ABSTRACT
Studies about head trauma are experimental or have a clinical or prognosis purpose. In this study, we used samples from human autopsies to answer common medical-legal questions.We studied 21 problem cases and 4 controls. Samples were obtained directly from the injured area, fixed in 10% formalin during 24 hours and then preserved in 70% ethanol. This procedure optimizes the immunohistochemical technique.The neurofilament antibody shows beaded axons since the first moment; over time, they increase their density and diameter as survival time also increases. These changes begin in the gray matter, 2 hours after trauma can be seen around vessels and in hemorrhagic areas. At 24 hours, beaded axons appear in the white mater, which finally loses its structure and cellular density.On the other hand, the ß-amyloid precursor protein marker begins to be weakly seen 2 hours after injury. At 24 hours, a diffuse pattern can appear, suggesting primary traumatic injury. The marker reading keeps increasing until day 26, when a "Z" pattern appears in the white matter, suggesting secondary hypoxic injury.All these chronologic changes could be useful to approach the date of trauma. They let us to distinguish between long surviving cases from those whose death was immediate (within the first 30 minutes).
Subject(s)
Amyloid beta-Protein Precursor/metabolism , Biomarkers/metabolism , Brain Injuries, Traumatic/metabolism , Immunohistochemistry , Intermediate Filaments/metabolism , Adult , Aged , Aged, 80 and over , Antibodies/analysis , Axons/pathology , Brain/metabolism , Brain/pathology , Case-Control Studies , Cell Count , Female , Forensic Pathology , Gray Matter/metabolism , Gray Matter/pathology , Humans , Male , Middle Aged , Time Factors , White Matter/metabolism , White Matter/pathologyABSTRACT
This study aims to evaluate the effects of ischemia on the myocardial fibers and the expression of the transcriptional factor for angiogenesis hypoxia-inducible factor-1 alpha (HIF-1alpha) in human heart specimens. We have prospectively analyzed the HIF-1alpha expression in human ischemic hearts with the ABC-inmunohistochemistry technique and amplification by biotinylated tyramide. The relationship between the expression of HIF-1alpha and the temporal evolution of ischemia has also been evaluated. As pathomorphological diagnosis of early myocardial ischemia has many problems in human autopsy material with less than 4 to 6 h after clinical onset, we suggest that HIF-1alpha is helpful in the early acute myocardial infarction diagnosis, so it stains necrotic areas within the first 2 h. The amplification procedure provides a higher intensity of the final staining without losing specificity. It is concluded that in normal cardiac fibers, basal expression of HIF-1alpha is not appreciable, but it steadily increases after ischemia. With regard to the practical applicability in forensic field, our observations suggest that positive immunohistochemical expression of HIF-1alpha on heart samples may be used as a reliable indicator of myocardial damage in cases without cardiac lesion evidence, using conventional microscopy. This method is especially useful and may provide definitive proof of myocardial ischemia in unexpected deaths without previous symptoms, or in forensic cases with a short period of clinical manifestations. In addition, it may have been involved in possible future cardiovascular therapies.
Subject(s)
Hypoxia-Inducible Factor 1, alpha Subunit/metabolism , Myocardial Ischemia/metabolism , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Forensic Pathology , Humans , Immunohistochemistry , Male , Middle Aged , Myocardial Ischemia/diagnosis , Myocardium/metabolism , Myocardium/pathology , Prospective StudiesABSTRACT
La fístula de ano es una entidad frecuente, cuyo origen más comúnmente aceptado es infeccioso. La clasificación más utilizada se basa en la teoría criptoglandular y en la situación del trayecto fistuloso en relación con el esfínter anal. La evaluación física permitirá orientar el tipo de fístula y planificar su tratamiento. Los métodos complementarios de investigación más utilizados son la ecografía endoanal y la resonancia magnética nuclear. Se revisan las opciones terapéuticas y sus resultados, en especial la fistulotomía, el colgajo endorrectal de avance, el uso de sedales, el colgajo de avance anocutáneo, la esfinterorrafia con reconstrucción esfinteriana y el empleo de adhesivos de fibrina (AU)
Anal fistula is a frequent condition. The most commonly accepted origin is infectious. The most widely used classification is based on cryptoglandular theory and on the position of the fistulous tract in relation to the anal sphincter. Physical examination will help to identify the type of fistula and allow its treatment to be planned. The most widely used complementary tests are endoanal ultrasound and magnetic resonance imaging. We review the various therapeutic options and their results, especially fistulotomy, endorectal advancement flap, use of sedal, anodermal advancement flap, sphincterorrhaphy with sphincter repair, and fibrin glue (AU)
Subject(s)
Humans , Rectal Fistula/surgery , Fecal Incontinence/etiology , Fibrin Tissue Adhesive/therapeutic use , Anal Canal/surgery , Rectal Fistula/etiologyABSTRACT
Anal fistula is a frequent condition. The most commonly accepted origin is infectious. The most widely used classification is based on cryptoglandular theory and on the position of the fistulous tract in relation to the anal sphincter. Physical examination will help to identify the type of fistula and allow its treatment to be planned. The most widely used complementary tests are endoanal ultrasound and magnetic resonance imaging. We review the various therapeutic options and their results, especially fistulotomy, endorectal advancement flap, use of sedal, anodermal advancement flap, sphincterorrhaphy with sphincter repair, and fibrin glue.
Subject(s)
Fissure in Ano/therapy , Digestive System Surgical Procedures/methods , Fissure in Ano/etiology , Fissure in Ano/surgery , HumansABSTRACT
A fatal case of intentional oral cyanide poisoning in a tetraplegic patient whose repeated legal requests to be allowed to perform euthanasia had been refused, is reported. The postmortem provided no specific findings and the diagnosis was based on the toxicological analysis of the different samples available. Cyanide was determined in all biological (blood, vitreous humour, bile, urine and viscera) and non-biological samples_received (liquid found in a glass beside the body in the scene of the crime). The high cyanide concentrations in blood (21.5 mg/L) are consistent with death through cyanide poisoning. Also, the cyanide concentration in the water held in the glass from which the casualty presumably drank 81900 mg/L), and the high levels of potassium ion found (186 mEq/L), allowed us to conclude that the death was due to the intake of an amount of potassium cyanide between 500 and 1000 mg.
Subject(s)
Potassium Cyanide/poisoning , Suicide , Humans , Male , Middle Aged , Poisoning/diagnosis , Poisoning/pathology , Quadriplegia , SpainABSTRACT
Many external injuries on the neck can often simulate ligature strangulation. This similarity could lead to mistakes or overestimation of these findings and consider them as violent deaths. Therefore, when the work of the forensic pathologist is to limit the external examination of body, the conclusions can be mistaken or wrong. In the present article four cases of apparent ligature strangulation are showed. All the autopsies were performed and completed with microscopical and toxicological examinations. During necropsic examination different causes of death, other than the initial suspected, were discobered.
