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PubMed2006

Historical and medico-legal aspects of infanticide: an overview.

In practice, all cases of abandoned newborn deaths are reported to the police/coroner, who asks for a post-mortem examination because only this can establish the viability of the infant, proof of separate existence, and the cause and manner of death in such cases. The pathologist who conducts the autopsy will have to use his skills and experience to assess a wide variety of marks and injuries so as to give his opinion fairly and frankly, not allowing any personal feelings to influence his findings. In some cases, he may be unable to give a firm opinion and should not shirk from stating this clearly. This paper examines some historical, legal and pathological aspects of infanticide.

Autopsy↗
PubMed2005

Ethylene glycol poisoning.

Ethylene glycol (EG) can be found in many agents, such as antifreeze. Ingestion of EG may cause serious poisoning. Adults are typically exposed when EG is ingested as a cheap substitute for ethanol or in suicide-attempts. Children may be exposed by accidental ingestion caused by decantation of EG to unlabeled bottles. EG has in itself a low toxicity, but is in vivo broken down to four organic acids: glycoaldehyde, glycolic acid, glyoxylic acid and oxalic acid. The metabolites are cell toxins that cause central nervous system depression, and cardio-pulmonary and renal failure. Glycolic acid causes severe acidosis, and oxalate is precipitated as calcium oxalate in the kidneys and other tissues. We present five case reports of fatal EG-poisoning, and review the literature concerning clinical presentation and diagnosis, pathological findings, treatment and prevention.

Acidosis↗
PubMed1983

[Intravital and postmortal CT examinations in cerebral gunshot injuries].

The value of CT was assessed in 24 patients who died of cerebral gunshot injuries and in two patients with more recent injuries in order to reconstruct the mode of injury and for adding forensic information. The post-mortem and intravital appearances described and are compared with ultrasound rotation compound scans of the isolated brains. CT showed good agreement with pathological findings. Ultrasound produced images with an accuracy between CT and photographs of the brain specimen. Both methods are regarded as valuable additions to the pathological and forensic information concerning gunshot injuries.

Brain↗
PubMed2005

Pseudolaminar necrosis in cyanide intoxication: a neuropathology case report.

We describe the gross and microscopic neuropathological changes in the brain of a 17-year-old male who died 4 days after being poisoned with cyanide. Previous reports indicate that following cyanide intoxication, the brain develops diffuse hypoxic/ischemic changes, predominantly of the basal ganglia. The case we describe here had similar features but in addition showed striking laminar necrosis of the cerebral cortex. This finding in cyanide poisoning has been previously demonstrated by neuroimaging, but not pathologically.

Administration, Oral↗
PubMed1992

Pathomorphology of Balkan endemic nephropathy.

Within the county of Slavonski Brod, Yugoslavia hyperendemic areas of Balkan endemic nephropathy (BEN) have been recognized for a long time. As the Department of Pathology and Forensic Medicine of the Medical Centre in Slavonski Brod is responsible for all diagnostic post-mortem examinations in the county, and at the same time is engaged in surgical pathological diagnosis, a considerable amount of material relating to BEN and concomitant urinary-tract tumours has been collected during a 16-year period. This material has been classified and used for pathological, anatomical and histological investigations. In this paper the most relevant findings are described and briefly discussed, without the intention to speculate on possible aetiology of BEN. As the origin of BEN and of the high frequency of urinary tumours among the people from the endemic areas are still unexplained, and uniform criteria for the pathomorphological diagnosis of BEN are badly needed, the proposal to set up an archive encompassing cases from all the centres investigating BEN is supported.

Age Factors↗
PubMed2006

Pediatric drowning: a 20-year review of autopsied cases: II. Pathologic features.

The pathologic findings in autopsies of drowning victims are nonspecific and vary from case to case. However, most reported pathologic series of drowning cases exclude children and do not take into consideration the unique circumstances surrounding bathtub drownings. In addition, the effect of resuscitation on the autopsy findings has not been studied in children. A retrospective review of autopsy records of non-bathtub drownings from a 20-year period (1984-2003) was performed and 63 cases were identified in 45 males and 18 females (age range 9 months to 17 years). The incidence of frothy exudate, pleural effusion, and increased lung weight was 43%, 36%, and 80%, respectively. The incidence of frothy exudate and the combination of all 3 factors was significantly higher in cases with no resuscitation compared with those cases with attempted resuscitation with or without delayed death. As the interval between the drowning episode and autopsy increased, the incidence of frothy exudate decreased significantly. There was no relationship between these findings and the age and sex of the decedent. Other clinical conditions or occult pathologic findings that may have contributed to death were found in 8 cases (13%). The findings highlight the need for thorough clinicopathologic correlation in cases of drowning to accurately interpret the pathologic findings.

Accidents↗
PubMed2005

Unusual sudden death: two case reports of hemorrhage by rupture of varicose veins.

Although varicose veins are frequent, they are rarely considered lethal. Still, rupture of a varicosity can result in significant and even fatal hemorrhage. External hemorrhage is an unusual complication of this common venous pathology. Reported here are 2 cases of severe external hemorrhage resulting from the perforation of a varicose vein.

Aged↗
PubMed2006

Fatal amphetamine-associated cardiotoxicity and its medicolegal implications.

Amphetamines are popular drugs of abuse, particularly among youngsters and at dance scenes. Cardiotoxicity (manifested as cardiomyopathy, acute myocardial infarction/necrosis, heart failure, or arrhythmia) after the recreational (mis)use of amphetamine and its synthetic derivatives has been documented but is rather rare. Amphetamine-related cardiac fatalities are even more rare. We present 6 cases of young persons who died unexpected after the chronic abuse of amphetamines. Death was not attributed to a lethal intoxication but to an acute myocardial necrosis, a right ventricle rupture, a cardiomyopathy, or an arrhythmia. Two of the deceased persons presented prior to their death to the emergency department, but their complaints were not considered (probably due to their young age) to be of cardiac origin. One case was a sport-related fatality where medical screening failed to identify the underlying cardiac pathology or the amphetamine abuse, and 1 case was a so-called idiopathic dilated cardiomyopathy where substance abuse was not considered by the treating physician. We think that amphetamine-associated cardiotoxicity is a rare but probably genuine entity that should be considered both in forensic and clinical/emergency medicine because of its potential medicolegal implications.

Adult↗
PubMedDate not supplied

[Morphological changes in the lungs in chronic drug addiction].

Morphological studies of the lungs and immune system organs were made in drug addicts with narcotic intoxication. Depletion of the central and peripheral lymphoid organs was found in most cases. It is shown that morphological changes in the lungs in acute and (or) chronic narcotic drug intoxication, the rate of acute and chronic inflammatory lung diseases reflect development of lung inflammation in the presence of aquired immunological deficiency in terminal chronic drug abuse. The documented features of different pathological processes in the lungs can improve diagnosis of acute and chronic drug intoxication by results of section and histological examinations.

Adolescent↗
PubMed1991

Some pathomorphological features of Balkan endemic nephropathy in Croatia.

Over the last 16 years, 214 autopsies were done at the Department of Pathology and Forensic Medicine, Slavonski Brod Medical Centre, on people from an area recognized as endemic for Balkan nephropathy in the county. Balkan endemic nephropathy was diagnosed pathoanatomically and histopathologically in 94 of these cases, and in none of 1040 autopsies on people from a nonendemic area. The most striking pathological finding in all advanced cases of the disease was a marked reduction in kidney size and weight; in one extreme case, the organ weighed only 20 g. The process is invariably bilateral, but there are considerable differences in the degree of involvement in each pair. Although the pathoanatomical changes, including lung oedema and haemorrhage and fibrinous pericarditis, are seen in the majority of cases, they are not considered to be specific for Balkan endemic nephropathy, since they are well recognized signs of long-standing primary uraemia. The relevance of the peculiar finding of sulfurous yellow discoloration and hardened subcutaneous adipose tissue, seen frequently post mortem, is unknown and should be investigated in more detail. Histopathologically, fibrosis and atrophy of kidney cortex, with tubular degeneration, are the most consistent findings. Lesions characteristic of pyelonephritis were superimposed over the picture of 'pure' Balkan endemic nephropathy in a considerable number of cases.

Adipose Tissue↗
PubMed2006

Pulmonary interstitial emphysema in live birth determination: radiographic and gross pathologic features.

Pulmonary interstitial emphysema (PIE) has previously been reported as a useful finding in the determination of live birth in cases where the birth and death were not attended. Herein, we present the radiographic and gross pathologic features of PIE in such a case. In this instance, in addition to parenchymal interstitial emphysema, there were subpleural air collections and a pneumothorax.

Adult↗
PubMed2005

Diagnosis of Alzheimer's disease in an exhumed decomposed brain after twenty months of burial in a deep grave.

After 20 months of interment in a deep grave, the decomposed body of the 81-year old testator of a will was exhumed to sustain the burden of proof that he lacked testamentary capacity when the will was rewritten two days prior to his death. The brain was mushy and pulverized with complete disappearance of the brainstem, cerebellum and subcortical ganglia. Small foci of relatively intact dorsal frontal neocortex were identified. Sections from these foci were stained with hematoxylin and eosin, bielchowsky silver stain and immunostains for beta amyloid peptide (betaA4), tau and alpha-synuclein. Despite severe autolysis and decomposition, the bielchowsky stain and the betaA4 immunostains showed preserved frequent neuritic amyloid plaques with very few residual neurofibrillary tangles. Cerebral Amyloid Angiopathy was present. At the present time this case represents the first documented and reported case of direct tissue diagnosis of Alzheimer's Disease pathology in a decomposed brain following long term burial in a deep grave.

Aged, 80 and over↗
PubMed2004

Sudden death: correlation histopathological and biochemical.

The causes of sudden cardiac death are diverse and are function of age. In young people, coronary anomalies, hypertrophic cardiomyopathy are the most common findings at autopsies; in adults, coronary atherosclerosis and acquired forms of cardiomyopathy are frequent findings. In many of non-ischemia related cases autopsies are unrevealing. One of the most frustrating challenges is the inability to determine the cause of death in a person previously healthy. The majority of such sudden deaths are caused by acute ventricular tachyarrhythmias, but unfortunately unassociated with structural injury to the heart. The present work evaluates incidence, clinical data, and laboratory tests. Biochemical studies on serum, pericardial fluid, vitreous humour and pathological characteristics of 38 cases of sudden cardiac death from 2003 were investigated by us. Also, non-cardiac natural causes of death must be excluded.

Coronary Artery Disease↗
PubMed2004

Trials and tribulations of using beta-amyloid precursor protein immunohistochemistry to evaluate traumatic brain injury in adults.

Axonal pathology is increasingly identified by beta-amyloid precursor protein (betaAPP) immunohistochemistry in the brains of patients who may or may not have a history of trauma. The presence of betaAPP-IR(+) has been variously interpreted as either that diffuse traumatic axonal injury (TAI) is indeed a universal finding in cases of fatal traumatic brain injury (TBI) or there are other causes of betaAPP-IR(+) axons which under certain circumstances may be sufficient to mimic TBI and therefore make the medico-legal interpretation of certain cases very difficult. To address some of the uncertainties we have undertaken a detailed analysis of the amount and distribution of betaAPP immunohistochemistry in 63 cases of fatal TBI, 17 cases of patients dying after cardiac arrest, 12 cases dying in association with status epilepticus, 3 cases of carbon monoxide (CO) poisoning, 13 cases of hypoglycaemia and in 60 controls. Three patterns of betaAPP-IR(+) were identified. First, diffuse multi-focal, second, corresponding to the outline of an infarct or haematoma, and thirdly a mixture of the two. The first pattern was seen in cases of the lesser grades of TAI, CO poisoning, and hypoglycaemia, the second pattern in cases in which there was evidence of raised intracranial pressure and the third in cases of severe TAI. It is concluded that the proper interpretation of cases requires the examination of a sufficient number of blocks ( [Formula: see text] ), processing using standardised protocols including betaAPP immunohistochemistry and in some cases the mapping of any IR(+) on anatomical line diagrams. betaAPP carried out on a small number of randomly taken blocks is likely to lead to misinterpretation of the clinico-pathological correlations and possibly to a miscarriage of justice.

Adolescent↗
PubMed2006

[Analysis on 27 autopsy cases died of anaphylactic shock induced by mainline].

27 autopsy cases died of anaphylactic shock induced by mainline during 1996-2005 were selected and analyzed. The results showed that most anaphylactic shock induced by mainline were rapid type and more easily happened in individual clinique and lawless clinique, and it could be arisen by either antibiotics or non-antibiotics. In some cases, there may be no pathologic findings by autopsy. So, all the materials must be taken into account for determination the anaphylactic shock, such as drugs, clinic symptom, autopsy findings, and so on.

Adolescent↗
PubMed2004

Isolated peliosis of the spleen: report of 2 autopsy cases.

Isolated peliosis of the spleen, characterized by the gross appearance of multiple cystlike, blood-filled cavities on cut surfaces of the organ, is a very rare pathologic entity that has been reported in 33 cases to date. We present 2 additional cases of isolated peliosis of the spleen observed at autopsy and confirmed by histology. In both cases investigated, cirrhosis of the liver was present. We hypothesize that local microcirculatory disturbances manifesting under altered local intravascular pressure conditions in the spleen may, at least to a certain degree, be responsible for the peliosis-associated vascular lesions. For the forensic pathologist, isolated peliosis of the spleen represents more than just another morphologic curiosity. The significance of peliosis lienalis lies in the potential of (1) overlooking the correct diagnosis as the cause of a spontaneous splenic rupture with intraabdominal hemorrhage, thus leading to the false conclusion of a violent death; and (2) misinterpreting the macromorphological appearance of this rare disease, also in the absence of splenic rupture, as a result of blunt force trauma.

Adult↗