Use of a cutting balloon for dilatation of a resistant venous stenosis of a hemodialysis fistula

In a 71-year-old patient with a Brescia-Cimino hemodialysis fistula, high-pressure balloon dilatation failed to open the stenosis completely and a constant waist of the balloon was found. The use of a 3.5-mm coronary cutting balloon (Barath balloon) was helpful in preparing the stenosis for subsequent successful dilatation.     

Death of a seven-month-old child in a washing machine: a case report

The authors present a case which brings out a unique modality of child homicide by placing the baby in a washing machine and turning it on. The murder was perpetrated by the baby’s mother, who suffered from a serious depressive disorder. A postmortem RX and then a forensic autopsy were performed, followed by histologic examinations and toxicology. On the basis of the results of the autopsy, as well as the histology and the negative toxicological data, the cause of death was identified as acute asphyxia. This diagnosis was rendered in light of the absence of other causes of death, as well as the presence of typical signs of asphyxia, such as epicardial and pleural petechiae and, above all, the microscopic examinations, which pointed out a massive acute pulmonary emphysema. Regarding the cause of the asphyxia, at least two mechanisms can be identified: drowning and smothering. In addition, the histology of the brain revealed some findings that can be regarded as a consequence of the barotrauma due to the centrifugal force applied by the rotating drum of the washing machine. Another remarkable aspect is that we are dealing with a mentally-ill assailant. In fact, the baby’s mother, after a psychiatric examination, was confirmed to be suffering from a mental illness—a severe depressive disorder—and so she was adjudicated not-guilty-by-reason-of-insanity. This case warrants attention because of its uniqueness and complexity and, above all, its usefulness in the understanding of the pathophysiology of this particular manner of death.

     

Identification of a cannabimimetic indole as a designer drug in a herbal product

A cannabimimetic indole has been identified as a new adulterant in a herbal product being sold illegally in Japan for its expected narcotic effect. Liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry analyses indicated that the product contained two major compounds. One was identified as a cannabinoid analog (1RS,3SR)-3-[4-(1,1-dimethyloctyl)-2-hydroxyphenyl]cyclohexan-1-ol (1) by direct comparison with the authentic compound, which we reported previously. The other compound (2) showed a molecular weight of 341 daltons, and accurate mass spectral measurements showed its elemental composition to be C₂₄H₂₃NO. Both mass and nuclear magnetic resonance spectrometric data revealed that 2 was 1-pentyl-3-(1-naphthoyl)indole [or naphthalen-1-yl-(1-pentylindol-3-yl)methanone] being identical to JWH-018, which was synthesized by Wiley and coworkers in 1998. This compound was reported as a potent cannabinoid receptor agonist possessing a pharmacological cannabimimetic activity.     

Death of a child following a superstitious ritual of exorcism

IntroductionDiseases, especially those related to the psyche produced by demons, are an accepted belief in many communities. This paper elaborates on the death of a child, a victim of an exorcism ritual, and calls for adequate awareness and preventive measures.Case reportThe deceased, a 9-year-old child, was taken by her mother to an exorcist to 'expel a demon from her body. The exorcist caned the child for two days while giving 'water' to drink. On the ^second day, the child lost consciousness and was pronounced dead on admission. On direct questioning, it was revealed that the child had been made to consume some medicinal syrups forcefully by the mother and the exorcist. The autopsy revealed multiple abrasions, tram-line contusions and burns on the body. There was mottling and consolidation in the lungs. Blood-stained secretions were found in the trachea, bronchi, and stomach. Musculoskeletal dissection revealed subcutaneous haemorrhages and muscular contusions over the buttocks and limbs. Histology revealed evidence of well-established aspiration pneumonia. There was no other significant pathology, especially no evidence of acute kidney injury due to rhabdomyolysis. Toxicological analysis was negative for common poisons, therapeutic drugs, and heavy metals. The cause of death was concluded as aspiration pneumonia in a child subjected to physical violence.ConclusionWith the forceful feeding of the syrup, the child can have aspiration, resulting in aspiration pneumonia. At the same time, it appears that even after the child became symptomatic, she had not been brought for medical treatment but had continued with the same exorcistic therapy. While the caregivers become responsible for the child's death, the lessons to be learnt are enormous. Thus, banning such practices against children is a need of the hour.     

CT in a case of intracranial penetration of a pencil

A case is reported of an unusual foreign body, a pencil, penetrating the right temporal lobe through the squamous temporal bone in a fall. Wood has low attenuation coefficients, so that the appropriate CT examination includes multiple window settings to permit accurate assessment of bone fragment displacement as well as recognition of detached wood splinters. CT scanning and early surgery are important steps in the management of these injuries to reduce significantly the overall mortality as well as immediate and long term complications. The necessity for meticulous surgical technique when removing the foreign body is stressed as retained wood can not easily be visualized against the hypodense background due to postoperative changes.     

某部潜艇人员长航期间膳食结构调查分析

目的 了解某部潜艇人员长航期间膳食营养状况和存在问题,为保障潜艇官兵健康以及制定军人营养素供给量、食物定量标准提供依据.方法 膳食调查采用记帐法,能量消耗采用能量平衡法.结果 (1)猪肉、牛羊肉、脏腑、禽蛋、鱼虾、乳粉、豆类及制品、食糖、蔬菜、木耳、海带、紫菜摄入量偏低.(2)热能71.1%来源于植物性食物,而摄入动物性蛋白质占摄入蛋白质总量的50.1%,符合军标要求,动物性脂肪占摄入脂肪总量的69.9%,超过军标要求.(3)人均每日维生素A、维生素E和维生素B1的摄入量明显低于军标,胆固醇摄入量明显超过军标.另外,人均每日摄人大量钠.结论 受调查的潜艇部队长航期间能量和多数营养素的摄入量能达到军标要求,维生素A、维生素E和维生素B1的摄入量偏低,胆固醇摄入量偏高,应增加牛羊肉、蔬菜、牛奶、禽蛋、鱼虾等水产品的供应,减少动物脂肪的摄人,减少食盐等调味品的摄入.