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Clinical Practice Guidelines are clinical tools addressed to medical and health professionals and are normally employed to improve quality and safety of diagnostic and therapeutical procedures but may sometimes limit the autonomy of medical and other health care professionals. The adherence to Clinical Practice Guidelines should not be an exclusive step to evaluate the liability and respect of standards of care in case of medico-legal investigations being each clinical case very specific. Medical liability and respect of standards of care should be evaluated with the support of Clinical Practice Guidelines and the extensive examination of all specific features, professional background and experience requested to treat each single patient.

In every relief run, both to the goals of medical performance quality and in the optics of a therapeutic alliance, it is fundamental to create a relationship of trust among the physician and the patient, in which communication assumes a fundamental role. The informed consent is set as an integral part of the sanitary action as conclusive moment of that "therapeutic alliance" fundamental to face in a correct way every illness, and it legitimates the same sanitary action, as it is the demonstration of the constitutionally guaranteed right of patient's autodetermination. The A.O.U.D. of Udine has undertaken a run of accreditation to the Joint Commission International that it foresees a revision of the informative runs and an updating of the forms of informed consent, with the purpose to overcome the traditional physician-patient relationship, recognizing to all the patients an active role in the exercise of the medical action and in the care process. In fact the information must be lived as integral part of the sanitary action, with the awareness that this, private of such a part, would result incomplete and inaccurate, independently from the result. In such optics, the consent form, created absorbing legislative, ethical and deontological principles and jurisprudential orientations, will be illustrated and particular considerations about the type of information that must be given to the patient for treatments effected in day-surgery, will be formulated.

Man's olfactory perception is considerably limited compared to that of other animals; this sense is, however, extremely important in our social lives: it helps us to "savour" our food, it enables us to appreciate perfumes and, even more important, to pick up smells that signal a danger, such as a gas leak or a fire. We describe the clinical case of a patient with anosmia and hypogeusia that appeared immediately after suffering a concussive head injury. We go through the diagnostic protocol for medico-legal assessment of hypoanosmias previously described in the literature, which includes a clinical and an imaging section. In 9% of all anosmic patients, a traumatic event precedes the onset of the disorder, with repercussions on the olfactory channels and centres of the peripherical and/or central nervous system. The overall rate of anosmia following head injury is estimated to be around 7.5%. Among the principal causes of anosmia, those of medico-legal interest constitute 35% of the total. On the basis of our personal experience and of clinical studies conducted by other Authors, we propose that a bioptic investigation of the olfactory mucosa be added to the existing protocol. The olfactory neuroepithelium of patients suffering from post-traumatic anosmia, in fact, evidences some characteristic degenerative aspects. In conclusion, we report several comments regarding the quantification of the reduction of the olfactory function in different areas of medico-legal interest.

The authors, in order to identify the causes of mortal poisonings by carbon monoxide in the domestic use of gaseous hydrocarbons and to evaluate the efficacy of the inherent law in force, in particular, the italian law 5 March 1990, n. 46, report 43 cases of mortal poisoning occurred in the Parma district and observed at the Istituto di Medicina legal of Parma University. The authors, for each of these cases, have pointed out responsibilities, causal factors and mechanisms, examining also judicial inquiries and, when possible, experts' technical reports. From the evaluation of the results of their researches, the authors, even if with some perplexity, judge the law in force as suitable to a correct prevention, but only on condition that the controls provided for in law, should be actually carried out. Finally, they evidence a lacking of publicizing about the mortal risk deriving from the non-observation of the legal regulations.