Toxicological investigations in a fatal and non-fatal accident due to hydrogen sulphide (H2S)poisoning

Hydrogen sulphide (H2S) is one of the most toxic natural gas and represents a not rare cause of fatal events in workplaces. We report here a serious accidental poisoning by hydrogen sulphide inhalation involving six sailors. Three of them died while the other three survived and were transported to the emergency room. No greenish discolouration of the body, that could be a feature of these type of deaths, was observed at autopsy. Given that blood and/or urine H2S detection does not allow to discriminate if it is related to inhalation or to putrefactive processes, the determination of thiosulphate, H2S main metabolite, is decisive. The succession of fatal events reported here can be rebuilt b…

Caspase 9 and Caspase 3 Immunohistochemical Pattern in Skeletal and Cardiac Muscles at Different Times after Death: An Experimental Study on PMI Estimation

(1) Background: The estimation of the post mortem interval (PMI) is a challenge for forensic pathologists because data emerging from methods commonly applied are not always conclusive, since several conditions exist that may affect the reliability of these parameters. Thus, new approaches have been proposed to overcome such a limit. In recent years, several studies have been performed on proteins analyzing their expression/degradation patterns in relation to the progressing of the post mortem interval. (2) Methods: The immunoreactivity patterns of two apoptosis mediators—Caspase 9 and Caspase 3—have been tested in order to evaluate their potential role as markers of the post mortem interval…

Forensic tools for the diagnosis of electrocution death: Case study and literature review

Diagnosis of death by electrocution may be difficult when electric marking is not visible or unclear. Accordingly, the body of a man who appeared to have died from accidental electrocution was carefully forensically analysed. Macroscopic and microscopic analysis of the current mark was carried out using a variable-pressure scanning electron microscope equipped with energy dispersive X-ray microanalyser to highlight skin metallisation, indicating the presence of iron and zinc. The histological findings of electrocution myocardial damage were supported by the results of biochemical analysis which demonstrated the creatine kinase-MB and cardiac troponin I elevation. The effects of electric cu…

Unusual attempted suicide or covered attempted homicide? A neck stabbing case report and review of literature.

A medico-legal consult is frequently required in a clinical context in order to assess the eventual compatibility of specific wounds with a self- or hetero-infliction. Accordingly, the case of a 52-year-old man with a single, penetrating stab wound of the neck, reported as self-inflicted, is here presented. The forensic aspects, taken into account in order to determine the self- or hetero-infliction nature of the wound, are further discussed and compared to cases described in the literature.

Quando bisogna discostarsi dalle linee guida? I casi problematici nella prassi odontoiatrica

Obiettivi Delineare vantaggi e limiti delle linee guida e dei riferimenti alle buone pratiche nella valutazione della condotta professionale dell’odontoiatra. Definire tipologie di pazienti e contesti operativi nei quali esse non risultano applicabili. Quest’obiettivo è coerente con i recenti sviluppi giurisprudenziali della Corte di Cassazione a Sezioni Unite del dicembre 2017 in tema di colpa e responsabilità dei sanitari. Materiali e metodi Si analizzano i riferimenti contenuti nella Legge 24/2017; quindi, in riferimento alla metodologia della responsabilità medico/odontoiatrica, si individuano i contesti della pratica clinica nei quali è più opportuno cercare di sviluppare buone pratich…

Killing methods in Sicilian Mafia families

The Sicilian Mafia is a criminal organisation founded in Sicily which is an island south of the Italian mainland in the Mediterranean Sea. Until recently, this organization was responsible for many murders and bombings. However, recently, based on the investigations known as the “Mare Nostrum” operation, the Supreme Court convicted 67 people and sent them to prison. Some defendants were found guilty of as many as 39 murders. This article reviews the forensic analysis that was used when investigating responsibility for these Mafia murders. Our review is based on the court documents and the ballistic investigations which were carried out to evaluate the reliability of “repented” or “pentiti”…

An unusual case of sudden cardiac death during sexual intercourse

The most common cause of sudden death during sexual intercourse in adults is heart disease, and it is usually the male, whereas the death of the woman is unusual. Generally, in these cases, death occurs as a result of cardiovascular disease. The authors report an unusual case of the sudden death of a young woman during sexual intercourse. The post-mortem investigations (autopsy, cardiac nuclear magnetic resonance and cardiac histology) demonstrated a previously undiagnosed arrhythmogenic right ventricular cardiomyopathy. The terminal cause of death was a malignant arrhythmia from arrhythmogenic right ventricular cardiomyopathy. This is the first report of a case in which sexual activity ca…

Profili di Responsabilita’ del Medico Competente

Gli autori analizzano la sentenza di cassazione n. 1856/2013 che chiarisce, ampliandolo, il concetto di collaborazione (con il datore di lavoro) del medico Competente previsto dall'art. 25 del D.Lgs 81/2008 sottolineando altresì i profili di responsabilità.

The COVID-19 Assessment for Survival at Admission (CASA) Index: A 12 Months Observational Study

Objective: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the stratification of patients at risk of mortality is not well defined. In this study, we aimed to define a mortality risk index to allocate patients to the appropriate intensity of care.Methods: This is a 12 months observational longitudinal study designed to develop and validate a pragmatic mortality risk score to stratify COVID-19 patients aged ≥18 years and admitted to hospital between March 2020 and March 2021. Main outcome was in-hospital mortality.Results: 244 patients were included in the study (mortality rate 29.9%). The Covid-19 Assessment for Survival at Admi…

Post-cesarean necrotizing fasciitis caused by surgical site infection

Necrotizing fasciitis (NF) is a rare, but rapidly progressive, potentially life-threatening soft tissue infection, with an incidence of 0.15-0.55 cases per 100,000 population. the gynecological-obstetric literature describes cases of NF due to surgical site infection (SSi) after cesarean delivery. this article discusses issues in the medicolegal evaluation of NF and the importance of prophylactic procedures, risk management protocols, and prompt diagnosis of this condition. two cases of post-cesarean NF due to SSi are reported. in both cases the responsibility lay with the hospitals and the medical staff owing to failure to adopt adequate SSi prophylaxis and to establish a timely diagnosis …

La vasectomia a sostegno del piacere: analisi casistica e considerazioni medico legali

In Italy, the resort to vasectomy, surgery adapted to determine an irreversible alteration of the physical state of an individual, resulting in the loss of the ability to procreate, is somewhat reduced compared to the others European countries, even though legitimate, it carries the disadvantage of the absence of a clear and univocal legislation concerning surgical sterilization. Despite, in recent years there has been a change in the assessment of such surgery. Nevertheless, is relevant that in the Italian legal system still lacks a regulatory of such medical-surgery activities, although several bills have been submitted to the competent parliamentary bodies. The attitude of indifference t…

Analysis on sarcoglycans expression as markers of septic cardiomyopathy in sepsis-related death

The post-mortem assessment of sepsis-related death can be carry out by many methods recently suggested as microbiological and biochemical investigations. In these cases, the cause of death is a multiple organ dysfunction due to a dysregulated inflammatory response occurring after the failure of infection control process. It was highlighted also that the heart can be a target organ in sepsis which determines the so-called septic cardiomyopathy characterized by myocardial depression. Several mechanisms to explain the pathophysiology of septic cardiomyopathy were suggested, but very few studies about the structural alterations of cardiac cells responsible for myocardial depression were carried…

An Insight into the Role of Postmortem Immunohistochemistry in the Comprehension of the Inflammatory Pathophysiology of COVID-19 Disease and Vaccine-Related Thrombotic Adverse Events: A Narrative Review

On 11 March 2020, the World Health Organization (WHO) declared a pandemic due to the spread of COVID-19 from Wuhan, China, causing high mortality rates all over the world. The related disease, which mainly affects the lungs, is responsible for the onset of Diffuse Alveolar Damage (DAD) and a hypercoagulability state, frequently leading to Severe Acute Respiratory Syndrome (SARS) and multiorgan failure, particularly in old and severe-critically ill patients. In order to find effective therapeutic strategies, many efforts have been made aiming to shed light on the pathophysiology of COVID-19 disease. Moreover, following the late advent of vaccination campaigns, the need for the comprehension …

The violence of men against women: Medico-legal and psychological issues

Violence against women breaches women’s human rights and is a global public health issue that can cause devastating life-long damage. This study considers the characters of victims, abusers and traumatic bonding in heterosexual couples from a medico-legal and psycological standpoint. After considering the devastating effects on women’s health, and with the objective of preventing future violence, it illustrates the weaknesses and strengths of new Italian guidelines related to violence against women in emergency departments including the use of “Brief Risk Assessment for IPV in the Emergency Department – DA5”.

Fatal anaphylactic shock and Taenia solium infestation: a possible link?

Are there positive lessons for Italy's NHS resulting from the Covid-19 pandemic?

The authors evaluate the importance of prevention measures and health care from their own experience and briefly analyse the factors that may have contributed to the rapid spread of Covid-19 in Italy, and hope this will feed into appropriate and new and improved health policies.

Pitfalls on Postmortem Imaging: The Need of Blending Conventional and Virtual Autopsy on Burnt-Charred Body

Joining forensic traditional autopsy and CT-MR postmortem virtual approach may assist forensic experts in adequate reconstruction of cause, manner, and way of death, significantly to find evidence of found wound/fracture and relative interpretation. Evaluation of criminal burning is often a difficult challenge in the view of misinterpretation of wound/fracture victims and usually poor case history of this criminal offense. In this scenario, a strong collaboration between imaging and classical forensic techniques is helpful.

Postmortem Imaging in Sudden Adult Death

Several definitions of “sudden and unexpected death” exist. The World Health Organization definition is of natural death within 24 h from the onset of symptoms, but this is much too long for many clinicians and pathologists; some will only accept death within 1 h from the onset of illness. If the event was not witnessed, sudden death is defined as the interval between the time the subject was last seen and the time the body was found within 6 h.

Violence and Abuse: Battered Child

Battered child is a crucial social and medical issue, which represents a major cause of morbidity and mortality among children. The ‘child abuse syndrome’ is a clinical condition in young children who have received serious physical abuse, and should be considered in any child exhibiting evidence of fracture of any bone, subdural haematoma, failure to thrive, soft tissue swellings or skin bruising, in any child who dies suddenly, or where the degree and type of injury is at variance with the history given regarding the occurrence of the trauma. A clinical-radiological-forensic collaboration is crucial for its identification.

Sodium oxybate therapy for the treatment of alcohol withdrawal syndrome and the maintenance of alcohol abstinence

Gamma-hydroxybutyrate (GHB or sodium oxybate) is both an exogenous and endogenous molecule with neuromodulator properties. In the United States, GHB is an approved drug for the treatment of narcolepsy and narcolepsy with cataplexy in adults. In some European Union countries, sodium oxybate is applied for the treatment of opioid and alcohol withdrawal.

Unexpected death for Takayasu aortitis associated with coronary ostial stenosis: case report.

The differential diagnosis of vasculitis is often a difficult task due to the frequent morphological similarities that various vasculitic syndromes express when the heart is the target organ. The more the lesions are limited to the arterial tree with absent or almost silent coronary events, the less specific the anatomical and clinical frameworks. To create a series of clinical records and on the basis of these assumptions, the authors report a case concerning the sudden death of a 43-year-old woman which occurred while an ergonometric test was being carried out 28 days after the onset of the symptoms. A subsequent postmortem investigation/autopsy enabled us to detect a granulomatous aortit…

APPROPRIATENESS OF CESAREAN SECTION IN A HOSPITAL OF SICILY (ITALY): STATISTIC EVIDENCES AND MEDIC LEGAL CONSIDERATIONS

ntroduction: Authors have carried out a survey to evaluate the appropriateness of the caesarean deliveries performed in a hospital of Sicily (Italy) during 2013. The choices of these surgeries have been compared with italian and sicilian guidelines. Materials: EpiInfo 7.1.4 software (CDC - Atlanta - USA) was used to perform the statistical data analysis (chi-square test). Results: We analyzed a total of 818 medical records related to 50.61% of spontaneous deliveries, :06% induced labor, and 46.33% of cesarean deliveries. Medical records showed that in 32.7% the caesarean section were justified by emergency conditions, whereas in 15.89% the choice was not quite justified according to guideli…

La responsabilità professionale ed il ricorso alla medicina difensiva ed evitativa

Infortunio Mortale in Edilizia e profili di responsabilità: analisi di una casistica

Sulla base di tre casi di infortunio mortale verificatisi nell'ambito dell'edilizia, gli autori hanno analizzato le problematiche connesse al mancato impiego dei DPI quali fattori favorenti il determinismo nonchè quale elemento di individuazione di possibile responsabilità per le figure coinvolte.

Segnalazione di un caso di trombosi sistemica massiva neonatale

Il ruolo della cartella clinica ai fini della valutazione della qualità per l'accreditamento istituzionale

The authors carried out research aimed at evaluating the quality of some aspects of a sample of medical records compiled in the operational uniti of a hospital. A subjective evaluation criterion was used, quantified by attibuting a correct numeric value by means of a weightingdeliberation factor. None of the medical record examined were judget qualitatively excellent. The main fact missing was the documentation regarding consensus, even in those medical records judget good or sufficient.

Immunohistochemical study on dystrophin expression in CAD-related sudden cardiac death: a marker of early myocardial ischaemia

The aims of this study were to assess if dystrophin can be a tool for the forensic evaluation of sudden cardiac death due to coronary atherosclerotic disease (CAD) and particularly if it can be a marker of early myocardial ischaemia. Then in this investigation, the dystrophin was compared to C5b-9 and fibronectin to analyze if there are some differences in the expression of these proteins. Two groups of CAD-related sudden cardiac death, respectively the group 1 with gross and/or histological evidence and the group 2 with no specific histological signs of myocardial ischaemia were used. A third group formed by cases of acute mechanical asphyxiation was used as a control. The immunohistochemi…

Pathological Findings in COVID-19 as a Tool to Define SARS-CoV-2 Pathogenesis. A Systematic Review

Introduction: The World Health Organization declared the COVID-19 pandemic in March 2020. COVID-19 still represents a worldwide health emergency, which causesa severe disease that has led to the death of many patients. The pathophysiological mechanism of SARS-CoV-2 determining the tissue damage is not clear and autopsycan be auseful tool to improve the knowledge of this infection and, thus, it can help achieve a timely diagnosis and develop an appropriate therapy. This is an overview of the main post-mortem findings reporting data on the infection effects on several organs.Methods: A systematic literature search was conducted in the PubMed database searching for articles from 1 January to A…

Forensic microbiology applications: A systematic review.

Abstract According to the Human Microbiome Project (HMP), a healthy human body contains ten times more microbes than human cells. Microbial communities colonize different organs of the body, playing fundamental roles both in human health and disease. Despite the vast scientific knowledge of the role of microbial communities in a living body, little is known at present about microbial changes occurring after death, thus leading many authors to investigate the composition of the thanatomicrobiome and its potential applications in the forensic field. The aim of the following review is to provide a general overview of the advances of postmortem microbiology research, mainly focusing on the role…

The role of PMCT for the assessment of the cause of death in natural disaster (landslide and flood): a Sicilian experience

AbstractIn this report, the authors provide a contribution of PMCT in assessing the cause of death due to natural disasters. Here, the PMCT findings of 43 subjects who died during both landslide and flood were described. The post-mortem imaging revealed, clearly, traumatic injuries and/or the presence of foreign material in airways allowing to assess the cause of death of each subject, together with external inspection and the collected circumstantial data. Particularly, the PMCT has been helpful for characterization and localization of the clogging substance in airways providing findings on bronchial branches involvement. Moreover, the investigation offered detailed data on skeletal injuri…

Hanging disguised as bondage: accidental or suicidal death?

The concept of autoerotic asphyxiation refers to the use of devices or substances intended to enhance one's arousal by inducing cerebral hypoxia, which can involuntarily lead to death. Although in most cases death occurs accidentally, it is nonetheless true that the same devices might be used by the practitioners in order to attempt suicide. The case of a 34-year-old practitioner of autoerotic asphyxiation found dead in his apartment with bondage-like ligatures and masking is reported here. The case raised some issues concerning the accidental or suicidal nature of the act. The aspects taken into account in the management of the case are discussed, along with a compared approach to the data…

Asthmatic bronchial lesions in drug addicted

Bilateral cyclic cheek lesions related to premenstrual syndrome: a multifactorial pathogenesis?

Introduction Cheek biting is a chronic, usually innocuous, self-inXicted injury that often occurs as a parafunctional habit. Case report We report an unusual case of bilateral cyclic cheek lesions in a 34-year-old woman characterized by hyperkeratinization near the biting edges of the teeth and hematic lesions accompanied by a cheek swelling sensation, without pain and burning. The lesions coincided with a premenstrual syndrome, characterized by Xuid retention Introduction Cheek biting is a chronic, usually innocuous, self-inXicted injury that often occurs as a parafunctional habit. Case report We report an unusual case of bilateral cyclic cheek lesions in a 34-year-old woman characterized …

Ustioni da elettrobisturi: contributo casistico e considerazioni medico-legali

[Electrosurgery burns: case series and medico-legal issues] In general and specialist surgical practice the use of the electrosurgical unit is consolidated for minimally invasive interventions, due to the ability to control the bleeding of the operative field and the interaction between the cutting and coagulative mechanisms. The authors take inspiration from four cases of personal observation, related to thermal injury produced by electrosurgery, to conduct a brief review of the literature on this issue and present some medical and legal aspects derived from their expert’s observation, in terms of healthcare liability. The authors underline the importance of an accurate knowledge of the pr…

Caspase 9 and Caspase 3 Immunohistochemical Reactivity Pattern in Skeletal and Cardiac Muscle at Different Times After Death: A New Tool for Postmortem Interval (PMI) Determination?

Learning Overview: After attending this presentation, attendees will understand the importance of the identification of new markers that could be used as possible PMI indicators, especially in contexts in which the reliance on the classic thanatochronological triad—livor, rigor, and algor mortis—is not conclusive. Impact on the Forensic Science Community: This presentation will impact the forensic science community by highlighting the relationship between the activation pattern of caspases 9 and 3 on skeletal and cardiac muscle samples and PMI. The determination of the amount of time elapsed from one’s death to the recovery of the body—the so-called PMI—has always relied on the evaluation o…

La sicurezza del paziente in ambiente ospedaliero e la responsabilità professionale dei vertici strategici

[Patient safety in the hospital setting and the professional responsibilities of top managers] The authors underline the evolution of legislation concerning the creation of Hospital Companies and the reasons for the implementation of clinical risk management activities, then analyse the responsibilities involving the top figures of the top hospital management. In particular, the authors highlight the obligation and responsibilities of the strategic apex of a Hospital Company and show that, sometimes, the technical consultants – who express a medical-legal advice – underestimate the responsibility of these figures. It is a management responsibility that determines the obvious and inevitable …

La responsabilità penale da derelizione di corpo estraneo in sito chirurgico

The authors focus on the liability of the surgery team members in the case they inadvertently forget behind in the patient's body a foreign abject, which causes injuries and/or death. The authors underline that, according to the current case law regarding medical malproactice, both the main surgeon and their assistant/subordinate are liable for engaging in a markedly imprudent and/or negligent conduct, such as not double-checking scrupulously the surgical site before its closure in order to highlight forgotten foreign bodies. As well, the authors underline that either the circulator nurse or the theatre nurse can be considered punishable by law when that medical error occurs, even if they a…

Una riflessione Medico-Legale sulle linee guida di cui alla c.d, "Balduzzì": la metodologia nell’accertamento del nesso causale in penale Ruolo della perizia nel processo penale

Gli autori effettuano una analisi delle caratteristiche che deve possedere il perito/consulente tecnico del Giudice nell'ambito dell'attività espletata nei casi di responsabilità professionale medica alla luce della Legge Balduzzi e di quanto dettato dal vigente Codice deontologico. Viene infine effettuato un escursus sul valore delle linee guida

Responsabilità per trattamenti tricologici: casistica ed indagine conoscitiva

The Authors report two cases of refund claim of personal damages for presumed professional responsibility of hairdressers, related to professional activities for trichological procedures. In fact acquired data show that, in the last years, there are many claims, even in civil litigation, for presumed professional responsibility concerning cosmetic medical-surgical practices, but also of typically moving crafts, for activities performed by these professionals. So, for many aspects of these events, medical examiner, is involved in the evaluation of causation between performed activities and complained subsistence of sequelae that could be considered damage of good constitutionally protected. …

Dystrophin and metalloproteinase 9 in myocardial ischemia: A post-mortem immunohistochemical study

The presented study evaluated the expression of dystrophin and MMP-9 in cases of sudden cardiac death (SCD) due to coronary atherosclerotic disease (CAD) in order to analyze the characteristics and the chronology of their expression, providing evidence on the possible role in post-mortem diagnosis of myocardial ischemia. The expression of these proteins was also compared to C5b-9 complex and fibronectin expression to evaluate any differences. Two groups of CAD-related SCD, respectively group 1 with gross and/or histological evidence and group 2 with no specific histological signs of myocardial ischemia, were used. A third group formed by cases of acute mechanical asphyxiation was used as a …

Clinical pharmacology of citrus aurantium and citrus sinensis for the treatment of anxiety

Objective. The aim of this review is to analyze preclinical and clinical studies investigating the anxiety effects ofCitrus aurantiumorCitrus sinensisessential oils (EOs).Design. The bibliographic research was made on the major scientific databases. Analysis included only articles written in English and published on peer-reviewed scientific journals describing preclinical experiments and clinical trials carried out to investigate the antianxiety effects ofCitrus aurantium or Citrus sinensisEOs on anxiety disorders. Clinical studies reporting the antianxiety effects of products containingCitrus aurantiumorCitrus sinensisEOs in combination with other active substances, including medicinal pla…

An unusual fatal case of overdose of Vinblastine and review of literature

The pharmacological treatment of neoplasia is based on the use of chemotherapeutic substances. Chemotherapeutic agents can cause acute and chronic toxicity even at therapeutic doses. For this reason their overdose puts a patient’s life at severe risk. This work presents an unusual fatal case of overdose subsequent to an accidental massive administration of Vinblastine (90 mg instead of 9 mg), slow bolus (five minutes), to a 33-year-old woman who suffered from Hodgkin’s Lymphoma. The administration of the massive dose was due to a transcription error of the therapeutic treatment plan and miscommunication between the health professionals which caused the use of the wrong dose. The foren…

Intraosseous gas distribution as a marker of postmortem interval

Abstract The postmortem interval is probably the most important puzzle piece in clarifying the circumstances in case of death occurred in unknown conditions. Over the years, radio-imaging modalities have proved their worth in forensic field, providing additional and significant improvements and findings. CT-scan is characterized by wide availability, fast scan times and sustainable healthcare costs. Detection of gas, hemorrhage and bone fractures are points of strength of CT-scan. A reliable evaluation of the post-mortem interval is interesting in the victims of a mass disaster, also following a natural disaster, for the individuation of responsibility in the efficiency of the help and assi…

Membrane Attack Complex in Myocardial Ischemia/Reperfusion Injury: A Systematic Review for Post Mortem Applications

The complement system has a significant role in myocardial ischemia/reperfusion injury, being responsible for cell lysis and amplification of inflammatory response. In this context, several studies highlight that terminal complement complex C5b-9, also known as the membrane attack complex (MAC), is a significant contributor. The MAC functions were studied by many researchers analyzing the characteristics of its activation in myocardial infarction. Here, a systematic literature review was reported to evaluate the principal features, advantages, and limits (regarding the application) of complement components and MAC in post mortem settings to perform the diagnosis of myocardial ischemia/infar…

Peculiar and Unusual Drowning in Waste Oil from Motor Vehicles: Case Report

Drowning is one of the most frequent causes of accidental or suicidal death, and more rarely it is associated with a homicide. Cases of drowning in water or in the sea are common. The authors report an unusual and peculiar case of drowning, that of a woman who accidentally fell inside a collection tank of waste oil of motor vehicles.

Investigation of the skin lesions in lightning strike death

Lightning strike-related deaths are unusual, and the victim bodies can present different lesions due to the different injury mechanisms associated with this event. Since the post mortem assessment can be challenging, the evaluation of the characteristics of the skin lesions becomes fundamental to reconstruct the event. Due to the paucity of literature on this topic, the authors report the case of a 59-year-old man found dead near his home after a thunderstorm. Initially considered a murder by gunshot, the autopsy revealed the typical lightning strike lesions, also known as Lichtenberg figures. The adequate interpretation of the autopsy data and the histological evidences allowed to reconstr…

La tutela assicurativa della responsabilità professionale

The Authors conducted a fact-finding survey among the health operators in some Sicilian and calabrian hospitals, hèreby eitending it to include doctors in training - in light of D.Lgs. 368/99 - and heilth operatórs in the area o in consideration oflaw42|9.T\esurveywas'aimedatdeterminingthedegree ofawarenessofthetypeofinsurancecoveràgeand/orcontraclsandlnlicies(>, "claims made") signed by the respective services, as well as about the protection supplied to health operators by the same insurance contracts.

ustione corneale durante intervento di facoemulsificazione: contributo casistico e considerazioni medico-legali

[Corneal burn during phacoemulsification surgery: case report and medico-legal considerations] The authors report a case of severe corneal burn, occured a few seconds later the beginning of the surgical procedure of phacoemulsification on a 63 years old woman affected by cataract. The authors analyzed the case as a result of claims for damage to the surgeons and the hospital by the patient. In terms of assessment of responsibility, medico-legal investigation is aimed at identifying whether the responsibility of the event of damage to the patient is to be attributed to the negligent conduct of the surgeon or to defects or damage to the equipment used by the same. The authors underline the im…

Fatal anaphylactic shock due to a dental impression material

Materials used for dental impressions are usually safe. This study describes a case of fatal anaphylaxis that appeared immediately after the oral mucosa came into contact with an alginate paste used for dental impressions. The cadaveric examination and the poslmortem toxicology report confirmed that the cause of death was anaphylactic shock. The patient was affected by both cardiovascular and lung dlseases that worsened the condition and forbade the use of epinephrine. To the authors' knowledge, dental impression materials, and alginate in particular, have not been reported previously as being a cause of anaphylaxis

Unexpected death for takayasu aortitis associated with coronary ostial stenosis

The differential diagnosis of vasculitis is often a difficult task due to the frequent morphological similarities that various vasculitic syndromes express when the heart is the target organ. The more the lesions are limited to the arterial tree with absent or almost silent coronary events, the less specific the anatomical and clinical frameworks. To create a series of clinical records and on the basis of these assumptions, the authors report a case concerning the sudden death of a 43-year-old woman which occurred while an ergonometric test was being carried out 28 days after the onset of the symptoms. A subsequent postmortem investigation/autopsy enabled us to detect a granulomatous aortit…

Neurological aspects of medical use of cannabidiol

Background: Cannabidiol (CBD) is among the major secondary metabolites of Cannabis devoid of the delta-9-tetra-hydrocannabinol psychoactive effects. It is a resorcinol-based compound with a broad spectrum of potential therapeutic properties, including neuroprotective effects in numerous pathological conditions. CBD neuroprotection is due to its antioxidant and antiinflammatory activities and the modulation of a large number of brain biological targets (receptors, channels) involved in the development and maintenance of neurodegenerative diseases. Objective: The aim of the present review was to describe the state of art about the pre-clinical research, the potential use and, when existing, t…

Sudden death in water: Diagnostic challenges

Abstract The authors report a case of sudden death in a breath-holding diver and highlight the forensic diagnostic difficulties in opining the cause of sudden death in water. The autopsy showed increased thickness of the left ventricular wall with a distinct pattern of concentric hypertrophy, evident particularly in the subaortic interventricular septum. Histological examination revealed diffuse interstitial fibrosis and associated findings of multifocal myocyte disarray especially evident in the subaortic interventricular septum. The analysis and discussion of this case made it possible to attribute sudden death to a lethal arrhythmia following myocyte disarray and hypoxia caused by breath…

Skull and Encephalic Injuries Caused by Beach Umbrellas: Case Reports and Review of Literature

This study reports two unusual cases of skull-encephalic injuries in bathers that were caused by violent impacts with beach umbrellas. The first case concerned a 36-year-old man who, while lying on a sun bed, was struck on his left temple by a beach umbrella, which had been blown away by a gust of wind. The second case concerned a six-year-old child who was struck on the right temporal region while he was playing on the sand. Both subjects died. A review of the literature was carried out. Various skull and brain injuries caused by several objects were found, but no injuries caused by beach umbrellas were detected. There were only cases of injuries caused by normal umbrellas. These cases sho…

Fire in operating room: The adverse "never" event. Case report, mini-review and medico-legal considerations.

Abstract The patient’s security and safety represent a topic of great importance for public health that led several healthcare organizations in many Countries to share documents to promote risk management and preventing adverse events. Surgical Fire (SF) is an infrequent adverse event generally occurring in the operating room (OR) and consisting of a fire that occurs in, on, or around a patient undergoing a medical or surgical procedure. Here a medico-legal case involving a 65-year-old woman reporting burns to the neck due to an SF during a thyroidectomy was described. A literature review was performed using Pubmed and Scopus databases, focusing on epidemiology, causes, prevention activitie…

Lethal Anaphylactic Reaction to Intravenous Gelatin in the Course of Surgery

Plasma volume expanders (PVEs) are widely used to increase circulating blood volume. Gelatins used as PVEs are heterogeneous mixtures of polypeptides, usually prepared by hydrolysis of bovine collagen containing large amounts of proline and hydroxyproline residues. It has been shown that gelatins can cause anaphylactic reactions. We describe the case of a 73-year-old man who during surgery for intestinal obstruction presented a lethal anaphylactic reaction after the administration of a PVE containing gelatin lysate. The reaction occurred 10 minutes after the start of plasma expander infusion. Then, patient became comatose, and he died without awakening after 76 days. Necroptic aspects and h…

Sodium Oxybate Therapy for Alcohol Withdrawal Syndrome and Keeping of Alcohol Abstinence

BACKGROUND Gamma-hydroxybutyrate (GHB or sodium oxybate) is both an exogenous and endogenous molecule with neuromodulator properties. In the United States, GHB is an approved drug for the treatment of narcolepsy and narcolepsy with cataplexy in adults. In some European Union countries, sodium oxybate is applied for the treatment of opioid and alcohol withdrawal. OBJECTIVE The aim of the present review was to describe the state of art of the pre-clinical research and the clinical evidence related to GHB used alone or in combination with other treatments in alcohol withdrawal syndrome and alcohol abstinence maintenance. METHOD Internationally published pre-clinical findings and clinical studi…

Competenze e limiti della nuova figura del mediatore di cui al D.Lgs. 28/2010

Gli autori dopo aver ripercorso l'iter normativo che ha introdotto in Italia l'Istituto della Mediazione/Conciliazione, delineano la figura del mediatore e le sue competenze nell'ambito della valutazione del danno da responsabilità civile, soffermandosi inoltre sulle specifiche competenze necessarie per il mediatore chiamato ad assolvere il suo ruolo in que casi ove la proposta conciliativa deve prevdere una valutazione della pretesa stessa, l'accertamento del nesso causale ed al contempo del quantum risarcitorio.

Post-Mortem Immunohistochemical Evidence of β2-Adrenergic Receptor Expression in the Adrenal Gland

The evidence from post-mortem biochemical studies conducted on cortisol and catecholamines suggest that analysis of the adrenal gland could provide useful information about its role in human pathophysiology and the stress response. Authors designed an immunohistochemical study on the expression of the adrenal &beta

A unique fatal case of Waterhouse–Friderichsen syndrome caused by Proteus mirabilis in an immunocompetent subject

Abstract Introduction: The Waterhouse–Friderichsen syndrome (WFS), also known as purpura fulminans, is a potentially lethal condition described as acute hemorrhagic necrosis of the adrenal glands. It is often caused by infection. Classically, Neisseriae meningitidis represents the main microorganism related to WFS, although, infrequently, also other infectious agents are reported as a possible etiologic agent. The authors report the first case of death due to Proteus mirabilis infection, with postmortem evidence of WFS. Patient concerns: After a facial trauma that provoked a wound on the nose, the subject, a healthy 40-years old man, was conducted to the local hospital (in Sicily, Italy) af…

Cardiomiopatia aritmogena del ventricolo destro in giovane uomo deceduto in incidente stradale

Gli autori segnalano un caso di propria osservazione riguardante il decesso di giovane uomo, sportivo, con anamnesi familiare e patologica negativa per patologie cardiache, coinvolto in incidente stradale autonomo; la cui causa del decesso veniva inizialmente attribuita (sulla scorta della sola ispezione cadaverica effettuata dal medico del 118 intervenuto sul luogo) ai gravi effetti contusivi cerebrali connessi al trauma cranico. Il successivo esame autoptico, disposto dall’A.G., completato dagli esami di laboratorio, consentiva di individuare la sussistenza di una ampia sostituzione fibro-adiposa del miocardio del ventricolo destro, comprendete la porzione epicardica e gli strati intermed…

Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

To date, sepsis is still one of the most important causes of death due to the difficulties concerning the achievement of a correct diagnosis. As well as in a clinical context, also in a medico-legal setting the diagnosis of sepsis can reveal challenging due to the unspecificity of the signs detected during autopsies, especially when no ante-mortem clinical data, laboratory, and cultural results are available. Thus, a systematic review of literature was performed to provide an overview of the main available and updated forensic tools for the post-mortem diagnosis of sepsis. Moreover, the aim of this review was to evaluate whether a marker or a combination of markers exist, specific enough to…

Allele frequencies distribution of 16 forensic STR loci in a Western Sicilian population sample

Abstract The PowerPlex® ESI 17 Fast and ESX 17 Fast Systems represent faster cycling versions released by Promega® to follow the requirements of ENFSI and EDNAP groups’ for new STR genotyping systems in Europe. Allele frequencies and forensic parameters were estimated in a population sample of 120 unrelated healthy individuals living in Sicily (Western Sicilian population sample) using PowerPlex® ESI 17 Fast and PowerPlex® 17 Fast Systems. Full concordance of the results for both systems was observed. No significant deviation from Hardy-Weinberg equilibrium was detected. The observed heterozygosity changed from 0.85833 for FGA to 0.95 for TH01. The combined power of discrimination for the 1…

Antiproliferative Effects of St. John’s Wort, Its Derivatives, and Other Hypericum Species in Hematologic Malignancies

Hypericumis a widely present plant, and extracts of its leaves, flowers, and aerial elements have been employed for many years as therapeutic cures for depression, skin wounds, and respiratory and inflammatory disorders. Hypericum also displays an ample variety of other biological actions, such as hypotensive, analgesic, anti-infective, anti-oxidant, and spasmolytic abilities. However, recent investigations highlighted that this species could be advantageous for the cure of other pathological situations, such as trigeminal neuralgia, as well as in the treatment of cancer. This review focuses on the in vitro and in vivo antitumor effects of St. John’s Wort (Hypericum perforatum), its derivat…

A machine learning application to predict early lung involvement in scleroderma: A feasibility evaluation

Introduction: Systemic sclerosis (SSc) is a systemic immune-mediated disease, featuring fibrosis of the skin and organs, and has the greatest mortality among rheumatic diseases. The nervous system involvement has recently been demonstrated, although actual lung involvement is considered the leading cause of death in SSc and, therefore, should be diagnosed early. Pulmonary function tests are not sensitive enough to be used for screening purposes, thus they should be flanked by other clinical examinations

FATAL ANAPHYLACTIC SHOCK CEFTRIAXONE-INDUCED IN A 4 YEAR-OLD CHILD

One of the most used cephalosporin in clinical practice is ceftriaxone. Anaphylaxis due to the administration of ceftriaxone is considered a rare event. Here, we report a case of fatal anaphylactic shock after the administration of ceftriaxone in a child who had tolerated the drug in past exposures. The allergic pathogenesis is sustained by the clinical data (short time between the inoculation of the drug and the onset of the symptoms; past exposure to the same molecule and probable sensitization) and the postmortem examination findings (polivisceral congestion and intense eosinophilia found in the histological examination).

Segnalazione di un caso di morte improvvisa neonatale

Il concetto di sindrome da morte improvvisa del lattante (SIDS) è definita come la morte improvvisa e inaspettata di un bambino di meno di un anno che posto in apparente buona salute nella culla viene poi rinvenuto cadavere senza che si sia manifestato alcun segno o sintomo di malattia e la cui causa rimane inspiegata dopo indagini approfondite. Esistono tuttavia altre ipotesi che rientrano nel capitolo della moprte improvvisa (SD), inattesa, che derivano da SD in corso di malattie paucisintomatiche, in genere di tipo infettivoovvero in corso di quadri patologici ben definiti o di malformazioni cardiache asintomatiche o in stato di pienop compenso o che, pur non essendo manifeste sul piano …