Search

L’attività del Chirurgo deve svolgersi tra gli intricati binari dei doveri e dei divieti stabiliti dalle varie norme penali, civili e quelle derivanti dai codici deontologici, oltre che dai codici di comportamento aziendali. Quando si incorre in una violazione delle regole si è chiamati a risponderne. La responsabilità nasce dal mancato adempimento dei doveri, salvo che sia provata l’impossibilità di tale adempimento per fattori inevitabili: in generale, le aspettative (non di rado, le pretese) dell’utenza sono accresciute nel tempo, molto di più di quanto la Sanità sia spesso in grado di offrire e di garantire. Con il progredire delle conoscenze e delle competenze sanitarie è aumentata l’insoddisfazione verso le prestazioni ricevute: infatti più attività si è chiamati a svolgere, più aumenta la probabilità di cadere in errore e, più alternative vi sono, più cresce il rischio di non scegliere quella più appropriata e di venire poi chiamati a rispondere della scelta adottata. I Chirurghi sono oggi chiamati sempre più a prendere coscienza di questa problematica e ad affrontarla con lucida fermezza. Questo libro offre una sezione generale, dedicata all’analisi dei vari principi e delle plurime regole della responsabilità professionale sanitaria, con i richiami di legge e dell’alta giurisprudenza, e una sezione speciale, con numerosi casi-tipo peritali chirurgici, formulati ad hoc sull’esperienza maturata nel corso degli anni di concreta pratica professionale nell’ambito del contenzioso sanitario. L’opera, in definitiva, si propone di venir in aiuto ai Colleghi per affrontare i problemi della responsabilità professionale, con qualche timore in meno e qualche conoscenza in più.

Introduzione e Scopo L’attività di prostituzione è ad alto rischio di violenza e i delitti correlati, sono difficili da indagare e molti di essi restano irrisolti [1]. Abbiamo condotto uno studio retrospettivo in 24 anni sugli omicidi occorsi a Milano in questa popolazione, documentandone le caratteristiche delittuose. Materiali e Metodi Da 23417 autopsie eseguite nell’intervallo di tempo considerato presso la Sezione di Medicina Legale dell’Università degli Studi di Milano, abbiamo estrapolato quelle che avevano per vittima una donna notoriamente dedita all’attività di prostituzione o, i cui dati circostanziali di rinvenimento giudiziario, ponessero fondati motivi di sospetto. Risultati e Discussione Nei 24 anni considerati, sono state uccise 71 prostitute che hanno rappresentato il 9% del totale degli 802 omicidi generali riguardanti vittime appartenenti ad ambo i sessi e il 29% dei 245 omicidi che hanno avuto per vittime le sole donne. Le prostitute, dopo avere subito violenze sessuali e fisiche, sono state uccise, prevalentemente, da clienti, protettori e spacciatori di droga a mezzo di armi da punta e taglio con cui le hanno attinte a capo e collo. Conclusioni Le donne dedite all’attività di prostituzione risultano particolarmente vulnerabili ed esercitano la professione in condizioni di gravi carenze preventive: la categoria si colloca in un quadro di violenza generale che fa da sfondo alle donne di tutto il Mondo. Bibliografia 1 Carchedi F et al. Casa editrice Ediesse, Roma, 2008.

Postpartum haemorrhage (PPH) is one of the main causes of mortality and severe maternal morbidity and its incidence is increasing also in Western countries. Aim of this study is to estimate the incidence and the trend of PPH in the Umbrian population using the validated Umbrian health database and to identify possible determinants for the development of PPH.The source of the data was the regional Healthcare Database of the Umbria Region. The population of interest was represented by women who gave birth in Umbria between 2006 and 2017. The PPH was identified from the hospital data using the ICD-9-CM 666.x codes. Demographic data, principal and secondary diagnoses and data on maternal morbidity and blood component transfusion were collected. The incidence of PPH was calculated taking into account cases of PPH over the total number of births. The determinants of PPH, the associated morbidity and the variation in the severity of the PPH over time have been identified by logistic regression models.In Umbria, between 2006 and 2017, 93,403 births were registered (69% by vaginal delivery and 31% by caesarean section) and the rate of caesarean sections decreased by about 4%. The incidence of PPH increased three-fold during this period with an increase (p0.001) of women with PPH who received transfusions. Regarding the caesarean sections, the PPH trend increased by 53% (p=0.3), while in the vaginal deliveries the PPHs increased by 233% (p0.001). Logistic regression analysis showed that possible risk factors for the occurrence of PPH are maternal morbidity (OR 22.8, 95% CI 18.5-30.0), twin birth (OR 2.0, 95% CI 1.3-3.2) and antepartum haemorrhage (OR 5.7, 95% CI 3.1-10.4).The incidence of PPH has increased in recent years, while the morbidity associated with PPH has remained substantially unchanged. The study identified several risk factors responsible for PPH that can be used in the monitoring of pregnant women and for planning prevention strategies such as Patient Blood Management.

The Authors analyze a case oof encephalitis characterized by a psycho-organic syndrome with deficits in memory, related with a Muscoril infiltration in a patient with lumbar herpetic neuropathy. Comparing this case with other similar cases of toxic encephalitis related to muscoril administration, the Authors find out that, in the present case, the pharmachological administration was improper.

The so called “Samaritan donation” is meant as non-directed altruistic donation, where the donor does not choose the recipient. It’s an uncommon practice in Italy, as in many over other countries. An critical hesitation to develop these type of transplantation programs is the fear of incentivize the recruitment of disadvantaged people to provide organs for paying recipients; another are doubts related to motivations (possible psychiatric or psychological illness). All Sa- maritan donors should be always carefully assessed by an independent Authority, to make sure the donor knows and understands what is involved, is not under any pressure to donate and is giving consent freely and voluntarily. Samaritan donation should not be intended as an alterna- tive to after-death-donation, but its exceptionality should contribute toward increasing aware- ness of people and the amount of after-death-donations.

The Authors present a review of rulings on the subject of transsexualism. They also illustrate some bills, with comparative notes. The desire to break free from the obligation of genital surgi- cal treatments emerges from the analysis of judgements. At the same time, the pathological con- notation of transsexualism is currently challenged on the scienti c front. If one day the opportu- nity to change the name and gender should be made independent from the surgical treatments, psychiatric forensic investigations will become even more relevant. At the same time, the loss of pathological connotation could endanger the guarantee of health care.

Nowadays the anatomic dissection is scientifically in decline. Neverthless in some Countries this procedure is undergoing a rebirth as a teaching tool for the School of Medecine. The mail interes is moving from simple learning of human anatomy to deontology and ethic training. Through this experience, medical students and future doctors should develop a deep respect with cadavers and then with patients. The tight relation between cadavers and end-users should be more considered then in the past. Authors provide a legislative and comparative analysis of this topic with a conclusive synthesis of their experience in the Institute of Legal Medecine in Milan.

The paper was intended as short review of historical and current behaviours of abandonment of infants and children. The analysis was developed through a long journey that starts from the dawn of civilization to this day. Social customs, legal rules, they application and their breach through the centuries are described. The purpose was to know how and why this phenomenon is unfortunately still present. A survey was conducted classifying stories reported by the main Italian daily newspaper. The study examined a period of 15 years (1995-2010). Data showed that this crime is still today undoubtedly closely related to social and economic conditions, especially in high populated regions. © Pensa MultiMedia Editore.

The Authors present brief review on the development of nursing triage and its current application. A detailed assestement of the relevant normative is given. Some rare judgment and case reports are presented. The Authors autline tho most sensitive aspects of the activity of the triage nurse, and analyse hypothesis of professional liability.

The cause of intraparenchimal cerebral haemorrhage can be difficult to assess, especially if information on the anamnesis and/or circumstances are missing or dubious. Difficulties may arise when the subject suffered an accident and clinicopathological investigations show a source of bleeding which seems apparently natural, otherwise, no story of trauma and investigations show findings which are unusual for natural haemorrhage. The authors present a review of the available literature as well as an analysis of four cases.

The Authors describe the story of a patient with rheumatoid arthritis being treated with weekly intramuscular low dose methotrexate, who developed a multifocal leukoencephalopathy, with significant neurological syndrome. The complication was related to drug administration only belatedly, which was suspended with stabilization of the clinical picture. Literature was reviewed.

Gli Autori segnalano un caso di osservazione personale relativo ad osteonecrosi avascolare dell’osso mascellare intervenuta in soggetto in terapia con bifosfonati post-estrazione dentaria. Dopo revisione della letteratura in merito ai fattori di rischio e all’eziopatogenesi delle complicanze correlate all’assunzione dei suddetti farmaci nonché analisi delle linee di comportamento da assumere in pazienti in terapia cronica con bifosfonati onde evitare complicanze osteonecrotiche gli Autori discutono degli aspetti di responsabilità professionale medica, con particolare riferimento alle complicanze insorte in soggetti sottoposti a trattamenti odontoiatrici.

Death by sodium chlorate poisoning is infrequently reported in recent forensic literature. The Authors report here a case of poisoning in a 28-year old man, who ingested a high dose of her- bicide in order to suicide. He was rapidly admitted to intensive care, but despite this, he had several cardiac arrests and refractory metabolic acidosis. He died 21 hours after his admission. A forensic autopsy was performed on the instruction of the Legal Authorities, with toxicological and full histological examination. After an examination of literature, the Authors describe path- ological and histopathological findings, with reflections on the role and the value of histology in lethal sodium chlorate poisoning diagnosis.

The acute compartment syndrome are pathological conditions with various etiology, characterized by increased pressure within one or more closed body spaces, fascial or osteo-fascial, with compromised perfusion and function of tissues in those spaces. These conditions, if not properly and promptly treated, lead to ischemia and necrosis, with fibrous tissue replacing of affected structures and inevitable functional damage. Only a timely treatment, carried out immediately, may prevent or limit the consequences of ischemic damage and, therefore, not infrequently these events lead to legal dispute with hypothesis of inadequate or late diagnosis and/or treatment. Starting from ten cases of personal observation and after an examination of literature, the authors have tried to highlight the possible existence of medical professional liability, with reflections on the assessment of personal damage.

Il fenomeno del "body packing" è ampiamente affrontato e discusso nella letteratura medica italiana, ma prevalentemente in quella di stampo clinico e chirurgico, mentre poco numerosa è la segnalazione di eventi letali nella letteratura medico legale soprattutto dell’ultimo decennio, con il rischio che venga sottovalutata una problematica sociale che è invece sempre più di attualità. Anche per questo motivo si è ritenuto opportuno segnalare il caso giunto alla nostra attenzione, da cui si è preso spunto per procedere con una ampia revisione della letteratura di merito. Sono state analizzate le caratteristiche strutturali degli ovuli, le possibili complicanze connesse al loro trasporto intracorporeo, le tecniche di indagine diagnostica sul vivente e soprattutto quelle utilizzate in ambito patologico forense.

Alternative or non-conventional medicine are terms covering a variety of treatments, some going back centuries, which use methodologies different to those sanctioned by "official" medicine. After having been shunned by conventional medicine for a long period, these practices have attracted growing demand by the western public in recent decades. Their spread, however, is conditioned by an istorical context,characterised by the enduring silence imposed by "official" medicine, and their application has mainly been throug non-medical practitioners. The atmosphere of confusion surrounding the practice of non-conventional medicine has inevitabily attracted the attention of the scientific community, as well as national and international disciplinary bodies and legislatures. Over the years these institutions have sought to regulate the practice of non-conventional medicine, not without some difficulties. The Authors, after giving an owerview of the phenomenon and after analysing the reasons for the increasing demand for non-conventional medicine, summarize the position taken by different legislative and disciplinary bodies, both nationally and on a Europe-wide level.Particular attention is dedicated to the debate in Italy generated by the intervention of the National federation of the Medical Association together with the stance taken recently by the National Bioethics Committee. Following a brief summary of Italian legislation and jurisprudence, the Authors conclude with an analisys of the professional responsability of general pratictioners in the application of non-conventional treatement from a medical-legal point of view

It is proposed, in light of an analysis of literature, the modern assignment of pain syndrome, once known as algo-distrophic or causalgic sindrome, facing medico-legal issues of diagnosis, prognosis and evaluation, in tort liability and personal accident insurance. More specifically are considered hypothesis of medical professional rersponsability in cases of complex regional pain syndrome (CRPS), following specific therapeutic choices.

Aortic dissection is a life-threatening condition, therefore it is important to recognise and treat it early. Good management of aortic dissection minimises or avoids the sequelae associated with a late diagnosis, and may also reduce the risk of malpractice claims. The aim of this article was to evaluate errors ascribed to the physicians and to identify how the damages could be avoided. Some claim cases were selected and the following were analysed for each case: clinical management before and after diagnosis of aortic dissection, imputed errors and professional fault. Conclusions: guide-lines and practical instructions for in-hospital diagnosis should be considered mandatory, in order to help physicians and to minimise diagnostic errors and treatment delay