Forensic tools for the diagnosis of electrocution death: Case study and literature review

Diagnosis of death by electrocution may be difficult when electric marking is not visible or unclear. Accordingly, the body of a man who appeared to have died from accidental electrocution was carefully forensically analysed. Macroscopic and microscopic analysis of the current mark was carried out using a variable-pressure scanning electron microscope equipped with energy dispersive X-ray microanalyser to highlight skin metallisation, indicating the presence of iron and zinc. The histological findings of electrocution myocardial damage were supported by the results of biochemical analysis which demonstrated the creatine kinase-MB and cardiac troponin I elevation. The effects of electric current flow were also highlighted by perforations of endothelial surface of a pulmonary artery using scanning electron microscope, and all the results were analysed by the main tools suggested in the literature

Chronic, nonspecific, postinfectious, retroperitoneal fibrosis and ureteral obstruction

ABSTRACT Introduction: Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal fibrosis are described, which both originated by a primitive intestinal pathology. Patients: This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second, 66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis, secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary. Histology demonstrated nonspecific inflammatory lesions. Discussions: Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral tissues, inducing an inflammatory and then a fibrotic process. Conclusions: We underline the opportunity of a precocious and radical treatment of every retroperitoneal infection. Keywords: Intestinal fistula, Retroperitoneal fibrosis, Retroperitoneal infection, Ureteral obstructionINTRODUCTION: Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal fibrosis are described, which both originated by a primitive intestinal pathology. PATIENTS: This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second, 66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis, secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary. Histology demonstrated nonspecific inflammatory lesions. DISCUSSIONS: Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral tissues, inducing an inflammatory and then a fibrotic process. CONCLUSIONS: We underline the opportunity of a precocious and radical treatment of every retroperitoneal infection

Does needle calibre affect pain and complication rates in patients undergoing transperineal prostate biopsy? A prospective, randomized trial

Transperineal prostate biopsy is a procedure that can be used to obtain histological samples from the prostate. To improve both the quality of the biopsy core samples and prostate cancer detection, we are currently performing a prospective, randomized trial comparing prostate biopsy samples obtained using an 18 G-needle to those obtained using a 16 G needle. The aim of this preliminary study was to evaluate pain and complication rates in both groups in order to assess whether performing a prostate biopsy with a larger calibre needle is a feasible procedure. One hundred and eighty-seven patients undergoing transperineal prostate biopsy were prospectively evaluated and divided into two groups. The first group (94 patients, Group A) received a transperineal prostate biopsy using a 16 G-needle and the second group (93 patients, Group B) underwent transperineal prostate biopsy with an 18 G-needle. Anaesthesia was obtained with a single perineal injection at the prostatic apex in all subjects. A visual analogue scale (VAS) and facial expression scale (FES) were used to assess pain during multiple steps of the procedure in each group. A detailed questionnaire was used to obtain information about drug use because it could potentially influence the pain and complications that patients experienced. Two weeks after the procedure, early and late complications were evaluated. Statistical analysis was carried out using non-parametric tests. Prostate Specific Antigen (PSA) and drug use were similar at baseline between the two groups. Pain during prostate biopsy, which was measured with both the VAS and FES instruments, did not differ significantly between the 18- and 16 G-needle groups, and no significant differences were found in early or late complication rates between the groups. Transperineal prostate biopsy with a 16 G-needle is a feasible procedure in terms of pain and complication rates. Further studies with larger patient populations are required to assess whether or not this procedure can improve prostate cancer detection rates

Corneal Structural Changes in Nonneoplastic and Neoplastic Monoclonal Gammopathies

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Embryological considerations on a case of coexistence of persistent left superior vena cava and partially left inferior vena cava

The persistent left superior vena cava (PLSVC) is the most common venous thoracic congenital anomaly. The PLSCV generally drains into the right atrium, which it reaches through a dilated coronary sinus. Its presence is usually unrecognized, until a venous approach is performed. Abnormalities of the inferior vena cava (IVC) are rare (0.2-0.3% of healthy subjects and 0.6-2% of patients with cardiovascular defects). A single left IVC (LIVC) is very rare (11.9% of all the abnormalities) [1]. To the best of our knowledge, the coexistence of PLSCV and LICV has not been previously described. We present a case of a 32-year-old woman on hemodialysis for more than 12 years. An angiography demonstrated both a normal right SVC and a PLSCV and a single IVC with a lower left course, an intermediate circumaortic ring and an upper normal right course. The double SVC can be consequent to the failed development of the anastomosis between the anterior cardinal veins and the patency of the caudal part of the left anterior cardinal vein forming the PLSCV. As to the partially LIVC, its iliac and subrenal parts can be the results of the persistence of the left supracardinal vein. The circumaortic venous ring might indicate that a persistent intersupracardinal anastomosis receiving the left and the right renal veins was maintained around the abdominal aorta [2], while the superior part represents the normal right subcardinal and hepatic derivatives. The existence of anomalies should be considered, as they can have important implications in invasive procedures such as venous catheter placement, and may represent a speculative bridge between clinicians and embryologists

Trehalose protects the corneal epithelium in alcohol delamination: a structural and ultrastructural study

During laser subepithelial keratomilieusis (LASEK) the corneal epithelium undergoes to peculiar morphological changes owing to the dilute alcohol used to facilitate its mechanical separation from the stroma. As it was shown that trehalose, a non-reducing disaccharide of glucose, protects corneal epithelial cells from drying [1] and is effective in the treatment of experimental [2] and of human dry eye [3], aim of the present work was to evaluate the advantages of a pretreatment with trehalose to improve the structural and ultrastructural features of the corneal epithelium. Twelve patients undergoing LASEK were consecutively included in the study and treated as follows: topical anesthesia with oxybuprocaine hydrochloride 0.4 %, 20% ethanol in distilled water for 25 seconds followed by Merocel wetting, treatment with hypotonic BSS in distilled water, lifting of the epithelial flap with a beaver blade, excimer laser treatment (0.8 mm flying spot), reposition of the epithelial flap, BSS wash of the entire surface, application of a contact lens for 5-7 days. The right eyes of each patient were pretreated, together with the anesthetic, with 3% trehalose eye drops, whilst the left eyes were used as controls. Small parts of the epithelium were collected with a forceps at the end of the epithelial reposition and were processed for light and transmission electron microscopy. From the micrographs obtained with both techniques a morphometric analysis was also performed. In the controls, the corneal epithelium showed flat superficial cells with well-preserved apical microfolds, wing cells with intracellular vesicles and slightly dilated intercellular spaces, and irregularly shaped basal cells filled with vesicle, separated by wide spaces. In the trehalose-treated epithelium superficial cells showed normal shape, regular apical microfolds and well-preserved intercellular borders; wing cells had a well evident cytoskeleton, sometimes apparently double nuclei and normal intercellular borders, glued by desmosomes. The basal cells demonstrated polygonal shape, round nuclei and evident intracytoplasmic vesicles. The morphometric analysis carried out on the height and on the number of the layers of the corneal epithelium demonstrated in the trehalose-treated group values significantly lower than the control group. Similarly, basal hemidesmosomes were more numerous in the trehalose-treated group when compared to the control group. The morphological changes of the corneal epithelium during LASEK represent a simple and reproducible experimental model to evaluate the antagonists of an acute stress, such as the alcohol delamination. Our results demonstrate that trehalose administration before LASEK is able to maintain better morphological and morphometric features when compared to the control cornea

The human corneal epithelium after alcohol delamination: a structural and ultrastructural study

Dilute alcohol is one of the most popular methods for corneal epithelial removal during photorefractive keratectomy (PRK) and laser subepithelial keratomilieusis (LASEK). Even if the technique is used by nearly fifteen years, no concordant data are available on the effects of the exposition to dilute alcohol on the corneal epithelium. As in LASEK the epithelial flap obtained by the previous delamination is repositioned to improve corneal recovery, aim of the present work was to investigate the structure and the ultrastructure of the corneal epithelium after alcohol delamination. Ten patients undergoing PRK for myopic correction were consecutively included in the study. A 9-mm diameter cone was placed on the anaesthetized cornea and it was filled with 25% ethanol in BSS for 25 seconds. The cone was emptied and the corneal surface was washed off with BSS. The epithelial layer was lifted with beaver blade, peeled off with forceps, and processed for light (LM) and transmission electron microscopy (TEM). With LM, whilst superficial and wing cells showed a normal appearance, basal cells had significantly different staining patterns. In fact, in the same microscopic field they showed either normal morphology or paler nuclei and cytoplasm. When the specimens were observed with the TEM, all epithelial cells showed well-preserved intercellular spaces and junctional complexes. In the superficial cells perinuclear vacuolizations were present, whilst wing cells demonstrated no evident morphological changes. Clear basal cells had roundish nuclei with pale chromatin and clear cytoplasm with perinuclear endoplasmic reticulum and mitochondria and a large number of tonofilaments. Their basal membrane was generally intact, with many hemidesmosomes adhering to the basement membrane, which was formed only by the laminae lucida and densa. Dark basal cells showed irregular nuclei with condensed chromatin, vacuolated cytoplasm and few basal hemidesmosomes. Alcohol debridement can be considered as a valuable technique for removing corneal epithelium before PRK or for preparing an epithelial flap before LASEK: in fact it affects the binding of hemidesmosomes to the underlying basement membrane so that the lamina densa is separated from the lamina fibroreticularis. However, the observation of structural and ultrastructural changes of the basal cells, similar to those demonstrated in epithelial flaps obtained with the epikeratome, indicates the need for further studies to evaluate the corneal toxicity of the ethanol

High-molecular weight hyaluronan reduced renal PKC activation in genetically diabetic mice

AbstractThe cluster determinant (CD44) seems to play a key role in tissues injured by diabetes type 2. CD44 stimulation activates the protein kinase C (PKC) family which in turn activates the transcriptional nuclear factor kappa B (NF-κB) responsible for the expression of the inflammation mediators such as tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), interleukin-18 (IL-18), inducible nitric oxide synthase (iNOS), and matrix metalloproteinases (MMPs). Regulation of CD44 interaction with its ligands depends greatly upon PKC. We investigated the effect of the treatment with high-molecular weight hyaluronan (HA) on diabetic nephropathy in genetically diabetic mice.BKS.Cg-m+/+Leprdb mice had elevated plasma insulin from 15days of age and high blood sugar levels at 4weeks. The severe nephropathy that developed was characterized by a marked increased in CD44 receptors, protein kinase C betaI, betaII, and epsilon (PKCβI, PKCβII, and PKCε) mRNA expression and the related protein products in kidney tissue. High levels of mRNA and related protein levels were also detected in the damaged kidney for NF-κB, TNF-α, IL-6, IL-18, MMP-7, and iNOS.Chronic daily administration of high-molecular mass HA for 2weeks significantly reduced CD44, PKCβI, PKCβII, and PKCα gene expression and the related protein production in kidney tissue and TNF-α, IL-6, IL-18, MMP-7, and iNOS expression and levels also decreased. Histological analysis confirmed the biochemical data. However, blood parameters of diabetes were unchanged.These results suggest that the CD44 and PKC play an important role in diabetes and interaction of high-molecular weight HA with these proteins may reduce inflammation and secondary pathologies due to this disease

Three-dimensional technology facilitates surgical performance of novice laparoscopy surgeons: a quantitative assessment on a porcine kidney model

Objective To determine whether the use of 3-dimensional (3D) imaging translates into a better surgical performance of naïve urologic laparoscopic surgeons during pyeloplasty (PY) and partial nephrectomy (PN) procedures. Materials and Methods Eighteen surgeons without any previous laparoscopic experience were randomly assigned to perform PY and PN in a porcine model using initially 2-dimensional (2D) and 3D laparoscopy. A surgical performance score was rated by an "expert" tutor through a modified 5-item global rating scale contemplating operative field view, bimanual dexterity, efficiency, tissue handling, and autonomy. Overall surgical time, complications, subjective perception of participating surgeons, and inconveniences related to the 3D vision were recorded. Results No difference in terms if operative time was found between 2D or 3D laparoscopy for both the PY (P =.51) and the PN (P =.28) procedures. A better rate in terms of surgical performance score was noted by the tutors when the study participants were using 3D vs 2D, for both PY (3.6 [0.8] vs 3.0 [0.4]; P =.034) and PN (3.6 [0.51] vs 3.15 [0.63]; P =.001). No complications occurred in any of the procedures. Most (77.2%) of the participating na??ve laparoscopic surgeons had the perception that 3D laparoscopy was overall easier than 2D. Headache (18.1%), nausea (18.1%), and visual disturbance (18.1%) were the most common issues reported by the surgeons during 3D procedures. Conclusion Despite the absence of translation in a shorter operative time, the use of 3D technology seems to facilitate the surgical performance of naive surgeons during laparoscopic kidney procedures on a porcine model