1,720,967 research outputs found
Contribution of asthma in opiate deaths
No full textPurpose Several studies showed an association between asthma and opiate abuse. This retrospective study aimed to analyze the demographic, toxicologic, and seasonal differences in asthmatic and non-asthmatic subjects who died of opiates. In addition, the relationship between toxicological levels of opiates and histologic grade of lung inflammation was examined, to understand if it was possible to determine a predominance of drug vs. asthma in the mechanism of death. Methods Deaths from 2013 to 2018 involving opiates as the primary cause of death in Cook County were reviewed. Twenty-six cases of opiate deaths of individuals with a history of asthma and lung histology slides available were identified. In comparison, 40 cases of deaths due to opiates only were reviewed. A check-list system for the evaluation of the grade of microscopic inflammation in asthma was developed. Results Statistically significant differences were found between the groups concerning demography and toxicology. Our results suggest that the association between asthma and opiate in the determination of death may not be linked to the quantity of drug administered and the grade of inflammation in the lung tissue. Conclusion Our results confirm the importance of encouraging all asthmatic people to refrain from using opiates, regardless of the route of administration. The results of this study could be helpful for the forensic pathologists, showing the importance of histologic examination in all the autopsies on suspected opiate-related deaths and the necessity to include asthma in the death certificate whenever this condition is observed histologically
Grafopatologia peritale: testamento olografo e capacità di intendere e volere del testatore.
No full textAutopsy features in a newborn baby affected by a central congenital diaphragmatic hernia
No full textCongenital diaphragmatic hernia is a congenital malformation of the diaphragm, resulting in the herniation of the abdominal organs into the thoracic cavity. The most common types of congenital diaphragmatic hernia are Bochdalek hernia (postero-lateral hernia), Morgagni hernia (anterior defect), and diaphragm eventration (abnormal displacement of part or all of an otherwise intact diaphragm into the chest cavity). Congenital diaphragmatic hernia is a life-threatening pathology in infants, and a major cause of death due to pulmonary hypoplasia and pulmonary hypertension. We present a fatal case of congenital diaphragmatic hernia in a newborn. At the autopsy, a central defect of the diaphragm was found, 8 × 5 cm in size, that led to a herniation of the small intestine, the right lobe of the liver, and the right adrenal gland into the thorax. An esophageal atresia was associated with the congenital diaphragmatic hernia. The lungs showed severe hypoplasia and atelectasia. Physicians should pay attention to a prenatal diagnosis of congenital diaphragmatic hernia in order to prevent newborn fatalities
Association between the intake of cocaine and a strong physical and emotional stress: a case report of a sudden death
Full text linkCocaine is a powerful sympathomimetic agent, that determines its effects either by inhibiting synaptic re-uptake of noradrenaline or through the direct stimulation of the release of catecholamines from the adrenal gland. Cocaine abuse is associated with various cardiovascular events including ventricular arrhytmias, systemic hypertension, myocardial infarction and left ventricular hypertrophy. These effects are independent of the dose and route of administration of the substance and can be noticeably enhanced by the synergistic action of factors such as stress, smoking and alcoholism. The case that we report has involved a 48 year old man, who died of acute myocardial infarction, which arose as the result of an intake of a large amount of cocaine and a strong physical and emotional stress
A rare and lethal case of right common carotid pseudoaneurysm following whiplash trauma
Full text linkWhiplash trauma from a car crash is one of the most common causes of neck injury, resulting in pain and dysfunction. We report on an unusual case of post-whiplash
pseudoaneurysm of the right common carotid artery, which led to acute massive hemorrhage and death days after the initial trauma. A post-mortem computed tomography
angiography showed rupture of the pseudoaneurysm of the right common carotid artery with the contrast agent leaking out into the mouth. The subsequent autopsy confirmed
a large hemorrhagic clot extending to the right side of the neck and mediastinum. A rupture of the right wall of the oropharynx was identified with massive bronchial hemoaspiration.
The case demonstrates a rare but lethal clinical entity, and is important in providing a better understanding of the potentially fatal consequences of minor trauma, such as whiplash injury, and its physiopathological mechanisms. Thus, changing symptoms after a whiplash injury should be carefully evaluated since they can be related to the underlying severe consequences of a
rapid hyperextension–hyperflexion of the neck, as in the reported case
LA LEGISLAZIONE E I PROVVEDIMENTI SUI FARMACI ORFANI PER LA CURA DELLE MALATTIE RARE: LO STATO DELL'ARTE NELL'UNIONE EUROPEA E IN ITALIA
No full textLa legislazione e i provvedimenti sui farmaci orfani per la cura delle malattie rare: lo stato dell’arte nell’Unione europea e in Italia. In Europa, si parla di malattie rare in riferimento alle patologie che colpiscono non piú di 5 persone su una popolazione di 10.000 cittadini. Malgrado ognuna di esse sia caratterizzata da una bassa prevalenza, il numero totale di persone colpite da malattie rare nell’UE si colloca tra 27 e 36 milioni ed è in costante aumento. Ciononostante, le industrie farmaceutiche si dimostrano ancora restie ad intraprendere ricerche in questo campo, poiché non riuscirebbero ad ammortizzarne i costi, essendo troppo esiguo il numero dei malati fruitori dei farmaci realizzati. Tali farmaci sono allora senza sponsor e pertanto vengono detti «farmaci orfa-ni». Tuttavia è inaccettabile che ad alcuni individui venga negata la possibilità di beneficiare di tali terapie solo perché la patologia da cui sono affetti colpisce un numero ridotto di persone. Il presente lavoro si propone di analizzare tutti quei provvedimenti – europei ed italiani – finalizzati a promuovere la ricerca, lo sviluppo e la commercializzazione dei «farmaci orfani», nonché ad assicurare un equo trattamento a quanti sono affetti dalle patologie rare
The usefulness of post-mortem computed tomography in a crush asphyxia. An excessive enjoyed rave party resulting in a fatal sleep!
No full textPMCT (Post-mortem computed tomography) is a reliable diagnostic instrument for identification of body gas.
The corpse of a 28 years-old man was found under a car. According to the declaration of the owner of the car, he started the engine of the vehicle but it did not move with ease. Therefore, he alighted from the car and found an unresponsive man lying on the ground. According to the investigation, the victim had been at a rave party the night before, drinking a lot of alcohol.
A PMCT scan was performed before the traditional autopsy examination. On the report, multiple fractures were described, together with an anterior bilateral small to moderate pneumothorax and a diffuse subcutaneous emphysema of the upper anterior trunk. During autopsy, the specific test for pneumothorax was performed, showing a negative result.
The cause of death was determined to be a crush asphyxia due to the running over by the car, associated with traumatic injuries of the chest and a respiratory distress due to acute ethanol intoxication. The presence of vital signs clarified the fact that the victim was alive at the time of the trauma.
PMCT was of great help in identifying multiple fractures and also the presence and the amount of gas, even if moderate. Thanks to the PMCT we were able to clarify the mechanism of death and to identify signs of vitality (pneumothorax and subcutaneous emphysema), even before the autopsy examination. Autopsy confirmed the features observed by the radiological scans. (C) 2012 Elsevier Ltd. All rights reserved
EVOLUZIONE VALUTATIVA DELL'ANCHILOSI E DELLA PROTESI D'ANCA IN RESPONSABILITà CIVILE
No full textLa protesizzazione dell’anca costituisce attualmente una significativa risorsa per la risoluzione di quelle patologie, come nel caso della coxartrosi, dell’artrite reumatoide, dell’osteonecrosi asettica della testa del femore, delle fratture e lussazioni da trauma, le quali, determinando dolore e grave limitazione dell’articolarità (anchilosi), esitano spesso in un importante deficit funzionale. Nel presente lavoro gli Autori hanno, in primis, analizzato dettagliatamente i rischi di questo intervento e le complicanze che possono portare alla sostituzione della protesi. Dopodiché, hanno messo a confronto i vari contributi tabellari in responsabilità civile, soffermandosi sulle valutazioni percentuali di volta in volta attribuite all’anchilosi d’anca – l’indicazione principale all’intervento protesico – e alla protesizzazione d’anca
Autopsy in Suspected Pediatric Non-Accidental Head Injuries.
No full textNon-accidental trauma is a leading cause of childhood traumatic injury and death in the United States. It is often under-reported in most of the countries. Non-accidental head trauma is a very common injury and a frequent problem in attempting to distinguish between inflicted and accidental injury. Inflicted head injury occurs usually at home in the presence of the individual who has inflicted the injury outside the view of unbiased witnesses. Distinguishing between inflicted and accidental injury is dependent upon the pathological findings and consideration of the circumstances surrounding the injury. This chapter reviews the autopsy technique that should be adopted by a forensic pathologist in case of suspected non-accidental head injury in infants and young children so as to determine the cause and manner of death
Accuracy of MRI skeletal age estimation for subjects 12–19. Potential use for subjects of unknown age
Full text linkIn forensic practice, there is a growing need for accurate methods of age estimation, especially in the cases of young individuals of unknown age. Age can be estimated through somatic features that are universally considered associated with chronological age. Unfortunately, these features do not always coincide with the real chronological age: for these reasons that age determination is often very difficult. Our aim is to evaluate accuracy of skeletal age estimation using Tomei's MRI method in subjects between 12 and 19 years old for forensic purposes.
Two investigators analyzed MRI images of the left hand and wrist of 77 male and 74 female caucasian subjects, without chronic diseases or developmental disorders, whose age ranged from 12 to 19 years. Skeletal maturation was determined by two operators, who analyzed all MRI images separately, in blinded fashion to the chronological age. Inter-rater agreement was measured with Pearson (R (2)) coefficient. One of the examiners repeated the evaluation after 6 months, and intraobserver variation was analyzed. Bland-Altman plots were used to determine mean differences between skeletal and chronological age.
Inter-rater agreement Pearson coefficient showed a good linear correlation, respectively, 0.98 and 0.97 in males and females. Bland-Altman analysis demonstrated that the differences between chronological and skeletal age are not significant. Spearman's correlation coefficient showed good correlation between skeletal and chronological age both in females (R (2) = 0.96) and in males (R (2) = 0.94).
Our results show that MRI skeletal age is a reproducible method and has good correlation with chronological age
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