Diagnosis of drowning by summation of sodium, potassium, and chloride ion levels in sphenoidal sinus fluid: Differentiating between freshwater and seawater drowning and its application to brackish water and bathtub deaths.

Analysis of ions in sphenoidal fluid can be a useful index for the diagnosis of drowning. We evaluated the reference ranges of non-drowning cases using statistical methods and three indices: sodium ion (Na+), summation of sodium and potassium ions (SUMNa+K), and summation of sodium, potassium and chloride ions (SUMNa+K+Cl). The reference ranges were 96≤Na+<152, 139≤SUMNa+K<179, 243≤SUMNa+K+Cl<311(mEq/L), respectively. Victim indices outside of the reference ranges indicate that the victim probably inspired water with higher or lower ion concentrations than those of body fluid in sphenoidal sinuses. Compared to the SUMNa+K+Cl index, the Na+ and SUMNa+K indices could distinguish among seawater drowning, freshwater drowning, and non-drowning. In drowning cases, sphenoidal fluid volume and time since death were not correlated, which suggests that water does not enter the sphenoidal sinuses after death and there is a different process for water accumulation in drowning and non-drowning cases. In bathtub cases, this method was not valid for the estimation of inspired water. Although it is necessary to observe the classical signs of drowning, this method is suitable for the estimation of drowning, especially in cases where pleural fluid or diatom tests are not available.

Myocardial Rupture following Carbon Monoxide Poisoning.

We present the first case of severe cardiotoxicity of carbon monoxide leading to myocardial rupture and fatal outcome. 83-year-old woman was hospitalized 4 hours after the fire in her house with no respiratory or cardiac symptoms. After two days, she has suffered sudden collapse leading to cardiac arrest. Postmortem examination revealed intramural haemorrhage with myocardial rupture at the apex of the left ventricle. Minimal stenosis was noted in the proximal coronary arteries with no evidence of distal occlusion or any other long-standing heart disease. This case supports recommendations for targeted cardiovascular investigations in cases of CO poisoning.

Characteristics of cardiovascular deaths in forensic medical cases in Budapest, Vilnius and Tallinn.

Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardiovascular death is essential for the determination of the cause of death. The main purpose of this study is to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn. There were 8482 (5753 male, 2729 female) cardiovascular deaths between 2005 and 2009. The highest rate was observed in the age group between 71 and 80 years (35.17%) and 51-60 years (24.45%). The highest number of cardiovascular deaths occur in January (805/9.49%) and December (770/9.07%). Seasonal distribution was observed, with winter prevalence in Tallinn (279/3.20%) and spring prevalence in Vilnius (760/8.90%). Though in Vilnius and Budapest a great number of deaths occurred in winter and spring, any correlation with other factors (e.g. age, gender, BAC) was not statistically significant. Based on our results we can conclude that environmental-geographical parameters may affect natural cardiovascular death. Examination of pathological patterns and predisposing environmental parameters may help to improve prevention strategies.

Fatal traffic injuries among children and adolescents in three cities (capital Budapest, Vilnius, and Tallinn).

Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.

Investigation of calcium and sodium in postmortem material as biochemical markers defining the cause of death from hypothermia.

The present investigation was undertaken to evaluate the usefulness of calcium and sodium measurements in the heart, liver, and muscle autopsy samples as biochemical markers defining the cause of death from hypothermia. The concentration of electrolytes in selected internal organ tissues of persons who died from hypothermia (n=26) was compared with element concentrations in analogous tissues of persons that died due to other causes (control group, n=26). Our study showed no significant differences in the calcium content of tissues in persons who died from hypothermia, over those who died in normothermic conditions. The concentration of sodium was significantly (p<0.001) increased in the skeletal muscle of subjects who died from hypothermia.