1,721,030 research outputs found
An unusual case of fulminant heart failure
No full textA 51-year-old patient presented with a 10-day history of breathlessness and back pain. Significant background his- tory included human immunodeficiency virus-2 and hepatitis C virus infections. Physical examination showed end-inspiratory crackles and muffled cardiac sounds and his blood test showed an increased aspartate aminotransferase level (500 IU/L), ala- nine aminotransferase level (654 IU/L), and lactate dehydroge- nase level (2354 IU/L). His chest radiograph confirmed pulmo- nary edema, and the echocardiogram showed severe pericardial effusion (2.5 cm). A computed tomography scan of the chest showed an incidental finding of a 5-cm liver mass at the liver dome. The patient was admitted to the intensive care unit to undergo percutaneous drainage of his pericardial effusion, and he died a few hours later of acute heart failure unresponsive to cardiovascular support. The patient underwent a post-mortem examination. The liver and the heart are shown in Figures A and B, respectively. Figure A shows a multifocal liver tumor ranging in size from 1 to 7 cm maximum. The heart, the pericardium, and the aortic arch were widely involved by metastatic deposits (Figure B). A section of the vertebral bones and the lungs also showed further small metastatic deposits. Initial histology of the liver lesions and the heart showed small-cell carcinoma (SmCC) (Figure C, tumor cells between myocardial cells, H&E, original magnification, 100). We performed immunohisto- chemistry on the pulmonary deposits to rule out a primary pulmonary SmCC. No positivity was seen for thyroid transcrip- tion factor-1, caudal type homeobox transcription factor 2, CK7, CK20, chromogranin, synaptophysin, or CD56. Immuno- histochemical stains for hepatocyte paraffin 1 (Figure D), car- cinoembryonic antigen, and -fetoprotein showed a strong pos- itivity and TTF-1 negativity. On the basis of the macroscopic framework and immunohistochemical features, a diagnosis of metastatic SmCC of the liver was made. Cardiac metastases from hepatocellular carcinoma are very uncommon.1 Hepatic SmCCs are even more uncommon: to our knowledge, only 13 cases have been reported.2 They usually present with locally advanced or metastatic disease, and no disease-free survivors have been reported to date. Interestingly, they do not show any association with chronic liver disease or with hepatitis C/hepatitis B viruses, and high fetoprotein levels also seem to be uncommon
Penalizing profiles of professional responsibility on the topic of lung cancer
No full textNo abstract availabl
A case of suicidal suffocation simulating homicide
No full textThis case concerns an unusual suicidal plastic bag suffocation. An elderly white man was found dead and partially disrobed in his apartment lying supine on a sofa with a plastic bag closed by a rope over the head and the upper and lower extremities tightly tied with two other ropes, the end of both arranged into slipknots (self-rescue mechanism). Police investigations found no pornography in the apartment, and circumstantial data alleged no psychiatric disorders or suicidal intentions. The autopsy excluded signs of struggle and sexual intercourse as well as any type of injury or physical illness. Chemical analyses on the peripheral blood excluded acute drugs and/or alcohol intoxication. A differential diagnosis of the manner of death was performed, including scenarios of accidental autoerotic asphyxiation, homicide during either sexual activity or ritualistic, elderly suicide. The collected data most strongly supported the hypothesis of a suicidal asphyxiation simulating homicide to devolve a life insurance to the victim's sons because of economic difficulties
Fatal bladder explosion during transurethral resection of prostate: Case report and literature review
No full textThe transurethral resection of the prostate (TURP) is the gold standard in the operative management of benign prostatic hypertrophy. In the last decade, the technological improvements have reduced perioperative and postoperative complications. The intravesical explosion is one of the most infrequent compli- cations of transurethral procedures. We present the case of a man with bladder outlet obstruction who underwent TURP. After complete resection of the ade- noma, an audible blast and a sudden movement were felt at the lower abdo- men. Inspection showed posterior wall bladder perforation that was repaired. Postoperative course was complicated by transurethral resection syndrome. This work show an evaluation of the relevant scientific literature available about bladder explosion to define the etiology of this complication, we point out the prevention strategies and discuss the possible connection between these unusual complications
Suicide case due to phosphoric acid ingestion: Case report and review of literature
No full textIngesting caustic substances represents a common event which may result in serious injuries of the gastrointestinal system. Severity of injury depends on the type of ingested substance: Caustic burns are more frequently associated with acid ingestion and their severity depends on type, concentration, time of exposure, and amount of the ingested substance. We report a case of phosphoric acid ingestion leading to death in a patient with depressive disorder. While reports ingestion of other acids and organophosphates can be found in the literature, there are no reports detailing a death due to phosphoric acid ingestion. We hope that presenting the findings in this case can aid death investigators in future cases that may involve ingestion of such a substance. After autopsy pH, phosphate and calcium ions concentration in the blood were analyzed. The cause of death was due to systemic effects: metabolic acidosis, hypophosphatemia, hypocalcemia, and hyperkalemia
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The key role of the pathologist in sepsis-related risk and claims management of tertiary hospitals
No full textSepsis is one of the leading causes of death even in the tertiary hospitals of Western Countries and sepsis-related in-hospital mortality contributes to define hospital performance and quality of care. A better understanding of its epidemiological and pathological characteristics seems the key to tailor public health interventions aimed at reducing its incidence, morbidity and mortality.A retrospective analysis of 109 autoptic cases of inpatients that acquired sepsis in a tertiary hospital was performed. In particular, we identified and analysed the recurrent anamnestic/clinical factors and histopathological features.The most common continuous foci were due to respiratory infections. Subendocardial myocardial ischaemia was the clinical cause of death in 56.8% of the study population. An inflammatory infiltrate was identified in specimens of the lung (28.4%), liver (28%), heart (23.5%) and kidneys (15%). Common findings were arteriosclerosis and atherosclerosis (57%), steatosis (24.5%), diffluent spleen (18%) and colliquation of adrenal glands (16.6%).The comorbidities and the autoptic features founded are consistent with the previous evidences in sepsis field. Clinical autopsy is certainly a useful tool to collect data on sepsis, but we did not find any feature that can be considered specific or sensitive for the diagnosis of sepsis. More efforts should be made in the direction of a multidisciplinary approach to in-hospital sepsis autopsies to grant pathologists a key role in the management of claims and clinical risk
Intraoperative cholangiography in the laparoscopic cholecystectomy era: Why are we still debating?
No full textLaparoscopic cholecystectomy is now one of the most frequently performed abdominal surgical procedures in the world. The most common major complication is bile duct injury, which can have catastrophic repercussions for patients and it has been suggested that intraoperative cholangiography may reduce the rate of bile duct injury. Whether this procedure should be performed routinely is still an active subject of debate. We discuss the available evidence and likely implications for the future
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