Subarachnoid hemorrhage during sexual activity after sildenafil intake: an accidental association?

We report and describe an autopsy case of a man dead for rupture of cerebral artery aneurysm with subsequent subarachnoid hemorrhage after sexual intercourse. Toxicologic analysis demonstrated that he had consumed sildenafil (Viagra). Although subarachnoid hemorrhage has been reported to be associated with sexual intercourse, it is not among the known adverse effects of sildenafil. However, sildenafil has been found to interact with vascular physiology via multiple mechanisms and in most of the vascular districts of the human body. This case provides an example of a very rare association between this drug and a fatal pathologic event and deserves to be added to the existing clinical knowledge about sildenafil and the pathophysiology of the events involved. This knowledge may be helpful in orienting further investigation into the mechanisms of action of sildenafil and their clinical implications.

[Fetal risks related to the administration of anti-arrhythmia drugs during pregnancy]. / Rischi per il feto legati alla somministrazione dei farmaci antiaritmici in gravidanza.

The major concern about the administration of antiarrhythmic drugs during pregnancy is related to their effect on fetal well-being. Even if teratogenic risks are higher during organogenesis in the first 8 weeks of pregnancy, after this period undesirable effects may include depression of uterine blood flow, interference with fetal growth and development, and interference with labor and delivery. Most drugs are secreted in the mother's milk, a fact that raises concern about the nursing infants. In this report we review the fetal risks related to the management of maternal arrhythmias during pregnancy showing that most patients can be treated with an excellent result for their babies.

Human DNA extraction from empty puparia.

Empty puparia, as well as larvae at different developmental stages, are potentially useful in the identification of a victim where a corpse has been removed from the scene of a forensic investigation. To evaluate the relevance and the reliability of this substrate to be used as forensic evidence, the authors report for the first time the extraction and typing of human DNA from empty puparia using STR analysis, in two actual cases where the bodies of the victims were still present thereby enabling validation of the typing.

Prevalence of newly diagnosed endometriosis in women attending the general practitioner.

OBJECTIVE: To investigate the prevalence of newly diagnosed endometriosis in premenopausal women who requested a consultation with their general practitioner because of non-gynecological problems. METHOD: Participants in the study were invited to complete a questionnaire investigating the presence of pain symptoms and infertility. On the basis of the characteristics of these symptoms, some patients underwent gynecological examination and transvaginal ultrasound. Radiological examinations were performed when bowel or bladder endometriosis were suspected. RESULTS: A total of 1291 women without a previous diagnosis of endometriosis were included in the study. On the basis of the symptoms, 108 women were referred to a gynecologist. After gynecological examination and transvaginal ultrasound, endometriosis was suspected in 51 women (47.2%). The diagnosis of endometriosis was confirmed by radiological investigations and/or surgery in 46 patients; the diagnosis of endometriosis was presumed in 2 other women but it was not confirmed by radiological investigations and/or surgery. The prevalence of endometriosis diagnosed by magnetic resonance imaging and/or surgery was 3.6% (46/1291). CONCLUSION: The prevalence of newly diagnosed symptomatic endometriosis in this study was at least 3.6%. A simple evaluation of symptoms (pain and infertility) that can be performed by a general practitioner facilitates the diagnosis of endometriosis.

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.