1/9. Deaths associated with liposuction: case reports and review of the literature.Tumescent liposuction is a common cosmetic procedure that is performed as an outpatient service in physician's offices and is largely believed to be safe. The protuberant areas of the body containing the undesirable fat deposits are injected with normal saline containing lidocaine and epinephrine for pain control and hemostasis, and the waterlogged cells are suctioned out via cannula through a small incision. We recently encountered three cases in which deaths were attributed to this procedure. Two showed fat embolization in the lung and one died from fluid overload. The osmium tetroxide post-fixed lung sections showed fat emboli in the interstitial capillaries and arterioles. We reviewed the recent literature and found that pulmonary thromboemboli, fat embolization, fluid overload, and lidocaine and epinephrine intoxication are found at autopsy in many cases. Forensic pathologists responsible for determining the cause and manner of death should become familiar with the postmortem findings and risks of liposuction therapy and communicate them to their clinical colleagues and communities.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/9. diffusion MRI in the postmortem brain: case report.Postmortem brain of a ten-month-old child was examined by MR imaging, and diffusion MR imaging at the 12th hour after death in order to disclose the cause of death. There were basal ganglion lesions indicating a mitochondrial disorder. There was a prominent difference between the ADC values of the white matter (0.28 /-0.04 x 10(-3) mm2/s) and cortex (0.42 /-0.04 x 10(-3) mm2/s), and this was statistically significant (p< 0.0001). This difference suggested that in the postmortem brain the conditions in the white matter leading to restriction of movement of water molecules are more severe than that in the cortex.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
3/9. An unusual case of post-mortem redistribution of ethanol.We report an unusual case of post-mortem redistribution of ethanol in a woman diver who died by drowning in seawater. The ethanol concentrations were right heart blood 0.60 g/l, left heart blood 2.08 g/l, femoral venous blood 0.63 g/l, gastric contents 5.87 g/l, bile 0.83 g/l. The mechanisms of post-mortem redistribution of ethanol described in the literature, that is, early redistribution from the stomach or the lung parenchyma in the case of inhalation of gastric contents, are inadequate to account for the degree of variation observed between the measurements. We believe that this difference in concentration is explained by the presence of seawater in the pulmonary alveoli at the time of death.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |
4/9. Unusual finding in a water-logged corpse--hyperchylomicronemia or pulmonary fat embolism?During excavation work at the bank of the River Inn the corpse of a 32-year-old alcoholic male was recovered. head injuries suggested a crime of violence. Postmortem examination demonstrated conspicuous milky turbidity of the blood, which was found by laboratory testing to be due to hyperchylomicronemia. The findings are interpreted and their relevance to the determination of postmortal head injuries is discussed. The inadequacy of double-edged knife specimens and frozen-section biopsies for the estimation of pulmonary fat embolism as a vital reaction is considered.- - - - - - - - - - ranking = 4keywords = water (Clic here for more details about this article) |
5/9. vibrio vulnificus septicaemia presenting as spontaneous necrotising cellulitis in a woman with hepatic cirrhosis.vibrio vulnificus is a virulent marine organism commonly found in hong kong coastal waters which contaminates local sea-food. It may produce a primary septicaemia, often associated with secondary skin lesions, following ingestion of raw shell fish. We report a rapidly fatal case of primary V. vulnificus septicaemia in a 50-year-old housewife with post-hepatitic cirrhosis presenting as spontaneous necrotising cellulitis of the legs. V. vulnificus infection should be considered in patients with a history of liver disease with acute septicaemia and characteristic skin lesions.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
6/9. diatoms and drowning.An examination is made of the applicability of quantitative and qualitative diatom analysis to the diagnosis of death by drowning, definition of the environment in which drowning occurred, and delimitation of the area where it occurred. the material comprises 107 bodies of subjects known or suspected to have died by drowning together with a control series of 15 bodies of subjects over 30 years of age who had died of various diseases on land. Whenever diatoms were found in the greater circulatory organs they were also found in the lungs, and when none were present in the lungs none were found in the other organs either. No diatoms or fragments of diatoms were found in the samples from the control subjects. All the fresh, well-preserved bodies for which death by drowning could be regarded as certain from the macroscopic autopsy findings and police reports, the cases used to test the method, gave quantitative diatom results that supported a diagnosis of water aspiration. The diatoms identified in the qualitative analyses served well to describe the ecological properties of the environments in which death had taken place, and the site of drowning could be defined by means of comparative water samples provided that sufficient diatoms were present, the local environment was not too homogeneous or the diatoms were not of quite different species due to a completely unknown location of death.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |
7/9. Preservation of human tissue immersed for five years in fresh water of known temperature.Two human bodies were recovered from the waters of the Duluth, minnesota harbor. Extensive adipocere formation resulted in remarkable preservation of gross anatomic features of internal organs. Total time of immersion could be precisely estimated at five years. Water temperature during those five years could also be accurately estimated by direct measurements taken during the year following recovery of the bodies and from information supplied by a local electric power generating company. immersion occurred at the time of the year when water temperature was highest (70 degrees F [21 degrees C]) facilitating the rapid formation of adipocere. A proposed mechanism for formation of adipocere is described.- - - - - - - - - - ranking = 6keywords = water (Clic here for more details about this article) |
8/9. diatoms and drowning--a cautionary case note.A case is described in which, due to long-term repeated exposure to the same body of diatom-containing water, comparable diatom findings in the tissues and environmental samples were not acceptable as proof of drowning. A commonly overlooked pitfall limiting the value of acid-digestion in marine cases is emphasized.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
9/9. Postmortem distribution pattern of morphine and morphine glucuronides in heroin overdose.The postmortem distribution of morphine and its metabolites was investigated in four cases of heroin overdose to evaluate some of the factors that influence intravasal blood concentrations. Variables included were the chemical stability of morphine conjugates, hemoconcentration, incomplete distribution of the drug and diffusion processes. blood samples from different sampling sites including the aorta, the infra- and suprarenal portion of the inferior vena cava, the superior vena cava, the femoral and subclavian veins, and the right and left ventricles were examined for morphine, morphine-3-glucuronide and morphine-6-glucuronide, hematocrit and water content. Drug concentrations were determined by HPLC based on the native fluorescence of the analytes. morphine glucuronides proved to be stable for a time period of 72 h. The water content ranged from 65 to 83% and hematocrit values from 25 to 75%, and were seen as contributory factors to the dramatic differences observed for drug concentrations from different sampling sites. The differences could neither be attributed to incomplete distribution during life-time nor to a diffusion process following the different distribution volumes of morphine and its conjugates. A definite relationship between the ratio of the molar concentrations of morphine and its glucuronides, as assessed in pharmacokinetical studies after morphine dosing, could not be established. For a better understanding more cases and changes over time and tissue concentrations should be analysed.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |