Kankuri, Esko

Lindford, Andrew

Nijsten, Maarten

Vuola, Jyrki

English

ARTS repository - University of Groningen

The fractal lightning burn results from a positively charged strike

Proceedings - University of Groningen

Dissertations of the University of Groningen

University of Groningen

Helsingin yliopiston digitaalinen arkisto

Intensive Care Med (2017) 43:1167–1168DOI 10.1007/s00134-017-4816-yCORRESPONDENCEThe fractal lightning burn results from  a positively charged strikeDiscussion on “Resuscitated unconscious male: Lichtenberg’s sign lighting the way”Maarten Nijsten1*, Andrew Lindford2, Jyrki Vuola2 and Esko Kankuri3© 2017 Springer-Verlag Berlin Heidelberg and ESICMInitial correspondence from Dr. NijstenDear Editor,A recent short piece in the “Imaging” section of Inten-sive Care Medicine reported by Lindford and colleagues describes a patient with so-called Lichtenberg figures [1]. In humans this fascinating pattern has long been known to be pathognomonic for lightning injury.  The authors state that the pathogenesis of the markings is unclear and that it would not be a physical phenomenon [1]. This is not true.In 1975, the revolutionary and highly influential con-cept of the fractal shapes was formulated by Benoit Mandelbrot of IBM Research [2]. Soon afterwards many research groups recognized the presence of fractal shapes in all sorts of physical and biological systems.In 1987, we analyzed Lichtenberg figures in lightning victims. In multidisciplinary research that included mathematical modelling, stochastic computer simula-tion, high-voltage discharge experiments and analysis of Lichtenberg burns, we elucidated the underlying mecha-nism [3]. The fern-like lesions are first-degree burns with an obviously non-anatomical pattern. The fractal nature of this pattern can be directly explained from a positive lightning strike, which is relatively infrequent as most direct strikes are negatively charged. The fractal shape can only result from a superficial positive discharge because such a discharge attracts the charge carriers, i.e. electrons. A negative discharge that emits electrons has a more deterministic and homogeneous structure and thus a non-fractal structure [3].Reply from Drs. Lindford, Vuola and KankuriWe read the letter from Dr. Nijsten with great interest and would like to thank him for his help in clarifying the actual pathogenesis of Lichtenberg figures (LFs). Their pathophysiology has indeed puzzled and fascinated clini-cians and scientists for centuries with various postulated mechanisms described in the literature. Their transient fern-like patterns do not correspond to any anatomical, vascular or neural distribution, and some consider LFs to represent extravasated red blood cells in the superfi-cial skin layer secondary to dielectric skin breakdown and subsequent massive electron shower [4]. Dr. Nijsten and his team demonstrated in 1987 that LFs are fractal patterns resulting from a less common positive lightning strike. They also describe LFs to be a first-degree (super-ficial) burn that affects only the superficial epithelium [3]. The latter may be supported by their transitory nature and absence of any findings on biopsy [1], but more typi-cally a first-degree burn is characterised by a diffuse area of erythema, in contrast to the precise delicate fern-like pattern of a LF. It is feasible, however, that the erythema-tous LF pattern derives from a dilated capillary network in the epidermis. It would in fact be interesting to utilize novel tools such as RNA expression profiling [5] or RNA sequencing [6] to reveal molecular level changes in the superficial skin during the course of LF evolution.Thus, whilst some doubt exists as to whether or not LFs represent a true pathological lesion, they can certainly be considered to be a physical phenomenon pathognomonic for lightning injury.*Correspondence:  m.w.n.nijsten@umcg.nl 1 Department of Critical Care, University Medical Center Groningen, Groningen, The NetherlandsFull author information is available at the end of the article1168 2. Mandelbrot B (1977) Fractals: form, chance and dimension. Freeman, San Francisco 3. ten Duis HJ, Klasen HJ, Nijsten MW, Pietronero L (1987) Superficial light-ning injuries—their ‘fractal’ shape and origin. Burns 13:141–146 4. O’Keefe Gatewood M, Zane RD (2004) Lightning injuries. Emerg Med Clin North Am 22:369–403 5. Nuutila K, Siltanen A, Peura M, Bizik J, Kaartinen I, Kuokkanen H, Nieminen T, Harjula A, Aarnio P, Vuola J, Kankuri E (2012) Human skin transcriptome during superficial cutaneous wound healing. Wound Repair Regen 20(6):830–839 6. Katayama S, Skoog T, Jouhilahti EM, Siitonen HA, Nuutila K, Tervaniemi MH, Vuola J, Johnsson A, Lönnerberg P, Linnarsson S, Elomaa O, Kankuri E, Kere J (2015) Gene expression analysis of skin grafts and cultured keratinocytes using synthetic RNA normalization reveals insights into differentiation and growth control. BMC Genom 25(16):476Author details1 Department of Critical Care, University Medical Center Groningen, Gronin-gen, The Netherlands. 2 Department of Plastic Surgery, Helsinki Burn Centre, Töölö Hospital, Helsinki University Hospital (HUS), Topeliuksenkatu 5, P.O. Box 00029, Helsinki, Finland. 3 Department of Pharmacology, Faculty of Medi-cine, University of Helsinki, Helsinki, Finland. Compliance with ethical standardsConflicts of interestThe authors declare that they have no conflict of interest.Accepted: 22 April 2017Published online: 15 May 2017References 1. Lindford A, Vuola J, Kankuri E (2017) Resuscitated unconscious male: Lichtenberg’s sign lighting the way. Intensive Care Med. doi:10.1007/s00134-017-4765-5

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The fractal lightning burn results from a positively charged strike

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Proceedings - University of Groningen

Dissertations of the University of Groningen

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Helsingin yliopiston digitaalinen arkisto

University of Groningen

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