Gianluca Landi

Death by electrocution: Histological technique for copper detection on the electric mark

The current observation of deaths by electrocution, both for domestic and work-related accidents as well as those in other contexts, has deepened the scope of investigation into electric marks, especially from the histological point of view. This is one of the few investigation tools that may lead to the diagnosis of death by electrocution in this distinct area, bearing in mind the diagnostic difficulties that this type of fatality presents. Our attention has been placed on the phenomenon of metallization. In particular, we focused on using the Timms method [1] to locate the copper deposits. The phenomenon of metallization, usually could be caused by the copper deposit, this happens due to the copper debris released onto the skin by the live conductor. To date, this technique has only been used in the pathological field. Nevertheless, we tried to assess its application in seven selected cases, after partially modifying the technique, comparing it with the most common staining detection techniques and analysing the specificity, sensitivity as well as the potential for its application in the routine.

A case of fatal Clostridium perfringens bacteremia and sepsis following CT-guided liver biopsy of a rare neuroendocrine hepatic tumor

Clostridium perfringens, formerly known as Clostridium welchii, is an anaerobic, Gram-positive, spore-forming bacillus [1–3]. Clostridia are ubiquitous organisms found in soil and water, as well as in the gastro-intestinal and urogenital tract of healthy humans [1, 4]. Some Clostridia, like Clostridium botulinum, Clostridium tetani and Clostridium difficile are pathogenic to humans and animals [3, 5–7]. Clostridium perfringens has the ability to cause disease in humans and animals, because of its rapid growth, spore formation, and toxin production. The clinical presentation of C. perfringens infection includes a variety of manifestations, such as gas gangrene, emphysematous cholecystitis, crepitant cellulitis, fasciitis and myositis [4, 8–10]. The main toxin is theα-toxin, an enzyme that splits lecithin into phosphocholine and diglyceride, causing damage to red blood cell membranes, leading to spherocytosis and subsequent intravascular hemolysis [3, 11, 12] Once inside the body, this organism can also perform anaerobic fermentation, producing large amounts of gaseous waste products [13–15]. The mortality rate of patients with Clostridium perfringens bacteremia is 27–44%; in 7%–15% of cases, hemolysis complicates the sepsis, raising the mortality to 70%–100% [7, 16–18]. The early clinical symptoms ofC. perfringens infection are non-specific, which leads to considerable difficulty with diagnosis [19–22]. Early recognition and initiation of appropriate antibiotic treatment and surgical intervention or drainage is essential [18, 19]. In some instances, the initial presenting symptom is anemia, with a raised mean cell hemoglobin concentration and a reduced mean cell volume, in conjunction with hemoglobinemia and hemoglobinuria [10, 23, 24]. Gram-positive rods on a peripheral blood smear and positive blood or tissue culture confirm the diagnosis. A plain radiograph of the abdomen may reveal the presence of abscesses or gas in tissues [2].