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Supine hypotensive syndrome is characterized by severe supine hypotension in late pregnancy, whose clinical presentation ranges from minimal cardiovascular alterations to severe shock, resulting from inferior vena cava compression by gravid uterus. We report a case of a 41-year-old 39-week-pregnant woman found dead supine. Autopsy revealed the following: cyanosis of the limbs; congestion of the jugular and subclavian veins; abundant abdominal subcutaneous fatty tissue; uterus displacing intestine and diaphragm; collapsed inferior vena cava; both femoral veins dilated and filled with blood; edematous and congested lungs; and placenta 790 g, fetus 3475 g, amniotic fluid 800 cm3. The diagnosis of supine hypotensive syndrome as the probable cause of death is supported by the position of the body and autopsy findings. This syndrome can be considered as the first stage of the physio-pathological mechanism that led to death in the case presented herein and should be considered by pathologists as a cause of sudden death. [ABSTRACT FROM AUTHOR]

Abstract: Several theories have been proposed to explain the Blunt Traumatic Aortic Rupture (BTAR) because different mechanical forces act on the aorta, at anatomically susceptible sites, including shearing, torsion and stretching, but the origin, transduction and relative importance of these forces remain uncertain. We report a case of a 74-year-old man injured by a kick to the abdomen. After 2 days he felt chest pain paroxysm and weakness in his left leg. The patient was admitted to an emergency care department where he experienced sudden and severe hemodynamic deterioration, dying rapidly. The autopsy, performed 3 days later, showed haemorragic infarction of hypogastric subcutaneous tissues and revealed an extended dissecting aneurysm of the thoracic aorta with following haemopericardium. In our case we considered that a low energy compression to the abdomen, in presence of underlying atherosclerosis, caused aortic dissection rather than rupture and then the 48h time span after the traumatic event and the cardiac tamponade was enough to complete the aortic retrograde dissection. We finally emphasise the importance of the careful surveillance of any trauma close to the abdomen in view of initially unpredictable, as well as eventful injuries. The finding of early signs of neointima formation in thoracoabdominal portions of aortic dissection strongly supported our interpretation. The forensic interest of this case is correlated to the voluntary character of the inflicted injury. The culprit was thus charged with manslaughter. [Copyright &y& Elsevier]

A fatality due to the intravenous self-injection of Ketorolac (Toradol®) is reported. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with marked analgesic activity. There is limited information of fatalities attributed to ketorolac toxicity. Here we report the case of a 53-year-old woman with a medical history of depression that was found deceased at home with no evidence of trauma or injuries. Near the body, a syringe and three empty vials (30 mg) of Toradol® were found. A fresh needle mark on the right arm was noticed. Toxicological analyses were performed using a gas chromatography-mass spectrometry (GC/MS) technique. The estimated ketorolac concentration in the blood was 8 μg/ml; urine and gastric content were negative for this compound. Based on the autopsy, histologic findings and toxicological results of anaphylactic shock associated with ketorolac self-administration was assumed to be the underlying pathophysiological mechanism of death and the manner, suicide. [ABSTRACT FROM AUTHOR]

Gastromalacia is the acute autolytic erosion of the gastric wall. It generally occurs postmortem, and it appears as a slimy brownish black region of the wall which occurs principally in the gastric fundus. A 59-year-old woman died in the Emergency Department following a 2-day period of mild abdominal pain, vomiting, and diarrhea. A forensic autopsy was performed which revealed a rupture of the gastric fundus that had caused leakage of gastric content into the abdominal cavity. There was no macroscopic evidence of peritonitis, and the stomach wall adjacent to the rupture site showed marked thinning. The gross appearance was typical of gastromalacia. In contrast, histological observations revealed the presence of an ulcer at the site of perforation and a severe acute inflammatory reaction indicating a robust reaction with an antemortem rupture. [ABSTRACT FROM AUTHOR]

This case study reports a fatal subarachnoid hemorrhage (SAH) with concomitant accidental carbon monoxide (CO) exposure in 32-year-old man. Autopsy results indicated an antemortem aspiration of smoke, and a massive SAH was identified as the cause of death. Intriguingly, the carboxyhemoglobin level was 30%, suggesting that CO could have played a specific role. Intracranial hemorrhages following CO exposure in brain areas and tissues such as the basal ganglia, globus pallidus, or white matter are rare, but well characterized, whereas SAH related to CO exposure has not been previously described. In this case report, the possible role of CO, either as a primary cause or as a facilitating factor, in the pathogenesis of SAH is discussed. In particular, we propose the hypothesis that the excessive vasodilating effects produced by CO on the cerebral endothelium results in consequential loss of microvascular integrity. [ABSTRACT FROM AUTHOR]

Abstract: Methane is a suffocating gas, and “methane deaths” are largely the result of suffocation by gas–air displacement after accidental or deliberate exposure. Neither methane gas nor other suffocating gases are a common means of homicide, with the potential exception of the use of gas in chemical weapons or gas chambers. Here, we report the case of a 53-year-old woman who was killed by her husband with methane gas. The man had given his wife a dose of Lorazepam before setting up a hose that conveyed methane from the kitchen into the apartment''s bedroom. The man subsequently faked his own suicide, which was later discovered. [Copyright &y& Elsevier]

Abstract: We report here the case of a 53-year-old man who suddenly fell to the ground after being involved in a physical aggression by two younger men. Forensic autopsy revealed no significant injury except for slight, pale abrasions on the face. There were extensive signs of hypertensive and severe coronary artery atherosclerosis, corresponding to the data available from clinical history. The cause of death was established as acute myocardial ischemia due to hypertensive and atherosclerotic cardiovascular disease, probably related to the physical and/or emotional stress due to the aggression. We discuss medico-legal aspects of the death. [Copyright &y& Elsevier]

This study reports the detection of a set of 35 peptide fragments and 7 intact proteins in the vitreous humour using a top-down proteomic platform based on high-resolution HPLC–MS and MS/MS analysis. The concentrations of thymosin β 4 (R = 0.932) and two peptide fragments (i.e., vimentin fragment (Fr.) 443–465 (R = 0.998) and polyubiquitin Fr. 1–73 (R = 0.968)) were observed to have very strong linear correlations with postmortem intervals. Data are available via ProteomeXchange with identifier PXD037095. These preliminary results suggest that some biochemical molecular events are linearly related to the postmortem interval and that the concentrations of these peptides and fragments can be clinically useful in establishing the time of death if measured within the first 160 h postmortem. [Display omitted] • A new application of proteomics of the vitreous humour to estimate the postmortem interval has been proposed. • MEROPS software was used to identify the proteases hypothetically responsible for the generation of 35 peptide fragments. • The concentrations of thymosin β 4 , vimentin and polyubiquitin fragments showed a strong correlation with postmortem interval. [ABSTRACT FROM AUTHOR]

Abstract: Child abuse has become an increasingly serious diagnostic challenge for physicians. The clinical manifestations include malnutrition and sometimes infection. In fact, stress in children has been reported to increase corticosteroid levels. As a consequence, the thymus begins an involution process, producing a severe impairment in cellular and humoral immunity. Here, we report the case of a 7-year-old child who suffered a prolonged history of abuse and died from a systemic Pseudomonas aeruginosa infection. An initial local chronic infection propagated to the pelvic lymph nodes in an immunologically weak body and evolved into abscesses/phlegmons of the pelvic tissue, sepsis, acute respiratory distress syndrome, multiple organ failure and finally, death. Abused children have to be considered as potentially immunologically impaired patients; therefore, it is very important to screen them for opportunistic infections. Moreover, a history of unusual or recurring infections may indicate abuse, especially neglect or malnutrition. In these cases, further investigations should be conducted to determine if a protective service case should be opened. Thus, there is a need for multidisciplinary cooperation to ensure the early identification and prevention of child abuse. [Copyright &y& Elsevier]