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.
BACKGROUNDThe term sudden unexpected infant death (SUID) is not always properly invoked. It refers to a broad range of conditions that sometimes defy classification. There is not only a strong ...emotional impact on the family, but such cases are also quite complex. Underlying causes may be multiple, not always readily apparent, and have potential repercussions, especially in terms of forensics. CASE SUMMARYA 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest. The parents had immediately rushed their child to the hospital, stating the baby was found prone and not breathing. Total-body postmortem computed tomography (PMCT) was performed, revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change. At autopsy, the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material. There was widespread airspace reduction due to parenchymal collapse. Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells. Immunohistochemical studies were performed, targeting CD15, CD68, and alpha-lactalbumin. Ultimately, the focus was on alpha-lactalbumin (milk protein), which showed marked immunopositivity within alveolar spaces. Cytoplasmic staining of macrophages was also particularly prominent. CONCLUSIONPostmortem investigations are thus essential to identify causes of death and surrounding circumstances. PMCT is a useful tool in this setting, given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases. These findings, later confirmed by immunohistochemical investigations, were indicative of active pneumonia due to aspirated milk. The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern. PMCT is a very valuable aid in cases of forensic interest, as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.
The new Italian code of medical ethics Fineschi, V; Turillazzi, E; Cateni, C
Journal of medical ethics,
08/1997, Letnik:
23, Številka:
4
Journal Article
Recenzirano
Odprti dostop
In June 1995, the Italian code of medical ethics was revised in order that its principles should reflect the ever-changing relationship between the medical profession and society and between ...physicians and patients. The updated code is also a response to new ethical problems created by scientific progress; the discussion of such problems often shows up a need for better understanding on the part of the medical profession itself. Medical deontology is defined as the discipline for the study of norms of conduct for the health care professions, including moral and legal norms as well as those pertaining more strictly to professional performance. The aim of deontology is therefore, the in-depth investigation and revision of the code of medical ethics. It is in the light of this conceptual definition that one should interpret a review of the different codes which have attempted, throughout the various periods of Italy's recent history, to adapt ethical norms to particular social and health care climates.
In June 2010, the priests of the church of Santa Maria in Silvis in Serracapriola, Italy, asked the University of Foggia to study skeletal remains which they believed to be those of San Fortunato. ...San Fortunato lived in Rome in the third century AD and little is known about his life and death. For forensic and anthropological study to determine the geographical origin, sex, age, stature and diagnose any diseases, multislice computed tomography (MSCT) was performed. Due to time and administrative constraints (we had access to the remains for only one day, and no biological sampling was permitted), dry bone and DNA analyses were not performed. The remains, thought to be 17 centuries old, were severely damaged and conventional anthropological methods already transposed to MSCT could not be used. However, considerable information for reconstructive identification was obtained. The skeletal remains were those of an Italian male, of height between 1.53m and 1.56m, with age at death estimated between 20 and 40 years. The effects of taphonomic processes were also visible. No historical physical description of San Fortunato is available so we were unable to compare our results. To the best of our knowledge, this is the first case in which MSCT has been used to examine the presumed skeletal remains of a Saint. It also demonstrates that reconstructive identification can be performed independently of dry bone study and illustrates the value of MSCT when skeletal remains must be preserved.
PDF
