Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35-year-old workman who collapsed and underwent ECM by his co-workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre-existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic–abdominal trauma, or medical history, is unclear.
This case confirms that clarithromycin although very rarely, can be a cause of fulminant hepatitis, especially in patients with pre-existing liver damage. Although the presumption that clarithromycin hepatotoxicity is dose related is reasonable, an immune-toxicologic hypothesis cannot be excluded.
We report the case of a 45-year-old railway worker who was literally decapitated during a work shift. He was working with his colleagues close to a Ballast Cleaning Machine (BCM) behind the driver. This case occurred during the night time, under artificial light that probably allowed this traumatic event. The workplace investigation revealed the victim's head and the right arm were detached from the remains of the body. Probably the cutter bar of the BCM caught his jacket and trapped him in the right arm of the machinery, cutting off his head. The external examination of the body and the following medico-legal autopsy showed excoriated streaks and de-epithelialization area on all over the body, fractures and laceration of the cervical region and of the right arm. Toxicological analyses were negative for alcohol or drug abuse. To the best of our knowledge, no other similar cases have been reported in the international literature.
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