| Research Abstract |
The objective of the present research was to assess pulmonary surfactant-associated protein A (SP-A) as a possible marker of pulmonary failure/respiratory distress to establish the forensic pathological criteria in postmortem investigation of death. A series of immunohistochemical and biochemical investigations of SP-A were performed in routine casework. On the basis of the comprehensive analyses of the accumulated data, a pathological classification of the types and severity of pulmonary failure/respiratory distress was proposed : a) acute asphyxiation/respiratory distress of peripheral origins, characterized by a high immunohistochemical score of intra-alveolar granular SP-A and/or an elevation in the ratio of subclass-gene SP-A1/A2 mRNA in the lung tissues ; b) alveolar injury, accompanied by an increase in immunohistochemical membranous SP-A score and/or an elevation in the serum SP-A level ; c) a combination of the above-mentioned two types ; d) protracted respiratory distress, sh
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owing intra-alveolar coarse granular/membranous SP-A and an elevation in the serum SP-A level (acute respiratory distress syndrome/hyaline membrane disease). Further investigations to differentiate the primary and secondary origins of respiratory distress suggested the possible usefulness of immunohistochemical ubiquitin positivity in the pigmented neurons of the substantia nigra and serum uric acid level for diagnosis of asphyxiation and drowning, serum creatinine for a marker of thermal and hypoxic skeletal muscle damage, serum and pericardial cardiac troponin-T levels for a marker of myocardial damage. As described above, practical criteria were established for forensic pathological assessment of pulmonary failure/respiratory distress. Furthermore, a possibility of evidence based assessment' using multiple biochemical markers in postmortem investigation of the cause of death, survival time and the related pathophysiology involving respiratory, circulatory and central nervous system dysfunction was suggested. Less
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