RESUMO
Clinical, biological, pathological, and imaging findings were all suggestive of lethal human herpesvirus-6-associated encephalitis in a 61-year-old man who had undergone a cord blood transplant. The neuropathological findings of this unusual autopsy case and the pathogenesis of this infection in immunocompromised patients are discussed.
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical , Encefalite Viral/complicações , Leucemia Mieloide Aguda/complicações , Complicações Pós-Operatórias , Infecções por Roseolovirus/complicações , Encefalite Viral/patologia , Herpesvirus Humano 6/isolamento & purificação , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Infecções por Roseolovirus/patologiaRESUMO
Toxoplasmosis is a rare but well recognized opportunistic infection that can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Besides encephalitis, other common presentations of Toxoplasma gondii infection are interstitial pneumonitis and myocarditis. Because of its non-specific clinical and biological signs and its lethal outcome, toxoplasmosis is often misdiagnosed and only revealed at autopsy. We report a case of a postmortem diagnosis of disseminated toxoplasmosis associated with hemophagocytic syndrome, which underlines the value of necropsy in cases of death after transplantation. We also discuss clinical presentations and risk factors that lead to toxoplasmosis in allo-HSCT recipients.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Toxoplasma , Toxoplasmose/diagnóstico , Animais , Anticorpos Antiprotozoários/sangue , Autopsia , Encéfalo/parasitologia , Encéfalo/patologia , Evolução Fatal , Doença Enxerto-Hospedeiro/tratamento farmacológico , Coração/parasitologia , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Leucemia Mieloide Aguda/cirurgia , Pulmão/parasitologia , Pulmão/patologia , Linfo-Histiocitose Hemofagocítica/etiologia , Linfo-Histiocitose Hemofagocítica/patologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Toxoplasmose/etiologia , Toxoplasmose/patologiaRESUMO
PURPOSE: Clinical autopsy rate have been declining since the 1950s, but it remains a useful investigation tool. METHODS AND RESULTS: Through six examples of our experience, we underline its interest for clinical, didactic and public health purposes. CONCLUSIONS: We try to understand the reasons for its decline and, as demonstrated, it can be attributed to a number of factors. These need to be addressed in order to reassert the status of the autopsy as an investigation and audit tool which is crucial to the future effectiveness of modern medicine.
Assuntos
Autopsia , Casuísmo , Hospitais Universitários , Adulto , Idoso , Aterosclerose/diagnóstico , Fibrilação Atrial/diagnóstico , Cardiotônicos/efeitos adversos , Causas de Morte , Doença da Artéria Coronariana/diagnóstico , Trombose Coronária/diagnóstico , Diagnóstico Diferencial , Digoxina/efeitos adversos , Educação Médica , Feminino , França , Alucinações/induzido quimicamente , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Meningite por Listeria/diagnóstico , Meningite Pneumocócica/diagnóstico , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnósticoRESUMO
INTRODUCTION: Giant coronary aneurysms are rare and often confused with cardiac tumours. OBSERVATION: We report a new case of this type of aneurysm occurring on the right coronary artery revealed by a cardiac congestion. COMMENTS: These aneurysms can be due to inflammatory diseases or dysplasia. But in these pseudotumoral forms, atherosclerosis is the main aetiology. The diagnosis and treatment require surgery and histological examination.
Assuntos
Aneurisma Coronário , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/patologia , Aneurisma Coronário/cirurgia , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Extrapontine myelinolysis is a well-known complication of hyponatremia and its treatment. It rarely occurs without central pontine myelinolysis, usually after overly rapid correction of hyponatremia. Its prognosis is considered poor. EXEGESIS: We report the case of a patient with autoimmune polyglandular syndrome with subacute adrenal failure responsible of severe hyponatremia. Despite a well-conducted treatment, the patient developed acute anxiety, catatonia, dysphagia and parkinsonism revealing extrapontine myelinolysis demonstrated on MRI. Outcome was favorable. CONCLUSION: Extrapontine myelinolysis may occur in the absence of central pontine myelinolysis despite a treatment of hyponatremia conducted according to published guidelines. Treatment should be extremely cautious when hyponatremia has been lasting for more than 48 hours.
Assuntos
Mielinólise Central da Ponte/etiologia , Poliendocrinopatias Autoimunes/complicações , Doenças das Glândulas Suprarrenais/etiologia , Adulto , Transtornos de Ansiedade/etiologia , Catatonia/etiologia , Transtornos de Deglutição/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Mielinólise Central da Ponte/patologia , Transtornos Parkinsonianos/etiologia , PrognósticoRESUMO
A scavenging postmortem crawfish (Austropotamobius pallipes) is presented. A 60-year-old woman was found dead immersed in 2m of water in an artificial lack near a dam. The divers, on discovering the body, observed numerous crawfish near the face, the abdomen and the hands of the cadaver that disappeared at their approach. Her face showed extensive hemorrhagic lesions of the eyelids, lips and neck, initially attributed by the police investigators to a possible criminal assault. On autopsy, the face injuries were identified as a postmortem defect by animal scavenging. We present the macro- and microscopic aspects of these postmortem changes in relation to animal predation.
Assuntos
Astacoidea , Afogamento/patologia , Comportamento Alimentar , Mudanças Depois da Morte , Animais , Traumatismos Faciais/etiologia , Traumatismos Faciais/patologia , Feminino , Patologia Legal , Humanos , Pessoa de Meia-IdadeRESUMO
Two cases of scavenging postmortem freshwater shrimps (Gammarus pulex) are presented. We report the two first illustrated observations of cutaneous postmortem injuries inflicted by a G. pulex population, a small freshwater crustacean, on two non putrefied drowning victims, and we describe their particular histological features and their potential in forensic investigations.
Assuntos
Anfípodes/fisiologia , Afogamento/patologia , Comportamento Alimentar/fisiologia , Mudanças Depois da Morte , Adulto , Animais , Feminino , Patologia Legal , Toxicologia Forense , Água Doce , Hemólise , Humanos , Hipnóticos e Sedativos/análise , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Psicotrópicos/análise , Pele/lesões , Pele/patologiaRESUMO
PURPOSE: The aim of the medical autopsy is to define the causes of a patient's death. Although its rate has dramatically decreased, the post-mortem examination remains one of the basic tools for the assessment of medical care. The objective of this study was to identify the factors influencing the acceptance of medical autopsies. METHODS: A prospective survey was performed using questionnaire that was administered to patients and health care professionals of the Saint-Étienne university hospital. The survey consisted in several questions relating to the autopsy practice (on one's own body) and the knowledge of the procedure. RESULTS: The population surveyed consisted of 186 individuals and 112 health care professionals, including physicians, residents and nurses. The results of the study overall showed a good acceptance of autopsy. Actually, 86% of the individauls and 94.6% of health professionals would not be opposed to their own autopsy (in order to identify the cause of the death, to help relatives bereavement, to foster medical research). The main reasons of medical autopsy opposition include religion belief, body integrity, dignity and respect. Only 42.5% of patients had previously received some information about autopsies, while 33.9% of health care professionals had received a specific formation. CONCLUSION: The rate of refusal of medical autopsy was low in this survey but information relative to this procedure remains insufficient. The current law imposes to look after a nonopposition to medical autopsy of the died individual, including asking his/her relatives that markedly limit the organ donation. Modification of the French bioethical law should be beneficial to increase both medical autopsy organ donation rates.
Assuntos
Autopsia/legislação & jurisprudência , Temas Bioéticos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Adulto , Atitude , Autopsia/ética , Autopsia/estatística & dados numéricos , Causas de Morte , Feminino , França/epidemiologia , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Universitários , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Direitos do Paciente , Pacientes/estatística & dados numéricos , Médicos/estatística & dados numéricos , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde , Religião , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/estatística & dados numéricosRESUMO
Aspergillus is a ubiquitous fungus that can cause primary cutaneous aspergillosis in extremely low-birth-weight (ELBW) neonates, then be invasive and lead to death. ELBW neonates are particularly at risk because of decreased qualitative immune defenses and defects in the skin barrier. Broad-spectrum antimicrobial therapy and corticosteroids, often used in these patients, contribute to increased risk. We present a fatal case of primary cutaneous aspergillosis complicated with invasive aspergillosis, confirmed by autopsy, in an ELBW infant. The source of contamination was probably non-sterile disposable latex gloves used for neonatal care. The early recognition of this source led to its eviction for other hospitalized ELBW infants and no outbreak was observed.
Assuntos
Aspergilose/etiologia , Látex/efeitos adversos , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/patologia , Autopsia , Equipamentos Descartáveis , Evolução Fatal , Luvas Protetoras/efeitos adversos , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Necrose , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia , Dermatopatias/microbiologia , Dermatopatias/patologiaRESUMO
PURPOSE: To evaluate laryngoscopic findings in hanging cases and to compare them with magnetic resonance imaging (MRI) and forensic autopsy results. MATERIALS AND METHODS: Postmortem nasolaryngofibroscopy and MRI of five people who died from hanging were performed. Three people who died from other causes than hanging were also examined with a flexible laryngofibroscope. The results were compared with injuries discovered during forensic autopsy. RESULTS: In all five hanging cases, laryngofibroscopic investigation showed a vocal fold position in complete adduction confirmed by MRI. This position did not seem to be influenced by the intensity of the forces applied to neck or postmortem delay and cadaveric phenomena. The vocal cords of the three non-hanging deceased were found in the intermediate position. These findings could suggest that pressure applied to the cervical nervous and cartilaginous structures or their elongation during hanging could lead to closure of the glottis with vocal cord adduction maintained after death. CONCLUSION: Laryngofibroscopic examination in hanging cases could be very useful in confirming the vital character of the hanging and understanding asphyxial phenomena in incomplete suspension without laryngeal crush.