Immunohistochemical determination of the extracellular matrix modulation in a rat model of choline-deprived myocardium: the effects of carnitine.

Choline has been identified as an essential nutrient with crucial role in many vital biological functions. Recent studies have demonstrated that heart dysfunction can develop in the setting of choline deprivation even in the absence of underlying heart disease. Matrix metalloproteinases (MMPs) are responsible for extracellular matrix degradation, and the dysregulation of MMP-2 and MMP-9 has been involved in the pathogenesis of various cardiovascular disorders. The aim of the study was to investigate the role of MMPs and their inhibitors (TIMPs), in the pathogenesis of choline deficiency-induced cardiomyopathy, and the way they are affected by carnitine supplementation. Male Wistar Albino adult rats were divided into four groups and received standard or choline-deficient diet with or without L-carnitine in drinking water (0.15% w/v) for 1 month. Heart tissue immunohistochemistry for MMP-2, MMP-9, TIMP-1, and TIMP-2 was performed. Choline deficiency was associated with suppressed immunohistochemical expression of MMP-2 and an increased expression of TIMP-2 compared to control, while it had no impact on TIMP-1. MMP-9 expression was decreased without, however, reaching statistical significance. Carnitine did not affect MMP-2, MMP-9, TIMP-1 or TIMP-2 expression. The pattern of TIMP and MMP modulation observed in a choline deficiency setting appears to promote fibrosis. Carnitine, although shown to suppress fibrosis, does not seem to affect MMP-2, MMP-9, TIMP-1 or TIMP-2 expression. Further studies will be required to identify the mechanism underlying the beneficial effects of carnitine.

Advanced bronchogenic carcinoma presented as cardiac tamponade: a case report and a review of the literature.

Although most fatal lung tumors are well diagnosed before a patient's death, occasionally forensic pathologists encounter cases of sudden death in which the presence of a primary small cell lung carcinoma was not suspected. We present the case of a 49-year-old man asymptomatic until 2 days before his death. The autopsy revealed a huge tumorous mass originating from the central bronchus, infiltrating the large vessels, pulmonary parenchyma, pericardium, and the right ventricle of the heart. Pericardial sac was distended due to pericardial effusion (700 mL). Examination also revealed metastases to the liver, pancreas, and right adrenal gland. Microscopic examination identified the primary neoplasm as a small cell lung carcinoma after common stain of hematoxylin-eosin, and additional immunohistochemistry were performed.

Undiagnosed primary cardiac liposarcoma in an adult: a case report and review of the literature.

Well-differentiated liposarcomas are locally aggressive malignant mesenchymal neoplasms, which rarely metastasize to the heart and pericardium. Primary cardiac liposarcomas are extremely rare as well, and in both instances, symptoms are difficult to recognize. Therefore, accurate antemortem diagnosis seldom happens. A rare case of an undiagnosed, primary, well-differentiated cardiac liposarcoma is presented, in a 67-year-old man who suffered a sudden cardiac death. The tumor seemed to arise from the epicardium of the left ventricle and expand into the myocardium of the left ventricle and intraventricular septum. Macroscopic and histopathological findings are presented, as well as a short review of current literature.

Evaluation of coronary stenosis with the aid of quantitative image analysis in histological cross sections.

Coronary artery atherosclerosis is a hugely prevalent condition in the Western World and is often encountered during autopsy. Atherosclerotic plaques can cause luminal stenosis: which, if over a significant level (75%), is said to contribute to cause of death. Estimation of stenosis can be macroscopically performed by the forensic pathologists at the time of autopsy or by microscopic examination. This study compares macroscopic estimation with quantitative microscopic image analysis with a particular focus on the assessment of significant stenosis (>75%). A total of 131 individuals were analysed. The sample consists of an atherosclerotic group (n=122) and a control group (n=9). The results of the two methods were significantly different from each other (p=0.001) and the macroscopic method gave a greater percentage stenosis by an average of 3.5%. Also, histological examination of coronary artery stenosis yielded a difference in significant stenosis in 11.5% of cases. The differences were attributed to either histological quantitative image analysis underestimation; gross examination overestimation; or, a combination of both. The underestimation may have come from tissue shrinkage during tissue processing for histological specimen. The overestimation from the macroscopic assessment can be attributed to the lumen shape, to the examiner observer error or to a possible bias to diagnose coronary disease when no other cause of death is apparent. The results indicate that the macroscopic estimation is open to more biases and that histological quantitative image analysis only gives a precise assessment of stenosis ex vivo. Once tissue shrinkage, if any, is accounted for then histological quantitative image analysis will yield a more accurate assessment of in vivo stenosis. It may then be considered a complementary tool for the examination of coronary stenosis.

Fatal hypernatraemia after laparoscopic treatment of hydatid liver cyst: medical and legal concerns of a rare complication.

A case of fatal hypernatraemia after laparoscopic treatment of hydatid livers cysts is presented in order to highlight the risks associated with the implementation of newer techniques and the use of hypertonic saline as a scolecocidal agent in hydatid disease. Additionally this case raises some concerns on the importance of obtaining a patient's informed consent.

The vulnerable atherosclerotic plaque: evaluation of the lipid core in human coronary arteries using morphometry.

In Greece, mortality due to coronary artery disease has alarmingly increased during the past 3 decades, especially among younger adults between 30 and 40 years old. Many studies have been conducted over the years in an effort to interpret the presence of acute coronary phenomena-myocardial infarction, thrombosis, and sudden death-in early diagnosis and treatment. The current study focuses on postmortem data from individuals who had sudden coronary death. The coronary arteries of 100 individuals who were routinely subjected to autopsy at the Department of Forensic Sciences of the University of Crete were removed and examined, aiming at the evaluation of the degree of stenosis of the lumen and measurement of proportion of cholesterol in the plaque using Image Pro Plus 4.5. The average degree of stenosis was 79.01%, ranging from 11% to 99%. The cholesterol proportion was measured in 66 specimens, and the average was 25.05%, ranging between 5.3% and 66.3%, whereas 25 of them (37.8% overall) were found to contain cholesterol above the average. It resulted that the degree of stenosis was not of major importance in vulnerable plaques and that the amount of cholesterol followed an almost linear pattern of accumulation.

Sudden unexpected death from oligodendroglioma: a case report and review of the literature.

Sudden and unexpected deaths due to asymptomatic 5 primary brain tumors are extremely rare, with an incidence that ranges from 0.16 to 3.2%. Usually, such tumors are glioblastomas or, less commonly, astrocytomas. Asymptomatic oligodendrogliomas causing sudden death are hardly ever reported among medico-legal investigated cases.We report a rare case of sudden and unexpected death from a previously asymptomatic and undiagnosed, well-differentiated, grade II oligodendrogloioma (WHO classification). According to the autopsy and the microscopic findings brain edema as a result of obstruction of the cerebrospinal fluid flow due to hemorrhagic leakage of the oligodendroglioma is incriminated as the most probable physiopathological mechanism for the sudden death. Diagnosis is mainly based on the special microscopic features of the tumor cells (typical "fried-egg" appearance), interrupted by a dense network of branching capillaries. We discuss further the pathophysiological mechanisms of death and present a short review of literature.

Suicide by firearms on the island of Crete: a 9-year record.

BACKGROUND: Whereas firearm suicide mortality has been a longstanding public concern worldwide, in Greece no systematic analysis has been reported so far despite the recent evidence of a rising rate of gun ownership. AIMS: To estimate the proportion of firearm suicides on the island of Crete, Southern Greece, well-known for its widespread gun ownership; to describe the victims' sociodemographic profile and firearm-related suicide variables; and to assess the severity of suicidal intention in the group. METHODS: Records of suicides between 1999 and 2007 were reviewed and information was extracted into a computerized database. A rating of the circumstances section of the Beck's Suicide Intent Scale (SIS) for each case was also performed. RESULTS: The firearm suicide rate was 1.3 per 100,000, with males constituting the vast majority. These men were more likely to be less than 55 years of age, to have lived in the western part of the island, to have some degree of planning prior to the suicidal act, and to have used a shotgun, but less likely to have left a note. CONCLUSIONS: As an important first step toward implementing preventive initiatives the authors stress the need for a thorough look at the sociocultural factors associated with firearms in the region.