Cardiac rupture during acute myocardial infarction : Autopsy study (2004-2020).

INTRODUCTION: Cardiac rupture is a rare but critical complication of myocardial infarction with an incidence of 1 to 3% of cases. We aimed in this autopsy study to analyze the anatomical, epidemiological, cardiac, and coronary profiles of cardiac rupture in the Monastir region. METHODS: We conducted a descriptive study with retrospective data collection of all cases of myocardial infarction complicated by a cardiac rupture over seventeen years (2004-2020). RESULTS: Thirty-one cases were included in this study. The mean age of the cases was 67 years with a male predominance. Sixteen cases (57%) had cardiovascular risk factors. The most common symptomatology reported before death was acute chest pain in 57% of cases. Fourteen cases (45%) corresponded to the definition of sudden cardiac death. At autopsy, the heart had a mean weight of 452.78 grams. A large hemopericardium was associated in 90% of cases. Myocardial rupture involved the posterior wall of the left ventricle in 50% of cases. The myocardial rupture occurred at a site of acute myocardial infarction in 86% of cases and on a myocardial scar in 14% of cases. The coronary study showed double or triple vessel atherosclerotic coronary artery disease in 57% of cases with fresh thrombi at the infarct-related coronary in 11% of cases. CONCLUSIONS: Our analysis found that cardiac rupture mostly involved elderly subjects with underlying cardiovascular risk factors. Our findings sustain that age is a determining prognostic factor after acute coronary syndrome with the need for further education and awareness-raising efforts to speed up access to care for these patients.

Sudden death and hydatid cyst: A medicolegal study.

The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease, to discuss the mechanism of death and to propose preventive measures. This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017). In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period. Of the 26 victims, 13 (50%) were men; the mean age was 43 years. Most victims were from rural zones (18 cases). In 20 cases, the complicated cyst was hepatic. It was cardiac in two cases. Of all cases, three cysts were cracked, and nine were broken. Of the 26 cases, only 15 were implicated in the death mechanism. Death was attributed to anaphylaxis in 12 cases, hydatid pulmonary embolism in 1 case, cardiac arythmia in one case and hemothorax in one case. Sudden death is the most dangerous complication of the hydatid cyst which can be discovered at autopsy. Several causes may explain its occurrence, the most common of which is anaphylactic shock.

Age assessment in canine and premolar by cervical axial sections of cone-beam computed tomography.

Age estimation in adults is a challenge in both anthropological and forensic situations compared to sub-adults age estimation. The present study explored, for the first time, the cervical zone of single rooted teeth. The deposition of secondary dentin is responsible for a decrease in the volume of the dental pulp cavity with aging, and therefore is often used as an age indicator. The current study aimed at estimating the chronological age among adults by measuring the pulp/dentin area ratio (physiological ratio) by axial sections at cervical region of maxillary canine and mandibular second premolar. The sample consisted of 120 cone beam CT images of 120 Tunisians whose age ranged from 22 to 67, from the database of a private clinic of radiology. The first axial section of chosen teeth without enamel was selected. Linear regression models were derived for canine, premolar and for all variables to predict the age. They indicated that dentin deposition on canine and premolar have almost the same correlation with age (r=-0.838 and -0.837 respectively). The residual standard errors (RSE), when these regression equations applied for the entire sample, were ranged between 8.27, 8.29 and 7.06 for canine, premolar and for all variables respectively. Tested for younger ages (from 22 to 44years) the RSE decreased considerably and thus ranged between 4.32, 4.72 and 4.05. The outcomes of this study show that the physiological ratio is a useful variable for assessing age with a satisfying accuracy.

Age estimation from the sternal end of the fourth rib: a study of the validity of Iscan's Method in Tunisian male population.

The aim of this study was to assess the fourth rib phase Iscan method on a Tunisian sample. One hundred and eight (108) specimens of sternal ends of fourth ribs of Tunisian male population were collected during forensic autopsies performed in the Department of Forensic Medicine and Pathology of the University Hospital Fattouma Bourguiba of Monastir. Two operators, independently, assigned each rib to Iscan's phase. The data obtained by the two operators were analyzed using SPSS 17.0 and MedCalc. The repeatability and accuracy of Iscan method was tested by kappa coefficient (κ), for each operator. Spearman correlation coefficient (R), between estimated Iscan phase and Iscan phase relative to chronological age, was good with values of 0.758 (CI: 0.664-0.828) and 0.717 (CI: 0.611-0.798) for operator 1 and operator 2, respectively. The perfect agreement, between Iscan phase related to chronological age and Iscan phase estimated by both operators, was found for phases fewer than 5. Intra-observer agreement was highest for both operators with kappa value of 0.73 for operator 1 and 0.71 for operator 2. The estimation of the observers fell within one phase from the ideal and there was minimal disparity. A good accuracy between operator 1 and operator 2 was found (κ=0.747, p=0.057). In order to improve the results, we have pooled ages in five new phases. The correlation, between new age groups and Iscan phase estimated by both operators, was moderate. We conclude that Iscan method can be applicable in Tunisian population with a good correlation for age ranges under 39years.

Multidisciplinary approach to fatal dog attacks: a forensic case study.

Dog-bite-related injuries and fatalities are increasing in incidence and represent an important public health concern, as dogs are more and more becoming an integral part of human social life. We report the case of a 27-year-old woman who was found dead in her home. Her body was discovered lying face down in a large pool of partially desiccated blood with signs of having been dragged. Site examination revealed the presence of severe injuries on the face, neck and head, which were then traced back to the dog she owned. Death was attributed to exsanguinations due to a neck blood vessel's laceration with fracture of the fifth cervical vertebra. This was uncommon because the dog bites injured the vertebral artery only without any lacerations of the carotid artery. Confirming that the injuries are dog-bite related was based on a multidisciplinary approach including histological findings, odontological examination of bite marks and DNA analysis.