Construcción y validación de la escala de predicción y valoración del riesgo de violencia (EPERV-55) en trastorno mental grave / Construction and validation of the violence risk prediction and assessment scale (EPERV-55) in severe mental disorder

OBJETIVO: diseñar y validar la Escala de Predicción y Evaluación de Riesgo de Violencia (EPERV-55) en personas con trastorno mental grave (TMG) hospitalizadas en unidades de media y larga estancia. MÉTODO: se elaboró un cuestionario EPERV-55, con 55 ítems, en función de la literatura revisada y del conocimiento del equipo investigador sobre diferentes herramientas de predicción y evaluación de violencia en TMG. Se integraron datos clínicos de predicción y de gestión del riesgo, incluyendo la taxonomía NANDA/NOC. Para la validez de constructo se obtuvieron datos de pacientes ingresados en Unidades de Salud Mental del Hospital Parc Sanitari Sant Joan de Déu (Barcelona). Se valoró la consistencia interna de la escala con el coeficiente alfa de Cronbach. La validez convergente se evaluó mediante el coeficiente de correlación de Rho de Spearman comparando la EPERV-55 con la Escala de Riesgo de Violencia de Plutchik. Para medir la sensibilidad y especificidad se utilizó el test U de Mann-Whitney. Los análisis se realizaron con los programas estadísticos R 2.13 y SPSS 19. RESULTADOS: participaron 177 sujetos. A escala presentó un alpha de Cronbach de 0,92. La fiabilidad test-retest fue buena en 23 ítems de la escala y moderado en 32 ítems. La validez convergente fue significativa con las escalas EPERV-55-RV (correl. Spearman: -0,348 y -0,458 respectivamente; p < 0,001). En la sensibilidad y especificidad se objetivaron diferencias significativas en violencia general (p < 0,004) y violencia heteroagresiva (p < 0,005). El índice de la curva de Roc fue significativa en violencia heteroagresiva, hacia objetos y general. CONCLUSIONES: la escala EPERV-55 es un instrumento válido para evaluar y predecir el riesgo de violencia en personas con TMG hospitalizadas en unidades de media y larga estancia

OBJECTIVE: to design and validate the Violence Risk Prediction and Assessment Scale (EPERV-55) in persons with severe mental disorder (SMD) hospitalized in medium and long-stay units. METHOD: an EPERV-55 questionnaire was prepared, including 55 items, based on the literature reviewed and the knowledge by the research team about different tools for violence prediction and evaluation in SMD. Clinical data on risk prediction and management were incorporated, including the NANDA/NOC taxonomy. For construction validity, data were collected from patients hospitalized in Mental Health Units of the Hospital Parc Sanitari Sant Joan de Déu (Barcelona). The internal consistency of the scale was assessed with Cronbach's Alpha Coefficient. Convergent validity was evaluated through Spearman's Rho Correlation Coefficient, comparing EPERV-55 vs. the Violence Risk Scale by Plutchik. Mann-Whitney's U Test was used in order to measure sensitivity and specificity; analyses were conducted with the R 2.13 and SPSS 19 statistic programs. RESULTS: the study included 177 subjects. The model presented 0.92 in Cronbach's alpha. Test-retest accuracy was good in 23 items of the scale, and moderate in 32 items. Convergent validity was significant with the EPERV-55-RV scales (Spearman's Correlation: -0.348 and -0.458 respectively; p < 0.001). Regarding sensitivity and specificity, significant differences were observed in Overall Violence (p < 0.004) and Hetero-aggressive Violence (p < 0.005). The Roc Curve index was significant in Hetero-aggressive Violence, against objects, and general. CONCLUSIONS: the EPERV-55 scale is a valid tool to evaluate and predict the risk of violence in persons with SMD hospitalized in medium and long-stay units

Stability studies in biological fluids during post-analysis custody. Opiate compounds derived from heroin consumption.

In Forensic Toxicology, the evidences have to be maintained under custody for, at least, one year. Depending on the conditions and duration of storage, drug concentrations might have changed considerably since the first analysis. The aim of this study is to evaluate in vitro stability of opiate compounds, derived from heroin consumption, 6-acetylmorphine (6-MAM), morphine (MOR) and codeine (COD), in blood and urine, during post-analysis custody. Parameters evaluated were: time of custody, temperature, addition of preservative (blood) and pH (urine). Blood and urine samples were spiked with the three analytes to give a final concentration of 1000 ng/mL. The prepared samples were divided into 2 groups and stored at two temperatures (4 °C and -20 °C). Each one of these groups was subsequently divided in other two groups: with and without preservative (1%NaF) for blood, and pH 4 and 8 in the case of urine. 6-MAM, MOR and COD were analyzed by GCMS after SPE and derivatization with BSTFA. Analyses were performed in triplicate every two weeks for a year. In blood samples 6-MAM is the only compound that degrades. The best storage conditions were at -20 °C with NaF, with 6-MAM recoveries, after one year of custody, of 47.1 ± 1.5%; while in the other conditions 6-MAM disappeared after 215 days (at 4 °C with NaF), 45 days (at -20 °C without NaF) and 15 days (at 4 °C without preservative). COD does not degrade, with recoveries higher than 90%, in all of the conditions. They ranged from 89.7 ± 3.6% in samples maintained at -20 °C without NaF to 95.9 ± 2.0% in those maintained at 4 °C with NaF. MOR recoveries were lower than those of COD. They ranged from 66.9 ± 3.6%, in frozen samples added with NaF, to 78.6 ± 0.5% in refrigerated samples without preservative. In urine samples the three compounds were stable in all the studied conditions, with the exception of 6-MAM in samples at pH 8 and stored at 4 °C. In these conditions, 6-MAM disappeared after 135 days of custody; while recoveries in the other conditions ranged from 93.7 ± 6.4%, at 4 °C and pH 4, to 85.1 ± 2.0% at -20 °C and pH 8. MOR and COD recoveries were similar in the four conditions. In the case of MOR, they ranged from 82.1 ± 1.2% at 4 °C and pH 4 to 89.5 ± 6.0% at -20 °C and pH 8. As far as COD is concerned, recoveries ranged from 111.6 ± 5.8% at 4 °C and pH 8 to 102.6 ± 1.2% at 4 °C and pH 4. In conclusion, the study showed that the most labile opiate compound is 6-MAM. Its stability mainly depends on urine pH or the addition of preservative, in blood samples. The best storage conditions for samples from heroin consumers are in the freezer, at -20 °C. In addition, blood samples must be added with 1%NaF and urine samples must be buffered at pH 4.

Muerte súbita por metástasis de melanoma en aurícula derecha: Revisión de los tumores cardiacos / Sudden death due to metastasis of melanoma in right atrium. Review of cardiac tumours

Los tumores cardiacos son entidades clínicas muy raras, sin embargo tienen especial interés desde el punto de vista médico-forense porque pueden ser la causa de una muerte súbita. Presentamos el caso de un varón de 38 años de edad con un melanoma de coroides que fallece de forma súbita cuatro años después de realizarse el diagnóstico. La autopsia médico legal y el estudio histopatológico mostraron un tromboembolismo pulmonar originado sobre una metástasis de melanoma en la aurícula derecha. En el presente artículo llevamos a cabo una revisión general de los tumores cardiaco (AU)

Cardiac tumors are rare clinical entity, however, they have an especial interest in forensic medicine because they can be the source of sudden death. We report a case of a 38-years old male who had been diagnosed with primary choroidal melanoma some years before his sudden death. Forensic autopsy and histopathologic examination revealed pulmonary embolism due to a melanoma metastasis in the right atrium. In addition, in this article we conduct a general review of cardiac tumors (AU)

[Study of oxidative stress in advanced kidney disease]. / Estudio del estrés oxidativo en enfermedad renal avanzada.

INTRODUCTION: Introduction Patients with Chronic renal Disease (CRD) often have cardiovascular disease that is the main cause of morbidity and mortality. Oxidative stress and a subclinical inflammation are crucial factors in its development. The aim of this study was to asses the oxidation of the main molecular lines in patients with advanced renal disease without dialysis and to determinate the best biomarker to asses this stress. PATIENTS AND METHODS: We performed an observational study to measure the most important oxidative biomarkers in 32 patients with stage 4 CRD (MDRD = 22.1 +/- 1.08 ml/min) compared with the values obtained in a control group. In peripheral lymphocytes we measured, the lipid peroxidation by Malondialdehyde (MDA) and F2 Isoprostanes in plasma; protein oxidation by glutathione oxidized/reduced ratio (GSSG/GSH) in peripheral lymphocytes and protein carbonyls in plasma and the oxidative damage in genetic material by modified nucleotide base 8-deoxiguanosina oxo -(8-oxo-dG), after isolating nuclear and mitochondrial DNA. We also studied the antioxidant defenses with superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GSR) and catalase (CAT) in peripheral lymphocytes. We studied the correlation between oxidative stress and the renal function and oxidative stress and co-morbidity factors. RESULTS: All biomarkers showed important differences in comparison with the control subjects. 821.89 +/- 300.47 ng/ml vs. 270 (95.66) * ng/ml (p < 0.000), MDA 0.11 (0.11) * vs. 0.7 +/- 0.31 nmol/mg prot (p <0.000). GSSG / GSH: 6.89 +/- 1.91 vs. 1.39 +/- 0.75 (p <0.000), protein carbonyls: 7.41 +/- 0.84 vs. 3.63 (1.12) *. Nuclear 8-oxo-dG 7.88 (2.32) vs. 2.96 (1.78) * mitochondrial 8-oxo-dG: 15.73 +/- 2.28 vs. 13.85 +/- 1.44 (p <0.05). The Antioxidant enzymes also showed differences. Nuclear 8-oxo-dG demonstrated an important relationship with the rest of biomarkers, homocysteine (r = 0.305, p <0.05), lipoprotein (a) (r = 0.375, p <0.01), mitochondrial 8-oxo-dG (r = 0.411, p <0.05), GSSH/GSH (r = 0.595, p <0.001) and protein carbonyls (r = 0.489, p <0.05). There was an inverse correlation with total protein (r = -0.247, p <0.01), GSH (r = -0.648, p <0.000), GSR (r = -0.563, p <0.001) and SOD (r = -0.497, p <0.000). We did not find any correlation between these parameters and renal function. The presence of diabetes or the treatment with statins did not showed significant differences. * Median (Interquartile range). CONCLUSION: There is an important oxidative stress in patients with advanced renal disease, probably established during early stages of disease. Of the studied parameters, the nuclear 8-oxo-dG is the best marker for oxidative stress in CRD.

Aquatic toxicity assessment of the additive 6-methylcoumarine using four experimental systems.

The toxicity assessment of chemicals is one of the main issues in the current policies in order to protect the health of the environment and human beings. Food and cosmetic additives have been extensively studied in relation to their toxicity to humans, but data about their ecotoxicological effects are scarce. The aim of this study was to evaluate the toxic effects of the additive 6-methylcoumarine in the aquatic milieu using a test battery comprising experimental model systems from different trophic levels. The inhibition of bioluminiscence was studied in the bacteria Vibrio fischeri (decomposer), the inhibition of growth was evaluated in the alga Chlorella vulgaris (producer) and immobilization was studied in the cladoceran Daphnia magna (first consumer). Finally, several end points were evaluated in the RTG-2 salmonid fish cell line, including neutral red uptake, protein content, methylthiazol tetrazolium salt metabolization, glucose-6-phosphate dehydrogenase activity, lactate dehydrogenase activity and leakage, and morphology. The sensitivity of the test systems employed was as follows: V. fischeri > D. magna > C. vulgaris > RTG-2 cell line. The results show that 6-methylcoumarine is not expected to produce acute toxic effects on the aquatic biota. However, chronic and synergistic effects with other chemicals cannot be excluded and should be further investigated.

Acute and subacute toxic effects produced by microcystin-YR on the fish cell lines RTG-2 and PLHC-1.

Approximately 80 microcystins (MCs) variants have been isolated in surface water worldwide. The toxicity of the most frequently MCs are encountered, MC-LR and MC-RR, has been extensively studied in humans and animals. However, studies dealing with MC-YR toxicity are still scarce. In this work, the toxic effects of MC-YR were investigated in the fish cell line PLHC-1, derived from a hepatocellular carcinoma of the topminnow Poeciliopsis lucida, and RTG-2 fibroblast-like cells derived from the gonads of rainbow trout Oncorhynchus mykiss. After 48 h, morphological and biochemical changes (total protein content, neutral red uptake and methylthiazol tetrazolium salt metabolization) were determined. The most sensitive endpoint for both cell lines was the reduction of total protein content, with EC(50) values of 35 microM for PLHC-1 cells and 67 microM for the RTG-2 cell line. Lysosomal function and methylthiazol tetrazolium salt metabolization were stimulated at low concentrations, while they decreased at high doses. Increase of piknotic cells, rounding effects, reduction in cell number and cell size, hydropic degeneration, and death mainly by necrosis but also by apoptosis were observed in the morphological study. Furthermore, PLHC-1 cells are more sensitive than RTG-2 cells to MC-YR exposure. These results were similar to those obtained when both cell lines were exposed for 24h to a Microcystis aeruginosa isolated strain extract containing MC-LR.

Miocarditis aguda y muerte súbita en jóvenes. Presentación de un caso / Acute myocarditis and sudden death in the young. Case report

La miocarditis puede ser definida simplemente como una inflamación del miocardio. Actualmente se considera una miocardiopatía adquirida producida por una amplia variedad de agentes infecciosos, habitualmente virus, así como toxinas y drogas. La presentación clínica de la enfermedad varía desde síntomas sistémicos inespecíficos hasta muerte súbita. Diversas series autópsicas han diagnosticado una miocarditis aguda como causa de muerte súbita en niños y adultos jóvenes entre el 4-12%. Por otra parte, la miocarditis se ha identificado como causa de miocardiopatía dilatada hasta en el 9% de los casos. La miocarditis en una de los diagnósticos que más a menudo pasa desapercibido macroscópicamente ya que en la mayor parte de los casos el corazón es absolutamente normal por lo que el diagnóstico requiere siempre el examen microscópico siguiendo los criterios de Dallas. Es aconsejable la caracterización del virus mediante Reacción en Cadena de la Polimerasa. Presentamos el caso de una joven que presentó una muerte súbita debida a una miocarditis aguda linfocitaria

Myocarditis could be defined simply as an inflammation of the myocardium. Nowadays it is considered an acquired cardiomyopathy produced by a wide variety of infectious agents, mainly viruses, as well as toxins and drugs. The clinical presentation of the disease varies from unspecific systemic symptoms to sudden death. Some post-mortem series have diagnosed an acute myocarditis as the cause of sudden death in children and young adults between 4-12% of cases. On the other hand, myocarditis has been identified as the cause of dilated cardiomyopathy in 9% of cases. Myocarditis is a diagnostic challenge in the autopsy room because in the great majority of cases the heart is completely normal on gross examination. For that reason, microscopical diagnosis according to the Dallas criteria is always mandatory. The characterization of the virus trough Polimerase Chain Reaction is recommended. We present the case of a young girl dying suddenly due to acute lymphocytic myocarditis

Miocardiopatía hipertrófica como causa de muerte súbita en una mujer joven / Hypertrophic cardiomyopathy presenting as sudden death in a young woman

La miocardiopatía hipertrófica (MCH) es una enfermedad genética muy heterogénea, con múltiples loci, identificándose para cada gen múltiples mutaciones. Está considerada en Estados Unidos la causa más frecuente de muerte súbita (MS) en jóvenes, fundamentalmente atletas, siendo en ocasiones la primera manifestación de la enfermedad. La MCH se caracteriza morfológicamente por una hipertrofia asimétrica del ventrículo izquierdo y/o derecho con un patrón histopatológico caracterizado por desestructuración (“disarray”) de los miocardiocitos en una matriz de tejido conectivo prominente así como hipertrofia de la íntima de las arterias coronarias intramurales. Se expone el caso de una mujer joven, de 25 años, diagnosticada clínicamente y con antecedentes familiares de MS por MCH en su madre, que presentó una MS mientras dormía

Hypertrophic cardiomyopathy (HCM) is a genetic and very heterogeneous disease with multiple loci, and with several mutations identified for every gene. In USA, it is regarded as the most common cause of sudden death (SD) in young people (mainly athletes), and occasionally SD is the initial presentation of the disease. HCM is morphologically characterized by an asymmetric hypertrophy of left and/or right ventricle with a histopathological pattern of cardiac myocytes dearrangement in a prominent connective tissue matrix, as well as intimal hypertrophy of intramural coronary arteries. In this paper, we present the case of a 25 year-old woman, clinically diagnosed with HCM, and with family history of HCM in her mother, who experienced a SD while sleeping

Toxic effects produced by microcystins from a natural cyanobacterial bloom and a Microcystis aeruginosa isolated strain on the fish cell lines RTG-2 and PLHC-1.

Toxic cyanobacterial blooms are a worldwide problem, causing serious water pollution and public health hazard to humans and livestock. The intact cells as well as the toxins released after cellular lysis can be responsible for toxic effects in both animals and humans and are actually associated with fish kills. Two fish cell lines-PLHC-1 derived from a hepatocellular carcinoma of the topminnow Poeciliopsis lucida and RTG-2 fibroblast-like cells derived from the gonads of rainbow trout Oncorhynchus mykiss were exposed to several concentrations of extracts from a natural cyanobacterial bloom and a Microcystis aeruginosa-isolated strain. After 24 hours, morphologic and biochemical changes (total protein content, lactate dehydrogenase leakage, neutral red uptake, methathiazole tetrazolium salt metabolization, lysosomal function, and succinate dehydrogenase [SDH] activity) were investigated. The most sensitive end point for both cyanobacterial extracts in PLHC-1 cells was SDH activity, with similar EC(50) values (6 microM for the cyanobacterial bloom and 7 microM for the isolated strain). RTG-2 cells were less susceptible according to SDH activity, with their most sensitive end point lysosomal function with an EC(50) of 4 microM for the M. aeruginosa-isolated strain and 72 microM for the cyanobacterial bloom. The lysosomal function was stimulated at low concentrations, although SDH activity increased at high doses, indicating lysosomal and energetic alterations. Increased secretion vesicles, rounding effects, decreased cell numbers and size, hydropic degeneration, esteatosis, and apoptosis were observed in the morphologic study. Similar sensitivity to the M. aeruginosa-isolated strain was observed in both cell lines, whereas the cyanobacterial bloom was more toxic to the PLHC-1 cell line.

Ecotoxicological evaluation of diethanolamine using a battery of microbiotests.

In order to investigate the potential ecotoxicity of diethanolamine (DEA), a battery of model systems was developed. DEA is widely used as a chemical intermediate and as a surface-active agent in cosmetic formulations, pharmaceuticals and agricultural products. DEA was studied using ecotoxicological model systems, representing four trophic levels, with several bioindicators evaluated at different exposure time periods. The battery included bioluminescence inhibition of the bacterium Vibrio fischeri, growth inhibition of the alga Chlorella vulgaris and immobilization of the cladoceran Daphnia magna. Cell morphology, total protein content, neutral red uptake, MTS metabolization, lysosomal function, succinate dehydrogenase activity, G6PDH activity, metallothionein levels and EROD activity were studied in the hepatoma fish cell line PLHC-1, derived from Poeciliopsis lucida. The systems most sensitive to DEA were both D. magna and V. fischeri, followed by C. vulgaris and the fish cell line PLHC-1. The most prominent morphological effect observed in PLHC-1 cultures exposed to DEA was the induction of a marked steatosis, followed by death at high concentrations, in some cases by apoptosis. The main biochemical modification was a nearly three-fold increase in metallothionein levels, followed by the stimulations of lysosomal function and succinate dehydrogenase and G6PDH activities. Judging by the EC(50) values in the assay systems, DEA is not expected to produce acute toxic effects in the aquatic biota. However, chronic and synergistic effects with other chemicals cannot be excluded.

The use of the fish cell lines RTG-2 and PLHC-1 to compare the toxic effects produced by microcystins LR and RR.

Cyanobacterial toxins, especially microcystins (MC), are found in eutrophied waters through the world. Acute poisonings of animals and humans has been reported following MC exposure. In the present study, two fish cell lines, PLHC-1 and RTG-2, were evaluated after exposure to the cyanobacterial toxins MC-LR and MC-RR. The effects of different concentrations of the toxins were investigated in both cell lines at morphological and biochemical levels (total protein content, lactate dehydrogenase leakage, lysosomal activity and succinate dehydrogenase activity). The results obtained showed a decrease in protein content and no relevant increase in cell disruption, except for MC-LR in PLHC-1 cells. Morphological changes produced by microcystins were cellular swelling, blebbling, rounding, reduction in the cell number and increase in the number and size of lysosomal bodies. In addition, steatosis was produced in hepatoma PLHC-1 cells, particularly with MC-RR. Furthermore, the fish PLHC-1 cell line was more sensitive than RTG-2 cells to the cyanobacterial toxins compared, being the stimulation of the lysosomal function and the induction of steatosis the most specific changes detected.

Patología cerebro-vascular hemorrágica en adultos asociada al consumo de cocaína / Cerebral haemorrhage in adults associated with the use of cocaine

La cocaína es la segunda droga de comercio ilegal más consumida en España después del cannabis. El número de pacientes atendidos en los servicios de urgencias tras consumir cocaína y los casos de muerte secundarios al consumo de la misma han ido aumentando hasta multiplicarse por seis en los últimos años. El consumo de este alcaloide ocasiona efectos nocivos, constatados sobre diferentes órganos y sistemas corporales, e incluso la muerte. A nivel del SNC destaca, por su gravedad e incidencia, la patología cerebro-vascular hemorrágica (PCVH). Este tipo de cuadro se halla asociado al consumo de drogas ilícitas entre el 9,5% y el 34% de los accidentes vasculares en menores de 45 años, siendo la cocaína la más frecuentemente implicada en su presentación. Por otro lado, la rotura de un aneurisma o malformación arteriovenosa se ha detectado hasta en el 50% de los pacientes con PCVH secundarios al consumo de cocaína. Presentamos tres casos de muerte súbita en adultos por patología cerebro-vascular hemorrágica asociada al consumo de cocaína

Cocaine is the second most frequent illegal drug consumed in Spain after cannabis. A significant increase has occurred in the number of individuals treated in emergency departments after cocaine use just as in the number of cocaine-related deaths. These rates have been actually multiplied by six in the latest years. Cocaine causes injury in different organ systems, even death. In the CNS the use of cocaine is frequently associated with cerebral haemorrhage. Stroke in young adults below 45 years is usually related to drug use between 9,5% and 34% of cases, and cocaine is the most frequently mentioned drug. Otherwise, even 50% of cocainerelated stroke is the result of rupture of saccular aneurysms involving the arteries at the base of the brain and vascular malformation. In this paper, we present three cases of sudden death in adults due to cerebral haemorrhage associated with cocaine use

Embolia grasa como complicación de politraumatismo por precipitación autolítica / Fat embolism as complication of polytraumatism by suicide jumping

El síndrome de embolia grasa (SEG) es un cuadro clínico debido a la oclusión de los vasos sanguíneos por glóbulos de grasa. Se asocia fundamentalmente a fracturas de los huesos largos y es una importante fuente de morbilidad y mortalidad en pacientes politraumatizados. Aunque las primeras descripciones se realizaron a finales del siglo XIX en la actualidad sigue siendo un desafío para el clínico por lo que, en ocasiones, el diagnóstico inicial se realiza en la autopsia. Presentamos un caso de SEG en una mujer de 19 años que fallece en el hospital doce días después de precipitarse desde un puente con finalidad suicida sufriendo politraumatismo con fractura de huesos largos. El SEG fue sospechado clínicamente y se diagnosticó en la autopsia macroscópica siendo posteriormente confirmado por los estudios histopatológicos. Así mismo se revisan las características clinico-patológicas del SEG

Fat embolism syndrome (FES) is a clinical entity which consists in the occlusion of blood vessels by fat droplets. It is commonly associated to long bone fractures and it's an important source of morbidity and mortality in polytraumatized patients. Although the first descriptions were made in the nineteenth century, nowadays it continues to be an important clinical challenge determining that, sometimes, the first diagnostic is made at autopsy. In this paper, we present a case of FES in a woman 19 years old who died in hospital twelve days after jumping from a bridge suffering polytraumatism with long bone fracture. FES was suspected clinically and diagnosed in the gross autopsy being confirmed microscopically. The clinic-pathological characteristics of this syndrome are also reviewed

Tromboflebitis en miembro superior como origen de un tromboembolismo pulmonar masivo. A propósito de un caso / Thromboflebitis in upper extremity as origin of a massive pulmonary embolism. A case report

El tromboembolismo pulmonar (TEP) masivo es una de las causas de muerte súbita en el adulto que se encuentra con frecuencia nada despreciable en las autopsias forenses. El origen del trombo suele ser una trombosis venosa profunda de las extremidades inferiores en el contexto de una enfermedad tromboembólica venosa. No obstante, en ocasiones, el origen del trombo se encuentra en las extremidades superiores como consecuencia de una tromboflebitis. Presentamos el caso de un paciente ingresado en un hospital, por patología digestiva, en el que se produce una tromboflebitis del miembro superior izquierdo donde portaba una vía intravenosa falleciendo de forma súbita. La autopsia demostró que la causa de la muerte era un TEP masivo. Las implicaciones médico legales del TEP no solo se limitan a determinar la causa de la muerte sino que puede ser necesaria la valoración de una supuesta mala praxis por interposición de una denuncia

Pulmonary thromboembolism is commonly associated with sudden death in adults and is a frequent post-mortem finding in forensic autopsies. The emboli aetiology and emplacement are usually related to deep vein thrombosis in lower extremities in the context of a venous thromboembolic disease. However, in some cases, the origin of the thrombus is located in the upper extremities as a result of a thromboflebitis. A case is presented of a patient admitted in hospital with bowel disease who died suddenly after intravenous therapy with thromboflebitis in the left arm. The post-mortem study showed a massive pulmonary embolism as the cause of death. The forensic implications of pulmonary embolism not only imply the investigation of the cause of death but it could also be related, in some cases, to the evaluation of malpractice claims

Esclerosis múltiple en una mujer fallecida por quemaduras en el incendio del domicilio / Multiple sclerosis in a woman died by burns in a house fire

La esclerosis múltiple (EM) o esclerosis en placas es la más común de las enfermedades inflamatorias desmielinizantes del SNC y el trastorno neurológico más incapacitante en los adultos jóvenes. Se caracteriza por la aparición de lesiones focales diseminadas en la sustancia blanca denominadas placas en las que lo más llamativo es la pérdida de la mielina (desmielinización) con preservación relativa de los axones. Es infrecuente que esta enfermedad entre en el campo de investigación médico-forense, ya que, habitualmente, está bien diagnosticada clínicamente y en caso de tener interés la confirmación del diagnóstico post-mortem se realizaría una autopsia clínica. Presentamos los hallazgos neuropatológicos de una mujer de 47 años, en situación de invalidez (silla de ruedas) por una EM de 17 años de evolución, que fallece como consecuencia de las quemaduras producidas por un incendio en el domicilio (AU)

The multiple sclerosis (MS) or plaque sclerosis is the most frequent of the inflammatory demyelinating diseases of the SNC and the most incapacitating neurological disorder in young adults. It is characterized by the presence of focal an scattered lesions in the white matter called plaques in which the hallmark is the loss of myelin (demyelination) with the preservation of axons. It is uncommon that this disorder enters in the medico-legal field because, in general, has a very good clinical diagnosis and in case of interest to confirm the post-mortem diagnosis a clinical autopsy would be performed. We present the neuropathological findings of a woman aged 47 years, handicapped (wheel's chair) due to MS with a progression of 17 years, who died by burns in a house fire (AU)

Lipoma del cuerpo calloso con crisis convulsiva que ocasiona broncoaspiración alimentaria mortal / Lipoma of the corpus callosum with seizure which causes fatal alimentary aspiration

Los lipomas del cuerpo calloso representan hasta el 5% de las malformaciones, tumorales o no, del cuerpo calloso. Actualmente son considerados malformaciones congénitas en lugar de verdaderas neoplasias. La mayoría son sintomáticos, pero algunos se asocian a síntomas neurológicos inespecíficos como retraso psicomotor, cefalea, epilepsia y parálisis cerebral. Se expone el caso de un varón de 42 años que fallece por broncoaspiración alimentaria secundaria a crisis convulsiva. El estudio neuropatológico puso de manifiesto dos lipomas situados en la rodilla del cuerpo calloso. Se destaca la necesidad de realizar tratamiento antiepiléptico en los lipomas del cuerpo calloso que se manifiestan clínicamente en forma de crisis comiciales (AU)

Lipomas of the corpus callosum make up approximately 5% of the tumours of the corpus callosum. Nowadays, they are considered congenital malformations rather than true neoplasms. They are usually asymptomatic; however they are sometimes associated with unspecific neurological symptoms such as psychomotor retardation, headache, epilepsy and cerebral palsy. A case is presented of a 42-year-old man who died due to alimentary aspiration following a seizure. Neuropathological study showed two lipomas located in the splenium of the corpus callosum. Also, we emphasise the importance of the anti-epileptic treatment in the corpus callosum lipomas which are associated with epilepsy (AU)

Ecotoxicological evaluation of carbamazepine using six different model systems with eighteen endpoints.

The occurrence of pharmaceutically active compounds in the aquatic environment has been recognized as one of the emerging issues in environmental chemistry. However, the ecotoxicological effects of pharmaceuticals have still not been researched adequately. Carbamazepine, an anticonvulsant commonly present in surface and groundwater, was studied, using six ecotoxicological model systems with eighteen endpoints evaluated at different exposure time periods. The battery included the immobilization of Daphnia magna, bioluminescence inhibition in the bacterium Vibrio fischeri, growth inhibition of the alga Chlorella vulgaris, and micronuclei induction and root growth inhibition in the plant Allium cepa. Cell morphology, neutral red uptake, total protein content, MTS metabolization, lactate dehydrogenase leakage and activity and glucose-6-phosphate dehydrogenase activity were studied in the salmonid fish cell line RTG-2. The total protein content, LDH activity, neutral red uptake and MTT metabolization in Vero monkey kidney cells were also investigated. The most sensitive system to carbamazepine was the Vero cell line, followed by Chlorella vulgaris, Vibrio fischeri, Daphnia magna, Allium cepa, and RTG-2 cells. EC50 values from 19 microM in Vero cells at 72 h to more than 1200 microM in other systems, were obtained. Comparing the concentrations in water and the toxicity quantified in our assay systems, carbamazepine is not expected to produce acute toxic effects in the aquatic biota under these circumstances, but chronic and synergistic effects with other chemicals cannot be excluded.

Tribromophenol induces the differentiation of SH-SY5Y human neuroblastoma cells in vitro.

Tribromophenol is a pesticide with fungicide activity, presently used as a replacement of pentachlorophenol as a wood preservative, and as a flame retardant in electronic and electrotechnical devices. Retinoic acid differentiated and non-differentiated SH-SY5Y human neuroblastoma cell cultures were exposed to a range of concentrations of tribromophenol for 24, 48 and 72 h and the effects evaluated at morphological, basal cytotoxicity and biochemical levels. Neuroblastoma cell number, evaluated by quantification of total protein content, was increasingly inhibited in accordance with the concentration of tribromophenol and the exposure time period. According to the mean effective concentrations, differentiated cultures were nearly three times more sensitive than naive cells. Lysosomal function evaluated by the neutral red uptake was stimulated, particularly in non-differentiated cells. MTS metabolization was stimulated by all the treatments, with more potency at 24 h for differentiated cells. Acetylcholinesterase activity increased with the time of exposure in non-differentiated cells, while in differentiated cells the activity was doubled at 24 h. Morphological alterations were evident from 12.5 microM, showing hydropic degeneration and reduction in cell number, and from that concentration, piknosis and apoptotic bodies were observed. In conclusion, the main effects detected for tribromophenol were the induction of neuroblastoma cell differentiation, as expressed by the inhibition of cell growth and the increase in acetylcholinesterase activity with a critical cell concentration of 0.1 microM. Apoptosis was observed at high concentrations. The induction of cell differentiation and the special sensitivity of differentiated cells can explain some mechanisms involved in the embryotoxic and foetotoxic potential of tribromophenol.

La causa y la manera de la muerte indeterminada: a propósito de un caso de muerte súbita en adolescente, portador de una tumoración quística intestinal, descubierta durante la autopsia / Cause and Manner of Death Undetermined: regarding a case of sudden death in an adolescent with an intestinal cystic tumour, discovered during autopsy

Presentamos un caso de muerte inesperada súbita, acaecida en un sujeto de 19 años, el cual presentó, en las horas previas al fallecimiento, un cuadro de mareos, náuseas y vómitos que fue tratado en el Centro de Atención Primaria con analgésicos y antiespasmódicos. Después de pocas horas de evolución el indivíduo fue trasladado de nuevo, por los familiares, al Centro Médico, en estado de inconsciencia. A pesar de la aplicación de maniobras de resucitación el sujeto presentó parada cardiorrespiratoría y exitus. Durante la autopsia Médico- Legal se demostró la existencia de una tumoración mesentérica, localizada en el ileon distal. El cadáver despedía un olor "sui generis" que le recordó al Médico Forense el típico de algunos plaguicidas organofosforados. Se avanzaron los siguientes diagnósticos de la causa de la muerte en el informe de autopsia: I) Shock séptico por absceso intestinal. 2) Intoxicación mortal por plaguicidas. 3) Muerte súbita cardiaca. La investigación químicotoxicológica resultó negativa. El estudio anatomopatológico no demostró lesiones cardiacas que pudiesen justificar la muerte y, el de la tumoración mesentérica demostró que se trataba de una duplicación intestinal, de tipo quístico, con discreta inflamación crónica de la pared; no se pusieron de manifiesto ulceraciones, hemorragias ni lesiones vasculares o isquémicas intestinales que pudiesen justificar una muerte súbita de causa digestiva. La causa y la manera de la muerte se consideraron de tipo indeterminado (AU)

Neuropatía hemorrágica tóxica aguda y fallo multiorgánico tras intoxicación por anticoagulantes, disolventes, AINES y antihistamínicos. A propósito de un caso fatal / Acute toxic haemorrhagic neuropathy and multiorganic failure following poisoning by anticoagulants, solvents, nsaids and antihistaminic drugs. Report of a fatal case

Se presenta un caso de intoxicación mortal por ingestión del raticida Brodifacum, un anticoagulante superwarfarínico, junto con otros fármacos, entre los que se incluían antiinflamatorios no esteroideos y un disolvente orgánico de uso doméstico. El sujeto falleció en la UCI, con un cuadro de insuficiencia respiratoria aguda, seguida de fallo hepático y renal. En la autopsia se pusieron de manifiesto lesiones hemorrágicas circunferenciales que afectaban a diversos tejidos, entre los que se encontraban la grasa mesentérica, el epicardio, y la grasa perirrenal. El estudio microscópico demostró la existencia de una típica lesión hemorrágica aguda, circunferencia¡, en los nervios vegetativos epicárdicos y del área del esplácnico. la explicación de porqué los nervios periféricos vegetativos se constituyen en diana de los efectos tóxicos se atribuye a la acción combinada de los disolventes y de los anticoagulantes, sobre el sistema nervioso periférico. Se sabe que los disolventes orgánicos producen una lesión neurona¡ aguda, consistente en tumefacción axonal y del soma neuronal, que conlleva a la alteración del sistema de transporte a lo largo del axón. Creemos que -desde el punto de vista fisiopatológico- la vasodilatación reactiva de los vasa nervorum, producida a consecuencia de la lesión neurona¡ aguda inducida por los disolventes, unida al estado de hipocoagulabilidad sanguínea -dependiente de la ingestión de Brodifacum (superwarfarina) y potenciada por los antiinflamatorios no esteroideos- constituyen los mecanismos íntimos que podrían explicar esta peculiar Neuropatía Hemorrágica Aguda Tóxica de los nervios periféricos del Sistema Nervioso Neurovegetativo. Desconocemos si los nervios periféricos mixtos se encontraban afectados por esta lesión, al carecer de muestras para un estudio definitivo (AU)