Procalcitonin and C-reactive protein in pericardial fluid for postmortem diagnosis of sepsis

The aim of this study was to investigate the presence and concentrations of procalcitonin and C-reactive protein in pericardial fluid and compare these levels to those found in the postmortem serum obtained from the femoral blood. Two groups were formed, a sepsis-related fatalities group and a control group. Postmortem native CT scans, autopsies, histology, neuropathology and toxicology as well as other postmortem biochemistry investigations were performed in all cases. Pericardial fluid procalcitonin levels were significantly different between the cases of sepsis-related fatalities and those of the control group. Postmortem serum procalcitonin levels below the detection limit were also reflected in undetectable pericardial fluid levels. Similarly, a large increase in postmortem serum procalcitonin levels was reflected in a large increase of procalcitonin pericardial fluid levels. Based on these findings, pericardial fluid could be an alternative to postmortem serum for the determination of procalcitonin levels in cases where postmortem serum is not available and measurements of procalcitonin are required to circumstantiate the pathogenesis of death.     

Cardiac troponin I (cTn I) and the postmortem diagnosis of myocardial infarction

In clinical practice several biochemical markers are used for the diagnosis of myocardial infarction. Because of its extremely high specificity for myocardial damage, cardiac troponin I (cTn I) is frequently used. The aim of this study was to evaluate the diagnostic efficacy of postmortem cTn I determinations in pericardial fluid and serum and to compare these results with other biochemical markers and with structural findings used to diagnose acute myocardial ischaemia. We studied 89 cadavers with a mean age of 51.38 ± 2.04 (SD 19.27 years). Cases were allocated to 1 of 4 diagnostic groups depending on the probable intensity of myocardial damage and cause of death. In pericardial fluid we obtained statistically significant differences for the four biochemical parameters, while in serum myosin heavy chains and myoglobin showed statistically significant differences. The highest levels of biochemical markers in pericardial fluid were observed in subjects who had died from definite myocardial infarction. Received: 7 August 1997 / Received in revised form: 5 January 1998     

Evaluation of postmortem urea nitrogen, creatinine and uric acid levels in pericardial fluid in forensic autopsy

In postmortem biochemistry, there is insufficient data available for the practical analysis of factors in the pericardial fluid. The aim of the present study was to examine postmortem pericardial fluid for urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels to investigate the pathophysiology of death in forensic autopsy cases (total, n = 409; within 48 h postmortem), which included blunt, sharp instrument injury, asphyxiation, drowning, fire fatalities, hyperthermia, hypothermia, methamphetamine-related fatalities, other poisoning, delayed death from trauma and natural diseases. There was a significant elevation in the three markers for chronic renal failure, gastrointestinal bleeding, hyperthermia, hypothermia, methamphetamine fatalities and delayed traumatic death, which was comparable with the clinical criteria for their serum levels. These postmortem findings showed azotemia due to renal failure, elevated protein catabolism and rhabdomyolysis. Although the pericardial levels were otherwise similar to the clinical serum reference ranges, only the drowning fatalities showed significantly lower levels for each marker. These observations suggested the stability of UN, Cr and UA in the pericardial fluid within 48 h postmortem and their usefulness for the pathophysiological investigation of death involving azotemia.     

The development of a highly sensitive IgE immunoradiometric assay using monoclonal antibodies

We have developed two-site immunoradiometric assay (IRMA) for quantitation of human serum IgE, using two different anti-IgE monoclonal antibodies which recognize different epitopes on IgE molecule. We obtained 25 different monoclonal antibodies classified seven groups, and then two different monoclonal antibodies were selected for bead coater and tracer after checking the titer and specificity of each antibody. IgE IRMA we developed here showed good performance in terms of specificity, sensitivity and reproducibility. No cross-reactivity to IgG, IgM and albumin in the level of normal range was observed. The sensitivity for IgE assay was 0.6 x 10(-3) IU/tube and measurable range was 0.01-20.0 IU/tube (0.5-10(3) IU/ml). Coefficient of variations of Intra assay were 2.2-4.3% and average recovery yield was 92.5-108%. Good correlations with Phadebas IgE PRIST and Pharmacia IgE RIA were obtained i.e., y = 1.12x-0.19 (r = 0.96) and y = 0.97x-5.9 (r = 9.7), respectively. These results indicate that the assay system will contribute much to the routine diagnosis for atopic allergy disease and parasitic infections.     

Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1. Analysis with special regard to traumatic causes of death

In forensic pathology, previous studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction. However, there appears to be insufficient practical data on other causes of death. The present study was a comprehensive analysis of the cardiac, peripheral blood and pericardial levels of cardiac troponin T (cTnT) in serial medicolegal autopsy cases (n = 405) with a survival time <24 h and within 48 h postmortem to assess the validity of investigating myocardial damage with special regard to traumatic causes of death. These included blunt and sharp instrument injury (n = 122 and 21, respectively), asphyxiation (n = 35), drowning (n = 27), fire fatalities (n = 94), hyperthermia (n = 13), hypothermia (n = 6), fatal methamphetamine (MA) abuse (n = 12) and carbon monoxide (CO) poisoning (n = 5) in comparison with myocardial infarction (MI, n = 57) and cerebrovascular diseases (n = 13). Cases within 12h postmortem usually showed lower cardiac and pericardial cTnT levels than did those of longer postmortem time of 12-48 h. In the early postmortem period of <12 h, significantly elevated serum cTnT levels were observed for hyperthermia. Thereafter, fatal MA abuse, CO poisoning and MI cases also showed higher levels. However, cTnT remained at lower levels for hypothermia and drowning. The elevation of cTnT was associated with the pathology of advanced myocardial damage involving swelling and liquefactive necrosis. The above-mentioned differences were the smallest for peripheral blood. These findings suggest that elevations in postmortem serum and pericardial cTnT levels depend on the severity of myocardial damage at the time of death and are related to the pathological findings, although postmortem interference should be taken into consideration.     

Differences in postmortem urea nitrogen, creatinine and uric acid levels between blood and pericardial fluid in acute death

Previous studies showed significant differences in postmortem urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels in heart blood depending on the causes of death, including acute death. In addition, the levels in pericardial fluid approximated the clinical serum reference ranges, and their elevations may be assessed based on clinical criteria. The present study investigated difference between blood and pericardial levels of these markers. Medicolegal autopsy cases (n=556, within 48h postmortem) of the following causes of death were examined: injury (n=136), asphyxiation (n=50), drowning (n=39), fire fatalities (n=99), hyperthermia (n=11), hypothermia (n=8), poisoning (n=26), delayed traumatic death (n=44) and natural diseases (n=143). When serum UN, Cr and UA levels were compared with the pericardial levels, there was an equivalency for delayed traumatic death and chronic renal failure, although each level was markedly elevated. Parallel increases in serum and pericardial UA and/or Cr levels were also observed for hypothermia and gastrointestinal bleeding. However, in drowning cases, the left cardiac and pericardial UN levels were lower than the right cardiac and peripheral levels, suggesting the influence of water aspiration. Significant elevations in serum and pericardial Cr and UA levels with a higher serum/pericardial UA ratio for fatal methamphetamine intoxication suggest progressive skeletal muscle damage due to advanced hypoxia/acidosis. Similar findings were often observed for other acute and subacute deaths. These findings suggest that a comparison between blood and pericardial nitrogenous compounds would be useful for investigating the cause and process of death.     

Combined determination of B-type natriuretic peptide and high-sensitivity troponin I in the postmortem diagnosis of cardiac disease

Forensic Science, Medicine and Pathology - Cardiac disease is the most common cause of sudden death in Western countries. It is known that high-sensitivity troponin I (hs-cTnI), widely used for...     

Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2: analysis for application in the diagnosis of sudden cardiac death with regard to pathology

Although previous forensic pathological studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction, there appears to be insufficient data with regard to its cardiac pathology. The present study analyzed the heart blood, peripheral blood and pericardial fluid levels of cardiac troponin T (cTnT) in sudden cardiac deaths (n = 96) within 48h postmortem in relation to pathological findings of acute myocardial infarction (AMI, n = 34), recurrent myocardial infarction (RMI, n = 23), ischemic heart disease without any pathological evidence of infarction (IHD, n = 24) and other heart diseases (OHD, n = 15). Control groups (n = 75, survival time <24 h) within 48 h postmortem consisted of asphyxiation (n = 35), drowning (n = 27) and cerebrovascular diseases (n = 13). There was a marked correlation in the cTnT levels between right and left heart blood samples. The pericardial level was usually higher than either heart blood level, and the external iliac venous blood level was the lowest. Although postmortem time-dependent increases in heart and pericardial blood cTnT levels were observed in most groups, they were most evident for AMI and asphyxiation. In the early postmortem period (<12 h) there was no significant difference between AMI or RMI and the other groups except for drowning. After 12 h postmortem, significantly elevated heart blood and pericardial cTnT levels were observed for AMI and RMI showing multiple interstitial hemorrhages and necrosis compared to those with localized eosinophilic changes or patchy interstitial hemorrhages, IHD and OHD. These differences were the smallest for peripheral blood. For sudden cardiac death cases, the difference in cTnT level at each site among the causes of death was independent of gender, age, heart or lung weight and pathologies of affected coronary artery and severity of coronary stenosis. These observations suggest that the elevation in postmortem blood and pericardial cTnT levels in sudden cardiac death may depend on the severity of ischemic myocardial damage including the size and intensity of myocardial lesions involving multiple interstitial hemorrhages and necrosis, and also the postmortem period for heart and pericardial levels.     

高原肺水肿患者血清肌钙蛋白T研究

目的 :探索高原肺水肿 (HAPE)患者血清肌钙蛋白 T(cTnT)的变化。方法 :放免法测定HAPE患者在一氧化氮(NO)治疗前后血清cTnT。结果 :cTnT治疗前显著高于治疗后 (P <0 0 1) ,SaO2 治疗后显著高于治疗前 (P <0 0 0 1) ,治愈率为 10 0 0 %。结论 :对较重的HAPE患者有心肌损害和心功能的下降 ;NO治疗HAPE是非常有效的 ,为HAPE治疗提供了新的方法     

Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy

The present study investigated cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) in the blood and pericardial fluid from medicolegal autopsy cases (n=234, within 48h postmortem) with regard to the cause of death. The cTnI and CK-MB levels in cardiac, peripheral blood and pericardial fluid generally showed a mild and gradual postmortem time-dependent elevation (r=0.231-0.449, P<0.05-0.001). However, postmortem elevation of cTnI was larger for specific causes of death including acute myocardial infarction (AMI), cerebrovascular diseases (CVD), hyperthermia, fatal methamphetamine (MA) abuse and carbon monoxide (CO) intoxication and insignificant for recurrent myocardial infarction (RMI), chronic congestive heart diseases (CHD) and drowning, while that of CK-MB was greater for CO intoxication and insignificant for drowning. Cardiac blood and pericardial cTnI levels were relatively high for AMI, RMI, hyperthermia, MA abuse and CO intoxication, and was low for drowning. Elevated CK-MB level was observed for cardiac blood in asphyxiation and MA abuse cases and for peripheral blood in hyperthermia and MA abuse cases. When the cTnI/CK-MB ratio was estimated, it was independent of postmortem time, and the ratios for cardiac blood and pericardial fluid were significantly higher in cases of AMI, RMI, hyperthermia and CO intoxication but lower in cases of drowning. Elevations of cTnI levels in cardiac blood and pericardial fluid were related to the morphological severity of myocardial damage. These findings suggest that elevated cTnI and CK-MB levels in blood and pericardial fluid are related to ischemic, hypoxic and/or cytotoxic myocardial damage, which are characteristic of the cause of death, although the levels increase after death depending on myocardial damage at the time of death.     

Estimation of postmortem interval from human pericardial fluid electrolytes concentrations in Chandigarh zone of India: log transformed linear regression model

Estimation of postmortem interval from changes in postmortem pericardial fluid electrolytes concentration is the topic of discussion in the study. Querido [Querido D. Double logarithmic, linear relationship between plasma sodium/potassium concentration ratio and postmortem interval during the 6–96 h postmortem period in rats. Forensic Sci Int 1990;44:125–34; Querido D. Linearization of the relationship between postmortem plasma chloride concentration and postmortem interval in rats. Forensic Sci Int 1990;45:117–27] and Singh et al. [Singh D, Prashad R, Parkash C, Bansal YS, Sharma SK, Pandey AN. Linearization of relationship between serum sodium, potassium concentration, their ratio and time since deaths in Chandigarh zone of north west India. Forensic Sci Int 2002;130:107; Singh D, Prashad R, Parkash C, Sharma SK, Pandey AN. Double logarithmic linear relationship between plasma chloride concentration and time since death in humans in Chandigarh zone of north west India. Legal Med 2003;5:49–54] had demonstrated a highly significant double logarithmic linear relationship between the time since death and the plasma sodium/potassium ratio as well as with plasma chloride concentration in Wistar rats and human, respectively. In view of these facts, the present study was carried out to substantiate this propensity in this transcellular extension of blood plasma. Electrolytes analysis in postmortem pericardial fluid obtained from 311 subjects revealed that correlation of time since deaths with potassium, sodium/potassium ratio and phosphorus was highly significant (p < 0.001) during 2.5–58 h of deaths. Not withstanding, time since death although modulated by ambient temperature could be predicted by log transformed multiple regression equation derived from the combination of potassium, chloride and phosphorus electrolytes concentration with standard error (SE) of prediction (in log hours) of 0.1840 h and by double logarithmic model with SE (in log hours) of 0.1959, 0.2068 and 0.2088 h from potassium, sodium/potassium ratio and phosphorus electrolytes, respectively.     

烧伤患者血清TnT及心肌酶变化的临床意义

目的:评估血清肌钙蛋白T(cardiactroponinTTnT)对烧伤后心肌损伤的诊断价值。方法:采用酶免法测定157例烧伤患者血清TnT水平并与患者伤后血清心肌酶水平比较。结果:TnT在重度烧伤组为(0.58±0.18)ng/ml阳性率为56%,电烧伤组为(0.71±0.45)ng/ml阳性率为50%,中度烧伤组为(0.08±0.06)ng/ml,阳性率为13%,表明烧伤后血清TnT升高水平及阳性率与烧伤面积有关。而心肌酶谱并非心肌损伤的特异性指标,在骨骼肌等其它脏器损伤时也出现增高。结论:血清TnT测定对于烧伤后心肌损伤诊断的特异性明显优于心肌酶。     

Distribution & diagnostic efficacy of cardiac markers CK-MB & LDH in pericardial fluid for postmortem diagnosis of ischemic heart disease

The aim of the present study is to evaluate the diagnostic efficacy of biochemical markers creatine kinase-MB (CK-MB) and LDH in pericardial fluid for postmortem diagnosis of ischemic heart disease (IHD). We studied 119 medico-legal autopsies selected during a period of 2 years. Subjects were assigned into diagnostic groups upon final cause of death as follows: (1) sudden cardiac death due to IHD's (n = 52), (2) violent asphyxia (n = 24); (3) polytraumatic deaths (n = 20); (4) natural deaths excluding cardiac causes (n = 23). Pericardial fluid samples were tested for estimating enzyme levels. Histological examination was performed with hematoxylin and eosin (H&E) stain on myocardial tissue samples. We observed highest levels of CK-MB & LDH in deaths due to IHD's. Kruskal–Wallis test revels significant differences in activities of CK-MB (P = 0.0001) and LDH (P = 0.0065) amongst all diagnostic groups. Mann–Whitney test showed highly significant (P < 0.0001) levels of CK-MB in group 1 as compared to other diagnostic groups. However, LDH levels were non-discriminatory (P = 0.0827) between cases of IHD's and cases of other natural deaths. CK-MB levels were statistically non-significant between cases divided as myocardial infarction (MI) and severe coronary artery disease in group 1, hence its role for postmortem detection of MI is somewhat limiting. However, sensitivity and negative predictive values of its cut off level obtained in cases of IHD's are nearly equal to diagnostic efficacy in clinical settings. Hence, it can be useful additional diagnostic tool for autopsy diagnosis of IHD's. Whereas, LDH is not useful for postmortem diagnosis in these cases.     

T3- and T4-antibodies in serum: screening and specific determination methods

Endogenous antibodies against T3 or T4 may falsify the radioimmunological determination of T3 and T4. Depending on the method of separation increased or decreased values will result. The clinical aspects are at variance with these radioimmunologically measured values. The TSH value is frequently elevated and the TRH test mostly positive. The determination of unspecific binding capacity allows the selection of suspect sera. In cases of increased binding capacity the diagnosis will be established by a precipitation reaction with human-anti-Ig-G and quantified with radio-T3 or radio-T4.     

经皮腔内冠状动脉成形术前后冠心病患者血清C反应蛋白及肌钙蛋白T的变化

 目的观测经皮腔内冠状动脉成形术(PTCA)对血清C反应蛋白(CRP)及肌钙蛋白T(TnT)的影响.方法我院进行PTCA的患者86例,同期进行冠状动脉造影(CAG)的患者90例.分别于PTCA和CAG当天及术后第2天清晨采集空腹血测定CRP及TnT值.结果PTCA组术后血清CRP水平显著高于术前(P＜0.01),而术后血清TnT水平与术前比较无显著变化(P＞0.05).CAG组造影后血清CRP及TnT水平与造影前比较均无显著性差别(P＞0.05).结论PTCA明显增加血清CRP浓度,可能与PTCA治疗后局部血管炎症有关,而非心肌坏死所致.