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Hypothermia

  • Reinhard B. Dettmeyer
Chapter

Abstract

Fatalities due to hypothermia occur primarily, but not exclusively, during the cold season and produce findings that can also be identified histopathologically, such as Wischnewski spots in the gastric mucosa. Other findings that form during the hypothermic process are only frequent on microscopy but cannot always be demonstrated, e.g., fat vacuoles in the renal tubular epithelial cells, as well as in the cytoplasm of cardiomyocytes; in the case of the latter, however, it is important to distinguish between fat vacuoles and lipofuscin deposits. Hypothermia-related microthrombi in internal organs, primarily evident in peripheral vascular branches of the mesenteric vessels, can only be detected using microscopy, much like microhemorrhages in pancreatic tissue. Findings of this kind, however, can yield important, indeed compelling information pointing to death due to hypothermia. Intracytoplasmic vacuoles in the pancreatic epithelium have also been described in hypothermia deaths, as has a level of colloid depletion within the thyroid follicles, even though the validity of these findings is controversial in some cases.

References

  1. Armbrust S, Nikischin W, Rochholz G, Franzelius C, Bielstein A, Kramer HH (2010) Hypothermia in a combined intoxication with doxepin and moclobemide in an adolescent. Forensic Sci Int 195:e1–e3CrossRefPubMedGoogle Scholar
  2. Bańka K, Teresiński G, Buszewicz G (2014) Free fatty acids as markers of death from hypothermia. Forensic Sci Int 234:79–85CrossRefPubMedGoogle Scholar
  3. Bańka K, Teresiński G, Buszewicz G, Mądro R (2013) Glucocorticosteroids as markers of death from hypothermia. Forensic Sci Int 229:60–65CrossRefPubMedGoogle Scholar
  4. Berger RL (1990) Nazi science – the Dachau hypothermia experiments. N Engl J Med 322:1435–1440CrossRefPubMedGoogle Scholar
  5. Birchmeyer MS, Mitchell EK (1989) Wischnewski revisited: the diagnostic value of gastric mucosa ulcers in hypothermic deaths. Am J Forensic Med Pathol 10:28–30CrossRefPubMedGoogle Scholar
  6. Bockholdt B, Maxeiner H, Müllter S (2004) Death due to hypothermia in the city of berlin: circumstances, post mortem findings, specific features. In: Oehmichen M (ed) Hypothermia. Clinical, pathomorphological and forensic features. Research in legal medicine, vol 31. Schmidt-Römhild, Lübeck, pp 85–103Google Scholar
  7. Bourne MH, Piepkorn MW, Clayton F, Leonard LG (1986) Analysis of microvascular changes in frostbite injury. J Surg Res 40:26–35CrossRefPubMedGoogle Scholar
  8. Brendel W, Müller C, Messmer K, Reulen HJ (1968) Der klinische Tod in Hypothermie. Z Gesamte Exp Med 146:189–205CrossRefPubMedGoogle Scholar
  9. Bright F, Winskog C, Byard RW (2013) Wischnewski spots and hypothermia: sensitive, specific, or serendipitous? Forensic Sci Med Pathol 9:88–90CrossRefPubMedGoogle Scholar
  10. Büchner F (1943) Die Pathologie der Unterkühlung. Klin Wochenschr 22:89–92CrossRefGoogle Scholar
  11. Cali JR, Glaubitz JP, Crampton RS (1965) Gastric necrosis due to prolonged local gastric hypothermia. JAMA 191:154–155CrossRefGoogle Scholar
  12. Coe JL (1984) Hypothermia: autopsy findings and vitreous glucose. J Forensic Sci 29:289–395CrossRefGoogle Scholar
  13. Coniam WS (1979) Accidental hypothermia. Anaesthesia 34:250–256CrossRefPubMedGoogle Scholar
  14. Danzl DF, Pozos RS (1994) Accidental hypothermia. N Engl J Med 331:1756–1760CrossRefPubMedGoogle Scholar
  15. Duguid H, Simpson G, Stowers J (1961) Accidental hypothermia. Lancet 2:1213–1219CrossRefPubMedGoogle Scholar
  16. Eckart WU, Vondra H (2004) Disregard for human life: hypothermia experiments in the Dachau concentration camp. In: Oehmichen M (ed) Hypothermia. Clinical, pathomorphological and forensic features. Research in legal medicine, vol 31. Schmidt-Römhild, Lübeck, pp 19–31Google Scholar
  17. Ehrlich E (2004) Wischnewski’s spots. A new sign of death from hypothermia. The translated text of the original Russian article from 1885. In: Oehmichen M (ed) Hypothermia. Clinical, pathomorphological and forensic features, research in legal medicine, vol 31. Schmidt-Römhild, Lübeck, pp 205–210Google Scholar
  18. Elshama SS, Osman HEH, El-Kenawy AEM (2016) Postmortem diagnosis of induced fatal hypothermia in adult albino rats. Rom J Leg Med 24:106–114Google Scholar
  19. Emslie-Smith D (1958) Accidental hypothermia. Lancet 2:492–495CrossRefPubMedGoogle Scholar
  20. Fisher ER, Fedor EJ, Fisher B (1957) Pathologic and histochemical observations in experimental hypothermia. AMA Arch Surg 75:817–827CrossRefPubMedGoogle Scholar
  21. Hirvonen J (1976) Necropsy findings in fatal hypothermia cases. Forensic Sci 8:155–164CrossRefPubMedGoogle Scholar
  22. Hirvonen J (1977) Systemic and local effects of hypothermia. In: Tedeschi CG, Eckert WG, Tedeschi LG (eds) Forensic medicine, vol 1. Saunders Company, Philadelphia, pp 758–774Google Scholar
  23. Hirvonen J, Elfving R (1974) Histamine and serotonin in the gastric erosions of rats dead from exposure to cold: a histochemical and quantitative study. Z Rechtsmed 74:273–281CrossRefPubMedGoogle Scholar
  24. Ishikawa T, Miyaishi S, Tachibana T, Ishizu H, Zhu BL, Maeda H (2004) Fatal hypothermia related vacuolation of hormone-producing cells in the anterior pituitary. Legal Med 6:157–163CrossRefPubMedGoogle Scholar
  25. Ishikawa T, Quan L, Li DR, Zhao D, Michiue T, Hamel M, Maeda H (2008) Postmortem biochemistry and immunohistochemistry of adrenocorticotropic hormone with special regard to fatal hypothermia. Forensic Sci Int 179:147–151CrossRefPubMedGoogle Scholar
  26. Kitamura O, Gotohda T, Ishigami A, Tokunaga I, Kubo S, Nakasono I (2005) Effect of hypothermia on postmortem alterations in MAP 2 immunostaining in the human hippocampus. Legal Med 7:24–30CrossRefPubMedGoogle Scholar
  27. Mant AK (1964) Some post-mortem observations in accidental hypothermia. Med Sci Law 4(1):44–46CrossRefPubMedGoogle Scholar
  28. Mant AK (1967) The pathology of hypothermia. In: Simpson K (ed) Modern trends in forensic medicine, vol 2. Butterworths, London, pp 224–232Google Scholar
  29. Mant AK, Path FC (1969) Autopsy diagnosis of accidental hypothermia. J Forensic Med 16:126–129PubMedGoogle Scholar
  30. Mizukami H, Shimizu K, Shiono H, Uezono T, Sasaki M (1999) Forensic diagnosis of death from cold. Legal Med 1:204–209CrossRefPubMedGoogle Scholar
  31. Müller E, Rotter W, Carow G, Kloos KF (1943) Über Untersuchungsergebnisse bei Todesfällen nach allgemeiner Unterkühlung des Menschen in Seenot. Beitr Pathol Anat 108:552–589Google Scholar
  32. Oehmichen M (2004) Hypothermia. Clinical, pathomorphological and forensic features. Research in legal medicine, vol 31. Schmidt-Römhild, LübeckGoogle Scholar
  33. Palmiere C, Bardy D, Letovanec I, Mangin P, Augsburger M, Ventura F, Iglesias K, Werner D (2013) Biochemical markers of fatal hypothermia. Forensic Sci Int 226:54–61CrossRefPubMedGoogle Scholar
  34. Parai JL, Kodikara S, Milroy C, Pollanen MS (2012) Alcoholism and the Armanni-Ebstein lesion. Forensic Sci Med Pathol 8:19–22CrossRefPubMedGoogle Scholar
  35. Pavlic M, Grubwieser P, Rabl W (2004) Death in snow avalanches: hypoxia – blunt trauma – hypothermia. In: Oehmichen M (ed) Hypothermia. Clinical, pathomorphological and forensic features. Research in legal medicine, vol 31. Schmidt-Römhild, Lübeck, pp 141–152Google Scholar
  36. Preuß J, Dettmeyer R, Lignitz E, Madea B (2004) Fatty degeneration in renal tubule epithelium in accidental hypothermia victims. Forensic Sci Int 141:131–135CrossRefPubMedGoogle Scholar
  37. Preuß J, Dettmeyer R, Lignitz E, Madea B (2006) Fatty degeneration of myocardial cells as a sign of death due to hypothermia versus degenerative deposition of lipofuscin. Forensic Sci Int 159:1–5CrossRefPubMedGoogle Scholar
  38. Preuß J, Thierauf A, Dettmeyer R, Madea B (2007a) Wischnewski’s spot in an ectopic stomach. Forensic Sci Int 169:220–222CrossRefPubMedGoogle Scholar
  39. Preuß J, Lignitz E, Dettmeyer R, Madea B (2007b) Pancreatic changes in cases of death due to hypothermia. Forensic Sci Int 166:194–198CrossRefPubMedGoogle Scholar
  40. Preuß J, Dettmeyer R, Poster S, Lignitz E, Madea B (2008) The expression of heat shock protein 70 in kidneys in cases of death due to hypothermia. Forensic Sci Int 176:248–252CrossRefPubMedGoogle Scholar
  41. Read AE, Emslie-Smith D, Gough KR, Holmes R (1961) Pancreatitis and accidental hypothermia. Lancet 2:1219–1221CrossRefPubMedGoogle Scholar
  42. Sano ME, Smith CW (1940) Fifty post-mortem patients with cancer subjected to local or generalized refrigeration. J Lab Clin Med 26:443Google Scholar
  43. Shimizu K, Ohtani S, Shiono H, Fukusima T, Sasaki M (1997) Expression of ubiquitin protein in each organ at death from hypothermia. Forensic Sci Int 86:61–68CrossRefPubMedGoogle Scholar
  44. Sperhake JP, Rothschild MA, Riße M, Tsokos M (2004) Histomorphology of Wischnewski’s spots: a contribution to the forensic histopathology of fatal hypothermia. In: Oehmichen M (ed) Hypothermia. Clinical, pathomorphological and forensic features. Research in legal medicine, vol 31. Schmidt-Römhild, Lübeck, pp 211–220Google Scholar
  45. Stoddard JC (1962) Mesenteric infarction during hypothermia. Br J Anaesth 34:825–830CrossRefGoogle Scholar
  46. Takada M, Kusano I, Yamamoto H, Shiraishi T, Yatani R, Haba K (1991) Wischnewski’s gastric lesions in accidental hypothermia. Am J Forensic Med Pathol 12:300–305CrossRefPubMedGoogle Scholar
  47. Thrun C (1992) Verfettung der Tubulusepithelien der Niere – ein Hinweis für Hypothermie? Rechtsmedizin 2:55–58Google Scholar
  48. Tidow R (1943) Kälteschäden des Magendarmkanals unter besonderer Berücksichtigung der Abkühlung. Münch Med Wochenschr 90:597–600Google Scholar
  49. Tsokos M, Rothschild MA, Madea B, Rie M, Sperhake JP (2006) Histological and immunohistochemical study of Wischnewski spots in fatal hypothermia. Am J Forensic Med Pathol 27:70–74CrossRefPubMedGoogle Scholar
  50. Türk EE, Sperhake JP, Pueschel K, Tsokos M (2005) An approach to the evaluation of fatal hypothermia. Forensic Sci Med Pathol 1:31–35CrossRefPubMedGoogle Scholar
  51. Türk EE, Sperhake JP, Madea B, Preuß J, Tsokos M (2006) Immunohistochemical detection of hemoglobin in frost erythema. Forensic Sci Int 158:131–134CrossRefPubMedGoogle Scholar
  52. Wischnewski SM (1895) Neues Merkmal des Todes bei Unterkühlung. Informationsblatt der Hygiene, gerichtliche und praktische Medizin 3:11–20Google Scholar
  53. Wang Q, Ishikawa T, Michiue T, Zhu BL, Guan DW, Maeda H (2013) Molecular pathology of pulmonary edema in forensic autopsy cases with special regard to fatal hyperthermia and hypothermia. Forensic Sci Int 228:137–141CrossRefPubMedGoogle Scholar
  54. Wolf DA, Aronson JF, Rajaraman S, Veasey SP (1999) Wischnewski ulcers and acute pancreatitis in two hospitalized patients with cirrhosis, portal vein thrombosis, and hypothermia. J Forensic Sci 44:1082–1085CrossRefPubMedGoogle Scholar
  55. Yoshida C, Ishikawa T, Michiue T, Quan L, Madea H (2011) Postmortem biochemistry and immunohistochemistry of chromogranin a as a stress marker with special regard to fatal hypothermia and hyperthermia. Int J Legal Med 125:11–20CrossRefPubMedGoogle Scholar
  56. Zhou C, Byard RW (2011) Armanni-Ebstein phenomenon and hypothermia. Forensic Sci Int 206:e82–e84CrossRefPubMedGoogle Scholar
  57. Živković V, Nikolić S (2013) The unusual appearance of black esophagus in a case of fatal hypothermia: a possible underlying mechanism. Forensic Sci Med Pathol 9:613–514CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Reinhard B. Dettmeyer
    • 1
  1. 1.University Hospital Giessen Institute of Forensic MedicineGiessenGermany

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