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31.
Cirrhosis cardiomyopathy is defined by cardiac dysfunction in cirrhotic patients. It is characterized by the reduced contractile response to stress and/or impaired diastolic relaxation associated with electrophysiological disturbances with unknown cardiac disease.Here we report a case of sudden death in a 44-year-old woman, with no personal and family medical history and in apparently good health before death.The death was occurred when performing agricultural activities. The autopsy revealed an elevated weight of the heart with heterogeneous myocardium. The liver was heavy and had a variegated appearance. The histologic examination showed fibrosis and partially disturbance of the texture of the left ventricular myocardial tissue with storiform patterns and circumscribed hypertrophic cardiomyocytes. The microscopic examination of the liver showed cirrhosis with no specific features of etiology.The death was attributed to arrythmia due to cirrhotic cardiomyopathy.Our case highlighted the importance of pathological examination to con-sider the diagnosis of cirrhotic cardiomyopathy in case of sudden death for patient with known or unknown cirrhosis. 相似文献
32.
Summary: Left ventricular (LV) wall motion studied by echocardiography (Echo) may give additional information of site and extension of myocardial damage in myocardial infarction (MI) compared to conventional ECG. We have therefore investigated patients with apparent poor short-term prognosis in the acute phase of an MI. Adequate autopsy data were available in 17 patients who died within a stipulated 2-month period. The left ventricle was divided into 16 segments and concomitant evaluation with ECG and Echo was possible in 164 (56%) of 272 (16 × 17) segments. The Echo parameter mean systolic wall velocity (V) was used with its percent deviation (PD-V) from that obtained in a healthy group. A reduction in PD-V by 30% was used for separating healthy from infarcted segments. This limit gives the method a sensitivity (S) of 92%, specificity (SP) 66%, and predictive accuracy (PA) of 79% with highest PA for anterior and posteroseptal segments (78–87%) in contrast to inferior and lateral segments (73%). Sensitivity for single ECG leads is lower (76%) with SP and PA of 76 and 75%, respectively. PA was highest for an-teroseptal and lateral segments (83%) as compared to 60% for inferoposterior segments. In 11 patients the MI was predominantly anterior which was adequately reflected by both Echo and ECG. Extension beyond this site was better evidenced by Echo than ECG. ECG was nondiagnostic in true posterior extension in contrast to Echo which was correct in all. In 6 patients the MI was predominantly inferior. Echo correctly identified this in 82% of segments and ECG in 71%. Again extensions beyond this site were better evidenced by Echo. Extensions to the true posterior and anterolateral walls were indicated in 79–100% by Echo, while ECG indicated MI in two posterior segments only. We conclude that Echo mapping provides useful information of segmental LV wall function in MI. In comparison to ECG additional information is obtained of MI involvement of especially the basal segments as well as the apical-posteroseptal segments and also of extension beyond the conventional anterior and inferior locations. 相似文献
33.
Matsuyama S Shimonishi T Yoshimura H Higaki K Nasu K Toyooka M Aoki S Watanabe K Sugihara H 《World journal of gastroenterology : WJG》2008,14(18):2924-2927
A 79-year-old man was referred to this department due to the presence of extrahepatic bile duct carcinoma with a tumor at the left chest wall. The lesion was suspected to be a metastasis of bile duct carcinoma to the left wall, however, computed tomography (CT) revealed no regional lymph node or liver metastases. In addition, cytological and pathological examinations did not show malignancy. At the time of admission, the white blood cell count was 21 460 cells/μL (neutrophils, 18 240 cells/μL) and this elevated to 106 040 before death. In addition, serum granulocyte colony-stimulating factor (G-CSF) was elevated. At 28 d after admission, the patient died. An autopsy showed a poorly differentiated adenocarcinoma with sarcomatous change, which had slightly invaded into the pancreas around the bile duct, and was found in the distal bile duct with multiple metastases to the chest wall, lung, kidney, adrenal body, liver, mesentery, vertebra and mediastinal and para-aortic lymph nodes, without locoregional lymph node and liver metastasis. The cancer cells showed positive immunohistochemical staining for anti-G-CSF antibody. This is believed to be the first report of an extrahepatic bile duct carcinoma that produces G-CSF. Since G-CSF-producing carcinoma and sarcomatous change of the biliary tract leads to poor prognosis, early diagnosis and treatment are needed. When infection is ruled out, the G-CSF in serum should be examined. In addition, examinations such as bonescintigraphy and chest CT should also be considered for distant metastasis. 相似文献
34.
BackgroundCardiopulmonary resuscitation (CPR) sometime cause severe injuries and can affect quality of life, lead to long-term disabilities or death of the patient. The aim of this study is to identify the risk factors causing CPR-induced injuries and those of serious injuries.MethodsThis was a retrospective forensic autopsy study in a single institution. Among 885 forensic autopsies undertaken between 2011 and 2018, those in which the victim had undergone CPR immediately after cardiac arrest were recorded. ‘Serious injuries’ were defined as an Abbreviated Injury Scale (AIS) score ≥ 3. CPR-induced injuries were evaluated by three experienced forensic pathologists. With the background and history of the patient, the circumstances of cardiac arrest and risks of causing CPR-induced injuries were determined by multivariate analyses.ResultsSeventy-five victims comprised the study cohort. CPR-induced injuries were found in 52 victims (69.3%). Rib fracture was the most common (60.0%), followed by sternal fracture (37.3%), heart injury (21.3%) and liver injury (8.0%). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced injuries (odds ratio [OR], 1.07, P < 0.001). Thirty-six victims had 39 serious injuries in the chest or abdomen: fracture of ≥ 3 ribs (35 cases), aortic dissection (two), lung contusion (one) and rupture of the heart (one). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced serious injuries (OR, 1.09; P < 0.001).ConclusionAging was the significant factor causing CPR-induced injuries and serious injuries. 相似文献
35.
The forensics literature on the relationship between ocular changes and the postmortem interval (PMI) has traditionally focused on time-related variations in concentrations of metabolites and elements within the eye. However, structural changes within the eye over time deserve the same attention because there is significant evidence of their importance in determining the time since death. Therefore, we reviewed publications that provided substantial evidence on this issue. In light of our inclusion and exclusion criteria, 26 papers were eligible for review. On the basis of the ocular parameters considered, we grouped the reviewed evidence into eight thematic areas: corneal opacities, corneal thickness, drug-induced pupil diameter variations, retinal changes, segmentation of retinal vessels, intraocular pressure reduction, globe temperature and crystalline alterations. The most important and common limitations of the reviewed studies were small study populations (many were monocentric studies), absence of robust statistical methodology, use of mathematical models valid only in ideal conditions and validation only for short PMIs. Although many phenomena cannot be used to reliably estimate PMI, there is rigorous evidence suggesting that promising factors, including corneal thickness, require methodological innovations for application to forensics practice but could be used in the near future to reliably estimate the time since death. 相似文献
36.
Atsushi Kurata Shigeru Inoue Shin-ichiro Ohno Ryosuke Nakatsubo Kengo Takahashi Tatsuya Ito Kenta Kawasaki Reiji Kokubo Takashi Sakai Jun Ubukata Shuya Matsubara Ryu Muraoka Jun Yamazaki Takao Hirose Mayuko Hojo Eri Watanabe Masahiko Kuroda 《Pathology, research and practice》2013
Although the presence of renal cysts has been reported to be associated with aortic aneurysm or dissection by imaging studies, an autopsy study has not been performed. Therefore, in our institute, recent consecutive adult autopsy cases (n = 108, 64 males and 44 females) were reviewed. The circumferences and atherosclerosis ratios of both thoracic and abdominal aorta were individually measured and graded. The number of renal cysts was scored and graded. Age of subjects along with histories of smoking, hypertension, and diabetes mellitus were confirmed. Multiple linear regression analyses demonstrated that severity of atherosclerosis and the number of renal cysts were correlated with thoracic aortic circumference, while only the number of renal cysts was correlated with abdominal aortic circumference (p < 0.05), which was more predominant in female subjects (p < 0.05). Microscopically, significantly more dilated renal tubules (by Student's t-test, p < 0.05) along with decreased stainability of basement membrane by Periodic acid-Schiff staining and immunostaining of type IV collagen were noted in background renal tissues in cases with numerous renal cysts than in age- and sex-matched controls without renal cysts (n = 10 vs. 10). The present study suggests that a syndrome that affects both aorta and renal tubules may exist. 相似文献
37.
38.
Background and objectivesIn this study, coroner's autopsy reports were used to validate results obtained from respiratory virus screening of swabs rather than tissue collected during autopsy in cases of adult death of unknown cause.Study designCoroner's autopsy samples collected for respiratory virus screening between October 2010 and February 2011, were identified. Autopsy reports were requested from cases positive for a virus. Each report was reviewed to correlate findings at autopsy with the virology result and to determine whether the virus found was listed as a contributing factor in the death.ResultsSixty-four coroner's autopsy cases were identified and a respiratory virus was found in 25 cases. Influenza A(H1N1)pdm09 virus was found most frequently, then RSV and influenza B with a dual influenza A and B infection and a parainfluenza type 1. Where multiple sites were swabbed, the virus was detected in all sites. Autopsy reports for 12 cases were obtained each reporting findings consistent with respiratory infection. Influenza A was always listed as a contributing factor in the death whereas RSV was listed once and influenza B was omitted in one case. The quality of the reports was variable and full histology was less likely to be performed in the elderly.ConclusionsWhile coroner's reports supported the use of swabbing rather than tissue collection, the lack of consistency and omission of the virology findings as contributing factors to death means that the burden of viruses on mortality statistics will remain under-estimated particularly in the elderly. 相似文献
39.
Yong Sang Lee Hyunsun Lim Hang-Seok Chang Cheong Soo Park 《Journal of Korean medical science》2014,29(5):676-679
The aim of this study was to review the literature of latent papillary thyroid carcinomas (PTCs) discovered at autopsy and describe the available pathologic and demographic differences from a group of papillary thyroid microcarcinomas (PTMCs) the reported in a previous publication. We searched the PubMed for published articles describing latent thyroid carcinomas detected at autopsy. Meta-analysis was performed to identify differences between the clinicopathologic features of PTMCs analyzed previously in our institution (Group I) and those of latent PTCs described in autopsy studies (Group II). We identified 1,355 patients with PTMC (Group I) and 989 with latent PTCs (Group II). Mean patient age was 47.3 yr in Group I and 64.5 yr in Group II. The male:female ratio was 1:10.9 in Group I and 1:1 in Group II. Most PTMCs (67.6%) were larger than 0.5 cm in size, whereas most latent PTCs were <1-3 mm in diameter. The rates of multifocality were 24.7% in Group I and 30.5% in Group II, and the rates of cervical lymph node metastasis were 33.4% in Group I and 10.0% in Group II. Currently available data indicated that clinically evident PTMCs differ from latent PTCs detected at autopsy. Therefore, these two entities should be regarded as different. 相似文献
40.
Thiago Ninck Valette Silvia Moreira Ayub-Ferreira Luiz Alberto Benvenuti Victor Sarli Issa Fernando Bacal Paulo Roberto Chizzola Germano Emilio Concei??o Souza Alfredo Inácio Fiorelli Ronaldo Honorato Barros dos Santos Edimar Alcides Bocchi 《Arquivos brasileiros de cardiologia》2014,102(5):505-509