Petechial hemorrhages, ethanol, and opioids in victims from intoxication.

Petechial hemorrhages are of interest to forensic pathologists because of their association with pressure on the neck. This study shows the associations between ethanol, opioids in blood and the risk of petechiae in conjunctivae and eye lids of 865 medico-legally examined victims from intoxication, 112 (12.9 %) with petechiae. Livor mortis on the front, face down body position, higher body weight, and younger age of the victims were independently associated with higher risk of petechiae. These variables were used for adjustment in the logistic regression analyzes. We found associations between ethanol, opioids, and the risk of petechiae when analyzed simultaneously. The association between ethanol and the risk of petechiae differed in opioid negative and positive victims (interaction, p = 0.028). In the opioid negative group, the association was J-formed, victims with low to medium level ethanol having lower risk (OR = 0.77) than those without ethanol or opioids, whereas high ethanol level gave a 4-fold higher risk (OR = 3.97). In the opioid positive group, the J-formed pattern was reversed. Victims with low to medium level ethanol had more than 4 times higher risk (OR = 4.65), whereas high level ethanol gave a slightly elevated risk (OR = 1.34) only compared to no ethanol or opioids. The results suggest that ethanol and opioids have a complex association with the risk of petechiae independent of livor mortis, initial body position, body weight, and age in victims from intoxication. Of practical value for the post-mortem examination is that the pathologist must consider both the ethanol level and the presence of opioids when judging the significance of petechiae in the eye regions.

Petechial Hemorrhages in Suicide by Hanging: Possible Contributing Variables in Petechial Development.

Hemorrhagic petechiae in the conjunctiva and the skin have been related to type of suspension and body height of the victims of hangings. In 265 cases of hanging, we retrospectively examined whether petechiae relate to type of suspension, body weight and height, body mass index (BMI), age, sex, type and thickness of the ligature, and blood alcohol content. The type of suspension was divided into completely suspended, incompletely suspended, and found with feet touching the ground. There was no significant difference in the frequency of petechiae between the feet touching the ground and complete suspension, and they were therefore considered as one group (complete suspensions). Incomplete suspensions had more (58.7%) petechiae than the complete suspension group (30.2%). Statistical analysis showed that incomplete suspension was significantly stronger related to the development of petechiae than complete suspension. Body mass index was the only variable able to add information to the type of suspension. In victims of incomplete hangings, high BMI yielded 2.58 times higher probability of developing petechiae than low BMI. These findings suggest that body size may contribute to the development of petechiae in hangings.

Petechial Hemorrhages and Ethanol in Deaths from Intoxication.

Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.

An experimental protocol for the fractionation and 2DE separation of HeLa and A-253 cell lysates suitable for the identification of the individual antigenic proteome in Sjögren's syndrome.

Sjögren's syndrome (SS) is an autoimmune disease affecting exocrine glands, especially the salivary and lacrimal glands. Although most of the SS patients' sera have autoantibodies that can target a variety of antigens, it is not clear what determines which proteins will become autoantigens. The muscarinic receptor M3, an integral plasma membrane protein, has been proposed as a possible autoantigen in SS, and is endogenous in HeLa cells. The aim of this study was to develop a method that is able to separate and identify antigens recognised by sera from SS patients using lysates of HeLa and A-253 cells in 2D Western Blot (2DWB). The HeLa and A-253 cell lysates were fractionated in soluble and membrane-bound proteins, and the membrane-bound proteins were enriched for integral proteins. The fractions were tested using WB, confirming the presence of the main cell compartments. The rehydration solution containing ASB-14 performed better than the others in all three steps (active rehydration, focus and transfer), and efficiently separated the muscarinic receptor M3. The M3 receptor was also detected in lysates from A-253 cells. The presence of this receptor in this cell line has not been proven earlier. This work develops a suitable protocol to perform a mapping of the autoantibodies present in the sera of single SS patients, using lysates from epithelial cell lines that represent the main cell compartments as an antigen source. It is our future aim to use this protocol to perform a mapping of the antibodies present in the sera of individual SS patients.

[Decline in hospital autopsies]. / Farre sykehusobduksjoner--lang svartid.

BACKGROUND: According to the new autopsy regulation from April 2004 the next to kin must be informed of an autopsy and the right to deny consent. The present study aims at documenting the impact of this regulation on the number of autopsies performed and to determine whether regular reminders and changed autopsy routines could reduce the time needed to complete autopsy reports. MATERIAL AND METHODS: The following information was gathered; the number of autopsies before and after implementation of the regulation, the number of next to kin who had been informed and the number that had denied consent. The consequence of monthly reminders to the pathologists for the time needed to complete the autopsy report was examined for the years 2000 to 2004. The autopsy routine was altered for six weeks in 2005; the doctors performed autopsies for two successive weeks instead of one. The time to complete the report in this period was compared with that of the same period the year before. The chi-squared test, the Mann-Whitney test and the Kruskal-Wallis test H test were used. RESULTS: After the autopsy regulation was introduced the number of autopsies/year decreased from 432 (39%) to 332 (31%) of all who had died in the hospital (p < 0.001). For 211 (20%) of the deaths, the next to kin had not been informed. The number who denied consent increased from 258 (23%) to 373 (35%). Monthly reminders reduced the median time for completing the autopsy report from 58 to 38 days (p < 0.001). Altering the autopsy routine reduced the median time needed to complete the report from 46 days the year before to 14 days after the changed routine (p < 0.001). INTERPRETATION: Better information to next to kin will probably increase the number of autopsies. The time needed for completing the autopsy report can be reduced by simple means.

The associations of obesity, lymph node status and prognosis in breast cancer patients: dependence on estrogen and progesterone receptor status.

Breast cancer patients who are obese have a higher risk of lymph node metastases and a poorer prognosis than those who are slim. It has been claimed that estrogens derived from fat are important for these associations. If estrogens are important, these relationships must be stronger in the hormone receptor-positive than in the hormone receptor-negative groups. Body mass index (BMI) was used as a measure of obesity. The second, third, and fourth quintiles of BMI were treated as one group and termed 'medium'. Patients in the fifth quintile were termed 'obese' and those in the first quintile 'slim'. The number of women with unilateral disease treated with modified radical mastectomy and included in the study was 1211. Of all patients included, obese patients had a 1.53 higher risk of lymph node metastases compared to slim patients (p=0.02). In the PgR-negative group, obesity gave a 3.08 times higher risk of lymph node metastases (p=0.03). The risk of dying of breast cancer tended to be higher in obese than in slim patients when all patients in the study were compared (relative risk=1.38, p=0.06). BMI did not show a statistically significant relationship with prognosis if only hormone receptor status was considered. However, if lymph node status and hormone receptor status were taken together, the association was strong and reversed in the lymph node-positive group with ER-negative tumours. The adjusted relative risk was 0.33, showing that slim patients had a 3.03 (1.0/0.33) times higher risk of dying of breast cancer compared to obese patients (p=0.002). These results indicate that non-hormonal mechanisms could be important.