Cases reported "Autolysis"

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1/11. Posttraumatic diaphragmatic hernia and death--etiologic factor or putrefactive artifact?

    Late-presenting diaphragmatic hernias, whether congenital or acquired, may remain clinically undetected until mediastinal shift with cardiorespiratory compromise or intestinal or gastric infarction with perforation occur. A right-sided diaphragmatic hernia with herniation of small intestine into the adjacent pleural cavity is described in a 72-year-old man who was found dead at home in a putrefactive state. Subsequently, a history of a motor vehicle accident 8 years previously was obtained. Although postmortem herniation due to extensive putrefactive change may have occurred, producing gaseous distention and migration of the intestine, tight twisting of the herniated intestine several times around a pleural fibrous adhesion suggested that the herniation could have been an antemortem event. Unfortunately, marked tissue autolysis prevented assessment of possible ischemic changes in the herniated intestine. Although diaphragmatic hernia may be a contributing factor to death at all ages, it may not be possible to exclude it as an artifact of putrefaction in a predisposed individual. ( info)

2/11. placenta increta; conservative management -- a successful outcome. Case report and literature review.

    placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and Doppler assessment, followed by interval manual removal of placenta. ( info)

3/11. Management of infiltration injury in neonates using duoderm hydroactive gel.

    Neonates are at increased risk of injury from infiltration of intravenous fluids because of small vessel size and immature skin structure. Until recently, hyaluronidase injection was used to prevent tissue injury following the infiltration of intravenous solutions in neonates. The production of hyaluronidase injection was discontinued in 2001. The alternative, compounded hyaluronidase injection is not regulated by the U.S. food and Drug Administration and is subject to variation in quality assurance practices. Amorphous hydrogels have been used as wound dressings for sloughy or necrotic wounds in a variety of clinical settings. hydrogels facilitate autodebridement of the wound by rehydrating slough and enhancing the rate of autolysis. No adverse effects or increased infection rates have been associated with the use of hydrogel dressings. DuoDerm Hydroactive gel is a sterile, preservative-free, viscous, hydrating gel composed of natural hydrocolloids. We report our experience using DuoDerm Hydroactive gel for management of injury secondary to the infiltration of total parenteral nutrition solution and lipid emulsion in three neonates. ( info)

4/11. diagnosis of Alzheimer's disease in an exhumed decomposed brain after twenty months of burial in a deep grave.

    After 20 months of interment in a deep grave, the decomposed body of the 81-year old testator of a will was exhumed to sustain the burden of proof that he lacked testamentary capacity when the will was rewritten two days prior to his death. The brain was mushy and pulverized with complete disappearance of the brainstem, cerebellum and subcortical ganglia. Small foci of relatively intact dorsal frontal neocortex were identified. Sections from these foci were stained with hematoxylin and eosin, bielchowsky silver stain and immunostains for beta amyloid peptide (betaA4), tau and alpha-synuclein. Despite severe autolysis and decomposition, the bielchowsky stain and the betaA4 immunostains showed preserved frequent neuritic amyloid plaques with very few residual neurofibrillary tangles. cerebral amyloid angiopathy was present. At the present time this case represents the first documented and reported case of direct tissue diagnosis of Alzheimer's disease pathology in a decomposed brain following long term burial in a deep grave. ( info)

5/11. Putrefaction and wound dehiscence: a potentially confusing postmortem phenomenon.

    The decomposed body of a 49-year-old man was found at his home address. At autopsy, 3 incised wounds of the lower abdomen and groins were identified, raising the possibility of some form of inflicted injury. Further dissection revealed that the wounds were healing surgical incisions that had been forced open by putrefactive tissue breakdown, swelling, and gas formation. Death was due to ischemic heart disease. Putrefaction is a common problem encountered in forensic practice that may result in considerable distortion and modification of tissues. Unusual skin lesions caused by the disruption and dehiscence of healing surgical wounds may be created by decomposition. This possibility should be considered when symmetrical, cleanly incised wounds are identified. ( info)

6/11. Autodigestion of the glans penis and urethra by activated transplant pancreatic exocrine enzymes.

    A case of synchronous kidney and pancreas transplantation in which a whole pancreas graft had been drained to the urinary bladder is discussed. On the 137th postoperative day, the patient presented with symptomatic balanitis and urethritis. Documented enzymatic activation of the trypsinogen/chymotrypsinogen, which is not present in symptom-free control patients, was thus thought to be responsible for these symptoms. Conversion to enteric drainage by means of a Roux-en-Y loop resulted in resolution of both symptoms and urinary enzymatic activation. Recurrent urinary tract infections were thought to be the most likely mechanism responsible for these findings. ( info)

7/11. Intravascular "mulberry-like" bodies: morphological, immunohistochemical, and ultrastructural observations of an incidental finding caused by autolysis?

    Intravascular "mulberry-like" bodies in a stillborn female infant with moderate maceration are reported. The histogenesis of these structures is discussed based on light-microscopic, immunohistochemical and ultrastructural findings. No demonstrable causal relation between the intravascular lesions and fetal death was found, the cause of death being attributed to intrauterine asphyxia. It is concluded, that intravascular "mulberry-bodies" most likely represent artifacts due to red blood cell autolysis. ( info)

8/11. Spinocerebellar degeneration with prominent involvement of the motor neuron system: autopsy report of a sporadic case.

    A sporadic case of spinocerebellar degeneration with prominent involvement of the motor neuron system is reported. A Japanese male without contributing family history, developed cerebellar ataxia at the age of 52, followed by generalized amyotrophy and ophthalmoplegia, and died aged 58. The clinical findings were pathologically verified as degeneration of the spino-ponto-cerebellar system and the motor neuron system, the latter almost identical to those of amyotrophic lateral sclerosis. Additional subclinical changes were found in the dentate nucleus and substantia nigra. Brain-stem nuclei subserving eye movements were well preserved, suggesting a supranuclear basis for the ophthalmoplegia. This unusual combination of system degenerations has on rare occasions been reported in the heredofamilial cerebellar disorders. As a sporadic case, however, this may be the first autopsy case of spinocerebellar degeneration with severe concurrent involvement of the motor neuron system. ( info)

9/11. Diagnostic significance of nerve cells in human CSF with particular reference to CSF cytology in the brain death syndrome.

    Cytological examination of the cerebrospinal fluid (CSF) in 5 cases of the brain death syndrome treated on a respirator revealed the presence of nerve cells (mostly purkinje cells), massive pleocytosis with many polymorphonuclear leukocytes, and numerous macrophages containing erythrocytes, leukocytes, lipid droplets, and hemosiderin. Portions of connective tissue with well preserved capillaries, and debris which could not be more closely identified, were also found. Neuropathological examination in 4 cases revealed progressive autolysis of brain tissue and displacement of the autolyzed tissue into the subarachnoid space of the spinal canal, partly due to tonsillar herniation. All five patients exhibited clinical signs of brain death and had been placed on respirators for various periods of time. The cytological findings in the CSF, together with the clinical signs of brain death, constitute an intravital morphological indication of brain tissue autolysis. ( info)

10/11. Mixed teratoid tumors of the liver and neck in trisomy 13.

    A fetus with trisomy 13 syndrome and teratomas of liver and neck is described. The relationship of aneuploidy and chromosomal instability to neoplasia is discussed. Teratomas of the liver are reviewed. ( info)
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