DOCSLIB.ORG

Bodies Recovered from Water: a Personal Approach and Consideration of Difficulties 657

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bodies Recovered from Water: a Personal Approach and Consideration of Difficulties 657 6545 JClin Pathol 1992;45:654-659 Bodies recovered from water: a personal approach and consideration of difficulties J Clin Pathol: first published as 10.1136/jcp.45.8.654 on 1 August 1992. Downloaded from W Lawler Introduction It has been reported that about 85-95% of For the pathologist providing a routine nec- those dying from water inhalation present ropsy service to the local coroner, examination features of drowning,59 although in most, not of bodies recovered from water can generate all the typical features are seen9; the remainder the most difficult of interpretational problems, die from vagal inhibition (sometimes, inaccu- and this is probably the prime context where rately, known as "dry drowning", and once appropriate historical and circumstantial evi- designated "hydrocution"), or the post dence is vital to interpretation and overall immersion syndrome; perhaps, rarely, laryn- conclusions,' 2 although such collateral evi- geal spasm may be important. dence should always be available before any At this stage, it is worth remembering that coroner's necropsy is undertaken.3 hypothermia can supervene very quickly in It must be appreciated, at the outset, that individuals swimming or trying to remain not all persons whose bodies are recovered afloat in cold water, and that it may be an from water will have died from its inhalation, important factor contributing to their although they may show features reflecting death'0 "; indeed, hypothermia may be the immersion in water. Such bodies should there- main cause of death after shipwreck in the fore be particularly carefully examined, both open sea.1 12 externally and internally, to catalogue (and subsequently to explain satisfactorily) all inju- DROWNING ries present, to determine whether death Mechanisms for death from drowning are indeed followed immersion in the water, and to multiple, complex, and, in part, still incom- see whether any natural disease, such as pletely understood. Although drowning is ischaemic heart disease, cerebrovascular dis- much more than simple asphyxia following ease, and hypertension, may have contributed mechanical airway obstruction by water, this to, precipitated, or even caused death. It is also process probably does at least contribute. important to determine whether the deceased Major factors, however, seem to be osmotic http://jcp.bmj.com/ was under the influence of alcohol or other and perhaps also hydrostatic effects of the drugs at the time of death (although inter- inhaled fluid once it reaches alveolar spaces pretation of laboratory results should be influ- and gains access to semipermeable alveolar enced by the knowledge that, as discussed membranes; here, water and electrolyte below, classic fresh water drowning may exchanges take place, the nature of which is increase the blood volume by as much as influenced by the tonicity ofthe inhaled fluid- 30-35%). Finally, the pathologist has a vital fresh or salt water. on September 26, 2021 by guest. Protected copyright. role in determining, from all pathological and circumstantial evidence available, whether the Fresh water This is hypotonic relative to overall findings are consistent with, or even plasma. Therefore, when present in alveoli, it is point directly towards accident, suicide, or rapidly absorbed into the pulmonary circula- homicide. tion; this causes pronounced haemodilution Unfortunately many bodies recovered from (the blood volume may be increased by up to water will have been there for several days, and 30-35%) which, in turn, soon produces local decomposition may have obscured or haemolysis. Although haemodilution will lead destroyed features of drowning; nevertheless, to hyponatraemia, circulatory overload, and, careful examination may elicit sufficient pos- ultimately, high output cardiac failure, hae- itive or negative findings to allow reasonable molysis is probably more important, as it conclusions to be drawn. causes hyperkalaemia and consequent cardiac For the pathologist to interpret accurately arrhythmias, particularly with concomitant the necropsy findings, it is necessary briefly to generalised hypoxia. These changes can consider the mechanisms of death after sub- develop very rapidly-over a few minutes, mersion in water and to appreciate the results supporting the view that drowning in fresh Department of of immersion in water, including artefactual water tends to occur more quickly than in sea Pathological Sciences, injuries. water.5 6 The Medical School, Stopford Building, Oxford Road, Salt water is hypertonic relative to plasma. Manchester M13 9PT Mechanisms of death after submersion Therefore, when present in alveoli, it attracts W Lawler in water water into the airways from the pulmonary Correspondence to: These are well documented in several circulation, causing local haemoconcentration Dr W Lawler of forensic medicine and and severe oedema. Haemocon- Accepted for publication standard textbooks pulmonary 20 December 1991 pathology.48 centration increases blood viscosity and pro- Bodies recovered from water: a personial approach anid cotisideratioon of difficullies 655 duces acute hypernatraemia, while severe Findings and interpretations in deaths pulmonary oedema causes clinically import- after submersion in water ant hypoxia/hypercapnoea; all these factors It is important to distinguish changes directly adversely affect the heart, with bradycardia attributable to death following submersion J Clin Pathol: first published as 10.1136/jcp.45.8.654 on 1 August 1992. Downloaded from and, ultimately, asystole. (discussed here) from those which purely reflect immersion (discussed later). The chan- "VAGAL INHIBITION" ("REFLEX CARDIAC ARREST") ges described here, which are well documented ' This is a well recognised and accepted mech- in standard textbooks4 and review art- anism, particularly since Simpson's widely icles,'8 20 are those encountered in fresh bod- quoted review. '3 Vagus nerve branches may be ies-that is, those removed from the water stimulated in several ways, with a direct and before decomposition becomes established; perhaps almost instantaneously fatal cardiac once a lengthy delay has occurred, positive inhibition. Following submersion, it may be diagnosis may be difficult. initiated by the sudden and unexpected entry of water into the larynx, nose, or naso- DROWNING pharynx4 4 16; concurrent emotional states Externally, although a range of changes may be may act as a contributing sensitising factor.'6 identified, there may be nothing specific to Vagal inhibition seems to be more common drowning. Sometimes, however, firm, tena- when the submersion is total and unantici- cious foam is present at the mouth or nostrils. pated, when the victim is under the influence Typically, it is white or blood tinged, and of alcohol and/or other drugs, when the water reappears after wiping away. It is thought to is cold, and when the individual enters it feet represent an admixture of air, fluid, mucus and first. surfactant, and therefore an ante mortem phenomenon. LARYNGEAL SPASM Internally, the foam, even if not apparent This probably occurs, at least to some extent, externally, is often found in major airways or in most individuals following submersion, as it secondary bronchi and bronchioles. The air- presumably represents a normal reflex to fluid ways may also contain water and such extrinsic entering the larynx.6 15 In most, however, it materials as silt, weeds, or sand. Similar seems to be transient, and a true asphyxial substances (particularly water) may be swal- death from laryngeal spasm, if it occurs at all, lowed and thus identified within the stomach. is probably extremely rare. Gardner reports Pulmonary changes vary according to the having seen only one fatal case-in a boy aged drowning fluid, although they are often not as 8 who sank into water immediately after distinct as suggested by differences in causative jumping in, and whose body showed asphyxial mechanisms and as implied in some text- changes and no features of drowning. '5 This books. mechanism is discussed by Polson, Gee, and Knight,6 who quote Gardner's case but do not Fresh water http://jcp.bmj.com/ offer any of their own; they do, however, state Typically, the lungs are almost twice their that laryngeal spasm is "a rare mode of death normal weight, and present an appearance from submersion." Several reviews9 12 16 do sometimes still designated "emphysema aquo- not mention it at all; some, illogically, link it sum"-they are bulky and overdistended (such with vagal inhibition as a mechanism for that they may well overlap the pericardial sac almost instantaneous death, and do not refer to and meet in the midline), with a very charac- asphyxial features.4 My views, and, I believe, teristic doughy texture which causes them to on September 26, 2021 by guest. Protected copyright. those of many colleagues involved in forensic pit on digital pressure and sometimes to show pathology, are well summarised by Donald, 7 prominent rib markings. Classic petechial who says "previous literature would suggest haemorrhages are uncommon, but larger sub- that a number of human beings are drowned pleural and intrapulmonary haemorrhages may with dry lungs owing to glottic spasm, but little be identified. Section releases frothy, often convincing evidence has been produced". blood tinged fluid. Elsewhere, haemodilution Recently, Knight has stated "another mechan- causes the blood to appear rather "watery"; ism that is often postulated as a cause of non- haemolysis may produce intimal staining of
Load more

Recommended publications
  • Forensic Medicine
    YEREVAN STATE MEDICAL UNIVERSITY AFTER M. HERATSI DEPARTMENT OF Sh. Vardanyan K. Avagyan S. Hakobyan FORENSIC MEDICINE Handout for foreign students YEREVAN 2007 This handbook is adopted by the Methodical Council of Foreign Students of the University DEATH AND ITS CAUSES Thanatology deals with death in all its aspects. Death is of two types: (1) somatic, systemic or clinical, and (2) molecular or cellular. Somatic Death: It is the complete and irreversible stoppage of the circulation, respiration and brain functions, but there is no legal definition of death. THE MOMENT OF DEATH: Historically (medically and legally), the concept of death was that of "heart and respiration death", i.e. stoppage of spontaneous heart and breathing functions. Heart-lung bypass machines, mechanical respirators, and other devices, however have changed this medically in favor of a new concept "brain death", that is, irreversible loss of Cerebral function. Brain death is of three types: (1) Cortical or cerebral death with an intact brain stem. This produces a vegetative state in which respiration continues, but there is total loss of power of perception by the senses. This state of deep coma can be produced by cerebral hypoxia, toxic conditions or widespread brain injury. (2) Brain stem death, where the cerebrum may be intact, though cut off functionally by the stem lesion. The loss of the vital centers that control respiration, and of the ascending reticular activating system that sustains consciousness, cause the victim to be irreversibly comatose and incapable of spontaneous breathing. This can be produced by raised intracranial pressure, cerebral oedema, intracranial haemorrhage, etc.(3) Whole brain death (combination of 1 and 2).
    [Show full text]
  • Death & Decomposition Part II
    Death & Decomposition Part II Review: Why is TSD/PMI so important? Review: What happens in the Fresh (1st) Stage of Decomposition? STAGE 2: Bloat ⦿ 0-10 days ⦿ Putrefaction: bacterially-induced destruction of soft tissue and gas formation › Skin blisters and marbling › Build-up of fluids from ruptured cells and intestines Putrefaction – the gross stuff ➢ Decomposition that occurs as a result of bacteria and other microorganisms ➢ Results in gradual dissolution of solid tissue into gases and liquids, and salts Putrefaction ➢ Characteristics: ○ Greenish discoloration ○ Darkening of the face ○ Bloating and formation of liquid or gas-filled blisters ○ Skin slippage Putrefaction ➢ Begins about 36 hours after death ➢ Further destruction is caused by maggots and insects ➢ Above 40 F, insects will feed until the body is skeletonized Influences of Putrefaction ➢ Heavy clothing and other coverings speed up the process by holding in body heat ➢ Injuries to the body surface promote putrefaction ○ provide portals of entry for bacteria Marbling Stage 3: Active Decay ➢ 10-20 days after death ➢ Body begins to collapse and black surfaces are exposed ➢ Bloated body collapses and leaves a flattened body ➢ Body fluids drain from body Active Decay Active Decay: Destruction of Tissue • Severe decomp can result in complete destruction of soft tissue Active Decay: Advanced Decomposition Stage 4: Dry Decay ➢ 20-365 days after death ➢ Remaining flesh on body is removed and body dries out ➢ Body is dry and continues to decay very slowly due to lack of moisture ➢
    [Show full text]
  • Three End-Of-Life Cases: Resolving Their Moral Dilemmas
    Vol. 33:2 Summer 2017 Three End-of-Life Cases: Resolving Their Moral Dilemmas RENÉ E MIRKES, OSF, PHD An organization of Roman Catholic physicians presented a set of questions to guide moral assessment of three end-of-life cases. The questions for each scenario highlight a corresponding ethical dilemma: (Case #1) the determination of brain death by neurological criteria; (Case #2) the decision to withhold or withdraw artificial nutrition and hydration from an unresponsive wakefulness syndrome (UWS) (formerly referred to as persistent vegetative state, [PVS]) patient; and (Case #3) the administration of pain medication that hastens death. To adjudicate the moral concern raised in each of these clinical cases, the following moral analyses appeal to the natural law perspective summarized in the Ethical & Religious Directives for Catholic Health Care Services1 and in other philosophical resources, both Catholic and secular. CASE #1 An 18-year-old involved in a motorcycle accident was brought to the emergency room with massive head trauma and life support. A brain angiogram showed no blood flow, and a neurological examination revealed no brainstem reflexes as well as persistent apnea. Blood pressure medication was required for heart rate and blood pressure control. Since the patient was an organ donor, the organ recovery team was called in after he was declared brain dead. Discussion (1) When and how do we declare a person dead? What is the difference between theological and scientific definitions of death? (A) A living human being is a substantial union of a (mammalian) body and a rational soul. We are not spiritual beings who use or have bodies.
    [Show full text]
  • Fermentation of Non-Digestible Oligosaccharides by Human Colonic Bacteria
    Proceedings of the Nutrition Society ( 1996), 55,899-9 12 899 Symposium 2 Fermentation of non-digestible oligosaccharides by human colonic bacteria BY GLENN R. GIBSON, ANNE WILLEMS, SALLY READING AND M. DAVID COLLINS Department of Microbiology, Institute of Food Research, Earley Gate, Reading RG6 6BZ The principal substrates for colonic bacterial growth are dietary carbohydrates which have escaped digestion in the upper gastrointestinal tract. These may be starches, dietary fibres, other non-absorbable sugars, sugar alcohols and oligosaccharides. In the large intestine, saccharolytic bacteria are able to metabolize carbohydrates for increased energy and growth with short-chain fatty acids (SCFA) and a variety of other metabolites, such as the electron-sink products lactate, pyruvate, ethanol, H, and succinate, being produced. The majority of human large intestinal micro-organisms, have a strictly anaerobic metabolism, whilst numbers of facultative anaerobes are many orders of magnitude lower than those of the obligate anaerobes. Of the culturable flora, numerically predominant anaerobes are Gram-negative rods belonging to the genus Bacteroides. Other groups which have hitherto been identified as quantitatively significant include bifidobacteria, clostridia, eubacteria, lactobacilli, Gram-positive cocci, coliforms, methanogens and dissimilatory sulphate- reducing bacteria. Generally, the various components of the large intestinal microbiota may be considered as exerting either pathogenic effects or they may have potential health- promoting values. Bifidobacteria and lactobacilli are considered to belong to the latter group. Bacteria in the colon respond largely to the available fermentable substrate, and there is currently some interest in the use of diet to specifically increase groups perceived as health promoting. Non-digestible oligosaccharides seem to have this (prebiotic) potential.
    [Show full text]
  • Part 3 Metabolism of Proteins and Nucleic Acids Частина 3 Обмін Білків І Нуклеїнових Кислот
    МІНІСТЕРСТВО ОХОРОНИ ЗДОРОВ'Я УКРАЇНИ Харківський національний медичний університет PART 3 METABOLISM OF PROTEINS AND NUCLEIC ACIDS Self-Study Guide for Students of General Medicine Faculty in Biochemistry ЧАСТИНА 3 ОБМІН БІЛКІВ І НУКЛЕЇНОВИХ КИСЛОТ Методичні вказівки для підготовки до практичних занять з біологічної хімії (для студентів медичних факультетів) Затверджено вченою радою ХНМУ Протокол № 1 від 26.01.2017 р. Approved by the Scientific Council of KhNMU. Protocol 1 (January 26, 2017) Харків ХНМУ 2017 Metabolism of proteins and nucleic acids : self-study guide for students of general medicine faculty in biochemistry. Part 3: / Comp. : O. Nakonechna, S. Stetsenko, L. Popova, A. Tkachenko. – Kharkiv : KhNMU, 2017. – 56 p. Compilers Nakonechna O. Stetsenko S. Popova L. Tkachenko A. Обмін білків та нуклеїнових кислот : метод. вказ. для підготовки до практ. занять з біологічної хімії (для студ. мед. ф-тів). Ч 3. / упоряд. О.А. Наконечна, С.О. Стеценко, Л.Д. Попова, А.С. Ткаченко. – Харків : ХНМУ, 2017. – 56 с. Упорядники О.А. Наконечна С.О. Стеценко Л.Д. Попова А.С. Ткаченко - 2 - SOURCES For preparing to practical classes in "Biological Chemistry" Basic Sources 1. Біологічна і біоорганічна хімія: у 2 кн.: підруч. Біологічна хімія / Ю.І. Губ- ський, І.В. Ніженковська, М.М. Корда, В.І. Жуков та ін. ; за ред. Ю.І. Губського, І.В. Ніженковської. – Кн. 2. – Київ : ВСВ «Медицина», 2016. – 544 с. 2. Губський Ю.І. Біологічна хімія : підруч. / Ю.І. Губський – Київ– Вінниця: Нова книга, 2007. – 656 с. 3. Губський Ю.І. Біологічна хімія / Губський Ю.І. – Київ–Тернопіль : Укр- медкнига, 2000. – 508 с. 4. Гонський Я.І.
    [Show full text]
  • Interpretation of Measured Alcohol Levels in Fatal Aviation Accident Victims
    INTERPRETATION OF MEASURED ALCOHOL LEVELS IN FATAL AVIATION ACCIDENT VICTIMS Overview By Dr Shelley Robertson MBBS, LLB, FRCPA, DMJ, FACLM, DAvMed, MHealSc (AvMed). CONTENTS SUMMARY............................................................................................................................... 3 INTRODUCTION.................................................................................................................... 4 BACKGROUND....................................................................................................................... 5 Chemistry of Ethanol ........................................................................................................ 5 Metabolism of Ethanol...................................................................................................... 5 Putrefaction....................................................................................................................... 6 Micro-organism Production of Alcohol............................................................................ 7 Methods of Analysis ......................................................................................................... 7 Specimens ......................................................................................................................... 8 DIFFICULTIES ASSOCIATED WITH THE ASSESSMENT OF POST-MORTEM ALCOHOL LEVELS.................................................................................................... 11 Post-accident Survival ...................................................................................................
    [Show full text]
  • Postmortem Imaging of Blood and Its Characteristics Using MSCT and MRI
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Bern Open Repository and Information System (BORIS) Int J Legal Med (2006) 120: 233–240 DOI 10.1007/s00414-005-0023-4 ORIGINAL ARTICLE C. Jackowski . M. Thali . E. Aghayev . K. Yen . M. Sonnenschein . K. Zwygart . R. Dirnhofer . P. Vock Postmortem imaging of blood and its characteristics using MSCT and MRI Received: 31 January 2005 / Accepted: 30 May 2005 / Published online: 19 November 2005 # Springer-Verlag 2005 Abstract The rapid development of computed tomography raphy (CT), for documentation of forensic findings is now (CT) and magnetic resonance imaging (MRI) led to the being initiated [1, 13, 24, 30, 33]. Broad clinical radiolog- introduction and establishment in postmortem investigations. ical experience has been collected under vital conditions The objectives of this preliminary study were to describe the with intact circulation and metabolism following main- imaging appearances of the early postmortem changes of taining of all physiological concentrations and pressure blood after cessation of the circulation, such as sedimenta- gradients. Postmortem tissues and blood are subjected to tion, postmortem clotting, and internal livores, and to give a gravity and show specific appearances, such as sedimen- few first suggestions on how to differentiate them from other tation processes, but blood proteins, such as fibrinogen, are forensic findings. In the Virtopsy project, 95 human corpses still functioning. Knowledge about these phenomena is of underwent postmortem imaging by CT and MRI prior to great importance to differentiate between normal postmor- traditional autopsy and thereof 44 cases have been inves- tem appearances and pathological findings (e.g., thrombo- tigated in this study.
    [Show full text]
  • Postmortem Changes and Time of Death
    POSTMORTEM CHANGES AND TIME OF DEATH Quotations "The time of death is sometimes extremely important. It is a question almost invariably asked by police officers, sometimes with a touching faith in the accuracy of the estimate. Determining the time of death is extremely difficult, and accuracy is impossible". (Ref. 8 at p. 115.) "No problem in forensic medicine has been investigated as thoroughly as that of determining the time of death on the basis of post mortem findings. Apart from its obvious legal importance, its solution has been so elusive as to provide a constant intellectual challenge to workers in many sciences. In spite of the great effort and ingenuity expended, the results have been meagre". (Ref. 15 at p. 33.) "Repeated experience teaches the investigator to be wary of relying on any single observation for estimating the time of death (or "duration of the post mortem interval"), and he wisely avoids making dogmatic statements based on an isolated observation". (Ref. 12 at p. 151.) "Considering the variables which influence the rate of body heat loss, the best one can say about the reliability of algor mortis as a post mortem clock is that it permits a rough approximation of the time of death. Errors in over-estimating and under-estimating the post mortem interval based on body cooling are common, even in the face of considerable experience by those making the estimate. Body temperature as an indicator of the post mortem interval should be correlated with all other phenomenon and observations utilised in establishing the time of death". (Ref.
    [Show full text]
  • Differentiation at Autopsy Between in Vivo Gas Embolism and Putrefaction Using Gas Composition Analysis
    Int J Legal Med DOI 10.1007/s00414-012-0783-6 ORIGINAL ARTICLE Differentiation at autopsy between in vivo gas embolism and putrefaction using gas composition analysis Yara Bernaldo de Quirós & Oscar González-Díaz & Andreas Møllerløkken & Alf O. Brubakk & Astrid Hjelde & Pedro Saavedra & Antonio Fernández Received: 18 January 2012 /Accepted: 4 October 2012 # Springer-Verlag Berlin Heidelberg 2012 Abstract Gas embolism can arise from different causes New Zealand White Rabbits models: control or putrefaction, (iatrogenic accidents, criminal interventions, or diving relat- infused air embolism, and compression/decompression. The ed accidents). Gas analyses have been shown to be a valid purpose of this study was to look for qualitative and quan- technique to differentiate between putrefaction gases and titative differences among groups and to observe how pu- gas embolism. In this study, we performed systematic nec- trefaction gases mask in vivo gas embolism. We found that ropsies at different postmortem times in three experimental the infused air embolism and compression/decompression models had a similar gas composition prior to 27- – Electronic supplementary material The online version of this article h postmortem, being typically composed of around 70 – (doi:10.1007/s00414-012-0783-6) contains supplementary material, 80 % of N2 and 20 30 % of CO2, although unexpected which is available to authorized users. higher CO2 concentrations were found in some decom- : Y. Bernaldo de Quirós A. Fernández (*) pressed animals, putting in question the role of CO2 in Veterinary Histology and Pathology, Department of Morphology, decompression. All these samples were statistically and Institute of Animal Health, Veterinary School, significantly different from more decomposed samples.
    [Show full text]
  • Factors Modifying the Process of Putrefaction
    Factors Modifying the Process of Putrefaction By: Dr Mohd Kalim Assistant Professor Glocal College of Unani Medical Science and Research Centre, Mirzapur Pole Saharanpur Factors Modifying the Process of Putrefaction External Factors Internal Factors Warmth and clothing Age and Condition of the body Moisture Sex Air Manner of Burial Cause of Death The external factors which modify the process of putrefaction are as follows Warmth and clothing Moisture Air Manner of Burial Putrefaction begins at 10ᵒ C Rapidly occurs at 37ᵒ C (Ideal Temperature) At freezing temperature the bacterial growth is inhibited and putrefaction will not occur The body can be preserved for indefinite period in cold storage, snow or ice. The clothing initially hasten the putrefaction by maintaining the body temperature at which the putrefactive organism multiply for a longer period. At later stage, they delay decomposition by protecting the body against the destruction of flies and insects. For putrefaction moisture is necessary. It helps rapid multiplication of organism. The death due to oedematous condition, putrefaction is very rapid. (Presence of fluid) Similarly, the body recovered from water if left in air, decompose with remarkable rapidity. Organs with high moisture contents putrefy more rapidity than dry ones. The brain with its high moisture and flat content will putrefy early in contrast to dry structures like nail, hair, teeth and bones. Muscular organs such as heart resist putrefaction and decompose late. The presence of air promotes decomposition and its absence retards it. Bodies lying in water putrefy more slowly because of exclusion of air and lowering of temperature. In air tight coffins the body remains with very little change for long periods while bodies buried without coffins putrefy at once.
    [Show full text]
  • Black Esophagus As an Autopsy Discovery: a Challenging Interpretation
    Kerschen et al. Egyptian Journal of Forensic Sciences (2020) 10:4 Egyptian Journal of https://doi.org/10.1186/s41935-020-0177-8 Forensic Sciences REVIEW Open Access Black esophagus as an autopsy discovery: a challenging interpretation Anja Kerschen1* , Gregory Schmit1,2,3, Evy De Boosere4, Cristian Palmiere5 and Jessica Vanhaebost1,2,3 Abstract Black esophagus is a rare medical condition, characterized by a circumferential blackish discoloration of the distal part of the esophageal mucosa, abruptly ending at the gastroesophageal junction. The etiology is multifactorial since patients suffer from multiple comorbidities. While the mortality rate specifically linked to black esophagus is only around 6%, the mortality rate linked to the underlying comorbidities amounts to 32%. A series of five cases is provided in which black esophagus was an unexpected discovery at autopsy. Black esophagus is generally considered being a challenge to the forensic pathologist. There are often no other major gross anomalies found at autopsy and information about the patient’s medical history is not always available, which complicates a correct assessment. We present a review of the literature on black esophagus, limited to reports on deceased patients. The reviewed publications are divided into autopsy and endoscopy series to correctly compare the causes of death. The aim of this review is to identify a possible divergence in causes of death in autopsy and endoscopy series and additionally to analyze the causes of these differences to enable better assessment and interpretation of black esophagus at forensic autopsies. This paper emphasizes the importance of a minimal knowledge of the victim’s comorbidities and medical record and the use of toxicology and postmortem biochemistry analysis as a valuable tool in investigating the cause of death in the setting of black esophagus.
    [Show full text]
  • Shaking the Foundations of Biopolitics
    Perspective Glob J Arch & Anthropol Volume 3 Issue 3 - April 2018 Copyright © All rights are reserved by Anna E Kubiak DOI: 10.19080/GJAA.2018.03.555615 Shaking the Foundations of Biopolitics Anna E Kubiak* Institute of Philosophy and Sociology, Polish Academy of Sciences, Poland, Europe Submission: January 27, 2018; Published: April 04, 2018 *Corresponding author: Anna E Kubiak, Institute of Philosophy and Sociology, Polish Academy of Sciences, Poland, Europe, Email: Abstract The objective of this opinion is to draw the outline of the condition of late modern biopolitics. The notion of “biopolitics is understood after Michele Foucault, Paul Rabinow and Nikolas Rose. The main observation is that the foundations of biopower are shaking because of resistance movements.Keywords: Biopolitics; Resistance Endtoward of life; biopower Resistance is specifically visible in end-of-life issues. Introduction that fewer and fewer things depend on individual projects, and After analyzing different areas of biopolitics (medicine, this anxiety and distrust acts in opposition to the ideology of bioethics, law, policy, health-care system and economy in Poland, neoliberalism. Terrorism and ecological catastrophes create Europe and USA), I observe tiny “folds” and “cracks” in the situations where social control is weak and the only possible foundations of biopower. The term “biopolitics”/“biopower” is action is to try to lessen the negative consequences: to mobilize additional military and police forces or to build dams against a knowledge, control and all practices in the name of life [1]. It is focused on the population and means strategies, clarification of systems and our crisis time when we still built security systems flood.
    [Show full text]