2023年6月24日发(作者：)

IntJLegalMedDOI10.1007/s00414-012-0727-1ORIGINALARTICLEIsthelungfloatingtestavaluabletoolorobsolete?AprospectiveautopsystudyAnna-LenaGroßeOstendorf&hild&AnnetteM.Müller&SibylleBanaschakReceived:#25February2012/Accepted:12June2012Springer-Verlag2012AbstractThelungfloatingtestisstillanortoverifythereliabilityofthefloatingtest,anewclinicaltrialshouldexaminetheresultsofcurrentcasesandthusexpose,ingthequestion,ifthetestisappropriateforthenowadaysbirthcollective,r,itindicatedafalsenegativeresultinfourcases,inwhichthelungssank,l,thestudywasabletoprovethattheresultsofthefloatingtestarereliablein98%.Further,therewasnotasinglefalse-positiveresult(lungsofastillbornswim).Nevertheless,thetestdemon-stratesthatanegativetenIntroductionThelungfloatingtest(alsoknownashydrostatictest,floa-tationtest,lungtest,ordocimasia),normallyundertakenduringthemedicolegalautopsyofnewbornsandpossiblyA.-ßeOstendorf:hild:hak(*)InstituteofLegalMedicine,UniversityHospitalCologne,Melatengürtel60/62,50823Köln,Germanye-mail:hak@.M.MüllerDepartmentofPaediatricPathology,UniversityofBonn,52137Bonn,Germanystillbornchildren,o-Saxoncountries,how-ever,stionwhetheranewbornbreathedbeforeitdiedornot“…hasprobablyprovokedmorediscussion,printedwords,andcontroversythananyothertopicinforensicmedicine”[1].InEnglishliterature,thetestisjudgedcritically[1–8],withoneauthorevensuggestingthat“thetestwassuspectevenin1900andrequiresnodetaileddiscussion,becauseitisnowknowntohavenovalue.…itis,therefore,pointlesstoapplythehy-drostatictestwhich,moreover,willimpairthematerialforotherandmoreimportantinvestigations”[4].Itisabouttimetofore,aprospectiveexperimentalstudyonthissubjectwasconductedinaclinicalstudygroup,andtheresultgivesadvice,whetherthefloatingtestisstillrelevantduringanewborn'sThelungfloatingtestwascarriedoutinaprreperformedintheDepartmentofPediatricPathology,rtohaveanentireclinicalcohort,everynaturalmisryfetusandneonate,therewasawrittenconsentbytheparentsforaclinical-pathologicalautopsy,he208children,rediedwithinafewhoursafterbirth,opsywasundertakenregularlybe-tween1and14daysafterthedeathofthechildren,cheawasligatedbelepackatingtestprovedpositive,whenthelungsfloated,ackagesank,showedagainanegativeresult,smallpieces(0.3–1cm)nition,aposithestudy,thelungstthefloatingtest,thelungswereexaminedmacroscopicallyandhistologicallyusingH&ase,thecontractionstartedinthe30thweekofpregnancy,butthefetusdiedduetoagrowthrestric194lungstestednegativebelongedtostillbornsbetweenthe10thand36thweekofpregnancy,ennewbornsofthestudywereverifiablybornalive(seeTable1)r,mesitshowedanegativeresult,al-thoughlifeandbreathinghadbeenreportedbymedicalstaff(seeTable2).Inallofthesefourcases,thewholelung,aswellastheseparatedleftandrightlungandsinglepiecesfrombothsides,sank;oursDiscussionWithintheclinicalstudy,198cases,thegsweretestedpositive;naturallyorinduced,189timesfetus'thefetuswasbornstill,eonatesdidnotbreatheair,cases,thefetuseswereborndea1681,Johtliteraturetestifies,thatAeliusGalenus,asearlyas200A.D.,recognizedthroughanimalexperiments,that“substantiapulmonum(perrespirationem)exrubra,graviacdensainalbam,levemetraramtransfertur”(thenatureofthefleshofthelungchanges(bybreathing)frombeingredandheavyandFig.1CaseswithnegativelungfloatingtestbyweeksofpregnancyIntJLegalMedsrueroviadhtloauirVwgceIcpX5eea3FNStndeedmrposochterlenvaelroituvIiItomsgeIXNoed5PRfogrevnaliditnuoanciicrIhggaeI6eXesp21NBn,otinsdeuedmffrpeosolchterlaenvaerluroitiuvetomsgelIXNoedp2PRlasuerhbpdmieoersgpdsinrsuhratnohlistt,cneseevieodhedunrittosertitmonsuioositfarXN0ol1PBgninrnalsirgoueeeovbvdilohtayairwglferXaop3eeI3FNE,gtnnidededmerpeloobcserleyvaellaraidtuvsIiItsgeaIoVN1oedb1PR,tnndeomyiersdspanrohonettcnerloreovaeelrmiuvmlptigeuyItosIedphVN0o1PRervadslo2yioiat+iersveI6doplV32PAevriadtloauirgcehecpV0Na33S,dosierceaprdtoertvanosll2yituebe+aiccfsvVoceo8dariI26PSlanro,btfayeisylrrllaaa;llbeeud-pasvy,icoigo1titcrnp+aihfsaeigspuyI7dlhirIoeI22PRv,sdnoisrreoendbpeanrwernbuvaiosllfe5yituamnaicyee+dsochamrfI6aoI26PSs,tenssdeeaecmcdaprdrtnoseoortcloeyvaenleailetvebriuttdecfosgroedeu4roIN1PRoFygfcnio1nfltygefaoaaonvognlghilfoulbketvtlergrgsoepnunethtsTaWeesuitLLHdensetobeingwhiteandlightandlessdense)[9,10].Physicianscouldonlyunderstandth1663,Bartholinusstatedthatthoselungs,whichdidnotbreathebefore,sink,whilethose,whichbreathed,swim[10].Thefirstphysician,whonotablyusedthisknowledge,wasRaygerin1677[9–11],butitwasJohannesSchreyer,4yearslater,whoperformedanddescribedthelungfloatingtestasitisstillpracticedtoday[11,12].Wherevermodernandcontemporarymedicaldiscoursesandmonographsoflegalmedicinerefertothefloatingtest,thetestproceduresandpossiblereasonsforfalse-positiveorfalse-negativeresults,,theonlyinformationaboutthefloatingtestavailabletodayisaconstantcopyofdatedrecords[12–16].TheonlypresentstudywasdonebyMoar[17]ed35newbornlungstoevaluatethefloatingtestsreliabilityincontrasttotheliverfloatingtest,themacro-scopicappearance,inentstudyotherthanMoar'rdtothecitedliterature,,-sonforafalse-positiveresult,meaningthatthelungsofastillborncanswim,canbethedevelopmentofgasesduetodecomposition[13–16].Ifbroughtforwarddur-ingatrial,testwastakenastheonlyevidence,theallegedperpetrator,mostlythemother,couldbeaccusedformurder,hestudyshows,-fore,thesefloatingtest'sresultsalwayshavetobeevaluatedverycarefully,andwithpossiblebodydecom-position,tical-ly,theremightalsobeapositiveresulr,thisargumentmightnotbeeligible,sincenonprofessionalswillprobablynotbeabletosuccess-fullyventilatethelungsduringtheirresuscitationefforts[13,14,16].Althoughafalse-positiveresultmayhavetheworsejuristicconsequencesandsuggesttheguiltofaninnocentperson,ly,anegativeresultimpliesthatthechildwasstillborn,butonecauseforanegativetestresultofababybornalivecanbefluidinnewborn'slungs;thismightoccurafterawaterbirth[18].Thetestcouldalsobenegativeifsomebodywasabletokillthenewbornbeforeittookitsfirstbreath[13–16].Ithasalsobeendiscussedthataircouldbereabsorbedfromthelungstothesurroundingtissueofapostmortem[13],butthisIntJLegalMedTable2DetailstothefournegativelungfloatingtestsbyneonatesbornaliveVWeekofpragnancyBirthweightLengthofsurvivalOperationResuscitation30weeks2,380g3hNoYesIX33weeks2,705gFewhoursYes,neurosurgeryYesYesNegativeSaccularperiodXII26weeks514g1hNoYesXIV35weeks1,800gFewhoursNoYesYesNegativeSaccularperiodCesareanduringreanimationofthemother(lungfloatingtest,InstituteofLegalMedicine,UniversityofCologne)IntubationNoLungfloatingtestNegativeHistology(lungdevelopment)SaccularperiodSpecialexplanatorynotesNoNegativeBeginningofsaccularperiodIntrauterinesupraventricularSubduralhematoma,Tracheoesophagealtachycardia,Hydropsfetalisoperationfistula≥missingoxygenationepossibilitiesforfalse-negativeandfalse-positivetestresultsinmind,thepresentclinicalresearchwasconduldbecomeespeciallyinterestingforthelegalmethodsofautopsies,emedicinehasdevelopedenormouslysincethedaysofSchreyeretal.,thetestscompatibilitytocoys,evennewbornsinthe24thweekofpregnancycansurviveinspiteofunderdevelopedlungs;thustheresultsofprematurelybornbabies,whohadknowinglybreathed,194outof208cases,tansthatthelungsofthedeadbornchildrendidnotswim,secases,thetestwasa100%r,thestudyshowedfourcasesinwhichthenewbornswerealiveafterdelivery,thepossiblereasonsforafalse-negativeresultmentionedbeforewereaffectingthetests,sighthesefourchildrenhadanillnessthatcausedtheirearlydeath,itisstilldocumentedthattheylivedforatleastsomehours;ationwasverydifficultwithoneofthenewborns,butintheotherthreecases,rsa,outofthe14casesinwhichthenewbornsbreathedorunderwentresuscitation,onlytenshowedapositiveresultThevalidityofthelungfloatingtesttoimplylifeafterdeliveryincontrasttostillbirthis71.42%sionThelungfloatingtestisonlyonetoolofamedicsnolaw,inGermany,demandingfortheimplementationofthefloatingtest;,overall,thestudyshowedavalidtestresultin204outof208cases,whichmeansitwas98%r,itpresentedawrongresultinfourcases;ultsshowthat,ifachildwasborndead,thelungfloatingtestis100%ewbornhaslivedshortlyafterdelivery,rcasesthatshowedawrongtehesecasesthhenewbornswereevenintubatedbymedicalstaff,wocasesallowtheconclusionthatapersonwithoutmedicalqualificationwillmostlik-positiveresultprovokedintheattempttorescueanewborn,asitisassumedinliterature[13,14,16],dyprovesthatforcontemporarymedicine,thelungfloatingtestisstillareliableindicatorofanewborn'ewasnofalse-positiveresult,awrongfulconvictionftherhand,thestgupthestudyallowstheadvicetostillperformthelungfloatingtestineverymedicolegalinvesti-gationwiththeuncertainty,wnrestrictions,aswellasstudy'sfindings,mustbetakenintoaccount,P,KnightB(2004)Knight'sforensicpathology,,London,pp439–nM(1994)Suspiciousinfantdeaths:thestatuteof1624andmedicalevidenceatcoroners':ClarkM,CrawfordC(eds)dgeUniversity,Cambridge,pp64–U(1993):SpitzWU,SpitzDJ,FisherRS(eds)SpitzandFisher'smedicolegalinvestigationofdeath:guidelinesfortheapplicationofpathologytocrimeinvestigation,Publisher,Illinois,pp681–(1985):PolsonCJ,GeeDJ,KnightB(eds)Theessentialsofforensicmedicine,on,Oxford,pp514–(1993)erHungaria,Debrecan,pp240–-JamesJ(ed)(2005)Encyclopediaofforensicandlegalmedicine,er,London,pp367–MT,HopsterDJ(2005)Postmortemtechniquehandbook,er,London,pp399–nK(1974)Forensicmedicine,Arnold,London,pp158–rK(1950)Leitfadendergerichtlichenmedizin—fürändSchwarzenberg,München,pp116–nER(1898)Lehrbuchdergerichtlichenmedicin(8thedn).Urban&Schwarzenberg,Wien,pp708–(1987)Dieunterschiedlichebeurteilungderkindestötation,MedizinischeFakultätderUniversitätDürB(1975)GerichtlicheMedizin().Springer,Heidel-berg,pp1185–beck-DiekeA(1994)Rechtsmedizinischeuntersuchungenunnatürlichertodesfälleneugeborener—eineforensischestudiezurKindestötation,FachbereichderHumanmedizinderJustus-Liebig-UniversitärB,RopohlD(1986)Rechtsmedizin(4thedn).FerdinandEnkeVerlag,Stuttgart,pp157–,DettmeyerR(2007)er,Heidelberg,pp173–gR(2006)Rechtsmedizinsystematisch,-MEDVerlag,Bremen,pp147–(1997)Thehydrostatictest—avalidmethodofde-termininglivebirth?AmJForensicMedPathol18(1):109–erJ,SchmidtU,HanischU,DemmlerG,RiehnA,PollakS(2011)ensicMedPathol32:119–123