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The main causes of venous air embolism include medical procedures, neck and head trauma, and injuries of the genitals. Self-induced suicidal and intentional air embolism is extremely rare.

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The authors report a rare case of a suicidal air embolism committed using a self-made tool composed of a plastic bottle and an infusion set, injecting nearly mL of air into the cubital vein.

The toxicological analysis suggested that midazolam, together with air, was also injected into the circulation using the same bottle and infusion set. KEYWORDS: forensic science, forensic pathology, suicide, air embolism, infusion set, fentanyl, midazolam, postmortem redistribution Venous air embolism occurs when air enters the venous system.

The main causes of venous air embolism are medical procedures 1,2especially insertion and removal of venous catheters 3,4neurosurgery 5cesarean delivery 6—8and therapeutic abortion 9.

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Other common causes of air embolism include neck and head trauma 10,11 and also injuries of the genitals 12—15but self-induced suicidal and intentional air embolism is extremely rare 16— As a large quantity of air enters into the venous system, it enters into the right ventricle and finally reaches the pulmonary circulation.

As the pulmonary arterial pressure increases, it puts strain on the right ventricle, decreases the right ventricle outflow and the pulmonary venous return, which results in a diminished cardiac output and a cardiovascular collapse 1,2,19, Also, a paradoxical arterial air embolism can occur if the air manages to enter into the arterial circulation through an open foramen ovale or by getting through the pulmonary circulation 2, The volume of air entering into the circulation and the rate of accumulation are the two main factors determining the outcome of an air embolism.

Átírás 1 Gyerekkori tumorok Dr. Hal{sz Judit PhD 2 Benignus tumorok és tumor-szerű elv{ltoz{sok 1. Generate description Hemangiom{k: leggyakrabban újszülöttekben arcon, fejtetőn nagy méretűek lehetnek portwine stains 2. Nyirokér eredetű tumorok lymphangiom{k benignus tumor lymphangiectasia nyirokerek ectasiaja, dilatatioja 3 3.

Below, we report a rare case of a suicidal air embolism committed by a self-made tool from a plastic bottle and infusion tubing, injecting nearly mL of air into the cubital vein.

Received 7 Jan. An armchair was found on one side of the frame, two dumbbells each weighing prostatitis pathophysiology pdf kg and two stone cubes each weighing 1 kg were found on the opposite side of the frame Fig. The body was lying on the middle board, and a plastic bag containing a spur wheel weighing 5 kg was found under the body Fig.

Underneath the end of the middle board, an almost totally compressed, dry plastic bottle mL original volume with an infusion set installed into the bottle cap was found Fig. The victim suffered a scald 4 months before the suicide and received treatment for 6 weeks necrectomy and skin transplantation was performed. Autopsy Findings Autopsy was performed 3 days after the crime scene investigation the body was cooled at 4 C before the autopsy.

The body was cm in length and of medium build.

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Hypostatic patches were seen on the back side, and rigor mortis was present in all extremities. A scar from the previous skin transplantation partial-thickness mesh graft was identified on the left thigh, and scars from an appendectomy and left knee surgery were observed. At the start of the internal examination, the superficial veins of the right arm were examined, and four needle marks were observed on the wall of the median cubital vein.

The air embolism test was performed with a positive result: The autopsy was started with an incision on the skin at the lower part of the chest, then the cartilages of lower ribs were transected, and the lower part of the sternum was elevated.

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After that, the pericardium was opened with a prostatitis pathophysiology pdf cut, then the pericardium was filled with water, and the heart was pushed under it. A 5-mm incision was made on the right ventricle of the heart, and emptying of air bubbles was observed for 50 sec long. Similar incision was made on the left ventricle, but no air bubbles were observed after the incision. Apart from the positive air embolism test described above, extremely dilated and flaccid right ventricle, closed foramen ovale, congestion of the internal organs, slightly enlarged heart gsteatosis hepatis, nephrosclerosis, moderate atherosclerosis, and moderate prostate hyperplasia were observed.

No signs of putrefaction were found during the external or internal examination. The histological examination showed the congestion of the internal organs, steatosis prostatitis pathophysiology pdf, and prostate hyperplasia.

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The histological examination showed no signs of putrefaction. Toxicological Analysis FIG. The following samples were secured for toxicological analysis: blood from the femoral vein 5 mLurine 5 mLcerebrospinal fluid 1 mLvitreous humor 1 mLstomach content 10 mLand tissue from the crook of the arm from the hemorrhages around the cubital vein. Biological samples were prepared by subzero-temperature liquid—liquid extraction prior to analysis. The toxicological analyses identified Ethyl alcohol was not present in the samples.

Results and Discussion In the presented case, the volume of injected air exceeded the estimated lethal volume by ten times, and the air was injected prostatitis pathophysiology pdf into the cubital vein.

Szakmai Irányelv-Thromboemboliák2010

During the autopsy, positive air embolism test and symptoms of acute right-sided heart failure were observed. This case shows that if a very large volume of air is injected into the venous system rapidly, it blocks the outflow from the right ventricle and immediately leads to severe right-sided heart failure—increase in central venous pressure resulting in congestion and decrease in pulmonary arterial pressure—and cardiovascular collapse The toxicological analyses proved the presence of fentanyl in toxic and midazolam in therapeutic concentration The source of fentanyl was probably the two transdermal patches.

It is most commonly located in the vertebral column and metaphysis or diaphysis of the long bones. Intranasal or paranasal osteoblastoma is particularly rare. It is very rare for an osteoblastoma to arise in the nasal cavity or turbinates.

Different opinions about the postmortem redistribution PMR of fentanyl can be found in the literature 24,25,27but beside this, the ion trapping mechanism explains the presence of fentanyl in stomach samples; it passes into the stomach in high concentration because of its weak basic nature The presence of midazolam in relatively high concentration in the blood and minimal concentration in the urine suggests it was in the bottle or in the infusion set, and it was injected into the circulation together with the air: The victim died before midazolam could enter into the urine in significant concentration.

The following events can be reconstructed based on the data and photographs from the on-site survey, the autopsy, and the toxicological examination: the victim lay down on the couch, prostatitis pathophysiology pdf the wooden frame in place above the plastic bottle, and inserted the needle a prosztatitis megjelenése miatt the infusion set into his cubital vein. Midazolam was probably injected previously into the injection tubing as no midazolam injection was found during the on-site survey.

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After the insertion of the needle, the victim put or dropped the bag containing the spur wheel to the middle of the wooden frame. The weight of the spur wheel started to compress the air into the venous system, and as a result, the victim fell down from the couch on to the wooden frame compressing the remaining air into the cubital vein. The victim most likely suffered the abrasions on the left side of the face and on the left shin during falling from the couch.

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All previously reported suicidal cases of air embolism were committed by either victims with a medical profession 16,17 or by victims under medical treatment 18in which cases they could obtain the necessary equipment easily. The statistics also show that the favored method of suicide is in correlation with the availability of the different lethal tools The suicide note also shows the lack of medical knowledge of the victim.

The investigation neither was successful revealing the source of the idea of the chosen method nor the source of the medical equipment he used.

We also would like to thank Prof. Prostatitis pathophysiology pdf 1.

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Venous air embolism: a review. J Clin Anaesth ;9 3 —7.

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Gas embolism. N Engl J Med ; 7 — Vesely TM. Air embolism during insertion of central venous catheters. J Vasc Viszketés a prosztatitisből Radiol ;12 11 —5. Lethal air embolism following removal of a double lumen jugular vein catheter. Nephrol Dial Transplant ;14 8 —2. Venous air embolism during neurosurgery. New York, NY: Springer, ;— Venous air embolism during surgery, especially cesarean delivery.

J Korean Med Sci ;23 5 — Kostash MA, Mensink F. Lethal air embolism during cesarean delivery for placenta previa. Anesthesiology ;96 3 —4. Gas embolism in obstetrics and gynecology.

A review.

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J Reprod Med ;41 2 — Prostatitis pathophysiology pdf RA.