Fatal poisoning by butane sniffing: A forensic analysis and immunohistochemical detection of myocardial hypoxic damage.

Although less widespread than twenty years ago, inhalant abuse remains an on-going problem, whose incidence among U.S. teenagers and young adults ranges from 10 to 15%. Death due to the inhalation of vapor from halogenated hydrocarbons is a well-known phenomenon, yet few cases of fatal butane-gas poisoning have been described. Many cases of volatile substance abuse in prison populations have been reported: drug-addicted inmates often resort to this alternative practice when unable to get their habitual drugs of abuse. A similar pattern occurs especially among adolescents. The study herein described was conducted including all cases of fatal acute intoxication of butane gas examined from 2007 to 2015 at the Institute of Legal Medicine and Forensic Sciences of the University of Genoa. In the absence of overt and specific macroscopic and histological findings indicating cause and pathological mechanism of death, we aimed to assess whether recent cardiac lesions were detectable by way of immunohistochemical (IHC) analysis. Specifically, fibronectin and troponin C expression in myocardial tissues were investigated in deaths from acute butane-gas poisoning so as to better define the underlying pathological mechanisms. IHC findings were indicative of hypoxic cardiac damage. In all cases, positivity to fibronectin and mildly to moderately reduced troponin C expression in cardiac muscle cells were immunohistochemically ascertained.

Sudden death due to primary atrial neoplasms: report of two cases and review of literature.

Primary cardiac tumours are very uncommon lesions with an estimated incidence of less than 0.03% during autoptic examination. Among these, about 75% are benign, mainly myxomas. The intracardiac tumours occur over a wide range of ages and can progress silently or have many clinical presentations, such as valvular dysfunction, cardiac compression and embolic accidents, mostly in case of atrial localization. Primary atrial tumours often progress asymptomatically. Sudden death could represent the "first symptom" of these pathological findings. Indeed, cardiac neoplasms may cause disorders of atrioventricular or intraventricular conduction, which are manifested by fatal arrhythmias. Two cases of sudden death due to atrial tumours are reported. A complete autoptic examination, with histologic and immunohistochemical study of cardiac lesions, confirmed that these neoplasms were primary. Very few cases of sudden death due to right atrial tumours have been described in forensic literature, a fact which emphasizes their rarity.

Fatal subarachnoid hemorrhage during sexual activity: a case report.

In this article, a case of sudden and unexpected death of a homeless 45-year-old woman is described. The woman suddenly died following sexual intercourse. When her partner described the circumstances surrounding her death, he reported that it was about 1:00 PM and they were on the beach lying under a boat. Shortly after intercourse,the woman had severe dyspnea and rigidity of the body. Medical assistance was immediately called to the place but despite attempts of resuscitation,the woman died. A complete medico-legal autopsy was performed.The external examination was unremarkable; no signs of injuries or trauma were observed. However, the sectioning of the skull showed a massive subarachnoid hemorrhage because of a rupture of the aneurysmatic basilar artery. This case demonstrates that subarachnoid hemorrhage secondary to a cerebral artery rupture is still an important cause of death despite steady advances in diagnosis and treatment.

Sudden death due to isolated right ventricular infarction: a case report.

INTRODUCTION: Isolated right ventricular infarction (RVI) is a rare phenomenon associated with atherosclerotic disease of the acute marginal vessels or of a non-dominant right coronary artery. It may happen in the absence of coronary disease when substantial right ventricular hypertrophy is present. The prognosis is usually good, although sudden collapse can occur due to ventricular fibrillation, rupture of the right ventricular free wall, or a massive pulmonary embolism. In this report, a case of sudden death in a patient with an isolated RVI due to an acute thrombosis of a non-dominant right coronary artery is presented. METHODS: A 46-year-old man without previous cardiopulmonary disease died suddenly at home. A medicolegal autopsy was performed within 72 h in order to clarify the circumstances that suddenly led the man to an unexpected death. Samples were collected for histological, immunohistochemical, and toxicological examination. RESULTS: The postmortem investigation revealed central cyanosis, polyvisceral stasis, and pulmonary oedema. The macroscopic examination of the heart showed left and right ventricular hypertrophy. A fresh thrombus located in the right coronary artery accompanied by a haemorrhagic infiltration of the posterolateral right ventricular wall was found. Microscopic findings confirmed the observations from the autopsy and showed miliary necrosis of the right ventricular wall. Toxicology was negative for drugs and alcohol. CONCLUSIONS: On the basis of morphologic and microscopic data, the cause of death was determined to be an isolated RVI. The autopsy findings of both right and left ventricular hypertrophy associated with a nondominant right coronary artery thrombosis were observed. In cases like this, the authors would like to underline the importance of a complete postmortem examination and a full pathological approach.

Old age as an "alternative" to illness: gerontological and medico-legal aspects.

The current trend toward an ever increasing aging population forces society to face the problem of how to care for elderly people who are exposed to the risk of so-called "elder abuse," a phenomenon becoming increasingly widespread in Italy, as legislation does not provide a precise juridical definition of "elderly" nor does it provide for their specific protection. From a geriatric and medico-legal point of view, it is difficult to assess the cognitive performance of elderly individuals due to a number of factors, including the lack of evaluation tools with well-defined reference parameters for assessing decision-making capacities. Nonetheless, according to Italian penal code, abandoning a person incapable of self-support due to old age is considered a violation of the obligation of family assistance. Just as in the USA, which has instituted the Adult Protective Services, the Authors propose that the local health authorities provide help desks for the victims of elder abuse in Italy.