An Analysis of Possible Mechanisms of Unexpected Death Occurring in Hydatid Disease (Echinococcosis)

Abstract:  Most cases of hydatid disease in human populations are due to Echinococcus granulosus. The hydatid life cycle involves passage between definitive hosts such as dogs and intermediate hosts such as sheep. Humans become accidental intermediate hosts following ingestion of food or water contaminated with eggs or by contact with infected dogs. Although hydatid disease may remain asymptomatic, occasional cases of sudden and unexpected death present to autopsy. Causes of rapid clinical decline involve a wide range of mechanisms including anaphylaxis (with or without cyst rupture), cardiac outflow obstruction or conduction tract disturbance, pulmonary and cerebral embolism, pericarditis, cardiac tamponade, myocardial ischemia, pulmonary hypertension, peritonitis, hollow organ perforation, intracerebral mass effect, obstructive hydrocephalus, seizures, cerebral ischemia/infarction, and pregnancy complications. The autopsy assessment of cases therefore requires careful examination of all organ systems for characteristic cystic lesions, as multiorgan involvement is common, with integration of findings so that possible mechanisms of death can be determined. Measurement of serum tryptase and specific IgE levels should be undertaken for possible anaphylaxis.     

Positive “Water Test”—An External Indicator of Base of Skull Hinge‐Ring Fracture

Abstract: Despite having significant internal injuries, victims of motor vehicle accidents may have surprisingly few external manifestations of trauma. The water test describes a technique whereby water placed in an upwardly facing ear results in drainage from the nose and opposite ear, thus demonstrating transcranial passage of water. This sign can be demonstrated in cases of blunt cranial trauma where there is a “hinge” fracture involving the petrous temporal bones bilaterally associated with a ring fracture extending around the foramen magnum posteriorly. Such a fracture results in separation of the posterior and middle cranial fossae providing a track for water to traverse. The water test provides a quick and noninvasive method for demonstrating the presence of a particular type of skull fracture.     

The Effect of Decalcifying Solutions on Hemosiderin Staining

Abstract: To determine whether routine decalcification may reduce the amount of stainable iron that is visible on tissue sections, samples of liver and lung tissue with excessive iron stores were placed in three standard decalcifying solutions (i) formic acid [33%], formaldehyde [4%], and NaCl [0.85%]; (ii) formic acid [30%], formaldehyde [4%], and water; and (iii) nitric acid [5%] for 24, 48, 72, and 96 h. After exposure to the decalcifying solutions, the tissues were stained with Perls stain. The slides were examined blind and the intensity of iron staining was scored semiquantitatively from 0 to 3+. The trend in all samples over the course of the experiment (96 h) was for reduction in the intensity of hemosiderin staining. As the amount of stainable hemosiderin in tissues may be significantly altered by decalcification, the absence of hemosiderin in tissues adjacent to a fracture site does not necessarily indicate that the injury was acute.     

A best practice model for e-consumer protection

This article outlines a set of criteria for assessing the value of e-consumer protection schemes. It is intended that it be used as a tool, for policy-makers, industry associations, corporations and consumer organisations in all jurisdictions, seeking to assess the appropriateness of their consumer protection regulation. It can be used to devise new, or improve existing, policies, and it can also be used to compare the usefulness of e-consumer protection in different jurisdictions. It commences with a brief review of existing frameworks for the protection of e-consumers, which demonstrates the need for a model that uncompromisingly presents the needs of consumers. An overview of the model is provided, followed by a presentation of the model's key features. A further section identifies the several ways in which the model can be applied in order to improve the usefulness of e-consumer protection. An earlier version of the model was published in checklist form (Clarke R. ‘A Major Impediment to B2C Success is … the Concept 'B2C' Invited Keynote, Proc. ICEC'06, Fredericton NB, Canada, 14–16 August 2006, at http://www.rogerclarke.com/EC/ICEC06.html#TNT). The present article revises and expands that checklist, and presents the rationale underlying each item in it.     

The construction of ‘So What?’ criminology: a realist analysis

From a realist perspective there is a growing body of criminology that can be classified as ‘So What?’ criminology in that it involves a low level of theorisation, thin, inconsistent or vague concepts and categories, embodies a dubious methodology or has little or no policy relevance. The production of ‘So What?’ criminology is, of course, no accident but the outcome of a number of lines of force that have served to shape the nature of mainstream academic criminology in recent years. The aim of this article is to identify some of these lines of force and to assess their impact.     

Manifestations and Medicolegal Significance of Loeys–Dietz Syndrome

Loeys–Dietz syndrome is a recently described autosomal dominant disorder with underlying vasculopathy characterized by aortic and other vascular aneurysmal dissection/rupture. A 61‐year‐old man is reported who died suddenly and unexpectedly and at autopsy was found to have a ruptured abdominal aortic aneurysm. Additional findings included dolichostenomelia, high‐arched palate, and pectus excavatum. There was a strong family history of Loeys–Dietz syndrome, although the decedent had never been tested. Death was, therefore, due to a ruptured abdominal aortic aneurysm in a case of probable Loeys–Dietz syndrome. Although Loeys–Dietz syndrome shares common characteristics with Marfan and other connective tissue syndromes, it is a distinct entity with a much more aggressive clinical course. Lethal events may not occur until later adult life; however, the identification of the syndrome and differentiation from other connective tissue disorders at autopsy is important so that genetic investigation of close relatives can be undertaken with prophylactic surgical treatment if necessary.     

Septic Ketoacidosis—A Potentially Lethal Entity with Renal Tubular Epithelial Vacuolization

Fatal ketoacidosis due to diabetes mellitus, alcoholism, and starvation may produce characteristic basal vacuolization of renal tubular epithelial cells (RTEC). Septic ketoacidosis has recently been recognized clinically as a distinct condition in which septicemia can lead to elevation of ketones and various anions unrelated to diabetes mellitus, alcoholism, or caloric deprivation. We report four lethal cases with significantly elevated vitreous ketones secondary to sepsis and/or severe localized infection in individuals with no history of diabetes mellitus, alcoholism, or starvation. Three of four cases exhibited typical basal vacuolization of RTEC. We suggest that septic ketoacidosis is an appropriate cause of death in the forensic setting where sepsis or severe localized infection is found with significant ketoacidosis (β‐hydroxybutyrate > 5 mmol/L)—in the absence of diabetes mellitus, alcoholism, starvation, or other states associated with accelerated ketogenesis. The finding of basal vacuolization of RTEC in such cases provides morphological support for the underlying metabolic derangement.     

An Isolated Perfused Rat Kidney Model for the Evaluation of the Effect of Glucose on Renal Tubular Epithelial Morphology

An isolated perfused kidney model was used to evaluate the effect of hyperglycemia on renal tubular epithelial cell morphology. Ten Sprague–Dawley rat kidneys were perfused with Krebs–Henseleit buffer containing 70 mmol/L of glucose (five for 1 h and five for 2 h). Two control groups consisted of 10 kidneys perfused with Krebs–Henseleit buffer without hyperglycemia (five for 1 h and five for 2 h), and 10 nonperfused contralateral kidneys placed in the same environment for the same duration. The hyperglycemia group had significantly increased renal tubular vacuolization (p < 0.001) compared to both control groups at 1 and 2 h. The isolated perfused kidney model recapitulates the renal tubular vacuolization phenotype found in hyperglycemia and may be a potential tool for the investigation into causal factors in renal histology. The full pattern of the Armanni–Ebstein phenomenon was not, however, reproduced, suggesting that this change requires more time or involves more complex factors.