Morphological characteristics of the sinus node on postmortem tissue

The sinus node is an intensively researched structure in terms of anatomical, histological, electrophysiological, molecular and genetic approach. For postmortem diagnosis it is still difficult to investigate due to a still reduced accessibility. In this study we tried and succeed to apply molecular biology techniques on postmortem tissues in order to widen the range of postmortem forensic investigation and provide information related to the diagnostic of cardiac arrhythmia. We described the stages of this investigation, with dissection, preservation and analysis that included classical histology, immunohistochemistry, confocal microscope, microdissection, RIN testing, mRNA expression obtaining a precise morphofunctional location of the sinus node

Current management and surgical advances in patients with hypertrophic obstructive cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a genetic disease and the most frequent primary cardiomyopathy, affecting 1:500 of the general population. Integrated multimodality imaging, including transthoracic echocardiography, 2- and 3‑dimensional transesophageal echocardiography, stress echocardiography, and cardiac magnetic resonance, has provided answers to questions on the management of HCM, leading to standardized protocols. The late 1990s brought the news of a nonsurgical treatment of obstruction in HCM. It is now increasingly evident that septal ablation cannot address all the mechanisms of the left ventricular outflow tract (LVOT) gradient, especially mitral valve involvement. According to American and European guidelines, surgical septal myectomy is the current gold standard treatment. However, deep septal myectomy requires specific operator and institutional experience; therefore, it should not be performed in small community hospitals but only in centers of excellence for HCM treatment. The so-called Ferrazzi technique involves cutting the fibrotic secondary chordae of the mitral valve (MV) and thus helps avoid a deep myectomy by moving the anterior mitral leaflet and the coaptation point of the MV posteriorly away from the septum. This technique, together with careful mobilization of the papillary muscles, helped us achieve excellent results since November 2015, with no mortality, resolution of the LVOT gradient, and MV preservation in all 72 patients. Owing to recent advances in the surgical treatment of hypertrophic obstructive cardiomyopathy, addressing not only the septum but also the MV, the procedure of a deep myectomy has been simplified and mitral regurgitation adequately corrected

Infectious risks in autopsy practice.

Abstract: The purpose of this article is to analyze whether after proper decontamination using standardized methods there are still infectious markers in the autopsy room, suggestive for the possibility of contacting infectious diseases from previous autopsies. In order to analyze the presence and severity of residual risk we performed the following procedures: air sampling for bacterial agents, microbiological identification on surfaces and immunoassays for viruses/agents with slow growth/ no growth on culture mediums. After autopsy room disinfection we found an increased number of Gram positive cocci (especially enteric), a decreased number of Gram negative bacteria and two positive immune reactions -one for HVB and one for HIV. As a conclusion, standard prophylactic procedures must always be used, as autopsy-related infectious risk is significantly increased compared to other specialties. Also, standard disinfection has a limited value in removing viral traces, leading to a residual infectious risk