Serum biochemical markers in drowning: diagnostic efficacy of Strontium and other trace elements.

The aim of our study was to analyse several serum biochemical markers in order to evaluate the discriminant capacity of trace elements individually and jointly in drowning (seawater drowning and freshwater drowning) and their correlation with age, sex, postmortem interval, time in water and concentrations of the trace elements in the drowning medium. Sixty-seven cases of drowning (53 seawater drownings (SWD); 14 freshwater drownings (FWD) and 73 control cases (other asphyxias, n=44, and other causes of death, n=29) were selected according to the scene, cause and circumstances of death, together with autopsy findings. Serum strontium (Sr), magnesium (Mg), sodium (Na), chloride (Cl), calcium (Ca), iron (Fe), urea, creatinine (Cr) and cardiac Troponine T (cTn-T) were measured in the left ventricle (Lv), right ventricle (Rv) and peripheral blood. Lv-Rv differences for each marker and Sr, Mg, Na, Cl, Ca and Fe concentrations in the drowning medium were determinated. Mean concentrations of Sr, Cl and Mg in both ventricles and peripheral serum and Lv-Rv differences and Ca Lv and Na Rv were significantly higher in cases of drowning than for other causes of death. In SWD, Sr, Mg, Ca, Na and Cl were significantly higher in Lv than in Rv as a result of aspirating water. In contrast, haemodilution is evident from the significantly higher levels of Fe and urea in Rv than in Lv in cases of SWD, and from the higher Mg and Cr levels in Rv in FWD. In the case of SWD, serum levels of Sr are confirmed as the best parameter for diagnosis, although other trace elements may also be useful, such as the serum concentrations of Mg and Cl. In the case of FWD, the joint determination of Sr and other biochemical markers, especially Fe, may increase correct diagnosis.

Signo del cono truncado y signo de Benassi en suicidio por arma de fuego / Cone-like sign and Benassi sign in a suicide by firearm

La variabilidad en los orificios de entrada y salida por arma de fuego depende de la distancia, tipo de arma y región anatómica, por lo que puede presentar una morfología muy variada; es por ello que, aunque ya se han publicado varias imágenes de suicidio por otro tipo de armas, hoy aportamos un caso de suicidio típico por arma corta, deteniéndonos en la descripción de las lesiones que se originan en el cráneo. Se presenta el caso de un suicidio por arma de fuego con un arma de calibre 6.35. Se pretende estudiar en el orificio de entrada el Signo del cono truncado (impropiamente denominado signo de Bonnet) y el Signo de Benassi (AU)

The variability in the entrance and exit wound produced by firearms, depends on the distance, type of weapon and anatomical region, so it can present a very different morphology, which is the reason why, that although several pictures of suicide by other weapons have been published, today we provide a typical case of suicide by a short barrelled gun (pistol), concentrating on the description of the injuries that originate in the skull. Here we present a case of a suicide with a 6.35 calibre gun. We intend to study the cone-like sign inside the entrance hole (incorrectly called Bonnet sign) and the Benassi sign (AU)

Strontium levels in different causes of death: diagnostic efficacy in drowning.

Trace element determination can be applied in forensic medicine to diagnose the cause of death. Drowning is the second leading cause of death from unintentional injury. Despite the many diagnostic methods used, the post-mortem diagnosis of drowning continues to be one of the most difficult in forensic pathology. Strontium is a highly sensitive marker of water aspiration in a liquid medium rich in this metal. The aims of this study were to confirm the diagnostic value of strontium in cases of drowning compared with other causes of death, to analyse factors that could affect its concentration and to ascertain the sensitivity and specificity of strontium in right and left ventricles and peripheral serum for the post-mortem diagnosis of drowning. We studied 120 cadavers selected from medico-legal autopsies with different causes of death. Strontium (Sr) levels were measured in the serum (left and right ventricles and peripheral vein) of all cadavers and, in the case of drowning, in the water medium itself, by using Zeeman AAS. Our results confirm the usefulness of blood Sr levels for diagnosing seawater and freshwater drowning, although great care should be exercised in the latter case.

Histological findings and immunohistochemical surfactant protein A (SP-A) expression in asphyxia: its application in the diagnosis of drowning.

The histopathological alterations that permit the diagnosis of death by asphyxia are very unspecific, although pulmonary alterations are of great importance in this respect. The postmortem diagnosis of drowning, particularly, continues to be one of the most difficult in forensic pathology. The aim of this study is to jointly evaluate microscopic findings and immunohistochemical surfactant protein A (SP-A) expression in the upper and lower lobes of lungs in different causes of death, and their possible application to the diagnosis of drowning. We studied 120 cadavers from subjects with a mean age of 48.73 years (SD 19.45; range 2-86 years), and with a mean post-mortem interval of 30 hours (SD 39.59; range 3-216 hours). According to the scene, cause and circumstances of death, and autopsy findings, cases were classified into groups as follows: (a) drowning (n=47); (b) other asphyxia (n=44) and (c) other causes (n=29). In the upper and lower lobes of lungs, histological studies of H&E staining and immunohistochemical surfactant protein A expression were made. The presence and severity of congestion, haemorrhage and oedema, together with immunohistochemical SP-A expression, may have a diagnostic value in differentiating asphyxia and drowning from other causes of death, and drowning from other types of asphyxia. Our findings suggest that both lobes should be investigated to establish the diagnosis, although the findings in the upper lobe might be the most important for differentiating the exact cause of death.

Lesiones por electricidad / Injuries by electricity

Desde que en 1879 Jex-Blake describió la primeramuerte por electrocución se han publicado diversos artículossobre el tema. En esta revista se han mostrado imágenesde la marca eléctrica de Jenillek y quemaduras encasos de muerte causada por electricidad; sin embargo,no se han expuesto casos que describan las deficienciastras un accidente eléctrico.En este número describimos las secuelas permanentes,tras un seguimiento de seis años, que sufrió unadolescente a consecuencia de las lesiones padecidas porun accidente por electricidad de alta tensión (más de1000 voltios)

Since in 1879 Jex-Blake described the first deathby electrocution have published diverse articles on thesubject. In this magazine have been to images of theelectrical mark of Jenillek and burns in cases of deathcaused by electricity; nevertheless, cases have not beenexposed that describe the deficiencies after an electricalaccident.In this number we described the permanentsequels, after a pursuit of six years, that underwent anadolescent as a result of the injuries suffered by anaccident by electricity of high tension (but of 1000 volts)

Muerte por ahorcadura / Death by hanging

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Pancreatitis aguda necrotizante en una intoxicación fatal por metadona / Acute necrotizing pancreatitis in a fatal poisoning with methadone

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Pancreatitis aguda necrotizante en una intoxicación fatal por metadona / Acute necrotizing pancreatitis in a fatal poisoning with methadone

La pancreatitis necrotizante es una causa infrecuente de muerte súbita. La metadona, un fármaco empleado en el tratamiento sustitutivo de adictos a opiáceos, ha sido responsable de muertes tras su ingestión accidental por niños cuando estaba a su alcance, en intentos autolíticos o después de un período de abstinencia en pacientes con tolerancia. La muerte se debe a depresión del sistema nervioso central y depresión respiratoria. Reportamos un caso de muerte súbita con pancreatitis aguda necrotizante y hemorrágica, hemorragia suprarrenal y edema pulmonar en el contexto de una sobredosis por metadona en un paciente en programa de mantenimiento. Se descartaron otras causas frecuentes de pancreatitis como el alcoholismo crónico o la patología de tracto biliar. Discutimos la constelación de hallazgos para sugerir un posible mecanismo fisiopatológico (AU)

Necrotic pancreatitis is a rare cause of sudden death. Methadone, a drug used as a substitution treatment in heroin addicts, has been responsible for deaths after accidental ingestion by children of carelessly stored methadone, in suicide attempts or after a period of abstinence in tolerant patients. Death results from central nervous system and respiratory depression. We report a case of a sudden death with acute hemorrhagic and necrotizing pancreatitis, suprarenal haemorrhagia and pulmonary edema in the context of an overdose of methadone in a patient in an opioid maintenance program. Other frequent causes of pancreatitis such as chronic alcoholism and biliary tract disease were ruled out. We discuss the constellation of findings with regard to possible pathophysiological mechanisms (AU)

Pancreatitis aguda necrotizante en una intoxicación fatal por metadona / Acute necrotizing pancreatitis in a fatal poisoning with methadone

La pancreatitis necrotizante es una causa infrecuente de muerte súbita. La metadona, un fármaco empleado en el tratamiento sustitutivo de adictos a opiáceos, ha sido responsable de muertes tras su ingestión accidental por niños cuando estaba a su alcance, en intentos autolíticos o después de un período de abstinencia en pacientes con tolerancia. La muerte se debe a depresión del sistema nervioso central y depresión respiratoria. Reportamos un caso de muerte súbita con pancreatitis aguda necrotizante y hemorrágica, hemorragia suprarrenal y edema pulmonar en el contexto de una sobredosis por metadona en un paciente en programa de mantenimiento. Se descartaron otras causas frecuentes de pancreatitis como el alcoholismo crónico o la patología de tracto biliar. Discutimos la constelación de hallazgos para sugerir un posible mecanismo fisiopatológico (AU)