322,908 research outputs found
Postmortem Diagnosis of Invasive Disseminated Aspergillosis After Tongue Piercing
No full textSevere fungal infections caused by highly invasive fungi such
as Aspergillus are not easy to diagnose and often have a poor prognosis. In
these cases, the nonspecific symptomsmaymake clinical diagnosis challenging,
and consequently, the autopsy and postmortem histological investigations
acquire a crucial role.We report the case of a youngman in good health
who died of septic shock 3 weeks after having had a tongue piercing. Intravitam
investigations did not identify the etiology of the rapidly fatal infectious
condition. The autopsy revealed flaccid organs of uniformly diminished
consistency with abscesses and granulomatous foci with central necrosis.
Histological examination showed the presence of septate mycotic hyphae,
with a dichotomous 45-degree bifurcation, typical for Aspergillus, in all the
examined organs, including the tongue. The molecular identification confirmed
the presence of Aspergillus fumigatus. The observed macroscopic
framework and the laboratory findings made it possible to diagnose
pseudomembranous invasive tracheobronchial aspergillosis and to attribute
the death to fatal invasive disseminated aspergillosis. The consistency and
concordance of all the findings in our possession led us to suspect the practice
of piercing as the triggering cause of the man's pathology
Approccio istologico sperimentale con soluzione reidratante di Sandison a tessuti cadaverici carbonizzati
No full textFor a forensic pathologist, the autopsy of a charred body represents a scenario that is difficult to handle from several points of view: identification of the victim, chronological determination of the injuries observed, and definition of the dynamics of the event to distinguish whether it is an accident, a suicide, or a homicide/cadaveric destruction. In fact, charring leads to darkening and desiccation of the skin with possible deep lacerations; moreover, when it affects deep tissues, it can cause injuries and a reduction in the volume of internal organs due to desiccation and the expansion of intracavitary gases. In this context, microscopic examination is particularly challenging, not only because fragile, disintegrated, and extremely dry tissues can be easily lost in standard histological examination procedures, but also because the few sections obtained have many technical artefacts. Since the use of various rehydration solutions has been shown to be effective in improving the histological examination of mummified and corified skin specimens, we experimentally applied Sandison's rehydration solution to skin and visceral samples from charred cadavers. Histological specimens observed after hematoxylin-eosin and Masson-Goldner trichrome staining showed qualitatively better morpho-structural aspects compared to those obtained with routine formalin fixation. In parenchymatous viscera, Sandison’s solution partially eliminated the changes caused by severe carbonization with a discrete improvement, while in hollow organs it caused a moderate regeneration of histological structures. Sandison’s solution was particularly effective in skin, brain, and aorta specimens; it caused partial histomorphological recovery of dura mater, esophagus, lung, heart, liver, and kidney. However, spleen and small intestine specimens, in which signs of heat protein coagulation, coarctations, and foci of nuclear pyknosis persisted, were not significantly improved. In addition, the use of Sandison’s solution resulted in a partial recovery of the affinity of the connective tissue dye for trichrome staining: in charred skin specimens not pretreated with rehydration solution, a paradoxal staining of the connective tissue was observed, which appeared red instead of green. This phenomenon, although little known, is reported in the literature and can be fully explained by the extreme destructive power of hyperthermic lesions, which, due to the severe dehydration of the tissue, as in the case of charring, denature the protein structures, leading to conformational changes in the microstructure of collagen and changes in the penetration capacity of dyes in the affected tissues. Sandison's rehydration solution, on the other hand, thanks to an emulsifier - sodium carbonate Na2CO3 - is able to penetrate deeply and homogeneously into the cadaveric tissue and, thanks to a solvent - 96% ethanol - stabilizes the tissue so that it does not collapse and the impaired structures are restored, ensuring better stainability [5]. Thus, overall, the Sandison rehydration procedure is useful and effective and results in high-quality histological sections with less destructive thermal effects, although complete recovery is not always possible. In view of these results, we recommend the use of this procedure in the histological examination of charred skin and viscera specimens
Letter to the Editor regarding the article "Mummification in a forensic context: an observational study of taphonomic changes and the post‐mortem interval in an indoor setting"
No full textForensic Diatom Analysis: Where Do We Stand and What Are the Latest Diagnostic Advances?
No full textBackground: diatoms are unicellular algae that have been used for more than a century for forensic purposes to diagnose drowning, with more or less success depending on the historical era. Although many years have passed, scientific research on diatoms has never ceased, which testifies to their enduring allure in forensics. Of course, diatom research has evolved and expanded over time, changing with the availability of new techniques and technologies. The volume of articles and their production over a period of many years has resulted in old, current, and new knowledge on diatoms being scattered over a large number of books and articles. Objectives: the purpose of this narrative literature review is, therefore, to summarize all this information and bring it together in a single work that can be useful for those who are studying diatoms and their usefulness for forensics for the first time, for those who are looking for proven methods of analysis, and finally for those who are interested in exploring new frontiers of research. Methods: a comprehensive literature search that included all studies dealing with the applications of diatoms in forensic science was performed in the most popular electronic databases. Results: traditional methods have been complemented by molecular and imaging methods and, more recently, by artificial intelligence. In addition, new biological substrates have been found for the analysis of diatoms. Conclusions: all this has led, on the one hand, to the consolidation of a whole body of knowledge on diatoms, on which this forensic analysis is still based, and, on the other hand, has opened up numerous new research directions
Letter to the Editor Regarding the Article "Complex (Multimodality) Suicides in New York City: 2008-2017"
No full textPorencephalic cyst in adult
No full textWe presented this case of death finding it of interest both for the rarity of the cerebral anomaly detected and for the survival of the man until adulthood in the absence of severe symptoms despite being a carrier of porencephalic cyst. In fact, the first diagnosis occurred only post mortem and the histopathological analysis confirmed the porencephalic nature of the large cerebral cavitated defect
A narrative review of astrocytes and suicide in psychiatric disorders
No full textSuicide is a real public health problem today, and in recent decades its possible neurobiological basis has been intensively studied. One particular strand of research has focused on suicide deaths and psychiatric disorders, with ample evidence for molecular mechanisms related to astrocytic abnormalities. The scope of the articles and their compilation over a period of many years has resulted in old, current and new knowledge being scattered across a large number of sources. The purpose of this narrative literature review is therefore to bring all this information together and summarize it in a single work that can be useful for those approaching this topic for the first time, for those looking for current evidence, and finally for those interested in exploring new frontiers of research. A comprehensive literature search has clearly shown that there are numerous converging findings indicating astrocyte changes in various biomarkers, particularly in the dorsolateral prefrontal cortex of suicidal individuals suffering from major depressive disorder. There is very little evidence for other brain regions and psychiatric disorders. Although these are preliminary results, they are encouraging and future studies could gradually overcome the limitations in the currently available literature and contribute to a better understanding of the etiopathological mechanisms of the occurrence of some of the main psychiatric pathologies leading to suicide
Uterine leiomyosarcoma as a rare cause of fatal retroperitoneal haemorrhage due to compression and rupture of the renal vein
No full textAbnormal uterine bleeding (AUB) can be caused by uterine tumors, both benign and malignant, although they rarely lead to fatal vascular complications. We present a case of a woman found dead in her home, in which the autopsy highlighted a massive retroperitoneal haemorrhage extending to the left renal lodge and a voluminous uterine tumor of stony consistency and exophytic growth weighing 2250g. The histopathological examination identified the mass as a leiomyosarcoma and demonstrated the presence of a dilation with rupture of the left renal vein, in the absence of neoplastic cells infiltrating the vascular wall. On these findings, it was concluded that the neoplastic mass had caused external compression of the left renal vein, leading to its rupture and to a fatal retroperitoneal haemorrhage. The case was considered of interest as it involved a peculiar etiopathogenetic mechanism causing a lethal complication from uterine leiomyosarcoma which has not yet been reported in the literature
Letter to the Editor regarding the article “Double suicide in Japan in the post-war reconstruction period, with reference to contemporary Japan”
No full textDiagnosi differenziale tra amiloidosi cardiaca e cardiomiopatia microfibrillare: importanza del ruolo sinergico di diverse indagini forensi
No full textIntroduzione
Il cuore è l’organo bersaglio di numerose patologie infiltrative che possono esitare in cardiopatie, spesso letali: amiloidosi, sarcoidosi, patologie da accumulo di metaboliti, e una recente cardiomiopatia, definita microfibrillare. Quest’ultima, caratterizzata da deposizione di microfibrille interstiziali Congo Red negative, si pone inevitabilmente in diagnosi differenziale con forme amiloidosiche non consuete [1]. Lo scopo della presente segnalazione è esporre le difficoltà interpretative e diagnostiche nella caratterizzazione di materiale eosinofilo intramiocardico, ponendo in luce come, solo grazie alla sinergica attività di più competenze professionali, si sia formulata la corretta diagnosi della causa di morte.
Il caso
Un’anziana signora di 95 anni fu rinvenuta semincosciente nel proprio letto dalla badante, la quale immediatamente allertava i Soccorsi, che ne constatarono il decesso. I familiari della defunta, al riconoscimento della salma dichiararono che la propria congiunta fosse affetta da Alzheimer e ipoacusia, negando l’esistenza di altre patologie. Come unico reperto significativo alla dissezione autoptica, fu la presenza nel cuore di macroscopiche e plurifocali aree più chiare, di aspetto “ceroso” e consistenza “gommosa” alla palpazione. Non essendo emerso alcun reperto letale in grado di giustificare l’exitus, fu disposta l’esecuzione di indagini tossicologiche e istologiche.
Risultati
Le indagini tossicologiche evidenziarono la presenza nel sangue di dosaggi terapeutici di Lorazepam e le indagini istologiche, all’Ematossilina-Eosina e nelle sole sezioni cardiache, numerose aree interstiziali irregolari di materiale ialino eosinofilo e aspetto fibrillare, suggestivo di amiloidosi. Alla classica colorazione con Congo RED, e sue modifiche (Bancroft Gamble e Bancroft 2012), non si evidenziò positività, analogamente all’osservazione in luce polarizzata, la quale non mostrò la tipica birinfrangenza color verde mela dell’amiloide.
Diagnosi Differenziale
Sulla base delle indagini istologiche, si suppose potesse trattarsi di un’altra entità patologica sconosciuta, caratterizzata anch’essa dalla deposizione di materiale eosinofilo intramiocardico Congo Red negativo, ossia la cardiomiopatia microfibrillare [1]. Ulteriori sezioni di organi e cuore, furono sopposte a colorazione con Congo Red modificata per cadavere [2] e Alcian Blu Sodio Solfato [3]; infine si eseguirono indagini Immunoistochimiche. In tutti i casi si ottenne positività per la presenza di amiloide A e P.
Conclusione
La colorazione Congo Red è il gold standard per evidenziare l’amiloide di colore arancio, tuttavia, quando cimentata su tessuti fissati in formalina e inclusi in paraffina, può presentare minore tingibilità e visibilità dell’amiloide stessa. La negatività al Congo Red, dunque, non escludendo la possibilità di una malattia amiloidosica occulta, impone in ambito forense, ulteriori approfondimenti. Il riscontro microscopico di materiale eosinofilo intramiocardico, la cui natura non è facilmente definibile come amiloide con la classica colorazione Congo Red – come nel caso presentato- solleva numerose difficoltà interpretative e diagnostiche e richiede una diagnosi differenziale con altre entità patologiche. Nel nostro caso, l’attività sinergica di differenti competenze professionali e la convergenza dei dati emersi dalle indagini, hanno permesso di escludere nel determinismo della morte, la cardiomiopatia microfibrillare, formulando diagnosi di amiloidosi letale, a sola localizzazione cardiaca, nel post-mortem
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