Chapter 230 Evidence from autopsy
Anatomy room.
Lin Xinyi and Asai Naomi have already changed into three-piece anatomy suits and wrapped themselves tightly.
But this autopsy is like nothing else, and the equipment is good enough and complete.
Therefore, Lin Xinyi specially used anti-cut gloves this time.
A layer of cut-resistant gloves over latex gloves is very useful during dissection.
Because cut-resistant gloves are not as easy to be cut by knives as latex gloves, wearing them can protect yourself from being cut by a scalpel as much as possible.
Moreover, it is anti-cut and anti-slip at the same time.
For example, when opening the chest of a deceased person, you need to use your hands to peel off the belt, fat and muscle layers to both sides.
This kind of anti-cut gloves can help increase friction and make it easier to exert force, so as to prevent the human tissue from slipping out if the grip is not tight.
"Asai, put on the gas mask again."
With that said, Lin Xinyi put on a high-quality gas mask on himself.
He rarely used this kind of luxury product before, and basically wore a disposable mask when going into battle.
But it's different now. The situation in the forensics class is that people are stupid and have too much money, so he doesn't need to help save money and supplies.
So, after putting on high-end equipment, Lin Xinyi and Asai Narumi walked into the anatomy room together.
The police officers who were responsible had already helped send the deceased's body to the autopsy table in advance.
The young man named "Matsuhara Kenichi" was lying quietly on the cold stainless steel dissecting table, waiting for someone to find the truth for him.
"Mr. Lin"
Asai Narumi looked at the corpse that he had already performed a post-mortem examination on, and finally couldn't help but asked curiously:
"Is Matsubara Kenichi's death really related to his father's violent abuse three days ago?"
"He died three days after being injured, and there were no serious symptoms during this period - is this possible?"
"Of course it's possible."
Lin Xinyi replied calmly.
Looking at Asai Narumi's eyes full of curiosity, he couldn't help but look serious:
"Asai, have you ever heard of crush syndrome?"
"Squeeze syndrome?" Asai's head skipped a beat.
Unlike Mao Lilan, a rookie assistant who has just started, Asai Narumi is a serious medical student from a prestigious school with a strong enough medical foundation.
Without Lin Xinyi's detailed explanation, he could understand the professional knowledge Lin Xinyi mentioned:
"Crush syndrome is a series of pathophysiological changes that occur after the muscle-rich parts of the human body are squeezed by heavy objects for a long time and the squeeze is relieved."
"The main clinical manifestations are acute renal failure characterized by limb swelling, myoglobinuria, and hyperkalemia."
"If not treated in time, the patient will indeed die some time after being squeezed."
Asai Narumi carefully recalled what she had learned about crush syndrome:
To put it bluntly, it means that the body is pressed by heavy objects for too long, which causes fatal diseases.
And this knowledge is not unfamiliar to him, nor to most Japanese medical staff today.
Because in the medical field, there was the earliest research on crush syndrome, and it was Japan that made crush syndrome known to the world.
This is mainly because
There are many earthquakes in Japan.
After an earthquake occurs, it is often the case that affected people are trapped in the rubble and their bodies are squeezed by heavy objects for a long time.
Even if these victims are lucky enough to be rescued from the rubble by the rescue team, if they do not receive timely and professional treatment, they may die suddenly and "bizarrely" after a period of time due to compression syndrome caused by long-term pressure on their limbs.
This time may be a few hours or a few days.
In the eyes of those who don’t know:
The wounded were obviously fine when they were rescued, but why did they disappear after a few days of recuperation?
It was crush syndrome that led to their deaths.
And this problem went unnoticed for many years.
It was not until the Great Hanshin Earthquake in Japan in 1995, when rescuers discovered that many injured people died suddenly of unknown causes after being rescued, that the medical community began to notice the existence of crush syndrome.
Therefore, in this era, the medical research on crush syndrome has just begun.
And Narumi Asai has been lurking on the island as a community doctor for the past two years. He has not studied in a hospital or school, and has not had the opportunity to be exposed to the latest medical research.
Although he had learned about crush syndrome from newspapers and magazines, he did not understand it deeply:
"If it is crush syndrome, the patient may indeed die suddenly after 3 days due to acute renal failure caused by worsening of the condition."
"But... wasn't the deceased a victim of domestic violence?"
"He was injured by a blunt object and was not continuously squeezed by a heavy object. How could he suffer from crush syndrome?"
Asai Narumi asked with some confusion.
"Haha. Don't be too limited in your thinking."
"Although the name of this disease is "crush", in fact, direct blow to the limb can also cause crush syndrome."
"Because violent blows can cause subcutaneous bleeding and muscle damage that are similar to, or even more serious than, crushing with heavy objects."
"Severe trauma to the body will lead to microcirculatory disorders and insufficient tissue perfusion, which will aggravate the damage to kidney function."
"Myoglobin damage caused by injury forms methemoglobin casts in acidic urine and is deposited in the renal tubules, causing renal tubule degeneration and necrosis, leading to acute renal failure."
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"In short, in terms of formation mechanism, there is not much difference between 'squeezing' and 'beating'."
Lin Xinyi explained methodically:
"So in us forensics, no, not just forensics."
"In doctors' daily work, crushing injuries caused by blows with sticks, fists and feet are the most common."
"After all, natural disasters like earthquakes cannot happen every day."
"And the ill will that humans have towards others is much worse than natural disasters."
"That's it." Asai Narumi quickly reacted:
"The deceased did not receive timely treatment after being subjected to domestic violence, so his condition continued to deteriorate within these three days, and he eventually died suddenly on the street due to acute renal failure caused by crush syndrome!"
"And the murderer who killed him was none other than his bastard father who punched and kicked his family!"
He concluded with an indignant expression.
But Lin Xinyi, who proposed this point, "singed the opposite tune":
"Don't sound so sure."
"We have to find evidence through autopsy before we can make a conclusion."
Lin Xinyi's attitude is always cautious.
Until he finds conclusive evidence, he will speculate, but he will always remain skeptical.
Otherwise, this is just looking for evidence with a purpose, and subjective bias may easily occur in the investigation.
To put it to the extreme, this is like asking a red neck who is anti-scientific to do a scientific experiment to verify the effectiveness of masks——
They concluded that the masks were completely useless and contained mind-control antennas.
"So, let's start the dissection!"
"Let the deceased tell us why he died."
Lin Xinyi said this, then stood on the right side of the autopsy table and bowed solemnly to the deceased.
Narumi Asai bowed to the deceased equally seriously.
He was a victim of the police's disregard for life and negligence in the past, so he can better understand the weight of the word "respect."
Then, the dissection officially began.
With Narumi Asai as a professional assistant, Lin Xinyi's anatomy went very smoothly.
He first cut open the back and chest, the two areas with the most bruises and swelling:
"Incisions into the skin tissue of the back and chest revealed extensive bleeding in the superficial and deep muscles, loose muscle tissue, and edema."
"Extensive subcutaneous bleeding is one of the classic symptoms of crush syndrome."
The necrotic muscle tissue was obviously pale and brittle, looking like dead fish flesh.
There is a clear demarcation between this and the surrounding muscle tissue.
And looking at the irregular shape of the boundary, it is even more certain that it was caused by repeated beatings——
If it is caused by the squeezing of a large heavy object, the necrotic muscle tissue will be connected into one piece and the shape will be more regular.
"besides."
Lin Xinyi opened the chest and abdominal cavity with the help of Asai.
Leaving aside the varying degrees of failure of other organs, the most important thing to determine whether the deceased died of crush syndrome is the condition of the three organs: heart, kidneys and bladder.
"The blood has been extracted and now it will be sent to the Department of Science and Technology for identification."
"If the concentration of blood potassium, blood magnesium, and myoglobin seriously exceeds the standard, it can be proved that the death is caused by crush syndrome."
After a lot of work, Lin Xinyi began to check the kidneys.
The two kidneys of the deceased were obviously swollen, and there was something wrong with them at first glance.
Then take it out and place the sections under a light microscope for histological examination:
"Glomerular hyaline degeneration, epithelial cells in the proximal tubule are degenerated, swollen, necrotic, and shed, and red-stained protein casts are seen in the distal tubule and collecting duct."
"This is a symptom of kidney failure and is one of the essential criteria for identifying crush syndrome."
Lin Xinyi found more conclusive evidence.
At the side, Asai Narumi was responsible for examining the bladder, and the problem became even more obvious:
"The urine is soy sauce color."
"You can tell at a glance that the concentration of myoglobin in the urine exceeds the standard."
The large amounts of myoglobin released after muscle tissue dies is the main culprit in kidney failure.
Therefore, brown myoglobinuria is strong evidence for identifying crush syndrome.
"Mr. Lin."
Asai Narumi breathed a sigh of relief:
"Should we be able to draw a conclusion now, right?"
"The deceased died of sudden death from acute renal failure caused by crush syndrome."
"And his murderer is undoubtedly Matsubara Masaru, who has admitted to domestic violence!"
He thought he could get a positive answer from Lin Xinyi now.
But Lin Xinyi’s answer was:
"Indeed, we have ascertained the cause of death of the deceased."
"Then we can try to confirm the identity of the murderer."
"Huh?" Asai Narumi was slightly startled: "Hasn't the identity of the murderer been confirmed?"
"Who else could it be besides the violent Matsubara Masaru?"
"He is indeed a murderer."
"Without the violence he committed three days ago, the deceased's crush syndrome would not have been so severe."
Lin Xinyi paused for a moment, and his tone became a little subtle:
"But who says"
"There can only be one murderer?"