Sudden cardiac death after robbery: Homicide or natural death?

Tako-Tsubo is one of a number of rare acquired cardiomyopathies that are characterized by left ventricular dyskinesia and symptomatology typical of acute myocardial infarction (AMI). The most important feature is that the clinical features are triggered by a severe physical or emotional stress. The authors describe the story of a woman, who was brutally assaulted by two men during a house robbery and died from sudden heart failure 8 hours later, after being taken to hospital. External examination revealed no macroscopic alteration of the inner organs, whereas microscopy showed contraction bands with myocardial necrosis, subendocardial and interstitial neutrophil infiltration and fibrosis. These findings were consistent with death due to stress cardiomyopathy even in the absence of previous heart disease. The robbers were convicted of homicide and sentenced to eighteen years in prison

Isolated persistence of the fifth aortic arch in an infant presenting with congestive heart failure

The persistence of the fifth aortic arch (PFAA) in postnatal life is an extremely rare and controversial cardiovascular malformation. PFAA is defined as an extra-pericardial vessel arising from the ascending aorta proximal to the origin of the brachiocephalic arteries, terminating either in the dorsal aorta or in the pulmonary arteries through the persistently patent arterial duct. An isolated PFAA with systemic-to-pulmonary connection best fits this definition, while the vast majority of cases reported as PFAA may have alternative embryological explanations. We present a unique case of a 5-week-old patient with an isolated PFAA with systemic-to-pulmonary connection, who presented with congestive heart failure. A first differential diagnosis was made with distal aortopulmonary window and an atypical patent arterial duct. A careful analysis of the case and a systematic review of the literature made us conclude for an isolated PFAA, which is one of the only five cases ever reported

Free radical-mediated formation of trans-cardiolipin isomers, analytical approaches for lipidomics and consequences for the structural organization of membranes

Free radical-mediated processes, such as peroxidation, isomerization and hydrogenation affecting fatty acid integrity and biological functions have a trans-disciplinary relevance. Cardiolipins [CL, (1,3-diphosphatidyl-sn-glycerol)] and tetra-linoleoyl-CL are complex phospholipids, exclusively present in the Inner Mitochondrial Membrane (IMM) lipids where they maintain membrane integrity and regulate enzyme functionalities. Peroxidation pathways and fatty acid remodeling are known causes of mitochondrial disfunctions and pathologies, including cancer. Free radical-mediated isomerization with the change of the cis CL into geometrical trans isomers is an unknown process with possible consequences on the supramolecular membrane lipid organization. Here, the formation of mono-trans CL and all-trans CL is reported using CL from bovine heart mitochondria and thiyl radicals generated by UV-photolysis from 2-mercaptoethanol. Analytical approaches for CL isomer separation and identification via 1H/13C NMR are provided, together with chemical study of CL derivatization to fatty acid methyl esters (FAME), useful for lipidomics and metabolomics research. Kinetics information of the radical chain isomerization process was obtained using γ-irradiation conditions. The CL isomerization affected the structural organization of membranes, as tested by reduction of unilamellar liposome diameter, and accompanied the well-known process of oxidative consumption induced by Fenton reagents. These results highlight a new molecular modification pathway of mitochondrial lipids with wide applications to membrane functions and biological consequences

CORRELATION BETWEEN CHEMICAL MEDIATORS AND HAEMORHEOLOGICAL - COAGULATIVE FACTORS IN THE PATHOGENESIS OF CHRONIC RESPIRATORY FAIL¬URE CAUSED BY INTERSTITIAL LUNG DISEASES (F.I.D)

Interstitial lung diseases are caused by deep lung inflammatory state, characterized by an increase of the immunocompetent cells and vascular compartment injury. To evaluate the physiopathological mechanics involved in the pathogenesis of chronic respiratory failure caused by interstitial lung diseases (F.I.D), we examined in six patients with F.I.D. (age: x ±sd = 55.5113.84) in comparison with three normal subjects (age: x ± sd = 52.66112.74) the levels of chemical mediators, cytokines both in BAL and in alveolar macrophages cultures (albumin; TxB2; LTB4; PAF: PGFl-a; PGE2; IL-la; IL-lp; IL-6; IL-8) and the levels of haemorheological parameters in the peripheral blood (V.E.; fibrinogen; P.T.; P.TT.; antithrombin III; beta- thromboglobulin). All patients have been tested to fibrobronchoscopy and BAL in order to study the immunocompetent cell activation by cytofluorimetry; chemical mediators and cytokins by radioimmunassay; haemorheological- coagulative parameters and haemogasanalysis by peripheral blood samples. In patients with F.I.D. the values of chemical mediators were increased significantly in comparison with normals subjects both in BAL (Albumin p=0.02; TxB2 p=0.02; LTB4 p=0.02) and in 24 h unstimulated A.M. culture (Albumin p=0.02; TXB2 p=0.05; LTB4 p=0.02; PAF p=0.02). Significant values of interleukin 1 (3-6-8 were obtained also in BAL (DL-lp p=0.09; IL-6 p=0.05; IL=8 p=0.05) and 24 h unstimulated A.M. culture (IL-lp p=0.05; IL- 6 p=0.05; IL-8 p=0.08). These results were confirmed “in vitro” LPS- stimulated macrophage culture at 12, 24, 48 and 72h. The immunocompetent cell activation shown by either the interleukins increase and by chemical mediators release, proves the presence of vascular phlogosis demonstrated by alterations of haemoreological-coagulative factors such as AP (p=0.05), Fibrin, (p=0.05), PT (p=0.09), PTT (p=0.09), beta-TG (p=0.02). The remarkable cellular activator induced by cytokines was well documented by multiple correlation test that showed a significant value between IL-1(3 vs VE (r=0.64); IL-lp vs AP (n=0.59) IL-lp vs p-TG (n=0.50); IL-8 vs AP (n=0.77); IL-8 vs Fibrin. (r=0.50)

Free-radical-mediated formation of trans-cardiolipin isomers, analytical approaches for lipidomics and consequences of the structural organization of membranes

Free-radical-mediated processes, such as peroxidation, isomerization and hydrogenation affecting fatty acid integrity and biological functions, have a trans-disciplinary relevance. Cardiolipins (CL, (1,3-diphosphatidyl-sn-glycerol)) and tetra-linoleoyl-CL are complex phospholipids, exclusively present in the Inner Mitochondrial Membrane (IMM) lipids, where they maintain membrane integrity and regulate enzyme functionalities. Peroxidation pathways and fatty acid remodeling are known causes of mitochondrial disfunctions and pathologies, including cancer. Free-radical-mediated isomerization with the change of the cis CL into geometrical trans isomers is an unknown process with possible consequences on the supramolecular membrane lipid organization. Here, the formation of mono-trans CL (MT-CL) and other trans CL isomers (T-CL) is reported using CL from bovine heart mitochondria and thiyl radicals generated by UV-photolysis from 2-mercaptoethanol. Analytical approaches for CL isomer separation and identification via 1H/13C NMR are provided, together with the chemical study of CL derivatization to fatty acid methyl esters (FAME), useful for lipidomics and metabolomics research. Kinetics information of the radical chain isomerization process was obtained using \u3b3-irradiation conditions. The CL isomerization affected the structural organization of membranes, as tested by the reduction in unilamellar liposome diameter, and accompanied the well-known process of oxidative consumption induced by Fenton reagents. These results highlight a potential new molecular modification pathway of mitochondrial lipids with wide applications to membrane functions and biological consequences