Postpartum maternal death associated with undiagnosed Hodgkin's lymphoma.

The authors describe the case of a 28-year-old patient who died from an extensive intracerebral haemorrhage due to disseminated intravascular coagulation (DIC) which occurred a few days after delivery. Access to an emergency department of gynaecology on three separate occasions in the three days preceding hospitalization made judicial evaluation of the case necessary. The case was studied with a methodological approach based on the following steps: (1) examination of clinical records; (2) autopsy; (3) study of the placenta; (4) anatomo-histopathological observations concerning particular organs and structures potentially involved in postpartum maternal death; and (5) evaluation of physicians' behaviour, in the light of necroscopic findings and a review of the literature. The causes of death most frequently described in the postpartum period were excluded; a mediastinal nodular sclerosing Hodgkin's lymphoma with transdiaphragmatic diffusion, not diagnosed in life, was demonstrated. The cause of death was identified as intracerebral haemorrhage following DIC, Hodgkin's disease and recent delivery by caesarean section. Analysis of the physicians' conduct, together with a review of the literature, revealed a medical error. However, no causal relationship between the error and the death of the patient was considered to exist. The interest of the case lies in the unusual cause of DIC discussed in relation to a hypothesis of obstetric-gynaecological liability.

Neurocognitive and behavioral markers in DUI recidivists.

Objective: Driving under the influence (DUI) of alcohol recidivism may be a risk-taking behavior motivated by a change in decision-making capacity. Decision-making capacity has been investigated by event-related potentials (ERPs) acquisition and specifically by analyzing feedback-related negativity (FRN) reflecting the activity of medial prefrontal cortex. Thus, the aim of our study was to test the role of FRN as a possible neurophysiological marker of underestimation of risk associated with DUI recidivism to provide novel insights into the influence of neurocognitive aspects of driving ability.Methods: The research was structured as a case-control study. The total cohort (30 Italian male subjects) was divided into 2 groups, according to positive or negative history of DUI recidivism. The protocol included informed consent collection, medical history and clinical examination, ERP registration, and sensation-seeking scale administration. ERPs were acquired during a gambling task. The data were analyzed with 2 analysis of variance (ANOVA) repeated measures. Statistical analyses were conducted using R to test the participants' risk behaviors. A multivariate ANOVA was run to compare the personality traits of the groups. ANOVAs and planned comparisons were performed with StatSoft software.Results: FRN amplitude analyses showed that the interaction Reward Magnitude × Valence (large vs. small × gains vs. losses) was significant for recidivists (F(1,13) = 11.75, P < .01) but not for controls (F(1,14) = 0.04, P = .84). The results of the logistic generalized linear models analysis showed that the 2 groups differed in risk-taking behavior (z = -3.65; P < .001) with an average of 70 risky choices for recidivists and 63 for controls. Both groups were homogeneous for personality traits.Conclusions: The FRN and gambling task results suggest that DUI recidivists seemed attracted by the prospect of a large reward and appeared unable to recognize small losses read as wins These results, if confirmed in a larger sample, could indicate the usefulness of ERP analysis in clinical and forensic evaluation of DUI subjects.

GABA Receptors Genes Polymorphisms and Alcohol Dependence: No Evidence of an Association in an Italian Male Population.

OBJECTIVE: The genes encoding for gamma-aminobutyric acid (GABA) A and B receptors may be considered as candidates for alcoholism; genetic alterations at this level may produce structural and functional diversity and thus play a role in the response to alcohol addiction treatment. To investigate these aspects further, we conducted a preliminary genetic association study on a population of Italian male alcohol addicts, focusing on GABA A and B receptors. METHODS: A total of 186 alcohol-dependent subjects (in the first phase 139, then 47 more samples) and 182 controls were genotyped for 25 single nucleotide polymorphisms (SNPs) of genes encoding the alpha-1 subunit of GABA A receptor (GABRA1) and subunits 1 and 2 of GABA B receptor (GABBR1 and GABBR2). The chi-squared test for allele and genotype distributions and Hardy-Weinberg equilibrium analysis of both subjects and controls were performed. Bonferroni's correction for multiple comparisons was applied. RESULTS: Preliminary results comparing 139 alcohol-dependent subjects and 182 controls showed differences in genotype distribution in the former for SNP rs29253, located in the intron region of the GABBR1 gene. In order to clarify the meaning of this association, 47 more samples from alcohol-dependent subjects were tested for this SNP only: the previously found association was not confirmed. CONCLUSION: The lack of significant differences between the two groups does not provide evidence that GABRA 1 and GABBR1 and 2 genes are candidates for alcoholism in this population. Further studies with larger samples are needed, together with investigation of other components of the GABA pathway.

GABA receptors, alcohol dependence and criminal behavior.

The aim of this study was to analyze the connection between alcohol dependence and criminal behavior by an integrated genetic-environmental approach. The research, structured as a case-control study, examined 186 alcohol-dependent males; group 1 (N = 47 convicted subjects) was compared with group 2 (N = 139 no previous criminal records). Genetic results were innovative, highlighting differences in genotype distribution (p = 0.0067) in group 1 for single-nucleotide polymorphism rs 3780428, located in the intronic region of subunit 2 of the GABA B receptor gene (GABBR2). Some environmental factors (e.g., grade repetition) were associated with criminal behavior; others (e.g., attendance at Alcoholics Anonymous) were inversely related to convictions. The concomitant presence of the genetic and environmental factors found to be associated with the condition of alcohol-dependent inmate showed a 4-fold increase in the risk of antisocial behavior. The results need to be replicated on a larger population to develop new preventive and therapeutic proposals.