RESUMEN
A 49-year-old male had undergone resection of biatrial multiple myxomas 4 years previously in another hospital. Echocardiography revealed new masses in the left atrium and the right ventricle. Both tumors were removed surgically and subsequently treated with adjuvant chemotherapy. There was no further recurrence during the following 4 years. It was considered that the multiple recurrences in our case were due to multicentricity of the tumor.
Asunto(s)
Neoplasias Cardíacas/cirugía , Mixoma/cirugía , Recurrencia Local de Neoplasia , Procedimientos Quirúrgicos Cardíacos , Quimioterapia Adyuvante , Atrios Cardíacos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patología , Ventrículos Cardíacos , Humanos , Masculino , Persona de Mediana Edad , Mixoma/diagnóstico , Mixoma/patología , Procedimientos de Cirugía Plástica , Resultado del TratamientoRESUMEN
In postmortem examination, it is difficult to diagnose pericardial tamponade in a dead body from the findings of conventional external examination alone. However, ultrasonography is a common diagnostic tool for pericardial tamponade in clinical practice. We studied the postmortem diagnosis of pericardial tamponade at external examination level by applying an ultrasonographic device. The ultrasonographic findings were compared with the conventional autopsy findings. Among 455 cases of forensic autopsy in Hamburg and Tokyo conducted within 5 days after death, we successfully diagnosed 11 cases of pericardial tamponade by ultrasound imaging prior to autopsy, and failed to diagnose pericardial tamponade in only two cases. In addition, 79 cases of external examination conducted at the Tokyo Medicinal Examiner's Office were also examined with ultrasonography, and we diagnosed three cases of pericardial tamponade and five cases of pericardial effusion. The differences in ultrasonographic findings between tamponade and effusion were relatively clear. Although autopsy provides definitive evidence for the cause of death, sometimes autopsy cannot be performed due to some social factors. In such cases, conventional external examination alone cannot establish a cause of death by pericardial tamponade, and application of diagnostic imaging technique will be helpful. While CT and/or MRI may provide more detailed information than ultrasound imaging, these techniques require special equipment, room and specialist, and most of all involves high cost, which is perhaps the most important consideration in the present atmosphere of medical cost containment. On the other hand, the ultrasonographic devices we use are compact, and can be used directly at the scene of death. Postmortem application of ultrasonography may be a valuable adjunct in the work of medical examiners and forensic pathologists.
Asunto(s)
Taponamiento Cardíaco/diagnóstico , Ecocardiografía , Derrame Pericárdico/diagnóstico por imagen , Pericardio/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Femenino , Patologia Forense , Humanos , Masculino , Persona de Mediana Edad , Cambios Post MortemRESUMEN
In regions with low autopsy rates, forensic examiners often have to rely on external findings. Imaging techniques can assist the external examination and provide a more objective diagnosis. The SonoSite 180, a portable ultrasound device, was used for the examination of dead bodies. The influence of different degrees of decomposition was estimated. Even in cases with intestinal gas formation images of internal organs could be obtained with special techniques. Various pathological findings were detected by ultrasound and verified by autopsy (e.g. pericardial tamponade, cardiac hypertrophy, fatty liver, aortic aneurysm, metastatic liver, etc.). The experiences with the SonoSite 180 are promising. The device can be carried to the death scene or to the morgue and therefore serve as a valuable tool for medicolegal applications.
Asunto(s)
Autopsia/instrumentación , Ultrasonografía/instrumentación , Aorta Abdominal/diagnóstico por imagen , Autopsia/métodos , Diseño de Equipo , Femenino , Humanos , Riñón/diagnóstico por imagen , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
Despite high suicide rates all over the world, complete decapitation as a consequence of violent suicide methods is exceptionally rare and there is always a potential for confusion with homicide as well as with body dismemberment or mutilation. We analyzed the phenomenology and morphology of 10 cases (six male, four female; individual age 18-60 years) of suicidal complete decapitation that were subjected to medico-legal autopsies at the Institute of Legal Medicine, University of Hamburg, Germany, between 1995 and 2002. All decapitations occurred while the person was alive as proven by signs of vitality. Blood alcohol levels were positive in five cases and ranged between 28 and 202 mg/dl. The applied methods of suicide were running over by a train in eight cases and hanging in two cases. In suicidal hanging resulting in complete decapitation the wound margins were clear-cut with an adjacent sharply demarcated circumferential band-like abrasion zone showing a homogenous width, the latter determined by the thickness of the rope. In decapitations due to railway interference a broad spectrum of pathologic alterations such as the co-existence of irregular, ragged and sharp-edged wound margins, vascular and nervous pathways forming bridges in the depth of the wound and bruising could be observed. In such cases skin abrasion zones were generally not circumferential and showed a heterogenous width. Concerning hanging-related complete decapitations, our findings are well in line with those of other authors, namely that heavy body weight of the suicidal, fall from a great height and in some cases inelastic and/or thin rope material used for the noose are the determining factors decisive for complete decapitation.
Asunto(s)
Traumatismos del Cuello/patología , Suicidio , Adolescente , Adulto , Asfixia/patología , Depresores del Sistema Nervioso Central/sangre , Etanol/sangre , Femenino , Alemania , Humanos , Masculino , Métodos , Persona de Mediana Edad , Automutilación/patología , MuñecaRESUMEN
We reported on a case of subcutaneous panniculitis-like T-cell lymphoma (SPTCL) with multiple erythematous nodular lesions on the extremities, trunk and face. Histological examination of an excised lesion revealed a dense infiltrate of markedly atypical T-lymphoid cells expressing the CD8+ phenotype located in the subcutaneous tissue with histiocyte-phagocytizing apoptotic cells. The 'bean-bag' histiocytic cells, the characteristic finding of SPTCL, are considered to be products of haemophagocytosis. In our case the 'bean-bag' cells were produced by phagocytosis of apoptotic bodies, as confirmed by electron microscopy. It is suspected that 'bean-bag' cells are related not to haemophagocytosis but to phagocytosis of apoptotic cells in the CD8+ T-cell type of SPTCL.
Asunto(s)
Linfoma Cutáneo de Células T/patología , Paniculitis/patología , Neoplasias Cutáneas/patología , Adulto , Apoptosis , Biopsia con Aguja , Estudios de Seguimiento , Humanos , Linfoma Cutáneo de Células T/tratamiento farmacológico , Masculino , Microscopía Electrónica , Paniculitis/tratamiento farmacológico , Fagocitosis , Prednisolona/administración & dosificación , Neoplasias Cutáneas/tratamiento farmacológicoRESUMEN
The rheumatoid papule has recently been described as the skin manifestation of rheumatoid arthritis (RA). The papules represent leukocytoclastic vasculitis and necrobiosis clinicopathologically. We report a 59-year-old Japanese woman with multiple recurrent rheumatoid papules located on the bilateral extensor forearms in correlation with the level of RA activity and as a cutaneous manifestation of rheumatoid vasculitis. These papules appeared prior to other cutaneous manifestations. It was suggested that rheumatoid papules represent the early stage of rheumatoid vasculitis and that they are a reliable early clinical marker of rheumatoid vasculitis.
Asunto(s)
Artritis Reumatoide/complicaciones , Enfermedades de la Piel/patología , Femenino , Humanos , Persona de Mediana Edad , Nódulo Reumatoide/patología , Enfermedades de la Piel/complicaciones , Vasculitis Leucocitoclástica Cutánea/complicaciones , Vasculitis Leucocitoclástica Cutánea/patologíaRESUMEN
To investigate the course of respiration and circulation in a head-down position, 14 rabbits were set in reverse suspension. The respiratory rate increased a little, but the amplitude of the respiratory movements did not change in the beginning of the experiment. The amplitude of respiratory movements then began to reduce gradually, and toward the end of the experiment, it reduced suddenly. PaO2 increased in the beginning of the experiment and then began to decrease in accordance with the reduction of the amplitude of the respiratory movements. The blood pressure decreased with relation to the decrease of PaO2 resulting from the reduction of the amplitude of the respiratory movements. All rabbits died in 17 to 44 hours (average, 26 hours). The results suggested that the cause of death in a head-down position is due to postural asphyxia resulting from hindered respiratory movements, and that it is possible to survive for at least half a day in a head-down position.
Asunto(s)
Asfixia/etiología , Inclinación de Cabeza/efectos adversos , Animales , Electrocardiografía , Electroencefalografía , Frecuencia Cardíaca , Conejos , Respiración , Posición SupinaRESUMEN
We report on a 47-year-old woman with a 10-year history of seronegative rheumatoid arthritis (RA) who had experienced an episode of bilateral aseptic pleuritis, and in whom livedo reticularis and ulcers had developed on both lower extremities. Histological examination revealed rheumatoid vasculitis. In rheumatoid vasculitis, high titers of rheumatoid factors are commonly observed. In our case, however, there have been no characteristic laboratory findings throughout the course of the disease so far, despite the active RA. This report describes a rare case of seronegative RA with systemic rheumatoid vasculitis.
Asunto(s)
Artritis Reumatoide/complicaciones , Artritis Reumatoide/patología , Úlcera de la Pierna/etiología , Vasculitis/etiología , Vasculitis/patología , Artritis Reumatoide/inmunología , Artritis Reumatoide/terapia , Biopsia con Aguja , Femenino , Técnica del Anticuerpo Fluorescente Directa , Humanos , Úlcera de la Pierna/patología , Úlcera de la Pierna/terapia , Microscopía Electrónica , Persona de Mediana Edad , Pronóstico , Pruebas Serológicas , Vasculitis/inmunología , Vasculitis/terapiaRESUMEN
A delayed death which occurred after accidental injection of thrombin into the right subclavian vein is described. The patient was given heparin intravenously after an erroneous intravenous injection of thrombin and died from lobar pneumonia 3 months afterwards without any apparently ill effects on the circulation of the body except for the brain. At autopsy, however, a large thrombus was observed extending continuously from the superior vena cava to the pulmonary trunk, via the right atrium and ventricle. From the results it was concluded that there was a causal relationship between the inadvertent intravenous administration of thrombin and death.
Asunto(s)
Autopsia/métodos , Hemostáticos/efectos adversos , Trombina/efectos adversos , Trombosis/inducido químicamente , Humanos , Inyecciones Intravenosas , Masculino , Errores Médicos , Persona de Mediana Edad , Neumonía Neumocócica/complicaciones , Neumonía Neumocócica/patología , Trombosis/complicacionesRESUMEN
A case of self-inflicted bite injuries of the fingers with an episode of small intracerebral haemorrhages is presented. There were many injuries on the right fingers. The tip of the right forefinger was bitten off, and some small pieces of the finger had been aspirated and swallowed. This unusual case seemed to be an emotional response to pain from cerebral episode.
Asunto(s)
Mordeduras Humanas/etiología , Hemorragia Cerebral/complicaciones , Traumatismos de los Dedos/etiología , Automutilación/etiología , Mordeduras Humanas/patología , Hemorragia Cerebral/patología , Hemorragia Cerebral/psicología , Traumatismos de los Dedos/patología , Cefalea/etiología , Cefalea/psicología , Humanos , Hipotermia/psicología , Masculino , Persona de Mediana Edad , Automutilación/patologíaRESUMEN
A sudden death case, a 21-year-old man, from retropharyngeal abscess is reported. It seemed to be caused by an injury in the posterior wall of the pharynx by an ingested foreign body. Because he had never consulted a doctor, it had grown large in several days and ruptured into the pharynx, and he died suddenly from airway obstruction by the inhaled pus.
Asunto(s)
Muerte Súbita/patología , Absceso Retrofaríngeo/patología , Adulto , Cuerpos Extraños/complicaciones , Humanos , Masculino , Faringe/patologíaRESUMEN
We present two patients with refractory papular eruptions and severe candidiasis. Both of them are positive for treponema pallidum and have suffered from pruritic papular eruptions (PPE) that had resisted therapy for years. Also, candidiasis appeared in the mouth, at intertriginous sites, and on the feet. The clinical features suggested immunodeficiency, and HIV tests were positive. Histologically, the specimen from the PPE lesion showed perivascular and perifollicular mixed cell infiltration. The fungus was identified by both Parker-KOH-mount examination and mycologic culture as Candida albicans. The pruritic papules were healed almost completely with oral antihistamine and topical corticosteroid treatment, and the candidiasis mostly disappeared after treatment with topical antifungal agents alone. We learned from these two cases that refractory PPE and severe candidiasis indicate a need for HIV testing.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Candidiasis/diagnóstico , Enfermedades Cutáneas Papuloescamosas/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/terapia , Candidiasis/complicaciones , Candidiasis/terapia , Homosexualidad Masculina , Humanos , Masculino , Persona de Mediana Edad , Prurito/complicaciones , Prurito/diagnóstico , Prurito/terapia , Enfermedades Cutáneas Papuloescamosas/complicaciones , Enfermedades Cutáneas Papuloescamosas/terapiaRESUMEN
The potential role of magnetic resonance (MR) imaging in the diagnosis of breast disease has been investigated since the late 1970s. Conventional MR imaging has not been reliable for diagnosis of breast masses, and so contrast MRI using Gd-DTPA has been performed. In particular the gradient echo (GRE) technique combined with administration Gd-DTPA (i.e., dynamic MRI) improves detection and tissue characterization of breast masses. In recent studies, breast MR imaging has shown up to 100% sensitivity in the detection of breast cancer. On the other hand, its specificity varies between 37% and 98% because of the fact that may benign lesions are also enhanced with many contrast media, similar to breast cancer. To improve the specificity of MR imaging, MR-guiding localization and fine needle aspiration biopsy for breast masses will be necessary. Recently breast conserving therapy has been widely accepted in our country, so we deduce that MRI is useful method for detecting multifocal or multicentric breast cancer.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Adulto , Biopsia con Aguja , Mama/patología , Neoplasias de la Mama/patología , Medios de Contraste , Femenino , Gadolinio DTPA , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Compuestos Organometálicos , Ácido Pentético/análogos & derivados , Sensibilidad y EspecificidadRESUMEN
A drinking experiment was performed to evaluate the efficiency of a breath alcohol monitor, Alcomed 3010. The ethanol concentrations in blood and breath were determined by gas chromatography, and in particular the breath ethanol concentration was determined with the breath alcohol monitor and by gas chromatography. The results obtained by two methods were compared. Based on the blood and breath ethanol concentrations, the following conclusions were drawn reading the breath alcohol monitor. The monitor has practical merit for determination of the breath ethanol level. It is small, usable anywhere, with little error in determination. In measuring principle, tobacco and acetone did not affected levels with the meter, but methanol, n-propanol and n-butanol affected determinations with the alcohol monitor. The breath (AM)/blood (GC) ethanol ratio was 1:2555. Comparison of the values determined with the alcohol monitor and gas chromatography yielded the equation: y = 0.998 x +/- 0.012 (r = 0.994). When determinations were made on the pure ethanol gas by the meter and gas chromatograph, the equation was: y = 0.974 x +/- 0.021 (r = 0.994). It may be said therefore that the alcohol monitor is both practically and functionally excellent.
Asunto(s)
Consumo de Bebidas Alcohólicas/metabolismo , Pruebas Respiratorias/métodos , Etanol/análisis , Adulto , Cromatografía de Gases , Electroquímica , Humanos , Masculino , Valor Predictivo de las PruebasRESUMEN
Monitoring of the arterial oxygen saturation (SaO2) in two sleeping infants was reported. They were a couple of female twins and had grown up normally after admission to NICU (Neonatal Intensive Care Unit) for a month. We investigated their SaO2 with the puls-oximeter at the terms between the 2nd and the 10th month. There was no significant difference between SaO2 in prone positions (n = 29) and that in supine positions (n = 30). In the infant with the sniffing conditions, however, SaO2 in prone positions seemed to be slightly lower than that in the healthy conditions. The slightly low SaO2 would give no effects on the healthy infants, but it may cause ALTE (Apparent Life Threatening Event) or death from SIDS (Sudden Infant Death Syndrome) to some infants who are not in good health and/or who are prone to get into ALTEA or SIDS. Especially, in the sniffing condition with hyperthermia, as the oxygen dissociation curve sifts to right and SaO2 degradation appears easily, sudden infant death may be possible to happen in prone position.
Asunto(s)
Monitoreo Fisiológico , Oximetría , Oxígeno/sangre , Postura/fisiología , Sueño/fisiología , Análisis de los Gases de la Sangre , Femenino , Humanos , Lactante , Posición Prona , Muerte Súbita del Lactante/etiología , Posición Supina , GemelosRESUMEN
We attempted to analyze biological specimens simultaneously for alcohols and hydrogen cyanide. A headspace gas chromatographic method with thick film wide bore column (PEG 20M) for the simultaneous determinations of methanol, ethanol, n-propanol and hydrogen cyanide in blood has been developed. This method was applied for the determinations of methanol, ethanol and hydrogen cyanide in a forensic autopsy case and animal experiments.
Asunto(s)
Alcoholes/análisis , Cianuro de Hidrógeno/análisis , 1-Propanol/análisis , Animales , Cromatografía de Gases/métodos , Etanol/análisis , Humanos , Masculino , Metanol/análisis , Conejos , Estándares de ReferenciaRESUMEN
Free and bound ethanol, acetaldehyde, acetate, acetone and methanol in urine during alcohol oxidation were analyzed by means of a head space gas chromatography. Four healthy male volunteers drank beer for 20 min with 16 ml/kg for non-flushers (A, B) and 8 ml/kg for flushers (C, D). In the urine, the highest bound ethanol levels were between 0.5-1.1 mM for the non-flushers (NF) and 0.2-0.3 mM for the flushers (F). The urine free ethanol levels were 23-70 times as high as bound ethanol levels. The maximum free acetaldehyde in urine was 11-13 microM for the NF and 26-55 microM for the F. The urine bound acetaldehyde levels were 4-5 microM for the NF and 7-15 microM for the F. Urine acetaldehyde existed in free forms at 2.4-3.6 times as high concentrations as in bound forms during ethanol oxidation. The urine free acetate ranged between 0.3-2.0 mM. The bound acetate varied between 0.7-1.1 mM. The urine free methanol at 70-110 microM before the intake increased to 104-180 microM. The bound methanol reached to 78-126 microM from 48-97 microM before the intake. Ethanol levels in the urine were ethanol dose-dependent, whereas it was thought that free and bound acetaldehyde or acetate reflected individual metabolic abilities and not the amount of ethanol consumed.
Asunto(s)
Etanol/metabolismo , Acetaldehído/orina , Acetatos/orina , Acetona/orina , Adulto , Consumo de Bebidas Alcohólicas/metabolismo , Etanol/orina , Rubor/metabolismo , Humanos , Masculino , Metanol/orina , Oxidación-ReducciónRESUMEN
A case of localized argyria with chrysiasis caused by implanted acupuncture needles in a 41-year-old Japanese woman was studied by electron microscopy and x-ray microanalysis. Large amounts of silver granules with selenium and sulfur were detected around eccrine secretory cells in much greater amounts than around ductal cells. Many granules were also observed along the outer edge of the basement membrane but never within cells or intercellular spaces. The granules were also present around blood vessels, lymphatics and nerve fibers, and in elastic fibers. Small numbers of gold fragments were also seen, mostly within macrophages. These results suggest that silver deposits extracellularly as selenide and sulfide, whereas free gold is found intracellularly.
Asunto(s)
Terapia por Acupuntura/instrumentación , Argiria/etiología , Dermatitis/etiología , Agujas/efectos adversos , Prótesis e Implantes/efectos adversos , Adulto , Argiria/diagnóstico por imagen , Argiria/patología , Membrana Basal/ultraestructura , Dermatitis/diagnóstico por imagen , Dermatitis/patología , Glándulas Ecrinas/ultraestructura , Femenino , Humanos , Macrófagos/ultraestructura , Microscopía Electrónica , Microscopía Electrónica de Rastreo , Radiografía , Selenio/análisis , Plata/análisis , Azufre/análisisRESUMEN
Both aconite toxins (aconitine, mesaconitine, and hypaconitine) and a pufferfish toxin (tetrodotoxin, TTX) were detected in the blood of a legal autopsy case. In order to elucidate the in vivo influence of TTX on the toxic effects of aconitine, a mixture of aconitine and TTX was administered to male ICR mice orally or intraperitoneally. The animal experiments revealed that the time of death due to aconitine was significantly delayed in proportion to the dose of TTX compared with the case for aconitine alone, and that the mortality of aconitine was lowered by TTX when the dose ratio of the two toxins was in a particular range. Accordingly, it is thought that the toxic effects of aconitine are attenuated by TTX in vivo.
Asunto(s)
Aconitina/envenenamiento , Tetrodotoxina/farmacología , Aconitina/antagonistas & inhibidores , Aconitina/toxicidad , Adulto , Animales , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Ratones , Ratones Endogámicos ICR , Tetrodotoxina/administración & dosificaciónRESUMEN
Giant serpentine aneurysm (GSA) is an entity defined on radiological and pathological grounds as a giant, partially thrombosed aneurysm containing tortuous vascular channels. We have had the opportunity to study two patients with GSAs, which has allowed for a complete comparative anatomical and radiological study. This report emphasizes the etiology of the GSAs. Twenty-two patients with GSAs have been reported in the literature, of which pathological studies were done in 10. In most of these, the aneurysm was found to be filled with an organized thrombus, but in our patients the aneurysm was filled with relatively new clot. The aneurysm enlarged and a change in the tortuous vascular channel was observed over a period of 1 year in the first patient, whereas a globoid aneurysm developed into a GSA in the brief period of just 2 weeks in the second patient. This rapid transformation of a globoid aneurysm into a GSA is of particular interest when the etiology of GSAs is considered. Our patients therefore shed some interesting light on the possible pathophysiology of GSAs. That is, the bloodstream may change dynamically in a giant aneurysm and may become a serpentine channel under conditions that lead to a "Coanda effect."