Acute myocardial infarction following off label retrobulbar injection of desmopressin for non-arteritic anterior ischemic optic neuropathy (NAION). Causal correlation or coincidence?

A 60-year-old man, apparently healthy with negative history for cardiovascular diseases, was hospitalized because of an unilateral sudden and painless severe visual loss. Diagnosis of NAION was made. Two separate and immediately consecutive injections of betamethasone (2 mg/0.5 mL) and desmopressin (2 mcg/0.5 mL) were performed in the retrobulbar space. Fifteen minutes later, the patient suddenly developed cold sweat, dyspnoea, thoracic pain and severe hypotension. Acute myocardial infarction was diagnosed by ECG. Desmopressin was the probable causative agent. Thrombotic events following intravenous or oral administration of desmopressin have been documented in the medical literature. To the best of our knowledge this is the first case in which a thrombotic event was associated with the retrobulbar route. Retrobulbar desmopressin administration in patients with NAION can be probably associated with AMI. Considering its invasiveness and the unproven benefit in the treatment of NAION, this therapeutic approach can not be currently recommende

HOW SHOULD LIVING ENTOMOLOGICAL SAMPLES BE STORED?

Sampling and storing insect evidence alive is an important task in forensic entomology as it can impact survival and growth rates. To investigate the effect of cooling and storing of insect evidence before its arrival in the laboratory, samples of all three larval stages of the blow fly species Lucilia sericata and Calliphora vicina were analysed. A first group was stored at room temperature and a second one in a refrigerator (~5°C) for 16h, all without air, supply of food and sawdust. Afterwards they were kept at 6-8°C in a Styrofoam box for 8h, simulating a transport situation. Mortality rate (MR) was calculated and 25% of the surviving larvae were killed and measured to check for interim growth. The remaining alive specimens were reared at 25 °C until adult’s eclosion for estimating a possible storage impact on survival during later development. The results were then compared with a control which was not temporary stored and chilled but left feeding in boxes with air-permeable lid on food substrate at 25°C. A 24h temporary storage stopped the larval growth in comparison with the control especially in early larval stages in both species. A high MR of up to100% for third instar (L3) larvae stored both at room temperature and in a cold environment without air supply was found. Oxygen supply can reduce significantly the MR at least for L3 larvae of L. sericata. Findings provide scientific evidence for the recommendation to store larval samples at cold temperatures with both oxygen and food supply. The high MR for samples of the last larval stage clearly shows the need for a fast delivery after sampling and a more sophisticated storage procedure like e.g. air supply. Storing live samples at room temperature without air access should be avoided

Effects of different storage and measuring methods on larval length values for the blow flies (Diptera: Calliphoridae) Lucilia sericata and Calliphora vicina

In forensic entomology, the methods of sampling, killing, and storing entomological samples can affect larval age estimation, and, hence, the estimation of the minimum post-mortem interval. In the existing manuals, there is a certain amount of heterogeneity regarding methods and the recommendations for best practice in forensic entomology are insufficiently validated. This study evaluated three different length-measurement methods for larval stages and examined the influence of different killing and storing methods on the larval length of two forensically important blow flies, Lucilia sericata and Calliphora vicina. The three different measuring methods were a) a ruler with a 0.1 mm scale, b) a geometrical micrometer, and c) a computer-aided stereomicroscope. They were used to measure the length of L1 –L 3 C. vicina larvae and detect no significant differences. This supports the view that a simple tool like a geometrical micrometer can produce reliable results in forensic entomology. Newly hatched larvae of L. sericata and C. vicina were killed with hot water (HW) and divided into two equal subsamples. Lengths of all larvae were measured immediately after killing, then every 24 h until day 4, and once more after 7 days of storage in ≥70%-ethanol. L. sericata larvae only showed significant changes in length in the HW group stored at room temperature. After 4 and 7 days of storage, these 24-h- and 72-h-old larvae showed a significant decrease in length compared with those in a fridge at 6 °C. This decrease can, however, be considered a negligible natural variation without forensically relevant consequences for larval age estimation of L. sericata samples. For C. vicina, an increase in length was observed over time. This was significant only for younger larvae (24-48 h old) stored in 70%-ethanol. This variance in length can lead to a wrong estimation of age; however, only for larvae stored in 70%-ethanol, not for those stored in 96%-ethanol. Novelty statement: We examined the influence of different killing and storing methods on two forensically important blow flies, Lucilia sericata and Calliphora vicina. For the latter species we additionally were evaluating three different length measurement methods. The results of both experiments suggest that it is possible to kill and store fly larvae directly in (not hot) ≥70%-ethanol. This simplifies the sampling and storing of fly evidence at the crime scene. We also compared the influence of three different measuring methods for estimating the length of L1–L3 C. vicina larvae by using a) a ruler with a 0,1 mm scaling, b) a geometrical micrometer and c) a computer-aided stereomicroscope. No significant differences were detected, supporting the view, that a simple tool like a geometrical micrometer can produce reliable results. This study helps to simplify the sampling and evaluation of entomological evidence and to backup or questioning existing guidelines and best practice recommendations

Insects found on a human cadaver in central Italy including the blowfly Calliphora loewi (Diptera, Calliphoridae), a new species of forensic interest

In the case of unidentified bodies the estimation of the period since death or of the season of death plays an important role to focus the attention on a reduced number of people among the ones reported missing. Forensic entomology can be one of the most important methods for these estimations, as occurred in this case. Flies are typically the first insects to colonize a dead body. The case reported here concerns the colonisation by insects of a male body in advanced decay found during the winter in Central Italy. This case is of particular interest as few data are available on the entomological evidence in the cold season. In particular, in this case we recovered Calliphora loewi (Calliphoridae), a species never collected before on dead bodies in Southern Europe. Larvae of the black soldier fly Hermetia illucens (Stratiomyidae), pupae and larvae belonging to genus Hydrothea (Muscidae), and Necrobia rufipes (Cleridae) specimens were also collected. The estimated PMI enabled identification of the cadaver, confirmed by DNA analysis

CLEIA of humor vitreous in a case of suicidal insulin overdose

Insulin overdoses have been mostly described in literature as accidental and suicidal deaths, especially in diabetic patients. The present case study deals with a 68 years old male found dead in his bedroom. The victim worked as health care professional in a rescue team, suffering from depression for several years. At the death scene, two ampoules of soluble insulin were recovered close to the body, one of which was empty. At autopsy, no signs of trauma and no injection marks were found at common sub-cutaneous or intravenous injection sites. No other remarkable findings, but hemorrhagic pulmonary edema along with astrogliosis and neuronal degeneration/necrosis in the subcortical regions and corpus callosum were observed. The blood specimen was inadequate due to hemolysis, since it was not centrifugated soon after sampling. Biochemical analysis was performed on bilateral samples of vitreous humor by using electro-chemiluminescence immunoassay (CLEIA). The insulin concentration was 61.11 mU/L in the right vitreous humor and 74.23 mU/L in the left one; the C-peptide concentration was 0.166 ng/mL in right vitreous and 0.157 ng/mL in the left one. The results are in agreement with levels of insulin and C-peptide detected in previous case studies. Based on these findings the cause of death was determined as suicidal insulin overdoses probably by sublingual administration. This way of self-administration was a diagnosis for exclusion as it has been demonstrated that sublingual human insulin has hypoglycemic effects similar to insulin injected. The case study emphasizes the potential role of vitreous humor as reliable alternative substrate for biochemical analysis compared to post-mortem serum or blood samples in cases of fatal insulin intoxication. Furthermore, the CLEIA is an encouraging analytical method to be considered in such cases, although still not validated to perform quantitative analysis of post-mortem fluids

Bladder irrigation and urothelium disruption: A reminder apropos of a case of fatal fluid absorption

Background: Irrigation or washouts of the bladder are usually performed in various clinical settings. In the 1980 Elliot and colleagues argued that urothelial damage could occur after washouts and irrigations of the bladder. Th exact mechanism underlying urothelial damage has not yet been discovered. To our knowledge, this is the first repor of fatal fluid overload and pulmonary edema, due to urothelium disruption occurring during bladder irrigation approached performing complete histological and immunohistochemical investigation on bladder specimens The exposed case deserves attention since it demonstrates that, although very rarely, irrigation or washouts o the bladder may have unexpected serious clinical consequences Case presentation: An 85 year-old Caucasian man, unable to eat independently and whose fluid intake was controlled underwent continuous bladder irrigation with a 3-way catheter due to a severe episode of macrohematuria. Durin the third day of hospitalization, while still undergoing bladder irrigation, he suddenly experienced extreme shortnes of breath, breathing difficulties, and cough with frothy sputum. His attending nurse immediately noted that there wa no return of the fluid (5 liters) introduced through bladder irrigation. He was treated urgently with hemodialysis. A the beginning of the dialysis treatment, the patient had gained 7.4 kg since the previous measurement (24 hours prior without any clear explanation. Although a significant weight loss (from 81 to 76 kg) due to the dialysis procedure the patient died shortly after the final treatment. The autopsy revealed that the brain and the lungs were heavil edematous. Microscopic examination of bladder specimens revealed interstitial and mucosal swelling, and loss o the superficial cell layer. Intermediate and basal urothelial cells were preserved. Altogether the abovementione findings were suggestive of a diffuse disruption of the urothelium. In conclusion the death of the man was attribute to an acute severe pulmonary edema due to massive fluid absorption Conclusion: Our case demonstrates that urothelium disruption may occur during irrigation and washouts of th bladder, also in the absence of other well-known predisposing conditions. Inappropriate use of bladder irrigatio should be avoided and a close attention is required of the fluid balance is mandatory when irrigating the bladder Keywords: Bladder irrigation, Fluid absorption, Pulmonary edema, Urothelium disruption

Effects of different storage and measuring methods on larval length values for the blow flies (Diptera: calliphoridae) Lucilia sericata and Calliphora vicina

In forensic entomology, the methods of sampling, killing, and storing entomological samples can affect larval age estimation, and, hence, the estimation of the minimum post-mortem interval. In the existing manuals, there is a certain amount of heterogeneity regarding methods and the recommendations for best practice in forensic ento- mology are insufficiently validated. This study evaluated three different length-measurement methods for larval stages and examined the influence of different killing and storing methods on the larval length of two forensically important blow flies, Lucilia sericata and Calliphora vicina. The three different measuring methods were a) a ruler with a 0.1 mm scale, b) a geometrical micrometer, and c) a computer-aided stereomicroscope. They were used to measure the length of L1–L3 C. vicina larvae and detect no significant differences. This supports the view that a simple tool like a geometrical micrometer can produce reli- able results in forensic entomology. Newly hatched larvae of L. sericata and C. vicina were killed with hot water (HW) and divided into two equal sub- samples. Lengths of all larvae were measured immediately after killing, then every 24 h until day 4, and once more after 7 days of storage in ≥70%-ethanol. L. sericata larvae only showed significant changes in length in the HW group stored at room temperature. After 4 and 7 days of storage, these 24-h- and 72-h-old larvae showed a significant decrease in length compared with those in a fridge at 6 °C. This decrease can, however, be considered a negligible natural variation without foren- sically relevant consequences for larval age estimation of L. sericata samples. For C. vicina, an increase in length was observed over time. This was significant only for younger larvae (24-48 h old) stored in 70%-ethanol. This variance in length can lead to a wrong estimation of age; however, only for larvae stored in 70%-ethanol, not for those stored in 96%-ethanol. Novelty statement: We examined the influence of different killing and storing methods on two forensically impor- tant blow flies, Lucilia sericata and Calliphora vicina. For the latter species we additionally were evaluating three different length measurement methods. The results of both experiments suggest that it is possible to kill and store fly larvae directly in (not hot) ≥70%-ethanol. This simplifies the sampling and storing of fly evidence at the crime scene. We also compared the influence of three different measuring methods for estimating the length of L1–L3 C. vicina larvae by using a) a ruler with a 0,1 mm scaling, b) a geometrical micrometer and c) a comput- er-aided stereomicroscope. No significant differences were detected, supporting the view, that a simple tool like a geometrical micrometer can produce reliable results. This study helps to simplify the sampling and evaluation of entomological evidence and to backup or questioning existing guidelines and best practice recommendations