Indirect effects of 3,4-methylenedioxy-N-methylamphetamine (MDMA) and metabolites on the cardiac cells are well-known, the mechanism(s) underlying direct MDMA-induced cardiotoxicity remaining to be ...clarified. To better understand the immuno-inflammatory phenomena accompanying the cardiac alterations during MDMA administration, we conducted a study in an in vivo animal model to evaluate the cellular morphological alterations related to the biological response between MDMA administration and inflammatory cytokines (tumor necrosis factor-alpha, IL-1beta, IL-6, 8, 10, and monocyte chemotactic protein-1). A total of 25 male rats were used. The effects were evaluated at 6, 16 and 24 hours after a single dose MDMA administered (20 mg/kg i.p.). We found high levels of the cardioinhibitory cytokines in rat heart after 3 and 6 hs from MDMA administration. Strongest reaction was observed at 24 hs for TNF-alpha, IL-1beta, IL-6, 8, 10 and for MCP-1. Furthermore, we still determined the presence of MDMA and MDA in the plasma of rats treated with MDMA intra-peritoneal single injection; it was present as early at 6 hs and still present 24 hs after treatment. Western blot analysis in cardiac samples demonstrated the IL-1beta and IL-6 reactions in rats died spontaneously at fourth hour. The rise of the selective cardioinhibitory cytokines may be interpreted as the adaptive response of jeopardized myocardium to the cardiac dysfunction resulting from MDMA injection.
Background: The aims of the present study are to quantify forms of myocardial and coronary changes found at postmortem and to discuss their significance in relation to causes of death and cardiac ...arrest in orthotopic transplanted human hearts.
Methods: The examined material included (1) 46 orthotopic transplanted human hearts and, as “controls”, hearts from (2) 25 sudden/unexpected coronary death cases, 38 patients with acquired immunodeficiency syndrome, 34 subjects with “silent” Chagas’ disease who died suddenly, 27 non cardiac patients who died from intracranial hemorrhage due to a ruptured cerebral aneurysm and 45 healthy subjects dead from head trauma.
Results: Contraction band necrosis was observed in 85% of transplanted hearts, 66% of AIDS cases and in 100% Chagas’ disease, 89% intracranial hemorrhage, 71% sudden coronary death, and 18% normal head trauma cases. Foci of lymphocytic infiltrate were present in 89% of transplanted heart, 50% AIDS, 100% Chagas’ disease, 37% intracranial hemorrage and 64% head trauma groups. An allograft coronary vasculopathy was observed in four transplanted hearts with a survival greater than 202 days. In another 12 cases, who survived more than one year, atherosclerosis was the only coronary lesion found. No relation was observed between coronary lesions of any degree of stenosis and myocardial injuries.
Conclusions: In the group studied acute rejection was the least frequent cause (2%) of graft failure at any time following transplantation and coronary vasculopathy a questionable cause of it in four cases. Rather, contraction band necrosis as an expression of catecholamine myotoxicity seemed to play a role in graft failure related to increased myocardial catecholamine sensitivity after global denervation.
The association between sudden infant death syndrome and immunization is frequently discussed. Serious adverse events following vaccination have generally been defined as those adverse events that ...result in permanent disability, hospitalization or prolongation of hospitalization, life threatening illness, congenital anomaly or death. They are generally referred to the inherent properties of the vaccine (vaccine reaction) or some error in the immunization process (programme error).The event could also be totally unrelated but only temporally linked to immunization (coincidental event). A fatal case of a 3-month-old female infant, who died within 24h of vaccination with hexavalent vaccine is presented. Clinical data, post-mortem findings (acute pulmonary oedema, acute pulmonary emphysema), quali-quantitative data collected from immunohistochemical staining (degranulating mast cells) and laboratory analysis with a high level of β-tryptase in serum, 43.3μg/l, allows us to conclude that acute respiratory failure likely due to post hexavalent immunization-related shock was the cause of death.
A sudden death likely due to mild anaphylactic reaction in a young man is described. Autoptic, histologic, immunohistochemical, and laboratory findings were strongly consistent with the diagnosis of ...a mild anaphylactic reaction. Genetic molecular analysis, performed on formalin-fixed, paraffin-embedded tissues, showed a mutation described as W822X in a family with electrocardiographic pattern typical of Brugada Syndrome. It results in a nonsense mutation generating a truncated form of the channel protein. The mutation is due to a point substitution of a guanine with an adenine residue (G2466A). Immunohistochemistry and laser scanning confocal microscopy on sections from heart formalin-fixed, paraffin-embedded tissues led us to confirm the cellular localization of the Na+ CP type Valpha (C-20) at the intercalated disks of ventricular myocytes and nearly 50% reduction in Na+ channels expression in ventricular myocytes when compared with control cases. We suggest that the anaphylactic reaction that occurred in the young man could serve as a trigger mechanism, responsible for his sudden death with a SCN5A mutation associated with the Brugada syndrome.
Death by hanging is asphyxiation when the body is suspended by means of a ligature. Most deaths by hanging are suicides, though occasionally they are accidental or a homicidal event. The ...characteristics of the hanging marks depend on the ligature used, the dynamics and on the node position with respect to the neck. When the crime scene is contaminated, the hanging mark must be checked with the type of suspension and ligatures used to establish how the hangings took place. We report on 20 cases (2013-2016) where the bodies were moved at or from the crime scene. We analysed the features of hanging marks, the tools of suspension and the ligatures employed in each case. Judicial inspections and an external examination were also carried out. Analysis of hanging marks enables the pathologist to clarify the manner of death and the type of hanging, and tools used especially where the crime scene has been contaminated and the body has been moved.
Most of the existing reports on abdominal compartment syndrome (ACS) deal with pathophysiology, focusing on its clinical picture and course, and knowledge of the histopathological features of ACS is ...very poor. Since the heart, kidneys and lungs are the organs primarily targeted for injury in multi-organ failure, we investigated the expression of TNFalpha and apoptosis in tissue specimens of the heart. This retrospective study was conducted at the Department of Forensic Pathology, University of Foggia. A retrospective review of records extending over a period of 4 years, from 1 April 2001 to 31 March 2005, was carried out and all cases subjected to medico-legal autopsy during this period, whose detailed history and case records were available, were the subjects of our study. Over a 4-year period, on 848 cases subjected to medico-legal autopsy, three cases qualified for inclusion into the study. The immunohistochemical study revealed an intensive positive result for TNFalpha in heart specimens. The TUNEL assay was positive in heart specimens too. The presented study can contribute to elucidate the pathophysiology of fatal ACS and also define efficient markers for future therapeutic approaches suggesting anti-TNFalpha strategies may be useful in the management of ACS.
Five fatal cases of poisoning from ingestion of Amanita phalloides, a very common mushroom in central Italy, are reported. The fact that four of the cases occurred simultaneously enabled uniform ...collection of clinical, pathology and toxicology data, which is presented with particular emphasis on the histological aspects. The fifth case involved a six-year-old girl, and is discussed with reference to differential diagnosis with respect to Reye's syndrome, which was the initial diagnosis, demonstrated incorrect by the histology, pathology and toxicology findings. The typical liver and kidney alterations of Amanita phalloides poisoning, consisting of massive hepatic central lobular cell necrosis and acute tubular necrosis of the kidney are described. Outside the liver, there was often general hemorrhagic diathesis and severe brain edema. Although poisoning by Amanita phalloides is rare, these cases confirm the requirement for as complete a comparison as possible between circumstantial histopathological and toxicological data for the purposes of forensic diagnosis.
PDF
