Biomedical subjects

Johan Duflou

Publications and source records attributed to Johan Duflou.

7 recordsLinked to original sources

PubMed2006

Diffuse pulmonary ossification: an uncommon incidental autopsy finding.

AIM: To determine the incidence of diffuse pulmonary ossification (DPO) and its subtypes at autopsy and correlation with clinical and histological features. METHODS: Autopsy reports from our institution over a 64-month period were reviewed for findings of DPO. The pattern of ossification, demographics and clinical data were obtained from both paraffin sections and final autopsy reports. In a selected case, chest radiograph and wet tissue were obtained. RESULTS: Seventeen histologically confirmed cases of DPO were found in 10,426 autopsy cases, representing an incidence of 1.63 cases/1000 autopsies. There was a predilection in males (88%) and underlying pulmonary disease (88%). In contrast to published studies, dendriform DPO was more common than the nodular type in our cohort (11 and 6 cases, respectively). The dendriform type was more commonly associated with marrow elements. CONCLUSIONS: Diffuse pulmonary ossification is uncommon and rarely diagnosed during life, but can easily be identified when sectioning the lungs at autopsy. There is recent renewed interest in diagnosing and determining the significance of DPO using high resolution computed tomography and thoracoscopic biopsy.

Adult↗

PubMed2006

Systemic disease among cases of fatal opioid toxicity.

AIMS: To determine levels of systemic disease among cases of death due to opioid toxicity. DESIGN: Analysis of coronial cases. SETTING: Sydney, Australia. CASES: A total of 841 cases of death due to opioid toxicity (1 January 1998-31 December 2002). FINDINGS: Ventricular hypertrophy was present in 5.9% of cases and severe coronary artery atherosclerosis in 5.7%. Severe coronary pathology was more pronounced among older cases. Pre-existing bronchopneumonia was present in 13.2% of cases. Hepatic pathology was the most common type of pathology, and was far more marked among older cases. Cirrhosis was present in 25.3% of those aged > 44 years. Levels of renal pathology were comparatively low, but were related significantly to increasing age. Systemic disease in more than one organ system was present in 24.4% of cases, and was related to increasing age (44% of those aged > 44 years). The only pathology for which gender was an independent predictor among opioid cases was ventricular hypertrophy, more common in males. CONCLUSIONS: Systemic disease, most prominently liver disease, is common among fatal opioid toxicity cases, and may be a factor in understanding the dynamics and age demographics of opioid-related death.

Adolescent↗

PubMed2006

Comparative cardiac pathology among deaths due to cocaine toxicity, opioid toxicity and non-drug-related causes.

AIM: To compare cardiac and cerebrovascular pathology among deaths due to cocaine toxicity, deaths due to opioid toxicity and deaths from hanging that were toxicologically negative for cocaine/opioids. DESIGN: Case-control. FINDINGS: The cocaine group had significantly higher proportions of left ventricular hypertrophy and ischaemic heart disease than either comparison group. Coronary artery atherosclerosis was also detected in significantly higher proportions of cocaine cases than in either comparison group. The cocaine group was more likely than either comparison group to have atherosclerosis of the left anterior descending coronary artery, right coronary artery and circumflex artery. Only in the left anterior descending coronary artery did the cocaine group exhibit higher levels of moderate-severe atherosclerosis. Cocaine cases also had significantly higher levels of cerebrovascular atherosclerosis than either comparison group. CONCLUSIONS: Levels of cardiac and cerebrovascular pathology were higher among cocaine users than either comparison group. The high levels of cardiac and cerebrovascular pathology seen among cocaine cases do not appear to be artefacts of a drug-dependent life-style, but relate specifically to cocaine.

Adolescent↗

PubMed2006

Artefactual contraction band necrosis of the myocardium in fatal air crashes.

BACKGROUND: The detection of conditions associated with possible medical incapacitation is a crucial component of the aviation autopsy. Acute myocardial ischemia is notoriously difficult to diagnose at autopsy, although various pathological markers may strongly support a diagnosis of acute myocardial infarction occurring just prior to the crash. HYPOTHESIS: Contraction band necrosis may not be a reliable indicator of acute myocardial ischemia in aircraft crashes because of the forces on myocardial tissue sustained in the crash. METHODS: Microscopic examination of the myocardium of fatal air crash occupants was compared with a control group of suicidal hanging deaths. This study examined 80 air crash fatalities and 44 age and sex matched suicidal ligature hanging controls. We assessed both the presence and extent of contraction band necrosis type lesions in both groups and scored the lesions. RESULTS: Contraction band lesions were seen in the left ventricular myocardium of all study groups. There was no significant difference between the contraction band score for crash victim deaths and hanging deaths. However, widespread contraction banding was significantly more common in air crash victims (p = 0.032). There was no significant difference between contraction banding in victims of impacts without a post-crash fire compared with those in crashes with a post-crash fire. CONCLUSIONS: Contraction band necrosis-like lesions in isolation should not be considered as evidence of acute myocardial ischemia in cases of massive trauma. Severe trauma, possibly as a result of sudden stretching of the cardiac myocytes, may cause a microscopic lesion which is indistinguishable from contraction band necrosis.

Accidents, Aviation↗

PubMed2005

Cocaine-related fatalities in New South Wales, Australia 1993-2002.

AIM: To ascertain the demographic characteristics, circumstances of death, toxicological results, and major autopsy findings of cocaine-related fatalities. DESIGN: Inspection of the coronial records of all cocaine-related deaths that occurred in New South Wales, Australia between 1 January 1993 and 31 December 2002. SETTING: New South Wales, Australia. FINDINGS: 146 cases were identified. Cocaine was implicated in the direct cause of death in 86% of cases, an antecedent cause in 8% and a significant condition contributing to death in 7%. The mean age of decedents was 34.1 years, and 84% were male. Half were employed, and 26% were in professional employment. The predominant route of administration was injection (86%), however nasal (8%), oral (3%), smoking (1%), and anal (1%) administration were all recorded. The most common location of death was a private home (53%). No intervention occurred prior to death in 82% of cases. The median blood benzoylecgonine concentration was 0.40 mg/L (range 0.00-20.00 mg/L). Cases had a mean of 3.5 drugs, with morphine (79%) the most common co-occurring drug. In 5% of cases cocaine was the sole drug detected. Cardiac pathology was noted in 57% of cases, most commonly coronary artery atherosclerosis (39%) and cardiac hypertrophy (14%). In 15% of cases moderate to severe arterial occlusion was noted. Cerebrovascular pathology was noted in 22% of cases, most commonly cerebrovascular atherosclerosis (10%). CONCLUSIONS: Cocaine-related deaths are a significant clinical problem in New South Wales.

Adolescent↗

PubMed2002

Hair morphine concentrations of fatal heroin overdose cases and living heroin users.

AIMS: To compare heroin and other opiate use of heroin overdose fatalities, current street heroin users and drug-free therapeutic community clients. DESIGN: Hair morphine concentrations that assess heroin use and other opiate use in the 2 months preceding interview or death were compared between heroin overdose fatalities diagnosed by forensic pathologists (FOD) (n = 42), current street heroin users (CU) (n = 100) and presumably abstinent heroin users in a drug-free therapeutic community (TC) (n = 50). SETTING: Sydney, Australia. FINDINGS: The mean age and gender breakdown of the three samples were 32.3 years, 83% male (FOD), 28.7 years, 58% male (CU) and 28.6 years, 60% male (TC). The median blood morphine concentration among the FOD cases was 0.35 mg/l, and 82% also had other drugs detected. There were large differences between the three groups in hair morphine concentrations, with the CU group (2.10 ng/mg) having concentration approximately four times that of the FOD group (0.53 ng/mg), which in turn had a concentration approximately six times that of the TC group (0.09 ng/mg). There were no significant differences between males and females in hair concentrations within any of the groups. Hair morphine concentrations were correlated significantly with blood morphine concentrations among FOD cases (r = 0.54), and self-reported heroin use among living participants (r = 0.57). CONCLUSIONS: The results indicate that fatal cases had a lower degree of chronic opiate intake than the active street users, but they were not abstinent during this period.

Adolescent↗

PubMed2002

Axonal injury in children after motor vehicle crashes: extent, distribution, and size of axonal swellings using beta-APP immunohistochemistry.

The brains of 32 children (3 months to 16 years) who died as a result of motor vehicle collisions were examined for axonal injury using beta-APP immunohistochemistry. The extent and distribution of axonal injury was assessed and quantified throughout the forebrain, brainstem and cerebellum. The mean diameter of immunoreactive axons in the corpus callosum was measured for this pediatric group and, for comparison, a small adult sample. beta-APP immunoreactivity was seen in 14 pediatric cases (survival 35 mins to 87 h), most frequently in the parasagittal white matter (12/14), the corpus callosum (11/14), the brainstem (10/14) and cerebellum (9/14). In 2 cases, axon swelling was visualized in the internal capsule after only 35-45-min survival, earlier than has previously been reported. No immunoreactivity was seen in the remaining 18 cases who died within 1 h. The extent and distribution of axonal injury throughout the brain showed a rapid early increase with increasing survival time and then a slower progression. The diameter of individual callosal axons increased with increasing survival times, rapidly over the first 24 h and then more slowly. There was no statistical difference (p < 0.05) for callosal axon diameters at different survival times between the children and the adults sampled here. The extent and distribution of axonal injury throughout the brain appears to be similar in children to that previously reported in adults. The spatial and temporal spread of axonal damage suggests there may be therapeutic potential for the process to be arrested or slowed in its early stages.

Accidents, Traffic↗