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Mummy 527 B* belongs to the “Giovanni Marro” Egyptian Collection of the Museum of Anthropology and Ethnography of the University of Turin. This mummy of a oneyear- old pre-dynastic child was found in Gebelein in 1935 in a small necropolis discovered during excavations of the “Missione Archeologica Italiana” led by G. Farina, the new Director of the Egyptian Museum of Turin, with the participation of Prof. G. Marro as anthropologist. A whole body spiral CT scan with thin slices (1,00 mm thickness, 0,5 mm reconstruction interval) was followed by multiplanar and 3D reconstruction. The aim was to evaluate the child’s age at death and the presence of lethal pathologies. This study confirms the fundamental role of non-invasive techniques in the study of such rare pre-dynastic specimens.

Colonoscopic perforation is a serious and potentially life-threatening complication of colonoscopy. Its incidence varies in frequency from 0.016% to 0.21% for diagnostic procedures, but may be seen in up to 5% of therapeutic colonoscopies. In case of extraperitoneal perforation, atypical signs and symptoms may develop. The aim of this report is to raise the awareness on the likelihood of rare clinical features of colonoscopic perforation. A 72-year-old male patient with a past medical history of myocardial infarction presented to the emergency department four hours after a screening colonoscopy with polypectomy, complaining of neck pain, retrosternal oppressive chest pain, dyspnea, and rhinolalia. Right chest wall and cervical subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and bilateral subdiaphragmatic free air were reported on the chest and abdominal X-rays. The patient was treated conservatively, with absolute bowel rest, total parental nutrition, and broad-spectrum intravenous antibiotics. Awareness of the potentially unusual clinical manifestations of retroperitoneal perforation following colonoscopy is crucial for the correct diagnosis and prompt management of colonoscopic perforation. Conservative treatment may be appropriate in patients with a properly prepared bowel, hemodynamic stability, and no evidence of peritonitis. Surgical treatment should be considered when abdominal or chest pain worsens, and when a systemic inflammatory response arises during the conservative treatment period.

A 15-18 months old child mummy, presently housed in Turin's Museum of Anthropology, was discovered in Gebelein (Upper Egypt) during excavations carried out by the Missione Archeologica Italiana, most likely in 1914. Atomic Mass Spectrometry radiocarbon dating indicated that the mummy belongs to the end of the Early Dynastic Period - beginning of the Old Kingdom. Whole body spiral CT scan and 3D reconstructions did not show evidence of congenital malformations or fractures. Immunochromatographic and immunohistochemical analyses on skin and muscle samples were positive for Plasmodium falciparum malaria and for Plasmodium spp. malaria. Our data provide clear evidence for the presence of P. falciparum infection in the sample we examined and show the usefulness of the immunological investigations for the detection of malaria in ancient human remains.

Many age-related changes are described in the nervous system of different species, but detailed studies of brain lesions in ageing horses are lacking. The aim of the present study was to systematically characterize lesions in the brains of 60 horses aged from 7 to 23 years. No gross changes were present in any brain. Microscopically, spongiform changes, lipofuscin storage, corpora amylacea, gliosis and satellitosis were common, together with axonal and neuronal swellings. The most important findings were the presence of pseudocalcium-calcium (pCa-Ca) deposits and arterial wall degeneration. Scanning electron microscopical examination of two cases with vascular mineralization revealed marked deposition of an amorphous substance in the vessel walls that was probably formed by a polyanionic protein matrix and a mineral component. Immunohistochemically, numerous axonal spheroids were positively labelled for ubiquitin. No PrPsc was detected in sections with neuronal vacuolation. Neuronal swelling, corpora amylacea, hippocampal Tau-positive neurons and methenamine-positive diffuse (preamyloid) plaques were also detected. Congo red staining failed to detect amyloid deposition. The characterization of age-related lesions in the brains of these horses will allow these changes to be discriminated from pathological processes in future studies. Some lesions described here, including some vascular changes, the presence of diffuse plaques and tau accumulation in hippocampal neurons, have not been described previously in the horse.

Five chemicals that are known to induce in rats thyroid follicular-cell adenomas and carcinomas were assayed for their ability to induce DNA damage and DNA repair synthesis in primary cultures of human thyroid cells. Significant dose-dependent increases in the frequency of DNA single-strand breaks and alkali-labile sites, as measured by the same Comet assay, were obtained after a 20-h exposure to the following subtoxic concentrations of the five test compounds: methimazole from 2.5 to 10 mM; nitrobenzene, potassium bromate, N , N ′-diethylthiourea and ethylenethiourea from 1.25 to 5 mM. Under the same experimental conditions, DNA repair synthesis, as evaluated by quantitative autoradiography, was present in potassium bromate-exposed thyroid cells from all the three donors and in those from two of three donors with either nitrobenzene or ethylenethiourea, but did not match the criteria for a positive response in thyroid cells from any of the donors with methimazole and N , N ′-diethylthiourea. Consistently with their ability to induce thyroid tumors, all the five test compounds, administered p.o. in rats in a single dose corresponding to 1/2 LD50, induced a statistically significant degree of DNA fragmentation in the thyroid. These findings suggest that the five test compounds might be carcinogenic to thyroid in humans.

The aim of this study was to evaluate the impact of patient age on the number of lymph nodes dissected during surgery for colorectal cancer. Clinical and histopathological data of 231 consecutive patients who underwent elective surgery for colorectal cancer were reviewed retrospectively. Patients were divided into those aged ≤70 years and >70 years. Our findings suggest that patient's age influences the number of lymph nodes detected in surgical specimens; this number was lower in patients aged >70 years and decreased with further aging.

To evaluate and compare the immediate and long-term outcomes of videothoracoscopic T2–T4 sympathectomy and T3–T4 sympathicotomy for the treatment of palmar and axillary hyperhidrosis. Between October 1993 and September 2007, we treated a total of 88 patients affected by palmar and axillary hyperhidrosis. Twenty-four patients underwent T2–T4 sympathectomy with 5–10 mm trocars (Group A), 43 T2–T4 sympathectomy with 2–5 mm trocars (Group B), 15 T3–T4 sympathicotomy with 5–10 mm trocars and 6 T3–T4 ganglion block with 2–5 mm trocars (Group C). The mean operative time, for each side, was 15 min for sympathicotomy and 28 min for sympathectomy. In September 2008, we recontacted 98% of patients (total 86), by telephone, to establish long-term results (follow-up range 1–15 years). In this series, we did not find any significant difference between T2–T4 sympathectomy and T3–T4 sympathicotomy in terms of postsurgical palmar anhidrosis or onset of compensatory hyperhidrosis, while both methods show high efficacy for remission of palmar hyperhidrosis. The slightly higher recurrence rate in our early experience (Group A) can be attributed to the learning curve. Using smaller trocars (2–5 mm), we reduced postsurgical intercostal pain and obtained better aesthetic results and a higher grade of patient’s satisfaction. Thoracoscopic approach to hyperhidrosis has evolved in the last few decades with a consequent decrease in side effects. In this series, all patients experienced an improvement in quality of life even in case of recurrence or onset of compensatory hyperhidrosis. Due to these results, the shorter operative time and easier performance of sympathicotomy, we prefer this method.

Hypervariable regions HV1 and HV2 of the mitochondrial DNA control region were sequenced in pre-therapy (serum) and post-therapy (saliva, hair) biological samples collected from HIV-infected patients ( n =13) treated with nucleoside reverse transcriptase inhibitors (NRTIs). Occurrence of length/point heteroplasmic mutations as a consequence of treatment with NRTIs was evaluated. The observed rate of length heteroplasmy in the analyzed samples was consistent with values previously reported in untreated subjects, whereas no evidence of point heteroplasmy in post-treatment tissue samples was seen.

Microscopic examination of a blood clot expelled by a physically and mentally disabled woman taken to the emergency room because of genital bleeding revealed the presence of chorionic villi encircled by decidua, hemorrhage, and necrosis. In order to identify the father of the product of conception, sections of formalin-fixed, paraffin-embedded abortion material were subjected to laser microdissection: DNA extraction from chorionic villi selectively isolated from the surrounding tissues allowed successful STR-typing of fetal cells, which was otherwise prevented by excess maternal DNA. The large number of homozygous genotypes in the fetal profile suggested incestuous paternity. Analysis of reference DNA samples from male relatives excluded the woman's father, paternal grandfather, and maternal grandfather, whereas the obligate paternal alleles of the fetus were constantly present in the genotypes of the woman's brother, clearly demonstrating brother-sister incest (probability of paternity > 99.99999%).

Background: The aim of this study was to ascertain the utility of echo-Doppler in the analysis of the low resistance thyroid vascularization in diffuse toxic goiter (DTG), and the effectiveness of Lugol's solution (iodine-iodide solution) in patients undergoing thyroidectomy. Study Design: Twenty-five patients with diffuse toxic goiter were evaluated and compared with 19 normal subjects. Patients were treated with increasing doses of Lugol's solution 2% for 7 days until a total dose of 75 mg of iodine was given. Echo-Doppler was performed on the last day of treatment, 12 hours before operation. Results: Mean basal Doppler Resistance Index (RI) of intrathyroid arterial flow was significantly lower in patients with DTG compared with normal controls (0.4718 ± 0.0625 versus 0.55 ± 0.05, range: 0.472 to 0.643; p=0.008). Moreover, the RI was significantly increased in patients with DTG after Lugol's solution (+16.46 ± 10.22%, range: −2.59 to +39.97; p Conclusions: Echo-Doppler RI allowed documenting lower arterial resistances within the thyroid gland in patients with DTG. The use of preoperative Lugol's solution therapy induces normalization of those changes for safer thyroidectomy.

The skull and vertebral column pathology of the Ancient Egyptian skeletal remains of the Marro Collection (1118 individuals) is mainly represented by “common” degenerative and inflammatory osteo-articular alterations. Apart from these, three cases of ankylosing spondylitis and two cases of probable multiple myeloma are described in detail. The frequency of these conditions seems to be almost the same as in modern times. Furthermore, a skull with larger osteolitic areas of probable metastatic origin is described.

The authors observed, with a scanning electron microscope, the dermal surfaces of experimental wounds, following the enzymatic digestion with trypsin of the dermo-epidermal junction. Cut lesions showed an early reconstitution of the basement membrane and progressive convergence of the margins. A peculiar arrangement of the dermal crests was also observed. In wounds with loss of substance, the complete coating by newly formed basement membrane took longer. There was an early deformation of the holes of hair follicles in the undamaged dermis surrounding the lesion, as well as the appearance of creases that moved toward the center. This process was over within a few days; then the lesion became very small and the holes of the hair follicles reappeared. The results suggest a force of traction bound toward the center of the lesion and acting on the surface, the effects of which on the basement membrane are most evident between the eighth and the 15th days.

We describe a method of enzymatic digestion of the dermo-epidermal junction, that allows an observation with a SEM of the finest details of the dermal surface covered by the reticular fibrils of the basement membrane. By means of this technique, we have made a panoramic review of the traumatology and have observed typical characteristics in all types of examined lesions. It seems that the method can constitute a new approach for medicolegal study, in all those cutaneous lesions that involve, even superficially, the dermis.

The dermal surface (after enzymatic digestion of the dermo-epidermal junction) in electric and heat lesions is described. There do not appear to be elements that help in forming a precise differential diagnosis. It is possible, however, to differentiate these lesions from all traumatic cutaneous injuries and some limited nontraumatic lesions (e.g., verrucae). Remarkably good preservation of the dermal surface even in an advanced state of decomposition does suggest the possibility of certain diagnosis of electric and heat lesions even when postmortem phenomena have greatly damaged or even totally removed the epithelial part of the skin. Language: en

The authors describe the aspect of the dermal surface in firearm wounds. In entrance wounds, the abraded area is rather evident, with loss of the papillary pattern and lacerations of the basement membrane. Exit wounds appear as irregularly lacerated interruptions, with protruding collagen fibers; the surrounding dermis has nearly undamaged papillae. Also described, still on the dermal surface, are the flame effect and the powder tattooing. Evident lesions of the basement membrane, produced by the grains of powder, can be observed. Particles gunshot residues (GSR). are often recognizable lying on the dermal surface or entrapped among the collagen fibers of the superficial dermis. Language: en

We measured immunoreactive insulin-like growth factor I (IGF-I) in extracts of normal and nodular thyroid tissue obtained at surgery from patients with nontoxic goiter. The nodular tissues contained a higher concentration [mean, 279.0 +/- 69.7 (+/- SE) mU/g] than paired normal tissues (115.5 +/- 17.9 mU/g; P = 0.024; n = 12); a difference was evident in all but one patient. Sephadex G-50 gel filtration of tissue extracts revealed two immunoreactive peaks, the first in the void volume of the column, and the second in the elution volume of authentic IGF-I. The first peak was identified as IGF-I-binding protein by sodium dodecyl sulfate-polyacrylamide gel electrophoresis after cross-linking with iodinated IGF-I. Isolated thyroid cell membranes contained high affinity IGF-I-binding sites of similar affinity and numbers in both normal and nodular thyroid tissue. The IGF-I content of six thyroid cancer extracts was higher than that of normal thyroid tissue, but the IGF-I content of thyroid tissue from six patients with Graves' disease and five patients with Hashimoto's thyroiditis was similar to that in normal thyroid tissue. These data suggest that the stimulatory effect of TSH on thyroid cell proliferation could be mediated through IGF-I action and suggest that an increase in IGF-I production could sustain the goitrogenic process.

The serum concentration of circulating somatomedins was measured in the blood of healthy donors and subjects with hepatic cirrhosis, and in culture media from in vitro explants of healthy and cirrhotic human liver. Serum levels of somatomedin bioactivity were significantly lower in cirrhotic subjects (0.42 +/- 0.03 U/ml; M +/- SEM) compared with age matched controls (0.99 +/- 0.03 U/ml). Radioreceptor assay of somatomedin concentrations confirmed this reduction in cirrhotic patients (0.89 +/- 0.06 U/ml) compared with controls (1.32 +/- 0.05 U/ml). A parallel reduction in somatomedin circulating binding ability was also observed (99.43 +/- 7.28% in cirrhotic and 123.5% +/- 10.8% in normal subjects). In vitro explants from normal human liver tissue produced a significant increase (0.57 +/- 0.09 U/ml) in somatomedin bioactivity contained in the medium (0.29 +/- 0.06 U/ml), while a decreased bioactivity (0.12 +/- 0.06 U/ml) was observed with explants of cirrhotic livers. These results support a role of liver in the biosynthesis of both somatomedin and somatomedin binding protein.

The authors describe the results obtained using the scanning electron microscope (SEM) to study drowned lungs and control lungs. Results are compared with a previous study carried out using laboratory animals. The results from both studies are analogous, in the absence of chronic pulmonary emphysema. The diagnosis of chronic pulmonary emphysema is simple with the SEM even when dealing with autoptic material obtained 24 to 48 h after death, but the diagnosis of drowning becomes difficult in lungs with chronic emphysema.

We studied the ultrastructure of human skin in a particular form of postmortem transformation: so-called "corification." Six- and 12-month-old corpses were examined. The epidermis showed a remarkable ultrastructural preservation of its components comparable to freshly fixed material. The dermis was less well preserved with altered bandage of collagen fibrils and amorphous precipitates in the ground substance. No explanation is found for such a phenomenon.

The acute mortality caused by two irreversible inhibitors of cholinesterases [disiopropylfuorophosphate (DFP) and diethoxyphosphorylthiocholine, 217 MI-phospholine iodide] has been investigated on chick embryos at different stages of development. The results demonstrate that the above compounds do not show any acute lethal action when administered before the 9th day of incubation; on the other hand, the administration is regularly followed by death after the 9th day of incubation. The doses are comparable to those causing death in hatched chicks. It has also been observed that no appreciable difference exists in DFP uptake from the yolk before and after the 9th day of incubation and that drug-induced cholinesterase inhibition is of the same order of magnitude at any developmental stage; the compound pyridine-2-aldoxime methanesulfonate (2-PAM) was a good antidote against DFP acute lethality. It seems likely that between the 8th and the 9th day of incubation the target system of organophosphorus inhibitors, that is, the cholinesterase enzymatic system, reaches a new point of maturation.

We report here the case of a young oligophrenic man killed by a psychopath by impalement, using a sharp stick which was thrusted into the perineal region, thus causing injuries to abdominal and thoracic viscera.

Scanning electron microscopic structural and ultrastructural alterations of alveolar wall in experimental drowning are described. The results obtained confirm the literature's data. Peculiar microlesions affecting Type I alveolar cells, the basement membrane, and sometimes the capillary endothelium could also be observed. Finally, Type II alveolar cells show alterations which could be related with a possible direct action of the drowning liquid.

Delayed Death from “Fisting” Carlo Torre; The American Journal of Forensic Medicine and Pathology

To the Editor.— Hidrotic ectodermal dysplasia (HED) is an uncommon autosomal-dominant disorder characterized by palmoplantar hyperkeratosis, dystrophy of the nails, and defects of the hair. It is sometimes associated with a large constellation of other abnormalities. 1 In this report, we describe a case of HED in a patient with numerous papules on the palmoplantar surfaces, which revealed the histologic pattern of the eccrine syringofibroadenoma. Report of a Case.— A 53-year-old woman presented in our clinic with a thickening of palms and soles, hypotrichosis, and defects of the nails that had been present since infancy. For at least 2 years she had noticed papular lesions on the soles and palms. She was the fourth of five siblings of nonconsanguineous parents. Only her elder brother, 63 years of age, exhibited a similar condition, but he refused to undergo the skin biopsies. She told us that her teeth were conical, small, and