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Background: Patients exposed to electricity are often referred to the Emergency Department, but guidelines differ as to how they should be managed. In this article, we describe patients with low-voltage electric shock in the Emergency Department at St Olav's Hospital, Trondheim University Hospital., Material and Method: Retrospective data from patients referred to the Emergency Department following low-voltage electric shock (< 1,000 V) in the period 1.1.2012-31.12.2017 (N = 210) were included., Results: The median age was 26 years and 186/210 (89 %) were men. Out of the 210 patients, 165 (79 %) had symptoms following electric shock. Localised pain and chest discomfort occurred in 84/165 (51 %) and 57/165 (35 %) of patients respectively. ECG findings were normal in 168/209 (80 %), and no patients had arrhythmias requiring treatment or elevated troponin T or creatine kinase. No patients had serious complications or died., Interpretation: Low-voltage electric shock did not cause serious arrhythmias or elevated levels of troponin T or creatine kinase. It should be possible to manage asymptomatic patients with normal findings on clinical examination and ECG in a prehospital setting without reducing patient safety.

Background: The risk of death or appropriate therapy varies widely among recipients of implantable cardioverter-defibrillators (ICDs). The goals of this study were to develop a risk prediction tool that jointly considers future outcome probabilities of ICD shock and death., Methods and Results: We performed a secondary analysis of patients receiving ICDs as part of the SCD-HeFT trial (Sudden Cardiac Death in Heart Failure Trial). We applied an illness-death regression model to jointly model both ICD shocks and death under the semi-competing risks framework, which predicts for each patient their probability of having received ICD shocks, dying, or both at any given point in time. Among 803 ICD recipients (mean age, 60 years; 23% women) followed for a median of 41.1 months, 430 (53.5%) patients completed the study without dying or receiving an ICD shock, 206 (25.7%) received at least 1 shock but survived, 113 (14.1%) died before experiencing a shock, and 54 (6.7%) received at least 1 shock and subsequently died. Predicted outcome probabilities based on baseline demographic and clinical variables reveal substantial heterogeneity in joint shock and death risks, both between patients at each time point and for each single patient across time. Overall, predictive performance for ICD shock and death individually was adequate, based on area under the curve at 5 years of 0.65 for shocks and of 0.79 for death., Conclusions: Our analysis of outcomes after ICD implantation provides an alternative predictive model for individual risk of death or ICD shocks. If validated, this may provide a useful tool for individualized counseling regarding likely outcomes after device implantation, while also informing the design of further studies to focus the clinical effectiveness and cost-effectiveness of ICD therapy., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000609.

IntroductionAlthough death due to electrical injury and lightning are rare in children, these injuries are often preventable. Twenty years ago, most injuries occurred at home, precipitated by oral contact with electrical cords, contact with wall sockets and faulty electrical equipment. We sought to assess the epidemiology of electrical injuries in children presenting to Emergency Departments (EDs) that participate in the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)., Methods: This study is a retrospective review of electrical and lightning injury data from CHIRPP. The study population included children and youth aged 0-19 presenting to participating CHIRPP EDs from 1997-2010. Age, sex, year, setting, circumstance and disposition were extracted. Variables were tested using Fisher's exact test and simple linear regression., Results: The dataset included 1183 electrical injuries, with 84 (7%) resulting in hospitalization. Most events occurred at home in the 2-5 year age group and affected the hands. Since 1997 there has been a gradual decrease in the number of electrical injuries per year (p<0.01) and there is an annual surge in electrical injuries over the summer (p<0.01). Forty-six percent of injuries involved electrical outlets, 65% of injuries involved some sort of electrical equipment. Injuries due to lightning were rare (n=19). No deaths were recorded in the database., Conclusion: Despite the decrease in the number of electrical injuries per year, a large portion of injuries still appear to be preventable. Further research should focus on effective injury prevention strategies.

Electrical injuries are a commonly encountered hazard in both the home and workplace. However, clinicians are often uncomfortable when faced with the patient who presents with an electric shock due to sparse literature and lack of systematic recommendations on this topic. Electrical injuries can range from minor skin burns to life threatening internal organ damage. A thorough clinical assessment to ascertain the path of current through the body and possible internal injury is essential. The main concern in an apparently stable individual after an electric shock is the potential for delayed occurrence of cardiac arrhythmias which will require monitoring in the intensive care setting. While it may be reasonable to discharge home from the emergency room selected patients with low voltage injuries, absence of syncope and a normal ECG, others may require monitoring for at least 24 h. Public education and increasing workplace as well as home safety measures are key steps in prevention. The present review summarizes current knowledge in pathophysiology, manifestations and management of electrical injuries, with specific focus on cardiac effects.

Introduction: Deaths from electricity, generally, do not have specific findings at the autopsy. The diagnosis is commonly based on the circumstances of the death and the morphologic findings, above all the current mark. Yet, the skin injury due to an electrocution and other kinds of thermal injuries often cannot be differentiated with certainty. Therefore, there is a great interest in finding specific markers of electrocution. The search for the metallization of the skin through Scanning Electron Microscope equipped with Energy Dispersive X-Ray Spectroscopy (EDS) probe is of special importance in order to achieve a definite diagnosis in case of suspected electrocution., Materials and Methods: We selected five cases in which the electrocution was extremely likely considering the circumstances of the death. In each case a forensic autopsy was performed. Then, the skin specimens were stained with Hematoxylin Eosin and Perls. On the other hand, the skin lesions were examined with a scanning electron microscope equipped with EDS probe in order to evaluate the morphological ultrastructural features and the presence of deposits on the surface of the skin., Results: The typical skin injury of the electrocution (current mark) were macroscopically detected in all of the cases. The microscopic examination of the skin lesions revealed the typical spherical vacuoles in the horny layer and, in the epidermis, the elongation of the cell nuclei as well as necrosis. Perls staining was negative in 4 out 6 cases. Ultrastructural morphology revealed the evident vacuolization of the horny layer, elongation of epidermic cells, coagulation of the elastic fibers., Eds-Microanalysis: In the specimens collected from the site of contact with the conductor of case 1 and 2, the presence of the Kα peaks of iron was detected. In the corresponding specimens taken from cases 2, 4, 5 the microanalysis showed the Kα peaks of titanium. In case 3, titanium and carbon were found., Conclusions: In the suspicion of electrocution, the integrated use of different tools is recommended, including macroscopic observation, H&E staining, iron-specific staining, scanning electron microscopy and EDS microanalysis. Only the careful interpretation of the results provided by all these methods can allow the pathologist to correctly identify the cause of the death. Particularly, the present study suggests that the microanalysis (SEM-EDS) represents a very useful tool for the diagnosis of electrocution, allowing the detection and the identification of the metals embedded in the skin and their evaluation in the context of the ultrastructural morphology., (Copyright © 2018. Published by Elsevier B.V.)

Lenticular changes are often seen following electrical injury. We report an unusual case of electrical injury with late spontaneous posterior dislocation of lens nucleus with intact anterior capsule with ruptured posterior capsule in the right eye and anterior subcapsular cataract in the left eye. The right eye was managed with pars plana vitrectomy with cortical matter removal with multipiece intraocular lens insertion in ciliary sulcus. This report adds posterior capsular rupture and posterior dislocation of lens to the usual ocular complications of electrical injury., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

In forensic practice, determination of electrocution as a cause of death usually depends on the conventional histological examination of electrical mark in the body skin, but the limitation of this method includes subjective bias by different forensic pathologists, especially for identifying suspicious electrical mark. The aim of our work is to introduce Fourier transform infrared (FTIR) spectroscopy in combination with chemometrics as a complementary tool for providing an relatively objective diagnosis. The results of principle component analysis (PCA) showed that there were significant differences of protein structural profile between electrical mark and normal skin in terms of α-helix, antiparallel β-sheet and β-sheet content. Then a partial least square (PLS) model was established based on this spectral dataset and used to discriminate electrical mark from normal skin areas in independent tissue sections as revealed by color-coded digital maps, making the visualization of electrical injury more intuitively. Our pilot study demonstrates the potential of FTIR spectroscopy as a complementary tool for diagnosis of electrical mark., Competing Interests: The authors have declared that no competing interests exist.

Electrical injuries in animals occur most often accidentally. They comprise contact to various forms of currents, including alternating, rotary, or direct currents. Depending on various parameters of the current (including the type of circuit, voltage, current and duration of exposure) and conditions of the animal (such as wet or dry hair coat and pathway of current through the body), lesions may be absent or may include early or localized development of rigor mortis, signs of acute circulatory failure, or severe thermoelectrical burns. Such burns may present as external current marks, singed hair or feathers, metallization of the skin, or occasionally internal electroporation injury resulting in muscle necrosis, hemolysis, vascular damage with thrombosis, injury to brain and spinal cord, or skeletal fractures. Furthermore, lightning strikes occur regularly in grazing animals, which have greater risk of death from step potentials (ground current) in addition to direct strike and contact injury. Such cases may have no lesions, external signs of linear or punctate burns, keraunographic markings, or exit burns on the soles of the hooves or the coronary bands. Besides detailed information about the circumstances at the location where the animal was found, electrical injuries in animals require a thorough morphological workup, including additional investigations in conjunction with certain knowledge about the possible lesion spectrum., (© The Author(s) 2016.)

Decades after the problem was first identified, power line electrocution continues to be a cause of avian mortality. Currently, several federal laws protect eagles and other migratory birds, meaning that utility companies may be liable for electrocution-related deaths. Veterinarians and veterinary pathologists called upon to diagnose and treat electrocuted birds should keep this in mind when conducting clinical and postmortem examinations. This review details necropsy findings and methods used to diagnose electrocution. A combination of gross, subgross, and radiographic examinations can aid in identification of subtle injury. Diagnosis is made based on the presence of skin and/or feather burns. Other necropsy findings may include skin lacerations, subcutaneous burns, bruising, limb avulsion, hemopericardium, and vascular rupture. At the US Fish and Wildlife Service's National Forensics Laboratory, from 2000 to 2015, 417 raptor deaths were determined to have been caused by electrocution. Bald eagles and golden eagles were the most commonly submitted species. In a retrospective review of 377 cases, for which whole bodies were submitted, 18% of the electrocuted birds had only a single, small (less than 3 cm in diameter) external burn. Small, isolated burns tended to occur on the undersides of the wings at and distal to the elbow and on the lower legs and feet. These areas should be most carefully examined in cases where electrocution injury is not immediately apparent., (© The Author(s) 2016.)

Introduction: A macular hole is a rare complication after high-voltage electrical shock injury and only a few cases have been reported to date. To the best of our knowledge, this is the first report of bilateral impending macular holes after high-voltage electrical shock., Case Presentation: We report a case of bilateral impending macular holes in a 39-year-old male Chinese patient who sustained a high-voltage electrical shock three months prior to presentation. Our patient complained of gradually diminished eyesight in both eyes, with visual acuity of 20/100 and 20/40 in his right and left eyes respectively. Our patient underwent pars plana vitrectomy accompanied by octafluoropropane gas and triamcinolone acetonide injections, and was discharged from our hospital with slightly improved vision., Conclusion: The visual outcome of impending macular holes caused by high-voltage electrical shock may be poor despite tissue residue at the fovea and surgical intervention aimed at aiding macular recovery. Surgery is, however, effective in the short term in restoring normal anatomical macular structure.

Background: There is no uniform, standardized procedure for the treatment of persons with electrical injuries in Germany. Even if they have no risk factors, such persons are often hospitalized and observed on an intensive care unit because of concern that cardiac arrhythmia might arise some time after the initial accident. We analyzed secondary data to determine the frequency of cardiac arrhythmia in survivors of electrical accidents., Method: Using the hospital information system (HIS), we retrospectively identified all patients admitted to the Charité Berlin, Campus Virchow Klinikum, for the ICD diagnostic code T75.4 (effects of electric current) in the years 2001 to 2008. The data pertaining to each case were extracted from the patients' medical records., Results: Over the study period, 268 children and adults were admitted to our hospital with electrical injuries. All underwent cardiac rhythm monitoring, usually for more than 12 hours. On admission, 33 children (28.7%) and 33 adults (24.2%) had mild cardiac arrhythmias of various types (sinus tachycardia, sinus bradycardia, isolated extrasystoles). No patient developed a cardiac arrhythmia requiring intervention at any point in his or her hospital course., Conclusion: Even though too few patients were included to permit any definitive conclusions from this retrospective study alone, the present findings accord with the findings of multiple earlier studies implying that asymptomatic, otherwise unharmed patients without any ECG changes may not need to be admitted to the hospital for observation. There should be an evidence-based, standardized procedure for the treatment of patients with electrical injuries, so that these patients can be cared for safely and cost-effectively.

Aims: Increased rates of structural abnormalities including externalized conductors have been reported in the Riata family of implantable cardioverter-defibrillator leads (St Jude Medical). Little is known about their reliability and the time lag for emergence of functional or structural abnormalities., Methods and Results: Thirty-six patients who received small-caliber leads of the Riata family and who completed face-profile flouroscopies, repeated at every 6 months were included. We assessed the prevalence of conductors' externalization and its relation to abnormal electrical parameters or adverse events. Thirty-six patients, mean age = 64 ± 10 years, with at least 7-month completed fluoroscopy follow-up were included in the analysis. Externalized conductors were identified in 12 (33%) patients after a 53-month (13-114) mean delay. A higher left ventricular ejection fraction (LVEF): 47 ± 13 vs. 33 ± 12%, P = 0.04, and a progressive decrease (≥30% of the initial value) in amplitude of ventricular electrogram 9/12 (75%) vs. 4/24 (17%), P = 0.03 were independently associated with the fluoroscopic failures. Detection of the conductors' externalization was preceded by an electrical lead abnormality in 10 (83%) patients., Conclusion: Repeated face-profile fluoroscopies allowed detection of conductors' externalization in 33% of patients implanted with Riata leads. Better LVEF and a progressive decrease in amplitude of intracardiac ventricular electrogram were independently associated with externalized conductors. The structural abnormality was preceded by an electrical lead dysfunction 83% of patients.

Background: Most European birds of prey find themselves in a poor state of conservation, with electrocution as one of the most frequent causes of unnatural death. Since early detection of electrocution is difficult, treatment is usually implemented late, which reduces its effectiveness. By considering that electrocution reduces tissue temperature, it may be detectable by thermography, which would allow a more rapid identification. Three individuals from three endangered raptor species [Spanish imperial eagle (Aquila adalberti), Lammergeier (Gypaetus barbatus) and Osprey (Pandion haliaetus)] were studied thermographically from the time they were admitted to a rehabilitation centre to the time their clinical cases were resolved., Cases Presentation: The three raptors presented lesions lacking thermal bilateral symmetry and were consistent with electrocution of feet, wings and eyes, visible by thermography before than clinically; lesions were well-defined and showed a lower temperature than the surrounding tissue. Some lesions evolved thermally and clinically until the appearance of normal tissue recovered, while others evolved and became necrotic. A histopathological analysis of a damaged finger amputated off a Lammergeier, and the necropsy and histopathology examination of an osprey, confirmed the electrocution diagnosis., Conclusions: These results suggest that thermography is effective and useful for the objective and early detection and monitoring of electrocuted birds, and that it may prove especially useful for examining live animals that require no amputation or cannot be subjected to invasive histopathology.

Introduction: There are limited long-term follow-up data on functional changes in the myocardium after high-voltage electrical injury (HVEI)., Methods: Twenty-three patients who had been exposed to HVEI (>20,000 volts) and preserved left ventricular ejection fraction (≥55%) were enrolled in the study. Echocardiographic parameters, including peak systolic strain (S) and strain rate (SR), were evaluated at baseline, six weeks and six months later. These data were compared with a healthy control group who were matched in terms of age, sex and body mass index., Results: The systolic and diastolic blood pressure and the heart rate were significantly higher in the HVEI group compared with the control group at baseline and at six weeks, but not at the six-month follow-up. Conventional echocardiographic data showed no differences between the groups during the study period. In contrast to the S, the baseline and six weeks, SR was significantly increased in the HVEI group compared with the control group. However, at the six-month follow-up, there was no difference in the SR between the groups. Among the 23 patients with HVEI, 17 of the patients had vertical current injury, and 6 patients had horizontal current injury. There was no difference in terms of the conventional echocardiography, S and SR between the patients with vertical injury and those with horizontal injury at baseline and at the six-month follow-up., Conclusions: The long-term contractile performance of the myocardium is preserved when patient do not experience left ventricular dysfunction in the early stages after HVEI.

Introduction: The aim of this study was to evaluate the functional changes of the arterial endothelium and smooth muscle after a high-voltage electrical injury (HVEI), using flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD)., Methods: Twenty-five male patients injured in the upper extremities by current due to contact with more than 20,000 volts were enrolled in the study. FMD and NMD were measured on the brachial artery within 48 hours after HVEI, and follow-up FMD and NMD were evaluated six weeks later. In addition, we enrolled an age, sex and body mass index matched healthy control group consisting of 25 individuals. Including FMD and NMD, all the variables of the control group were investigated one time and compared with the initial and six week follow-up data of the HVEI group., Results: A significantly lower initial FMD was seen in the HVEI group compared with the control group (2.1±1.2% versus 13.6±3.4%, P<0.01). At the six week follow-up, the FMD of the HVEI group had significantly improved compared to the initial FMD (2.1±1.2% versus 5.1±2.1%, P<0.01), but it was still lower than the FMD of the control group (5.1±2.1% versus 13.6±3.4%, P<0.01). A significantly lower NMD was seen both initially and at the six week follow-up compared with the NMD of the control group (7.3±4.7% versus 20.4±4.1%, P<0.01 and 11.4±6.7% versus 20.4±4.1%, P<0.01, respectively). The FMD study of the contralateral arm which was uninjured by HVEI was available in six patients. In those patients, the six week follow-up FMD was significantly improved in the HVEI arm compared with the initial FMD (1.8±0.6% versus 4.4±1.6%, P<0.01). However, in the contralateral uninjured arm, there was no difference between the initial and the six week follow-up FMDs (5.5±1.4% versus 6.9±2.2%, P=0.26)., Conclusions: After HVEI, the endothelial and smooth muscle functions of the brachial artery were significantly decreased for at least six weeks. Long term cautious care might be needed for all victims of HVEI, because there is a chance of increased risk of thrombosis or stenosis in the injured arm.

Posterior shoulder dislocation is a rare event that may occur after a direct trauma, an epileptic seizure, electric shock or electroconvulsive therapy. In more than 50% of the cases, posterior dislocations are missed on initial evaluation and often misdiagnosed as frozen shoulders with unfortunate consequences. We present the case of a missed posterior subluxation and reverse Hill Sachs lesion (McLaughlin lesion) in a 40-year-old woman caused by anelectric shock of 240 V. The patient underwent surgery in our institute two weeks after the injury. The humeral head was reduced and the reverse Hill Sachs lesion was filled by demineralized bone matrix allograft with osteoinductive factors. Tendons were repaired and a temporaneous artrodesis was performed. At the final follow up of 12 months, we obtained a Costant Score of 93 and the patient returned to her previous daily activities.

A 67-year-old woman sustained electric shock while using her hair dryer. During this process her left leg shot up in the air following which she could not walk properly with that leg. She attended the accident and emergency and, considering a possibility of an undisplaced fracture of the calcaneum, she was referred to the fracture clinic the next day. She was clinically diagnosed to have tendoachilles rupture and this was further confirmed by an ultrasound scan. Predisposing factors like drug intake or chronic inflammatory arthritis were excluded and she was treated with conservative management.

We describe an unusual case of near fatal inappropriate implantable cardioverter defibrillator therapies due to atrial oversensing by a newly implanted ventricular lead. Chest X-ray revealed dislodgement of the active fixation lead to the tricuspid annulus area explaining the atrial oversensing and intermittent ventricular therapies.

Simple clinical and laboratory indexes have been identified as predictors of arrhythmic events in implantable cardioverter defibrillator patients. Biomarkers, which are playing a growing role in the prognosis and treatment of patients with heart failure, could provide an auxiliary tool in this context, given that their measurement is now easy and widely available.

Ventricular tachycardia episodes terminating during or immediately after device charging are not expected to be treated by current implantable cardioverter defibrillators as shocks are non-committed. For proper troubleshooting, the reconfirmation algorithm will be reviewed.

Extensive deep-vein thrombosis (DVT) may result from a high-voltage electrical injury. Little is known about the effects of long-term, low-voltage electrical stimulation. We report on the unusual finding of deep-vein thrombosis in a black patient, affecting the superior vena cava and right femoral vein, in association with a right atrial mural thrombus, following low-voltage electrical stimulation of the body for analgesic purposes. The patient had slightly decreased blood levels of proteins C and S, with no other known risk factors. The diagnosis, management and prognosis are discussed. This case demonstrates the need to investigate the cardiovascular effects of chronic, low-voltage electrical stimulation.

Cardiac resynchronization therapy (CRT) is now an accepted treatment for heart failure [McAlister et al. in Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review. JAMA 2007;297:2502-14.]. In addition to the complications associated with standard pacemaker implants, CRT procedures have their own additional complications such as coronary sinus dissection, diaphragmatic stimulation, and longer implant times. We present a case of CRT implantation which illustrates these problems because of an unusual complication.

Electrical trauma can be caused by low-voltage current (from 60 to 1000 V, usually 220 or 360 V), high-voltage (more than 1000 V) current, lightning, and voltaic arc. Often victims are little children, teenagers, and working-age adults. Electrical injuries and clinical manifestations can vary a lot and range from mild complaints not demanding serious medical help to life-threatening conditions. Lightning causes serious injuries in 1000-1500 individuals every year worldwide. The case fatality rate is about 20-30%, with as many as 74% of survivors experiencing permanent injury and sequela. The primary cause of death in victims of lightning strike or other electrical trauma is cardiac or respiratory arrest. That is why appropriate urgent help is essential. Subsequently electrical burns, deep-tissue and organ damage caused by electricity, secondary systemic disorders often demand intensive care and prompt, usually later multistage surgical treatment; therefore, prevention of electrical trauma, which would help to reduce electrical injuries in children and working-age population, is very actual. The most important is to understand the possible danger of electricity and to avoid it.

A case is reported in which death is caused due to electrocution by a copper wire that was used as string of the kite. Electric current flowed through the copper wire of cut down kite when it touched power line transmitting alternate current of 240 V at 50 Hz. The free end of copper wire had abraded against the victim's shoulder, neck and face, and finally entangled around the ear. A unique type of electrical injury is noticed due to contact with live copper wire. This paper stresses the unique danger of the kite flying.

It is not always recognized that morbidity from electrical injury is not confined to effects in the pathway of current flow. Indeed a major element of the disability suffered by victims occur from effects remote to the line of current passage. Recent papers have rightly drawn further attention to this, and it is an active area of controversy and research. This paper documents the authors experience in this area and confirms the recognizable elements of remote injuries which are seen to be generally psychological in nature. The question of mechanisms of causation of these disabilities is raised. This paper then presents summary results of a collation of neuropsychological investigations and functional cerebral scanning in an attempt to correlate the two. It is concluded that it is possible to overlook the remote effects of electrical injury to the detriment of victims.

Low voltage energy source is not free from danger. An exceptionally rare and peculiar mode of facial blast injury is reported. The blast took place silently in the mouth of a 15-year-old boy, due to short-circuiting of wires connected to a12-volt car battery while peeling off insulation with the intent of running a musical instrument. Airway compromise due to soft tissue injury produced further problem during tracheostomy. Emergent airway management is discussed. Post-healing sequel resulted in loss of voice and prevented normal oral feeding. The case report emphasizes need for education to public in handling low voltage energy source.

The diagnosis of electrical injuries may be difficult and sometimes we should use some methods to support that. In this experimental rat study; electrical injuries were made in the dorsal skin of rats using 110 V, 100 A ac current. Swabs were taken from these injuries and investigated for iron and copper by using atomic absorption spectrometry. There was a great significance between study and control groups for copper (p<0.01). It was suggested that metallic deposition to skin in electrical injuries can be shown by atomic absorption spectrometry as quantitatively and can be used for improving the diagnostic sensitivity of electrical lesions.

Historically, tissue damage from electrical contact was thought to arise from resistive heating of tissues along the current pathway. The modern view has accepted that tissue damage can result from cellular rupture (electroporation) induced by the presence of an electric field. There remain electrical injuries that defy explanation by either theory. In rare electrical contacts, diffuse symptomatology arises that is neither proportionate to the electrical contact nor does it occur along the theoretical linear pathway of the current from entry point to exit point. Disproportionate, remote electrical injury is most notable when the contact voltage is low (120 and 240 V). Symptoms occur, absent diagnostic evidence, that defy explanation as organic injury. A Web-based interactive survey was used to locate and query individuals suffering from rarely occurring responses to electrical contact. The results of the study suggest that there is a common symptomatology that is neither linked to voltage nor loss of consciousness at the time of contact.

To evaluate cardiac complications associated with electrical injury, 7 patients with high-tension electrical injury (6,600 V alternating current) underwent 201Tl and 123I-metaiodobenzylguanidine (MIBG) imaging in addition to conventional electrocardiographic and echocardiographic assessments. Electrocardiography showed transient atrial fibrillation, second degree atrioventricular block, ST-segment depression, and sinus bradycardia in each patient. Echocardiography showed mild hypokinesis of the anterior wall in only 2 patients, but 201Tl and 123I-MIBG myocardial scintigraphy showed an abnormal scan image in 6/7 and 5/6 patients, respectively. Decreased radionuclide accumulation was seen primarily in areas extending from the anterior wall to the septum. Decreased radionuclide accumulation was smaller in extent and milder in degree in 123I. MIBG than in 201Tl imaging. These results suggest that even in patients without definite evidence of severe cardiac complications in conventional examinations, radionuclide imaging detects significant damage due to high-tension electrical injury, in which sympathetic nerve dysfunction might be milder than myocardial cell damage.

The site of neurological damage causing paralysis after electrical trauma remains to be clarified. A patient is described who developed a flaccid tetraplegia after a high voltage electrical injury. The findings on initial examination and neurophysiological investigation showed a very severe generalised sensory-motor polyneuropathy. His subsequent follow up over 60 months showed a remarkable degree of reinnervation and the unmasking of a myelopathy. The degree of reinnervation noted suggests an axonopathy that left the other elements of the peripheral nerves relatively spared. These findings provide the most convincing evidence to date that a generalised polyneuropathy can follow electrical injury and that it results from non-thermal mechanisms such as electroporation.

An investigation on the diagnosis of drowning by analysis of chlorophyll(a) (Chl.(a)) of planktons in the lung sample with a spectrofluorophotometer (SFPM) is reported. The diagnostic criteria or main points of death by drowning are suggested are according to our experimental studies. Meanwhile two cases of submersion in water were investigated and the causes of death were diagnosed correctly. It is concluded that examination of lung Chl.(a) of planktons could be used as a reliable diagnostic method in forensic practice.

The differentiation of minute current marks from the faint traces of burns may offer some difficulties. Marcinkowski and Wojciechowski (1973) treated the skin of corpses with the same metal objects either heated to a high temperature or exposed to 250 V of alternating current, and determined (by an electrographic method) that metallization appeared only after applying the electric current. The continuation of these observations is linked with the actual experimental studies of Pankowski. By treating the skin of corpses with alternating and direct current of 10, 50, 100 and 250 V for 0.3 sec, 1 sec, 30 sec and 1 min passing through a radioactive electrode of 60Co, he has shown that the radioactivity of the skin at the site of electrode contact increases with the elevation of the voltage and its duration. In the case of direct current the rise was 630-54000-fold at the site of the positive electrode. Using electrodes of copper, aluminium and iron (not radioactive) it has also been shown (by an electrographic method) that metallization intensifies under the same conditions of time and voltage. Metallization could be detected even when no current marks on the skin were evident. Electrography appears to be extremely useful in the detection of metallization. No metallization was detected at the site of the negative electrode (as refers to direct current).