Diagnosis of asphyxiation in advanced decomposed corpses by using Oil-Red-O Stain and immunohistochemical technology.

BACKGROUND: The unambiguous diagnosis of asphyxiation is still a major challenge for the forensic pathologist, especially in terms of highly advanced decomposed corps. METHODOLOGY: In order to demonstrate asphyxiation particularly in profoundly putrid bodies we hypothesized that hypoxic stress is basically responsible for generalized fatty degeneration of visceral organs which can be detected by histological examination using a special staining technique referred to as Oil-Red-O Stain (Sudan III-red-B-stain). To test this hypothesis we examined different tissues (myocardium, liver, lung and kidney) of 107 people divided into 5 groups. These are: (i) 71 case-victims who were found in a truck and died most likely due to asphyxiation, whereby any other violent or natural cause of death was ruled out by postmortem examination; (ii) 10 barely decomposed positive-control-victims; (iii) 6 non-decomposed positive-control-victims; iv) 10 drowning non-decomposed positive-control victims, and v) 10 negative-control-victims. Apart from general histological special staining methods, an immunohistochemically approach as a case-control-study on lung tissues of same individuals was carried out by means of using two polyclonal rabbit-antibodies against (i) HIF-1-α (Hypoxia Inducing Factor-1 alpha) and (ii) SP-A (pulmonary surfactant-associated protein A) to detect both the transcription factor and pulmonary surfactants. The positive proof of already either of them gives evidence of death caused by hypoxia. RESULTS: Histological examination of myocardium, liver and kidney of the 71 case-victims and the 10 positive-control-victims using Oil-Red-O Stain showed a fatty degeneration of small droplet type; there was no evidence for fatty degeneration in tissues of the 10 negative-control-victims. These findings strongly indicate a causal association between oxygen deficiency and generalized fatty degeneration of viscera due to insufficient oxygen supply. In terms of methodology, this special staining technique seems to be very informative, even applicable on decomposed corps. Results of immunohistochemistry indicate that on the one hand the detection of HIF-1α is not possible to perform on (advanced) putrid bodies, whereas the verification of SP-A is still feasible on the other. CONCLUSION: Positive Oil-Red-O staining and the immunohistochemical detection of SP-A can serve as a serious hint for the diagnosis of asphyxia on putrid corpses, considering other circumstances of death that have been determined.

Cancer incidence and survival among American Indians registered for Indian health service care in Montana, 1982-1987.

BACKGROUND: Cancer incidence and cancer survival estimates in American Indians are quite limited. PURPOSE: Our purpose was to estimate cancer incidence and survival in American Indians who were registered for Indian Health Service (IHS) care in Montana. METHODS: We linked databases from the IHS and the Montana Central Tumor Registry (MCTR) to ascertain cases for the time period from January 1, 1982, through December 31, 1987. To calculate survival rates, we used a relative survival method that incorporated age-specific risks for noncancer deaths among American Indians. RESULTS: We identified 344 cases that were compatible with the National Cancer Institute (Surveillance, Epidemiology, and End Results Program) surveillance definition of cancer. Of these cases, 249 (72%) were listed in both the MCTR and the IHS databases; 56 (16%) and 39 (11%) were listed in only the MCTR or the IHS database, respectively. Compared with the overall cancer incidence in U.S. White men, the overall cancer incidence in Montana American Indian men was markedly lower, as was the incidence for colorectal and bladder cancers and for non-Hodgkin's lymphoma. The overall cancer incidence for Montana American Indian women differed less markedly, however, from the overall incidence in U.S. White women. Compared with the cancer incidence in U.S. White women, the incidence in Montana American Indian women was significantly higher for cervical cancer but was significantly lower for colorectal, breast, and uterine cancers. Survival rates from cancer were also examined for the first time in this population. For those sites examined, the survival rates were much lower in Montana American Indians than in U.S. Whites. CONCLUSIONS: We conclude that it is feasible to develop state-specific cancer incidence and survival estimates for American Indians in at least some states in different regions of the United States. Collaboration between the IHS and a state tumor registry is likely to improve the case ascertainment achieved by either agency alone.

Phenotypic heterogeneity in cystic fibrosis.

We have confirmed heterogeneity in CF using a different combination of primary clinical variables than those used in previous studies. Subgroupings of individuals with similar levels of sweat chloride were independent of the clustering based on level of pancreatic enzyme supplementation and degree of pulmonary involvement. Data from families with multiple CF children are consistent with the hypothesis that the genetic etiology of CF involves two or more genes that modify the expression of the primary gene defect.

Similar deficits of central histaminergic system in patients with Down syndrome and Alzheimer disease.

In order to study whether Alzheimer-like neuropathological changes involve the central histaminergic system we measured the concentration of histamine, its precursor histidine as well as the activity of histidine decarboxylase (HDC) and histamine-N-methyl-transferase (HMT) in frontal cortex of aging Down syndrome (DS) patients, Alzheimer patients and control individuals. The study populations were also investigated for choline acetyltransferase (ChAT) activity, since reduced ChAT activity is an established biochemical hallmark in DS and Alzheimer disease (AD). HDC and ChAT activity were reduced in brains of both DS and Alzheimer patients versus control patients. Additionally, we observed a significant decrease of histamine levels in the DS group. Histamine levels in AD brains tended to be decreased. Histidine concentrations and HMT activities were comparable between the three groups. Thus, our results for the first time show histaminergic deficits in brains of patients with DS resembling the neurochemical pattern in AD. Neuropathological changes may be responsible for similar neurochemical alterations of the histaminergic system in both dementing disorders.

Polyamines in frontal cortex of patients with Down syndrome and Alzheimer disease.

Polyamines may play an important role in brain development, mature brain function and also in neurodegenerative conditions. We investigated polyamine levels in frontal cortex of human post-mortem brain samples of elderly patients with Down syndrome (DS), Alzheimer disease (AD) and normal controls by means of chromatographic separation after dansylation. Spermidine and spermine concentrations were markedly decreased in DS and AD. Polyamine levels were neither related to age and post-mortem interval nor to choline acetyltransferase activity, as indicator of neuronal loss. Our results support the idea that besides other neurotransmitter systems, endogenous polyamine levels are altered in dementing illnesses such as Alzheimer disease and Down syndrome.

Endogenous opioids in frontal cortex of patients with Down syndrome.

The main purpose of this study was to investigate differences regarding endogenous opioids in post-mortem frontal cortex of adult patients with Down syndrome (DS), patients with Alzheimer disease (AD) and neurologically healthy persons, respectively, using specific radioimmunoassays. The results of this study show that there is an increase in the levels of leu-enkephalin and dynorphin A in the frontal cortex of patients with DS as compared to the control group. An almost identical increase was also observed when comparing patients with AD to controls. In conclusion, the results of this study suggest a relationship between elevated tissue levels of leuenkephalin and dynorphin A in cerebral cortex and cognitive impairments in patients with DS and AD.

Drug-related deaths between 1985 and 1992 examined at the Institute of Forensic Medicine in Vienna, Austria.

Considering the official figure on drug-related deaths in Austria, the problem of substance abuse has dramatically worsened over the last years. There is a distinct lack of comprehensive information concerning drug-related deaths in Austria, although deaths of drug users may be potentially important indicators of the extent of drug-related problems in the population. The results of examinations performed on 372 deceased substance abusers at the Institute of Forensic Medicine in Vienna between 1985 and 1992 are presented. Drug-related deaths are defined according to the official definition issued by the Austrian Federal Ministry of Internal Affairs. A distinction was made between injecting drug users and non-injecting drug users with respect to infectious diseases transmitted by sharing of paraphernalia. Between 1985 and 1992 there was a distinct increase in drug-related deaths. In approximately 30% an accidental single substance intoxication, mainly due to morphine, was found. A connection with a better quality of street drugs is assumed but not proven. In 207 corpses more than one drug, including alcohol, was detected. During the investigation there was an evident trend towards multi-substance abuse patterns. Furthermore, blood alcohol concentration, an additional risk factor for narcotic overdose, was strongly associated with higher age. The small number of examined drug injectors found positive for the human immunodeficiency virus type-1 (HIV-1) makes it difficult to draw any kind of conclusion regarding the HIV-I seroprevalence among injecting drug users in Vienna.

Quality of heroin and heroin-related deaths from 1987 to 1995 in Vienna, Austria.

AIMS: To investigate the quality of heroin seized in Vienna between 1987 and 1995 and to examine whether there was a relationship between the quality of heroin and the rate of drug-related deaths. DESIGN: Reports of heroin seizure analysis and post-mortem reports of heroin-related deaths in Vienna from 1987 to 1995 were analysed. RESULTS: There were 386 seizures of heroin comprising a total weight of 25 640.12 g heroin. All the seizures were in the base form. All seizures also contained a diluent, mainly lactose. Additionally, in 95 seizures caffeine, in four seizures paracetamol and in three seizures metaqualon were detected. Of a total of 764 drug-related deaths 506 cases were classified as heroin-related deaths. In 336 cases other central nervous system-depressant drugs and/or alcohol could be detected in the blood in addition to morphine (polydrug heroin-related deaths). There was evidence of a trend towards greater polydrug involvement during the study period. The age of victims of polydrug heroin-related deaths remained unchanged over time while the age of victims of pure heroin-related deaths decreased significantly. The morphine concentration in the medulla oblongata in heroin-related deaths decreased significantly. Finally, there was no statistically significant relationship between the rate of heroin-related deaths per year and the diacetylmorphine concentration of heroin seizures in that year. CONCLUSION: The results did not substantiate the widely held belief that increases in heroin-related deaths could be explained by an increase in the quality of heroin.

Mortality of opiate users in Vienna, Austria.

The purpose of this study was to investigate whether there are differences in overall and cause-specific mortality rates of opiate users in maintenance treatment and of opiate users not in any drug treatment program in Vienna, Austria. A cohort of opiate-users enrolled in maintenance treatment in Vienna and a cohort of individuals involved in opiate-related emergencies from 1995 to 1997 were retrospectively analyzed. The standardized mortality rate of opiate-users enrolled in maintenance treatment was 12.1 and that of individuals involved in opiate-related emergencies was 48.8. Excess mortality was found for all categories for both groups. In the face of the extremely high excess mortality of opiate users involved in opiate-related emergencies, measures have to be taken to get these individuals in drug treatment programs as soon as possible.

Drug-related emergencies and drug-related deaths in Vienna, 1995-1997.

The demographics of drug-related emergencies and drug-related deaths that occurred in Vienna between January 1st, 1995 and December 31st, 1997 were compared to investigate whether they represent two different subgroups of the drug-taking community. Analysis indicated that drug-related emergencies were significantly younger and that the proportion of females was higher than amongst the fatalities. In addition, emergencies were more likely than fatalities to occur in private residences than public places. No significant association between the number of contacts with the Vienna Ambulance Service and the fatal outcome of drug use could be substantiated. The results of this study indicate that drug-related emergencies and drug-related deaths represent two different subpopulations of the drug-taking community. Therefore, different strategies of prevention are considered.

Excitatory amino acids and monoamines in parahippocampal gyrus and frontal cortical pole of adults with Down syndrome.

Aspartate (ASP), glutamate (GLU), noradrenaline (NA), dopamine (DA) and its acidic metabolites DOPAC and HVA, serotonin (5-HT) and its metabolite 5-HIAA were simultaneously investigated in post-mortem tissue samples from right parahippocampal gyrus (temporal cortex) and frontal cortical pole (frontal cortex) of adults with Down syndrome (DS), and of neurologically healthy controls by use of high performance liquid chromatography (HPLC). In parahippocampal gyrus, ASP, GLU, NA, DOPAC and 5-HT levels were significantly decreased in patients with DS, compared to levels found in control subjects (approximately 50%). No significant changes were observed in frontal pole. ASP and GLU levels were significantly lower in parahippocampal gyrus than in frontal pole of DS, a regional distribution that could not be observed in control subjects. In conclusion, the results of this study suggest that the temporal cortex would be more affected than the frontal cortex in adult patients with DS, a finding in line with reports showing a marked hypometabolism and extensive cell loss in temporal cortex of DS, and with those showing that parahippocampal gyrus abnormality may correlate with the extent of mental retardation affecting this type of patients.

Experience with the cytological demonstration of smoker cells in the identification of disaster victims illustrated by the findings concerning the Lauda-Air airliner crash near Bangkok.

On 26 May 1991, a Lauda-Air airliner crashed after take-off at Bangkok from an initial height of approximately 8000 m. The plane came down in inaccessible jungle terrain, so that the difficulties of locating and salvaging the victims were considerably increased by the tropical conditions and the looting that had occurred. Identification of the victims took place in extremely adverse working conditions in the pathological department of the Police Hospital in Bangkok. The technique developed by the first author for the identification of persons in the light of their smoking habits by determining the existence of the so-called smoker cells was used to subdivide the entire autopsy material into 'smokers', 'non-smokers' and 'incidental or passive smokers'. This allows the division of mass disaster victims into smaller specific groups and the application of further identification procedures within these groups in a shorter time. The findings of the cytological examination carried out locally were compared with the police investigations regarding the individual victim's smoking habits, and the method quick and simple to use even in 'field conditions', proved highly efficaceous.

Risk of dying after a free fall from height.

Falls from height are predominantly an urban phenomenon and represent an important form of blunt trauma. Disagreement predominates regarding the height at which death results. The aim of this study was to investigate the risk of dying after a free fall from height in relation to the distance fallen. Therefore, medical records of victims of a fall from height treated in 1989 at Viennese emergency units were analysed. In addition, post-mortem reports of deaths due to falls from height, examined in the same year at the Institute of Forensic Medicine in Vienna, were studied. For the purpose of an homogenous investigation sample in regard to physical condition, only people aged from 20 to 50 years were taken into account. A total of 11 females and 30 males suffered an accidental fall from buildings, seven men from scaffolding and two men from a tree. A total of 18 females and 18 males jumped from residential buildings. One woman and nine men intentionally fell from other buildings. All victims landed on concrete or pavement. Suicidal jumps occurred from significantly higher places than accidental falls. The results of this analysis suggest that death usually occurs when distance is more than five storeys.

Suicide of a body packer.

The smuggling of illicit drugs by means of body packing has become a common problem at European airports. Europe is considered to be the fastest growing market for cocaine worldwide, and the air route is the most frequently used method of trafficking cocaine. Smuggling illicit drugs by use of body packing is considered to be a high toxicological hazard because of the risk of leakage or a package bursting. We report about the first case of suicide of a body packer by re-ingesting the content of excreted cocaine packages. The consequence of this case is that the death scene investigation and autopsy assessments in case of a body packer's death should always consider the possibility of re-ingested packages. Detention personnel should be instructed by forensic and criminalistic experts to take preventive measures.

HIV-1- prevalence among drug deaths in major cities of central and northern Europe.

Since 1985, a number of Institutes of Forensic Medicine in Germany have cooperated in a multicenter study, to provide a constant monitoring of HIV-1-prevalence among drug related deaths. In 1990/91, the Institutes in Copenhagen, Stockholm, Vienna and Zürich also participated in this study. HIV-1-prevalence is decreasing in the German cities, whereas the epidemiological development is not uniform in the other major cities. Regional differences are obvious. In 1991, the prevalence rates were as follows: Berlin 15% (n = 220), Hamburg 4% (n = 179), Frankfurt 17% (n = 167), Munich 9% (n = 136), Stockholm 10% (n = 79), Copenhagen 14% (n = 130), Vienna 20% (n = 56), and Zürich 23% (n = 84).

Middle digestive cancers in Texas Hispanics: a New World syndrome?

To test the hypothesis that middle digestive cancers in Texas Hispanics follow the patterns predicted by the New World Syndrome (1984), cancer incidence rates and relative risks for middle digestive cancers were estimated for 1944-1992. The relative risk for all middle digestive cancers is significantly elevated in Texas Hispanics compared with Anglos, and this risk has increased over time. Elevated risks of these cancers in Texas Hispanics have been explained as resulting from the evolutionary history of Native Americans (American Indians), their genetic relation to Texas Hispanics, and a changing diet and lifestyle. Recent Texas cancer incidence data add further support to the hypothesis. Other current disease prevalence data in Texas Hispanics, percent of the population which is diabetic and percent which is overweight, are also consistent with the New World Syndrome. Expected patterns of disease in males vs females are also confirmed. Factors that do not support the New World Syndrome hypothesis and can be examined by future studies are described. This is the first report since the original describing and updating patterns of middle digestive cancers in Texas Hispanics as resulting from the New World Syndrome. Application of these findings to contemporary medical practice and to cancer prevention are reviewed.

Carbon monoxide-related deaths from 1984 to 1993 in Vienna, Austria.

Carbon monoxide poisoning occurs frequently in industrialized countries. Between 1970 and 1978 in Vienna, the capital of Austria, carbon-monoxide-rich coal gas was replaced with natural gas. Despite this fact, people still die of unintentional carbon monoxide poisoning. The main purpose of this study was to determine the reasons for unintentional carbon monoxide-related deaths, and further to describe the epidemiology of these fetal poisonings in Vienna between 1984 and 1993. A secondary purpose was to investigate whether intentional carbon monoxide poisoning still plays a role among suicides as was the case up to the 1970s. For this purpose we analyzed carbon monoxide-related deaths in Vienna from 1984 to 1993, based on actual autopsy reports of postmortems performed at the Viennese Institute of Forensic Medicine. Deaths due to fire were excluded. The main reason for unintentional carbon monoxide-related deaths in Vienna between 1984 and 1993 was flueless gas-fueled water heating appliances, overused especially by old people during the cold period of the year. The frequency of unintentional carbon monoxide-related deaths in 1993 was almost as high as in 1984. A total of 53% of deceased persons were over age 60. Most fatal carbon monoxide poisoning occurred during the cold period of the year. Suicides decreased significantly during the investigation period. In 76% of these deaths car exhaust fumes were inhaled, especially by men. In conclusion, we recommend programs to prevent unintentional carbon monoxide-related deaths. These programs should especially target the elderly. Flueless gas boilers should not be overused. Furthermore, apartments should be aired sufficiently, even during the cold period of the year.(ABSTRACT TRUNCATED AT 250 WORDS)

Should coroners be able to recognize unintentional carbon monoxide-related deaths immediately at the death scene?

The aim of this retrospective survey of unintentional carbon monoxide-related deaths in Vienna was to determine whether the cherry-pink coloring of livor mortis is a reliable finding for the coroner to suspect a carbon monoxide-related death immediately at the death scene. In addition, we investigated the recognition pattern of unintentional carbon monoxide-related deaths by Viennese coroners between 1984 and 1993. Therefore, we analyzed autopsy reports of postmortems performed at the Viennese Institute of Forensic Medicine between 1984 and 1993. The study involved 182 unintentional carbon monoxide-related deaths: 92 females and 90 males. We found a strong association between the carboxyhemoglobin level and the cherry-pink coloring of livor mortis. In 98.4% of unintentional carbon monoxide-related deaths livor mortis were clearly cherry-pink. During the 10-year study period Viennese coroners recognized only 61% of unintentional carbon monoxide-related deaths immediately at the death scene. The percentage of unrecognized carbon monoxide fatalities with a clear cherry-pink coloring of livor mortis almost doubled from 1984 to 1993. The older the victim, the worse the coroners recognition. In summary, we have shown that coroners should be able to recognize unintentional carbon monoxide-related deaths immediately at the death-scene, because fresh corpses with carboxyhemoglobin levels greater than 31% show a clear cherry-pink coloring of livor mortis. Therefore, coroners should be encouraged to examine naked corpses thoroughly, especially regarding the color of livor mortis. Thus, a carbon monoxide-related death can be recognized immediately and the source of gas release identified as soon as possible protecting people who otherwise would also be at risk of poisoning.(ABSTRACT TRUNCATED AT 250 WORDS)

Does drug abuse lead to criminal behavior? An analysis based on criminal registers of 117 drug-related deaths, examined in 1992 at the Institute of Forensic Medicine in Vienna, Austria.

That there is a link between drug abuse and criminal behavior has been established. However, explaining the nature of this relationship has proven difficult. The purpose of this study was to investigate whether the traditional view that drug abuse leads to future criminal behavior holds true in case of the drug-related deaths examined in 1992 at the Institute of Forensic Medicine in Vienna, Austria. For this purpose postmortem reports and criminal registers of 117 drug-related deaths were analyzed. A total of 43% of the examined sample had no criminal register. Regarding age at time of death there was no difference between those with or without a criminal register. A total of 57% had at least one conviction. A minority committed about one third of offenses. Property offenses were the most frequent type. Those who started their criminal history with a property offense were younger at time of first conviction and committed more offenses during their life. In summary, the traditional view that drug abuse leads to future criminal behavior does not seem to hold true in case of the drug-related deaths examined in 1992 at the Institute of Forensic Medicine in Vienna, Austria. The results of this retrospective study speak in favor of a view that drug abuse may be a part of contemporary delinquent behavior, rather than the cause of criminality.

Family background of drug-related deaths: a descriptive study based on interviews with relatives of deceased drug users.

Drug abuse and problems arising from it are increasing all over the world. Most of the research concerning substance abuse has focused on three dimensions: sociocultural influences, personal characteristics, and interpersonal factors. The aim of this descriptive study was to describe family characteristics of drug-related deaths examined at the Viennese Institute of Forensic Medicine in 1993. Furthermore, it was of interest to analyze the onset of substance use as well as traumatic life events during childhood. For this purpose, relatives or partners for life of drug-related deaths, examined from 1 Jan. to 30 June 1993 at the Institute of Forensic Medicine in Vienna, were interviewed using a semistructured technique. Eighty percent of drug users were reported to have experienced a traumatic event during their childhood. In the majority, this was the parents' divorce or the death of a parent. Male drug users were significantly younger at time of this event than females. The first signs of smoking and alcohol drinking of examined drug users, as recognized by the interviewees, occurred at the age of about 15. Those who experienced a traumatic event during their childhood started to smoke at a significantly lower age. In 3/4 of investigated cases, parents also were smokers, and more than one third of families had a problem drinker, mostly the father. In 16% of drug users, a mental disturbance concerning the mother was reported, and in 14%, prescribed psychoactive drugs were regularly used. Physical violence, generally by the father, was a common phenomenon in 20% of investigated families. About 45% of the victims were from families having more than one of these factors present.