[Show abstract][Hide abstract] ABSTRACT: The authors' aim was to conduct a surgical anatomy and feasibility study on the use of an extended posterolateral approach to the cervicothoracic junction (Fessler approach) in cadavers to facilitate en bloc removal of the second thoracic vertebra using the Tomita technique. To apply this technique, it is mandatory to approach both sides of the vertebra. But such a maneuver is very difficult in the region of the cervicothoracic junction because the scapula and its muscles represent an anatomical barrier to the paravertebral compartment and lateral aspects of the vertebrae.
To study the extended posterolateral Fessler approach to the cervicothoracic junction and the possible application of the Tomita technique on the second thoracic vertebra, 3 fresh-frozen cadavers were used in the Laboratory of Human Anatomy at the University of Nantes.
The proposed approach allows exposure of both the posterior arch and the body of the second thoracic vertebra without any significant resection or traction of the superficial and deep posterior thoracic muscles, enabling application of the Tomita technique and facilitating intraoperative spinal fixation.
The proposed surgical technique is technically feasible. Nevertheless, it should be an option reserved for selected patients for whom the surgical complexity can be justified by the characteristics of their malignancy and expected curative outcome.
Journal of neurosurgery. Spine 01/2012; 16(1):22-6. · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Herein, we report a comparison of multidetector computed tomography (MDCT) and autopsy in the evaluation of three cases of charred human bodies. Interestingly, MDCT identified several findings useful for forensic purposes, including traumatic injuries not related to the fire, relevant vital reaction signs and detection of foreign bodies. Our results, in addition to data gathered in previous studies, indicate that MDCT is an excellent tool for imaging in postmortem investigations and that it has great potential for the forensic documentation and examination of charred bodies.
Medicine, science, and the law 10/2010; 50(4):211-6. · 0.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a case of a calf-related fatality on a farm. The victim was a 60-year-old man who was possibly attempting to sexually approach the animal from behind when he was struck by it, sustaining fatal blunt injuries, mostly to the thorax. This case is reported because of its rarity and because of the particular circumstances of death. Fatal trauma associated with bovines is rare on the whole, and when it does occur it is usually caused by kicking or pushing during regular agricultural activity. Although the cause of death in our case could be determined, the circumstances and the manner of death remain speculative to some degree.
Medicine, science, and the law 10/2009; 49(4):307-10. · 0.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Congenital coronary anomalies represent a condition often unrecognized in the living and in the dead. Investigating this condition is relevant for both clinicians and pathologists in order to identify potentially unrecognized coronary causes of sudden death. Hypoplastic coronary artery disease (HCAD) is a rare congenital abnormality reported to be associated with sudden death. We report two additional cases of previously apparently healthy people who died suddenly and were found to have HCAD at postmortem evaluation. The clinicopathologic findings are discussed along with a review of the literature.
Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology 08/2009; 19(4):e107-11. · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report here the case of a 53-year-old man who suddenly fell to the ground after being involved in a physical aggression by two younger men. Forensic autopsy revealed no significant injury except for slight, pale abrasions on the face. There were extensive signs of hypertensive and severe coronary artery atherosclerosis, corresponding to the data available from clinical history. The cause of death was established as acute myocardial ischemia due to hypertensive and atherosclerotic cardiovascular disease, probably related to the physical and/or emotional stress due to the aggression. We discuss medico-legal aspects of the death.
Legal Medicine 04/2009; 11 Suppl 1:S531-2. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A fatality due to ingestion of triazolam and promazine is reported. Triazolam is a benzodiazepine widely prescribed as a hypnotic drug for the treatment of sleep disorders. Promazine is a neuroleptic drug. There is no previous evidence in the literature of death due to an overdose related to the contemporaneous intake of these two drugs. In this report the authors present the case of a 76-year-old woman who was found deceased at home with no evidence of trauma or asphyxia; near the body several empty pharmaceutical boxes containing triazolam and promazine were noticed. Toxicological analyses were performed and drug levels measured by means of gas chromatography coupled with mass spectrometry. The triazolam concentration in each specimen was as follows: blood 1100ng/ml; gastric content 1300ng/ml; the promazine concentration in blood and in gastric content was 3450ng/ml and 5800ng/ ml respectively. Based on the autopsy findings, patient history and toxicological results, the cause of death was determined to be acute intoxication due to the effect of triazolam and promazine and the manner of suicide.
Medicine, science, and the law 02/2009; 49(1):65-8. · 0.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A fatality due to ingestion of triazolam and promazine is reported. Triazolam is a benzodiazepine widely prescribed as a hypnotic drug for the treatment of sleep disorders. Promazine is a neuroleptic drug. There is no previous evidence in the literature of death due to an overdose related to the contemporaneous intake of these two drugs. In this report the authors present the case of a 76-year-old woman who was found deceased at home with no evidence of trauma or asphyxia; near the body several empty pharmaceutical boxes containing triazolam and promazine were noticed. Toxicological analyses were performed and drug levels measured by means of gas chromatography coupled with mass spectrometry. The triazolam concentration in each specimen was as follows: blood 1100 ng/ml; gastric content 1300 ng/ml; the promazine concentration in blood and in gastric content was 3450 ng/ml and 5800 ng/ml respectively. Based on the autopsy findings, patient history and toxicological results, the cause of death was determined to be acute intoxication due to the effect of triazolam and promazine and the manner of suicide.
Medicine, science, and the law 01/2009; 49(1):65-68. · 0.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Several theories have been proposed to explain the Blunt Traumatic Aortic Rupture (BTAR) because different mechanical forces act on the aorta, at anatomically susceptible sites, including shearing, torsion and stretching, but the origin, transduction and relative importance of these forces remain uncertain. We report a case of a 74-year-old man injured by a kick to the abdomen. After 2 days he felt chest pain paroxysm and weakness in his left leg. The patient was admitted to an emergency care department where he experienced sudden and severe hemodynamic deterioration, dying rapidly. The autopsy, performed 3 days later, showed haemorragic infarction of hypogastric subcutaneous tissues and revealed an extended dissecting aneurysm of the thoracic aorta with following haemopericardium. In our case we considered that a low energy compression to the abdomen, in presence of underlying atherosclerosis, caused aortic dissection rather than rupture and then the 48h time span after the traumatic event and the cardiac tamponade was enough to complete the aortic retrograde dissection. We finally emphasise the importance of the careful surveillance of any trauma close to the abdomen in view of initially unpredictable, as well as eventful injuries. The finding of early signs of neointima formation in thoracoabdominal portions of aortic dissection strongly supported our interpretation. The forensic interest of this case is correlated to the voluntary character of the inflicted injury. The culprit was thus charged with manslaughter.
Legal Medicine 11/2008; 11(2):87-90. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Identification of chronic excessive alcohol consumption in living and deceased individuals is a fundamental task in forensic pathology. Reliable methods for post-mortem diagnosis of chronic alcohol abuse are required because morphological findings are unspecific and ante-mortem data are often unreliable. In clinical practice, several biochemical markers indirectly demonstrating chronic alcohol abuse are employed, but thus far these methods have not been used in routine post-mortem investigations. We reviewed publications in which these markers have been applied to autopsy material. Based on this review, some of these biochemical parameters are useful in post-mortem diagnostics, although further systematic research is required.
Legal Medicine 10/2008; 10(5):229-35. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: T-lymphocyte activation within atherosclerotic plaque, and widespread to the myocardium, has been shown in patients with acute coronary syndromes.
To investigate the presence of T-lymphocyte infiltrate at different stages of acute coronary syndromes by studying patients with sudden coronary death, acute myocardial infarction (AMI) and healed infarction, in comparison with patients with myocarditis and patients with non-ischaemic heart failure.
72 cases were studied at autopsy: 12 dying of sudden coronary death (group 1), 12 dying <4 weeks (group 2) and 12 dying >4 months after AMI (group 3), 12 with active lymphocytic myocarditis (group 4), 12 with hypertensive heart disease (group 5), and 12 control subjects (group 6). Light microscopy was performed to measure the number of activated T-lymphocytes (CD3+/DR+) in the myocardium and coronary artery wall, and intercellular adhesion molecule-1 (ICAM-1) expression in the myocardium.
Activated T-lymphocyte infiltrates and ICAM-1 myocardial expression in both remote and peri-infarction regions and activated T-lymphocytes within the epicardial coronary artery wall of both the infarct- and non-infarct-related arteries were found in groups 1, 2 and 3, whereas myocardial, but not coronary, infiltrates were found in groups 4 (p<0.001 vs groups 1, 2 and 3 for coronary infiltrates). Groups 5 and 6 had no evidence of myocardial or coronary inflammation (p<0.001 vs groups 1, 2 and 3).
The study shows the presence of a lymphocytic infiltrate in both coronary arteries and myocardium and a proinflammatory phenotype shift in the myocardium associated with acute coronary thrombosis in patients dying suddenly, shortly, or even late after coronary thrombosis.
[Show abstract][Hide abstract] ABSTRACT: Post-mortem diagnosis of chronic alcohol abuse is a challenge for forensic experts due to the lack of pathognomonic morphological findings and often also inadequate background information. Objective methods demonstrating chronic excessive alcohol consumption would therefore be a useful tool for forensic pathologists. In clinical practice, several markers of chronic alcohol abuse have recently been introduced, among which carbohydrate-deficient transferrin (CDT) is the most accepted, but the use of these markers in autopsy has not yet been established. We examined post-mortem stability and possible post-mortem redistribution of CDT and compared two analytical methods, capillary zone electrophoresis and high-performance liquid chromatography. According to our results, CDT remains stable for an appreciable time after death. The results further indicate that CDT is not subject to major post-mortem redistribution.
Forensic science international 02/2008; 174(2-3):161-5. · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ranitidine hydrochloride (Zantac), a histamine-2-receptor antagonist, is a widely used medication with an excellent safety record. Anaphylactic reaction to ranitidine is an extremely rare event and a related death has never been described in the literature.
We present the clinical history, histological and toxicological data of a 51-year-old man with negative anamnesis for allergic events, who died suddenly after the intravenous administration of one phial of Zantac 50 mg prescribed as a routine post-surgical prophylaxis for stress ulcer.
Although the incidence of anaphylactic reactions related to ranitidine is low, caution needs to be exercised on administration of this drug. In addition, further study is needed to define strategies for the prevention of adverse drug reactions in hospitalized patients.
[Show abstract][Hide abstract] ABSTRACT: Fatalities due to animal bites, the vast majority of which are associated with dogs and big cats, are relatively uncommon and rarely described in the literature. Especially rare are fatal bear attacks on humans. We herein present a forensic investigation of a fatal assault, involving numerous bites on a 42-year-old man in Finland by an European brown bear (Ursus arctos arctos).
Forensic science international 12/2007; 173(1):64-7. · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Firearm-related injuries are a major problem worldwide and one of the central issues in forensic pathology. An atypical appearance of a gunshot wound can create surgical or medico-legal diagnostic problems. We report a case of a homicidal shotgun fatality with an unusual trajectory of pellets in the body. Two large pellets perforated the anterior chest wall near to each other but made their exit through a common wound in the back. Our report describes the results of the medico-legal investigation and discusses problems related to examination of firearm wounds.
Medicine, science, and the law 11/2007; 47(4):353-6. · 0.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A fatality due to the intravenous self-injection of Ketorolac (Toradol) is reported. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with marked analgesic activity. There is limited information of fatalities attributed to ketorolac toxicity. Here we report the case of a 53-year-old woman with a medical history of depression that was found deceased at home with no evidence of trauma or injuries. Near the body, a syringe and three empty vials (30 mg) of Toradol were found. A fresh needle mark on the right arm was noticed. Toxicological analyses were performed using a gas chromatography-mass spectrometry (GC/MS) technique. The estimated ketorolac concentration in the blood was 8 mug/ml; urine and gastric content were negative for this compound. Based on the autopsy, histologic findings and toxicological results of anaphylactic shock associated with ketorolac self-administration was assumed to be the underlying pathophysiological mechanism of death and the manner, suicide.
[Show abstract][Hide abstract] ABSTRACT: We describe a death in a hospital wardrobe of a 40-year-old male suffering from HIV infection and lobar pneumonia. On the basis of circumstantial evidence and autopsy findings we conclude that the cause of death was asphyxia in a confined space as a result of several pathomechanical factors. As well as establishing the cause and manner of death, the interpretation of the case involves the evaluation of the professional responsibility of the medical personnel. This report discusses different aspects concerning the cause, mechanism, and manner of death and illustrates various problems encountered in forensic pathology.
Medicine, science, and the law 05/2007; 47(2):165-70. · 0.48 Impact Factor