The frequency of ethanol, higher alcohols and other low molecular weight volatiles in postmortem blood samples from unnatural deaths.

The determination of various volatiles in postmortem blood samples has been reported in many previous studies. The presence of some of them in postmortem specimens reflects microbial activity in the sample while others are detected mainly after consumption of alcoholic beverages or due to antemortem metabolic processes. This contribution aims to determine in 1954 postmortem blood samples, from respective number of unnatural deaths autopsy cases, the frequency of detection of some common volatile compounds, including acetaldehyde, acetone, 2-propanol, ethyl acetate, methanol, as well as, the higher alcohols 1-propanol, 1-butanol, isobutanol and 2-methyl-1-butanol and 3-methyl-1-butanol; moreover, their patterns in respect to the ethanol and 1-propanol concentrations and the putrefaction state of the corpse at autopsy. Acetone was the most frequently detected volatile (82 %), followed by acetaldehyde (44 %) and 2-propanol (34 %). Methanol was detected in 12 % of the samples and only in the presence of ethanol. The most frequently detected higher alcohol was 1-propanol (51 %), followed by isobutanol (8.5 %), 1-butanol (3.6 %) and methyl-butanols (2.0%); the latter three higher alcohols were detected in the presence of 1-propanol indicating possibly a common origin. Samples from cases with putrefaction had higher 1-propanol concentrations, than those without putrefaction, and, moreover, they were significantly correlated with 1-butanol concentrations.

Fibrolipoma of the left ventricle: an uncommon incidental autopsy finding.

Fibrolipoma of the heart is an unusual benign tumorous entity encountered, if present, during an ordinary imaging workout or at autopsy. It is often clinically silent but it can also be symptomatic depending on the size and location of the tumor. We report a case of an 82-year-old man with a medical history of malignant pleural mesothelioma. The decedent was referred to our department to undergo a forensic autopsy after a fall. Postmortem examination revealed a large encapsulated gelatinous, yellowish cardiac mass with its pedicle on the subendocardial region of the left ventricular anterior wall and interventricular septum, protruding into the left ventricular cavity. Histological examination confirmed the diagnosis of cardiac fibro-lipoma, a rare histologic variant of lipoma, irrelevant to the cause of death in the present case. The rarity of the occurrence of fibro-lipomas provides clinical implications for the inclusion of the entity in the differential diagnosis of a cardiac mass.

The effect of range and ammunition type on fracture patterns in porcine postcranial flat bones.

Pig half-carcasses were shot in scapulae, ribs and mandibles with either 0.243 hunting rifle using high velocity expanding ammunition (N = 30) or AK47 using full metal jacketed (FMJ) ammunition (N = 12) from a range of either 5 or 20 m. Fracture patterns related to distance of fire and ammunition type were compared on de-fleshed, macerated, and reconstructed bones. For expanding ammunition, location of fracture on ribs affected the resulting pattern. Scapulae shot from 5 m presented a comminuted pattern different from those shot from 20 m. Mandibles shot from 20 m showed a characteristic radiating pattern at entrance with the opposite ramus un-fractured; those shot from 5 m exhibited fractures to both rami. Using decision tree analysis provided accuracies of 93.8% for scapulae and 87.5% for mandibles. For FMJ, no distance dependent fracture differences were apparent in any bone. Decision tree analysis facilitated the interpretation of fracture patterns caused by projectile trauma.

Giant Metastatic Liver Tumor of Unknown Primary Origin: Thoracic Autopsy Solves the Mystery.

A 59-year-old male patient was hospitalized in the Internal Medicine Department for investigation of hepatic metastases from an unknown primary neoplasm. During the hospitalization the patient died from acute myocardial infarction. The autopsy revealed a 8.2 kilograms (kg) liver that was diffusely infiltrated by whitish metastatic masses. No other tumor was detected, apart from a 2.5 centimeters (cm) pulmonary nodule next to the right intermediate bronchus that was histologically compatible with small cell lung cancer (SCLC). Despite the fact that hepatic metastases from SCLCs are common, diffuse metastatic hepatomegaly from a malignant pulmonary nodule are rarely seen. Given that the most common cause of malignancy-related death is lung cancer, early diagnosis and appropriate management of pulmonary nodules is of paramount importance.

Survey of medico-legal investigation of homicide in the region of Epirus (Northwest Greece).

This study analyzed the forensic features of homicides in North-West Greece (Epirus) from 1998 to 2013, a borderland area between Greece and Albania. Although Greece is critically influenced by both the increasing flow of refugees and the current socioeconomic crisis, very little information has been published regarding the patterns of homicide in the country. Fifty-eight autopsied victims (36 males; 22 females) were investigated. The median age was 37 years old. The average annual homicide rate was 0.85 per 100,000 inhabitants and showed remarkable fluctuation, with largest increase during Greek financial downturn. Sixteen victims were not Greek citizens. The most common method of commitment was the use of firearm (40%). The main motives were economical causes (26%) and passion (14%). Four cases were categorized as matricide (7%), 3 as homicide-suicide (5%), 2 as patricide (3%) and 1 as infanticide (2%). Toxicological analysis proved negative for ethanol and other psychotropic substances in the majority of the victims (50%). There is an urgent need for public actions both in Epirus and in Greece, with the application of effective strategies against criminality.

Residues of selected polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP) in postmortem lungs from Epirus, northwestern Greece.

Organochlorine (OC) pesticides and polychlorinated biphenyls (PCB) are compounds characterized as persistent organic pollutants (POP) in the environment. These compounds are monitored globally since they enter the human body and accumulate in tissues, resulting in consequent adverse effects. In this study concentrations of selected OC compounds were determined in human autopsy lungs from Epirus, a relatively restricted region in northwestern Greece. This is the first epidemiologic study from Greece reporting on monitoring of environmental pollutants in human autopsy material. Thirty lungs collected from that number of autopsy cases were analyzed: 19 males and 11 females. The age range was 14-91 yr (mean ± SD = 61.8 ± 22.5 yr). Twenty-two cases (73%) were positive for at least one pollutant and eight cases were negative (27%). PCB were the most abundant class of contaminants, detected in 15 out of the 30 cases (50%). Dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexanes (HCH) were second and third in abundance with 9 (30%) and 8 (27%) positive cases, respectively. The frequency of detection showed a tendency to increase with age of individuals. The patterns of OC found in human autopsy lungs were similar to those reported previously for other human specimens. Our results demonstrated a similar trend in contamination sources and distribution has occurred in western Greece as noted globally.

Unusual death due to a bleeding from a varicose vein: a case report.

BACKGROUND: Varicose veins are a common entity presenting a worldwide distribution. Although they are usually benign, sometimes are proved to be a threatening condition. Massive hemorrhage is an unusual complication of this common venous pathology that demands immediate medical intervention. CASE PRESENTATION: We present a case of a 66-year-old woman found dead in her house surrounded by a large quantity of blood. Autopsy revealed a 7 mm ulcer on the internal surface of the left lower leg communicating with a varicose vein, signs of exsanguinations and liver cirrhosis. Toxicological analysis was negative. CONCLUSION: Massive hemorrhage from a ruptured varicosity is a severe medical emergency. Awareness of the risk of massive hemorrhage may provoke preventive treatment to be undertaken so as terminal loss of consciousness and a subsequent unattended death to be averted.

An autopsy case of necrotizing eosinophilic myocarditis causing left ventricular wall rupture.

Acute necrotizing eosinophilic myocarditis (ANEM) is a rare entity with sudden onset and rapidly progressive course, usually leading to a fatal outcome. It is characterized by focal or widespread myocyte necrosis. The entity's clinical presentation is quite variable, rendering the antemortem diagnosis difficult. A case of a 66-year-old woman dying suddenly, initially considered to have suffered a myocardial infarction and finally proved at autopsy to have died due to ANEM resulting in myocardial rupture, is presented. Left ventricular wall rupture is in the majority of cases, a complication of myocardial infarction and its association with acute myocarditis has been very rarely reported. The case reported herein highlights the infrequent presentation of ANEM as cardiac rupture. Myocardial rupture is associated with a high mortality rate, even if immediate surgical repair and intervention are provided.

Sudden cardiac death: an 11-year postmortem analysis in the region of Epirus, Greece.

The aim of the study was to determine the rate of sudden cardiac death in people aged between 1 and 80 years, and to investigate its etiology. All autopsies performed during an 11-year period were reviewed. Circumstances of death, individual's information, and post-mortem findings were determined. Among 1254 sudden death autopsies performed during the study period, 688 cases were recognized as sudden cardiac death (79.8% males). The estimated annual frequency of sudden cardiac death in the region of Epirus was 18.6/100,000. The major cause of death was ischemic heart disease (82%), and in 2.6%, death was unexplained. Among our study's total population, 4.1% were <35 years old. The estimated annual rate of sudden cardiac death in the population 1-35 years old was 1.78/100,000. The most common etiology in that age group was atherosclerosis (17.8%), myocarditis (10.7%), and cardiomyopathies (10.7%), whereas 39.3% exhibited structurally normal heart. Although ischemic heart disease accounts for most of sudden cardiac death episodes, many other causes contribute. Most sudden deaths in the young were "unascertained". The likely cause of death in these cases might be a primary arrhythmogenic disorder. Correct identification of such cases at autopsy will enable an appropriate clinical screening of surviving relatives.

Death-related gastric necrosis after laparoscopic adjustable gastric banding in the early post-operative period.

We report a case of a rare complication of laparoscopic adjustable gastric banding (LAGB) as a cause of death in the immediate post-operative period. The number of relevant reports and postmortem images presented in the literature is extremely restricted. Gastric necrosis may constitute a cause of death after LAGB in the early post-operative period. Postmortem examination reveals the extension of gastric ischemia and necrosis, responsible for the lethal outcome. To date, only one case of gastric necrosis after LAGB in the immediate post-operative period leading to death has been reported, according to authors' knowledge. The diagnosis of this complication may be delayed on the grounds of its rarity. In our opinion, surgeons should be aware of the clinical state implying gastric ischemia early after LAGB, so as to recognize and, in turn, to treat it promptly.