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Vilmont V, Ngatchou N, Lioux G, Kalucki S, Brito W, Burnier M, Rotman S, Lardi C, Pruijm M. A new, deep learning-based method for the analysis of autopsy kidney samples used to study sex differences in glomerular density and size in a forensic population. Int J Legal Med 2024; 138:873-882. [PMID: 38177496 PMCID: PMC11003899 DOI: 10.1007/s00414-023-03153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Abstract
Artificial intelligence (AI) is increasingly used in forensic anthropology and genetics to identify the victim and the cause of death. The large autopsy samples from persons with traumatic causes of death but without comorbidities also offer possibilities to analyze normal histology with AI. We propose a new deep learning-based method to rapidly count glomerular number and measure glomerular density (GD) and volume in post-mortem kidney samples obtained in a forensic population. We assessed whether this new method detects glomerular differences between men and women without known kidney disease. Autopsies performed between 2009 and 2015 were analyzed if subjects were aged ≥ 18 years and had no known kidney disease, diabetes mellitus, or hypertension. A large biopsy was taken from each kidney, stained with hematoxylin and eosin, and scanned. An in-house developed deep learning-based algorithm counted the glomerular density (GD), number, and size. Out of 1165 forensic autopsies, 86 met all inclusion criteria (54 men). Mean (± SD) age was 43.5 ± 14.6; 786 ± 277 glomeruli were analyzed per individual. There was no significant difference in GD between men and women (2.18 ± 0.49 vs. 2.30 ± 0.57 glomeruli/mm2, p = 0.71); glomerular diameter, area, and volume also did not differ. GD correlated inversely with age, kidney weight, and glomerular area. Glomerular area and volume increased significantly with age. In this study, there were no sex differences in glomerular density or size. Considering the size of the kidney samples, the use of the presented deep learning method can help to analyze large renal autopsy biopsies and opens perspectives for the histological study of other organs.
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Affiliation(s)
- Valérie Vilmont
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Nadine Ngatchou
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | | | - Sabrina Kalucki
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Wendy Brito
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christelle Lardi
- University Center of Legal Medicine Geneva, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Menno Pruijm
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland.
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Larribau R, Payot C, Lardi C, Suppan L, Fehlmann CA. Influence of population characteristics and use of emergency medical systems on the rate of asystolic out-of-hospital cardiac arrest for which resuscitation is attempted. Resuscitation 2023; 185:109730. [PMID: 36773838 DOI: 10.1016/j.resuscitation.2023.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland.
| | - Charles Payot
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland.
| | - Christelle Lardi
- CURML, University Center of Legal Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland.
| | - Christophe Alain Fehlmann
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva 14, Switzerland.
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Aguiar D, Fracasso T, Lardi C. Fatal Ogilvie’s syndrome after hip surgery and review of the literature. Forensic Sci Med Pathol 2022; 18:170-175. [PMID: 35258784 PMCID: PMC9106643 DOI: 10.1007/s12024-022-00470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/24/2022]
Abstract
Ogilvie’s syndrome refers to a massive dilation of the colon without mechanical obstruction. Although this syndrome is well-known in the clinical literature and may sometimes be encountered as a complication of abdominal, pelvic, or hip surgery, it has only been reported sporadically in the forensic literature. We present the case of a forensic autopsy carried out on a patient whose death was related to cecal necrosis with acute peritonitis due to Ogilvie’s syndrome following hip surgery. This diagnosis was based on clinical data, post-mortem imagery, autopsy findings, histological analysis, post-mortem chemistry, and microbiological analysis. A review of the literature and possible physiopathology of this disease are performed, while focusing on medico-legal perspectives.
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Affiliation(s)
- Diego Aguiar
- University Center of Legal Medicine (CURML), Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Tony Fracasso
- University Center of Legal Medicine (CURML), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Christelle Lardi
- University Center of Legal Medicine (CURML), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Marti V, Augsburger M, Widmer C, Lardi C. Significant postmortem diffusion of ethanol: A case report. Forensic Sci Int 2021; 328:111046. [PMID: 34687994 DOI: 10.1016/j.forsciint.2021.111046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
In the realm of forensic pathology, ethanol is one of the most frequently encountered xenobiotics. The determination of ethanol concentration in blood after death is of great interest in forensic settings. It is important to be able to determine the level of intoxication of the deceased at the time of death, which is directly correlated to the ability to act prior to death, especially when a suicide is suspected. This estimation is not always easy to establish owing to various artifacts that are important to know for a proper ethanol blood level interpretation, among them postmortem (PM) diffusion. We describe here a case of unusual ethanol distribution in body compartments and discuss the importance of PM diffusion and redistribution while performing complementary toxicological analysis, especially when the blood and urine samples seemed to be inconsistent after the first results.
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Affiliation(s)
- Valentin Marti
- Unit of Forensic Pathology, University Centre of Legal Medicine Lausanne-Geneva, Geneva University Hospitals and University of Geneva, Rue Michel-Servet 1, CH-1211 Geneva, Switzerland.
| | - Marc Augsburger
- Unit of Forensic Toxicology and Chemistry, University Centre of Legal Medicine Lausanne-Geneva, Geneva University Hospitals and University of Geneva, Rue Michel-Servet 1, CH-1211 Geneva, Switzerland
| | - Christèle Widmer
- Unit of Forensic Toxicology and Chemistry, University Centre of Legal Medicine Lausanne-Geneva, Geneva University Hospitals and University of Geneva, Rue Michel-Servet 1, CH-1211 Geneva, Switzerland
| | - Christelle Lardi
- Unit of Forensic Pathology, University Centre of Legal Medicine Lausanne-Geneva, Geneva University Hospitals and University of Geneva, Rue Michel-Servet 1, CH-1211 Geneva, Switzerland
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Payot C, Fehlmann CA, Suppan L, Niquille M, Lardi C, Sarasin FP, Larribau R. Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest. Int J Environ Res Public Health 2021; 18:ijerph18168323. [PMID: 34444071 PMCID: PMC8391446 DOI: 10.3390/ijerph18168323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.
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Affiliation(s)
- Charles Payot
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Christophe A. Fehlmann
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Emergency Medicine, Research Group, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Christelle Lardi
- University Center of Legal Medicine (CURML), Geneva University Hospitals, 1211 Geneva, Switzerland;
| | - François P. Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
- Correspondence: ; Tel.: +41-79-553-9400
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Lefrancois E, Reymond N, Thomas A, Lardi C, Fracasso T, Augsburger M. Summary statistics for drugs and alcohol concentration recovered in post-mortem femoral blood in Western Switzerland. Forensic Sci Int 2021; 325:110883. [PMID: 34229141 DOI: 10.1016/j.forsciint.2021.110883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
In post-mortem investigations of fatal intoxication, it is challenging to determine which drug(s) were responsible for the death, and which drugs did not. This study aims to provide post-mortem femoral blood drug levels in lethal intoxication and in post-mortem control cases, where the cause of death was other than intoxication. The reference values could assist in the interpretation of toxicological results in the routine casework. To this end, all post-mortem toxicological results in femoral blood from 2011 to 2017 in Western Switzerland were considered. A full autopsy with systematic toxicological analysis (STA) was conducted in all cases. Results take into account the cause of death classified into one of four categories (as published by Druid and colleagues): I) certified intoxication by one substance alone, IIa) certified intoxication by more than one substance, IIb) certified other causes of death with incapacitation due to drugs, and III) certified other causes of death without incapacitation due to drugs. This study includes 1 990 post-mortem cases where femoral blood was analysed. The material comprised 619 women (31%) and 1 371 men (69%) with a median age of 50 years. The concentrations of the 32 most frequently recorded substances as well as alcohol are discussed. These include 6 opioids and opiates, 3 antidepressants, 6 neuroleptics and hypnotics, 1 barbiturate, 11 benzodiazepines (and related drugs), 2 amphetamine-type stimulants, cocaine, paracetamol, and tetrahydrocannabinol (THC). The most common substances that caused intoxication alone were morphine, methadone, ethanol, tramadol, and cocaine. The post-mortem concentration ranges for all substance are categorized as I, IIa, IIb, or III. Statistical post-mortem reference concentrations for drugs are discussed and compared with previously published concentrations. This study shows that recording and classifying cases is time-consuming, but it is rewarding in a long-term perspective to achieve a more reliable information about fatal and non-fatal blood concentrations.
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Affiliation(s)
- Elodie Lefrancois
- School of criminal justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Switzerland; University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Naomi Reymond
- School of criminal justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Switzerland
| | - Aurélien Thomas
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Christelle Lardi
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Tony Fracasso
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Marc Augsburger
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
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Kalucki SA, Lardi C, Garessus J, Kfoury A, Grabherr S, Burnier M, Pruijm M. Reference values and sex differences in absolute and relative kidney size. A Swiss autopsy study. BMC Nephrol 2020; 21:289. [PMID: 32689967 PMCID: PMC7372852 DOI: 10.1186/s12882-020-01946-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background Men have larger kidneys than women, but it is unclear whether gender remains an independent predictor of kidney size (expressed as weight or length) after correction for body size. We analysed autopsy data to assess whether relative renal length and weight (e.g. corrected for body weight, height or body surface area (BSA)) are also larger in men. Assuming that kidney size is associated with nephron number, opposite findings could partly explain why women are less prone to the development and progression of chronic kidney disease than men. Methods All forensic autopsies performed between 2009 and 2015 at the local university hospital of Geneva in individuals of European descent aged ≥18 years without a known history of diabetes and/or kidney disease were examined. Individuals with putrefied or severely injured bodies were excluded. Relative renal weight and length were respectively defined as renal weight divided by body weight or BSA and renal length divided by body height or BSA. Results A total of 635 autopsies (68.7% men) were included in the analysis. Left kidneys were on average 8 g heavier and 2 mm longer than right kidneys (both: p < 0.05). Absolute renal weight (165 ± 40 vs 122 ± 29 g) and length (12.0 ± 1.3 vs 11.4 ± 1.1 cm) were higher in men. Relative renal weight was also higher in men, but relative renal length was larger in women. In multivariable regression analysis, body height, body weight, the degree of blood congestion or depletion at autopsy and age were determinants of renal weight, whereas arterial hypertension and smoking were not. Percentile curves of renal weight and length according to sex and body height were constructed. Conclusion Absolute and relative renal weights were both smaller in women. This is in line with recent studies stating that nephron numbers are also lower in women. Relative renal length was longer in women, suggesting that female kidneys have a more elongated shape. In comparison with older autopsy studies, renal weight appears to be stable over time.
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Affiliation(s)
- Sabrina Addidou Kalucki
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Christelle Lardi
- University Center of Legal Medicine Lausanne-Geneva, Rue Michel-Servet 1, Geneva University Hospital, Geneva, Switzerland
| | - Jonas Garessus
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Alain Kfoury
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne-Geneva, Rue Michel-Servet 1, Geneva University Hospital, Geneva, Switzerland.,UUniversity Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland.
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Abstract
In the setting of the coronavirus disease 2019 (COVID-19) pandemic, only few data regarding lung pathology induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is available, especially without medical intervention interfering with the natural evolution of the disease. We present here the first case of forensic autopsy of a COVID-19 fatality occurring in a young woman, in the community. Diagnosis was made at necropsy and lung histology showed diffuse alveolar damage, edema, and interstitial pneumonia with a geographically heterogeneous pattern, mostly affecting the central part of the lungs. This death related to COVID-19 pathology highlights the heterogeneity and severity of central lung lesions after natural evolution of the disease.
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Affiliation(s)
- Diego Aguiar
- University Center of Legal Medicine (CURML), Geneva University Hospital, Geneva, Switzerland.
| | | | - Manuel Schibler
- Laboratory of Virology, Geneva University Hospital, Geneva, Switzerland
- Infectious Diseases Division, Geneva University Hospital, Geneva, Switzerland
| | - Tony Fracasso
- University Center of Legal Medicine (CURML), Geneva University Hospital, Geneva, Switzerland
| | - Christelle Lardi
- University Center of Legal Medicine (CURML), Geneva University Hospital, Geneva, Switzerland
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Wiskott K, Genet P, Lobrinus JA, Fracasso T, Lardi C. Intimomedial mucoid arterial degeneration, a rare arterial disorder of forensic significance. Forensic Sci Med Pathol 2019; 15:591-594. [PMID: 31446611 DOI: 10.1007/s12024-019-00154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
Abstract
The body of a 43-year-old African woman with a history of aortic aneurysm and hypertension was forensically investigated after her sudden death. The cause of death was related to a cardiac tamponade due to a ruptured aneurysm of the ascending aorta. Post-mortem gross examination showed an abnormal whitish discoloration of the intima with fibrous thickening of the aortic wall. Several arteries (left main and circumflex coronaries, carotid, renal and iliac arteries) showed similar features. Upon histological examination, the aortic aneurysm as well as the other arteries sampled showed mucoid degeneration, excess mucopolysaccharides and pools of mucin inside the intima and the media associated with collagen and elastic fiber destruction and loss of smooth muscle cells. This pattern strongly suggested the diagnosis of intimomedial mucoid degeneration (IMMD), a rare arterial disorder consisting of a progressive deposition of mucin into the intima and media, with a strong prevalence in middle-aged black African females with high blood pressure. In addition to the typical features of IMMD, histological examination of the ascending aorta showed a thickening of the adventita with sparse mixed inflammatory infiltrates and fibrosis, suggesting an additional chronic infectious aortitis. No infectious agent was detected. The body of literature on IMMD is reviewed and the origin of death is discussed in this case report.
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Affiliation(s)
- Kim Wiskott
- University Center of Legal Medicine, Rue Michel-Servet 1, 1205, Geneva, Switzerland.
| | - Pia Genet
- University Center of Legal Medicine, Rue Michel-Servet 1, 1205, Geneva, Switzerland
| | - Johannes A Lobrinus
- Clinical Pathology Division, Geneva University Hospitals, Rue Michel-Servet 1, 1205, Geneva, Switzerland
| | - Tony Fracasso
- University Center of Legal Medicine, Rue Michel-Servet 1, 1205, Geneva, Switzerland
| | - Christelle Lardi
- University Center of Legal Medicine, Rue Michel-Servet 1, 1205, Geneva, Switzerland
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Milani B, Lardi C, Schneider A, Stuber M, Burnier M, Pruijm M. MP334REDUCED RENAL TISSUE OXYGENATION WITH AGING IN MEN, BUT NOT IN WOMEN. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx169.mp334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Palmiere C, Tettamanti C, Augsburger M, Burkhardt S, Sabatasso S, Lardi C, Werner D. Postmortem biochemistry in suspected starvation-induced ketoacidosis. J Forensic Leg Med 2016; 42:51-5. [PMID: 27239954 DOI: 10.1016/j.jflm.2016.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/12/2016] [Accepted: 04/24/2016] [Indexed: 11/26/2022]
Abstract
Significantly increased blood ketone body levels can be occasionally observed in the forensic setting in situations other than exposure to cold, diabetic or alcoholic ketoacidosis. Though infrequent, these cases do occur and deserve thorough evaluation in order to establish appropriate differential diagnoses and quantify the role that hyperketonemia may play in the death process. Starvation ketoacidosis is a rare cause of metabolic acidosis and is a phenomenon that occurs normally during fasting, as the body switches from carbohydrate to lipid energy sources. The levels of ketonemia in starvation ketoacidosis is usually mild in comparison to those seen in diabetic or alcoholic ketoacidosis. In the clinical setting, several cases of starvation-induced ketoacidosis mainly associated with gastric banding, pregnancy, malnutrition and low-carbohydrate diets have been reported. However, starvation ketosis causing severe metabolic acidosis has been rarely described in the medical literature. In the realm of forensic pathology, starvation-induced hyperketonemia has been rarely described. In this paper we present the postmortem biochemical results observed in situations of suspected starvation-induced hyperketonemia that underwent medico-legal examination. In all these cases, the diagnosis of starvation induced-hyperketonemia and the subsequent ketoacidosis was established per exclusionem based on all postmortem investigation findings. A review of the literature pertaining to the clinical diagnosis of starvation ketoacidosis is also provided.
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Affiliation(s)
| | - Camilla Tettamanti
- Department of Legal Medicine, University of Genova, Via de Toni 12, 16132 Genova, Italy
| | | | | | | | | | - Dominique Werner
- Laboratory of Clinical Chemistry, Lausanne University Hospital, Lausanne, Switzerland
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Lardi C, Vogt S, Pollak S, Thierauf A. Complex suicide with homemade nicotine patches. Forensic Sci Int 2014; 236:e14-8. [DOI: 10.1016/j.forsciint.2013.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/13/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
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Lardi C, Schmit G, Burkhardt S, Mangin P, Palmiere C. Philemon and Baucis Deaths: Case Reports and Postmortem Biochemistry Contribution. J Forensic Sci 2014; 59:1133-8. [DOI: 10.1111/1556-4029.12419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 04/23/2013] [Accepted: 05/04/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Christelle Lardi
- University Centre of Legal Medicine Lausanne-Geneva; Rue du Bugnon 21, 1011 Lausanne, Switzerland - rue Michel-Servet 1 1211 Genève 4 Switzerland
| | - Gregory Schmit
- University Centre of Legal Medicine Lausanne-Geneva; Rue du Bugnon 21, 1011 Lausanne, Switzerland - rue Michel-Servet 1 1211 Genève 4 Switzerland
| | - Sandra Burkhardt
- University Centre of Legal Medicine Lausanne-Geneva; Rue du Bugnon 21, 1011 Lausanne, Switzerland - rue Michel-Servet 1 1211 Genève 4 Switzerland
| | - Patrice Mangin
- University Centre of Legal Medicine Lausanne-Geneva; Rue du Bugnon 21, 1011 Lausanne, Switzerland - rue Michel-Servet 1 1211 Genève 4 Switzerland
| | - Cristian Palmiere
- University Centre of Legal Medicine Lausanne-Geneva; Rue du Bugnon 21, 1011 Lausanne, Switzerland - rue Michel-Servet 1 1211 Genève 4 Switzerland
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Shiferaw K, Burkhardt S, Lardi C, Mangin P, Harpe RL. A half century retrospective study of homicide–suicide in Geneva – Switzerland: 1956–2005. J Forensic Leg Med 2010; 17:62-6. [DOI: 10.1016/j.jflm.2009.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 05/07/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Burkhardt S, Lardi C, La Harpe R. [Post-mortem partial skeletization of the face and neck by an Appenzell mountain dog]. Arch Kriminol 2009; 223:117-122. [PMID: 19432090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
An 81-year-old man died unexpectedly from a cardiac cause. His wife, who lived in the same house and suffered from Alzheimer's disease, did not realize his death. When the body was found at the foot of the stairs 2-3 days afterwards, extensive soft tissue defects with notched wound edges, but no signs of vitality, were observed on the head and neck. The site where the body was found showed almost no traces of blood. In view of the injuries and their obviously post-mortem origin it was assumed that they had been caused by the man's Appenzell mountain dog which also lived in the house. By means of DNA typing, swabs from the wound edges of the soft-tissue defects could be assigned to the deceased's dog.
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Affiliation(s)
- Sandra Burkhardt
- Institut für Rechtsmedizin, Universität Genf ( Direktor: Prof. Dr. med. P. Mangin)
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Delay D, Lardi C, Jaussi A, von Segesser LK. Hepato-atrial anastomosis, the "other Senning operation" for treatment of Budd-Chiari syndrome. Swiss Med Wkly 2005; 135:235-7. [PMID: 15971116 DOI: 2005/15/smw-11002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A now 36-year-old woman developed a suprahepatic inferior vena cava stenosis, 9 years after liver transplantation for extensive liver echinococcosis. The lesion was treated by percutaneous angioplasty and stenting. Five years later, recurrence of echinococosis with intrastent stenosis together with clinical symptoms, prompted surgical treatment. Hepato-atrial anastomosis was performed under cardiopulmonary bypass with good result.
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Affiliation(s)
- Dominique Delay
- Department of cardiac surgery, University Hospital Centre of Canton Vaux (CHUV), Lausanne, Switzerland.
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Delay D, Lardi C, Jaussi A, von Segesser LK. Hepato-atrial anastomosis, the "other Senning operation" for treatment of Budd-Chiari syndrome. Swiss Med Wkly 2005; 135:235-7. [PMID: 15971116 DOI: 10.4414/smw.2005.11002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A now 36-year-old woman developed a suprahepatic inferior vena cava stenosis, 9 years after liver transplantation for extensive liver echinococcosis. The lesion was treated by percutaneous angioplasty and stenting. Five years later, recurrence of echinococosis with intrastent stenosis together with clinical symptoms, prompted surgical treatment. Hepato-atrial anastomosis was performed under cardiopulmonary bypass with good result.
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Affiliation(s)
- Dominique Delay
- Department of cardiac surgery, University Hospital Centre of Canton Vaux (CHUV), Lausanne, Switzerland.
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