1,721,017 research outputs found
Patterned bruising indicating a complete renal artery transection in a fatal occupational accident
No full textBlunt renal artery injury (BRAI) is a rare finding with incidence ranging from 0.05% to 0.08% among blunt abdominal trauma patients. BRAI occurs in 1% to 4% of patients with renal injury, and the most common cause is motor vehicle accidents. An unusual case of BRAI in a 47-year-old man at work is reported. The victim accidentally fell from a scaffold (approximately 3 m in height). He was transported to the hospital where he was intubated, but he died after 30 min despite the cardio-pulmonary resuscitation. Surveillance cameras showed the man falling from the scaffold, but his impact with the ground was not captured. At autopsy, except for an oval bruise on the left hypochondrium, no external injury was found. The same mark was noticed on the shirt worn by the victim. Bilateral ribs fractures were found. The abdominal cavity was filled with 2 l of fresh blood and clots as a consequence of a complete transection of the left renal artery. Investigation of the workplace revealed a partial footprint on the external side of the scaffold, matching shoes worn by the victim. On the ground, a metallic pedestrian gate with a 1 m high post was found placed just below the scaffold. It was concluded that the man hit the gate’s post as intermediate impact after the fall, which caused the oval bruise, ribs fractures, and the rupture of the left renal artery without injury of the internal organs
A case of intrauterine lethal fetal injury after attempted suicide of the mother
No full textTraumatic injuries in pregnancy such as abdominal trauma, pelvic fractures and penetrating trauma are major causes of maternal and neonatal morbidity and mortality. The most common causes of trauma during pregnancy are motor vehicle accidents, falls, assaults, gunshots, and burns. Pregnancy itself has been identified as a risk factor for trauma, together with a younger age, drug use, alcohol use, and domestic violence. We report the case of a 46-year-old woman, 34 weeks pregnant, who attempted suicide by jumping from a flyover, immediately after a probably deliberate traffic collision with the guardrail. She had fractures of five lumbar vertebrae and three ribs with pulmonary contusions, but was without other injuries. Following the mother's stabilization, the fetal heart tones were detected as abnormal and the patient had an emergency caesarean section delivering a still-born male infant. Neither alcohol nor drugs were found in the mother who had been diagnosed with an unspecified episodic mood disorder. She recovered completely from her injuries. At autopsy of the newborn, a massive subarachnoid hemorrhage with deformity of the skull was found, caused by maternal blunt abdominal trauma following car accident and fall. This case is an outstanding example of fetal head trauma which occurred with no life-threatening maternal injury due to attempted suicide. It is important for clinicians and forensic pathologists to have adequate knowledge and practical experience of these cases, because pregnancy is a special risk factor for self-inflicted injuries among females, with significant adverse effects on the fetus even with minor injuries to the mother
Acute Lymphoblastic Leukemia misdiagnosed as lethal child neglect
No full textLethal child neglect is a rare cause of death in industrialized countries. Starvation and dehydration are
peculiar signs of such abuse even if it is mandatory to exclude organic diseases that may mimic neglect. A 4 months-year-old
infant started vomiting at his home and then collapsed in a local hospital, where he expired. The mother stated that baby had had
symptoms (fever, vomit and diarrhea) but she was afraid to seek medical care. At autopsy, clear signs of dehydration were found.
Histological examination showed a T-cell lymphoblastic infiltrate of the organs with foci of bronchopneumonia in lungs. The
results of autopsy suggested that the cause of death was a Cancer-Cachexia-Syndrome from an Acute Lymphoblastic Leukemia.
The manner of death was attributed to natural death. In the present article, crime scene investigations as well as medical history,
autopsy findings, and possible liability of the parents in determining child’s death are discussed
Sepsis and nosocomial infections: The role of medico-legal experts in Italy
Get PDFSepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people’s loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers’ work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections
Dismemberment by a tamping machine: an unusual case of work-related accidental decapitation
No full textWe report the case of a 45-year-old railway worker who was literally decapitated during a work shift. He was working with his colleagues close to a Ballast Cleaning Machine (BCM) behind the driver. This case occurred during the night time, under artificial light that probably allowed this traumatic event. The workplace investigation revealed the victim's head and the right arm were detached from the remains of the body. Probably the cutter bar of the BCM caught his jacket and trapped him in the right arm of the machinery, cutting off his head. The external examination of the body and the following medico-legal autopsy showed excoriated streaks and de-epithelialization area on all over the body, fractures and laceration of the cervical region and of the right arm. Toxicological analyses were negative for alcohol or drug abuse. To the best of our knowledge, no other similar cases have been reported in the international literatur
A Case of Lethal Idiopathic Plasmacytic Lymphadenopathy with Polyclonal Hypergammaglobulinemia: A Medical Challenge for the Forensic Pathologist
No full textA rare case of lethal idiopathic plasmacytic lymphadenopathy (IPL) with polyclonal hyperimmunoglobulinemia with chronic renal failure is described. A 40-year-old woman who had suffered from upper airways disease was admitted to the Emergency Room with acute renal failure and hypergammaglobulinemia. She developed pericardial effusion, a pruritic rash, splenomegaly and fell into a coma after 6 days. Multiple myeloma, infection, collagenopathy, and coagulopathy were ruled out. Finally, a form of malignant hypergammapathy was suspected. At autopsy, lymph nodes were infiltrated by polyclonal plasma cells and lymphocytes, with erythrophagocytosis features; immunohistochemistry confirmed the plasma cells (CD138+), with a prevalence of kappa-positive cells, B (CD20+) and T (CD3+) cells. Kidneys showed advanced glomerulosclerosis containing similar infiltrates. The cause of death was IPL with polyclonal hypergammaglobulinemia and advanced renal failure. Similar cases are unusual, and possible medical liability associated with failure to diagnose and treat idiopathic plasmacytic lymphadenopathy deserves discussion and further studies
Postmortem detection of Neisseria Meningitidis in a case of Waterhouse-Friderichsen syndrome from fulminant meningococcal disease in an adult patient
No full textWaterhouse-Friderichsen syndrome (WFS) from meningococceal sepsis is a rare life-threatening condition which generally occur during infancy and childhood with a high mortality rate (from 10-30% up to 95%). It is very rare in the adult population, usually with pathological risk factors of invasive meningococcal infection. In such fatalities, the condition may rapidly progress into septic shock and disseminated intravascular coagulation with skin lesions (known as “purpura fulminans”) and early recognition and therapy is often difficult owing to the unspecific findings at onset. The purpose of this case report is to present an unusual case of WFS from fulminant meningococceal disease with no meningeal involvement in a previously healthy adult patient, unexpectedly associated with dysmegakaryocytopoiesis findings in bone marrow. The conclusive diagnosis was due to the detection of Neisseria Meningitidis in cerebrospinal fluid despite a postmortem interval of four days and the long cadaver refrigeration
Nasal ciliary motility: a new tool in estimating the time of death.
No full textDetermination of time since death is one of the most difficult and crucial issue
in forensic medicine. Apart from body cooling, which is commonly used in the
early postmortem interval (PMI), supravital reactions are the most interesting
postmortem changes for time of death estimation. Nasal ciliary motility has been
occasionally observed in postmortem period although no studies have focused on
this phenomenon for forensic purposes. We aimed to evaluate the diagnostic
usefulness of ciliary motility as a potential tool in estimating the time of
death. Specimens of ciliated epithelium from 100 consecutive cadavers were
obtained by scraping the nasal mucosa at three different postmortem intervals.
The samples were then smeared on a slide, and an in vitro evaluation of ciliary
movement was analyzed by phase-contrast microscopy. A postmortem nasal ciliary
motility was observed, and a statistically significant relationship between
decreasing ciliary movements and increasing postmortem interval was detected even
in presence of putrefactive changes of nasal ultrastructure integrity. Some
peculiar causes of death seem to influence ciliary motility in the early PMI,
while no significant correlations with sex or age were observed. According to the
results of this study, postmortem evaluation of nasal ciliary motility may be a
bona fide and a feasible option for estimating the time of death
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