Objective: The main objective of this study is to evaluate the medico-legal aspects of fatal road traffic accidents.
Methods: This is a retrospective study consisting of 80 forensic autopsies performed at the Institute of Legal Medicine – Tîrgu Mureș, Romania during a two years period, between January 1st, 2016 to December 31st, 2017. The information obtained was based on the medical records and the evaluation of autopsy reports.
Results: Male victims involved in road traffic accidents were nearly three times more numerous than women (72.5% vs. 27.5%). Divided into 3 age groups (under 35 years old, 36-59 years old and over 60 years old) we noticed a relatively uniform distribution of the victims, with a slight dominance of the 36-59 age group and the over 60 years of age group. The highest number of victims was among the pedestrians (36.25%), followed in decreasing order by the drivers (33.75%), passengers (17.5%), cyclists (7.5%) and motorcyclists (5%). Positive alcohol testing was found in 14 of drivers (81 %). The analysis of lesions found during necropsies of the deceased at the scene of the accident highlights some particularly life-incompatible injuries that resemble any rescue effort on the part of the medical crew moved to the scene of the accident.
Conclusion: Inappropriate road conditions and indiscipline in traffic of both drivers and pedestrians contribute to unacceptably high mortality.
Carasca Cosmin, Muresan Vasile Adrian, Tilea Ioan, Magdas Annamaria, Carasca Emilian and Incze Alexandru
Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension.
Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking.
Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation.
Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.
Caraşca Cosmin, Caraşca Emilian, Ţilea Ioan, Voidazan Septimiu and Incze Alexandru
Objective: In patients with critical limb ischemia who undergone revascularization procedures, the assessment of risk factors that may affect the postoperative outcome is of great importance. The main objective in this study is to assess the utility of two specific risk scores, the Finnvasc score and the modified Prevent III score.
Methods: We evaluated the applicability of these two risk scores in 150 patients who undergone an unilateral infrainguinal surgical revascularization procedure. The receiver operating characteristic curve analysis was used to estimate the predictive value of the scoring methods. A comparison between the risk scores, determine the areas under the curve. Medium-term prediction ability was analyzed for both scoring methods.
Results: The area under the curve of Finnvasc score for predicting amputation was 0.739 (95%CI:0.661-0.807) and of the modified PIII score 0.713 (95%CI:0.633-0.784); for restenosis we obtained 0.528 (95%CI:0.444-0.611), respectively 0.529 (95%CI:0.445-0.612) and for thrombosis 0.628 (95%CI:0.544-0.706) and 0.556 (95%CI:0.472-0.638), demonstrating that the Finnvasc score performs better in overall prediction. Heart failure is a strong independent predictor of amputation (p=0.0001, OR=26.90; 95%CI:5.81-124.2), restenosis (p=0.0003, OR=4.80; 95%CI:1.96-11.8) and mortality (p=0.01, OR=7.16; 95%CI:1.33-38.52).
Conclusions: The accuracy of the two risk scoring methods in predicting the medium-term outcome of patients undergoing surgical infrainguinal revascularization is acceptable. The Finnvasc score is easier to be applied to the characteristics of our patients.
Cosmin Carasca, Annamaria Magdas, Ioan Tilea and Alexandru Incze
Background: The aim was to assess endothelial function with photoplethysmography (PPG), by post-occlusive reactive hyperaemia (PORH) combined with alprostadil challenge test in patients with peripheral artery disease (PAD).
Methods: Forty-nine PAD patients stage II-III Fontaine (39 male, 10 female, mean age 68.45±5.86 years) and a control group of 49 healthy individuals (24 male, 25 female; mean age 25.1±3.8 for a young subgroup; 71.0±0.16 years for an elderly subgroup) were included. Ankle-brachial index (ABI) was assessed at baseline, peripheral perfusion (PP) and PORH were assessed at baseline and after the 30 minutes administration of parenteral alprostadil.
Results: After 3 minutes of arterial occlusion, peripheral perfusion increased from 0.69±0.94 mV/V to 2.27±2.42 mV/V (p<0.0001). After alprostadil challenge, peripheral perfusion increased from 0.84±1.24 mV/V to 4.52±3.52 mV/V (p<0.0001). In controls PP was 2.4±1.7 mV/V versus 3.8±1.5 mV/V, p<0.0001.
Conclusion: In patients with PAD, an increase in PORH after alprostadil challenge due to the release of nitric oxide (NO), provides information on the endothelial function and could reflect the presence of collaterals. In the healthy control group, the increase in PORH could reflect the integrity of main arterial branch. In PAD patients with an increase in PORH, conservative therapy should be preferred over surgical revascularisation.