1,721,057 research outputs found
Long-term care and elderly care in Europe: are they good synonyms?
No full textThere is a general consensus, in Europe, in considering LTC public financing as a proxy of the resources committed to elderly care by each Government; the preciseness of this approximation depends on the extent to which LTC is representative of elderly care. We investigate this issue by estimating the resources spent on elderly LTC in Lombardy, an Italian region which, in terms of
population, dimension, health care organization and economic development, could be compared to
many European countries. Results highlight the absence of an appropriate method for assessing
LTC elderly expenditure and suggest that the latter, as reported in international comparisons, is
actually overestimated
Severe Pulmonary Artery Hypertension Persisting After a Late Atrial Septal Defect (ASD) Closure: Presentation of a Case
No full textLearning Overview: After attending this presentation, attendees will understand the pathophysiology and the autopsy findings of pulmonary artery hypertension after a late ASD closure. Impact on the Forensic Science Community: This presentation will impact the forensic science community by demonstrating that pulmonary hypertension can persist after a late surgical repair of ASD. ASD is the most prevalent congenital cardiac anomaly in adults, representing ~35% of all congenital heart defects. oxygen-rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart, or vice versa. This can lead to lower-than-normal oxygen levels in the arterial blood that supplies organs and tissues. Due to the high blood flow from left to right, an ASD can also cause right ventricular remodeling and failure, with enlargement of right cardiac chambers, severe arrhythmias, and pulmonary artery hypertension. The left ventricle can be smaller than the right one and a reduced coronary perfusion can occur. blood flows between the atria of the heart: It consists of a heart defect in which Most adults with ASD are safely treated using available techniques of surgical or percutaneous repair and become free of complications over the long term. However, there is a small fraction of patients who are at risk for post-operative complications, particularly the persistence of elevated pulmonary vascular resistance and pulmonary artery hypertension. This presentation describes the case of a 47-year-old Asian female (height: 152cm; weight: 36kg) who was found unresponsive by her husband in the bathroom of their house. The husband promptly called the emergency medical services. A cardiopulmonary resuscitation was performed with negative results and the woman was pronounced dead. According to the medical records, the woman underwent a surgical repair of an atrial septal defect at the age of 37 and suffered from severe pulmonary hypertension, high blood pressure, paroxysmal atrial fibrillation, and multivalvular insufficiency. A few months prior to death, she had an episode of acute heart failure and underwent a chest-abdomen Computed Tomography (CT) and an echocardiogram that showed: persistence of a left superior vena cava probably draining in the coronary sinus, enlargement of the right heart with massive tricuspid regurgitation, enlargement of the pulmonary arteries with severe pulmonary regurgitation, bilateral pleural effusion, atelectasis of the left lung, chronic passive congestion of the liver, and ascites. At the autopsy, the heart weighted 650 grams and showed: an enlargement of the coronary sinus, a correctly positioned interatrial patch, a notable right ventricular hypertrophy with a small left ventricle, enlarged pulmonary arteries with fatty streaks, and pulmonary and tricuspid valve insufficiency. It was not possible to identify the left superior vena cava detected during the imaging studies; this could be due to the relatively small size of the vessel or to the presence of massive adhesions from prior surgery. At the microscopic examination, the heart showed multiple myocardiocites with enlarged nuclei and multiple areas of fibrosis. The lung showed hypertrophy of the media of the arterioles and plexiform lesions, findings consistent with a severe pulmonary artery hypertension. In this case, since the woman did not have the defect closed until such an advanced age (37 years old), probably all the autoptic findings could be attributed to the ASD. The left superior vena cava persistence may have contributed. A prolonged flow from the left atrium across the ASD to the right atrium caused the right ventricular hypertrophy and pulmonary hypertension. Moreover, the left ventricle was reduced in size and a myocardial fibrosis (presumably due to low coronary perfusion) was observed. It was not possible to understand if, in this case, the delay in surgical treatment was due to a late presentation of the defect or due to different reasons. In any case, the late surgical treatment allowed the subject to become free from the interatrial communication, but not from the advanced right ventricular remodeling and pulmonary vasculopathy, which caused death
Long-term care and elderly care in Europe: Are they good synonyms?
No full textThere is a general consensus, in Europe, in considering LTC public financing as a proxy of the resources committed to elderly care by each Government; the preciseness of this approximation depends on the extent to which LTC is representative of elderly care. We investigate this issue by estimating the resources spent on elderly LTC in Lombardy, an Italian region which, in terms of population, dimension, health care organization and economic development, could be compared to many European countries. Results highlight the absence of an appropriate method for assessing LTC elderly expenditure and suggest that the latter, as reported in international comparisons, is actually overestimated
Pneumosinus Dilatans frontalis: a case of incidental autopsy diagnosis
No full textPneumosinus Dilatans Frontalis (PDF) is a rare pathologic condition characterized by expansion and hyper aeration of the frontal sinuses. This abnormality has been described in otolaryngology, ophthalmology, neurology, and radiology journals, while only a few autopsy studies are reported in the English literature. The etiology of this condition remains unclear, although multiple theories have been proposed. Clinically, PDF is often an asymptomatic condition, but it can lead to significant bone deformation with esthetic complaints, and even severe associated neurological deficits. In the following case report, a 20-year-old Caucasian male committed suicide by asphyxia due to plastic bag suffocation combined with a vitiated atmosphere as a consequence of helium inhalation. At postmortem an abnormal expansion of the frontal sinuses was detected, involving the frontal bone just above the orbits. The defect showed a multiloculated appearance in the sinus cavities. An incidental diagnosis of PDF was made. A description of the findings and a hypothesis of the clinical relevance of PDF in the reported case are presented
Massive Intracranial Bleeding Due to the Rupture of a Rare Spontaneous Pseudoaneurysm of the Middle Cerebral Artery in a Pediatric Patient: A Case Report With Clinical, Radiological, Gross, and Microscopic Findings
No full textLearning Overview: After attending this presentation, attendees will understand the features and appearance of a rare intracranial idiopathic pseudoaneurysm. Impact on the Forensic Science Community: This presentation will impact the forensic science community by showing the features of a rare cause of intracranial bleeding in a pediatric patient. Pediatric pseudoaneurysms are a rare and underdiagnosed cause of intracranial hemorrhage. Regarding the head and neck districts, approximately 80% of the pseudoaneurysms affect extracranial vessels (mostly carotid and vertebral arteries), while only 20% are intracranial. The most common etiologies of pseudoaneurysm are trauma, infection, drugs, or neoplasm. Spontaneous/idiopathic pseudoaneurysms are rarely observed in the clinical and forensic practice. A 14-year-old White female was brought to the hospital after she lost her consciousness while attending her morning school session. She had no pertinent familial history or history of traumas. According to her recent medical history, she had a heavy menstrual bleeding, with a three-week-long recurrent mild headache, and a lack of appetite started the night before. On arrival at the emergency department, the neurological examination showed a drowsy but easily arousable girl, with a Glasgow Coma Scale (GCS) score of 13 (E3V4M6). Physical and neurological examinations were unremarkable. A pregnancy test was negative. An Electrocardiogram (EKG) showed no cardiac rhythm alterations. Plain computed tomography of the brain without contrast showed an intra-axial hemorrhage in the right temporal lobe, 6cm in diameter, without evidence of skull fractures; it produced a mass effect, without deviation of the median line structures. Cerebral edema and subarachnoid hemorrhage were also noted. After the neuroradiological study, the GCS score decreased to 10 (E2V3M5). The patient was referred to the Neurosurgery Department of a primary health care provider. Upon arrival, the patient underwent a plain computed tomography of the brain with contrast that showed an increase of the intraparenchymal hematoma in the right cerebral hemisphere with a 10-centimeter dislocation of the median line structures. The patient immediately underwent a decompressive craniotomy, and an external ventricular drainage was placed. A cerebral angiography was performed, showing an active bleeding from a right middle cerebral artery pseudoaneurysm, and an endovascular aneurysm repair was performed. Despite the multiple neurosurgical operations, the patient died after three days of coma due to the massive intracranial bleeding. At the postmortem examination, the young girl was an organ donor, but the whole brain was saved in formalin for a neuropathology consultation. At the examination of the fixed brain, a massive subarachnoid hemorrhage was observed on the right cerebral hemisphere, together with an extensive right temporal lobectomy as a result of the neurosurgical intervention. Following the right branches of the circle of Willis, the right middle cerebral artery was found: it showed the presence of a fusiform vessel dilatation, 2.5x1 centimeters in size, filled by surgical glue. The microscopic examination of the vessel dilatation confirmed a pseudoaneurysm of the right middle cerebral artery, showing the loss of normal arterial architecture with intermittent disruption of the internal elastic lamina and vacuolar degeneration of the tunica media. Unlike true aneurysms, pseudoaneurysms are typically found along a vessel wall, distal from a branch point. They differ pathologically from true or dissecting aneurysms. In pseudoaneurysms, there is a disruption of all three layers of the vessel wall with a contained hematoma. They have a specific wall formed by hematoma organization and fibrosis with the surrounding and connective tissue indicating vessel wall injury. Pseudoaneurysms must be distinguished from true saccular aneurysms because of their friable nature, the tendency of rupture, and different pathologic findings. At the postmortem examination, a massive intracranial hemorrhage or a previous surgical manipulation of the brain may hide the existence of a vessel malformation. Therefore, in the case of pediatric intracranial bleeding, a multidisciplinary approach (clinicians, radiologists, neurosurgeon, pathologists, and neuropathologists) is required, and a careful inspection of the central nervous system structures is mandatory
The Performance of European Full Service Airlines after Liberalisation: An Econometric Analysis
No full textDeregulation in the airline industry has forced full service airlines to change their strategies in order to respond to increasing challenges. In this paper, an econometric analysis of the possible determinants of economic performance of full service airlines after liberalization has been carried out. A fixed effects model was used and the performance of ten European full service airlines has been analyzed over a period of 11 years. Variables considered in this analysis were the number and type of aircraft in the fleet, the number and type of destinations, investments, number of employees and alliances. The analysis suggests that full service airlines should adjust fleet composition and re-organize operations on their routes in order to react to the increasingly competitive environment
Death due to severe blood loss following an accidental lesionto the femoral vessels
No full textDeaths from sharp force injuries are a significant cause of violent death. While homicides and suicides caused by sharp force wounds are common, accidental injuries are less often described in forensic literature, so their actual incidence or prevalence is not known. This paper presents an accidental death due to massive blood loss which resulted from lesions to the left femoral vessels by glass fragments. The body was found in a pool of blood surrounded by hundreds of glass fragments. Autopsy revealed a near-total transection of the superficial femoral artery, and two wounds of the superficial femoral vein. In case of accidental sharp force injuries, a thorough medico-legal process, including death scene investigation, autopsy examination and toxicological analyses, is always necessary to determine the manner of death
Anatomical Distribution and Autopsy Features of Gunshot Injuries to Discriminate Between Homicides and Suicides: A Five-Year Retrospective Study From the Onondaga County Medical Examiner’s Office
No full textLearning Overview: After attending this presentation, attendees will better understand the most common features of fatal gunshot wounds encountered in homicides and suicides. Impact on the Forensic Science Community: This presentation will impact the forensic science community by illustrating the most common body regions affected by gunshot wounds and the relevant autopsy features, showing their relationship with the manner of death. Firearm-related injuries are commonly encountered by forensic pathologists worldwide. In these fatalities, a careful evaluation of all the evidence is mandatory to prevent wrong conclusions concerning the manner of death. The analysis of the location of the gunshot wounds can be useful to understand the circumstances of death. This study will provide data to support an association between a specific wound location and the manner of death. The files of the Onondaga County Medical Examiner’s Office were searched for deaths due to gunshot wounds between January 2012 and December 2016. Only cases in which gunshot wounds were the primary cause of death and in which a clear and reliable manner of death was reported were included in the study. Undetermined deaths were not considered as part of study population. The investigative report, the autopsy report, and postmortem toxicological studies were reviewed in each case. The following parameters were recorded from the files: manner of death, gender, race and age, firearms and bullets type (if available), number and sites of entrance and exit wounds, shooting distance, internal bullet pathway, blood drugs and/or alcohol concentration, and investigative narratives. The obtained data were then subcategorized as to the manner of death (suicide, homicide, and accident). The information detected on the autopsy report was used to create a graphic reconstruction of the anatomical distribution of the gunshot wounds on the body surface. A total of 5,231 accepted cases in the studied period were found in the Onondaga County Medical Examiner’s Office database, including 626 suicides, 208 homicides, and 2,275 accidents. Of these, 347 deaths due to gunshot wounds were identified and were then subcategorized based on the manner of death, showing: 238 suicides (~69%), 108 homicides (~31%), and 1 accident (<1%). A thorough discussion of the results, including graphical models showing the most common location of the injuries, and demographic data will be presented. This study will illustrate distinct differences in suicidal and homicidal wounds that should be considered while investigating gunshot wounds related deaths. The autopsy findings, together with the scene findings, the investigative report, and the medical history of the victim, can help determine a reliable manner of death
A Case of Sudden Death Due to Persistent Severe Pulmonary Arterial Hypertension After Late Atrial Septal Defect Closure.
No full textAtrial septal defects (ASDs) are one of the most prevalent congenital cardiac anomalies in adults. These interatrial communications can produce changes in the right heart (remodeling and failure) and the lungs (pulmonary hypertension). Most adults with ASDs are surgically treated with excellent results. However, a small fraction of patients is at risk for postoperative complications, particularly the persistence of pulmonary hypertension. A case of a 47-year-old woman who was found unresponsive in the bathroom of her house and died despite resuscitative efforts is described. According to medical records, the woman underwent a surgical repair of an atrial septal defect at the age of 37. At the autopsy, macroscopic and microscopic signs of advanced pulmonary hypertension were detected, highlighting the importance for the forensic pathologists to recognize pulmonary hypertension as a cause of sudden death in adults with a history of late surgical closure of an atrial septal defect
- …
