BackgroundSevere intoxication with carbon monoxide (CO) is extremely lethal and causes numerous deaths due to cardiac or respiratory failure. Conventional intensive treatment may not be sufficient. The aim of this study was to investigate the treatment effect of extracorporeal veno-arterial extracorporeal membrane oxygenation (ECMO) following severe CO poisoning in an experimental porcine model.MethodsA total of twelve pigs were anaesthetized, routinely monitored and intoxicated by inhalation of CO until the beginning of cardiac failure and randomized to a treatment (ventilator using an FiO2 of 100% or ECMO). In the case of cardiac arrest, advanced resuscitation using standard guidelines was performed for at least 10 min. ECMO was also initiated in the ventilation group if the return of spontaneous circulation did not occur within 10 min. Lung tissue biopsies were obtained before and after CO intoxication.ResultsAll animals in the ECMO group survived; however, one had to be resuscitated due to cardiac arrest. A single animal survived in the ventilator group, but five animals suffered from cardiac arrest at an average of 11.8 min after initiation of treatment. Conventional resuscitation failed in these animals, but four animals were successfully resuscitated after the establishment of ECMO.A significant decrease was noticed in PO2 with increasing HbCO, but there was no increase in pulmonary vascular resistance. No differences in H&E-stained lung tissue biopsies were observed.ConclusionsThe use of ECMO following severe CO poisoning greatly improved survival compared with conventional resuscitation in an experimental porcine model. This study forms the basis for further research among patients.

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The aim of this study was to compare medical and nonmedical findings in police reported and unreported cases of rape and attempted rape in the county of Aarhus, Denmark, and to explore whether legal outcomes were influenced by medico-legal findings in the cases reported to the police.Data on rapes and attempted rapes were collected from the files of the Department of Forensic Medicine, police reports, and court files. Eighty-seven victims of alleged rape and attempted rape were included in a 14-month period. Of these, 60% were categorized as date rapes, 23% as stranger rapes, and 16% as partner rapes. Sixteen percent did not report the alleged crime to the police, but still participated in a medico-legal examination. Twenty-nine percent filed police reports, but did not have a medico-legal examination undertaken.Extra-genital lesions were more common among the women who filed police reports (63 vs 43%). Women who weee subjected to date rape and partner rape and had not suffered physical injuries were more reluctant to report to the police. Twelve cases were taken to court; 11 offenders were convicted with 1 acquitted. The presence of injuries, vaginal penetration, or the findings of semen, in this study, had not in fluenced the legal outcome.

A review was undertaken of the range of possible congenital lesions of the major airways and adjacent tissues that may cause critical compromise of luminal diameter with resultant respiratory arrest from airway occlusion. Lesions included micrognathic syndromes, macroglossia, choanal atresia and stenosis, tumors and choristomas, posterior lingual masses, laryngeal atresia and stenosis, laryngeal webs, laryngeal cysts and laryngoceles, laryngomalacia, tracheomalacia, and bronchomalacia. An autopsy approach to possible congenital obstructive lesions of the upper airway requires: (1) review of the clinical and family histories looking specifically at the nature of the terminal episode; (2) external examination looking for dysmorphic syndromes with mandibular or mid-facial hypoplasia; and (3) internal examination with layer dissection of the soft tissues of the neck and en bloc removal of the upper aerodigestive tract, with photographic recording and histological sampling.

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