RESUMEN
The present study was aimed to assess the prevalence and possible causal relationship of alcohol intake prior to a sudden cardiac death event in patients with coronary artery disease. The retrospective research was performed at the Vilnius branch of The State Forensic Medicine Service. The autopsy protocols for five years were analyzed and the cases of sudden cardiac death were selected, when the determined cause of death was Coronary Heart Disease (CHD), a forensic autopsy and toxicological blood and urine test had been performed. Cases of the sudden death of non-cardiac origin, cases of cardiomyopathy of various origins, and cases of acute cardiac arrest of unspecified origin were excluded. The data collected was processed using R software. The study sample consisted of 2133 cases. 706 (33%) CHD cases were alcohol positive. Males and young age CHD victims were more likely to find alcohol than females (72% vs. 28%, respectively, P < .001). The mean blood alcohol concentration of the sample was 1.37 ± 1.01, urine's 1.73 ± 1.29. Alcohol was more commonly found during the winter months and the holidays. Deaths in alcohol-positive individuals were more common in the alcohol elimination phase with hemodynamically insignificant coronary artery stenosis (up to 50% of arterial lumen). Nearly every third CHD victim in Lithuania who experienced sudden death also had signs of antemortem alcohol consumption.
Asunto(s)
Enfermedad de la Arteria Coronaria , Masculino , Femenino , Humanos , Enfermedad de la Arteria Coronaria/complicaciones , Estudios Retrospectivos , Nivel de Alcohol en Sangre , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , EtanolRESUMEN
Discrepancies between clinical and autopsy diagnoses range from 30% to 37%. The significance of deontological examinations remains high. In the pursuit of proper evaluation of diagnostic discrepancies, the establishment of pathogenesis, the mechanism of death, and a correct diagnosis are of particular importance.A retrospective study of deontological examinations, aimed at the detection of medical errors and carried out by the State Forensic Medicine Service during the period 1989 to 2016, was performed. The clinical and autopsy data from 1007 cases were collected in compliance with the research protocol.The number of deontological examinations tends to increase. In 60% of cases, the deceased were men. Most cases were in the age group of 50 to 59 years. Most examinations were carried out in relation to improperly provided healthcare services and the patient's death in surgery, admission, intensive care and obstetrics-gynecology departments. In 13% of cases, the diagnosis did not coincide and, in 79% of cases, the diagnoses fully coincided. In 68% of cases, the medical error was disproved.The number of deontological examinations is increasing. In most cases, clinical and autopsy diagnoses fully matched. Incorrectly clinically diagnosed intracranial injuries were the most common diagnostic mistakes. The data are similar to the results of research in other countries and would be relevant to ensuring the prevention of medical mistakes and the improvement of healthcare quality.
Asunto(s)
Causas de Muerte , Errores Diagnósticos/estadística & datos numéricos , Medicina Legal/métodos , Errores Médicos/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Autopsia , Femenino , Humanos , Lituania , Masculino , Estudios RetrospectivosRESUMEN
Spleen is typically injured in blunt abdominal trauma. Spleen injuries make 42% of all blunt abdominal injuries. The aim of this study was to perform a retrospective assessment of the cases of acute and subacute isolated traumatic spleen ruptures.A retrospective study performed on 50 patients, whose cause of death was isolated spleen rupture and bleeding into the abdominal cavity.An acute spleen rupture was diagnosed in 47 cases, whereas the rest 3 cases demonstrated a subacute rupture. In cases of acute spleen rupture, the mean weight of spleen was 309.6âg, whereas in 3 cases of subacute rupture the mean weight of the organ achieved 710âg. The mean weight of spleen in the control group with no spleen rupture was 144.7âg.Recording of the cases of isolated acute and subacute traumatic spleen ruptures and morphological assessment of them are important in forensic pathology science and in clinical practice as well.
Asunto(s)
Bazo/patología , Rotura del Bazo/patología , Heridas no Penetrantes/patología , Adulto , Anciano , Autopsia , Femenino , Patologia Forense , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A retrospective analysis of 2000 intentional homicide cases from the State Forensic Medicine Service (Vilnius, Lithuania) was carried out in order to evaluate the portrait of homicide victims and mechanisms of death between 2004 and 2016. The definition of intentional homicide appears to be quite straightforward, as a homicide occurs when one person's cause of death can be attributed to another one. Moreover, homicide is accomplished by conscious, active, intentional, or unintentional activities or inaction. All included cases of homicide were qualified as intentional murder. Children rarely become victims of intentional homicide. The group of child intentional murder made only 4.2% of all homicide cases. Seventy-three percent of homicide victims were male. The female victims were older than male and were murdered using a larger variety of objects (pâ¯<â¯0.001). Heavily alcohol-intoxicated victims were murdered using more traumatic affliction by sharp, stabbing-cutting objects (pâ¯<â¯0.001). The largest number of traumatic afflictions was associated with using a blunt object (pâ¯<â¯0.001). Lithuania differs from other European countries in terms of death by shooting: while 13% of homicides resulted from gunshot wounds in Europe, in Lithuania, only 5.6% of homicides did. This fact can be attributed to a relatively lower firearm ownership in Lithuania. This research is the first study that evaluates homicide in Lithuania based on autopsy findings. This study is highly important for homicide investigation tactics, as it emphasizes the portrait of the victim, providing valuable information about the most common mechanism of death, used weapons and traumatic afflictions for the law enforcement agencies.
Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Intoxicación Alcohólica/epidemiología , Asfixia/mortalidad , Niño , Preescolar , Escolaridad , Producto Interno Bruto , Humanos , Lactante , Recién Nacido , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Desempleo/estadística & datos numéricos , Armas/estadística & datos numéricos , Heridas no Penetrantes/mortalidad , Heridas Penetrantes/mortalidad , Adulto JovenRESUMEN
Carfentanyl, an ultra-potent synthetic opioid, is approved for use only in veterinary medicine as a tranquilizing agent. However, many cases of human poisoning with carfentanyl have recently appeared in the news with limited information given and scientific literature provides only 1 case of documented human exposure to carfentanyl.Fifteen cases of death from drug overdoses with carfentanyl involvement are being presented. Fifteen blood and urine samples have been taken for alcohol and drug testing. Headspace gas chromatography was used for alcohol detection. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) and liquid chromatography-time-of-flight mass spectrometry (LC/MS TOF) system was used for drug detection.Sixty-three cases of death from poisoning with drugs have been tested for carfentanyl in the State Forensic Medicine Service. Fifteen of them were positive for carfentanyl.The cases mentioned above show that carfentanyl exposure causes signs and symptoms similar to other opioid toxicity. Carfentanyl intoxication may even be fatal if appropriate treatment is not available. Therefore, nowadays it is very important to draw forensic medicine expert's attention to new substances in drug trade.
Asunto(s)
Analgésicos Opioides/envenenamiento , Sobredosis de Droga/etiología , Fentanilo/análogos & derivados , Medicina Legal/tendencias , Fentanilo/envenenamiento , Humanos , Estudios Retrospectivos , Detección de Abuso de Sustancias/métodosRESUMEN
Subdural hemorrhage is commonly associated with mechanical brain injury and has a correspondingly high mortality rate. Subdural hematomas may immediately provoke symptoms or may be initially asymptomatic, with further symptoms evolving rapidly and fatally.The data regarding forensic autopsy of victims were obtained from The State Forensic Medicine Service of Lithuania between the years 2013 and 2016. A retrospective study was performed including 110 patients, whose cause of death was subdural hemorrhage. 95% confidence intervals were calculated.It was calculated, that in cases of sudden death, after subdural hemorrhage was diagnosed, a higher concentration of ethyl alcohol in blood (mean 2.22â±â1.3%) demanded a smaller amount of blood under the dura matter (mean 81.6â±â60.5âg) in order for the patient to die. It was also noted that hospitalized patients with subdural hemorrhage had a smaller concentration of blood ethyl alcohol (mean 1.33â±â1%) and a larger amount of blood under the dura (mean 135.6â±â82.9âg).Due to the toxic effect of ethyl alcohol, even a small amount (81.6â±â60.5âg) of blood under the dura matter can determine a sudden death.
Asunto(s)
Intoxicación Alcohólica/complicaciones , Autopsia , Muerte Súbita/etiología , Muerte Súbita/patología , Duramadre/patología , Traumatismos Cerrados de la Cabeza/complicaciones , Hematoma Subdural Agudo/complicaciones , Adulto , Anciano , Intoxicación Alcohólica/patología , Femenino , Traumatismos Cerrados de la Cabeza/patología , Hematoma Subdural Agudo/patología , Humanos , Lituania , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
RATIONALE: Positional asphyxia is a rare cause of sudden death and a difficult diagnosis, based mostly on the circumstances of the incident, along with particular external and internal findings, frequent in asphyxia (signs of sudden death). PATIENT CONCERNS: In this report, we are describing one case of adult who was found positioned in a way that led to eventual asphyxiation. DIAGNOSES: The final diagnosis of positional asphyxia was determined after the autopsy. INTERVENTIONS: In a head-down position, gravitation and mechanical forces lead to an increased pressure on the diaphragm from the weight of the abdominal organs. Abdominal breathing, and later, chest breathing were hindered by the raised diaphragm and the difference between abdominal and breathing pressures. OUTCOMES: It is known that death from positional asphyxia can emerge in several ways, such as the external breathing suppression when the victim's torso is compressed or deformed. LESSONS: Therefore, the current criteria for positional asphyxia are based on the obstruction of normal gas exchange caused by the body position, the impossibility to move to another position, and the exclusion of other causes of death. The forensic medical examination must also be started at the scene of the incident.
Asunto(s)
Asfixia/etiología , Causas de Muerte , Muerte Súbita/etiología , Autopsia , Humanos , Masculino , Persona de Mediana Edad , PosturaRESUMEN
The article presents 3 forensic medicine cases in the field of electric injury. In addition to traditional findings in electric injury (electric mark and histological findings), the forensic medicine experts in Lithuania also perform an atomic absorption spectrometry analysis. This method confirms the effects of electric current to the body through the electric conductor. Typical macroscopic finding in the skin is electric mark. Histologically, the damaged skin possesses characteristic features of thermal burns. The atomic absorption spectroscopy analysis identifies traces of metal particles devolved from the electrical conductor, which confirms a premortal contact with it. In one of our presented cases, the metallization was negative, although there were obvious data of electric current effect. This shows that it is not always worth to rely on the method of atomic absorption spectrometry analysis recognized worldwide in forensic medicine. The determination of electrical injury diagnosis requires a critical and comprehensive assessment of all the available data and laboratory tests.
Asunto(s)
Quemaduras por Electricidad/patología , Piel/química , Adulto , Niño , Cromo/análisis , Cobre/análisis , Femenino , Patologia Forense , Humanos , Hierro/análisis , Masculino , Persona de Mediana Edad , Níquel/análisis , Piel/lesiones , Piel/patología , Espectrofotometría AtómicaRESUMEN
Hepatodiaphragmatic interposition of the colon is a rare, usually asymptomatic, anomaly and is typically an incidental radiologic finding. There are few cases in the literature describing the symptomatic form of the condition, known as Chilaiditi syndrome. In some cases, it may be accompanied by various severe complications. If symptoms are present, usually conservative treatment is given. However, conservative treatment only addresses the symptoms but does not prevent their recurrence and possible complications. Our present report shows that this anomaly may not only cause symptoms, but may also progress and cause severe complications, in our case-megacolon leading to right heart failure and, ultimately, death. To date, however, there have been no literature reports of death caused by colonic interposition. Therefore, it is important to draw attention to the importance of this anomaly and its appropriate diagnosis and treatment to ensure the most favorable patient outcomes.
Asunto(s)
Síndrome de Chilaiditi/patología , Estreñimiento/complicaciones , Estreñimiento/etiología , Resultado Fatal , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Megacolon/complicaciones , Megacolon/etiología , Persona de Mediana EdadRESUMEN
Approximately 50% of all suicides performed worldwide are strangulations. This article presents options for the medicolegal examination of hanging. The pathogenetic mechanisms and clinical pictures of victims are discussed. Examples of the process of diagnosis and expert conclusions are given. This article is intended for physicians and forensic pathologists. The literature focusing on asphyxia by strangulation is reviewed. Data from Vilnius Hospitals and the State Forensic Medicine Service concerning strangulations performed between 2012 and 2014 are analyzed and include the findings of 5650 autopsies (36% asphyxia) and 4 survived victims. The predominant symptoms were neurological, cardiovascular, and respiratory symptoms. After asphyxia, patients should consult by a psychiatrist, ophthalmologist, gastroenterologist, and endocrinologist. A ligature mark was the most observable sign of asphyxia by neck strangulation. Only complications in the poststrangulation period were treated. Mechanical asphyxia must be identified as the main injury in the clinical diagnosis and encoded as ICD-10.