Radiologic picture of the thorax in acute asphyxia caused by near drowning. A caseload contribution

One hundred-fifteen drowning and near-drowning patients were hospitalized in Jesolo and Mestre over the last 10 years. A correlation between radiological patterns and clinical features was thoroughly investigated by the authors. A close relationship was found between clinical findings and the X-ray pattern of the first radiography, taken immediately after the rescue. The longer the hospitalization (or when SNC is assessed) the less significant the correlation. According to the author's experience, prognosis is good when the first radiograph does not demonstrate any lesions. On the contrary, when lesions are seen on the first radiograph the patient is to be carefully monitored in order to treat every complication promptly, including ARDS (10% of all cases). Chest radiographs are also useful to explain autopsy findings. No typical radiological pattern was found: however, four signs were observed, which were very frequently associated-i.e., bilateral parenchymal shadows, pneumothorax, pneumopericardium, and gastrectasia. These findings appear to be characteristic of near-drowning.     

Unusual femoral artery mycotic aneurysm complicated by infective spondylitis

We present a patient who experienced an aortic aneurysm and a left femoral artery mycotic aneurysm, which resulted from L4-infective spondylitis via the iliopsoas compartment. This rare complication could be underdiagnosed in the absence of a more extended field of imaging view such as is provided by computed tomography.     

Fatal recurrent subarachnoid hemorrhage after complete endovascular aneurysm occlusion

Endovascular treatment of aneurysms has become an alternative to the neurosurgical approach. Here, we describe a patient presenting with a subarachnoid hemorrhage (SAH) due to a basilar tip aneurysm, which was completely occluded with coils. Fourteen days later the patient died due to massive recurrent SAH. Histologic evaluation showed aneurysm rerupture with coil dislocation in the subarachnoid space. This is a rare histologically documented case of fatal recurrent hemorrhage early after coil embolization of cerebral aneurysms.     

Fatal accident caused by isoflurane abuse

A fatal accident after isoflurane abuse is presented in this report. A hospital employee was found dead in the operating area with a plastic bag over his head. In his locker an almost empty bottle of isoflurane was found. Autopsy revealed signs of asphyxiation and toxicological examination revealed nordazepam and isoflurane in non-toxic concentrations in the blood. Quantification of the anaesthetic was also carried out in urine, gastric contents, liver, kidney and brain samples, and in addition, oxazepam, prothipendyl and metabolites of midazolam and prothipendyl were found in the urine. Although the drug problems of the deceased were known before, no efforts had been made to restrict access to these drugs.     

An unusual case of homicidal near drowning followed by electrocution

A young woman was found dead in a bath-tub with her facial orifices under water and current burn marks at the right big toe and at the neck near the hairline. Initial police investigations assumed an accidental electric shock due to a radio falling into the water. The forensic autopsy was followed by extensive histology and immunohistochemistry of the internal organs and skin marks. Intensive vital reactions of a near-drowning were detected that suggested a survival period of at least 20 min. Furthermore, an energy dispersive x-ray spectroscopy analysis on the current burn marks and on possible current applicators was performed, as well as reconstruction experiments with a cadaver of a pig that had been slaughtered shortly before. The results of all investigations revealed a two-step procedure with a primary near-drowning and a final current application with consecutive cardiac arrest.     

Occult aortic arch mycotic aneurysm diagnosed by radiogallium scintigraphy.

Aortic arch mycotic aneurysm, an uncommon cause of sepsis, carries a grave prognosis. Clinical presentations as well as laboratory and radiologic examinations may be noncontributory and often misleading. In a patient with a fever of unknown origin, only the radiogallium study could enable an accurate diagnosis and pinpoint the anatomic localization of the mycotic aneurysm as the cause of fever.     

Fatal firearm injuries caused by handmade weapons

Six cases of accidental death caused by a shot from handmade or improvised firearms are described. Data were collected on incident, victim and special autopsy findings. In three cases the weapon used was a so-called 'pen gun' of small calibre (5.6 mm) and in two cases a home-made shotgun/muzzle loader with shotgun cartridge (containing 16 mm pellets) was used. In one case, the weapon was a shop-made gun with home-made ammunition. It is perhaps surprising that in the present war situation in Croatia, when all kinds of firearms are easily available, people continue to produce handmade weapons.     

成人淹溺肺损伤的CT表现(附17例分析)

目的探讨成人淹溺肺损伤的CT表现,为观察该病病情的变化提供依据。方法回顾性分析本院17例成人淹溺后一系列胸部CT图像,采用标准肺窗和纵膈窗观察图像,分析胸部CT影像表现。结果病灶形态:表现大片状实变伴空气支气管征2例(11.76%),斑片状实变4例(23.53%),磨玻璃影14例(82.35%),边缘模糊的小叶中心结节12例(70.59%),局限性肺气肿5例(29.41%)。病灶分布:13例两肺各叶分布,其中8例两肺弥漫性分布,5例呈蝶翼状分布,3例分布于两肺下叶,1例右肺中下叶及左肺下叶。治疗后3~7天复查病灶均有不同程度的吸收。结论胸部CT能客观反映淹溺肺损伤的表现特征,有助于指导临床治疗和疗效评估。     

Infective endocarditis complicated by cerebral abscess and mycotic intracranial aneurysm: A case report

Infective endocarditis (IE), is an infection of the endocardial surfaces of the heart, which primarily affects the valve leaflets, the mural endocardium, chordae tendinae and prosthetic valves among others. IE has various complications among which neurological complications include stroke, infected intracranial aneurysms, intracranial abscesses, meningitis, encephalopathy and seizures which could prove fatal if not treated on time. We report a case of a 17 year old girl, who was a known case of bacterial endocarditis that presented with sudden onset deterioration of mental status, fever and dizziness. On CT scan imaging of the brain, the patient showed features of intracranial abscess and mycotic aneurysm. Since early detection, diagnosis and timely management is crucial for the prognosis of the patient, we should always opt for timely imaging in patients of infective endocarditis with neurological symptoms.     

Fatal rhabdomyolysis after torture by reverse hanging

Purpose

Reverse hanging (also known as Palestinian hanging) is a form of positional torture where the victim is suspended for a prolonged period of time by the wrists, after the wrists are bound at the back. We report the first autopsy case of reverse hanging. We have discovered that fatal myoglobinuric renal failure due to rhabdomyolysis can be a complication of Palestinian hanging.

Method

An adult detainee, who underwent interrogation by authorities, was admitted to hospital from a prison and died in hospital after a few days. Death was due to myoglobinuric renal failure. An autopsy was performed.

Results

At autopsy, the body showed anasarca due to renal failure. There were healing ligature marks on the wrist and forearm, but no blunt impact injury to the shoulders or arms. There was extensive necrosis of the pectoralis major, biceps, and deltoid muscles, organizing hemoarthrosis of the right glenohumeral joint and hemorrhage into the joint capsule of the both glenohumeral joints. The kidneys showed evidence of myoglobin deposition grossly. The overstretching of the major muscles of the shoulder, in response to the prolonged Palestinian hanging, gave rise to the muscle necrosis.

Conclusion

This case underscores the importance of conducting autopsies on people who die in custody, particularly if detained at times of political instability when torture may be practiced by state actors and others. This case also reveals that fatal rhabdomyolysis can occur by positional torture in a stress position, despite the absence of direct trauma due to blunt impacts.

     

海水淹溺肺水肿大鼠肺血管通透性变化的观察

目的研究海水淹溺肺水肿大鼠的肺血管通透性变化与超氧化物歧化酶(SOD)、丙二醛 (MDA),髓过氧化物酶(MPO)的关系。方法 16只雄性SD大鼠按随机表法随机分为对照组和淹溺组,均以伊文思蓝(EB)20 mg／kg静脉注射,淹溺组气管内注射海水4 ml／kg,建立海水淹溺性肺水肿大鼠模型,于注射4 h后处死大鼠,计算肺组织湿重／干重比(W／D),取肺组织做病理切片HE染色,高倍镜下中性粒细胞(PMN)计数,测定肺组织中的EB浸出量(每100 mg湿肺用1 ml甲酰胺浸泡),测定肺组织匀浆中的SOD、MDA、MPO含量,以及血浆的SOD、MDA含量。结果对照组和淹溺组结果分别为: W／D 4．45 ±0．18、8．61±0．42,P<0．05;PMN(13．6±3．4)、(120．2±21．2)个／高倍视野,P<0．05;肺组织EB浸出量(18．4 ±1．8)、(30．9±4．1)μg/ml,P<0．05;肺匀浆MPO(0．64±0．08)、(1．14 ±0．16)活力单位／g湿片,P<0．05;SOD(75．6±11．7)、(67．6±10．3)U／mg protein,P>0．05;MDA(1．32±0．21)、 2．21±0．33 nmol／mg protein,P<0．05;血浆中的SOD(96．6±29．3)、(92．3±33．9)U／mg protein,P> 0．05;MDA(8．24±1．79)、(15．21±2．93)nmol／ml,P<0．05。结论海水淹溺后4 h肺血管通透性明显增加,组织湿重／干重比、中性粒细胞计数、MPO含量、血浆和肺组织匀浆中的MDA含量均增加。血浆和肺组织匀浆中的SOD未见明显变化。     

Fatal wounds to the thorax caused by gunshots from blank cartridges

Lethal injuries of the thorax due to shots fired from blank cartridges calibre 8 mm are reported in three cases. The muzzle of the weapon was in contact with the left side of the breast (contact discharge) and injuries to bones were absent in all three cases. In two of the cases the pericardium was not involved but the anterior wall of the right heart ventricle was ruptured and death was due to cardiac tamponade. In the third case the pericardial sac and the left ventricle were both ruptured and the victim died due to rapid exsanguination. The cases demonstrate that the gas pressure from the exploding propellent of blank ammunition can be powerful enough to penetrate the thoracic wall. Received: 26 May 1997 / Received in revised form: 9 September 1997