No cash no whiplash?: Influence of the legal system on the incidence of whiplash injury.

Whiplash injury has been a continuous source of controversy due to its association with litigation. We studied the incidence of whiplash associated disorder (WAD) in two similar socioeconomic areas and carried out a retrospective study based on the hypothesis that the Spanish law 30/1995 might have an affect on the incidence and duration of cervical symptoms and the persistence of impairment. More than 10,000 patients injured in traffic accidents were studied over a period three years. Of these, only patients with an initial diagnosis of whiplash injury were included in the study. Patients with other injuries were excluded. The patients were classified into two groups: Galicia-Spain and North-Central Portugal (depending on where the accident took place and the medico-legal evaluation procedure in force). Statistical analysis was made using SPSS 13.0 and Statistix 8.0. We found a statistically significant difference between Spain and Portugal in the incidence of WAD and in the duration of symptoms. The incongruities caused by the compulsory application of Spanish law arise from the fact that evaluation on a points scale of impairment does not always reflect the functional state of the injured person.

Immunohistochemical analysis of P-Selectin as a possible marker of vitality in human cutaneous wounds.

Immunohistochemical detection of mediators of inflammation, such as P-Selectin, has been proposed to assess vitality of wounds. Forty-five incised cutaneous wounds (24 vital, 14 post-mortem, seven with induced autolysis/putrefaction) were immunostained with antibodies against P-Selectin and CD31. The percentage of stained lumina for P-Selectin out of the total of CD31 positive vessels (P-S/CD31 index) was calculated at both edges of every specimen. In vital samples, the P-S/CD31 index ranged from 10.7% to 71.4% at the wound edge, and was 12.5-58.8% for the opposite margin, with a ratio between both indices of 0.37-1.77 (mean: 0.94). In post-mortem cases, the index ranged from 22.5% to 69.2% at the wound edge, and was 28-89.5% at the opposite margin, with a ratio between both indices of 0.76-1.9 (mean: 0.96). Differences between ratios were not statistically significant and thus precluded any assessment of vitality. The analysis of P-Selectin/CD31 immunoreactivity in skin wounds was not useful for the diagnosis of vitality when evaluating both edges for each specimen. Moreover, P-Selectin has been detected in post-mortem injuries and it is not specific to vital injuries. Microscopic evaluation becomes difficult after autolysis/putrefaction.

The pathology of the heart conduction system in congenital heart block.

The incidence of congenital complete heart block is estimated in 1 of 2500-20,000 births. Many cases are isolated (found in an otherwise normal heart) and the pathology of the heart conduction system is variable. We report a 51-year-old man with the diagnosis of complete heart block, with a permanent pacemaker. No family history of rhythm disturbances was available. The patient presented and endocarditis after replacement of the pacemaker battery. The prognosis was poor and the patient died three months later. Autopsy examination showed signs of shock, of septic origin. The heart was hypertrophic (450g) and the left ventricle thickened. Histopathological examination of the heart conduction system showed that the sinus and atrioventricular nodes were normal, but the His bundle was interrupted and replaced by fibrous tissue. No inflammatory signs were present. Loss of conducting fibres and their replacement by fibrous tissue is the most common pathological process in complete heart block. In this case His bundle was mostly affected, different to Lev's disease where the process is more distal (branching atrioventricular bundle) and to Lenegre's disease, which shows a diffuse damage in the conducting system.

A high-performance liquid chromatography method for hypoxanthine determination in vitreous humour: application to estimation of post mortem interval.

We have developed a new technique to determine the concentration of hypoxanthine [Hx] in a reverse phase column using a modified high-performance liquid chromatography (HPLC) method that is faster and more reliable than those previously described. In this paper we present a formula for estimating the post mortem interval (PMI) based on this HPLC method by applying the inverse prediction method. The regression line obtained by changing the variables gives PMI = 0.183 [Hx] + 0.599 (PMI in hours, [Hx] in micromol/L, R2 = 0.531, P < 0.05).

Rupture of liver cell adenoma with fatal massive hemoperitoneum resulting from minor road accident.

Blunt abdominal trauma can cause rapid death resulting from serious injuries of internal organs. The liver is commonly involved and may show tearing, usually in its upper surface, resulting in hemoperitoneum eventually leading to death. Minor trauma implies serious liver damage only when previous pathologic changes causing enlargement of the organ are present. The case of a 25-year-old woman who died as a consequence of a minor road accident is reported. At autopsy, the body showed no external injuries, the only relevant finding being a massive hemoperitoneum from the rupture of an unusually large liver cell adenoma. Liver cell adenomas carry a serious risk of spontaneous rupture, which may result in the death of the patient. The occurrence of the rupture after a minor blunt abdominal trauma is highly unusual.

Detection of apoptosis in ischemic heart. Usefulness in the diagnosis of early myocardial injury.

Myocardial samples of hearts with histologic findings of acute myocardial infarction (group A), sudden coronary deaths without histologic changes (group B), and chronic ischemic heart disease (group C) were analyzed to investigate the appearance of apoptosis in acute and chronic ischemic cardiac disorders. This analysis involved the morphologic detection of DNA strand breaks in myocyte nuclei by the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay and the biochemical determination of DNA laddering in the myocardium using archival formalin-fixed, paraffin-embedded tissue sections of human myocardium. The authors demonstrated that apoptosis of myocardial cells could occur after ischemic myocardial cell injury. In all documented cases of acute myocardial infarction (group A), the infarcted area included extensive presence of both apoptosis and necrosis. In the tissue bordering on and away from the obviously infarcted areas, positive nuclei were intermingled with nonstained normal myocytes. The number of positive nuclei decreased with the distance from the infarction foci. In group B, myocardial samples showed focal or diffuse nuclear positivity of varying degrees for apoptosis, confirming the presence of myocardial ischemic cell death, whereas the histologic diagnosis remained inconclusive. This finding suggests that apoptosis could be used as a marker for acute ischemic injury. In group C, stained nuclei were dispersed with intermingled normal cardiomyocytes.

A new perspective in the estimation of postmortem interval (PMI) based on vitreous.

The relation between the potassium concentration in the vitreous humor, [K+], and the postmortem interval has been studied by several authors. Many formulae are available and they are based on a correlation test and linear regression using the PMI as the independent variable and [K+] as the dependent variable. The estimation of the confidence interval is based on this formulation. However, in forensic work, it is necessary to use [K+] as the independent variable to estimate the PMI. Although all authors have obtained the PMI by direct use of these formulae, it is, nevertheless, an inexact approach, which leads to false estimations. What is required is to change the variables, obtaining a new equation in which [K+] is considered as the independent variable and the PMI as the dependent. The regression line obtained from our data is [K+] = 5.35 + 0.22 PMI, by changing the variables we get PMI = 2.58[K+] - 9.30. When only nonhospital deaths are considered, the results are considerably improved. In this case, we get [K+] = 5.60 + 0.17 PMI and, consequently, PMI = 3.92[K+] - 19.04.

Stature estimation from radiographically determined long bone length in a Spanish population sample.

The estimation of stature from of a variety of bones is an important aspect of forensic work. In order to obtain reliable results, it is important to have comparative data obtained from the same population group as the skeletal remains. However, lack of up to date information on the population groups of Southern Europe makes the estimation of stature from bones in this area subject to possible error. In this study, the stature of 104 healthy adults from Spain was measured, and an anteroposterior teleradiograph of the right lower and the right upper limb of every subject in the study was made in order to measure the lengths of the femur, tibia, fibula, humerus, cubitus and ulna. Pearson's regression formulae were obtained for both limbs. In males, we found the femur to be the most accurate predictor of stature (R = 0.851), whereas in females best results were obtained with the tibia (R = 0.876).

Concealed homicidal strangulation by burning.

Compression of the neck, either with the hands or by a ligature, is not an uncommon method of homicide. Burning of the body to try to conceal the homicide may complicate the situation by making it difficult to interpret the findings. We hereby report two cases of homicidal ligature strangulation with extensive burning of the bodies. In both cases, external findings included the presence of a soft piece of fabric around the neck that, when removed, disclosed a portion of pale, unburned skin that vividly contrasted with surrounding areas. Osteocartilaginous lesions were present in only one case. Carboxyhemoglobin levels in both cases were very low, and the histopathologic examination of distal airways for soot particles was negative.

Biochemical diagnosis of the intravital origin of skin wounds.

The performance of a spectrophotometric and a spectrofluorimetric method in the determination of histamine and serotonin in skin samples was compared. The spectrophotometric method was found to be superior in terms of reproducibility and sample stability, so it was chosen for subsequent use. An overall 30 rabbits were wounded at different times prior to and after death and the histamine and serotonin concentrations in the wounds were compared to those of control specimens. Vital wounds were found to result in increased concentrations of the amines. The spectrophotometric method was also applied to human skin samples from 12 corpses showing body signs of violence.

Isoelectric focusing of human hair keratins: correlation with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) patterns and effect of cosmetic treatments.

A new isoelectric focusing (IEF) technique in polyacrylamide gels with 6M urea and 1.5% Nonidet P40 has been developed to characterize human hair samples. The phenotypes demonstrated with this procedure has been correlated with the sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) patterns described by other authors. The method described can be applied in the forensic science analysis of a single human hair. Using the same IEF technique we have studied the changes in electrophoretic patterns of cosmetically treated hair. The characteristics of the modifications observed and its utility in forensic science work are also discussed in this paper.

Genetic markers in alcoholic liver cirrhosis.

11 genetic markers were typed in 157 individuals suffering from alcoholic cirrhosis, and compared with a random sample of healthy individuals. No significant differences were found for transferrin, specific group component, orosomucoid, esterase D, phosphogluconate dehydrogenase and adenylate kinase. Strong associations between alcoholic cirrhosis and alpha-1-antitrypsin PI*Z allele, haptoglobin HP*1 allele and acid phosphatase ACP AC phenotype were observed. The biological significance of these associations and their relationships with the development of alcoholic cirrhosis are also discussed.

The use of hybrid isoelectric focusing for the detection of polymorphic proteins in blood stains.

alpha1-Antitrypsin (Pi), transferrin (Tf) and orosomucoid (ORM) were determined in bloodstain extracts by isoelectric focusing (IEF) with carrier ampholytes (CA) and also with a mixture of immobilines (HIEF). HIEF yields superior results from proteins typing in bloodstain extracts, since phenotypes are better distinguished and the bands are straighter and sharper. Also the sensitivity of HIEF is similar to IEF with CA.

Direct carboxyhemoglobin determination by derivative spectroscopy.

A fast and sensitive method for the determination of carboxyhemoglobin (COHb) in blood using derivative spectroscopy is described. The addition of sodium dithionite as a reducing agent is not required. The concentration interval studied was from 0.5% to 100% COHb.

Comparison between isoelectric focusing methods for the detection of orosomucoid phenotypes.

Orosomucoid (ORM) polymorphism was investigated by different methods including isoelectric focusing in acid pH ranges followed by silver staining, print immunofixation of desialyzed ORM, fixation using a lectin from the sea-weed Codium tomentosum, isoelectric focusing followed by immunofixation in miniaturized gels and isoelectric focusing in immobilized pH gradients. Population genetics studies were carried out in Galicia (NW Spain) and two new ORM variants were found.

Correlation between native and desialyzed forms of orosomucoid.

The correlation between ORM phenotypes in untreated serum and ORM phenotypes after isoelectric focusing of neuraminidase-treated serum is demonstrated. ORM subtypes were determined using isoelectric focusing in immobilized pH gradients. Population genetic studies of ORM polymorphism in the Galician population were also carried out.