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Maiese A, Del Duca F, Ghamlouch A, Treves B, Manetti AC, Napoletano G, De Matteis A, Dimattia F, Wan H, Pignataro L, La Russa R. Sudden Death: A Practical Autopsy Approach to Unexplained Mediastinitis Due to Fatal Untreated Neck Infections-A Systematic Review. Diagnostics (Basel) 2024; 14:1150. [PMID: 38893677 PMCID: PMC11171920 DOI: 10.3390/diagnostics14111150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing descending necrotizing mediastinitis (DNM). However, the application of the post-mortem approach in such cases is not well-described in the literature. A literature review was carried out according to the PRISMA methods. Nine papers were included in the final review, revealing different levels of involvement of neck layers that can be linked to different causes. Expertise with respect to the anatomy of the fasciae and spaces of the neck enables an understanding of the pathogenesis of DNM. However, a clear autoptic description was not provided in any of the articles. Therefore, we also employed a practical post-mortem approach to cases of death due to DNM. It is fundamental for pathologists to identify the exact head and neck structures involved. Providing dissectors with support from an otolaryngologist could be useful. This paper could help address such difficult cases.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alessandro Ghamlouch
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Biancamaria Treves
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alice Chiara Manetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy; (A.C.M.); (A.D.M.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alessandra De Matteis
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy; (A.C.M.); (A.D.M.)
| | - Francesca Dimattia
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Huan Wan
- Criminal Justice School, Zhongnan University of Economics and Law, Wuhan 430073, China;
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Alfieri L, Montana A, Frisoni P, D'Errico S, Neri M. Application of Aquaporins as Markers in Forensic Pathology: A Systematic Review of the Literature. Int J Mol Sci 2024; 25:2664. [PMID: 38473914 DOI: 10.3390/ijms25052664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
The study of aquaporins (AQPs) in various forensic fields has offered a promising horizon in response to the need to have reliable elements for the identification of the manner of death and for the individuation of forensic markers for the timing of lesions and vitality of injury. In the literature, various tissues have been studied; the most investigated are the lungs, brain, kidneys, skin, and blood vessels. A systematic literature review on PubMed following PRISMA 2020 guidelines enabled the identification of 96 articles. In all, 34 of these were enrolled to identify Aquaporin-like (AQP-like) forensic markers. The analysis of the literature demonstrated that the most significant markers among the AQPs are as follows: for the brain, AQP4, which is very important in brain trauma and hypoxic damage; AQP3 in the skin lesions caused by various mechanisms; and AQP5 in the diagnosis of drowning. Other applications are in organ damage due to drug abuse and thrombus dating. The focus of this review is to collect all the data present in the literature about the forensic application of AQPs as forensic markers in the most important fields of application. In the current use, the individuation, validation, and application of markers in forensic investigation are very useful in real forensic applications in cases evaluated in court.
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Affiliation(s)
- Letizia Alfieri
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Angelo Montana
- Department of Biomedical Sciences and Public Health, University Politecnica delle Marche, 60126 Ancona, Italy
| | - Paolo Frisoni
- Unit of Legal Medicine, AUSL Romagna, G.B. Morgagni-L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Stefano D'Errico
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Margherita Neri
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
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Del Duca F, Maiese A, Spina F, Visi G, La Russa R, Santoro P, Pignotti MS, Frati P, Fineschi V. Idiopathic Pulmonary Hemorrhage in Infancy: A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13071270. [PMID: 37046488 PMCID: PMC10093109 DOI: 10.3390/diagnostics13071270] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
Acute idiopathic pulmonary hemorrhage in infants (AIPHI) is a rare and quite low-described entity. Nowadays, pathophysiological mechanisms are poorly understood, although the lethality remains high. We present an autopsy case report of a 2-day-old male who developed respiratory distress and blood leakage from the endotracheal tube (ET) and suddenly died because of acute pulmonary hemorrhage. A postmortem examination and histological analysis were performed and are reported in this paper. Alveolar spaces were filled with red blood cells and hyaline membranes in all the examined samples. The absence of other findings led us to select a post-mortem diagnosis of AIPHI. To support our diagnosis, we conducted a systematic review of the updated scientific literature and found that only 61 cases have been reported. Most of them presented acute respiratory distress and bleeding from the upper airways with blood leakage from ET (9.83%), hemoptysis (52.45%), epistaxis (8.2%), and hematemesis (3.27%). The autopsy data revealed hemorrhages of the lower airways and hemosiderin-laden macrophages. The data from the scientific publications and our findings are essential to achieving a correct diagnosis. On these bases, we suggest autoptic criteria to achieve a post-mortem diagnosis of AIPHI.
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Vignali G, Franceschetti L, Attisano GCL, Cattaneo C. Assessing wound vitality in decomposed bodies: a review of the literature. Int J Legal Med 2023; 137:459-470. [PMID: 36550324 DOI: 10.1007/s00414-022-02932-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
The capability of discriminating between a vital and a post-mortem injury has always been a central theme in forensic pathology, particularly when the corpse is an advanced state of decomposition. Post-mortem decay of the body can mask or disrupt the classical features of a skin lesion, making it difficult to establish the cause and manner of death. Taphonomically challenging situations pose several interpretative issues of skin lesions which need to be addressed with scientifically recent methods that are still limited in the forensic literature. For that reason, the present research aims at resuming what is currently available in the attempt to provide some insight regarding this topic. This review considers only original researches, in which the markers of vitality were studied a significant amount of time after death, in order to test post-mortem persistency of these markers over time. A number of 132 original articles and reviews were considered, and the most significant results are resumed in an overview table and in two intuitive figures. Though many researchers tried to establish the vitality of lesions in specimen, few analysed samples from bodies when a significant degree of putrefaction or burning had occurred. The most significant marker proved to be GPA, which sowed a satisfying persistence over time (up to 6 months in air putrefaction and 15 days in water). However, what clearly emerged is that further studies are needed to address the challenges of taphonomically transformed specimen and to possibly neutralize the variability of experimental conditions, which affect the reproducibility of results. In conclusion, this study could be a starting point for providing food for thoughts about the most useful markers to search for in unusually tricky autopsy cases.
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Affiliation(s)
- Giulia Vignali
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Lorenzo Franceschetti
- LABANOF (Laboratorio Di Antropologia E Odontologia Forense), Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe Carlo Lanza Attisano
- LABANOF (Laboratorio Di Antropologia E Odontologia Forense), Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Cattaneo
- LABANOF (Laboratorio Di Antropologia E Odontologia Forense), Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Maiese A, Manetti AC, Santoro P, Del Duca F, De Matteis A, Turillazzi E, Frati P, Fineschi V. FOXO3 Depletion as a Marker of Compression-Induced Apoptosis in the Ligature Mark: An Immunohistochemical Study. Int J Mol Sci 2023; 24:ijms24021396. [PMID: 36674912 PMCID: PMC9866130 DOI: 10.3390/ijms24021396] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
One of the most challenging issues in forensic pathology is lesion vitality demonstration, particularly in cases of hanging. Over the past few years, immunohistochemistry has been applied to this field with promising results. In particular, protein and transcription factors involved in the apoptotic process have been studied as vitality markers for the ligature mark. This study represents an implementation of our previous studies on ligature mark vitality demonstration. In this study, we evaluated the FOXO3 expression in post-mortem cervical skin samples through an immunohistochemical analysis. To evaluate FOXO3 expression, anti-FOXO3 antibodies (GTX100277) were used. The study group comprised 21 cases, 8 women and 13 men, whereas the control group consisted of 13 cases of subjects who died due to other causes. Decomposition and no clear circumstantial data were exclusion criteria. We found that FOXO3 is decreased in hanging cases compared with normal skin in other causes of death (p-value < 0.05). No differences were seen concerning the type of hanging material (hard or soft), type of hanging (complete or incomplete), and position of the knot. Our results suggest that FOXO3 depletion could be a valid immunohistochemical marker of ligature mark vitality.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, PI, Italy
- Correspondence:
| | - Alice Chiara Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, PI, Italy
| | - Paola Santoro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, RM, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, RM, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, RM, Italy
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, PI, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, RM, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, RM, Italy
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Pigolkin YI, Zhandarov KA, Gornostaev DV, Yagmurov OD, Sheptulin DA. [Dissection technique for organs of the neck in hanging]. Sud Med Ekspert 2023; 66:52-55. [PMID: 37192460 DOI: 10.17116/sudmed20236603152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The aim of this study is to develop a comprehensive dissection technique to examine the deep structures of the neck in hanging, including extraction of the cervical spine and investigation of the removed segment with access to vertebral arteries and spinal cord. Its advantages include the unnecessity of any special instruments usage, the short period of time, which is necessary for performing dissection techniques, as well as the possible detailed examination of the spine, spinal cord and vertebral arteries. The improved dissection technique simplifies the diagnosis of injuries and increases the objectivity of the forensic medical examination in hanging.
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Affiliation(s)
- Yu I Pigolkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - K A Zhandarov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - D V Gornostaev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Bureau of Forensic Medical Expertise, Moscow, Russia
| | - O D Yagmurov
- Bureau of Forensic Medical Expertise, St. Petersburg, Russia
| | - D A Sheptulin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Maiese A, Manetti AC, Iacoponi N, Mezzetti E, Turillazzi E, Di Paolo M, La Russa R, Frati P, Fineschi V. State-of-the-Art on Wound Vitality Evaluation: A Systematic Review. Int J Mol Sci 2022; 23:6881. [PMID: 35805886 PMCID: PMC9266385 DOI: 10.3390/ijms23136881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 12/29/2022] Open
Abstract
The vitality demonstration refers to determining if an injury has been caused ante- or post-mortem, while wound age means to evaluate how long a subject has survived after the infliction of an injury. Histology alone is not enough to prove the vitality of a lesion. Recently, immunohistochemistry, biochemistry, and molecular biology have been introduced in the field of lesions vitality and age demonstration. The study was conducted according to the preferred reporting items for systematic review (PRISMA) protocol. The search terms were "wound", "lesion", "vitality", "evaluation", "immunohistochemistry", "proteins", "electrolytes", "mRNAs", and "miRNAs" in the title, abstract, and keywords. This evaluation left 137 scientific papers. This review aimed to collect all the knowledge on vital wound demonstration and provide a temporal distribution of the methods currently available, in order to determine the age of lesions, thus helping forensic pathologists in finding a way through the tangled jungle of wound vitality evaluation.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (A.C.M.); (N.I.); (E.M.); (E.T.); (M.D.P.)
| | - Alice Chiara Manetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (A.C.M.); (N.I.); (E.M.); (E.T.); (M.D.P.)
| | - Naomi Iacoponi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (A.C.M.); (N.I.); (E.M.); (E.T.); (M.D.P.)
| | - Eleonora Mezzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (A.C.M.); (N.I.); (E.M.); (E.T.); (M.D.P.)
| | - Emanuela Turillazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (A.C.M.); (N.I.); (E.M.); (E.T.); (M.D.P.)
| | - Marco Di Paolo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (A.C.M.); (N.I.); (E.M.); (E.T.); (M.D.P.)
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Institute of Legal Medicine, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy;
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Institute of Legal Medicine, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy;
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Zhang S, Ishida Y, Ishigami A, Nosaka M, Kuninaka Y, Hata S, Yamamoto H, Hashizume Y, Matsuki J, Yasuda H, Kimura A, Furukawa F, Kondo T. Forensic Application of Epidermal Ubiquitin Expression to Determination of Wound Vitality in Human Compressed Neck Skin. Front Med (Lausanne) 2022; 9:867365. [PMID: 35492347 PMCID: PMC9045732 DOI: 10.3389/fmed.2022.867365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
Ubiquitin is a member of the heat shock protein family and is rapidly induced by various types of stimuli, including ischemic and mechanical stress. However, its significance in determining wound vitality of neck compression skin in forensic pathology remains unclear. We immunohistochemically examined the expression of ubiquitin in the neck skin samples to understand its forensic applicability in determining wound vitality. Skin samples were obtained from 53 cases of neck compression (hanging, 42 cases; strangulation, 11 cases) during forensic autopsies. Intact skin from the same individual was used as the control. Ubiquitin expression was detected in 73.9% of keratinocytes in intact skin samples, but only in 21.2% of keratinocytes in the compression regions, with statistical differences between the control and compression groups. This depletion in the case of neck compression may be caused by the impaired conversion of conjugated to free ubiquitin and failure of de novo ubiquitin synthesis. From a forensic pathological perspective, immunohistochemical examination of ubiquitin expression in the skin of the neck can be regarded as a valuable marker for diagnosing traces of antemortem compression.
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Affiliation(s)
- Siying Zhang
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuko Ishida
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akiko Ishigami
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mizuho Nosaka
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yumi Kuninaka
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Satoshi Hata
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Yamamoto
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yumiko Hashizume
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Jumpei Matsuki
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Haruki Yasuda
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akihiko Kimura
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Fukumi Furukawa
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshikazu Kondo
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
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