Publications by authors named "Stefania Zerbo"

27 Publications

  • Page 1 of 1

Spontaneous extrusion of male genital pearling.

Urol Case Rep 2021 Sep 23;38:101728. Epub 2021 May 23.

Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy.

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.
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http://dx.doi.org/10.1016/j.eucr.2021.101728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167157PMC
September 2021

Cardiovascular Implantable Electronic Device Infection and New Insights About Correlation Between Pro-inflammatory Markers and Heart Failure: A Systematic Literature Review and Meta-Analysis.

Front Cardiovasc Med 2021 3;8:602275. Epub 2021 May 3.

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, Palermo, Italy.

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. 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 extraction; and correlation between alteration of hematological parameters and poor prognosis analysis. Epidemiological analysis confirmed high prevalence of male sex, staphylococcal infection, and coagulase-negative staphylococci (CoNS). The most common comorbidity was heart failure. Complete removal of CIED and antimicrobial therapy combination are the gold standard. CIED replacement was associated with higher survival. High preoperative white blood cell count and C-reactive protein levels increased the risk of right ventricular failure (RVF) development. Increased red blood cell distribution width (RDW) value or decreased platelet count was correlated with poor prognosis. No correlation was noted between preoperative leukocytosis and CIED infection. A relevant correlation between leukocytosis and RVF was observed. Heart failure may be related to high RDW values and decreased platelet count. Data on the correlation between hematological parameter alteration and poor prognosis are missing in many studies because of delayed implantation in patients showing signs of infection.
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http://dx.doi.org/10.3389/fcvm.2021.602275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126630PMC
May 2021

Violence against women in heterosexual couples: A review of psychological and medico-legal considerations.

Med Sci Law 2021 Jan;61(1_suppl):113-124

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties - Medico Legal Section, University of Palermo, Italy.

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 why some women stay in such relationships and to explain the personality profiles of victims and perpetrators. In this short narrative review, we have combined perspectives of depth psychology and attachment theory from studies on trauma, traumatic bonds and the perpetrator/victim complex in gender violence. We have also considered the growing literature on IPVAW as it relates to the medico-legal field. Our search strategy included intimate partner violence, attachment styles, risk factors and the victim/perpetrator relationship. Distinguishing the different types of IPVAW is a necessary step in understanding the complexity, causes, correlations and consequences of this issue. Above all, it enables the implementation of effective prevention and intervention strategies.
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http://dx.doi.org/10.1177/0025802420936081DOI Listing
January 2021

Preventable fatal injury during rally race: a multidisciplinary approach.

Int J Legal Med 2021 May 25;135(3):893-901. Epub 2020 Nov 25.

Radiology Section, DIBIMED, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.

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 support (HANS) collar. PMTC clearly highlighted multiple and bilateral fractures involving roof and base of skull; a displaced fracture of the right acetabulum was also encountered. Autopsy confirmed PMCT data and revealed a brainstem laceration. AIS (Abbreviated Injury Scale) achieved a maximum score in consideration of fatal injuries.

Discussion: The injuries analysis resulting from photographic surveys examination, conventional autopsy, and PMCT has led us to confirm a fatal front collision with a tree trunk. Head trauma represents a major injury in the present case. In this case, head injuries, related to whiplash trauma, are a consequence of a double shoulder belt system (HANS collar component) wrong installation.

Conclusion: MVC and especially high-speed motor racing represent an important death cause. There was, for this reason, a marked development of cars and occupants' safety systems, such as HANS collar. PMCT improves the diagnostic performance of conventional autopsy and increases forensic medical knowledge related to traumatic injuries.
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http://dx.doi.org/10.1007/s00414-020-02470-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036227PMC
May 2021

The medico-legal implications in medical malpractice claims during Covid-19 pandemic: Increase or trend reversal?

Med Leg J 2020 Nov 10;88(1_suppl):35-37. Epub 2020 Jun 10.

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, Palermo, Italy.

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 they want to extend the concept of "gross negligence" to healthcare facilities. Several Extended Care Units have suffered from outbreaks of Covid-19, so the Prosecutor's Office of several cities initiated investigations against them. This situation has reached Sicily, where the Prosecutor's Office of Palermo has opened an inquiry against an Extended Care Unit. Simultaneously, the Covid-19 pandemic may change patients' attitudes towards healthcare professionals, who are risking their lives daily. So the Italian medico-legal community is debating these questions, with one last pending question remaining: is the number of medico-legal claims likely to increase or trend down?
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http://dx.doi.org/10.1177/0025817220926925DOI Listing
November 2020

Telemedicine during Covid-19 pandemic: Advantage or critical issue?

Med Leg J 2020 Jul 3;88(2):76-77. Epub 2020 Jun 3.

Department of Health Promotion, Maternal and Child Care, "G. D'Alessandro", Legal Medicine Section, University of Palermo, Palermo, Italy.

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-legal sudden natural death investigations and dealing with the Public Prosecutor's office of Palermo. Even after the Covid-19 emergency, telemedicine will be essential to streamline outpatient visits, while at the same time limiting costs, with significant benefits for the Italian National Public Health Service budget. In conclusion, telemedicine can offer a valuable support to the doctor's activity by streamlining and facilitating their work. In this sense, the Covid-19 pandemic represents a positive input for the acceleration and enhancement of these tools.
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http://dx.doi.org/10.1177/0025817220926926DOI Listing
July 2020

Myocardial bridge pathology and preventable accidents during physical activity of healthy subjects: A case report and a literature review.

Med Leg J 2020 Dec 21;88(4):209-214. Epub 2020 May 21.

Department Pro.Mi.Se, Legal Medicine, School of Medicine, University of Palermo, Palermo, Italy.

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. Histological examination of ventricular septal and left myocardium showed early signs of ischaemic injury without disease of small coronary vessels and hypertrophic cardiomyopathy. The cause of the death was due to malignant ventricular arrhythmia during intense physical activity.
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http://dx.doi.org/10.1177/0025817220923638DOI Listing
December 2020

Covid-19: A new challenge for forensic medicine.

Med Leg J 2020 07 21;88(2):104-105. Epub 2020 May 21.

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, Palermo, Italy.

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http://dx.doi.org/10.1177/0025817220923696DOI Listing
July 2020

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

Med Leg J 2020 Jul 18;88(2):84-86. Epub 2020 May 18.

Section Legal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, Italy.

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.
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http://dx.doi.org/10.1177/0025817220923698DOI Listing
July 2020

The risk of the 'prison-emptying' effect in Italy due to the Covid-19 pandemic.

Med Leg J 2020 07 15;88(2):103-104. Epub 2020 May 15.

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, Palermo, Italy.

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http://dx.doi.org/10.1177/0025817220923697DOI Listing
July 2020

A novel LC-MS/MS analytical method for detection of articaine and mepivacaine in blood and its application to a preliminary pharmacokinetic study.

J Pharm Biomed Anal 2020 Aug 29;187:113335. Epub 2020 Apr 29.

U.R.I.To.N - Unit of Research of University of Florence, Florence, Italy; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. Electronic address:

Local anaesthetics (LAs) are commonly used in surgery, especially in dentistry. They cause a transitory inhibition of nerve signal due to the blockade of the voltage-gated sodium channels. LAs are administrated alone or with vasoconstriction agents, such as adrenaline. Toxicity of LAs is associated to neurological and cardiovascular alterations. Tachycardia, arrhythmia, tremors, tonic-clonic seizure and respiratory depression (at high doses) are the main symptoms of intoxication by LAs. Lidocaine, articaine and mepivacaine are among the most used anaesthetics. This study aimed to fully validated a new method for the simultaneous detection of articaine and mepivacaine in whole blood. Sample treatment consisted in a liquid-liquid extraction with phosphate buffer (pH 8, 0.1 M) and ethyl-acetate. Analysis was performed by liquid chromatography-tandem mass spectrometry in multiple reaction monitoring mode (transitions: articaine, 285→8658 m/z; mepivacaine, 247→9870 m/z; lidocaine - internal standard -, 235→8658 m/z). The method proved to be highly sensitive with limit of quantifications for articaine and mepivacaine of 0.8 and 0.1 ng/mL, respectively. Accuracy and precision were always within the acceptance criteria. The new procedure was also successfully applied to a preliminary pharmacokinetics study.
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http://dx.doi.org/10.1016/j.jpba.2020.113335DOI Listing
August 2020

Guidelines and Current Assessment of Health Care Responsibility in Italy.

Risk Manag Healthc Policy 2020 10;13:183-189. Epub 2020 Mar 10.

Department of Health Promotion, Maternal and Child Care, "G. D'Alessandro", Legal Medicine Section, University of Palermo, Palermo, Italy.

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 purview of Law no. 24/2017, adherence to national guidelines can lead to a reduction in medical malpractice claims and the practice of so-called "defensive medicine". The law has assigned a central role to the guidelines, establishing the National Institute of Health through the new Italian National Center for Clinical Excellence, Quality, and Security (CNEC) as the methodological guarantor in the process of national guideline development. Here we discuss the issue of professional liability as recently outlined by the Gelli-Bianco Law (no. 24/2017), taking into account the clinical significance and medicolegal value of the guidelines.
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http://dx.doi.org/10.2147/RMHP.S238353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073368PMC
March 2020

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

Med Leg J 2020 Mar 18;88(1):37-40. Epub 2019 Dec 18.

Department PROMISE - Medico Legal Section, University of Palermo, Palermo, Italy.

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http://dx.doi.org/10.1177/0025817219882169DOI Listing
March 2020

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

Forensic Sci Int 2019 Jul 1;300:e4-e8. Epub 2019 May 1.

Department "G.F. Ingrassia", University of Catania, Catania, Italy.

Hydrogen sulphide (HS) 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 HS detection does not allow to discriminate if it is related to inhalation or to putrefactive processes, the determination of thiosulphate, HS main metabolite, is decisive. The succession of fatal events reported here can be rebuilt by toxicological data interpretation: the subject 1 died after a longer interval of time as demonstrated by the highest blood and urine thiosulfate concentrations; the subject 2 died after a short interval of time as showed by a lower blood and urine thiosulfate concentrations than subject 1; the subject 3 died almost immediately after HS inhalation since he showed the lowest blood thiosulfate concentration, and no trace of sulphide and thiosulfate was found in the urine.
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http://dx.doi.org/10.1016/j.forsciint.2019.04.026DOI Listing
July 2019

Virtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging.

Semin Ultrasound CT MR 2019 Feb 27;40(1):67-78. Epub 2018 Oct 27.

Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy.

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 disasters.
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http://dx.doi.org/10.1053/j.sult.2018.10.013DOI Listing
February 2019

Role of Imaging in the Assessment of Age Estimation.

Semin Ultrasound CT MR 2019 Feb 28;40(1):51-55. Epub 2018 Oct 28.

Department of Biopathology and Medical Biotechnologies (Di.Bi.Med) University of Palermo, Palermo, Italy.

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.
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http://dx.doi.org/10.1053/j.sult.2018.10.010DOI Listing
February 2019

Forensic microbiology applications: A systematic review.

Leg Med (Tokyo) 2019 Feb 3;36:73-80. Epub 2018 Nov 3.

Legal Medicine Section - Department for Health Promotion and Mother-Child Care, University of Palermo, Via del Vespro, 129, 90127, Italy. Electronic address:

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 of microbiological investigations carried out on internal organs and fluids. To this end, a total of 19 studies have been sistematically reviewed, each one chosen according to specific inclusion/exclusion criteria. The selected studies assess the contribution of contamination, postmortem transmigration and agonal spread to microbial isolation from dead body samples, and shed light on the role of postmortem microbiological investigations in several forensic fields, such as cause of death or PMI determination.
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http://dx.doi.org/10.1016/j.legalmed.2018.11.002DOI Listing
February 2019

Self-inflicted long bone fractures for insurance fraud.

Int J Legal Med 2019 Jul 26;133(4):1083-1088. Epub 2018 Jun 26.

Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Via del Vespro, 90100, Palermo, Italy.

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 define a possible mechanism of these types of injuries.
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http://dx.doi.org/10.1007/s00414-018-1884-7DOI Listing
July 2019

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

Med Leg J 2018 Jun 5;86(2):89-93. Epub 2018 Jan 5.

3 Legal Medicine Section, Department for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy.

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 current flow were also highlighted by perforations of endothelial surface of a pulmonary artery using scanning electron microscope, and all the results were analysed by the main tools suggested in the literature.
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http://dx.doi.org/10.1177/0025817217749503DOI Listing
June 2018

A possible biomarker for methadone related deaths.

J Forensic Leg Med 2017 Jul 3;49:8-14. Epub 2017 May 3.

MD, FFFLM, FFSSoc, Berkeley, CA 94705, United States.

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 cell death, either necrotic or apoptotic, within the TS of humans is more common in deaths due directly to MTH toxicity than with in the solitary tract itself.

Design, Setting, Participants: This was a single cohort study of MTH related decedents autopsied at a large university hospital. Each decedent had a recent history of non medical/illicit MTH use and had been pronounced dead in the field, prior to ever reaching the hospital. Complete autopsy and complete toxicology testing were performed on the formalin fixed brains of each individual. Multiple blocks were prepared of the area of interest, namely the tissue lying immediately between the inferior and the super colliculi. This volume, by definition, would have included the area of the Rostral Ventrolateral Medulla (RVLM), the location of the TS. Immunohistochemistry studies utilizing caspase-9 reaction (a protease enzyme involved in the process of preprogrammed death) were performed in order to estimate the degree and proportion of neuronal apoptosis, and also access the degree of classical necrosis within the NTS.

Main Outcomes And Measures: The primary outcome measure was the presence or absence of neuronal apoptosis and/or necrosis within the NTS.

Results: Cells displaying evidence of early apoptosis and advanced apoptosis, consisting primarily of nuclear fragmentation, admixed with other neurons displaying the features of classic necrosis were found. Evidence of classic necrosis was identifiable in most of the controls, though minor degrees of apoptosis were identifiable with Caspase staining and quantitative image analysis of immunohistochemical stains.

Conclusions: and Relevance: Our study shows that neurons, primarily along the TS, but occasionally in other cell nuclei (even controls) are vulnerable, both to direct MTH toxicity (via apoptosis) and indirectly (via hypoxia leading to classical cell necrosis). When MTH is found to be present in significant concentrations, but apoptotic lesions are absent, it would be reasonable to assume that MTH was not primarily the cause of cardiorespiratory arrest.
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http://dx.doi.org/10.1016/j.jflm.2017.05.010DOI Listing
July 2017

Role of virtopsy in the post-mortem diagnosis of drowning.

Radiol Med 2015 Mar 11;120(3):304-8. Epub 2014 Jul 11.

Department of Radiology, DIBIMEF, University Hospital P. Giaccone, University of Palermo, Via del Vespro, 129, 90127, Palermo, PA, Italy.

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.

Results: All the cadavers showed fluid in the airways and patchy ground-glass opacities in the lung. Only one patient had no fluid in the digestive tract; this patient had a left parietal bone fracture with a large gap and other multiple bone fractures (nose, clavicle, first rib and patella). One of the three patients who had fluid in the digestive tract had no fluid in the paranasal sinuses. This latter patient showed cerebral oedema with subarachnoid and intraventricular haemorrhage, multiple bone fractures (orbital floor, ribs, sacrum and acetabular edge) and air in the heart, in the aorta and in bowel loops.

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 that it allows us to understand if the victim was alive or dead when he entered the water and if the cause of death was drowning.
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http://dx.doi.org/10.1007/s11547-014-0438-4DOI Listing
March 2015

A fatal case of a paint thinner ingestion: comparison between toxicological and histological findings.

Am J Forensic Med Pathol 2010 Jun;31(2):186-91

Department of Biotechnology and Legal Medicine, University of Palermo, Palermo, Italy.

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 brain, liver, lungs, and body fat and also in central nervous system. The available studies indicate that xylenes are rapidly absorbed independently from the kind of exposition. We illustrate a fatal case of self-poisoning by ingestion of varnishes diluting solvents, reporting the identification and quantification of volatile organic compounds (toluene, o-m-p xylene) from human biologic liquids and viscera samples using the Solid-Phase Microextraction-Headspace-Gas Chromatography/Mass Spectrometry to toxicological analysis, and the histopathological findings evaluated in liver, kidney, and lungs.
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http://dx.doi.org/10.1097/PAF.0b013e3181c6c11fDOI Listing
June 2010

Lethal rupture of post-traumatic aneurysm of the vertebral artery case report.

J Forensic Leg Med 2009 Apr 30;16(3):168-71. Epub 2008 Oct 30.

University of Palermo, Department of Legal Medicine, Via del Vespro 127, 90129 Palermo, Italy.

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.
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http://dx.doi.org/10.1016/j.jflm.2008.07.011DOI Listing
April 2009

Sudden death in adolescence caused by cardiac haemangioma.

J Forensic Leg Med 2009 Apr 25;16(3):156-8. Epub 2008 Oct 25.

Department of Legal Medicine, Via Del Vespro, 127, 90129 Palermo, Italy.

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 and arteriolar hemangioma, a very rare type of primary tumor in adolescents.
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http://dx.doi.org/10.1016/j.jflm.2008.08.020DOI Listing
April 2009

Cervical necrotizing fasciitis and descending necrotizing mediastinitis in a patient affected by neglected peritonsillar abscess: a case of medical negligence.

J Forensic Leg Med 2008 Aug 18;15(6):391-4. Epub 2008 Mar 18.

Department of Legal Medicine, University of Palermo, Via Del Vespro, 127-90129 Palermo, Italy.

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 professional malpractice chargeable to doctors.
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http://dx.doi.org/10.1016/j.jflm.2007.12.008DOI Listing
August 2008

Post-traumatic lethal carotid-cavernous fistula.

J Forensic Leg Med 2008 May 23;15(4):266-8. Epub 2007 Oct 23.

University of Palermo, Department of Legal Medicine, Via del Vespro, 127, 90129 Palermo, Italy.

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.
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http://dx.doi.org/10.1016/j.jflm.2007.07.004DOI Listing
May 2008