Malignant Peritoneal Mesothelioma -An Unforgotten Abdominal Malignancy

Malignant peritoneal mesothelioma is a rare lethal malignancy of the serosal membranes of the peritoneum. The pathogenesis and association is strongly related with industrial pollutants asbestos, but less than pleural mesothelioma. Symptoms are nonspecific and related to the tumor spread within the abdominal cavity. CT scan is the investigation of choice and mostly disease is discovered incidentally on routine imaging. Diagnosis is confirmed on histopathology as well as immunohistochemical analysis of markers. The mainstay of treatment is cytoreductive surgery with Hyperthermic intraperitoneal chemotherapy. Here we present a very unusual case of malignant peritoneal mesothelioma diagnosed on routine evaluation of a 62 year old male admitted in emergency for obstructed inguinal hernia. Introduction: Malignant peritoneal Mesothelioma MPM is a very rare malignancy of the abdominal cavity. Mesotheliomas usually originate from the serosal membrane of different body cavities. Pleura is most commonly affected by mesothelioma followed by peritoneum and also other cavities pericardium and tunica vaginalis testis.10 to 30% of all mesothelioma affects peritoneum. Malignant peritoneal mesothelioma is a highly lethal malignant tumor of peritoneum and its pathogenesis is strongly related with industrial pollutant asbestos exposure. Diagnosis is difficult in most of the cases because of its nonspecific presentation and detected on routine abdominal imaging or Surgery.

Patterns of fatal scald burns in Central Delhi A retrospective study.

Thirty six unselected autopsy cases of fatal scald burn received from Central Delhi were studied during the period from July 1998 to June 2010 at Department of Forensic Medicine, Maulana Azad Medical College and associated Hospitals, Delhi. The data was analyzed with regard to age, sex, place of occurrence, pattern of injury, mode of infliction, survival period, cause and manner of death. The cases represented approximately 0.31% of all autopsy received during the same period. There were 24 males (66.7%) and 12 females (33.3%) with male to female ratio 2:1. The age range of the victims was 10 months to 70 yrs with mean age of 16.93 years and Standard deviation of 19.32. Domestic accidents were attributed to 72.2% of all deaths. All except one case were accidental in nature. Hot water splashing from the cooking utensils/ falling over to boiled water in kitchen (68.75%) was the most common mode of injury. Thorax (86.1%) was the most common body region involved. The average total body surface area (TBSA) burn was 50.83%.The mean survival period of all victims was 3.83 days. All the victims were hospitalized after the incident and in majority (75%) of them died due to septicemia.

A suicidal hanging with unusual findings at crime scene.

A 42 year old male, was found hanging by a plastic rope in his unbolted bed room. The rope was found attached to two suspension points (one end attached to the window panel and the other side to the ceiling knob) and the middle part of it used for the binding of neck. There was no knot present in the ligature as the right hand was found holding the ligature loop for the purpose of constriction of neck .A towel was found covering the head and underneath the ligature material on the neck used for padding. Blood stain was present on the floor below the suspended body which oozed out from the haemorrhoids. He was holding the cloth, wore in lower half of the body up to the mid thigh label, which appreciated by the authors as cadaveric spasm that developed in his flexor muscles of left hand. Detailed autopsy, crime scene examination and police investigation supported the manner of death as suicidal.

Fatal nitrobenzene poisoning: Some case reports and medicolegal aspects.

Nitrobenzene is a synthetic organic compound, pale yellow in colour, freely soluble in alcohol, with a pleasant odour like that of bitter almonds or shoe polish. It is widely used in chemical industry, and is present in commercial products such as shoe and metal polish, ink, paint remover and soap. Poisoning due to nitrobenzene is usually chronic in nature, mainly due to occupational exposure, except for a few acute cases of industrial accidents or suicides. We report three cases of fatal nitrobenzene poisoning through oral ingestion. All persons consumed alcohol prior to, or along with nitrobenzene. The alleged manner of poisoning was different in every case (one case each of homicide, suicide and accident). Clinical features, autopsy findings and medicolegal aspects of nitrobenzene poisoning are discussed.

Pattern of injuries in a Fatal small aircraft accident.

Aircraft accident investigation is divided between human and machine factors. Human factors include intoxication, cardiovascular pathology, CO Poisoning, hypoxia, vertigo, operational errors. Machine factors are focused on impact based on speed, direction of travel, angle of impact and altitude. Autopsy data from individual aviation crashes have long been used in aviation safety research. The present study examines the injury pattern in occupants of a light executive jet aircraft crashed in bad monsoon weather, while on a flight, killing all eight persons on board including the two pilots. The bodies of the victims were brought to All India Institute of Medical Sciences, New Delhi. All bodies were sufficiently intact and were easily identifiable. Detailed autopsies were performed on all the eight occupants, which yielded findings relevant to the cause of the accident. Our findings emphasize the need for autopsy on all aviation accident victims, especially pilots, as it is the only reliable method to find out the various factors contributing to an accident.

Fatal pseudo aneurysm in common femoral artery a case report.

Pseudoaneurysm is a rare condition arising from disruption in arterial wall with blood dissecting into the tissues around the damaged artery creating a perfused sac that communicates with the arterial lumen. Its incidence is on rise due to increase in endovascular procedures, hemodialysis and intravenous drug abuse. Here we report an young male who was found by a NGO worker, lying on roadside near a Mandir with a pulsatile inguinal swelling and blood oozing out from it. He was taken immediately to emergency department of LN Hospital. He was a rickshaw puller and known drug addict. The swelling was diagnosed as pseudo-aneurysm of common femoral artery on clinical examination and by Doppler ultrasonogrphy. He was referred to CTVS department and admitted there for surgery. In the meanwhile, he collapsed in the hospital toilet and died due to hemorrhagic shock consequent upon rupture of pseudoaneurysm of femoral artery. In this report the gross and histopathological findings of pseudo-aneurysm of common femoral artery were described in autopsy.

Fatal gastro-duodenal perforation following electrocution: A case report.

A 45 yrs old male was accidentally electrocuted, while cooking on a locally made heater in his home. He was immediately brought to the hospital in unconscious state by the family members. After first aid he was referred to a tertiary care hospital, where he was admitted about two hrs after the incident. On admission he was unconscious, abdomen was distended, with fluid in peritoneal cavity. There was tachycardia and hypotension. Bowel sounds were absent. Electrocution burn marks were present over the right hand. Arterial blood analysis showed severe metabolic acidosis. He was immediately shifted to the ICU. His condition continued to be critical with persistent metabolic acidosis despite repeated sodium bicarbonate infusion. An exploratory laprotomy was planned to rule out abdominal visceral injuries. However the patient expired six hrs after admission to the hospital before being taken to the operation theatre. Autopsy examination showed perforated anterior wall of stomach antrum and first part of duodenum.

Collection, preservation and forwarding of biolgical samples for toxicological analysis in medicolegal autopsy cases : A review.

Collection of proper autopsy specimen is an essential step in the process of toxicology case work¹. Improper collection of these specimens can greatly alter or negate chemical and toxicological analysis. This article is an update about the standard methods of biological specimen collection procedures for toxicological analysis which will be helpful for the forensic pathologist and forensic scientists.

Sudden death due to aortic rupture while swimming: A case report.

An eleven year old, healthy boy with no past history of illness suddenly felt acute excruciating chest pain which was radiating to back, while he was swimming in a private swimming pool. He was immediately transferred to a hospital where he was declared dead on arrival. Autopsy and histopathological findings were suggestive of death was due to extensive advential haemorrhge due to inherent weakness in aortic wall.

Outcome of parapneumonic empyema.

OBJECTIVE: Empyema thoracis is known to have variable age group affection, causative agents and controversy regarding primary mode of management. To look into current demography, bacteriology and treatment outcome. METHODS: Prospective study made on admitted cases of parapneumonic empyema from July 2001 to June 2003. All cases were treated with chest tube drainage, parenteral antibiotics or thoracotomy in multiloculated or non-improving cases. RESULTS: 0.8% (C.I. 0.6-1.0) of total pediatric admission had empyema, who were more likely to be females (P< 0.05), under-weight (P< 0.05) compared to children admitted for other reasons. Staphylococcus aureus is still the commonest isolate (13.2%). All cases received antibiotics prior to hospitalisation. Majority of cases (90.5%) could be successfully managed with antibiotics and chest tube drainage alone. 9.4% cases needed thoracotomy. 5.8% cases needed salvage thoracotomy following non-improvement with chest tube drainage. Fever remission time and duration of hospital stay were comparable in both groups. Thoracotomy cases required antibiotics for shorter period (P=0.04). Two cases died due to reasons other than mode of management. Radiological and lung function recovery was excellent in most of the cases. CONCLUSION: Chest tube drainage is a safe, efficacious primary method of empyema management.