0000000000933056
AUTHOR
Stefania Zerbo
Cervical necrotizing fasciitis and descending necrotizing mediastinitis in a patient affected by neglected peritonsillar abscess: a case of medical negligence.
Abstract We report a case of fatal cervical necrotizing fasciitis (CNF) and descending necrotizing mediastinitis (DNM) due to primary peritonsillar abscess in 60-year-old male patient with no history or evidence of immunocompromising disorders. The patient was treated with antibiotic and corticosteroid drugs but he developed mediastinitis and septic shock and died of multiple organ failure six days later from recovery in hospital. After a clinical, diagnostic and therapeutical consideration of the cervical necrotizing fasciitis and some related risks of a delayed diagnosis and treatment, the authors analysed the clinical history of the patient and of the medical conduct pointing out profess…
Torture and Maltreatment in Prison: A Medico-Legal Perspective
The maltreatment and torture of prisoners constitute a global problem. Methods of maltreatment are classified as the psychological and the physical, and physical methods inevitably lead to psychological sequelae. Our review offers an analysis from the medico-legal perspective of the literature on the torture and physical and sexual abuse experienced by prisoners and their psychological sequelae and aims to investigate the medico-legal issues of investigating maltreatment in prison so as to suggest methodologies and updated approaches for dealing with such cases in a forensic context. We performed a comprehensive literature search of peer-reviewed publications (articles and reviews), researc…
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…
Attività di verifica in ambito di invalidità civile. Esperienza della Commissione Medica di Verifica di Palermo
Gli autori analizzano l'esperienza della Commissione Periferica di invalidità Civile della Provincia di Palermo, specificatamente in ordine alle patologie cronico-degenerative
A CASE OF SUDDEN DEATH FOR CARDIAC HEMANGIOMA IN CHILD.
Role of Imaging in the Assessment of Age Estimation
Age assessment by skeletal age estimation of unknown individuals is of paramount importance in forensic science, both for assessing imputability (if the author of a crime is old enough to be tried and judged), both in case of unaccompanied minors, or whether refugees and asylum seekers are adults or juveniles, which implies different legal issues and procedures. The aim of this article is to review the age estimation methods used in forensic practice.
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…
La (indimostrata) relazione causale tra Thimerosal ed autismo infantile: revisione della letteratura scientifica e osservazione casistica
Il consenso informato nella responsabilità professionale
Virtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging
The applications of forensic radiology involve both Virtopsy both studies on living people - to demonstrate bone age, search for foreign bodies, such as voluntary injection of drug ovules or surgical sponges accidentally forgotten, to assess gunshot wounds, to evaluate injuries by road accidents, and cases of violence or abuse (both in adults and in children). Computed tomography is the most used imaging tool used in forensic pathology and its indications are mainly focused on cases of unnatural deaths or when a crime is suspected. It is preferred over the standard autopsy in selected cases, such as in putrefied, carbonized or badly damaged bodies; or as a preliminary evaluation in mass dis…
Fibrodisplasia arteriosa misconosciuta ad esito letale. Descrizione casistica e rivisitazione della letteratura
gli autori presentano due casi di displasia fibromuscolare (DFM) oggetto di indagine giudiziaria per ipotizzata responsabilità professionale nell'operato dei sanitari all'esordio clinico e nell'approccio chirurgico. Viene sottolineata la necessità di una rapida risoluzione chirurgica in ambiente specialistico e l'importanza delle linee guida che devono essere rispettate nell'approccio al pziente
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…
Refertazione in ecografia ostetrica e profili di responsabilità.
From 1997 to 2007: Modified Approach to Sexual Assault in Our Experience
Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries
The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that con…
An Overview on the Use of miRNAs as Possible Forensic Biomarkers for the Diagnosis of Traumatic Brain Injury
Determining the cause of death is one of the main goals of forensic pathology. However, conditions can occur in which common approaches—external inspection, autopsy, histology, etc.—might not be conclusive. With the advancement of molecular biology, several investigative techniques have been developed over the years, and the application as approaches complementary to routine procedures has proved useful in these cases. In this context, microRNA (miRNA) profiling has attracted increasing interest due to these molecules’ ability to regulate physiological and pathological processes. The evidence of differential miRNA expression in both animal models and human samples of traumatic brain injury …
Sudden death in adolescence caused by cardiac haemangioma
Primary tumors of the heart in infants and children are rare. The types of heart tumors in pediatric age groups are generally different from those in adults. Cardiac myxoma is by far the most common tumor in adults, but in infants and adolescents the prevalent tumor of the heart is rhabdomyoma. Among benign cardiac tumors, cardiac hemangiomas are rare and often diagnosed post-mortem due to the lack of specific clinical symptoms and signs. We report a case of sudden death due to cardiac hemangioma in an apparently healthy 15-year-old adolescent. The autopsy revealed a cardiac hemangioma located at the apex of the heart; the histopathological examination showed the tumor was a mixed capillary…
When a virus (Covid-19) attacks human rights: The situation of asylum seekers in the medico-legal setting
The Covid-19 pandemic is a global health emergency that requires immediate, effective action by governments to protect the health and basic human rights of everyone’s life. Refugees and migrants are potentially at increased risk because they typically live in overcrowded conditions often without access to basic sanitation. Since the beginning of the official lockdown for Covid-19, the medico-legal assessment of physical violence related to obtaining status or other forms of human protection has been frozen.
Cardiac rupture caused by traffic accident: Case reports and a literature review.
The commonest cause of blunt cardiac injuries is from traffic accidents followed by violent falls, sport activities, accidents or a fight but rupture of the heart is rare and lethal. The precise incidence of cardiac injury after a blunt chest trauma is unknown as rates vary greatly in the literature from between 7% and 76% of cases. Autopsy studies have shown that the right ventricle is the most frequently ruptured, followed by the left ventricle, right atrium, intraventricular septum, left atrium and interatrial septum with decreasing frequency. Post-mortem imaging is a rapidly advancing field of post-mortem investigations of trauma victims. The available literature dealing with the compa…
Self-inflicted long bone fractures for insurance fraud.
Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to defin…
Focus on Liability of Residences for Elderly and Sick People: A Case Series and Medico-Legal Issues
Residences for elderly and sick people, self-sufficient or dependent, are varied. To date, the liability profiles of these structures are not clearly delineated, and increasingly often, their operating and organization criteria are entrusted to subnational, regional, or local regulations. Among the various deficits, there is the keeping of a complete and detailed documentation/diary of the patient, the lack of which can generate medico-legal problems. In this paper, we present three cases of guests in residences for a dependent person brought to the attention of the Institute of Forensic Medicine of the University Hospital of Palermo due to criminal proceedings, where the lack of existing d…
Il consenso informato in cardiologia interventistica
Lo scenario della responsabilità nel dolore toracico: illustrazione casistica
Radiology for Postmortem
Thanatology deals with the study of early and postmortem changes in relation to the estimation of the time since death. These normal postmortem changes depend on internal and external factors, such as body temperature, preexisting conditions, underlying disease or injury, and the postmortem interval.
SINDROME COMPARTIMENTALE (su un caso di omessa diagnosi)
Homicide with post mortem dismemberment of the victim
Interpretation of Diagnostic Imaging for Medicolegal Issues
Forensic radiology is a relative recently emergent part of forensic medicine characterized by the application of radiological methods in criminal investigations, such as the forensic M.E’s radiological reports in civil or penal matters for judicial technical advice. The various imaging modalities like X-rays, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and ultrasonography can be used depending on various forms of cases and their requirements in routine investigations.
Ipoacusia neurosensoriale causata da scoppio di petardo. Aspetti medico-legali
Gli Autori illustrano un caso di ipoacusia neurosensoriale permanente rilevata all’orecchio di sinistra con un deficit uditivo pantonale pari a 70 dB. La lesione è stata determinata dallo scoppio di un petardo, lanciato in vicinanza della persona lesa. Vengono valutati i risvolti medico-legali in ambito penale e civile. Per quanto concerne la sfera penalistica l’ipotesi di reato è quella di lesione personale grave, in ragione dell’indebolimento permanente della funzione uditiva; relativamente al contesto civilistico, si pone particolare attenzione alla questione inerente al risarcimento cui il soggetto danneggiante è obbligato, considerando in particolar modo gli effetti che la lesione ha d…
SUDDEN UNEXPLAINED JUVENILE DEATH AND THE ROLE OF MEDICOLEGAL INVESTIGATION: UPDATE ON MOLECULAR AUTOPSY
In the past few years, contributions of molecular biology assays to the investigation of sudden juvenile death have permitted to clarify some of the pathogenetic aspects of sud-den arrhythmic death, opening the way to preventive action on victims’ relatives. We reviewed literature on the genetics of sudden juvenile death, and on molecular biol-ogy assays performed on autoptic samples. Biological investigation permits the detection of genetic mutations underlying the suscep-tibility to sudden cardiac death of individuals with rare inherited forms of arrhythmia (Long QT Syndrome, Brugada Syndrome, Lev’s disease etc.) through the analysis of criti-cal sequences codifying for ion channel subuni…
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”.
Informed consent and minors: hiv testing in italian legislation.
Case Report: Unusual Clinical Presentation of a Rare Cardiac Inflammatory Myofibroblastic Tumor in Children: The Differential Diagnosis With Pediatric Emergencies
Introduction: There are still no guidelines about pediatric cardiac cancers. The purpose of this work is to provide new scientific data facilitating the differential diagnosis of a rare cardiac tumor with an unusual presentation, such as the cardiac inflammatory myofibroblastic tumor (IMT).Case Presentation: A 3-year-old male child presented with several symptoms including unconsciousness, vomiting, and drowsiness. A clinical and neurological examination revealed a unilateral (right) motor delay and positive unilateral Babinski sign. Electrocardiogram (ECG) was normal.Diagnostic Assessment: The total body computed tomography (CT) scans showed hypodensity in the left temporal–parietal lobe, …
Legal aspects of sexually transmitted diseases: abuse, partner notification and prosecution
Sexually transmitted diseases (STDs), with special emphasis to HIV infection, involve legal and ethical issues regarding informed consent to submit to a diagnostic, observance of professional secrecy in regard to partner(s) and community; legal troubles of particular difficulties are related to STD involving minors; lastly, physicians must be able to recognize the state of so called medical necessity. Knowledge and awareness of these related obligations are crucial to STD in medical practice; it is also important to allow for proper protection of victims of suspected sexual abuse under observation of healthcare. With regard to this aspect should be emphasized that violence against women and…
Lethal rupture of post-traumatic aneurysm of the vertebral artery case report.
Abstract Traumatic aneurysms or dissections of the vertebral artery have been reported in patients who have suffered minor craniofacial injuries in traffic accidents. A case is reported of ruptured traumatic vertebral artery aneurysm due to closed head injury without without penetrating injuries or skull fractures. The macroscopic and histological findings relevant to the vertebral wall were compatible with post-traumatic aneurysm; the rupture of the wall was assumed to be caused by sepsis and local infiltration of inflammatory cells.
La nutrizione artificiale: l'assistenza palliativa domiciliare. aspetti bioetici e possibili profili di responsabilità professionale
Gli Autori esaminano gli apsetti salienti della quetione bioetica della nutrizione artificiale, facendo riferimento anche ai più recenti casi di spospensione dlla NA e approfondiscono gli correlati ad evntuali profili di responsabilità professionale
VALUE OF INFORMED CONSENT IN AESTHETIC DENTAL PROCEDURES
In the last decade there have been an exponential increase in both the supply and demand for non invasive aesthetic procedures involving the face and the lips to contrast age changes in the perioral area. We briefly report the main non invasive aesthetics treatments in which dentists are involved and the professional liability related to the issues of informed consent. To avoid deontological and judiciary consequences the informed consent has to be obtained by the patient before any clinical procedure and documented in medical record. Recently Italian law no. 219/2017 highlighted the principle of autonomy and self-determination of patient and maximizes an optimal relationship between patien…
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.
Medico legal procedures related to sexual assault: a 10-year retrospective experience of a Daphne protocol application
Background: Sexual assault is a worldwide problem that has not yet been sufficiently acknowledged as confirmed by the literature. Italian law n.96, 1996, foreseeing norms regarding rape and sexual abuse, finally gave significant relevance to sex crimes. In 2004, the European Commission for Justice Internal Affairs and Social Politics promoted the Daphne II program to support victims of rape and abuse, and the Violence and Operative Healthcare Networks (Ve.R.S.O.) project started at the Policlinico âP. Giacconeâ University Hospital of Palermo in 2006. Aim: data analysis emerging from 10 years experience of Daphne protocol utilization for the management of sexual assault victims. Methods:…
Forensic investigation in aircraft accident with the aid of CT (MSCT), and Magnetic Resonance Imaging (MRI): our experience
The autors report their experience in a case of air disaster in which a Tuninter airlines ATR 72 fallen down into the sea near Capo Gallo coast (Palermo, Italy) with 39 persons on board, resulting in six-teen victims. In the present contribute the authors argued the causes of the death and analysed patternes of injuries sustained by passengers involved in the fatal airplane accident using the conventional autopsy combined with postmortem Multi Slice Computed Tomography (MSCT) examination.
Penile Enhancement Procedures: Urological And Ethicolegal Issues
Phalloplasty procedures for most men requiring penile augmentation surgery are cos-metic procedures; generally the patients have a normal-sized and fully functional penis but they think that their penis is too small. There are not well defined indications for penile enhancement surgery and, except for the treatment of “micropenis”, there are not established guidelines and the outcome measures for success are still unclear. All penile enhancement techniques often do not reach the expected result and the grade of pa-tient’s satisfaction is frequently poor. Phalloplasty procedures for psychological dys-morfism are not approved by any scientific society and the majority of these procedures are …
The medico-legal implications in medical malpractice claims during Covid-19 pandemic: Increase or trend reversal?
The Covid-19 pandemic caused a marked increase in admissions to intensive care units. The critically ill patients’ condition from the infection resulted in their deaths. The healthcare facilities have got into trouble because of the pandemic. In fact, they had to create additional beds in a very short time and to protect health workers with personal protective equipment. Healthcare professionals fear that there will be an increase in complaints and medico-legal malpractice claims and hence they have urged politicians to discuss this. The Italian Parliament recently debated the topic of medical liability and passed the Decree-Law no. 18 of 17 March 2020 (DL – so called Cura Italia) by which…
The Essential of Bone Histology for Forensic Applications
This chapter illustrates characteristics of bone, as specialized connective tissue, taking into account fundamentals of histology for forensic purposes (Cells of Bone, Concentric or Haversian system, Systems of internal and external circumferential lamellae, Bone Remodeling).
COVID-19 Vaccination in Pediatric Population: A Necessity or Obstruction to the Protection of the Right to Health? Biojuridical Perspective.
One of the most recently debated topics worldwide is the mass vaccination of children against coronavirus disease 2019 (COVID-19). Next, the risk/benefit ratio of COVID-19 vaccination and infection in children are compared. Nonetheless, the real question in this debate is as follows: Does the vaccine represent a necessary tool or is it an obstacle in protecting the right to health? From a public health point of view, the Supreme Court of Nova Scotia, in Canada, recommends COVID-19 vaccination in the pediatric population. Based on Article 25 of the Draft Articles on State responsibility, vaccination can be considered a social act necessary for protecting the individual's right to health. The…
Morte improvvisa giovanile inspiegata e ruolo dell'indagine medico-legale: aggiornamento dell'autopsia molecolare
Can Immunohistochemical stains aid torule out pitfalls in suffucation death?
Spontaneous extrusion of male genital pearling
Pearling is a practice of inserting small beads beneath the skin of the genitalia. Patients generally underwent this practice believing that this would have made their penis bigger and able to better satisfy their partners during intercourse. Pearling can cause complications. We report a case of spontaneous extrusion of genital pearling exiting in a granuloma of the inner face of the foreskin.
Death of a 23-year-old man from cardiac conduction system injury through a blunt chest impact after a car accident.
Abstract Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent causes of cardiac contusion resulting from a direct blow to the chest. Myocardial contusion is difficult to diagnose; the clinical presentation varies greatly, ranging from a lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. The authors report a case of death due to a cardiac conduction system injury from a blunt chest impact following a car accident. The autopsy showed no external signs of thoracic trauma, no evident rib or sternum fractures. A small sub-endoc…
Cardiovascular Implantable Electronic Device Infection and New Insights About Correlation Between Pro-inflammatory Markers and Heart Failure: A Systematic Literature Review and Meta-Analysis
Introduction: Surgical approaches to treat patients with abnormal pro-inflammatory parameters remain controversial, and the debate on the correlation between hematological parameter alteration in cardiac implantable electronic device (CIED) infection and the increase in mortality continues.Methods: We performed a systematic review using the PubMed, Scopus, and Cochrane Library databases. Twenty-two articles from May 2007 to April 2020 were selected and divided according to the following topics: prevalence of microbes in patients with CIED infection; characteristics of patients with CIED infection; comparison between patients who underwent and did not undergo replantation after device extrac…
Juvenile sudden cardiac death due to congenital coronary ostial valve-like ridges: A case report and literature review
Coronary artery anomalies are a heterogeneous group of congenital disorders affecting the coronary pattern with a characteristic (origin, number, number of hosts, course, etc.). They are rarely found in the population. We report the case of a 21-year-old male who died from sudden cardiac death caused by an isolated coronary ostial obstruction, secondary to a rare anomaly, the presence of a valve-like ridge consisting of a small fold in the Valsalva aortic sinus. The study provides a brief literature review on the pathophysiology, diagnosis, and clinical and medico-legal issues in coronary artery anomaly cases that may be helpful in forensic practice when dealing with sudden cardiac death i…
AN INTERVIEW STUDY OF THE AWARENESS AND UNDERSTANDING OF CHILD ABUSE AND NEGLECT IN THE EMERGENCY ROOM.
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…
Can immunohistochemical stains aid to rule out pitfalls in suffocation deaths ?
Role of MDCT virtopsy in valuation of burned bodies and its comparison with traditional autopsy
Aims and objectives Methods and materials Results Conclusion Personal information References
LA CARTELLA CLINICA NELL’ATTUALE CONTESTO DELLA PRIVACY
Coronary artery anomalies and juvenile sudden cardiac death
Cartella clinica
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…
A possible biomarker for methadone related deaths
Abstract Methadone (MTH) concentrations in those dying of MTH toxicity totally overlap concentrations where the presence of MTH is only an incidental finding, making it very difficult to make distinctions in actual cases. A biomarker, be it anatomical or biochemical for MTH toxicity is badly needed, particularly if that markers were known to disrupt effective ventilation. Because the brainstem houses the regulatory centers for cardiorespiratory-control enters, it would seem to be the most likely anatomical site to seek abnormalities in cardiorespiratory control. Objective To locate and describe the cells of nucleus of the solitary tract (TS)(NTS) in human brainstem and determine if neuronal…
Asthmatic bronchial lesions in drug addicted
La prevenzione del rischio clinico nel trattamento della calcolosi urinaria. Illustrazione casistica
Linee guida in ortodonzia e attuale valutazione dei profili di responsabilitÃ
Alla luce della nuova legge entrata in vigore in Italia, si discute il valore protettivo delle linee guida in ortodonzia sotto il profilo medico-legale. OBJECTIVES. In view of the Italian law recently come into force, this study aims at discussing the protective value of orthodontic guidelines in terms of legal medicine. MATERIALS AND METHODS. A review of orthodontic guidelines was conducted, including general orthodontic guidelines as well as specific guidelines for clinical and surgical cases. RESULTS AND CONCLUSIONS. Orthodontic practices envisaging professional liability include diagnosis, prevention, interception, care planning and treatment of all types of malocclusion (even when asso…
Role of virtopsy in the post-mortem diagnosis of drowning.
Purpose: Due to admitted limits of autopsy-based studies in the diagnosis of drowning, virtopsy is considered the new imaging horizon in these post-mortem studies. The aim of our study was to evaluate the role of virtopsy performed through computed tomography (CT) in the forensic diagnosis of drowning. Materials and methods: We retrospectively examined the CT data of four cadavers recovered from sea water and suspected to have died by drowning. Each patient underwent a full-body post-mortem CT scan, and then a traditional autopsy. Conclusion: To date, there are no autopsy findings pathognomonic of drowning. This study proves that virtopsy is a useful tool in the diagnosis of drowning in tha…
Il dolore cronico: profili di responsabilità medico legale
Utility of post mortem MRI in definition of thrombus in aneurismatic coronary arteries due to incomplete Kawasaki Disease in infants
Abstract Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that primarily affects the coronary artery (CA) and presents in childhood. The characteristic coronary arterial lesion is an aneurysm, which may lead to thrombosis, dilatation, stenosis, and occlusion. Such an aneurysm is typically calcified and generally develops five or more years after the onset of acute KD. It becomes more noticeable after ten years. KD is sometimes difficult to diagnose because of the limited clinical features, especially in infants younger than 6 months old, where the clinical presentations often do not fulfill the diagnostic criteria for KD. We report a case of Incomplete Kawasaki…
Postmortem Computed Tomography: From Acquisition to Reporting
PMCT in a noninvasive, fast, and quite available method which coroners and forensic experts tend to use more and more often, especially when a crime is suspected. PMCT proved to be an excellent tool for detection and assessment of bone fracture injuries due to sharp trauma and bullet trajectories.
Sexual Abuse-Current Medico-legal, Forensic and Psychiatric Aspects
Abstract Violence against women and minors is a worldwide problem that has not yet been sufficiently acknowledged. There are many obstacles especially when sexual abuses have to be evaluated. These problems are present both when victims of sexual abuse are evaluated and when sex offenders are dealt with, especially when the offenders are juvenile sex offenders (JSO). These issues give cause for great concern about prognosis, and the resulting psychosocial implications, and call for a special effort from the scientific community in identifying appropriate prevention and treatment methods. This chapter is divided into two parts. The first part deals with the forensic and psychiatric features,…
La persona nel diritto civile
Idoneità all'attività sportiva e doping: profili di responsabilità professionale.
Percorsi di integrazione e modello operativo della rete anti-violenza: esperienza del progetto Daphne
Unexpected Traumatic Carotid Artery Lesion
La nutrizione artificiale: l'assistenza palliativa domiciliare. Aspetti bioetici e possobili profili di responsabilità professionale
WORK ACTIVITIES AT INCREASED RISK OF TRAUMATIC INJURIES: AN INTEGRATED PREVENTIVE APPROACH
Included in the scope of workplace safety is that relating to potential accidents, i.e. the harmful consequences for human health crossed with the work environment factor. In the study of the determinism of these accidental events, it is important to achieve a biomechanical balance between two main elements: the human and the work environment (consisting of the physical, chemical and environmental factors, i.e. the equipment and what generates its use). Considering the most recent statistically recorded incidents, our analysis has focused on the accident sphere proper, where an imbalance in the above-mentioned binomial triggers the activation of multiple disciplines that actively and pro-ac…
Complicanze neurogene iatrogene in esito ad erronea esecuzione di tecnica di riduzione secondo weber di frattura del gomito.
Implementation of A Year-Long Antimicrobial Stewardship Program in A 227-Bed Community Hospital in Southern Italy
Background: Healthcare-Acquired Infections (HAIs) are serious healthcare complications affecting hospital stay, in-hospital mortality, and costs. Root cause analysis has identified the inappropriate use of antibiotics as the main causative factor in the expansion of multi-drug-resistant organisms (MDRO) in our hospital. An Antimicrobial Stewardship (AMS) program was implemented to optimize antibiotic use, limit the development of resistance, improve therapeutic efficacy and clinical outcomes, and reduce costs. Methods: The stewardship strategies were: antimicrobial oversight on “critical” antibiotics; the development of hospital guidelines on antibiotic selection with the production of a co…
COVID-19 Vaccine-Related Thrombosis: A Systematic Review and Exploratory Analysis
IntroductionThe World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic on March 11, 2020. Two vaccine types were developed using two different technologies: viral vectors and mRNA. Thrombosis is one of the most severe and atypical adverse effects of vaccines. This study aimed to analyze published cases of thrombosis after COVID-19 vaccinations to identify patients’ features, potential pathophysiological mechanisms, timing of appearance of the adverse events, and other critical issues.Materials and MethodsWe performed a systematic electronic search of scientific articles regarding COVID-19 vaccine-related thrombosis and its complications on the PubMed (MEDLINE) d…
Biphasic pleural mesothelioma in a electrician working in a railway company: Case report and current trends in mesotheliomas in Italy
Background: Mesothelioma is an aggressive tumour that can involve the pleura, the peritoneum, and sometimes other mesothelia, such as the pericardium and the tunica vaginalis testis. Scientific communities have known for a long time the causal correlation between exposure to asbestos (work related or not) and the onset of the disease (in 75% - 90% of cases) and the increasing number of asbestos-correlated mesotheliomas expected in the next years. Case presentation: The authors present the case of an electrician, 66-year-old man, died for pleural mesothelioma, working in Palermo in the company of the Italian Railways for a period of about 20 years, exposed to asbestos. Frequently he disassem…
Immigrant death and human trafficking crimes. A report of August 28th 2015 tragedy in Mediterranean sea
Il consenso informato per l’effettuazione del test per la diagnosi da HIV: come comportarsi in caso di minori.
EtG Quantification in Hair and Different Reference Cut-Offs in Relation to Various Pathologies: A Scoping Review
Ethyl glucuronide (EtG) is a non-volatile, non-oxidative, hydrophilic, and stable ethanol phase II metabolite. EtG is produced through ethanol glucuronidation by UDP-glucuronosyltransferase (UGT), a phase II enzyme. EtG can be extracted from different biological matrices, including keratin ones, such as hair or nails. The purpose of this scoping review is to describe the relationship between EtG levels in hair and some of the most common and frequent pathological conditions and verify whether different reference cut-offs in relation to various pathologies have been identified in the scientific literature. In fact, in-depth knowledge of the influence of pathologies, such as diabetes mellitus…
La ricerca clinica tra scienza ed etica nella malattia di Parkinson.
Il dolore non toracico a genesi cardiaca nello scenario della responsabilità: illustrazione casistica
L’uso diffuso delle statine nell’era della prevenzione di massa della cardiopatia ischemica: occasione per riflettere sugli eventi avversi dei farmaci e sulla possibile responsabilità medica.
Office ecografia: l’ecografia come supporto alla visita ostetrico-ginecologica. il ruolo dell’ostetrica.
L'ETICA DELLA RESPONSABILITA' NELLA RICERCA SCIENTIFICA
Post-traumatic lethal carotid-cavernous fistula.
The authors report about an unexpected death by traumatic lesion of the internal carotid artery in a 30-year-old man who had fallen two metres. The man suffered a fracture of the left maxillary sinus and a fracture of the right orbit with bilateral haemorrhage of the maxillary sinus. Surgical treatment was performed with favorable outcome. Clinically, there were no neurological symptoms but about 60 days after his accident, the man died from uncontrolled epistaxis. He was submitted to the autopsy that show a linear fracture in the left side of the turcic sella and lesion of the left internal carotid artery with carotid-cavernous fistula.
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…
Evidence and witness of a child victim of sexual abuse in Italian penal process.
Perioperative and anesthetic deaths: toxicological and medico legal aspects
Abstract Background Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms “operati…
Telemedicine during Covid-19 pandemic: Advantage or critical issue?
Telemedicine offers a support to traditional medicine, delivering clinical services when distance is a critical factor. Although this tool does not replace a medical examination, during Covid-19 pandemic, it reduces the spread of infection and avoids the need for a patient’s visit. It is useful in the management of chronic disorders or for patients undergoing palliative treatment. The University Hospital of Palermo has applied this in cases of chronic illness caring for patients who cannot stop their treatment, such as Department of Onco-Haematology, Internal Medicine, Dermatology, etc. The Department of Legal Medicine of Palermo, in particular, is also using telemedicine to manage medico-…
La valutazione del danno biologico in implantoprotesi.
Sexual abuse and maltratment on child: protocols, cooperation strategies, daphne II - V.eR.S.O. (Violenza e reti sanitarie operative) Project- our experience
Possibili profili di responsabilità nelle fistole oro-sinusali iatrogene. illustrazione casistica
Governo clinico e sicurezza: il ruolo del medico legale.
La responsabilità professionale del cardiologo: il dialogo informato e la scelta terapeutica
The risk of the 'prison-emptying' effect in Italy due to the Covid-19 pandemic.
People who live and work or are detained inside restricted communities (including prisons) need to be considered as they are at a high risk of becoming infected with Covid-19 during this pandemic.1 InItaly, the spread of Covid-19 has provoked numerous riots within the prisons and local detention centres, and there is a consequent increase in requests for inmates to be released and detained at home
The analysis of SUDEP forensic autopsies leading to preventable events
Introduction: The diagnosis of unexpected death by excluding non-natural causes, particularly in subjects with epilepsy, is a topic of interest and it is difficult to identify in the forensic field. Health professionals sometimes are faced with cases of sudden death, generally in young adults with a long history of epilepsy that require, for judicial purposes, an explanation in terms of cause and means to determine the death. SUDEP is an entity diagnosed by the exclusion of other causes that may have led to death, and then for forensic purposes, it requires particular attention and knowledge, and there is difficulty in identifying it. Our contribution aims to illustrate the scientific commu…
La rilevanza medico-legale dei biofilms batterici nelle infezioni nosocomiali
Sexual abuse and maltreatment on child: protocols, cooperation strategies, Daphne II V.eR.S.O. project, our experience.
CARDIAC RUPTURE FOLLOWING BLUNT CHEST TRAUMA: REPORT OF TWO CASES.
An inusual catastrofic intra-abdominal hemorrhage caused by spontaneus segmental arterial mediolysis dissection
Postmortem Imaging in Drowning
The diagnosis of drowning is one of the most difficult in the field of forensic medicine since the autopsy findings are often not specific and the laboratory examinations are controversially appreciated by the scientific community. In a cadaver recovered from water, it is of utmost importance to differentiate antemortem and postmortem drowning. This chapter fully investigates biological/thanato-chemical, pathological and imaging findings which may guide the definitive diagnosis.
A fatal case of a paint thinner ingestion: Comparison between toxicological and histological findings
Toluene and xylene are aromatic hydrocarbons commonly used as an industrial solvent for the manufacturing of pharmaceuticals, paints, and chemicals. The Occupational Safety and Health Administration has determined that toluene levels of 2000 parts per million (ppm) are considered dangerous to life and health. Several studies have examined the absorption of toluene and xylene following inhalation and oral ingestion in humans. Volatile organic compounds that are absorbed into the blood are distributed throughout the body; in particular, distribution of absorbed toluene and xylene in humans and rodents is characterized by preferential uptake in well-perfused and lipophil tissues such as the br…
Utility of post mortem computed tomography in clivus fracture diagnosis. Case illustration and literature review
Clivus fractures are usually associated with head blunt trauma due to traffic accident and falls. A 23 - year-old man died immediately after a smash-up while he was stopping on his motorcycle. Post-mortem Computed tomography (PMCT), performed before autopsy, revealed a complex basilar skull base fractures associated with brainstem and cranio-vertebral junction injuries, improving the diagnostic performance of conventional autopsy. Imaging data were re-assessable and PMCT offers the possibility to perform multiplanar and volume rendered reconstructions, increasing forensic medicine knowledge related to traumatic injuries.
Lie Detection: fMRI
Objective detection of deception was extensively studied, starting from polygraph to more modern techniques, the functional MR (fMRI), and they are based on neural (sympathetic) activation that is evoked in stressful conditions, such as lying. The role of fMRI in neurophysiology has been extensively developed and studied, and its principles lie in the correlation between the brain demand of energy during determined task and its supply. Although being extensively studied, its role for judiciary purpose presents many shortcomings.
HS-SPME-GC/MS analysis in a fatal case of a paint thinner ingestion
A Forensic Diagnostic Algorithm for Drug-Related Deaths: A Case Series
The best evidence provided in the literature worldwide suggests the importance of harmonizing the investigation in drug-related fatalities. In this study, the application of a multidisciplinary approach in eight cases of drug-related deaths is presented. Although death scene findings could be highly suggestive of drug intoxication, external examination and toxicological screening test alone are insufficient. There are several variables, and it is not always easy to give the proper interpretation of the drug detection. A complete autopsy is necessary to correctly complete organ and tissues sampling for further histological and toxicological studies and obtain body fluids. The use of peripher…
A CASE OF SUDDEN CARDIAC DEATH BY ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA
The Impact on Healthcare Workers of Italian Law n. 24/2017 “Gelli–Bianco” on Patient Safety and Medical Liability: A National Survey
Italian “Gelli–Bianco” law (law n. 24 enacted by the Italian Government on 8 March 2017) introduced innovative changes and regulations regarding patient safety and healthcare workers’ (HCWs) liability. We promoted a national survey to evaluate the effect of the law on HCWs. The questionnaire was edited and distributed using the free online tool “Google Forms” (Google LLC). The mode of administration chosen for the questionnaire was telematic self-completion. In particular, the questionnaire was sent to several portals of information, websites, in the scientific and medical sectors. Four hundred forty-five subjects participated in the survey. The differenc…
Profili di responsabilità professionale nella terapia antalgica
VALIDITY AND CREDIBILITY OF A CHILD’S TESTIMONY OF SEXUAL ABUSE: A CASE REPORT
The allegation by a child victim of sexual abuse is, in many cases, the most important evidence of wrongdoing, especially in absence of medical or physical evidence or confes-sions of guilt. The Rorschach inkblot test is a projective personality assessment technique used to evaluate child witnesses. We report a case of three girls allegedly abused by the father, in which the psychometric evaluation with the Rorschach test did not give credibility to the testimony of the chil-dren. When interrogating a minor, it is very difficult to distinguish between a true and a lie. Indeed, many different elements can affect the dialogue, such as the child’s age, the events being discussed, interrogation…
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…
COVID-19 Pandemic: New Prevention and Protection Measures
As of the end of February 2021, more than 420,000,000 confirmed cases of COVID-19 have been reported worldwide, with 5,856,224 deaths. Transmission of the different genetically engineered variants of SARS-CoV-2, which have been isolated since the beginning of the pandemic, occurs from one infected person to another by the same means: the airborne route, indirect contact, and occasionally the fecal–oral route. Infection is asymptomatic or may present with flulike symptoms such as fever, cough, and mild to moderate and severe respiratory distress, requiring hospitalization and assisted ventilation support. To control the spread of COVID-19, the World Health Organization (WHO) and Centers for …
Role of virtopsy in the postmortem diagnosis of drowning
Aims and objectives Methods and materials Results Conclusion Personal information References
Origine e decorso anomalo della coronaria destra in un caso fatale di tromboembolismo polmonare post-operatorio
La rilevanza del tromboembolismo polmonare trova giustificazione nella sua grande incidenza, nei dati sulla mortalità e nella sua brusca modalità di insorgenza, che la rende trattabile durante la fase acuta. L'arma più efficace contro la TEP è la prevenzione e a tal fine sono state proposte numerose linee guida. Scopo del presente lavoro è illustrare un evento tromboembolico polmonare fatale determinatosi nonostante la somministrazione di una tromboprofilassi aderente alle più accreditate linee guida emanate sull'argomento. La particolare origine anomala della coronaria destra del soggetto, non nota in vita, ha certamente favorito il decesso. Gli Autori pertanto illustrano il ruolo causale …
Evidenze medico legali in tema di dolore toracico
Ethical and legal issues of end of life between past and future in the "globalized" european mediterranean culture: the Italian experience.
CONGENITAL NEUROBLASTOMA: A RARE CASE OF PLURIVISCERAL METASTATIC DISSEMINATION
Neuroblastoma is one of the most common neonatal tumors. It involves children in early infancy and originates from neural crest cells of the adrenal gland medulla or sympathetic glia. We report an unusual case of congenital poorly differentiated neuroblastoma with multiple metastases in the brain and cerebellum. The biophysical profile showed a prominent polyhydramnios at 25.3 weeks of gestation; meantime, the mother was diagnosed with gestational diabetes. The mass was detected during the third ultrasonographic examination at 31.4 weeks of gestation. The fetus lived only one day after birth and the postmortem examinations were performed subsequently. An autopsy was performed both to unders…
Attività clinica : colpa medica e responsabilità professionale
Psychological and medico-legal perspectives on electroconvulsive therapy and patient-centered care: A short review of cross-cutting issues
Electroconvulsive therapy is a treatment that, since its first administration, has been a major topic for debate within the scientific world. In recent years, the debate has become increasingly focused on the short- and/or long-term efficacy of electroconvulsive therapy, its appropriateness in clinical settings, its mechanism of action, the impact evaluation of transient and/or persistent adverse effects, and the drafting of international guidelines,etc.From the authors’ point of view, these themes are inevitably crossed by three other fundamental issues of significant psychological, relational, ethical, and medico-legal impact. Still, they are less studied than purely biomedical issues in …
Gli strumenti di valutazione delle difficoltà persistenti a svolgere i compiti e le funzioni dell'età nel minore
La valutazione del minore in ambito previdenziale ed assistenziale richiede una adeguato apporto multidisciplinare ed approccio interdisciplinare, di ordine clinico e psico-sociale; gli strumenti operativi di cui la scienza medica può dotarsi sono molteplici, ma nel contesto medico legale è soprattutto la valutazione secondo le direttive dell’Organizzazione Mondiale della sanità, nella recente codifica ICF (Classificazione Internazionale del Funzionamento, della Disabilità e della salute, Erikson ed.2001) nella versione YC, a fornire gli odierni strumenti di valutazione a supporto delle Commissioni Medico Legali.
Lethal Traumatic Injuries due to Traffic Accidents
The Global status report on road safety published by the World Health Organization (WHO) in 2015 estimating information from 180 countries indicates that worldwide the total number of road traffic deaths has plateaued at 1.25 million per year. This report, the third Global status report on road safety, shows that low- and middle-income countries are more affected with a mortality rate of 90% of global road traffic deaths.
Useful Evidence by Post-Mortem CT and Stereomicroscopy in Bone Injury: A Case Series from Forensic Practice
The investigation of bone injuries is an essential topic in forensics. We sometimes have to deal with charred or dismembered human remains that have lost soft tissue, making it difficult to diagnose the mechanisms of injury that led to death. Our contribution aims to share with the scientific community how we approached two cases of very different bone injuries and the techniques used to differentiate relevant pathology findings of bone fragments. Two cases are analyzed from the case history of the forensic medicine institute of Palermo. PMCT made it possible to differentiate heat bone lesions from traumatic lesions. The stereomicroscope was superior to PMCT in being able to better characte…
Violence against women in heterosexual couples: A review of psychological and medico-legal considerations.
Intimate partner violence against women (IPVAW) is the most pervasive violation of women’s rights worldwide, causing devastating lifelong damage. Victims can suffer physical, emotional or mental health problems, and experience detrimental effects in social, psychological and relational health with their families, especially children. Due to the complexity regarding violence against women in heterosexual couples, it is important to make a clear distinction between psychological and physical mistreatment, which also includes psychological violence. This differentiation is important in determining different emotional and psychological aspects of mistreatment in order to understand the reasons …
Malpractice medica. Un osservatorio per una prevenzione. Atti delle prime giornate di studio del GISDI. Napoli 12-13 marzo 2004
Guidelines and Current Assessment of Health Care Responsibility in Italy
Stefania Zerbo, Ginevra Malta, Antonina Argo Department of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, Legal Medicine Section, University of Palermo, Palermo, ItalyCorrespondence: Stefania ZerboDepartment of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, Legal Medicine Section, University of Palermo, via del Vespro N. 129, Palermo 90127, ItalyTel +39 33 3725 0209Fax +39 09 1655 3203Email stefania.zerbo@unipa.itAbstract: Clinical guidelines are a potential tool for improving the effectiveness and quality of healthcare, decreasing variability in clinical practice, and preventing adverse events. In the…
Dentistry and Drug Adverse Events: Between Responsibilities and Regulations
The purpose of this paper is to renew interest and attention to the medical history, prescription, and/or use of drugs during dental practice. The work analyzes the issue of the use of drugs in dentistry from both a clinical and a medical–legal point of view. The laws governing the matter were also taken into consideration, relating them to the roles of prescriber and user that the dentist can acquire. Analysis of various aspects of this matter demonstrates that it is necessary for dentists to know the drugs and medical substances, their characteristics and properties, related effects, and interactions in order to use them appropriately and adequately. Knowledge of interferences, reac…
Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims
Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims. Sexual assault is a worldwide problem that has not yet been sufficiently acknowledged, as confirmed by analyses and studies carried out at different levels and in different contexts. Internationally, different approaches are taken to the collection of forensic evi- dence and to the clinical and psychological treatment of alleged victims. Italian law n.96, 1996, foreseeing norms regarding rape and abuse, finally gave signifi- cant relevance to sex crimes. In 2004, the European Commission for Justice Internal Affairs and Social Politics promoted the Daphne II pro- gram to support victims of rape and abu…
Preventable fatal injury during rally race: a multidisciplinary approach
Abstract Introduction The motor vehicle crash (MVC) constitutes an important challenge for forensic pathology in order to identify the manner and cause of death. Our study focuses on a fatal accident during a rally race corresponding to MVC sub-category. Materials and method Postmortem computed tomography (PMCT) was performed before the conventional autopsy. Autoptic and PMCT data were compared. Data collection allowed analyzing biomechanical dynamics of the incident and post-traumatic injuries through qualitative-statistics and solicitation quantitative indices. Results Photo and circumstantial evidence analysis showed a wrong installation of double shoulder belt system of head and neck su…
Rischio clinico e sistemi di Incident Reporting a confronto: critesi ed ipotesi di miglioramento, quando funzionano e perché falliscono
gli Autori individuano alcune criticità del sistema di incident reporting attraverso un'analisi retrospettiva di esperienze nazionali ed internazionali, e, a conclusione, descrivono alcune possibili vie percorribili per il miglioramento del sistema.
Postmortem Imaging in Mass Disasters
The term “mass casualty” in the forensic field refers to a sudden tragic event involving a large number of people; such an event determines the need to perform a large number of autopsy exams, possibly in a short time. Mass casualties tend to involve emergencies that are unexpected and result in stressful situation when even those with no or scarce interest or experience could be called to play a role. Radiology could be helpful in the task of identifying victims, in cooperation with a multidisciplinary team, usually headed by a forensic specialist.
La casistica di responsabilità professionale in ambito nefro-urologico esaminata alla luce dei principi di Clinical Risk Management
Intrauterine and Neonatal Exposure to Opioids: Toxicological, Clinical, and Medico-Legal Issues
Opioids have a rapid transplacental passage (i.e., less than 60 min); furthermore, symptoms characterize the maternal and fetal withdrawal syndrome. Opioid withdrawal significantly impacts the fetus, inducing worse outcomes and a risk of mortality. Moreover, neonatal abstinence syndrome (NAS) follows the delivery, lasts up to 10 weeks, and requires intensive management. Therefore, the prevention and adequate management of NAS are relevant public health issues. This review aims to summarize the most updated evidence in the literature regarding toxicological, clinical, and forensic issues of intrauterine exposure to opioids to provide a multidisciplinary, evidence-based approach for managing …
Myocardial bridge pathology and preventable accidents during physical activity of healthy subjects: A case report and a literature review.
Myocardial bridging is a congenital coronary pathology described as a segment of coronary artery which courses through the myocardial wall under the muscle bridge. Although the prognosis of myocardial bridging is benign, sports medicine recognises myocardial bridging as a leading cause of sudden death among young basketball, football and soccer players. The authors report a case of a 42-year-old man who collapsed while playing football. He died notwithstanding prompt medical assistance and cardiopulmonary resuscitation. At autopsy, gross examination of the heart revealed the intramural course of the left anterior descending coronary artery to be 2 cm from its coronary ostial origin. Histol…
Role of post mortem computed tomography in diagnosis of upper cervical fractures in child due to road accident: A case report and literature review
The upper cervical spine has unique anatomical features that distinguish it from the remainder of the cervical spine. Its motion segments make up a large amount of total cervical spine motion and, as a result,predispose it to a unique set of injuries. Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to section of the spinal cord. The use of post mortem CT (PMCT), and the subsequent multi-planar and volume rendering reconstruction techniques can provide non-invasive, objective operator-independent imaging data set that may be further reviewed by other specialists. and can substantially add to forensic examinations of the skeleton, especial…
Informatica, web e telemedicina
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…
Definizione di una mappa del rischio della specialità urologica
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…
Overdose of Quetiapine—A Case Report with QT Prolongation
Quetiapine is an atypical antipsychotic drug used to treat bipolar disorder, schizophrenia, and major depressive disorder. Although several studies describe the adverse effects of intoxication with Quetiapine, only a few report an extreme overdose without comedications that lead to a life threat. We present a case of a 75-year-old male who tried to attempt suicide by ingesting 28 g of Quetiapine. During the management in the emergency department, both serum and urine samples were collected, allowing a complete pharmacokinetic analysis to be conducted, from the admission to the discharge.
Consenso informato
Homicide with post mortem dismemberment of the victim with previous amputation of right lower limb: Case report and review of the literature
The dismemberment of a corpse is comparatively rare in forensic medicine and usually performed with different types of sharp tools. The victim is always the victim of a homicide. Dismemberment usually occurs where the killing took place without prior planning by the perpetrator. We report a case of homicide with post mortem mutilation of the victim’s body with previous amputation of right lower limb in which the perpetrator was not identified. At autopsy, several fractures were detected on the cranial vault, and the cause of death was due to skull and brain injuries from multiple blunt force traumas.
A Fatal Case of a Paint Thinner Ingestion: Comparison Between Toxicological and Histological Findings
MATERNAL EXPOSURE TO STRESSFUL/TRAUMATIC EVENTS AND AUTISM SPECTRUM DISORDERS IN OFFSPRING: PRELIMINARY FINDINGS OF A CASE CONTROL PILOT STUDY.
The correlation between maternal exposure to stressful and traumatic events during pregnancy and autism spectrum disorder (ASD) in offspring has been studied in the literature. Fewer studies, however, have considered the mother's exposure to traumatic events during childhood. This work focuses on maternal exposure to these events in childhood and/or adulthood, relating it to autism spectrum disorder in offspring. A questionnaire was used to assess whether and to what type of event the mothers have been exposed, and to assess eventual peri-traumatic dissociation related to the traumatic event. The mothers involved in this study were recruited at the Child Neuropsychiatry Outpatient Clinic of…