Descriptions of two new cases of Rocky Mountain spotted fever in Panama, and coincident infection with Rickettsia rickettsii in Rhipicephalus sanguineus s.l. in an urban locality of Panama City, Panama.

The clinical and pathologic characterisation of two fatal cases of tick-borne rickettsiosis in rural (El Valle) and urban (City of Panama) Panama are described. Clinical and autopsy findings were non-specific, but the molecular analysis was used to identify Rickettsia rickettsii in both cases. No ticks were collected in El Valle, while in the urban case, R. rickettsii was detected in Rhipicephalus sanguineus s.l., representing the first molecular finding in this tick in Panama and Central America.

The diagnosis of drowning by quantitative and qualitative diatom analysis.

The reliability and applicability of quantitative and qualitative diatom analysis in the diagnosis of drowning has been evaluated. Water and organ samples of immersion cases reported in the area covered by the Department of Forensic Medicine of the London Hospital Medical College, were analysed using both light and scanning electron microscopy. Controls included organ samples of the bodies of people who died from natural causes and exclusion of contamination. Organ samples of both immersion and control cases were prepared by chemical digestion with concentrated nitric acid. Diatoms were present in the majority of samples of organs of both immersion and control cases but there was a significant quantitative difference between the number of diatoms in control and immersion cases. Qualitative analysis of water and organ samples of immersion cases supported the diagnosis of death due to aspiration of water in approximately a third of the total of bodies found in water. It has been suggested that the present analysis can be used as basic criteria for standardization of the diatom method.

A fatal case of neuroleptic malignant syndrome.

A fatal case of Neuroleptic Malignant Syndrome (NMS) affecting a middle-aged woman is presented. Most of the signs and symptoms described for NMS were present and death occurred three hours after the onset of hyperpyrexia. Laboratory and postmortem findings were non-specific. The uses and risks of Haloperidol and Phenelzine on a patient with severe liver impairment are considered. Finally, the medico-legal implications in the context of sudden unexpected death are mentioned.

An exceptional case of lethal disulfiram-alcohol reaction.

A case of fatal disulfiram-alcohol reaction due to ingestion of ethanol and antabuse is presented. Unusual autopsy findings and toxicological results are described. This case represents a report of corrosion lesion in the lower oesophagus and stomach due to a violent chemical reaction in situ and also the highest blood concentration of acetaldehyde (41 mg/l) ever recorded.

Scanning electron microscopy: application in the identification of diatoms in cases of drowning.

A simple and rapid method is described for processing organ and water samples for the identification of diatoms so that they can be studied and recorded for taxonomic and diagnostic purposes. Samples are treated with concentrated nitric acid; the fluid obtained is centrifuged, and its sediment is dried, coated, and examined under the scanning electron microscope. The method does not alter the morphology of diatoms and allows the study of freshwater and seawater species present in the organs of bodies found in the water, making possible the diagnosis of drowning under specific conditions.

Submersion cases: a retrospective study--1988-1990.

According to the studied material the majority of the bodies found submersed in water (in the area covered by this report) were predominantly those of Caucasian males between 20 and 40 years of age, probably sober and without drug consumption when they entered the water. The majority of the cases were recovered from the water in the late spring and early summer and many of them were in different stages of decomposition which made the diagnosis of drowning impossible. The diagnosis of the cause and manner of death in such cases requires a complex interpretation of all investigative evidence and a logical approach in each case in particular.

[Angioimmunoblastic lymphadenopathy with dysproteinemia. The first reported case at the "Santo Tomás" Hospital]. / Linfadenopatiá angioinmunoblástica con disproteinemia. Primer caso reportado en el Hospital "Santo Tomás".

Description of the first case of angio-immunoblastic lymphadenopathy with dysproteinemia diagnosed in a male patient 64 years old and which preceded the development of a lymphoma. The importance of this study is the association that may exist between certain drugs and the development of angioimmunoblastic lymphadenopathy, which occurred in our patient with the use of diphenylhydantoin. This disease can present itself up to 22 years after exposure to the agent.

[Thymoma of fusiform cells. Report of a case]. / Timoma de células fusiformes. Informe de un caso.

A 63 yo female was hospitalized with a 2 week history of vomiting, epigastric pain, anorexia and weight loss. She had an incidental finding of left anterior upper mediastinal mass on Chest Xray and TSP of 2.2 gm% and globulins of 1.2 gm% along with endobronchial larvae of Ascaris lumbricoides and malignant cells and Strongyloides stercoralis in the gastric mucosa. She died after a progressively deteriorating course and at autopsy a thymoma predominantly composed of spindle shaped cells was found. This rare variant of thymoma has been associated with red cell agenesis and with immunodeficiency (Good's syndrome).