Death of a seven-month-old child in a washing machine: a case report.

The authors present a case which brings out a unique modality of child homicide by placing the baby in a washing machine and turning it on. The murder was perpetrated by the baby's mother, who suffered from a serious depressive disorder. A postmortem RX and then a forensic autopsy were performed, followed by histologic examinations and toxicology. On the basis of the results of the autopsy, as well as the histology and the negative toxicological data, the cause of death was identified as acute asphyxia. This diagnosis was rendered in light of the absence of other causes of death, as well as the presence of typical signs of asphyxia, such as epicardial and pleural petechiae and, above all, the microscopic examinations, which pointed out a massive acute pulmonary emphysema. Regarding the cause of the asphyxia, at least two mechanisms can be identified: drowning and smothering. In addition, the histology of the brain revealed some findings that can be regarded as a consequence of the barotrauma due to the centrifugal force applied by the rotating drum of the washing machine. Another remarkable aspect is that we are dealing with a mentally-ill assailant. In fact, the baby's mother, after a psychiatric examination, was confirmed to be suffering from a mental illness-a severe depressive disorder-and so she was adjudicated not-guilty-by-reason-of-insanity. This case warrants attention because of its uniqueness and complexity and, above all, its usefulness in the understanding of the pathophysiology of this particular manner of death.

The behavioral variant of frontotemporal dementia: An analysis of the literature and a case report.

The aim of this case report is to underline the importance of possible legal consequences of the behavioral variant of frontotemporal dementia (bvFTD). This disease is associated with antisocial behavior, impulse control disorder and cognitive and personality impairment, which are often the earliest manifestations of the bvFTD. One of the antisocial behaviors possibly associated with this neurodegenerative disease is pathological stealing. This case report is about a 50-year-old Italian man who had a regular life until 2010. In 2010 and 2011, some critical events occurred: he lost his job, his father-in-law, to whom he was particularly close, died, and his wife had a serious illness. He began to show symptoms of depression, a significant weight loss, apathy, poor self-care, and lack of interest in the activities of his family. He became disengaged from his prior activities, emotionally detached from his family and developed compulsive hoarding. Moreover, he had uninhibited behaviors, a memory retrieval deficit, executive dysfunctions and impulsive behaviors. In January 2012, the subject began stealing objects, particularly components of computer, without premeditation or concern for resulting legal actions. He was then diagnosed affected by bvFTD. He was charged with theft and attempted theft and the Court asked for a psychiatric evaluation, in order to analyze the effect of the neurodegenerative disease on his behavior. To answer to the Court, the Authors analyzed his history of life and made a mental examination. The subject was considered mentally insane at the time of his crimes. This is an example of the practical application in judicial cases of the latest knowledge and evidence in the literature about the frontotemporal dementia, a disease associated with antisocial behaviors that could create tensions with the criminal law. The focus of the paper is to explain how the behavioral symptoms of bvFTD can have legal implications and how to deal with legal aspects of the behaviors induced by a neuro-psychiatric condition, such as bvFTD.

The choking game: A deadly game. Analysis of two cases of "self-strangulation" in young boys and review of the literature.

The choking game is defined as a self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia. Death may occur, but forensic pathologists often classify them as suicides or accidental deaths, without focusing on the possibility that they may result from a deliberate self-temporary-asphyxiation, turned into a deadly game. Presenting two fatal cases of self-strangulation involving an 11-year-old boy and a teenager of 15 years, the authors identify victims' characteristics and death scene's evidence, which may help to distinguish if a death is from an asphyxial suicide or an asphyxial game.

Leucemia promielocitica aguda: utilidad de la citometría de flujo en el diagnóstico / Acute promyelocytic leukemia: usefulness of flow cytometry in diagnosis

La Leucemia Promielocítica Aguda (LPA) requiere una rápida identificación ya que deben tomarse decisiones terapéuticas tempranas. Habitualmente el estudio morfológico es suficiente, pero la existencia de falsos positivos y negativos hace necesario buscar métodos más objetivos y rápidos que la confirmación molecular de la t(15;17) (PMLRARα) patognomónica. Objetivo: Evaluar la utilidad del inmunofenotipo por Citometría de Flujo (CF) como método diagnóstico temprano a LPA ya que presenta un patrón fenotípico aberrante característico. Materiales y Métodos: Se evaluaron 85 pacientes con diagnóstico presuntivo de Leucemia Mieloide Aguda, de los cuales 10 presentaron perfil inmunofenotipico de LPA. Procedimientos diagnósticos en el aspirado medular: 1) observación microscópica e histoquímica para mieloperoxidasa; 2) análisis multiparamétrico con anticuerpos monoclonales por CF, que cubrió el espectro de los distintos linajes. Los datos se adquirieron y analizaron en un FACScalibur (Becton Dickinson). Los parámetros hemostáticos evaluados fueron: Tiempo de Protrombina y Tiempo de Tromboplastina Parcial Activado, Fibrinógeno, Dímero D y Productos de Degradación del Fibrinógeno. Resultados: Las características fenotípicas de probable LPA M3 t(15,17) la presentaron 10 de los pacientes. El perfil inmunofenotípico tuvo correlación con la morfología en 6 casos; en 2 pacientes, la morfología no fue suficiente para clasificarlos como portadores de LMA M2 o M3. Pacientes (n=2), que presentaban inicialmente morfología monocítica, el diagnóstico definitivo fue M3v hipogranular. Patrón inmunofenotípico: única población de blastos, autofluorescencia, CD33++ homogéneo, expresión heterogénea de CD13, ausencia de expresión de HLA DR, patrón CD15/ CD34 definido. Conclusiones: el inmunofenotipo aporta gran valor para un screening rápido de LPA con rearreglo PML/RARα.

Acute Promyelocytic Leukemia (APL) requires rapid identification since early therapeutic decisions should be made. In general, morphological screening is enough. However, the existence of false positive and false negative results requires a search for methods that are more objective and rapid than molecular confirmation of pathognomonic t(15;17) (PMLRARa+). The objective of this study was to assess the usefulness of immu- nophenotype by means of Flow Cytometry (FC) as an early diag- nosis method for APL since it presents a characteristically aberrant phenotypical pattern. The study consisted in the assessment of 85 patients presu- mably with a diagnosis for Acute Myeloid Leukemia (AML). Among these patients, 10 presented an APL immunophenotypical profi- le. The diagnostic procedures performed in the medullar aspi- ration were the following: 1) microscopic and histochemical observation for myeloperoxidase; 2) multi-parameter analysis with monoclonal antibodies by means of FC, that covered the spectrum for the different strains. Data were acquired and analyzed in a FACScalibur (Becton Dickinson). The hemostatic parameters assessed were the following: Prothrombine Time and Partially Activated Thromboplastine Time, Fibrinogen, D Dimer, and Fibrinogen Degradation Products. The following results were obtained: 10 of the patients showed phenotypical characteristics of probable APL M3 t(15,17). The immunophenotypical profile showed correlation with the morphology in 6 cases; in 2 patients, the morphology was not enough to classify them as AML M2 or M3 carriers. For those patients (n=2), presenting monocytic morphology at the on-set, the final diagnosis was hypogranular M3v. The immunophenotypical pattern found was only one blast population, auto-fluorescence, homogeneous CD33++, heterogeneous CD13 expression, lack of expression of HLA DR, defined CD15/CD34 pattern. In conclusion, the immunophenotype is very useful for rapid screening of APL with PML/RAR rearrangement.