chest radiography revealed air in the right side of the heart. A third victim, with basilar fractures, had a small gas bubble in the pulmonary artery not detected by the case pathologist. A fourth victim, with a basilar skull fracture, had an unusual radiographic finding that was thought to be air in the posteromedial aspect of the lower lobe of the left lung but could not be excluded as an air embolus. Optimal postmortem documentation of venous air embolism includes the demonstration of the embolus and the site of air ingress. This study demonstrates that venous air embolism occurs in some victims of homicidal bludgeoning and suggests that when significant, it is easily demonstrated in the absence of putrefactive gas formation. The presence of venous air embolism can serve as evidence that a victim was alive and breathing at the time of the infliction of head wounds. In the belief that venous air embolism might be underdiagnosed in many medical examiner offices, the authors have sought to bring attention to the entity by publishing their experience with it in cases of bludgeoning.

Adult↗

PubMed2003

Infanticide in Malaysia: two case reports and a review of literature.

In a strict and conservative society like Malaysia, the number of cases of infanticide has continued to occur. The authors present two typical cases of infanticide in Malaysia. Case 1 concerned a body of a fully mature newborn fetus disposed in a rubbish bin. The head was traumatically amputated by the rubbish truck's compactor. The umbilical cord was still attached to the body, with no reddening around the insertion. The severed neck showed features consistent with post-mortem amputation. The significant finding was expanded crepitant lungs, which floated in water. The histology of the lungs showed expanded alveoli. It was concluded that the baby had been born alive, but no cause of death could be elicited. Case 2 concerned a decomposed mature newborn found in a scrub forest. The internal organs showed advanced putrefaction, the lungs being collapsed, congested, and hemorrhagic, typical of decomposed lungs. No conclusion could be made about the state of birth or the cause of death because of the putrefied state of the body. The two cases illustrate the typical cases and problems faced by pathologists locally and probably elsewhere in the world. Most of the bodies are found in a putrefied state. Pathologists have to ascertain not only maturity and live birth but also the cause of death, which may be very subtle or masked by putrefaction. The problems of diagnosis of live birth are discussed.

Amputation, Traumatic↗

PubMed2006

Noninvasive estimation of organ weights by postmortem magnetic resonance imaging and multislice computed tomography.

OBJECTIVE: Computed tomography (CT) and magnetic resonance imaging (MRI) are introduced as an alternative to traditional autopsy. The purpose of this study was to investigate their accuracy in mass estimation of liver and spleen. METHODS: In 44 cases, the weights of spleen and liver were estimated based on MRI and CT data using a volume-analysis software and a postmortem tissue-specific density factor. In a blinded approach, the results were compared with the weights noted at autopsy. RESULTS: Excellent correlation between estimated and real weights (r = 0.997 for MRI, r = 0.997 for CT) was found. Putrefaction gas and venous air embolism led to an overestimation. Venous congestion and drowning caused higher estimated weights. CONCLUSION: Postmortem weights of liver and spleen can accurately be assessed by nondestructive imaging. Multislice CT overcomes the limitation of putrefaction and venous air embolism by the possibility to exclude gas. Congestion seems to be even better assessed.

Adolescent↗

PubMed2004

Impact of tongue cleansers on microbial load and taste.

OBJECTIVES: Tongue cleaning has been advocated to improve oral malodor and to reduce reinfection of periodontal niches by eliminating tongue coating and/or reducing putrefaction by bacteria. MATERIAL AND METHODS: This cross-over, single-blind study on periodontitis-free, non-smoking, subjects with habitual oral hygiene (n=16), evaluated the effect of tongue cleaning (with either plastic scraper or nylon multi-tufted toothbrush), on the microbial load of the tongue dorsum (anterior and posterior of the sulcus terminalis), the extent of tongue coating, and taste sensation for bitter, sweet, salt, and sour. Both devices had been used twice daily for 2 weeks (toothbrush three forward-backward movements along the linea mediana and for each longitudinal third of the tongue; two strokes with the scraper along the linea mediana and along the borders of the tongue). RESULTS: Two weeks of tongue brushing or scraping resulted in only negligible reductions in aerobic and anaerobic bacteria on the tongue (reductions <0.5 log). The amount of tongue coating, however, decreased significantly (p<0.05), with both devices. The taste sensation improved after 2 weeks of tongue cleaning, especially with the scraper (significant improvements for quinine and sodium chloride). CONCLUSION: Tongue cleaning improves taste sensation and seems to reduce the substrata for putrefaction, rather than the bacterial load.

Adult↗

PubMed1966

Use of the anaerobic pouch in isolating Clostridium botulinum spores from fresh meats.

The anaerobic film pouch was demonstrated to be an effective device for the primary isolation of Clostridium botulinum types A and B spores from raw pork, beef, and chicken. Optimal pasteurization of these meats (for reduction of nonspore microflora without affecting indigenous putrefactive anaerobic spore levels) was 50 min at 60 C. C. botulinum spores were recovered with good precision from meat samples inoculated with mixtures of C. botulinum and Putrefactive Anaerobe 3679 at 1:1 and at 1:99 ratios. Verification of C. botulinum isolates was accomplished by protection testing of subcultures in mice.

Animals↗