Accidents, Traffic ; Adult ; Heart Injuries ; complications ; etiology ; pathology ; Hernia ; etiology ; pathology ; Humans ; Male ; Pericardium ; injuries ; Rupture ; Wounds, Nonpenetrating ; complications

Migration of a bullet to a distant part of the body after a gunshot is rarely observed in the clinical setting, and migration to the heart is even rarer. There are usually no clear symptoms or signs from migration of a bullet. The bullet can be easily missed and sometimes identified in a review examination. A case of bullet migration to the heart 2 months after a gunshot to the left knee was reported.
Adult ; Heart Injuries ; etiology ; pathology ; Humans ; Knee ; pathology ; Male ; Wounds, Gunshot

The advancement of studies about the molecular biology and electronic physiology on sudden cardiac death was summarized in this article, including particularly cardiac concussion(commotio cordis), congenital long QT syndrome, and Brugada syndrome which probably resulting in fatal arrhythmia and sudden cardiac death. These corpses of fatal functional disorders often show the results of negative autopsy without obvious organic pathological changes. So when come across negative autopsy the medical examiner and the pathologist should be careful to investigate the inductive cause of sudden death, the history of disease, and the family history, then to rule out the possibility of the above disorders.
Arrhythmias, Cardiac/pathology* ; Death, Sudden, Cardiac/pathology* ; Forensic Medicine ; Heart Injuries/pathology* ; Humans ; Long QT Syndrome/pathology*

BACKGROUNDThe two most prevalent causes of sudden cardiac death are ventricular fibrillation cardiac arrest (VFCA) and asphyxiation cardiac arrest (ACA). Profound postresuscitation myocardial dysfunction has been demonstrated in both VFCA and ACA animal models. Our study aimed to characterize the two porcine models of cardiac arrest and postresuscitation myocardial metabolism dysfunction.

METHODSThirty-two pigs were randomized into two groups. The VFCA group (n = 16) were subject to programmed electrical stimulation and the ACA group (n = 16) underwent endotracheal tube clamping to induce cardiac arrest (CA). Once induced, CA remained untreated for a period of 8 minutes. Two minutes following initiation of cardiopulmonary resuscitation (CPR), defibrillation was attempted until return of spontaneous circulation (ROSC) was achieved or animals died. To assess myocardial metabolism, (18)F-FluoroDeoxyGlucose Positron Emission Tomography was performed at baseline and 4 hours after ROSC.

RESULTSROSC was 100% successful in VFCA and 50% successful in ACA. VFCA had better mean arterial pressure and cardiac output after ROSC than ACA. Arterial blood gas analysis indicated more detrimental metabolic disturbances in ACA compared with VFCA after ROSC (ROSC 0.5 hours, pH: 7.01 ± 0.06 vs. 7.21 ± 0.03, P < 0.01; HCO3(-): (15.83 ± 2.31 vs. 20.11 ± 1.83) mmol/L, P < 0.01; lactate: (16.22 ± 1.76 vs. 5.84 ± 1.44) mmol/L, P < 0.01). Myocardial metabolism imaging using Positron Emission Tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA at 4 hours after ROSC (the maximum standardized uptake value of the whole left ventricular: 1.00 ± 0.17 vs. 1.93 ± 0.27, P < 0.01). Lower contents of myocardial energy metabolism enzymes (Na(+)-K(+)-ATPase enzyme activity, Ca(2+)- ATPase enzyme activity, superoxide dismutase and phosphodiesterase) were found in ACA relative to VFCA.

CONCLUSIONSCompared with VFCA, ACA causes more severe myocardium injury and metabolism hindrance, therefore they should be treated as different pathological entities.

Animals ; Asphyxia ; pathology ; Cardiomyopathies ; pathology ; Cardiopulmonary Resuscitation ; Disease Models, Animal ; Female ; Heart Arrest ; pathology ; Heart Injuries ; pathology ; Male ; Swine ; Ventricular Fibrillation ; pathology

Since first application of computed tomography (CT) in postmortem examination in 1990, investigators have been discussing the value and advantage of CT in full-body examination in cadaver. CT examination before autopsy is able to provide not only the informations to guide the autopsy, but also the significant findings to analysis the causes of death, which may be not fount in autopsy. This review focuses on the value of CT in analysis of the death causes, injury manners, and personal identifications in postmortem examination as well as its development in the field of forensic medicine. It is our belief that CT in combination with other newly developed technologies will make more contribution to forensic medicine in the future.
Autopsy ; Cause of Death ; Craniocerebral Trauma/pathology* ; Forensic Pathology ; Heart Diseases/pathology* ; Humans ; Imaging, Three-Dimensional ; Lung Diseases/pathology* ; Postmortem Changes ; Tomography, X-Ray Computed ; Wounds and Injuries/pathology*

OBJECTIVETo investigate therapeutics for and the pathological basis of combined radiation and burn injuries.

METHODSCombined radiation and burn injuries on mice and rats were inflicted by gamma ray irradiation from a (60)Co source and thermal radiation from a 5 kW bromotungsten lamp.

RESULTSThe dysfunction of myocardium played an important role in the development of early stage shock. Transfusion of irradiated (in vitro, 20 Gy) or stored (4 degrees C, 7 days) blood after irradiation was done to promote the success of allo-transplantation of bone marrow. Decrease of IL-4 mRNA expression was the molecular basis of depression of intestinal mucosa immune and intervention of IL-4 showed an antagonistic effect on enterogenic infection. A new lipid component extracted from burn eschar was documented for the first time and its toxic effects were elucidated. The survival rate of alloskin grafts after removal of burn eschar from the recipient animals was obviously increased in combined injury due to reduction of immune rejection activity by the radiation effect. In contrast, in animal models with simple burn, the alloskin grafts were all rejected within ten days after the procedure. A successful therapeutic result (survival rate: 92% for 30 days and 67% for 100 days) was obtained by comprehensive management of treated animals, while the untreated control animals all died within 3 - 7 days after injury.

CONCLUSIONThe pathogenesis of injury caused by simultaneous radiation and burn is extremely complicated and the treatment is very difficult. A comprehensive management program consisting of several therapeutic measures aimed at key links of the pathogenesis may achieve significantly improved results.

Animals ; Burns ; pathology ; physiopathology ; therapy ; Calcium ; metabolism ; Heart ; physiopathology ; Hematopoiesis ; Mice ; Radiation Injuries ; pathology ; physiopathology ; therapy ; Rats ; Rats, Wistar

Endomyocardial biopsy (EMBx) is a useful tool for diagnosing various cardiac pathologies. However, the routine use of EMBx has not gained widespread acceptance due to the possible complications related to the EMBx. Thus, not much information is available on the complications related to the EMBx. We prospectively evaluated 90 consecutive patients who underwent 2-D echocardiography guided transfemoral right ventricular EMBx at Kyungpook National University Hospital between March 2002 and November 2005 to determine the incidence, nature and subsequent management of complications related to EMBx. The clinical diagnoses before the EMBx were arrhythmogenic right ventricular dysplasia in 54, dilated cardiomyopathy in 19, Brugada syndrome in 9, myocarditis in 6 and miscellaneous in 2 patients. The overall major complication rate was 5.6% and no procedure-related mortality occurred. Myocardial perforation (n=3), which was the most frequent complication, did not progress to cardiac tamponade requiring pericardiocentesis in any patient. Hemodynamically unstable ventricular tachycardia occurred in 1 patient. New and persistent right bundle branch block occurred in another. Our findings suggest that 2-D echocardiography guided transfemoral right ventricular EMBx is a relatively safe procedure.
Wounds, Penetrating/*etiology/ultrasonography ; Treatment Outcome ; Surgery, Computer-Assisted/methods ; Middle Aged ; Male ; Humans ; Heart Ventricles/injuries/*pathology/*ultrasonography ; Heart Injuries/*etiology/ultrasonography ; Female ; Endocardium/injuries/pathology ; Echocardiography/methods ; Biopsy, Needle/*adverse effects ; Arrhythmia/*etiology/*ultrasonography

Endomyocardial biopsy (EMBx) is a useful tool for diagnosing various cardiac pathologies. However, the routine use of EMBx has not gained widespread acceptance due to the possible complications related to the EMBx. Thus, not much information is available on the complications related to the EMBx. We prospectively evaluated 90 consecutive patients who underwent 2-D echocardiography guided transfemoral right ventricular EMBx at Kyungpook National University Hospital between March 2002 and November 2005 to determine the incidence, nature and subsequent management of complications related to EMBx. The clinical diagnoses before the EMBx were arrhythmogenic right ventricular dysplasia in 54, dilated cardiomyopathy in 19, Brugada syndrome in 9, myocarditis in 6 and miscellaneous in 2 patients. The overall major complication rate was 5.6% and no procedure-related mortality occurred. Myocardial perforation (n=3), which was the most frequent complication, did not progress to cardiac tamponade requiring pericardiocentesis in any patient. Hemodynamically unstable ventricular tachycardia occurred in 1 patient. New and persistent right bundle branch block occurred in another. Our findings suggest that 2-D echocardiography guided transfemoral right ventricular EMBx is a relatively safe procedure.
Wounds, Penetrating/*etiology/ultrasonography ; Treatment Outcome ; Surgery, Computer-Assisted/methods ; Middle Aged ; Male ; Humans ; Heart Ventricles/injuries/*pathology/*ultrasonography ; Heart Injuries/*etiology/ultrasonography ; Female ; Endocardium/injuries/pathology ; Echocardiography/methods ; Biopsy, Needle/*adverse effects ; Arrhythmia/*etiology/*ultrasonography

OBJECTIVE: To study cellular mechanism of cardiomyocytes injury in the early stage of crush injury by observing some effects of crush injury rat sera on cultured neonatal rat cardiomyocytes. METHODS: One to three days old neonatal rat cardiomyocytes were cultured in vitro and some effects of crush injury rat sera on beating rate, cell surface area, total protein content, 3H-Leu incorporation, intracellular calcium concentration ([Ca2+]i) and Fos protein expression were observed in cultured rat cardiomyocytes. RESULTS: Compared with normal rat serum group, crush injury rat sera decreased beating rate(beats/min) of cardiomyocytes from 88.3 to 26.4, cell surface area, total protein content, 3H-Leu incorporation, [Ca2+]i (nmol/L) and PI of Fos protein expression were increased. CONCLUSION Crush injury rat sera suppress cell beating, increase intracellular calcium, induce Fos protein synthesis and cause cell hypertrophy, which may cause cardiac injury in the early stage of rush injury.
Animals ; Calcium/metabolism* ; Cell Size/drug effects* ; Cells, Cultured ; Disease Models, Animal ; Extremities/injuries* ; Heart Injuries/pathology* ; Heart Rate/drug effects* ; Immune Sera/pharmacology* ; Myocytes, Cardiac/pathology* ; Proto-Oncogene Proteins c-fos/metabolism* ; Rats ; Rats, Sprague-Dawley

OBJECTIVE: To observe the changes of cardiac functional indicators in spontaneously hypertension rats (SHR) suffered by struck injuries of soft tissues, form which to discuss the significance in relationship between injury and disease. METHODS: SHRs were divided into four groups according to the degree, and whose thigh was struck with the homemade hit instrument. Then the blood pressure, heart rate as well as serum biochemical indicators (CK, CK-Mb, LDH, Cr, BUN, HBDH and AST) were examined. In addition, the morphological changes of heart, brain and kidney were also observed. RESULTS: The observe values of heart rate and blood pressure of SHRs seemed have relation to the degree of damage, but there were no statistically significance between different hit degree groups. In terms of serum biochemical indicators, all seven indicators of the hit group had significant difference with that of the control group, and the AST CK, CK-MB levels were difference between the group of different strike degree. CONCLUSIONS Struck injuries of soft tissues can result in forepart damage of cardiac muscle. The biochemical indicators reflect the degree of injury, and they could be used as a type of objective enzymology indicators for analysis of the relationship between injury and disease in forensic practice.
Animals ; Aspartate Aminotransferases/blood* ; Biomarkers/blood* ; Blood Pressure ; Creatine Kinase/blood* ; Female ; Heart/physiopathology* ; Heart Rate ; Hindlimb/injuries* ; Hypertension/physiopathology* ; Kidney/physiopathology* ; Male ; Myocardium/pathology* ; Random Allocation ; Rats