Can pulmonary foam arise after postmortem submersion in water? An animal experimental pilot study.

It is difficult to differentiate drowning from postmortem submersion. Pulmonary foam can be found in bodies retrieved from water. It is unknown whether foam is a result of drowning or if it also forms after postmortem submersion. We divided deceased piglets into three groups: postmortem saltwater submersion (N = 20), postmortem freshwater submersion (N = 20) and dry-land controls (N = 20). All carcasses underwent endoscopic examination within 24 h of death and the presence of external and internal pulmonary foam was scored. No external foam was detected in the postmortem freshwater or the postmortem saltwater group. Internal foam was seen in 35% of the postmortem freshwater and 40% of the postmortem saltwater group. No external or internal foam was detected in the dry land control group. The literature shows external as well as internal foam in drowned humans. Internal foam is seen in postmortem submersion in the current piglet study and antemortem submersion in the literature in humans, and can therefore not be used to support/refute the diagnosis of drowning. No external foam was present in the postmortem submersed piglets, yet has been described in drowned humans. Hence the presence of external foam in bodies recovered from water may be indicative for drowning. The presence of external foam is a potentially valuable clinical sign in distinguishing drowning from postmortem submersion.

The correlation between the Aquatic Decomposition Score (ADS) and the post-mortem submersion interval measured in Accumulated Degree Days (ADD) in bodies recovered from fresh water.

The Aquatic Decomposition Score (ADS) made by van Daalen et al., was developed to approximate the Post-Mortem Submersion Interval (PMSI) in bodies recovered in salt water. Since the decomposition process in salt water differs from the process in fresh water due to salinity, the temperature, and the depth of the water, we wanted to investigate whether there is a correlation between the ADS and the PMSI and if the ADS can be used to make an estimation of the PMSI in bodies recovered from fresh water. For the latter, the PMSI was measured using Accumulated Degree Days (ADD). In our study we included seventy-six human remains found outdoors in fresh water. Their decomposition was measured using the ADS. A strong correlation was found between the ADS and the PMSI. Also, it was found that the ADS can significantly estimate the ADD. Despite the more varied circumstances under which bodies in fresh water are found when compared to those found in salt water, the ADS can be used to measure the decomposition and accurately estimate the ADD, and thus the PMSI. More research is needed to validate our method and make a prediction model with smaller confidence intervals.

Post-mortem findings in 22 fatal Taxus baccata intoxications and a possible solution to its detection.

BACKGROUND: The yew (Taxus baccata) is a common evergreen tree containing the toxin taxine B. Between 42 and 91 g of yew leaf is lethal to a 70-kg adult. The objective of this article is to present an overview of findings in fatal yew intoxications. METHODS: A search using MeSH terms was performed in PubMed for yew intoxications in the period between January 1960 and August of 2016. RESULTS: We describe a total of 22 cases. Fatal intoxications can be divided into intoxications by leaves, by pulp, by bark and by yew tea. Recognizing yew tea intoxication is difficult since tea no longer contains any botanically recognisable parts. In autopsy and external examination no characteristic findings are reported, regarding the presence of parts of plants. CONCLUSIONS: Indications for yew tree intoxications at a post-mortem examination and autopsy are limited to finding parts of yew tree. The absence of recognisable parts can result in yew intoxications being overlooked. Therefore toxicological screening is recommended in unexplained deaths.

[Pressure ulcer prevention with pressure-reducing seat cushions]. / Preventie van decubitus met drukreducerende zitkussens.

OBJECTIVE: Analysis of the effectiveness of pressure-reducing seat cushions. DESIGN: Literature review. METHOD: Investigation of the literature yielded 8 relevant studies. These studies encompassed three clinical trials with a total of 296 patients, and five laboratory experiments with a total of 107 subjects, including patients. The publications were written at level A (RCT and meta-analysis) and level B (other study forms) according to the principles of evidence-based medicine. Both the pressure parameters of the pressure-reducing seat cushion and the development of pressure ulcers were used as measures for outcome. A 7.6 cm foam cushion was used as reference; it was not considered as one of the pressure-reducing systems. RESULTS: Two studies compared different types of air seat cushions with a foam/gel seat cushion. The best distribution of pressure was found for the air compartment seat cushion. This type of seat cushion provided the smallest contact surface with high pressures. Three studies compared the pressure-reducing systems with a 7.6 cm foam cushion. The methodologically most solid one of these three studies found a lower incidence of sitting-related pressure ulcers for users of a pressure-reducing system (0.9 vs. 6.7%; p = 0.04). The two other studies had too low a power to show significant differences. These two compared different types of foam/gel seat cushions and a low profile air seat cushion and found no significant differences in distribution of pressures. One study compared various foam cushions of differing thickness and found that foam cushions most optimally distributed pressure at a thickness of 8 centimetres. CONCLUSION: Pressure-reducing systems are effective in preventing pressure ulcers. Within the group of pressure-reducing systems, the air compartment seat cushion has the best pressure-distributing properties.