Multi-phase post-mortem CT-angiography （MPMCTA） has the great potential to increase the quality of the postmortem investigation, especially in the area of sudden death; however, its role as routine complement to the...Multi-phase post-mortem CT-angiography （MPMCTA） has the great potential to increase the quality of the postmortem investigation, especially in the area of sudden death; however, its role as routine complement to the pathology toolbox is still questioned as it needs to be further standardized. The aim of this study is to investigate the contribution of MPMCTA in cases of sudden unexplained death in adults and in particular in sudden cardiovascular death. Sixty-eight sudden unexpected deaths of adults were investigated at our institution between 2012 and 2013. Ten cases underwent MPMCTA and autopsy and were included in the study. Before the angiographic step by complete filling of the vascular system, prior to any manipulation of the body, a non-contrast CT-scan was carried out. Image reconstructions were performed on a CT workstation （Vitrea） and two radiologists experienced with post mortem imaging interpreted the MPMCTA findings. In all 10 cases, we could state a good correlation between combination of post-mortem CT and MPMCTA and autopsy procedures, confirming a high diagnostic sensitivity. With this case series we want to illustrate the advantages offered by performing MPMCTA when facing a sudden death, regardless of specific suspicion for acute coronary syndrome or other vascular or ischemic disease.展开更多
A group of 19th century inmates dead in the prison of Parma are the protagonist of an incredible scientific collection. Lorenzo Tenchini started the creation of this collection and dedicated his work and his studies t...A group of 19th century inmates dead in the prison of Parma are the protagonist of an incredible scientific collection. Lorenzo Tenchini started the creation of this collection and dedicated his work and his studies to its completeness. Anatomist and academic, Lorenzo Tenchini (1852–1906) dedicated his scientific studies to macroscopic anatomy, particularly about central nervous system and its correlation with psychic function. In 1881 he became ordinary professor in Normal Human Anatomy at the University of Parma dedicating himself to the study of the anatomical organization of the brain and psychic and social disturbs. During the study of the skulls and brains of psychotic patients and the deformations of skulls belonging to patients admitted in the Hospital of Brescia, he started a collaboration with Alessandro Cugini (1829–1913), founder of the Institute of Legal Medicine at the University of Parma. Tenchini realized an anatomical collection, preserved today in the Museum of Biomedicine of the University of Parma. This collection represents the master-piece of his research carried out during his academic activity and still a unicum in the west-ern world, as there are no similar collection assembling such a multidisciplinary information. The peculiarity of this collection is due not only to the scientific interest of the anatomic samples and their full clinical documentation, but also to the methods employed in order to realize it. At the end of the 19th century, as a student of Cesare Lombroso (1835–1909), Tenchini based his work on the study of the face, the skull and brain of each dead inmate of Parma's prison or Colorno's mental hospital. These individuals as protagonists of Tenchini's collection, leave a legacy identifiable as scientific heritage. Their skulls and brains, the reproduction of their faces through ceroplastic and other anatomical samples treated with other techniques, are accompanied by an autoptic and psychiatric full documentation, allowing the collection to be complete with every aspect related to the inmates studied. Through his work, a comparison between different kind of studies, such as psychiatry, psych-ology, neurology, legal medicine and anthropology, is suitable in scientific research to be realized. Moreover, data come from a forensic context: this allows a comparison with differ-ent methodologies employed in modern age by forensic expertise such as the comparison between modern and ancient medical diagnostic technique. This masterpiece represents Tenchini's neuroanatomical research on behaviour and set a pioneering step in the history of biomedical science allowing further multidisciplinary studies.展开更多
Myocarditis is associated with an increased risk of sudden cardiac death (SCD) in the young.However,Information on nationwide burden of SCD caused by myocarditis (SCD-myocarditis) is sparse.For this study all deaths a...Myocarditis is associated with an increased risk of sudden cardiac death (SCD) in the young.However,Information on nationwide burden of SCD caused by myocarditis (SCD-myocarditis) is sparse.For this study all deaths among persons in Denmark aged 1-35years in 2000-2009 and 36-49years in 2007-2009 (27.1 million person-years) were induded.Autopsy reports,death certificates,discharge summaries,and nationwide registries were used to identify all cases of SCD-myocarditis.In the 10-year study period,there were 14294 deaths,of which we identified 1 363 (10%) SCD.Among autopsied SCD (n=753,55%),cause of death was myocarditis in 42 (6%) cases corresponding to an SCD-myocarditis incidence of 0.16 (95%CI: 0.11-0.21) per 100000 person-years.Males had significantly higher incidence rates of SCD-myocarditis compared to females with an incidence rate ratio of 2.2 (95%CI:1.1-4.1).Myocarditis was not registered as cause of death In any of the non-autopsied SCD (n=610,45%).In conclusion,after nationwide unselected Inclusion of 14294 deaths,we found that 6% of all autopsied SCD was caused by myocarditis.No cases of SCD-myocarditis were reported in the non-autopsied SCD,which could reflect underdiagnosing of myocarditis in non-autopsied SCD.Furthermore,our data suggest a female protection towards SCDmyocarditis.展开更多
This is a multicentre forensic study that identifies all sports-related sudden deaths (SRSDs) in young people,due to myocardial diseases (MDs) that occurred in a large area of Spain.The aim of the study is to assess t...This is a multicentre forensic study that identifies all sports-related sudden deaths (SRSDs) in young people,due to myocardial diseases (MDs) that occurred in a large area of Spain.The aim of the study is to assess the epidemiology,causes of death,and sport activities associated with these fatalities.This is a retrospective study based on forensic autopsies performed in the provinces of Biscay,Seville,Valencia and in the jurisdiction covered by the National Institute of Toxicology and Forensic Sciences in Madrid (Spain).The retrospective study encompasses from 2010 to 2017.All sudden cardiac deaths (SCDs) in persons 1-35years old were selected.The total number of SCDs were divided into death occurred during exercise (SRSD) and death during rest,sleep or normal activities (non-SRSD).Each of these two groups was subdivided according to the cause of death into MD (primary cardiomyopathies and myocarditis) and non-MD.Clinic-pathological,toxicological and genetic characteristics of SRSD due to MD were analysed.Over the 8-year study period,we identified 645 cases of SCD in the young: 75 SRSD (11.6%) and 570 non-SRSD (88.4%).MD was diagnosed in 33 (44.0%) of the SRSD and in 112 (19.6%) of the non-SRSD cases.All cases of SRSD due to MD were males (mean age (24.0±7.6) years) practicing recreational sports (85%).SRSDs were more frequent in arrhythmogenic cardiomyopathy (ACM) (37%) and hypertrophic cardiomyopathy (HCM) (24%),followed by myocarditis (15%) and idiopathic left ventricular hypertrophy (ILVH) (9%).Only in five cases of SRSD the MD responsible of death (HCM) had been diagnosed in life.Cardiovascular symptoms related to the disease were present in other seven patients (six of them with ACM).Postmortem genetic studies were performed in 15/28 (54%) primary cardiomyopathies with positive results in 12 (80%) cases.The most frequent sports disciplines were football (49%) followed by gymnastics (15%) and running (12%).In Spain,SRSD in young people due to MDs occurs in males who perform a recreational activity.Compared with control group we observed a strong association between MDs and exertion.One in three SRSDs are due to cardiomyopathy,especially ACM,which reinforces the need for preparticipation screening to detect these pathologies in recreational sport athletes.Further studies are warranted to understand the causes and circumstances of sudden death to facilitate the development of preventive strategies.展开更多
文摘Multi-phase post-mortem CT-angiography （MPMCTA） has the great potential to increase the quality of the postmortem investigation, especially in the area of sudden death; however, its role as routine complement to the pathology toolbox is still questioned as it needs to be further standardized. The aim of this study is to investigate the contribution of MPMCTA in cases of sudden unexplained death in adults and in particular in sudden cardiovascular death. Sixty-eight sudden unexpected deaths of adults were investigated at our institution between 2012 and 2013. Ten cases underwent MPMCTA and autopsy and were included in the study. Before the angiographic step by complete filling of the vascular system, prior to any manipulation of the body, a non-contrast CT-scan was carried out. Image reconstructions were performed on a CT workstation （Vitrea） and two radiologists experienced with post mortem imaging interpreted the MPMCTA findings. In all 10 cases, we could state a good correlation between combination of post-mortem CT and MPMCTA and autopsy procedures, confirming a high diagnostic sensitivity. With this case series we want to illustrate the advantages offered by performing MPMCTA when facing a sudden death, regardless of specific suspicion for acute coronary syndrome or other vascular or ischemic disease.
文摘A group of 19th century inmates dead in the prison of Parma are the protagonist of an incredible scientific collection. Lorenzo Tenchini started the creation of this collection and dedicated his work and his studies to its completeness. Anatomist and academic, Lorenzo Tenchini (1852–1906) dedicated his scientific studies to macroscopic anatomy, particularly about central nervous system and its correlation with psychic function. In 1881 he became ordinary professor in Normal Human Anatomy at the University of Parma dedicating himself to the study of the anatomical organization of the brain and psychic and social disturbs. During the study of the skulls and brains of psychotic patients and the deformations of skulls belonging to patients admitted in the Hospital of Brescia, he started a collaboration with Alessandro Cugini (1829–1913), founder of the Institute of Legal Medicine at the University of Parma. Tenchini realized an anatomical collection, preserved today in the Museum of Biomedicine of the University of Parma. This collection represents the master-piece of his research carried out during his academic activity and still a unicum in the west-ern world, as there are no similar collection assembling such a multidisciplinary information. The peculiarity of this collection is due not only to the scientific interest of the anatomic samples and their full clinical documentation, but also to the methods employed in order to realize it. At the end of the 19th century, as a student of Cesare Lombroso (1835–1909), Tenchini based his work on the study of the face, the skull and brain of each dead inmate of Parma's prison or Colorno's mental hospital. These individuals as protagonists of Tenchini's collection, leave a legacy identifiable as scientific heritage. Their skulls and brains, the reproduction of their faces through ceroplastic and other anatomical samples treated with other techniques, are accompanied by an autoptic and psychiatric full documentation, allowing the collection to be complete with every aspect related to the inmates studied. Through his work, a comparison between different kind of studies, such as psychiatry, psych-ology, neurology, legal medicine and anthropology, is suitable in scientific research to be realized. Moreover, data come from a forensic context: this allows a comparison with differ-ent methodologies employed in modern age by forensic expertise such as the comparison between modern and ancient medical diagnostic technique. This masterpiece represents Tenchini's neuroanatomical research on behaviour and set a pioneering step in the history of biomedical science allowing further multidisciplinary studies.
基金This work was supported by Novo Nordisk Foundation,Copenhagen,Denmark[grant number NNFOC140011573]The Heart Centre,Department of Cardiology,University Hospital Rigshospitalet,Copenhagen,Denmark+2 种基金Section of Forensic Pathology,Department of Forensic Medicine,Aarhus University,DenmarkSection of Forensic Pathology,Department of Forensic Medicine Copenhagen University,Denmarkand Rigshospitalets Forskningspuljer,Rigshospitalet,Copenhagen,Denmark.
文摘Myocarditis is associated with an increased risk of sudden cardiac death (SCD) in the young.However,Information on nationwide burden of SCD caused by myocarditis (SCD-myocarditis) is sparse.For this study all deaths among persons in Denmark aged 1-35years in 2000-2009 and 36-49years in 2007-2009 (27.1 million person-years) were induded.Autopsy reports,death certificates,discharge summaries,and nationwide registries were used to identify all cases of SCD-myocarditis.In the 10-year study period,there were 14294 deaths,of which we identified 1 363 (10%) SCD.Among autopsied SCD (n=753,55%),cause of death was myocarditis in 42 (6%) cases corresponding to an SCD-myocarditis incidence of 0.16 (95%CI: 0.11-0.21) per 100000 person-years.Males had significantly higher incidence rates of SCD-myocarditis compared to females with an incidence rate ratio of 2.2 (95%CI:1.1-4.1).Myocarditis was not registered as cause of death In any of the non-autopsied SCD (n=610,45%).In conclusion,after nationwide unselected Inclusion of 14294 deaths,we found that 6% of all autopsied SCD was caused by myocarditis.No cases of SCD-myocarditis were reported in the non-autopsied SCD,which could reflect underdiagnosing of myocarditis in non-autopsied SCD.Furthermore,our data suggest a female protection towards SCDmyocarditis.
文摘This is a multicentre forensic study that identifies all sports-related sudden deaths (SRSDs) in young people,due to myocardial diseases (MDs) that occurred in a large area of Spain.The aim of the study is to assess the epidemiology,causes of death,and sport activities associated with these fatalities.This is a retrospective study based on forensic autopsies performed in the provinces of Biscay,Seville,Valencia and in the jurisdiction covered by the National Institute of Toxicology and Forensic Sciences in Madrid (Spain).The retrospective study encompasses from 2010 to 2017.All sudden cardiac deaths (SCDs) in persons 1-35years old were selected.The total number of SCDs were divided into death occurred during exercise (SRSD) and death during rest,sleep or normal activities (non-SRSD).Each of these two groups was subdivided according to the cause of death into MD (primary cardiomyopathies and myocarditis) and non-MD.Clinic-pathological,toxicological and genetic characteristics of SRSD due to MD were analysed.Over the 8-year study period,we identified 645 cases of SCD in the young: 75 SRSD (11.6%) and 570 non-SRSD (88.4%).MD was diagnosed in 33 (44.0%) of the SRSD and in 112 (19.6%) of the non-SRSD cases.All cases of SRSD due to MD were males (mean age (24.0±7.6) years) practicing recreational sports (85%).SRSDs were more frequent in arrhythmogenic cardiomyopathy (ACM) (37%) and hypertrophic cardiomyopathy (HCM) (24%),followed by myocarditis (15%) and idiopathic left ventricular hypertrophy (ILVH) (9%).Only in five cases of SRSD the MD responsible of death (HCM) had been diagnosed in life.Cardiovascular symptoms related to the disease were present in other seven patients (six of them with ACM).Postmortem genetic studies were performed in 15/28 (54%) primary cardiomyopathies with positive results in 12 (80%) cases.The most frequent sports disciplines were football (49%) followed by gymnastics (15%) and running (12%).In Spain,SRSD in young people due to MDs occurs in males who perform a recreational activity.Compared with control group we observed a strong association between MDs and exertion.One in three SRSDs are due to cardiomyopathy,especially ACM,which reinforces the need for preparticipation screening to detect these pathologies in recreational sport athletes.Further studies are warranted to understand the causes and circumstances of sudden death to facilitate the development of preventive strategies.
