Early markers for myocardial ischemia and sudden cardiac death.

The post-mortem diagnosis of acute myocardial ischemia remains a challenge for both clinical and forensic pathologists. We performed an experimental study (ligation of left anterior descending coronary artery in rats) in order to identify early markers of myocardial ischemia, to further apply to forensic and clinical pathology in cases of sudden cardiac death. Using immunohistochemistry, Western blots, and gene expression analyses, we investigated a number of markers, selected among those which are currently used in emergency departments to diagnose myocardial infarction and those which are under investigation in basic research and autopsy pathology studies on cardiovascular diseases. The study was performed on 44 adult male Lewis rats, assigned to three experimental groups: control, sham-operated, and operated. The durations of ischemia ranged between 5 min and 24 h. The investigated markers were troponins I and T, myoglobin, fibronectin, C5b-9, connexin 43 (dephosphorylated), JunB, cytochrome c, and TUNEL staining. The earliest expressions (≤30 min) were observed for connexin 43, JunB, and cytochrome c, followed by fibronectin (≤1 h), myoglobin (≤1 h), troponins I and T (≤1 h), TUNEL (≤1 h), and C5b-9 (≤2 h). By this investigation, we identified a panel of true early markers of myocardial ischemia and delineated their temporal evolution in expression by employing new technologies for gene expression analysis, in addition to traditional and routine methods (such as histology and immunohistochemistry). Moreover, for the first time in the autopsy pathology field, we identified, by immunohistochemistry, two very early markers of myocardial ischemia: dephosphorylated connexin 43 and JunB

3D CT scan study of fetal cranial base : interests of occipital bone measurements in age estimation

International audienceOBJECTIVES:Cranial base development during fetal life is of major interest for many research purposes. In this study, we focused on fetal age estimations which are extremely important in forensic contexts. Nevertheless, there have been very few studies using occipital measurements to determine fetal age.OBJECTIVES:To evaluate change in the sagittal length/maximum width ratio of the basilar part of the occipital bone and to propose a simple and reliable method for fetal age determination.METHODS:A sample of 30 male and 7 female fetuses aged 24 to 41 weeks amenorrhea underwent CT scan. Occipital bones were reconstructed (Amira 4.0) and measurements were carried out on each part.RESULTS:A multivariate analysis (ANOVA) gave an age formula using right exoccipital measurements and a linear regression supplied the age of reversion of the sagittal length/maximum width ratio.CONCLUSION:This preliminary study clearly highlighted the promises of 3D CT-Scan studies of fetal cranial base and gave interesting results and the method deserves to be tested on a larger sample

Validation of biometric study of fetal mandibles by 3D tomodensitometric images

We carried out a biometric study of the mandible during the last two trimesters of fetal life using three-dimensional tomodensitometric images. We first validated the method of fetal mandible measurement from three-dimensional reconstructions, and then compared these measurements with direct measurements on dissected mandibles. Thanks to the biometric technique on three-dimensional images, dissection of mandibles is no longer necessary, allowing the material to be conserved for later studies. Tomodensitometric images of the whole fetal skull can be obtained in 10 minutes, a much shorter time than that required for dissection of the fetal mandible. Another major advantage is the possibility of computerized image storage, which allows subsequent studies on the same material, its observation and manipulation as well as exchange of findings with the research community, with no risk of damage to the original material

Liability under post-tonsillectomy lethal bleeding of the tonsillar artery : a report of two cases

International audiencePost-operative haemorrhage is a frequent complication of tonsillectomy: a primary haemorrhage occurring in the first hours is rapidly dealt with by the surgical team. A secondary haemorrhage, which commonly occurs once the child has returned home, can be fatal if it is not dealt with quickly. We present two cases of a lethal outcome in children following a secondary post-tonsillectomy haemorrhage, for which the parents filed legal proceedings. Medical liability can be exercised during all stages of health care. Performing an autopsy associated with histological analyses is found to be indispensable for the identification of the causes of bleeding, as well as its mechanism

Fatal diffuse thrombotic microangiopathy after a bite by the "Fer-de-Lance" pit viper (Bothrops lanceolatus) of Martinique.

In Martinique, a man bitten two days earlier by a pit viper (Bothrops lanceolatus) was hospitalized with impaired consciousness and tetraplegia. Investigations confirmed cerebral and myocardial infarctions. Resolving thrombocytopenia was associated with virtually normal blood prothrombin time/activated partial thromboplastin time but increasing hyperfibrinogenemia. Despite specific antivenom treatment, he developed fatal left ventricular failure six days after the bite. At autopsy, multiple cerebral, myocardial and mesenteric infarctions were found. Rupture of mitral chordae tendinae was the likely cause of death. Histopathologic examination showed multi-focal thrombotic microangiopathy with intimal-medial dissection by thrombi extending from foci of endothelial damage in small cerebral, myocardial, pulmonary, mesenteric, and interlobular renal arteries and arterioles. These findings were the causes of infarctions. There was intense angiogenesis in organizing cerebral infarcts. Immunohistochemical analysis showed platelet aggregates and endothelial cells within microthrombi. Viperidae venoms contain vascular endothelial toxins, notably metalloproteinase hemorrhagins, but von Willebrand factor activators or vascular endothelial growth factor-type factors are more likely to have been implicated in this case

Postmortem Whole Body CT Angiography Using Aqueous Contrast Agent

In modern postmortem imaging, the visualization of the vascular system by postmortem angiography is mostly done using multidetector computed tomography (CT). Like clinical radiologic investigations, whole body angiography makes the vascular system visible and allows identification of vascular lesions such as traumatic dissection or rupture. Additionally, the injection of contrast agent enhances soft tissue and aids in the visualization of lesions in organ parenchyma. In this chapter, we describe two methods of whole body postmortem CT angiography (PMCTA) that can be classed in the category of “PMCTA using aqueous contrast agent.

Plasma Concentration of Adrenocorticotropic Hormone in Traffic Policemen

Plasma Concentration of Adrenocorticotropic Hormone in Traffic Policemen: Francesco Tomei, et al. University of Rome "La Sapienza", Department of Occupational Medicine— The aim of this study is to evaluate whether traffic policemen exposed to urban pollutants and possible psycho‐social stressors could be at risk of changes on plasma adrenocorticotropic hormone [ACTH(P)] levels compared to a control group. Traffic policemen were matched by sex, age, length of service and drinking habit (<50 g of wine or beer per day) with a control group after excluding principal confounding factors; 62 traffic policemen with outdoor activity (34 men and 28 women) and 62 control subjects with indoor activity (34 men and 28 women) were included in the study. The levels of ACTH(P) were significantly higher in male and female traffic policemen than in the control subjects (respectively P=0.040, P=0.043). The authors hypothesise that occupational exposure to chemical and physical stressors, that may interact with possible psycho‐social stressors, could cause a change in ACTH(P) levels in traffic policemen