Fabio De Giorgio

Cocaine found in a child’s hair due to environmental exposure?

We report a case of a 6-year-old boy who had been living with his parents, both cocaine smokers, and who was urgently admitted to hospital for general distress. Upon examination, cocaine and cocaine metabolites were detected in hair and urine samples. These toxicological findings most likely indicate that the child had passively consumed the drug when living in a heavily contaminated environment.

Reduced post-infarction myocardial apoptosis in women: a clue to their different clinical course?

Heart failure (HF) is less prevalent and has a better prognosis in women than in men. Also, the outlook after acute myocardial infarction (AMI) is more favourable in elderly women.1 Such sex related differences are probably related to sex specific cardiac remodelling processes.2 However, despite several hypothetical pathogenetic mechanisms, there are no established explanations. Myocardial apoptosis is a pivotal determinant of left ventricular (LV) dysfunction and cardiac failure in experimental and clinical studies, including after AMI. Sex may indeed influence apoptosis, as shown in normal aging and in end stage HF.3 However, little is known about the role of sex in post-infarction apoptosis. We thus evaluated the influence of sex on expression of pro-apoptotic mediators and myocardiocyte apoptotic index (AI) in subjects dying after AMI. Using established methods,4 we selected six females who had died after AMI with permanent infarct related artery occlusion at necropsy (< 30 hours after death); 15 males with similar characteristics were selected during the same period. Three men and one woman dying from non-cardiac causes were included as controls. Re-infarction was excluded on clinicopathologic grounds in all cases. Infarct size was quantified at gross pathology on a four grade scale (small, moderate, moderate to extensive, and extensive). Tissue specimens were obtained at peri-infarct and remote sites. In situ end labelling of DNA fragmentation by transferase-mediated biotinylated UTP nick end labelling (TUNEL) was performed (Apoptag, Oncor) and sections were stained with antibodies against muscle actin (DAKO-Carpintera; dilution 1:50), and activated caspase-3 (Cell …

Hypoplastic coronary artery disease causing sudden death. Report of two cases and review of the literature

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.

Death due to railway-related suicidal decapitation: a case report

In Italy, railway-related deaths give rise to extensive inquiries because it is mandatory for the public prosecutor to investigate the circumstances of death. For the railway embankment, normal traffic rules are not valid and the guilt of the engine driver usually cannot be proven. Consequently, these cases are very often declared as suicides without adequate evidence. Furthermore, there is a potential risk of confusion with homicide, body dismemberment or mutilation. Our medico-legal institutes are increasingly engaged with expert opinions on questions of accident, suicide or homicide because they lead to complications in the fields of insurance, criminal and civil law.

1H NMR metabolite fingerprinting as a new tool for body fluid identification in forensic science

In this feasibility study, we propose, for the first time, 1H NMR spectroscopy coupled with mathematical strategies as a valid tool for body fluid (BF) trace identification in forensic science. In order to assess the ability of this approach to identify traces composed either by a single or by two different BFs, samples of blood, urine, saliva, and semen were collected from different donors, and binary mixtures were prepared. 1H NMR analyses were carried out for all samples. Spectral data of the whole set were firstly submitted to unsupervised principal component analysis (PCA); it showed that samples of the same BF cluster well on the basis of their characterizing molecular components and that mixtures exhibit intermediate characteristics among BF typologies. Furthermore, samples were divided into a training set and a test set. An average NMR spectral profile for each typology of BF was obtained from the training set and validated as representative of each BF class. Finally, a fitting procedure, based on a system of linear equations with the four obtained average spectral profiles, was applied to the test set and the mixture samples; it showed that BFs can be unambiguously identified, even as components of a mixture. The successful use of this mathematical procedure has the advantage, in forensics, of overcoming bias due to the analysts personal judgment. We therefore propose this combined approach as a valid, fast, and non‐destructive tool for addressing the challenges in the identification of composite traces in forensics. Copyright

Homicide by heart attack

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.

Objective post-mortem diagnosis of chronic alcohol abuse--a review of studies on new markers.

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.

Acute Ibuprofen intoxication: report on a case and review of the literature.

AbstractA fatality following the ingestion of ibuprofen is reported. Ibuprofen is a prototypical nonsteroidal anti-inflammatory drug widely prescribed as an analgesic, anti-inflammatory, and antipyretic agent. To date, there are few case reports of fatal overdose with ibuprofen, following ibuprofen self-poisoning or accidental overdose. We report the case of a 51-year-old man with medical history of psychiatric disease, who was brought to the emergency department by ambulance with a chief complaint of having taken large amounts of drugs in a suicide attempt.Multiple empty containers of medications (ibuprofen, meloxicam, celecoxib, risperidone, citalopram, ketorolac, bromazepam) were found at the scene. He died 4 hours after admission to the emergency department, despite vigorous supportive care. Toxicological analyses were performed using a gas chromatography/mass spectrometry technique. The estimated ibuprofen concentration in the plasma was 600 &mgr;g/mL; gastric content was 200 &mgr;g/mL for this compound. Our report describes results of the forensic investigation and discuss the review of the literature.

Fatal injection of ranitidine: a case report

IntroductionRanitidine 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.Case presentationWe 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.ConclusionAlthough 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.

Non-atherosclerotic coronary pathology causing sudden death

Coronary atherosclerosis is responsible for >50% of all cases of sudden death and for 90% of sudden coronary death. Four cases encountered in routine autopsy evaluation at our institute in 2004 in which non-atherosclerotic coronary pathology was responsible for sudden cardiac death are reported. The cases of a 31-year-old man with epicardial coronary arteritis, a 57-year-old man with intramyocardial vasculitis, a 45-year-old woman with spontaneous coronary dissection and a 50-year-old man with vascular fibrosis are described. Searching for non-atherosclerotic coronary disease is relevant for both the clinician and the pathologist to prevent coronary causes of sudden death going unrecognised.