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Oyarzun A, Parsons S, Bassed R. Myocarditis in the forensic setting - a review of the literature. Cardiovasc Pathol 2023; 62:107475. [PMID: 36116635 DOI: 10.1016/j.carpath.2022.107475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/16/2022] [Accepted: 09/11/2022] [Indexed: 12/13/2022] Open
Abstract
Diagnosis of myocarditis as the cause of death at post-mortem is currently determined by a forensic pathologist. There is no systematic method for diagnosis and thus the determination is subject to inter-observer variability and is non-reproducible. Postmortem studies often rely on the clinical method of diagnosis, which is inaccurate. Furthermore, there is no current standardized method of distinguishing between myocarditis as cause of death, and myocardial inflammation as an incidental finding post-mortem. Only a few studies have investigated a method of quantifying this difference using variables such as number of inflammatory cells and presence of myocyte necrosis, however, there are several limitations hindering the reproducibility of this research. This review investigates the current practices and limitations associated with the diagnosis of myocarditis as cause of death in the autopsy setting.
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Affiliation(s)
- Adele Oyarzun
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Melbourne, Australia.
| | - Richard Bassed
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Melbourne, Australia
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Wen S, Unuma K, Funakoshi T, Aki T, Uemura K. Contraction Band Necrosis with Dephosphorylated Connexin 43 in Rat Myocardium after Daily Cocaine Administration. Int J Mol Sci 2022; 23:ijms231911978. [PMID: 36233284 PMCID: PMC9570416 DOI: 10.3390/ijms231911978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
Contraction band necrosis (CBN) is a common abnormality found in the myocardium of cocaine abusers, but is rarely reported in experimental models of cocaine abuse. Connexin 43 (Cx43) is essential for cardiac intercellular communication and the propagation of CBN. Under stress or injury, cardiac Cx43 is dephosphorylated, which is related to cardiomyocyte dysfunction and pathogenesis, whereas adiponectin exerts beneficial effects in the myocardium. In this study, we explore the effects of cocaine on cardiac Cx43 in vivo. Rats were administered cocaine via the tail vein at 20 mg/kg/day for 14 days, and showed widespread CBN, microfocal myocarditis and myocardial fibrosis, corresponding to a dysfunction of cardiac mitochondria under increased oxidative stress. The increase in dephosphorylated cardiac Cx43 and its negative correlation with the myocardial distribution of CBN after cocaine administration were determined. In addition, apoptosis and necroptosis, as well as increased adiponectin levels, were observed in the myocardium after cocaine exposure. Accordingly, we found altered profiles of cardiac Cx43, CBN and its negative correlation with dephosphorylated cardiac Cx43, and the possible involvement of adiponectin in the myocardium after 14 days of cocaine administration. The latter might play a protective role in the cardiotoxicity of cocaine. The current findings would be beneficial for establishing novel therapeutic strategies in cocaine-induced cardiac consequences.
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Brunner A, Schmidt VM, Zelger B, Woess C, Arora R, Zelger P, Huck CW, Pallua J. Visible and Near-Infrared hyperspectral imaging (HSI) can reliably quantify CD3 and CD45 positive inflammatory cells in myocarditis: Pilot study on formalin-fixed paraffin-embedded specimens from myocard obtained during autopsy. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 274:121092. [PMID: 35257987 DOI: 10.1016/j.saa.2022.121092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION To implement Hyperspectral Imaging (HSI) as a tool for quantifying inflammatory cells in tissue specimens by the example of myocarditis in a collective of forensic patients. MATERIAL AND METHODS 44 consecutive patients with suspected myocardial inflammation at autopsy, diagnosed between 2013 and 2018 at the Institute of ForensicMedicine, Medical University of Innsbruck, were selected for this study. Using the IMEC SNAPSCAN camera, visible and near infrared hyperspectral images were collected from slides stained with CD3 and CD45 to assess quantity and spatial distribution of positive cells. Results were compared with visual assessment (VA) and conventional digital image analysis (DIA). RESULTS Finally, specimens of 40 patients were evaluated, of whom 36 patients (90%) suffered from myocarditis, two patients (5%) had suspected healing/healed myocarditis, and two did no have myocarditis (5%). The amount of CD3 and CD45 positive cells did not differ significantly between VA, HSI, and DIA (pVA/HSI/DIA = 0.46 for CD3 and 0.81 for CD45). Coheńs Kappa showed a very high correlation between VA versus HSI, VA versus DIA, and HSI versus DIA for CD3 (Coheńs Kappa = 0.91, 1.00, and 0.91, respectively). For CD45 an almost as high correlation was seen for VA versus HSI and HSI versus DIA (Coheńs Kappa = 0.75 and 0.70) and VA versus DIA (Coheńs Kappa = 0.89). CONCLUSION HSI is a reliable and objective method to count inflammatory cells in tissue slides of suspected myocarditis. Implementation of HSI in digital pathology might further expand the possibility of a sophisticated method.
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Affiliation(s)
- A Brunner
- Innsbruck Medical University, Institute of Pathology, Neuropathology, and Molecular Pathology, Muellerstrasse 44, 6020 Innsbruck, Austria
| | - V M Schmidt
- Institute of Forensic Medicine, Medical University of Innsbruck, Muellerstraße 44, 6020 Innsbruck, Austria
| | - B Zelger
- Innsbruck Medical University, Institute of Pathology, Neuropathology, and Molecular Pathology, Muellerstrasse 44, 6020 Innsbruck, Austria
| | - C Woess
- Institute of Forensic Medicine, Medical University of Innsbruck, Muellerstraße 44, 6020 Innsbruck, Austria.
| | - R Arora
- University Hospital for Orthopedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - P Zelger
- University Clinic for Hearing, Voice and Speech Disorders, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - C W Huck
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, Innsbruck, Austria
| | - J Pallua
- Innsbruck Medical University, Institute of Pathology, Neuropathology, and Molecular Pathology, Muellerstrasse 44, 6020 Innsbruck, Austria; Institute of Forensic Medicine, Medical University of Innsbruck, Muellerstraße 44, 6020 Innsbruck, Austria; University Hospital for Orthopedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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4
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Kasuda S, Kondo T, Terazawa I, Morimoto M, Yuui K, Kudo R. Cardiac sudden death in a young cannabis user. Leg Med (Tokyo) 2021; 53:101955. [PMID: 34438239 DOI: 10.1016/j.legalmed.2021.101955] [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: 04/29/2021] [Revised: 07/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
We report a case of sudden death due to acute coronary syndrome (ACS) in a young cannabis user. A man in his late thirties died at home, and marijuana was found. The autopsy revealed severe occlusion by an atherosclerotic plaque in the left anterior descending artery. The histopathological examination revealed ischemic changes, likely caused by cannabis-induced sympathetic β-adrenergic stimulation. Both cannabinoid receptors (CB1 and CB2) were expressed in the atherosclerotic lesions. The CB2 expression was higher than CB1 expression in the atherosclerotic plaque, corresponding to macrophage infiltration. Since cannabis is regarded as a casual drug due to its lower levels of dependency, some individuals have supported legalized marijuana use. However, this case report will provide cautions on the casual use of cannabis.
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Affiliation(s)
- Shogo Kasuda
- Department of Legal Medicine, Nara Medical University, Kashihara, Nara, Japan.
| | - Takeshi Kondo
- Division of Legal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ikuko Terazawa
- Department of Legal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Mami Morimoto
- Department of Legal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuya Yuui
- Department of Legal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Risa Kudo
- Department of Legal Medicine, Nara Medical University, Kashihara, Nara, Japan
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5
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Arenas DJ, Beltran S, Zhou S, Goldberg LR. Cocaine, cardiomyopathy, and heart failure: a systematic review and meta-analysis. Sci Rep 2020; 10:19795. [PMID: 33188223 PMCID: PMC7666138 DOI: 10.1038/s41598-020-76273-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/26/2020] [Indexed: 01/16/2023] Open
Abstract
Although the cardiotoxic effects of cocaine are universally recognized, the association between cocaine and cardiomyopathy and/or heart failure is poorly understood. To conduct a comprehensive review and meta-analysis on the association between cocaine, heart failure, and cardiomyopathy, we first conducted a broad-term search in PubMed, Embase, Web of Science, and Scopus for human studies containing primary data on the relationship between cocaine and heart failure or cardiomyopathy. We were interested in studies with data beyond acute coronary syndromes. Retrieved studies were grouped into different categories based on possible hypotheses to test by meta-analysis. A second search with specific terms was then conducted. For grouped studies with sufficient clinical and methodological homogeneity, effect sizes were calculated and combined for meta-analysis by the Random Effects model. There is in general a need for more primary data studies that investigate heart failure and/or cardiomyopathy in cocaine users for mechanisms independent of ischemia. There were, however, enough studies to combine by meta-analyses that showed that chronic cocaine use is associated with anatomical and functional changes more consistent with diastolic heart failure instead of the commonly taught dilated cardiomyopathy pathway. In patients without a history of ACS, chronic cocaine use was not associated with significantly reduced EF. The few studies on acute cocaine had conflicting results on whether single-dose intravascular cocaine results in acute heart failure. Studies identified that included beta-blockade therapy in cocaine users with cardiac disease suggest that beta-blockers are not unsafe and that may be effective in the treatment of cocaine-associated heart failure. Chronic cocaine use is associated with anatomical and physiological changes of the heart muscle that are potentially reversible with beta-blockade therapy.
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Affiliation(s)
- Daniel J Arenas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Sourik Beltran
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
| | - Sara Zhou
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, USA
| | - Lee R Goldberg
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
- Penn Medicine Heart Failure and Cardiac Transplant Center, Perelman Center for Advanced Medicine, 11-171 South Tower, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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6
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Muras LH, Iwersen-Bergmann S, Püschel K, Heinemann A. Cocainkonsumintensität als Ursache erworbener Herzerkrankungen? Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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D'Errico S, Niballi S, Bonuccelli D. Aortic dissection in cocaine abuse: A fatal case. J Forensic Leg Med 2018; 58:179-182. [PMID: 30005338 DOI: 10.1016/j.jflm.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/20/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Affiliation(s)
- S D'Errico
- Department of Legal Medicine, Azienda USL Toscana Nordovest Lucca, Italy.
| | - S Niballi
- Department of Legal Medicine, Azienda USL Toscana Nordovest Lucca, Italy
| | - D Bonuccelli
- Department of Legal Medicine, Azienda USL Toscana Nordovest Lucca, Italy
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8
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Comprehensive Histological and Immunochemical Forensic Studies in Deaths Occurring in Custody. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:9793528. [PMID: 28386585 PMCID: PMC5366222 DOI: 10.1155/2017/9793528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/05/2017] [Accepted: 02/28/2017] [Indexed: 01/17/2023]
Abstract
In-custody deaths have several causes, and these include homicide, suicide, natural death from chronic diseases, and unexplained death possibly related to acute stress, asphyxia, excited delirium, and drug intoxication. In some instances, these deaths are attributed to undefined accidents and natural causes even though there is no obvious natural cause apparent after investigation. Understanding these deaths requires a comprehensive investigation, including documentation of circumstances surrounding the death, review of past medical history, drug and toxicology screens, and a forensic autopsy. These autopsies may not always clearly explain the death and reveal only nonspecific terminal events, such as pulmonary edema or cerebral edema. There are useful histologic and biochemical signatures which identify asphyxia, stress cardiomyopathy, and excited delirium. Identifying these causes of death requires semiquantitative morphologic and biochemical studies. We have reviewed recent Bureau of Justice Statistics on in-custody death, case series, and morphological and biochemical studies relevant to asphyxia, stress cardiomyopathy, and excited delirium and have summarized this information. We suggest that regional centers should manage the investigation of these deaths to provide more comprehensive studies and to enhance the expertise of forensic pathologists who would routinely manage potentially complex and difficult cases.
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10
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Nielsen TS, Nyengaard JR, Møller J, Banner J, Nielsen LP, Baandrup UT. Quantitative diagnosis of lymphocytic myocarditis in forensic medicine. Forensic Sci Int 2014; 238:9-15. [DOI: 10.1016/j.forsciint.2014.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/15/2014] [Accepted: 02/14/2014] [Indexed: 11/30/2022]
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Zhang M, Tavora F, Zhang Y, Ripple M, Fowler D, Li L, Zhao Z, Burke A. The role of focal myocardial inflammation in sudden unexpected cardiac and noncardiac deaths—A clinicopathological study. Int J Legal Med 2011; 127:131-8. [DOI: 10.1007/s00414-011-0634-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/07/2011] [Indexed: 11/29/2022]
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12
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García-Repetto R, Giménez MP, Martinez MC, Soria ML. A fatally mistaken fruit juice drink: an unordinary way of cocaine intoxication. J Forensic Leg Med 2010; 17:434-6. [PMID: 21056879 DOI: 10.1016/j.jflm.2010.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 06/30/2010] [Accepted: 08/19/2010] [Indexed: 11/28/2022]
Abstract
Cocaine is one of the drugs of abuse more frequently consumed in Spain. Furthermore, Spain due to its geographical position is used by trafficker's organizations as the port of entrance of cocaine in the European Union. We present here a case of a fatal intoxication caused by a mistake in the cocaine distribution net in our country. Cocaine was concealed in a tropical juice only sold by the Internet.
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Affiliation(s)
- R García-Repetto
- National Institute of Toxicology and Forensic Sciences, Department of Seville, Avda. Dr. Fedriani s/n 41015 Seville, Spain
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13
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14
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Dettmeyer R, Friedrich K, Schmidt P, Madea B. Heroin-associated myocardial damages--conventional and immunohistochemical investigations. Forensic Sci Int 2009; 187:42-6. [PMID: 19304418 DOI: 10.1016/j.forsciint.2009.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 02/04/2009] [Accepted: 02/12/2009] [Indexed: 10/21/2022]
Abstract
Well-known complications related to drug abuse are myocardial insufficiency, myocardial infarction, endocarditis, myocarditis, aortic dissection, neurologic damages, ischemic colitis, thrombotic phenomenons, renal infarction and acute liver failure. Furthermore, microfocal fibrosis of the myocardium is found in stimulant abuse. The origin of myocardial fibrosis associated with opiate abuse (endocarditis, myocarditis, embolism) is still unclear. This question shall be investigated using immunohistochemical staining for early diagnosis of myocarditis. A quantification of myocardial interstitial leucocytic infiltrates was accomplished in 21 chronic drug abusers who died of heroin/morphine intoxication and compared to 15 normal subjects who died suddenly due to non-cardiac causes of death without intoxication (e.g. traffic accidents, head trauma). Toxicological investigations were performed and in addition, blood samples were checked to clarify the status of HIV, hepatitis A, B and C in both groups. To verify signs of inflammation, myocardial specimen from different locations were investigated with conventional histological stainings and immunohistochemical techniques for characterization and quantification of interstitial myocardial leucocytes, T-lymphocytes and macrophages. The number of cells were found up to fivefold increased in heroin addicts compared to the control group without reaching the cut-off values for immunohistochemically based diagnosis of myocarditis.
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Affiliation(s)
- R Dettmeyer
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
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15
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Michaud K, Augsburger M, Sporkert F, Bollmann M, Krompecher T, Mangin P. Interpretation of lesions of the cardiac conduction system in cocaine-related fatalities. J Forensic Leg Med 2007; 14:416-22. [PMID: 17720593 DOI: 10.1016/j.jflm.2007.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 02/06/2007] [Accepted: 02/07/2007] [Indexed: 10/23/2022]
Abstract
This study examines cases of chronic drug users who died suddenly after drug administration. Victims were young subjects, aged from 19 to 35 from Switzerland and known to the police as long-term drug users. The circumstances of death suggested the occurrence of a sudden, unexpected death. Some victims were undergoing methadone treatment. In each case, a forensic autopsy and toxicological analyses were performed at the Institute of Forensic Medicine in Lausanne in Switzerland between 2002 and 2004, including hair analysis as a means to establish chronic drug use in general, and cocaine use in particular. The conduction system was examined histologically and cases showing potentially lethal changes were chosen for this report. The most frequent lesions found were severe thickening of the atrioventricular node artery, intranodal and perinodal fibrosis, and microscopic foci of chronic inflammatory infiltration. The authors conclude that pathological lesions in the conduction tissue may play a role in the occurrence of death attributed to intoxication consecutive to cocaine ingestion.
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Affiliation(s)
- Katarzyna Michaud
- Institut Universitaire de Médecine Légale, University Hospital Center and University of Lausanne, Bugnon 21, 1005 Lausanne, Switzerland.
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16
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Pozner CN, Levine M, Zane R. The cardiovascular effects of cocaine. J Emerg Med 2005; 29:173-8. [PMID: 16029829 DOI: 10.1016/j.jemermed.2005.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Revised: 11/25/2004] [Accepted: 01/26/2005] [Indexed: 10/25/2022]
Abstract
Cocaine use continues to be prevalent among all races and socioeconomic groups in the United States. Patients presenting to emergency departments after cocaine ingestion frequently present with a chief complaint of chest pain. Although acute myocardial infarction is perhaps the most concerning diagnosis in this setting, there are many other potential causes of chest pain after cocaine ingestion. This article reviews the pharmacology of cocaine, as well as the etiologies and treatment of cocaine-associated chest pain, with an emphasis on this drug's range of cardiovascular effects.
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Affiliation(s)
- Charles N Pozner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, 75 Francis Street, Boston, MA 02115, USA
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17
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Fineschi V, Karch SB, D'Errico S, Pomara C, Riezzo I, Turillazzi E. Cardiac pathology in death from electrocution. Int J Legal Med 2005; 120:79-82. [PMID: 16078070 DOI: 10.1007/s00414-005-0011-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 06/10/2005] [Indexed: 10/25/2022]
Abstract
To better characterize the morphologic changes in electrocution, morphologic changes in the hearts of 21 subjects, who died instantaneously of electrocution, were compared to the hearts of decedents with different types of death. Sixteen myocardial samples per heart were processed for histological examination, and sections were prepared with a variety of specific stains. The frequency, location and extent of myocellular segmentation (stretching and/or rupture) of intercalated discs and associated changes of myocardial bundles and single myocells [myofibre break-up (MFB)] were recorded, quantitatively analysed and statistically evaluated. The frequency of MFB was maximal in cases of electrocution (90%). The findings show that MFB is an ante-mortem change and may be a distinct finding in electrocution.
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Affiliation(s)
- Vittorio Fineschi
- Institute of Forensic Pathology, Faculty of Medicine, University of Foggia, Ospedali Riuniti, Via L. Pinto 1, 71100 Foggia, Italy.
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18
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Baroldi G, Silver MD, Parolini M, Pomara C, Turillazzi E, Fineschi V. Myofiberbreak-up: A marker of ventricular fibrillation in sudden cardiac death. Int J Cardiol 2005; 100:435-41. [PMID: 15837088 DOI: 10.1016/j.ijcard.2004.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2004] [Revised: 08/08/2004] [Accepted: 10/04/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Electrophysiologically, ventricular fibrillation is defined as a "chaotic, random, asynchronous electrical activity of the ventricles due to repetitive re-entrant excitation and/or rapid focal discharge". To this point its morphological equivalent has not been defined. MATERIAL AND METHOD Several groups of different diseases and types of accidental death in normal subjects were studied. A complete autopsy was performed and the hearts were examined in 432 cases. A total of 16 myocardial samples per heart were processed for histological examination and sections were stained by haematoxylin and eosin or by specific stains. The frequency, location and extent of myocellular segmentation (stretching and/or rupture) of intercalated discs and associated changes of myocardial bundles and single myocells were investigated. A quantitative analysis was performed and the data were processed for statistical evaluation. RESULTS The frequency of MFB was maximal in coronary (88%) and Chagas (76%) groups followed by the intracranial brain haemorrhage group (52%). The extent of myofiberbreak-up was maximal in coronary/Chagas groups followed by intracranial haemorrhage and transplant groups. CONCLUSIONS No correlation was seen between gender, age, heart weight, degree of coronary atherosclerosis, myocardial fibrosis, survival and MFB. If our postulate is correct, finding MFB in the myocardium might allow the diagnosis of a malignant arrhythmia followed by cardiac arrest due to ventricular fibrillation even in the absence of clinical information (sudden death out-of-hospital).
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Affiliation(s)
- Giorgio Baroldi
- Institute of Clinical Physiology, National Research Council (CNR), Pisa and Milan, Italy
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19
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Dettmeyer R, Schlamann M, Madea B. Cocaine-associated abscesses with lethal sepsis after splenic infarction in an 17-year-old woman. Forensic Sci Int 2004; 140:21-3. [PMID: 15013162 DOI: 10.1016/j.forsciint.2003.11.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Accepted: 11/04/2003] [Indexed: 10/26/2022]
Abstract
Well known complications related to cocaine use are myocardial insufficiency, myocardial infarction, myocarditis, aortic dissection, neurologic damages, ischemic colitis, thrombotic phenomenons, renal infarction and acute liver failure. Cases of splenic infarctions related to cocaine use are extremely rare. A 17-year-old drug addict was found by her boy-friend liveless in her bed. She was well known using cocaine since years. Autopsy revealed multiple splenic infarctions with secondary mixed bacterial infection and abscesses. Petechial bleedings were found and microabscesses in the myocardium, the meninges and the kidneys. The absolutely rare bacterial infection of the cocaine-associated splenic infarction leads to sepsis with lethal course.
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Affiliation(s)
- R Dettmeyer
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
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20
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Püschel K, Stein S, Stobbe S, Heinemann A. Analysis of 683 drug packages seized from “body stuffers”. Forensic Sci Int 2004; 140:109-11. [PMID: 15013172 DOI: 10.1016/j.forsciint.2003.10.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Accepted: 10/28/2003] [Indexed: 11/26/2022]
Abstract
The wrappings and contents of 683 drug containers (bubbles) seized from 154 street dealers have been analysed since 2001, when the law enforcement policy in Hamburg, Germany, allowed the application of emetics to be used by so-called body stuffers for the recovery of swallowed drug packages. Of the bubbles recovered 96% contained cocaine. Cases of intoxication have not yet been observed but a 20-year-old man with a previously unknown toxic cardiomyopathy died 3 days after a sudden cardiac arrest which followed the forced application of ipecacuanha via correctly placed nasogastral tube.
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Affiliation(s)
- K Püschel
- Institute of Legal Medicine, Butenfeld 34, Hamburg 22529, Germany
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21
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Fineschi V, Centini F, Monciotti F, Turillazzi E. The cocaine "body stuffer" syndrome: a fatal case. Forensic Sci Int 2002; 126:7-10. [PMID: 11955824 DOI: 10.1016/s0379-0738(02)00011-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Body stuffer, sometimes called "mini packer", is the definition of someone who admits to or is strongly suspected of ingesting illegal drugs in order to escape detection by authorities, and not for recreational purposes or to transport the drug across borders. Cocaine is the drug most commonly involved in the body stuffer syndrome. Reported cases of body stuffer deaths are rare, however a fatality related to the ingestion of a plastic bag containing cocaine is described regarding a 17-year-old dealer. The authors describe how the cocaine body stuffer syndrome differs from the usual body packer. Histological and toxicological findings are examined and discussed for a better definition of this unique syndrome.
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Affiliation(s)
- Vittorio Fineschi
- Institute of Legal Medicine, University of Foggia, Ospedali Riuniti, Via L. Pinto 1, I-71100, Foggia, Italy.
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22
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Abstract
Histological appearances of the fractured superior horns (SH) of the thyroid cartilage and their surrounding tissues were reviewed, with particular reference to signs of vital origin of the fracture. Twenty-nine autopsies with either histories or findings indicating asphyxial neck compression, with a total of 39 fractured SHs, and three autopsies with history of suicidal jump from height with a total of two SH fractures, were examined. Fifteen autopsies with finding of 19 artefactually fractured SHs while removing neck organs at autopsy were used as controls. In the cases of neck compression and victims of jump from height haemorrhages, retraction of fractured SH fragments with invagination or squeezing of the perichondrium, contraction bands, contraction band necrosis and 'opaque fibres', in the adjacent muscle fibres could be seen. Fibrin deposition and/or leucocytic reaction were noted in cases where circumstances of death indicated prolonged death struggle (as in incomplete hanging, resuscitation or homicidal neck compression). However, retraction of fractured fragments and invagination of perichondrium between artefactually fractured SH fragments were observed in both control cases and cases with antemortem trauma to the larynx. Many of these histological findings, including haemorrhages and fractures had not been evident at gross examination. We conclude that histological examination of SHs may not only uncover macroscopically overlooked injuries but also may facilitate the clarification of an injury's vital origin.
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Affiliation(s)
- J Rajs
- Department of Forensic Medicine, Karolinska Institute, S-171 77, Stockholm, Sweden
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Fineschi V, Centini F, Mazzeo E, Turillazzi E. Adam (MDMA) and Eve (MDEA) misuse: an immunohistochemical study on three fatal cases. Forensic Sci Int 1999; 104:65-74. [PMID: 10533279 DOI: 10.1016/s0379-0738(99)00095-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Three fatal cases of MDMA/MDEA misuse have been examined. These referred to white males between 19 and 20 years of age, in which post-mortem toxicology showed the presence of MDMA (in one case), MDEA (in one case) and both (in one case). The clinical data were analysed and the histopathological findings were studied following immunohistochemical investigations. A complete immunohistochemical study has made it possible to demonstrate rhabdomyolysis and myoglobinuria with alterations of the organs typical of a DIC. Clinical, histopathological and toxicological data suggest that severe or fatal complications following ecstasy ingestion could be related to idiosyncratic response.
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Affiliation(s)
- V Fineschi
- Unit of Legal Medicine, University of Bari, Italy.
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