A forensic pathology approach to sudden death in children and young adults in Biscay and Seville ... more A forensic pathology approach to sudden death in children and young adults in Biscay and Seville (Spain)
Intestinal ischemia induced by cocaine abuse is a rare condition. To this date, only three cases ... more Intestinal ischemia induced by cocaine abuse is a rare condition. To this date, only three cases have been described. The diagnosis of bowel ischemia should be suspected whenever a cocaine addict has severe abdominal pain. A pathological examination of the resected bowel segment was performed in one case, and the diagnosis was confirmed microscopically. However, the existence of pathologic alterations of the intestinal vessels was not confirmed. Why the intestinal injury is segmental and whether it is related to the dose ingested, the administration route, or the combination of cocaine with alcohol, caffeine, or marijuana remain unclear. The authors report one fatal case associated with cocaine-alcohol overdose. The postmortem examination demonstrated the existence of segmental intestinal ischemia. Microscopic study failed to demonstrate thrombosis in the mesenteric vessels; however, we found an unusual lesion affecting the arterioles located in the intestinal submucosa of the hemorrhagic areas.
Bullet embolism of the arterial, venous and paradoxical types are well known but rare complicatio... more Bullet embolism of the arterial, venous and paradoxical types are well known but rare complications of penetrating missile injuries. Retrograde transthoracic venous bullet embolization is extremely rare with only four cases previously reported in the literature. Single gunshot can cause multiple wounds, mainly because the bullet passes through an intermediate target before striking the victim. We present the autopsy findings of a retrograde transthoracic bullet embolism to the right external iliac vein after a single gunshot with multiple wounds in the left arm and thorax. Problems related to medico-legal investigations of gunshots are reviewed. #
Ab stract. Pro gres sive Multifocal Leukoencephalopathy (PML) is a fa tal demyelinating dis ease ... more Ab stract. Pro gres sive Multifocal Leukoencephalopathy (PML) is a fa tal demyelinating dis ease of the cen tral ner vous sys tem (CNS) caused by the hu man vi rus JC (JCV), a small DNA vi rus which be longs to the subfamily of polyomaviruses. JVC in fec tion is widely ex tended in the hu man pop u la tion in asymp tom atic pa tients; how ever, in se verely immunocompromised pa tients the vi rus is able to rep li cate it self and reach the brain caus ing PML. It is an ex tremely rare dis ease in pa tients with a com pe tent im mune sys tem and few cases have been de scribed in med i cal lit er a ture. We re port the case of an el derly immunocompetent man, with no patho log i cal an te ced ents, who died of sep sis 50 days af ter suf fer ing ex ten sive and se vere flame burns. In the fo ren sic au topsy, a PML was dis covered as an in ci den tal find ing in the neuropathological ex am i na tion that was not de tected dur ing his time in hos pi tal. Di ag no sis was con firmed by the de tec tion of JCV in the brain by in situ hy brid iza tion. Pos si ble pathophysiol ogical mech a nisms for the re ac ti vation of the JCV and the rapid evo lu tion to the fa tal brain demyelinating le sions are discussed. One of the main clin i cal im pli ca tions of this case is that immunocompetence should not be con sid ered as an exclusion criterion for the diagnosis of PML.
) developed a new components method for the estimation of age-at-death from the sternal end of th... more ) developed a new components method for the estimation of age-at-death from the sternal end of the fourth rib. This approach consists of the assignment of numerical scores for several age-related morphological characteristics, which are then inserted into a regression equation for predicting chronological age. The present study tested the accuracy of the new components method on a sample from Spain, consisting of 58 males and 36 females. The results demonstrated that the regression equation devised by the aforementioned authors for an Italian male sample was less accurate when applied to the Spanish population sample. This was true for separate male and female samples, as well as a combined-sex sample. A pair of population-specific regression formulae was then generated from the Spanish sample data in an attempt to improve the accuracy of the age estimate. The new equation which incorporated sex as an independent variable did not yield more accurate age estimates than a non-sex-specific equation. Furthermore, both of these formulae provided only marginally more accurate results for the Spanish sample compared to the original Italian equation. Thus, the standard errors of the estimate associated with these population-specific models (8.1-8.9 years) were still noticeably larger than the 5.2 years observed by Verzeletti and colleagues in their Italian study. Given the high standard errors associated with the age estimates for the Spanish population sample, the new rib components method should be used in conjunction with other adult aging techniques.
Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Ber... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Berlin Heidelberg. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com". Abstract A number of previous studies have demonstrated that osteometric analysis of the sternum provides a highly accurate method for discriminating adult sex in diverse population groups. In this study, sternal measurements were recorded from posteroanterior digital radiographs of the chest plate of 116 Spanish individuals (65 males and 51 females).
FONSECA, G. M.; CANTÍN, M. & LUCENA, J. Odontología Forense II: La Identificación Inequívoca. Int... more FONSECA, G. M.; CANTÍN, M. & LUCENA, J. Odontología Forense II: La Identificación Inequívoca. Int. J. Odontostomat., 7(2):327-334, 2013.
CANTÍN, M.; LUCENA, J. & BENTKOVSKI, A. Odontología Forense I: Las huellas de mordedura. Int. J. ... more CANTÍN, M.; LUCENA, J. & BENTKOVSKI, A. Odontología Forense I: Las huellas de mordedura. Int. J. Odontostomat., 7(1):161-169, 2013.
FONSECA, G. M.; CANTÍN, M. & LUCENA, J. Forensic dentistry as a morphological exercise in the med... more FONSECA, G. M.; CANTÍN, M. & LUCENA, J. Forensic dentistry as a morphological exercise in the medico-legal investigation of death. Int. J. Morphol., 31(2):399-408, 2013.
The ependyma may befall a variety of pathogenic noxae during fetal life. resulung in histological... more The ependyma may befall a variety of pathogenic noxae during fetal life. resulung in histological changes w hich may per s ist after birth but arc without clinical manifestations. Eight of a senes of 19 children who died suddenly and unexpected ly, where no explanation as to the cause of death wa s found at autopsy. were shown to have diverse histological features invol ving the ependyma. Five IJ.m paraffin-embedded brain tissue sections including frontal. tem poral. oc cipital, and ventricular horns as well as the fourth ventricle were stained with hematoxylin-eosin (H&E) and luxol fa st blue (LFB) . Immunohistochemical stams using antibodies to glial fibrillary acidic protein ( G FAP l. virnentin and Sol 00 were also performed, Findings included areas of denuded and/or desquamated ependyma. rosettes in different stag es of formation. vacuoles and/or pseudocysts, inflammatory changes consisting in macro-and microglial nodules in the subependyrnal layer. and gliosis. Chronic brain edema was seen in 4 cases. Our findings indicate that ependymal changes in sudden infant death syndrome (S IDS) cases belong to the prenatal or early postnatal period, thus providing. indirectly. a morphological substrate for the previous existence of a noxa that may also affect other CNS areas. and thus being in the position to produce cardiorespiratory control dysfunction .
Commotio cordis is a clinic-pathological syndrome related to sudden death in young people involve... more Commotio cordis is a clinic-pathological syndrome related to sudden death in young people involved in sports activities. It has been described, mainly, in athletes without previous cardiac anomalies who received a minor blow to the chest which produces ventricular fibrillation and cardiac arrest in the absence of structural damage to the ribs, sternum, or heart. There are few reported cases of commotio cordis associated with violent, non-sports related actions, which are commonly considered to be imprudent homicides. We present the case of a 20-year-old man, who was kicked in the chest during a fight; he suddenly collapsed although advanced cardio-respiratory resuscitation started shortly. Autopsy showed no cardiac lesions concluding that death was due to commotio cordis (blunt trauma to the chest). Toxicological analysis determined the presence of 5.14 mg/L benzoylecgonine in blood. On the basis of medico-legal investigation, the official prosecution considered the death to be imprudent homicide and the aggressor was sentenced to 4 years in prison. We emphasize the importance of the knowledge of the death circumstances through the witnesses' testimony, prior to beginning the autopsy, to confirm this important medico-legal diagnosis. Arrhythmogenic effects of cocaine and its contribution in the production of these deaths are also exposed. #
With an estimated 12 million consumers in Europe, cocaine (COC) is the illicit drug leading to th... more With an estimated 12 million consumers in Europe, cocaine (COC) is the illicit drug leading to the most emergency department visits. The aim of this study was to examine a consecutive series of sudden deaths (SDs) to focus on the prevalence, the toxicological characteristics, and the causes of death in COC-related fatalities.
Este estudio retrospectivo analiza los 57 homicidios ocurridos en la provincia de Sevilla durante... more Este estudio retrospectivo analiza los 57 homicidios ocurridos en la provincia de Sevilla durante un periodo de cuatro años (2004)(2005)(2006)(2007).
Pulmonary embolism (PE) and deep venous thrombosis (DVT) are clinical manifestations of the same ... more Pulmonary embolism (PE) and deep venous thrombosis (DVT) are clinical manifestations of the same entity, venous thromboembolic disease (VTD). In approximately 25% of patients, the first manifestation of PE is sudden-unexpected death.
La miocardiopatía hipertrófica (MCH) es una enfermedad genética muy heterogénea, con múltiples lo... more 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 Palabras clave: Miocardiopatía hipertrófica, muerte súbita, autopsia, patología forense.
La Transposición de los Grandes Vasos con septum íntegro (TGV con SI) es una cardiopatía congénit... more La Transposición de los Grandes Vasos con septum íntegro (TGV con SI) es una cardiopatía congénita caracterizada por la existencia de una discordancia aislada ventrículo-arterial con concordancia aurículo-ventricular. Al no existir mezcla entre las circulaciones sistémica y pulmonar a través de una comunicación interventricular se trata de una cardiopatía cianosante severa, ya que no es posible la oxigenación a nivel sistémico.
A forensic pathology approach to sudden death in children and young adults in Biscay and Seville ... more A forensic pathology approach to sudden death in children and young adults in Biscay and Seville (Spain)
Intestinal ischemia induced by cocaine abuse is a rare condition. To this date, only three cases ... more Intestinal ischemia induced by cocaine abuse is a rare condition. To this date, only three cases have been described. The diagnosis of bowel ischemia should be suspected whenever a cocaine addict has severe abdominal pain. A pathological examination of the resected bowel segment was performed in one case, and the diagnosis was confirmed microscopically. However, the existence of pathologic alterations of the intestinal vessels was not confirmed. Why the intestinal injury is segmental and whether it is related to the dose ingested, the administration route, or the combination of cocaine with alcohol, caffeine, or marijuana remain unclear. The authors report one fatal case associated with cocaine-alcohol overdose. The postmortem examination demonstrated the existence of segmental intestinal ischemia. Microscopic study failed to demonstrate thrombosis in the mesenteric vessels; however, we found an unusual lesion affecting the arterioles located in the intestinal submucosa of the hemorrhagic areas.
Bullet embolism of the arterial, venous and paradoxical types are well known but rare complicatio... more Bullet embolism of the arterial, venous and paradoxical types are well known but rare complications of penetrating missile injuries. Retrograde transthoracic venous bullet embolization is extremely rare with only four cases previously reported in the literature. Single gunshot can cause multiple wounds, mainly because the bullet passes through an intermediate target before striking the victim. We present the autopsy findings of a retrograde transthoracic bullet embolism to the right external iliac vein after a single gunshot with multiple wounds in the left arm and thorax. Problems related to medico-legal investigations of gunshots are reviewed. #
Ab stract. Pro gres sive Multifocal Leukoencephalopathy (PML) is a fa tal demyelinating dis ease ... more Ab stract. Pro gres sive Multifocal Leukoencephalopathy (PML) is a fa tal demyelinating dis ease of the cen tral ner vous sys tem (CNS) caused by the hu man vi rus JC (JCV), a small DNA vi rus which be longs to the subfamily of polyomaviruses. JVC in fec tion is widely ex tended in the hu man pop u la tion in asymp tom atic pa tients; how ever, in se verely immunocompromised pa tients the vi rus is able to rep li cate it self and reach the brain caus ing PML. It is an ex tremely rare dis ease in pa tients with a com pe tent im mune sys tem and few cases have been de scribed in med i cal lit er a ture. We re port the case of an el derly immunocompetent man, with no patho log i cal an te ced ents, who died of sep sis 50 days af ter suf fer ing ex ten sive and se vere flame burns. In the fo ren sic au topsy, a PML was dis covered as an in ci den tal find ing in the neuropathological ex am i na tion that was not de tected dur ing his time in hos pi tal. Di ag no sis was con firmed by the de tec tion of JCV in the brain by in situ hy brid iza tion. Pos si ble pathophysiol ogical mech a nisms for the re ac ti vation of the JCV and the rapid evo lu tion to the fa tal brain demyelinating le sions are discussed. One of the main clin i cal im pli ca tions of this case is that immunocompetence should not be con sid ered as an exclusion criterion for the diagnosis of PML.
) developed a new components method for the estimation of age-at-death from the sternal end of th... more ) developed a new components method for the estimation of age-at-death from the sternal end of the fourth rib. This approach consists of the assignment of numerical scores for several age-related morphological characteristics, which are then inserted into a regression equation for predicting chronological age. The present study tested the accuracy of the new components method on a sample from Spain, consisting of 58 males and 36 females. The results demonstrated that the regression equation devised by the aforementioned authors for an Italian male sample was less accurate when applied to the Spanish population sample. This was true for separate male and female samples, as well as a combined-sex sample. A pair of population-specific regression formulae was then generated from the Spanish sample data in an attempt to improve the accuracy of the age estimate. The new equation which incorporated sex as an independent variable did not yield more accurate age estimates than a non-sex-specific equation. Furthermore, both of these formulae provided only marginally more accurate results for the Spanish sample compared to the original Italian equation. Thus, the standard errors of the estimate associated with these population-specific models (8.1-8.9 years) were still noticeably larger than the 5.2 years observed by Verzeletti and colleagues in their Italian study. Given the high standard errors associated with the age estimates for the Spanish population sample, the new rib components method should be used in conjunction with other adult aging techniques.
Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Ber... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Berlin Heidelberg. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com". Abstract A number of previous studies have demonstrated that osteometric analysis of the sternum provides a highly accurate method for discriminating adult sex in diverse population groups. In this study, sternal measurements were recorded from posteroanterior digital radiographs of the chest plate of 116 Spanish individuals (65 males and 51 females).
FONSECA, G. M.; CANTÍN, M. & LUCENA, J. Odontología Forense II: La Identificación Inequívoca. Int... more FONSECA, G. M.; CANTÍN, M. & LUCENA, J. Odontología Forense II: La Identificación Inequívoca. Int. J. Odontostomat., 7(2):327-334, 2013.
CANTÍN, M.; LUCENA, J. & BENTKOVSKI, A. Odontología Forense I: Las huellas de mordedura. Int. J. ... more CANTÍN, M.; LUCENA, J. & BENTKOVSKI, A. Odontología Forense I: Las huellas de mordedura. Int. J. Odontostomat., 7(1):161-169, 2013.
FONSECA, G. M.; CANTÍN, M. & LUCENA, J. Forensic dentistry as a morphological exercise in the med... more FONSECA, G. M.; CANTÍN, M. & LUCENA, J. Forensic dentistry as a morphological exercise in the medico-legal investigation of death. Int. J. Morphol., 31(2):399-408, 2013.
The ependyma may befall a variety of pathogenic noxae during fetal life. resulung in histological... more The ependyma may befall a variety of pathogenic noxae during fetal life. resulung in histological changes w hich may per s ist after birth but arc without clinical manifestations. Eight of a senes of 19 children who died suddenly and unexpected ly, where no explanation as to the cause of death wa s found at autopsy. were shown to have diverse histological features invol ving the ependyma. Five IJ.m paraffin-embedded brain tissue sections including frontal. tem poral. oc cipital, and ventricular horns as well as the fourth ventricle were stained with hematoxylin-eosin (H&E) and luxol fa st blue (LFB) . Immunohistochemical stams using antibodies to glial fibrillary acidic protein ( G FAP l. virnentin and Sol 00 were also performed, Findings included areas of denuded and/or desquamated ependyma. rosettes in different stag es of formation. vacuoles and/or pseudocysts, inflammatory changes consisting in macro-and microglial nodules in the subependyrnal layer. and gliosis. Chronic brain edema was seen in 4 cases. Our findings indicate that ependymal changes in sudden infant death syndrome (S IDS) cases belong to the prenatal or early postnatal period, thus providing. indirectly. a morphological substrate for the previous existence of a noxa that may also affect other CNS areas. and thus being in the position to produce cardiorespiratory control dysfunction .
Commotio cordis is a clinic-pathological syndrome related to sudden death in young people involve... more Commotio cordis is a clinic-pathological syndrome related to sudden death in young people involved in sports activities. It has been described, mainly, in athletes without previous cardiac anomalies who received a minor blow to the chest which produces ventricular fibrillation and cardiac arrest in the absence of structural damage to the ribs, sternum, or heart. There are few reported cases of commotio cordis associated with violent, non-sports related actions, which are commonly considered to be imprudent homicides. We present the case of a 20-year-old man, who was kicked in the chest during a fight; he suddenly collapsed although advanced cardio-respiratory resuscitation started shortly. Autopsy showed no cardiac lesions concluding that death was due to commotio cordis (blunt trauma to the chest). Toxicological analysis determined the presence of 5.14 mg/L benzoylecgonine in blood. On the basis of medico-legal investigation, the official prosecution considered the death to be imprudent homicide and the aggressor was sentenced to 4 years in prison. We emphasize the importance of the knowledge of the death circumstances through the witnesses' testimony, prior to beginning the autopsy, to confirm this important medico-legal diagnosis. Arrhythmogenic effects of cocaine and its contribution in the production of these deaths are also exposed. #
With an estimated 12 million consumers in Europe, cocaine (COC) is the illicit drug leading to th... more With an estimated 12 million consumers in Europe, cocaine (COC) is the illicit drug leading to the most emergency department visits. The aim of this study was to examine a consecutive series of sudden deaths (SDs) to focus on the prevalence, the toxicological characteristics, and the causes of death in COC-related fatalities.
Este estudio retrospectivo analiza los 57 homicidios ocurridos en la provincia de Sevilla durante... more Este estudio retrospectivo analiza los 57 homicidios ocurridos en la provincia de Sevilla durante un periodo de cuatro años (2004)(2005)(2006)(2007).
Pulmonary embolism (PE) and deep venous thrombosis (DVT) are clinical manifestations of the same ... more Pulmonary embolism (PE) and deep venous thrombosis (DVT) are clinical manifestations of the same entity, venous thromboembolic disease (VTD). In approximately 25% of patients, the first manifestation of PE is sudden-unexpected death.
La miocardiopatía hipertrófica (MCH) es una enfermedad genética muy heterogénea, con múltiples lo... more 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 Palabras clave: Miocardiopatía hipertrófica, muerte súbita, autopsia, patología forense.
La Transposición de los Grandes Vasos con septum íntegro (TGV con SI) es una cardiopatía congénit... more La Transposición de los Grandes Vasos con septum íntegro (TGV con SI) es una cardiopatía congénita caracterizada por la existencia de una discordancia aislada ventrículo-arterial con concordancia aurículo-ventricular. Al no existir mezcla entre las circulaciones sistémica y pulmonar a través de una comunicación interventricular se trata de una cardiopatía cianosante severa, ya que no es posible la oxigenación a nivel sistémico.
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