Malignant diseases in medicolegal practice

Introduction: In many cases of natural death (so-called obscure natural death), medicolegal assessment and elucidation are required. Although malignant tumors may be the cause of obscure natural death, their forensic significance has not been particularly studied in our population. Objective The objective of the study was to provide a general report on medicolegal importance of malignant diseases. Method Autopsy material of the Institute of Forensic Medicine, Belgrade, from 1990 to 2000, was analyzed. The data were obtained from autopsy records, investigation reports, family members of the deceased and available medical documentation. Results The malignant tumor was the cause of death in 81 cases (0.69% out of a total of 11771 autopsies), in 52 males and 29 females, respectively. The incidence of malignant diseases increased with age. The most frequent cause of death was the lung cancer - diagnosed in 33 cases (40.7% out of 81), with somewhat higher percentage in females (41.4%) than in males (40.4%), but this difference was not statistically significant (χ2 =0.13; p>0.05). Other locations of malignancies were less frequently found: brain (7 cases), colon (6), stomach (5) and pancreas (4). In 67 cases, widespread tumor with metastases was identified as an immediate cause of death, in 8 cases there was a hemorrhage from eroded blood vessels, and in 6 cases peritonitis due to gastric or intestinal leakage into the abdominal cavity at the site of wall perforation. In 61.7% cases, fatal tumor was not diagnosed during the life, and was recorded more frequently in female group (75.9%) than in males (53.8%), but this difference was not statistically significant (χ2=2.71; p>0.05). In most cases of lung cancer (22 or 66.7% out of 33), which was predominant type in the analyzed sample, malignancy remained unrecognized during the life. Conclusion The most important medicolegal problems regarding fatal malignant diseases are associated with exclusion of violent death in cases that are characterized as obscure (suspicious) natural death, as well as assessment of possible legal responsibility of medical staff in cases in which malignant tumor has not been diagnosed during the life

Malignant diseases as suicidal motives

Introduction Suicide is a conscious and intentional destruction of one’s own life, which occurs as a result of mutual influence of a person’s disposition and motives (facts inspiring the commitment of suicide). It is well known that various diseases, including malignancies, could be important and in some cases the only motive for committing suicide. Objective The purpose of the study was to analyze in detail suicides of persons whose only motive was an established malignant disease. Method The analysis was performed using the autopsy material of the Institute of Forensic Medicine, School of Medicine, University of Belgrade, during the period from 1990 to 2004. The reports on performed medico-legal autopsies were used, as well as history data obtained from the family members of suicidal persons, investigation reports and the available medical documents. Results In 1931 cases there was established suicidal nature of a violent death. Neoplasms were the suicidal motive in 37 persons (1.9%). The basic characteristics of the analyzed sample were predominance of males (26:11, ratio 2.4:1), the age of over 70 years and the highest incidence of malignant lung and breast tumors. Almost all cases were the persons who underwent treatment for malignant neoplasms over a longer period of time. During 19 autopsies (51.3% out of 37), a progressive phase of malignancy was established, i.e. metastases. The data on prior oral announcement of suicide intention were obtained for 70.3% (26 cases), and on previous suicidal attempts only for 13.5% (5) cases. In the majority of cases (78.4%) the place of committed suicide was the person’s home. In 16 cases (43.2%) the suicide was committed with a firearm. Hanging as a manner of destroying one’s own life was chosen by 12 persons (32.4%), while other ways were less frequently used. Conclusion Although malignancies were not present with high incidence as a suicidal motive in our analyzed sample, such cases require particular care of health workers in order to enable the application of adequate measures in the prevention of suicides in persons with malignant diseases. The suicide analyses performed so far indicated that a malignant disease was the motive. Doctors have to show maximal interest for the patient. Prevention is crucial, so the patient should be provided with such surroundings in which the person will not feel alone and abandoned

Study on the immunopathological effect of titanium particles in peri‐implantitis granulation tissue: A case–control study

Objectives To identify titanium particles (TPs) in biopsy specimens harvested from peri-implantitis lesions and secondarily to study the histopathological characteristics in peri-implantitis compared to periodontitis, in order to evaluate whether the presence of TPs could alter respective inflammatory patterns. Material and methods Biopsies containing granulation tissue were harvested during routine surgical treatment in 39 peri-implantitis cases and 35 periodontitis controls. Serial sections were obtained using titanium-free microtome blades. The first and last sections of the peri-implantitis specimens were used for identification of TPs by scanning electron microscopy coupled with dispersive X-ray spectrometry. Intermediate sections and periodontitis specimens were processed for descriptive histological study using haematoxylin–eosin staining and for immunohistochemical analysis using CD68, IL-6, Nf-kB and VEGF markers. Results TPs were identified in all peri-implantitis specimens as free metal bodies interspersed within granulation tissue. However, presence of macrophages or multinucleated giant cells engulfing the TPs were not identified in any specimen. Peri-implantitis granulations were characterized by a chronic inflammatory infiltrate rich in neutrophils. About half of peri-implantitis patients exhibited a subacute infiltrate characterized with lymphocytes interweaved with neutrophils and eosinophils. When compared to periodontitis, peri-implantitis tissues showed higher proportions of macrophages and a more intense neovascularization, based on significantly higher expression of CD68 and VEGF respectively. Conclusion TPs were identified in all peri-implantitis specimens, but without evidencing any foreign body reaction suggestive for direct pathological effects of TPs. The peri-implantitis granulation tissue was characterized by intense neovascularization and presence of a chronic inflammatory infiltrate dominated by plasma cells, neutrophils and macrophages

The fractal and textural analysis of glomeruli in obese and non-obese patients

BackgroundFractal dimension is an indirect indicator of signal complexity. The aim was to evaluate the fractal and textural analysis parameters of glomeruli in obese and non-obese patients with glomerular diseases and association of these parameters with clinical features.MethodsThe study included 125 patients mean age 46 ± 15.2 years: obese (BMI ≥ 27 kg/m2—63 patients) and non-obese (BMI  0.05) compared to non-obese. Mean value of COR (t = 0.108) and IDM (t = 0.185) were almost the same in two patient groups. Obese patients had higher value of lacunarity (t = 0.499) in comparison with non-obese, the mean value of fractal dimension (t = 0.225) was almost the same in two groups. Significantly positive association between variance and creatinine concentration (r = 0.499, P < 0.01), significantly negative association between variance and CKD-EPI (r = -0.448, P < 0.01), variance and sex (r = -0.339, P < 0.05) were found.ConclusionsVariance showed significant correlation with serum creatinine concentration, CKD-EPI and sex. CON and IDM were significantly related to sex. Fractal and textural analysis parameters of glomeruli could become a supplement to histopathologic analysis of kidney tissue

Acute pretreatment with chloroquine attenuates renal I/R injury in rats.

BACKGROUND: Acute kidney injury (AKI) still remains an unresolved problem in pharmacotherapy and renal inflammation is a major factor in its development. Chloroquine, a well-known antimalarial drug, posses pleitropic effects as well: antiinflammatory, anticoagulant and vascular actions. The effects of chloroquine on renal function may involve significant increase in urine flow rate, glomerular filtration rate and sodium excretion, as well as stimulation of nitric oxide synthase. However, its role in experimental models of renal I/R injury is unknown. We aimed to analyze the acute effects of a single-dose intravenous chloroquine administered at three different times in the experimental model of I/R injury in rat. METHODS: Rats were subjected to bilateral renal ischemia (45 min) followed by reperfusion with saline lasting 4 hours. Chloroquine was administered in doses of 0.3 mg/kg i.v. and 3 mg/kg i.v. 30 min before ischemia, 30 min before reperfusion and 5 min before reperfusion. Selected a hemodynamic, biochemical and morphological parameters were followed in the Sham-operated animals and rats subjected to I/R injury and pretreated with saline or chloroquine. RESULTS: Chloroquine (0.3 and 3 mg/kg, i.v.) protected the I/R injured kidney in an U-shaped manner. Both doses were protective regarding biochemical and histological markers of the I/R injury (serum urea, creatinine and fractional excretion of sodium, as well as total histological score, tubular necrosis score and KIM-1 staining score) (P<0.05 vs. corresponding controls, i.e. rats subjected to I/R injury and treated with saline only). The protective effects of the lower dose of chloroquine were more profound. Time-related differences between pretreatments were not observed (P>0.05, all). CONCLUSION: Our study shows for the first time that a single dose of chloroquine (0.3 mg/kg i.v.) could afford significant protection of the injured rat kidney

The effects of chloroquine (0.3 mg/kg; 3 mg/kg, i.v. bolus) on total histological score of renal I/R injury and histological micrographs of renal tissues.

<p>Chloroquine in dose of 0.3/kg, i.v. was injected 30 min before ischemia (IR+H03-30I), 30 min before reperfusion (IR+ H03-30R) and 5 min before reperfusion (IR+H03-5R), and in dose of 3 mg/kg, i.v. was injected 30 min before ischemia (IR+H3-30I). Control groups, Sham+Saline and IR+Saline received an i.v. bolus of 0.5 ml saline only. A minimum of 10 fields for each kidney slide were examined and assigned for severity of changes. The scoring system was as follows: 0, absent; 1, mininal changes; 2, moderate changes and 3, marked changes. Total histological score was calculated by addition of all scores (Panel A). Each bar represants mean ± S.E.M. +: P<0.05 <i>vs</i>. IR+Saline, *: P<0.05 <i>vs</i>.Sham+Saline (N = 6–10 rats). Histological micrographs of renal tissues: kidney sections taken from Sham-operated rats or rats subjected to renal I/R injury. Periodic acid–Schiff (PAS) stain coloring. Original magnification ×20. Figures were randomly chosen from the series of at least 6 experiments (Panels B–G). Panel B: Sham-operated animals treated with saline only (Sham+Saline group) - normal renal parenchyma (PAS staining). Panel C: Rats subjected to renal I /R injury, pretreated with chloroquine at 0.3 mg/kg, i.v. 30 min before ischemia (IR+H03-30I group) - moderate kidney damage, about half of proximal tubules show loss of brush border, dilatation of lumen and loss of nuclei in some epithelial cells. Panel D: Rats subjected to renal I /R injury, pretreated with chloroquine at 0.3 mg/kg, i.v. 30 min before reperfusion (IR+ H03-30R group) - moderate kidney damage, loss of brush border was observed in half of proximal tubules, in addition to dilatation of lumen and loss of nuclei in some epithelial cells. Panel E: Rats subjected to renal. I /R injury, pretreated with chloroquine at 0.3 mg/kg, i.v. 5 min before reperfusion (IR+H03-5R group) - moderate kidney damage, two thirds of proximal tubules show loss of brush border, dilatation of lumen and loss of nuclei in numerous epithelial cells. Panel F: Rats subjected to renal. I /R injury, pretreated with chloroquine at 3 mg/kg, i.v. 30 min before ischemia (IR+H3-30I group) - moderate kidney damage, two thirds of proximal tubules show loss of brush border, dilatation of lumen and loss of nuclei in majority of epithelial cells (marked necrosis). Panel G: Rats subjected to renal I / R injury, pretreated with saline only (IR+Saline-group) - marked kidney damage, interstitial edema diffusely present, proximal tubules show loss of brush border and lumen dilatation and loss of nuclei in some epithelial cells.</p

The effects of chloroquine (0.3 mg/kg; 3 mg/kg, i.v. bolus) on histological score of renal I/R injury.

<p>Chloroquine in dose of 0.3/kg, i.v. was injected 30 min before ischemia (IR+H03-30I), 30 min before reperfusion (IR+ H03-30R) and 5 min before reperfusion (IR+H03-5R), and in dose of 3 mg/kg, i.v. was injected 30 min before ischemia (IR+H3-30I). Control groups, Sham+Saline and IR+ Saline received an i.v. bolus of 0.5 ml saline only. The histological parameters evaluated were tubular necrosis, interstitial edema, loss of brush border, and cast formation score (Panels A–D). A minimum of 10 fields for each kidney slide were examined and assigned for severity of changes. The scoring system was as follows: 0, absent; 1, mininal changes; 2, moderate changes and 3, marked changes. Each bar represents mean ± S.E.M. +: P<0.05 <i>vs</i>. IR+Saline, *: P<0.05 <i>vs</i>.Sham+Saline (N = 6–10 rats).</p