Gastric mucosal tears and wall micro perforations after cardiopulmonary resuscitation in a drowning case

A fifty year-old woman died after drowning in a swimming-pool. Rescue and ambulance paramedic teams started resuscitation attempts followed by a medical care helicopter team. Acute haematemesis, mucosal tears and gastric micro perforations occurred, due to the cardiorespiratory resuscitation manoeuvres. Death occurred seven days later due to the cerebral anoxia and multiorgan failure. Forensic investigations excluded possible malpractice during external cardiac massage as responsible for the woman's death, while Judicial Authority considered the death as the consequence of the delayed intervention of the swimming-pool rescue team

Early Postoperative Complications in Meningioma: Predictive Factors and Impact on Outcome

BACKGROUND: Craniotomies carry inherent risks of postoperative complications that may have a negative impact on patients\u27 status. Recognizing and preventing surgical complications is of paramount importance, especially in meningioma surgery, where most of these tumors are benign and current management protocols are effective in terms of disease control and maintenance of higher quality of life. The objective of this study was to describe the early complications after surgery and their predictive factors in patients undergoing resection of intracranial meningiomas. METHODS: A partly retrospective, partly prospective review was conducted in a Norwegian population-based cohort of 1469 consecutive cases of meningioma surgery treated at the university hospitals of Oslo, totaling 11,414 patient-years of follow-up. RESULTS: 2.6% of patients had a postoperative hematoma, 2.7% a postoperative infection, 3.9% a postoperative worsening of neurologic status; 5.4% of patients died during a 30-day period after surgery. Predictive factors of increased risk of postoperative complications were patient\u27s age for the hematoma, a non-skull base meningioma for infection, and postoperative hematoma for the risk of neurologic worsening or 30-day mortality. CONCLUSIONS: Early postoperative complications in meningioma surgery have a negative impact on patient survival and postoperative neurologic status, in a disease where survival is usually not limited by the meningioma itself. In this study, we identified risk factors for early postoperative complications, the identification of at-risk populations may help to prevent the occurrence of these risk factors

Transverse dimension measurement of the heart is a good estimator for heart weight

Heart weight is a routine measurement during a post-mortem examination. An increased heart weight is associated with preexisting heart disease and sudden cardiac death. In cases where the heart is partially fragmented, it may be hard to obtain an accurate heart weight by weighing it. If a compromised/fragmented heart size can be approximated, assessing the heart dimensions may provide a heart weight estimation. This study examined 46 fresh Caucasian adult hearts and found a high and significant correlation between heart dimensions and heart weight. Using linear regression modelling, heart weight can be estimated using only the transverse dimension (or width) of the heart with a relatively high accuracy. The established equation in estimating heart weight was heart weight (g) = −298 + 5.92 * heart width (mm), R2 = 0.71

Cardiac dimensions measured from post-mortem photographs: are they accurate?

Peer reviewing post-mortem reports, photographs and histology is a mandatory process in the everyday practice of forensic pathology. In the context of organ measurement/dimensions, comparing the dimensions measured from a post-mortem photograph and what was recorded in the post-mortem report is sometimes necessary. However, there are limited studies validating the accuracy of dimensions measured from a photograph in forensic pathology. This study examined the cardiac dimensions measured from a standard post-mortem photograph of a heart section. It showed that although there was acceptable intra- and inter-rater reliability, the overall accuracy was low compared with gross measurement at post-mortem examination. The results from this study suggest that measurements taken from a post-mortem photograph have limited utility in assessing cardiac dimensions. The reasons for this discrepancy and recommendations on how to improve the accuracy are provided

Posterior fossa meningiomas: perioperative predictors of extent of resection, overall survival and progression-free survival

BACKGROUND: Posterior fossa meningiomas (PFMs) often represent surgical challenges due to their proximity to neurovascular structures. Factors predicting the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS) were identified and integrated in a prediction tool to offer evidence-based personalized therapeutic strategies. METHODS: All meningiomas managed surgically from 1990 to 2010 from a single-center were reviewed. A classification tree was created using the classification and regression tree recursive partitioning analysis that incorporated patient and tumor data available before surgery in order to predict the rates of gross total resection (GTR). RESULTS: A total of 198 patients were identified (female-to-male ratio, 2.7; mean age, 59.1 years) and compared with 1271 supratentorial meningiomas (STMs) operated in the same institution during the same time period. GTR was achieved less often (59.6% versus 81.9%; p < 0.01) in PFMs than STMs. Preoperative neurological symptoms were predictive of higher Simpson grades (OR, 2.19 [1.05; 4.58]; p = 0.04). Age was associated with reduced OS (OR, 1.08 [1.04;1.12]; p < 0.001). A KPS ≥ 70 was associated with higher survival rates (OR, 2.70 [2.19;2.92]; p = 0.02). Higher WHO grades were associated with reduced OS (OR, 3.56 [1.02;12.47]; p = 0.05). The GTR rate varies from 80% in patients without a preoperative deficit to 40% patients with a preoperative deficit, younger than 60 years old, and with adjacent bone invasion. CONCLUSIONS: This study provides a classification tree of the predictors of EOR in PFMs, based upon preoperative demographic, clinical, and radiological variables. An evidence-based management protocol with estimated EORs may guide the decision-making process in PFMs

WHO grade I meningiomas: classification-tree for prognostic factors of survival

World Health Organization (WHO) grade I meningiomas are intracranial extracerebral tumors, in which microsurgery as a stand-alone therapy provides high rates of disease control and low recurrence rates. Our aim was to identify prognostic factors of overall survival and time-to-retreat (OS; TTR) in a cohort of patients with surgically managed WHO grade I meningioma. Patients with WHO grade I meningiomas from a retrospectively (1990 to 2002) and prospectively managed (2003 to 2010) databank of Oslo University Hospital, Norway, were included. The mean follow-up was 9.2 ± 5.7 years, with a total of 11,414 patient-years. One thousand three hundred fifty-five patients were included. The mean age was 58 ± 13.2, mean Karnofsky Performance Status (KPS) 92.6 ± 26.1 and female-to-male ratio 2.5:1. The 1-year, 5-year, 10-year, 15-year, and 20-year probabilities were 0.98, 0.91, 0.87, 0.84, and 0.8 for TTR. Patient age (OR 0.92 [0.91, 0.94]), male sex (OR 0.59 [0.45, 0.76]), preoperative KPS ≥ 70 (OR 2.22 [1.59, 3.13]), skull base location (OR 0.77 [0.60, 1]), and the occurrence of a postoperative hematoma (OR 0.44 [0.26, 0.76]) were identified as independent prognostic factors of OS. Patient age (OR 1.02 [1.01, 1.03]) and skull base location (OR 0.30 [0.21, 0.45]) were independent predictors of decreased PFS. Using a recursive partitioning analysis, we suggest a classification tree for the prediction of 5-year PFS based on patient and tumor characteristics. The findings from this cohort of meningioma WHO I patients helps to identify patients at risk of recurrence and tailor the therapeutic management

DECESSO PER OMICIDIO O INTOSSICAZIONE DA ETANOLO ?

Il meccanismo di morte dovuto all\u2019intossicazione da etanolo \ue8 generalmente ascritto alla soppressione del centro cerebrale del respiro con un seguente abbassamento della saturazione dell\u2019ossigeno arterioso. Evidenze scientifiche dalla Medicina Forense e studi di avvelenamenti acuti da etanolo, suggeriscono che le concentrazioni letali di Blood Alcohol Concentration (BAC) relative ad etanolo siano > 400 mg per 100 mL. Il valore di BAC \ue8 solitamente ottenuto analizzando il sangue dell\u2019arteria femorale mediante gas cromatografo a spazio di testa. Un altro parametro utile \ue8 il rapporto della concentrazione nell\u2019umor vitreo (VAC) su BAC. Quando VAC: BAC \ue8 1 la fase di eliminazione era raggiunta prima della morte. Questo parametro potr\ue0 essere utile per stabilire il tempo intercorso tra l\u2019assunzione dell\u2019alcool ed il decesso. La stima del BAC e/o VAC pu\uf2 per\uf2 essere complicata da variabilit\ue0 individuale, dalle matrici biologiche utilizzate e molti altri fattori. L\u2019etnia pu\uf2 contenere differenti livelli di alcool deidrogenasi. Per es. nativi Americani non producono sufficienti ADH e quindi avranno una Cl ridotta con accumulo dell\u2019alcool e maggiori effetti tossici. In circostanze come suicidio e omicidio la intossicazione da alcool pu\uf2 giocare una ruolo indiretto come causa di morte. In una recente revisione, il consumo eccessivo di alcool (es. binge drinking, heavy drinking e uso di alcool da individui sotto i 21 aa) \ue8 associato con un aumentato rischio di morte violenta. Gli effetti farmacologici del consumo di alcool possono contribuire all\u2019associazione tra alcool e aggressione (subita o eseguita). In questo case report, portiamo l\u2019esempio di un individuo di 28 aa, sesso maschile, peso 75 Kg, altezza 175 cm, razza afro-americana, che \ue8 stato trovato deceduto in un sottoscala con n\ub05 ferite da arma da taglio, di cui tre in regione addomino-pelvica, una alla regione del collo e una in sede toracica. All\u2019apparenza, in sede di sopraluogo giudiziario, la causa del decesso poteva essere messa in relazione con le ferite, ma in sede autoptica tali ferite non avevano lesionato organi vitali e neppure avevano prodotto eccessiva emorragia. All\u2019esame della BAC e/o VAC aveva una concentrazione di 473 e 278 mg/dL, rispettivamente. Poich\ue9 queste concentrazioni ematiche sono state frequentemente correlate come causa di decesso e le ferite non avevano leso organi vitali, la causa del decesso \ue8 stata ascritta ad intossicazione da alcool. In conclusione, questo caso solleva l\u2019importanza di eseguire, nella vittima e/o nell\u2019aggressore, correttamente le analisi di alcool ematico, urinario e dell\u2019umor vitreo anche se, in una prima analisi, esistono prove per ferite da armi da taglio, da fuoco, incidenti, ecc. In secondo luogo l\u2019importanza di prevenire il binge drinking che porta a maggiore rischio di morte violenta come vittima o aggressore

DECESSO PER OMICIDIO O INTOSSICAZIONE DA ETANOLO ?

Il meccanismo di morte dovuto all\u2019intossicazione da etanolo \ue8 generalmente ascritto alla soppressione del centro cerebrale del respiro con un seguente abbassamento della saturazione dell\u2019ossigeno arterioso. Evidenze scientifiche dalla Medicina Forense e studi di avvelenamenti acuti da etanolo, suggeriscono che le concentrazioni letali di Blood Alcohol Concentration (BAC) relative ad etanolo siano > 400 mg per 100 mL. Il valore di BAC \ue8 solitamente ottenuto analizzando il sangue dell\u2019arteria femorale mediante gas cromatografo a spazio di testa. Un altro parametro utile \ue8 il rapporto della concentrazione nell\u2019umor vitreo (VAC) su BAC. Quando VAC: BAC \ue8 1 la fase di eliminazione era raggiunta prima della morte. Questo parametro potr\ue0 essere utile per stabilire il tempo intercorso tra l\u2019assunzione dell\u2019alcool ed il decesso. La stima del BAC e/o VAC pu\uf2 per\uf2 essere complicata da variabilit\ue0 individuale, dalle matrici biologiche utilizzate e molti altri fattori. L\u2019etnia pu\uf2 contenere differenti livelli di alcool deidrogenasi. Per es. nativi Americani non producono sufficienti ADH e quindi avranno una Cl ridotta con accumulo dell\u2019alcool e maggiori effetti tossici. In circostanze come suicidio e omicidio la intossicazione da alcool pu\uf2 giocare una ruolo indiretto come causa di morte. In una recente revisione, il consumo eccessivo di alcool (es. binge drinking, heavy drinking e uso di alcool da individui sotto i 21 aa) \ue8 associato con un aumentato rischio di morte violenta. Gli effetti farmacologici del consumo di alcool possono contribuire all\u2019associazione tra alcool e aggressione (subita o eseguita). In questo case report, portiamo l\u2019esempio di un individuo di 28 aa, sesso maschile, peso 75 Kg, altezza 175 cm, razza afro-americana, che \ue8 stato trovato deceduto in un sottoscala con n\ub05 ferite da arma da taglio, di cui tre in regione addomino-pelvica, una alla regione del collo e una in sede toracica. All\u2019apparenza, in sede di sopraluogo giudiziario, la causa del decesso poteva essere messa in relazione con le ferite, ma in sede autoptica tali ferite non avevano lesionato organi vitali e neppure avevano prodotto eccessiva emorragia. All\u2019esame della BAC e/o VAC aveva una concentrazione di 473 e 278 mg/dL, rispettivamente. Poich\ue9 queste concentrazioni ematiche sono state frequentemente correlate come causa di decesso e le ferite non avevano leso organi vitali, la causa del decesso \ue8 stata ascritta ad intossicazione da alcool. In conclusione, questo caso solleva l\u2019importanza di eseguire, nella vittima e/o nell\u2019aggressore, correttamente le analisi di alcool ematico, urinario e dell\u2019umor vitreo anche se, in una prima analisi, esistono prove per ferite da armi da taglio, da fuoco, incidenti, ecc. In secondo luogo l\u2019importanza di prevenire il binge drinking che porta a maggiore rischio di morte violenta come vittima o aggressore