31 results on '"Santurro, A."'
Search Results
2. Postmortem computed tomography angiography (PMCTA) and traditional autopsy in cases of sudden cardiac death due to coronary artery disease: a systematic review and meta-analysis.
- Author
-
La Russa R, Catalano C, Di Sanzo M, Scopetti M, Gatto V, Santurro A, Viola RV, Panebianco V, Frati P, and Fineschi V
- Subjects
- Cause of Death, Death, Sudden, Cardiac, Humans, Sensitivity and Specificity, Autopsy methods, Computed Tomography Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality
- Abstract
Introduction: Several studies have been performed to assess the efficacy of postmortem computed tomography angiography (PMCTA) in solving cases of sudden cardiac death, even in comparison with the traditional autopsy. However, the results were often inconsistent and inconclusive. Therefore, a global discussion on the subject through a systematic review of the literature and a meta-analysis is necessary., Methods: A systematic search of PubMed was performed up to April 23, 2018. Studies exploring the role of PMCTA in cases of sudden cardiac death and the accuracy of this method in diagnosing the cause of death compared to traditional autopsy were included., Results: The overall sensitivity and specificity of the seven included studies, using conventional autopsy as a reference standard, were 92% and 95%, respectively. The positive and negative likelihood ratios were, respectively, 20.76 (95% CI 1.16-370.2) and 0.08 (95% CI 0.03-0.17), showing that PMCTA represents a strong indicator of the posttest probability of disease. The diagnostic odds ratio and the area under the curve were, respectively, 261.54 (95% CI 1.87-5760.53) and 0.93 (95% CI 0.90-0.95), indicating a high diagnostic power of the test., Conclusion: PMCTA demonstrated a high accuracy in the diagnosis of parietal and luminal coronary changes but was less effective in detecting myocardial ischemia and necrosis. Therefore, the only radiological investigation is often insufficient to determine the cause of sudden death and the conventional autopsy remains the gold standard. However, PMCTA can improve the performance of the autopsy, serving as an aid and guide in the sampling phase for histopathological investigations.
- Published
- 2019
- Full Text
- View/download PDF
3. Evolution of post-mortem coronary imaging: from selective coronary arteriography to post-mortem CT-angiography and beyond.
- Author
-
De Marco E, Vacchiano G, Frati P, La Russa R, Santurro A, Scopetti M, Guglielmi G, and Fineschi V
- Subjects
- Humans, Autopsy methods, Computed Tomography Angiography methods, Coronary Angiography methods, Forensic Pathology methods
- Abstract
Since the 1970s, remarkable efforts have been made in the post-mortem coronary study, especially by angiography, as an added tool to diagnose heart-related deaths. In more recent times, post-mortem CT (PMCT) and post-mortem CT-angiography (PMCTA) have become an established practice in numerous forensic units, because of the undeniable advantages these diagnostic instruments can offer: data acquisition times are increasingly fast, costs have become lower and, once acquired, data can be re-utilized and re-evaluated at any given time. This review aims to chart the history of post-mortem cardiac imaging, highlighting its evolution both in terms of methodology and technology as well as the contribution that forensic radiology has been able to offer to forensic pathology, not as an alternative to autopsy but as a guide and aid when performing one. Finally, the latest advances in the study of cardiac deaths are explored, namely by cardiac post-mortem MRI (PMMR), able to visualize all the various stages of a myocardial infarction, post-mortem MRI-angiography (PMMRA), useful in investigating coronary artery pathology and post-mortem cardiac micro-CT, able to provide near-histological levels of myocardial, coronary and valvular detail.
- Published
- 2018
- Full Text
- View/download PDF
4. Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings.
- Author
-
Vullo A, Panebianco V, Cannavale G, Aromatario M, Cipolloni L, Frati P, Santurro A, Vullo F, Catalano C, and Fineschi V
- Subjects
- Adult, Female, Humans, Middle Aged, Pregnancy, Autopsy methods, Fetal Death, Magnetic Resonance Imaging methods, Postmortem Changes
- Abstract
The aim of the present study is to offer our experience concerning post-mortem magnetic resonance (PMMR) in foetal death cases and an evaluation of the differences between the findings acquired by PMMR and by forensic autopsy. Fifteen foetuses were recruited from July 2014 to December 2015. These had suffered intrauterine death in women in the 21st to 38th week of gestation who were treated in the emergency department for non-perception of foetal movements. We performed a PMMR on foetuses, 3 ± 1 days on average from the time of death, and then a complete forensic autopsy was performed. All 15 foetuses were examined with a whole-body study protocol, starting from the skull, down to and including the lower limbs. The total time of examination ranged from 20 to 30 min in each case. The external evaluation and description of post-mortem phenomena (maceration), record of the weight and detection and the various measurements of foetal diameters were evaluated before performing autopsy. A complete histopathological study was performed in each case. Out of 15 cases examined, eight were negative for structural anatomical abnormalities and/or diseases, both in the preliminary radiological examination and the traditional autopsy. In the remaining seven cases, pathological findings were detected by PMMR with corresponding results at autopsy. PMMR can provide useful information on foetal medical conditions and result in improved diagnostic classification. It may enable the planning of a more suitable technique before proceeding to autopsy, including focusing on certain aspects of organ pathology otherwise not detectable. The association between PMMR, post-mortem examination and related histological study of the foetus-placenta unit could help reduce the percentage of cases in which the cause of foetal death remains unexplained. Lastly, it may allow a selective sampling of the organ in order to target histological investigations.
- Published
- 2016
- Full Text
- View/download PDF
5. Cytokine storm and histopathological findings in 60 cases of COVID-19-related death: from viral load research to immunohistochemical quantification of major players IL-1β, IL-6, IL-15 and TNF-α
- Author
-
Frisoni, Paolo, Neri, Margherita, D’Errico, Stefano, Alfieri, Letizia, Bonuccelli, Diana, Cingolani, Mariano, Di Paolo, Marco, Gaudio, Rosa Maria, Lestani, Maurizio, Marti, Matteo, Martelloni, Massimo, Moreschi, Carlo, Santurro, Alessandro, Scopetti, Matteo, Turriziani, Ombretta, Zanon, Martina, Scendoni, Roberto, Frati, Paola, and Fineschi, Vittorio
- Published
- 2022
- Full Text
- View/download PDF
6. Challenges and Complications in the Management of Advanced Oropharyngeal Carcinoma: Role of Post-Mortem Diagnosis and Future Perspectives.
- Author
-
Consalvo, Francesca, De Simone, Matteo, Scarpa, Alfonso, Acerra, Alfonso, Salzano, Francesco Antonio, Fineschi, Vittorio, and Santurro, Alessandro
- Subjects
SQUAMOUS cell carcinoma ,CANCER diagnosis ,AUTOPSY ,DIAGNOSIS ,QUALITY of life - Abstract
Oropharyngeal squamous-cell carcinoma (OPSCC) poses significant challenges in diagnosis, treatment, and management and has important medico-legal and forensic implications. In particular, the management of OPSCC and its treatment-related complications can often be challenging. In cases with advanced OPSCC, a loco-regional extension of the tumor can contribute to the destruction of oral cavity tissues, while the radiotherapy treatment can induce profound changes in tissue morphology and structure. These changes, which resemble tumor neoplasms and endovascular effects, are related to a higher risk of fatal bleeding, as reported in the case study illustrated, in which a hemorrhage occurred from a lingual artery, originating from an ulcerative, necrotic, hemorrhagic lesion on the tongue. Bleeding complications in OPSCC and prolonged radiotherapy are associated with high mortality and require comprehensive management strategies to improve survival and quality of life. Autopsy investigations, contributing to the definition of post-mortem diagnosis, can provide valuable insights into the pathogenetic mechanisms underlying bleeding and guide therapeutic decisions and preventive measures. The integration of autopsy and histopathological investigation into clinical practice should be considered as a necessary support to optimize the management of complications in advanced OPSCC patients, emphasizing the importance of a patient-centered approach and continued research. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
7. Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review
- Author
-
Federico Manetti, Maria Chiara David, Sara Gariglio, Francesca Consalvo, Martina Padovano, Matteo Scopetti, Antonio Grande, and Alessandro Santurro
- Subjects
fentanyl ,morphine ,transdermal patch ,protective film ,autopsy ,forensic toxicology ,Chemical technology ,TP1-1185 - Abstract
Fentanyl is a synthetic L-opioid receptor agonist, approximately 100 times more potent than morphine, that is experiencing an upward trend in the field of abuse. Fentanyl patches’ abusive consumption can occur either by transdermal absorption or through other atypical and ingenious routes. In the present case, a 29-year-old man with a history of illicit drug use was found dead in a suburban neighborhood of an Italian city. At autopsy, lungs appeared increased in weight and showed minute subpleural hemorrhages. Airways contained abundant reddish foamy material; in addition, a fentanyl patch protective film was found inside the left main bronchus. Toxicological analysis revealed the presence of morphine, fentanyl, BEG and ethyl alcohol in peripheric blood; 6-MAM was also revealed in urine. Findings collected during post-mortem investigations allowed us to identify fentanyl consumption as the cause of death. Fentanyl consumption presumably took place by chewing of a transdermal patch, with subsequent aspiration of the protective film. The pathophysiology of death can be identified as combined respiratory failure—both central suppression and a fentanyl-induced increase in muscular stiffness; a further minor contribution may be identified in the mechanical airflow obstruction caused by the presence of the protective film at the bronchial level.
- Published
- 2022
- Full Text
- View/download PDF
8. Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital.
- Author
-
Di Fazio, Nicola, Scopetti, Matteo, Delogu, Giuseppe, Morena, Donato, Santurro, Alessandro, Cipolloni, Luigi, Serviddio, Gaetano, Papi, Luigi, Frati, Paola, Turillazzi, Emanuela, and Fineschi, Vittorio
- Subjects
HEPARIN ,DRUG overdose ,BIOAVAILABILITY ,HOSPITAL administration ,BIOMATERIALS ,VITALITY - Abstract
Healthcare-related homicidal cases are not novel within the medical–legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
9. Cytokine storm and histopathological findings in 60 cases of COVID-19-related death: from viral load research to immunohistochemical quantification of major players IL-1β, IL-6, IL-15 and TNF-α
- Author
-
Paola Frati, Massimo Martelloni, Letizia Alfieri, Roberto Scendoni, Maurizio Lestani, Stefano D'Errico, Carlo Moreschi, Diana Bonuccelli, Paolo Frisoni, Martina Zanon, Vittorio Fineschi, Alessandro Santurro, Margherita Neri, Rosa Maria Gaudio, Ombretta Turriziani, Mariano Cingolani, Marco Di Paolo, Matteo Marti, and Matteo Scopetti
- Subjects
ARDS ,Pathology ,medicine.medical_specialty ,Interleukin-1beta ,RT-PCR ,Autopsy, COVID-19 related-death, Cytokines, Immunohistochemistry, Pneumonia, RT-PCR, SARS-CoV-2 ,NO ,Pathology and Forensic Medicine ,Proinflammatory cytokine ,Settore MED/43 - Medicina Legale ,Humans ,Medicine ,Respiratory system ,Interleukin 6 ,Interleukin-15 ,Lung ,biology ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,SARS-CoV-2 ,business.industry ,COVID-19 ,Endothelial Cells ,Correction ,Pneumonia ,General Medicine ,Viral Load ,Autopsy ,COVID-19 related-death ,Cytokines ,Immunohistochemistry ,medicine.disease ,medicine.anatomical_structure ,Interleukin 15 ,biology.protein ,Original Article ,Cytokine Release Syndrome ,business ,Cytokine storm - Abstract
This study involves the histological analysis of samples taken during autopsies in cases of COVID-19 related death to evaluate the inflammatory cytokine response and the tissue localization of the virus in various organs. In all the selected cases, SARS-CoV-2 RT-PCR on swabs collected from the upper (nasopharynx and oropharynx) and/or the lower respiratory (trachea and primary bronchi) tracts were positive. Tissue localization of SARS-CoV-2 was detected using antibodies against the nucleoprotein and the spike protein. Overall, we tested the hypothesis that the overexpression of proinflammatory cytokines plays an important role in the development of COVID-19-associated pneumonia by estimating the expression of multiple cytokines (IL-1β, IL-6, IL-10, IL-15, TNF-α, and MCP-1), inflammatory cells (CD4, CD8, CD20, and CD45), and fibrinogen. Immunohistochemical staining showed that endothelial cells expressed IL-1β in lung samples obtained from the COVID-19 group (p
- Published
- 2021
10. Post-Mortem Cardiac Magnetic Resonance in Explanted Heart of Patients with Sudden Death
- Author
-
Giovanni Aquaro, Benedetta Guidi, Michele Emdin, Angela Pucci, Enrica Chiti, Alessandro Santurro, Matteo Scopetti, Federico Biondi, Aniello Maiese, Emanuela Turillazzi, Giovanni Camastra, Lorenzo Faggioni, Dania Cioni, Vittorio Fineschi, Emanuele Neri, and Marco Di Paolo
- Subjects
Magnetic Resonance Spectroscopy ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,sudden death ,Magnetic Resonance Imaging ,sudden cardiac death ,post-mortem cardiac magnetic resonance ,autopsy ,forensic investigation ,histology ,Death, Sudden ,Formaldehyde ,Humans ,Autopsy - Abstract
Background: We sought to evaluate the diagnostic accuracy of post-mortem cardiac magnetic resonance (PMCMR) of explanted hearts to detect the cardiac causes of sudden death. Methods: PMCMR was performed in formalin-fixed explanted hearts of 115 cases of sudden death. Histological sampling of myocardium was performed using two different approaches: (1) guideline-based sampling; (2) guideline-based plus PMCMR-driven sampling. Results: Forensic diagnosis of cardiac cause of death was ascertained in 72 (63%) patients. When the guideline-driven histological sampling was used, the PMCMR interpretation matched with final forensic diagnosis in 93 out of 115 cases (81%) with sensitivity of 88% (79–95%), specificity of 65% (47–80%), PPV of 84% (78–90%), NPV of 73% (58–84%), accuracy of 81% (72–88%), and AUC of 0.77 (0.68–0.84). When a PMCMR-driven approach was added to the guideline-based one, the matching increased to 102 (89%) cases with a PMCMR sensitivity of 89% (80–94%), a specificity of 86% (67–96%), PPV of 95% (89–98%), NPV of 73% (59–83%), accuracy of 89% (81–93%), and AUC of 0.88 (0.80–0.93). Conclusions: PMCMR has high accuracy to identify the cardiac cause of sudden death and may be considered a valid auxilium for forensic diagnosis. PMCMR could improve histological diagnosis in conditions with focal myocardial involvement or demonstrating signs of myocardial ischemia.
- Published
- 2022
11. Mors Gaudet Succurrere Vitae. The Role of Clinical Autopsy in Preventing Litigation Related to the Management of Liver and Digestive Disorders
- Author
-
Monica Concato, Vittorio Fineschi, Stefano D'Errico, Matteo Scopetti, Martina Padovano, Michela Peruch, Martina Zanon, Alessandro Santurro, D’Errico, Stefano, Zanon, Martina, Peruch, Michela, Concato, Monica, Padovano, Martina, Santurro, Alessandro, Scopetti, Matteo, and Fineschi, Vittorio
- Subjects
digestive and liver disease ,Medicine (General) ,medicine.medical_specialty ,Clinical Biochemistry ,Autopsy ,risk management ,healthcare quality ,Article ,Patient safety ,R5-920 ,adverse events ,digestive and liver diseases ,error prevention ,gastroenterology claims ,hospital autopsy ,patient safety ,Malpractice ,gastroenterology claim ,ad-verse events ,Health care ,Medicine ,Adverse effect ,Cause of death ,business.industry ,General surgery ,Medical record ,Retrospective cohort study ,ad-verse event ,business - Abstract
Over the last 50 years, the number of clinical autopsies has decreased, but their role in assessing cause of death and clinical performance is still acknowledged. Few publications have studied their role in malpractice claim prevention. The paper aims to highlight the role of clinical autopsy in preventing errors and improve healthcare quality. A retrospective study was conducted on 28 clinical autopsies performed between 2015 and 2021 on patients dead unexpectedly after procedures for the diagnosis and treatment of digestive and hepatic diseases. After an accurate analysis of medical records and consultation with healthcare professionals, all cases were subjected to autopsy and histopathology. The data obtained were analyzed and shared with the risk-management team to identify pitfalls and preventive strategies. Post-mortem evaluations confirmed the clinical diagnosis only in six cases (21.4%). Discordances were observed in 10 cases (35.7%). In the remaining 12 cases (42.9%) the clinical diagnosis was labeled as “unknown” and post-mortem examinations made it possible to document the cause of death. Post-mortem examinations can concretely enrich hospital prevention systems and improve patient safety. The methodological approach outlined certainly demonstrates that, even in the risk-management field, “mors gaudet succurrere vitae” (“death delights in helping life”).
- Published
- 2021
12. Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review.
- Author
-
Manetti, Federico, David, Maria Chiara, Gariglio, Sara, Consalvo, Francesca, Padovano, Martina, Scopetti, Matteo, Grande, Antonio, and Santurro, Alessandro
- Subjects
FENTANYL ,TRANSDERMAL medication ,DRUG abuse ,SYNTHETIC receptors ,LITERATURE reviews ,BLOOD alcohol - Abstract
Fentanyl is a synthetic L-opioid receptor agonist, approximately 100 times more potent than morphine, that is experiencing an upward trend in the field of abuse. Fentanyl patches' abusive consumption can occur either by transdermal absorption or through other atypical and ingenious routes. In the present case, a 29-year-old man with a history of illicit drug use was found dead in a suburban neighborhood of an Italian city. At autopsy, lungs appeared increased in weight and showed minute subpleural hemorrhages. Airways contained abundant reddish foamy material; in addition, a fentanyl patch protective film was found inside the left main bronchus. Toxicological analysis revealed the presence of morphine, fentanyl, BEG and ethyl alcohol in peripheric blood; 6-MAM was also revealed in urine. Findings collected during post-mortem investigations allowed us to identify fentanyl consumption as the cause of death. Fentanyl consumption presumably took place by chewing of a transdermal patch, with subsequent aspiration of the protective film. The pathophysiology of death can be identified as combined respiratory failure—both central suppression and a fentanyl-induced increase in muscular stiffness; a further minor contribution may be identified in the mechanical airflow obstruction caused by the presence of the protective film at the bronchial level. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
13. Widespread septic embolization in injection drug use mitro-aortic infective endocarditis as a remote cause of death
- Author
-
Matteo Scopetti, Stefano D'Errico, Alessandro Santurro, Federico Manetti, Lara Consoloni, Manetti, Federico, Scopetti, Matteo, Santurro, Alessandro, Consoloni, Lara, and D’Errico, Stefano
- Subjects
Male ,medicine.medical_specialty ,educational autopsy ,Injection drug use infective endocarditis ,unexpected death ,widespread septic embolization ,medicine.medical_treatment ,Embolism ,Autopsy ,Injection drug use infective endocarditi ,Pathology and Forensic Medicine ,Cause of Death ,medicine ,Endocarditis ,Humans ,Embolization ,Abscess ,Intensive care medicine ,Substance Abuse, Intravenous ,Widespread septic embolization ,Cause of death ,Educational autopsy ,Septic shock ,business.industry ,Unexpected death ,Middle Aged ,medicine.disease ,Shock, Septic ,Infective endocarditis ,Bacteremia ,business - Abstract
Injection drug use-related infective endocarditis (IDU-IE) assumes peculiar epidemiological, pathogenetic, and prognostic characteristics that allow to consider it a distinct nosological entity, as well as a current problem of considerable social weight. Incidence is reasonably underestimated because diagnosis is often accidental in postmortem examination when drug-related death is suspected. In many cases, postmortem toxicological examinations are negative for acute drug abuse, and findings of infective endocarditis became relevant in the explanation of the mechanism of death. Extracardiac involvement of infective endocarditis is rarely reported as fatal. Fragmentation and embolization of bacterial vegetations can be associated with parenchymal infarcts, systemic spread of the infectious process by formation of an abscess. A case of septic shock as a consequence of the constant bacteremia determined by the continuous proliferation and release of bacteria into the circulation is presented in an injection drug user with left-sided endocarditis and widespread septic embolization. Authors reviewed forensic and medical literature and promote epidemiological value of medical and forensic autopsy. Extracardiac involvement of infective endocarditis may represent a remote and alternative cause of death in injection drug users, and an early diagnosis can be relevant for prognosis. Postmortem examination still represents a valuable opportunity of learning for clinicians and improving diagnostic accuracy with injection drug users. A call for changing of attitudes and practice toward autopsy is finally demanded.
- Published
- 2020
14. Corpse dismemberment: A case series. Solving the puzzle through an integrated multidisciplinary approach
- Author
-
Aniello Maiese, Vittorio Fineschi, Mariano Cingolani, Alessandro Santurro, Federico Manetti, Stefano D'Errico, Matteo Scopetti, Alessandra De Matteis, Margherita Neri, Enrica Pinchi, Raffaele La Russa, Paola Frati, Maiese, A., Scopetti, M., Santurro, A., La Russa, R., Manetti, F., D'Errico, S., De Matteis, A., Cingolani, M., Neri, M., Pinchi, E., Frati, P., and Fineschi, V.
- Subjects
Wounds vitality ,Forensic pathology ,Adolescent ,Lewis X Antigen ,Socio-culturale ,Dismemberment ,Computed tomography ,Autopsy ,Desmemrament ,forensic pathology ,Gas Chromatography-Mass Spectrometry ,Pathology and Forensic Medicine ,Corpse dismemberment, Forensic pathology, Immunohistochemistry, Post-mortem computed tomography, Post-mortem techniques, Wounds vitality ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,medicine ,Crime scene ,Humans ,Whole Body Imaging ,Corpse dismemberment ,030216 legal & forensic medicine ,030212 general & internal medicine ,Genetic Testing ,Skin ,Protocol (science) ,Interleukin-15 ,medicine.diagnostic_test ,General Medicine ,Middle Aged ,medicine.disease ,Post-mortem computed tomography ,people.cause_of_death ,Immunohistochemistry ,Corpse Dismemberment ,Connective Tissue ,Post-mortem techniques ,Female ,Tryptases ,Medical emergency ,people ,Psychology ,Homicide ,Tomography, X-Ray Computed ,Law ,Post-mortem technique - Abstract
The finding of corpse parts poses several challenges for the forensic pathologist presenting implications for identification, diagnosis of death and determination of wounds vitality. Further interpretative difficulties in cases of cadaveric dismemberment derive from the scarcity of tanatochronological parameters useful to estimate the post-mortem interval (PMI) and the absence of uniform investigative protocols in the different centres of forensic pathology. The present study proposes an investigation protocol for the cadaveric dismemberment through the discussion of a case series. The study group consisted of cases in which the dismemberment was performed after the murder. For all cases, a study protocol based on crime scene investigation, post-mortem computed tomography (PMCT), autopsy, toxicological, histological, immunohistochemical and genetic investigations was implemented. In particular, the standardised use of radiographic study before the autopsy allows all to have information that can guide the forensic pathologist during the autopsy. The use of immunohistochemistry allows an assessment of the vitality of the lesions possibly involved in the determinism of death, as well as of the surfaces of dismemberment, representing a tool of considerable utility for forensic purposes. The genetic investigations allow the identification of the victims, while the toxicological ones highlight the possible abuse of substances. The implemented protocol presents a demonstrated usefulness in improving diagnostic accuracy in corpse dismemberment cases.
- Published
- 2020
15. Management of the corpse with suspect, probable or confirmed COVID-19 respiratory infection - Italian interim recommendations for personnel potentially exposed to material from corpses, including body fluids, in morgue structures and during autopsy practice
- Author
-
Fineschi, V., Aprile, A., Aquila, I., Arcangeli, M., Asmundo, A., Bacci, M., Cingolani, M., Cipolloni, L., D'Errico, S., de Casamassimi, I., Mizio, G. D., Paolo, M. D., Focardi, M., Frati, P., Gabbrielli, M., Russa, R. L., Maiese, A., Manetti, F., Martelloni, M., Mazzeo, E., Montana, A., Neri, M., Padovano, M., Pinchi, V., Pomara, C., Ricci, P., Salerno, M., Santurro, A., Scopetti, M., Testi, R., Turillazzi, E., Vacchiano, G., Crivelli, F., Bonoldi, E., Facchetti, F., Nebuloni, M., Sapino, A., Fineschi, Vittorio, Aprile, Anna, Aquila, Isabella, Arcangeli, Mauro, Asmundo, Alessio, Bacci, Mauro, Cingolani, Mariano, Cipolloni, Luigi, D'Errico, Stefano, De Casamassimi, Ilaria, Di Mizio, Giulio, Di Paolo, Marco, Focardi, Martina, Frati, Paola, Gabbrielli, Mario, La Russa, Raffaele, Maiese, Aniello, Manetti, Federico, Martelloni, Massimo, Mazzeo, Elena, Montana, Angelo, Neri, Margherita, Padovano, Martina, Pinchi, Vilma, Pomara, Cristoforo, Ricci, Pietrantonio, Salerno, Monica, Santurro, Alessandro, Scopetti, Matteo, Testi, Roberto, Turillazzi, Emanuela, Vacchiano, Giuseppe, Crivelli, Filippo, Bonoldi, Emanuela, Facchetti, Fabio, Nebuloni, Manuela, and Sapino, Anna
- Subjects
safety ,COVID-19 ,autopsy ,guidelines ,COVID19 ,Health Personnel ,Pneumonia, Viral ,NO ,Betacoronavirus ,Cadaver ,Humans ,Autopsy ,Body Fluids ,Coronavirus Infections ,Italy ,Morgue ,Pandemics ,Personal Protective Equipment ,Viral ,Autopsy, Body Fluids, COVID-19, Cadaver, Coronavirus Infections, Health Personnel, Humans, Italy, Morgue, Pandemics, Personal Protective Equipment ,SARS-CoV-2 ,Pneumonia ,guideline ,Autopsy, Body Fluids, COVID-19, Cadaver, Coronavirus Infections, Health Personnel, Humans, Italy, Morgue, Pandemics, Personal Protective Equipment, Pneumonia, Viral, SARS-CoV-2, Betacoronavirus - Abstract
non disponibile
- Published
- 2020
16. A technical report from the Italian SARS-CoV-2 outbreak. Postmortem sampling and autopsy investigation in cases of suspected or probable COVID-19
- Author
-
Stefano D'Errico, Matteo Scopetti, Alessandro Santurro, Vittorio Fineschi, Santurro, Alessandro, Scopetti, Matteo, D’Errico, Stefano, and Fineschi, Vittorio
- Subjects
medicine.medical_specialty ,forensic sciences ,Autopsy ,Context (language use) ,Postmortem diagnosis ,Autopsy investigation ,autopsy investigation ,COVID-19 ,postmortem diagnosis ,SARS-CoV-2 ,virological diagnosis ,autopsy ,betacoronavirus ,cause of death ,coronavirus infections ,host microbial interactions ,humans ,italy ,pandemics ,pneumonia ,viral ,predictive value of tests ,respiratory system ,specimen handling ,virology ,medicine.disease_cause ,Virological diagnosis ,Pathology and Forensic Medicine ,Technical Report ,Pandemic ,medicine ,Intensive care medicine ,Coronavirus ,Cause of death ,Virological diagnosi ,Postmortem Diagnosis ,business.industry ,Outbreak ,General Medicine ,medicine.disease ,Pneumonia ,business - Abstract
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is a coronavirus responsible for COVID-19 (coronavirus disease 2019) which resulted in a cluster of cases of pneumonia that originated in China around 31 December 2019 and has subsequently spread across the globe. Currently, COVID-19 represents a health emergency worldwide, leading, in severe cases, to pneumonia, severe acute respiratory syndrome, multiorgan dysfunction or failure, and death. In the context of limited scientific knowledge and evidence of SARS-CoV-2 infection, guidance is becoming increasingly necessary for pathologists who have to perform postmortem investigations on COVID-19 cases. The aim of the present report is to share a procedure applicable to cases of COVID-19-related death, particularly in cases of death without medical intervention and in the absence of an ascertained SARS-CoV-2 infection and/or COVID-19 diagnosis, therefore providing support for diagnostic activity in the present COVID-19 pandemic. For this purpose, a standard operating procedure for correct swab collection, autopsy investigation and tissue sampling is provided.
- Published
- 2020
17. Response to the letter by Meng-jun Zhan et al. regarding the paper 'A technical report from the Italian SARS-CoV-2 outbreak. Postmortem sampling and autopsy investigation in cases of suspected or probable COVID-19'
- Author
-
Alessandro Santurro, Vittorio Fineschi, Stefano D'Errico, Matteo Scopetti, Santurro, A., Scopetti, M., D'Errico, S., and Fineschi, V.
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Autopsy ,Legal Medicine ,Pathology ,Covid-19 ,Disease Outbreaks ,Pathology and Forensic Medicine ,Betacoronavirus ,medicine ,Humans ,Sampling (medicine) ,Letter to the Editor ,Pandemics ,SARS-CoV-2 ,business.industry ,Medical jurisprudence ,Outbreak ,General Medicine ,Dermatology ,Italy ,Coronavirus Infections ,business - Abstract
N/A
- Published
- 2020
18. Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies
- Author
-
Margherita Neri, Alessandro Santurro, Raffaele La Russa, Fulvio Zaccagna, Valeria Panebianco, Emanuela Turillazzi, Carlo Catalano, Vittorio Fineschi, Gaia Cartocci, Paola Frati, Fineschi, Vittorio [0000-0002-1686-3236], Apollo - University of Cambridge Repository, Cartocci G., Santurro A., Neri M., Zaccagna F., Catalano C., La Russa R., Turillazzi E., Panebianco V., Frati P., and Fineschi V.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Forensic pathology ,Adolescent ,Ga ,Socio-culturale ,Autopsy ,030218 nuclear medicine & medical imaging ,Decomposition processe ,03 medical and health sciences ,Decomposition processes, Forensic radiology Gas, Post-mortem computed tomography, Radiological alteration index ,0302 clinical medicine ,Decomposition processes ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Putrefaction ,Forensic Pathology ,Neuroradiology ,Aged ,Retrospective Studies ,Aged, 80 and over ,Forensic radiology ,Gas ,Post-mortem computed tomography ,Radiological alteration index ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,General Medicine ,Middle Aged ,Forensic radiology Gas ,Italy ,030220 oncology & carcinogenesis ,Radiological weapon ,Postmortem Changes ,Female ,Radiology ,Cadaveric spasm ,business ,Tomography, X-Ray Computed - Abstract
Purpose: The aim of the study is to report radiological findings and features in advanced decomposed bodies obtained by post-mortem computed tomography (PMCT) with autopsy correlation. Materials and methods: This retrospective descriptive multicentric study included 41 forensic cases examined between May 2013 and November 2016. All the bodies were PMCT-scanned prior to autopsy, and internal putrefactive state was determined using the radiological alteration index (RAI) by a radiologist with expertise in forensic radiology and a forensic pathologist trained in forensic imaging. After PMCT scans, grade of external putrefaction (GEP) was assigned during the external examination and the complete autopsy was performed by forensic pathologists. Results: The PMCT images evaluation revealed that the RAI index was > 61 in all bodies, corresponding to a moderate-massive presence of putrefactive gas. The gas grade was > II in correspondence of the major vessels, heart cavities, liver parenchyma, vertebra L3 and subcutaneous pectoral tissues, and varied from I to III in correspondence of the kidney. Cadaveric external examination revealed the presence of advanced transformative phenomena, with a GEP3 and GEP4 in most of the cases, with body swelling, eyes and tongue protrusion, body fluids expulsion and fat liquefaction. Conclusion: Radiological imaging by PMCT as an adjunct to autopsy in advanced decomposed bodies represents a useful tool in detecting post-mortem gas, even in very small amounts. A correct interpretation process of the PMCT data is essential to avoid images pitfalls, due to natural decomposition that can be mistaken for pathologic processes.
- Published
- 2019
- Full Text
- View/download PDF
19. Management of the corpse with suspect, probable or confirmed COVID-19 respiratory infection – Italian interim recommendations for personnel potentially exposed to material from corpses, including body fluids, in morgue structures and during autopsy practice
- Author
-
Vittorio, Fineschi, Anna, Aprile, Isabella, Aquila, Mauro, Arcangeli, Alessio, Asmundo, Mauro, Bacci, Cingolani, Mariano, Luigi, Cipolloni, Stefano, D’Errico, Ilaria De Casamassimi, Giulio Di Mizio, Marco Di Paolo, Martina, Focardi, Paola, Frati, Mario, Gabbrielli, Raffaele La Russa1, Aniello, Maiese10, Federico, Manetti1, Massimo, Martelloni13, Elena, Mazzeo14, Angelo, Montana15, Margherita, Neri16, Martina, Padovano, Vilma, Pinchi, Cristoforo, Pomara, Pietrantonio, Ricci, Monica, Salerno, Alessandro, Santurro, Matteo, Scopetti, Roberto, Testi, Emanuela, Turillazzi, Giuseppe, Vacchiano, Filippo, Crivelli20, Emanuela, Bonoldi, Fabio, Facchetti, and Anna Sapino, Manuela Nebuloni.
- Subjects
Autopsy ,Guidelines ,Covid-19 ,Autopsy, Covid-19, Guidelines - Published
- 2020
20. Imaging techniques for postmortem forensic radiology
- Author
-
Raffaele La Russa, Giuseppe Guglielmi, Gaia Cartocci, Alessandro Santurro, Paola Frati, and Vittorio Fineschi
- Subjects
forensic radiology ,postmortem CT ,foreign bodies ,bone fractures ,PMMRA ,medicine.medical_specialty ,Forensic pathology ,business.industry ,Autopsy ,Gold standard (test) ,Body identification ,Imaging Tool ,medicine ,Forensic radiology ,Radiology ,business ,Foreign Bodies ,Cause of death - Abstract
Postmortem forensic radiology aims to acquisition, interpretation, and reporting of radiologic images for the purpose of forensic investigations, in the living as well as the deceased. Conventional radiology still remains the most common modality used in the forensic setting and the gold standard method for many forensic challenges. X-rays are commonly used for visualization and localization of foreign bodies, and for body identification and identities confirmation. Computed tomography (PMCT) is the most frequent imaging tool in forensic pathology besides X-ray. Indications of PMCT are especially focused on cases of unnatural deaths: traumatic events such as bone fractures and nonaccidental injury in children; gunshot injuries; hanging, strangulation, and drowning cases; putrefied, carbonized, and badly damaged bodies. In order to visualize the soft tissue, especially organs, MRI can be used. Although this technique has the potential to overcome the limitations of PCMT, it is only rarely used in forensic imaging as it is a complex technology requiring specific training, expensive, and with some complication in execution due to body size, artifact, and protocols. MRI is of special significance for the diagnosis of natural death, especially related to diseases of the cardiovascular or central nervous system, and for investigations concerning neonatal and perinatal deaths. Comparing the results of postmortem imaging with subsequent autopsies, rates of major discrepancies between cause of death identified by radiology and autopsy of 32% for PMCT, 43% for PMMR, and 30% for PMCT + PMMRI have been reported. Vice versa, different studies have demonstrated that PMCT or PMMRI in conjunction with conventional postmortem examinations can augment the value of postmortem examinations, providing more information than either examination alone.
- Published
- 2019
21. Postmortem computed tomography angiography (PMCTA) and traditional autopsy in cases of sudden cardiac death due to coronary artery disease: a systematic review and meta-analysis
- Author
-
Paola Frati, Vittorio Fineschi, Mariantonia Di Sanzo, Carlo Catalano, Valeria Panebianco, Rocco Valerio Viola, Raffaele La Russa, Vittorio Gatto, Matteo Scopetti, and Alessandro Santurro
- Subjects
medicine.medical_specialty ,cardiac ,Computed Tomography Angiography ,Autopsy ,Coronary Artery Disease ,Sudden death ,Sensitivity and Specificity ,sudden cardiac death ,030218 nuclear medicine & medical imaging ,Sudden cardiac death ,Coronary artery disease ,nuclear medicine and imaging ,03 medical and health sciences ,0302 clinical medicine ,death ,Cause of Death ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,traditional autopsy ,Neuroradiology ,Computed tomography angiography ,Cause of death ,sudden ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,postmortem computed tomography angiography ,radiology ,coronary artery disease ,autopsy ,cause of death ,humans ,sensitivity and specificity ,computed tomography angiography ,Death, Sudden, Cardiac ,030220 oncology & carcinogenesis ,Diagnostic odds ratio ,Radiology ,business - Abstract
Several studies have been performed to assess the efficacy of postmortem computed tomography angiography (PMCTA) in solving cases of sudden cardiac death, even in comparison with the traditional autopsy. However, the results were often inconsistent and inconclusive. Therefore, a global discussion on the subject through a systematic review of the literature and a meta-analysis is necessary. A systematic search of PubMed was performed up to April 23, 2018. Studies exploring the role of PMCTA in cases of sudden cardiac death and the accuracy of this method in diagnosing the cause of death compared to traditional autopsy were included. The overall sensitivity and specificity of the seven included studies, using conventional autopsy as a reference standard, were 92% and 95%, respectively. The positive and negative likelihood ratios were, respectively, 20.76 (95% CI 1.16–370.2) and 0.08 (95% CI 0.03–0.17), showing that PMCTA represents a strong indicator of the posttest probability of disease. The diagnostic odds ratio and the area under the curve were, respectively, 261.54 (95% CI 1.87–5760.53) and 0.93 (95% CI 0.90–0.95), indicating a high diagnostic power of the test. PMCTA demonstrated a high accuracy in the diagnosis of parietal and luminal coronary changes but was less effective in detecting myocardial ischemia and necrosis. Therefore, the only radiological investigation is often insufficient to determine the cause of sudden death and the conventional autopsy remains the gold standard. However, PMCTA can improve the performance of the autopsy, serving as an aid and guide in the sampling phase for histopathological investigations.
- Published
- 2018
22. Evolution of post-mortem coronary imaging: from selective coronary arteriography to post-mortem CT-angiography and beyond
- Author
-
Alessandro Santurro, Giuseppe Vacchiano, Vittorio Fineschi, Matteo Scopetti, Raffaele La Russa, Emidio De Marco, Giuseppe Guglielmi, and Paola Frati
- Subjects
medicine.medical_specialty ,Forensic pathology ,Post-mortem magnetic resonance imaging ,Computed Tomography Angiography ,Autopsy ,Post-mortem angiography ,Post-mortem computed tomography ,Post-mortem computed tomography angiography ,Post-mortem magnetic resonance angiography ,Post-mortem micro computed tomography ,Coronary Angiography ,Forensic Pathology ,Humans ,Radiology, Nuclear Medicine and Imaging ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Nuclear Medicine and Imaging ,Medicine ,Radiology, Nuclear Medicine and imaging ,030216 legal & forensic medicine ,Myocardial infarction ,Radiology ,Cardiac imaging ,Neuroradiology ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,General Medicine ,medicine.disease ,Angiography ,Forensic radiology ,business - Abstract
Since the 1970s, remarkable efforts have been made in the post-mortem coronary study, especially by angiography, as an added tool to diagnose heart-related deaths. In more recent times, post-mortem CT (PMCT) and post-mortem CT-angiography (PMCTA) have become an established practice in numerous forensic units, because of the undeniable advantages these diagnostic instruments can offer: data acquisition times are increasingly fast, costs have become lower and, once acquired, data can be re-utilized and re-evaluated at any given time. This review aims to chart the history of post-mortem cardiac imaging, highlighting its evolution both in terms of methodology and technology as well as the contribution that forensic radiology has been able to offer to forensic pathology, not as an alternative to autopsy but as a guide and aid when performing one. Finally, the latest advances in the study of cardiac deaths are explored, namely by cardiac post-mortem MRI (PMMR), able to visualize all the various stages of a myocardial infarction, post-mortem MRI-angiography (PMMRA), useful in investigating coronary artery pathology and post-mortem cardiac micro-CT, able to provide near-histological levels of myocardial, coronary and valvular detail.
- Published
- 2017
23. Personalized medicine applied to forensic sciences: new advances and perspectives for a tailored forensic approach
- Author
-
Anna Maria Vullo, Maurizio Simmaco, Paola Frati, Giovanna Gentile, Alessandro Santurro, Raffaele La Russa, Vittorio Fineschi, and Marina Borro
- Subjects
Forensic Genetics ,Forensic pathology ,forensic sciences ,Pharmaceutical Science ,sudden death ,030204 cardiovascular system & hematology ,Polymorphism, Single Nucleotide ,Risk Assessment ,Sudden death ,03 medical and health sciences ,transcriptomics ,0302 clinical medicine ,proteomics ,genomics ,Humans ,Crime scene ,Medicine ,personalized medicine ,theragnostic ,molecular autopsy ,pharmacogenomics ,metabolomics ,030216 legal & forensic medicine ,Justice (ethics) ,Precision Medicine ,Forensic Pathology ,business.industry ,Precision medicine ,Data science ,Pharmacogenomics ,Identification (biology) ,Autopsy ,Personalized medicine ,business ,Biomarkers ,Biotechnology - Abstract
Personalized medicine (PM), included in P5 medicine (Personalized, Predictive, Preventive, Participative and Precision medicine) is an innovative approach to the patient, emerging from the need to tailor and to fit the profile of each individual. PM promises to dramatically impact also on forensic sciences and justice system in ways we are only beginning to understand. The application of omics (genomic, transcriptomics, epigenetics/imprintomics, proteomic and metabolomics) is ever more fundamental in the so called "molecular autopsy". Emerging fields of interest in forensic pathology are represented by diagnosis and detection of predisposing conditions to fatal thromboembolic and hypertensive events, determination of genetic variants related to sudden death, such as congenital long QT syndromes, demonstration of lesions vitality, identification of biological matrices and species diagnosis of a forensic trace on crime scenes without destruction of the DNA. The aim of this paper is to describe the state-of-art in the application of personalized medicine in forensic sciences, to understand the possibilities of integration in routine investigation of these procedures with classical post-mortem studies and to underline the importance of these new updates in medical examiners' armamentarium in determining cause of death or contributing factors to death.
- Published
- 2017
24. A very unusual accidental mechanical asphyxia of choking with a whole solea solea
- Author
-
Aldo Maggiordomo, Francesco Paolo Busardò, Alessandro Santurro, Giulio Mannocchi, Simona Zaami, and Paola Pugnetti
- Subjects
medicine.medical_specialty ,forensic science ,mechanical asphyxia ,Poison control ,Autopsy ,01 natural sciences ,Pathology and Forensic Medicine ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Swallowing ,Genetics ,medicine ,030216 legal & forensic medicine ,Esophagus ,Clotiapine ,adverse effects ,clotiapine ,fatal case ,fish choking ,2734 ,genetics ,Asphyxia ,business.industry ,010401 analytical chemistry ,medicine.disease ,0104 chemical sciences ,Surgery ,medicine.anatomical_structure ,chemistry ,Anesthesia ,Accidental ,medicine.symptom ,Choking ,business - Abstract
The case here reported involves a schizophrenic 19-year-old girl under treatment with clotiapine, which was well tolerated except for a moderate dry mouth. The woman ingested a whole sole (Solea solea), which caused a very rapid death by choking. A complete autopsy was performed 24 h later, as well as histological and toxicological analysis. At autopsy, the sole was wedged in the esophagus causing a choking ab extrinseco. The fish had a length of 18 cm and a maximum width of 6 cm, weighing 188.7 g. Toxicological analysis detected 0.57 mg/L of clotiapine in blood, which falls within the therapeutic range. The peculiarity of this case is represented by two factors: one is the choking by fish and the second was the adverse affect caused by clotiapine, which induced a condition of dry mouth making the act of swallowing even more difficult, thereby contributing to a very rapid mechanical asphyxia and the death of the young woman.
- Published
- 2017
25. A technical report from the Italian SARS-CoV-2 outbreak. Postmortem sampling and autopsy investigation in cases of suspected or probable COVID-19.
- Author
-
Santurro, Alessandro, Scopetti, Matteo, D'Errico, Stefano, and Fineschi, Vittorio
- Subjects
- *
COVID-19 , *SARS-CoV-2 , *AUTOPSY , *FORENSIC pathology , *COVID-19 pandemic , *SCIENTIFIC knowledge - Abstract
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is a coronavirus responsible for COVID-19 (coronavirus disease 2019) which resulted in a cluster of cases of pneumonia that originated in China around 31 December 2019 and has subsequently spread across the globe. Currently, COVID-19 represents a health emergency worldwide, leading, in severe cases, to pneumonia, severe acute respiratory syndrome, multiorgan dysfunction or failure, and death. In the context of limited scientific knowledge and evidence of SARS-CoV-2 infection, guidance is becoming increasingly necessary for pathologists who have to perform postmortem investigations on COVID-19 cases. The aim of the present report is to share a procedure applicable to cases of COVID-19-related death, particularly in cases of death without medical intervention and in the absence of an ascertained SARS-CoV-2 infection and/or COVID-19 diagnosis, therefore providing support for diagnostic activity in the present COVID-19 pandemic. For this purpose, a standard operating procedure for correct swab collection, autopsy investigation and tissue sampling is provided. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
26. Widespread septic embolization in injection drug use mitro-aortic infective endocarditis as a remote cause of death.
- Author
-
Manetti, Federico, Scopetti, Matteo, Santurro, Alessandro, Consoloni, Lara, and D'Errico, Stefano
- Subjects
INFECTIVE endocarditis ,AUTOPSY ,CAUSES of death ,DRUG abuse ,SEPTIC shock ,INJECTIONS - Abstract
Injection drug use-related infective endocarditis (IDU-IE) assumes peculiar epidemiological, pathogenetic, and prognostic characteristics that allow to consider it a distinct nosological entity, as well as a current problem of considerable social weight. Incidence is reasonably underestimated because diagnosis is often accidental in postmortem examination when drug-related death is suspected. In many cases, postmortem toxicological examinations are negative for acute drug abuse, and findings of infective endocarditis became relevant in the explanation of the mechanism of death. Extracardiac involvement of infective endocarditis is rarely reported as fatal. Fragmentation and embolization of bacterial vegetations can be associated with parenchymal infarcts, systemic spread of the infectious process by formation of an abscess. A case of septic shock as a consequence of the constant bacteremia determined by the continuous proliferation and release of bacteria into the circulation is presented in an injection drug user with left-sided endocarditis and widespread septic embolization. Authors reviewed forensic and medical literature and promote epidemiological value of medical and forensic autopsy. Extracardiac involvement of infective endocarditis may represent a remote and alternative cause of death in injection drug users, and an early diagnosis can be relevant for prognosis. Postmortem examination still represents a valuable opportunity of learning for clinicians and improving diagnostic accuracy with injection drug users. A call for changing of attitudes and practice toward autopsy is finally demanded. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
27. Myocardial oxidative damage is induced by cardiac Fas-dependent and mitochondria-dependent apoptotic pathways in human cocaine-related overdose
- Author
-
Marco Di Paolo, Lucia Micheli, Santina Cantatore, Margherita Neri, Emanuela Turillazzi, Alessandro Santurro, Daniela Cerretani, Luigi Cipolloni, Vittorio Fineschi, Annamaria Vullo, Enrica Pinchi, Paola Frati, Irene Riezzo, and Anna Ida Fiaschi
- Subjects
0301 basic medicine ,Adult ,Male ,Adolescent ,Socio-culturale ,Nitric Oxide Synthase Type II ,Apoptosis ,Oxidative phosphorylation ,030204 cardiovascular system & hematology ,Mitochondrion ,Pharmacology ,medicine.disease_cause ,Mitochondria, Heart ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,Cocaine-Related Disorders ,Young Adult ,0302 clinical medicine ,Cocaine ,Medicine ,Humans ,fas Receptor ,Heart metabolism ,Multidisciplinary ,business.industry ,Nitrotyrosine ,Myocardium ,Fas receptor ,Oxidative Stress ,030104 developmental biology ,chemistry ,Female ,Autopsy ,Signal transduction ,Drug Overdose ,business ,Oxidative stress ,Signal Transduction - Abstract
The aim of this study is to analyse cardiac specimens from human cocaine-related overdose, to verify the hypothesis that cardiac toxicity by acute exposure to high dosage of cocaine could be mediated by unbalanced myocardial oxidative stress, and to evaluate the apoptotic response. To address these issues, biochemical and immunohistological markers of oxidative/nitrosative stress were evaluated. We found that i-NOS, NOX2 and nitrotyrosine expression were significantly higher in the hearts of subjects who had died from high doses of cocaine, compared to the control group. Increase of these markers was associated with a dramatic increase in 8-OHdG, another marker of oxidative stress. A high number of TUNEL-positive apoptotic myocells was observed in the study group compared to the control group. The immunoexpression of TNF-α was significantly higher in the cocaine group compared to the control group. Furthermore, we detected a significantly stronger immunoresponse to anti-SMAC/DIABLO in our study group compared to control cases. Both cardiac Fas-dependent and mitochondria-dependent apoptotic pathways appeared to be activated to a greater extent in the cocaine group than in the control group. Our results highlight the central role of oxidative stress in cocaine toxicity. High levels of NOS can promote the oxidation process and lead to apoptosis.
- Published
- 2016
28. Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings
- Author
-
Mariarosaria Aromatario, Giuseppe Cannavale, Paola Frati, Vittorio Fineschi, Annamaria Vullo, Valeria Panebianco, Alessandro Santurro, Luigi Cipolloni, Francesco Vullo, and Carlo Catalano
- Subjects
Adult ,Pathology ,medicine.medical_specialty ,Maceration (bone) ,Autopsy ,Postmortem Changes ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,foetal and perinatal autopsy ,Humans ,Radiology, Nuclear Medicine and imaging ,Fetal Death ,Pathological ,reproductive and urinary physiology ,Neuroradiology ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,histological examination ,post-mortem magnetic resonance ,Magnetic resonance imaging ,Interventional radiology ,General Medicine ,Middle Aged ,Magnetic Resonance Imaging ,Skull ,medicine.anatomical_structure ,embryonic structures ,Female ,business - Abstract
The aim of the present study is to offer our experience concerning post-mortem magnetic resonance (PMMR) in foetal death cases and an evaluation of the differences between the findings acquired by PMMR and by forensic autopsy. Fifteen foetuses were recruited from July 2014 to December 2015. These had suffered intrauterine death in women in the 21st to 38th week of gestation who were treated in the emergency department for non-perception of foetal movements. We performed a PMMR on foetuses, 3 ± 1 days on average from the time of death, and then a complete forensic autopsy was performed. All 15 foetuses were examined with a whole-body study protocol, starting from the skull, down to and including the lower limbs. The total time of examination ranged from 20 to 30 min in each case. The external evaluation and description of post-mortem phenomena (maceration), record of the weight and detection and the various measurements of foetal diameters were evaluated before performing autopsy. A complete histopathological study was performed in each case. Out of 15 cases examined, eight were negative for structural anatomical abnormalities and/or diseases, both in the preliminary radiological examination and the traditional autopsy. In the remaining seven cases, pathological findings were detected by PMMR with corresponding results at autopsy. PMMR can provide useful information on foetal medical conditions and result in improved diagnostic classification. It may enable the planning of a more suitable technique before proceeding to autopsy, including focusing on certain aspects of organ pathology otherwise not detectable. The association between PMMR, post-mortem examination and related histological study of the foetus-placenta unit could help reduce the percentage of cases in which the cause of foetal death remains unexplained. Lastly, it may allow a selective sampling of the organ in order to target histological investigations.
- Published
- 2016
29. Mors Gaudet Succurrere Vitae. The Role of Clinical Autopsy in Preventing Litigation Related to the Management of Liver and Digestive Disorders.
- Author
-
D'Errico, Stefano, Zanon, Martina, Peruch, Michela, Concato, Monica, Padovano, Martina, Santurro, Alessandro, Scopetti, Matteo, and Fineschi, Vittorio
- Subjects
CAUSES of death ,MEDICAL personnel ,AUTOPSY ,DIAGNOSIS ,HOSPITALS - Abstract
Over the last 50 years, the number of clinical autopsies has decreased, but their role in assessing cause of death and clinical performance is still acknowledged. Few publications have studied their role in malpractice claim prevention. The paper aims to highlight the role of clinical autopsy in preventing errors and improve healthcare quality. A retrospective study was conducted on 28 clinical autopsies performed between 2015 and 2021 on patients dead unexpectedly after procedures for the diagnosis and treatment of digestive and hepatic diseases. After an accurate analysis of medical records and consultation with healthcare professionals, all cases were subjected to autopsy and histopathology. The data obtained were analyzed and shared with the risk-management team to identify pitfalls and preventive strategies. Post-mortem evaluations confirmed the clinical diagnosis only in six cases (21.4%). Discordances were observed in 10 cases (35.7%). In the remaining 12 cases (42.9%) the clinical diagnosis was labeled as "unknown" and post-mortem examinations made it possible to document the cause of death. Post-mortem examinations can concretely enrich hospital prevention systems and improve patient safety. The methodological approach outlined certainly demonstrates that, even in the risk-management field, "mors gaudet succurrere vitae" ("death delights in helping life"). [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
30. Response to the letter by Meng-jun Zhan et al. regarding the paper "A technical report from the Italian SARS-CoV-2 outbreak. Postmortem sampling and autopsy investigation in cases of suspected or probable COVID-19".
- Author
-
Santurro, Alessandro, Scopetti, Matteo, D'Errico, Stefano, and Fineschi, Vittorio
- Subjects
- *
COVID-19 , *SARS-CoV-2 , *TECHNICAL reports , *COVID-19 pandemic , *FORENSIC pathology , *AUTOPSY - Abstract
Response to the letter by Meng-jun Zhan et al. regarding the paper "A technical report from the Italian SARS-CoV-2 outbreak. Postmortem sampling and autopsy investigation in cases of suspected or probable COVID-19". Postmortem sampling and autopsy investigation in cases of suspected or probable COVID-19. [Extracted from the article]
- Published
- 2020
- Full Text
- View/download PDF
31. Assessment of the stability of mephedrone in ante-mortem and post-mortem blood specimens.
- Author
-
Busardò, Francesco Paolo, Kyriakou, Chrystalla, Tittarelli, Roberta, Mannocchi, Giulio, Pantano, Flaminia, Santurro, Alessandro, Zaami, Simona, and Baglìo, Giovanni
- Subjects
- *
MEPHEDRONE , *AUTOPSY , *BLOOD sampling , *DRUG abusers , *ETHYLENEDIAMINETETRAACETIC acid , *SODIUM fluoride , *POTASSIUM , *OXALATES , *COLLECTION & preservation of biological specimens , *DRUG stability , *DRUGS of abuse , *FORENSIC toxicology , *GAS chromatography , *HISTOLOGICAL techniques , *MASS spectrometry , *METHAMPHETAMINE , *POSTMORTEM changes , *TEMPERATURE - Abstract
Aims: The aim of this work is to test the stability of mephedrone added to whole blood collected from alive and dead mephedrone free-users and stored at three different temperatures (-20, +4 and +20°C) with and without preservatives up to 6 months, trying to establish the best storage condition in order to reduce possible analyte loss/degradation during the storage period.Materials and Methods: Different sources of blood were obtained as follow: 10 samples of blood came from 10 alive mephedrone free-users (mean age 34±15.8 years old) (Group 1), whereas 10 post mortem blood samples were obtained from 10 cadavers, in which the post mortem interval was between 24 and 36h (Group 2). The cause of death in post mortem cases (mean age 45±14.2 years old) was not drug related. Pools of blood were spiked with mephedrone at the concentration of 1mg/L and 1mL aliquots were transferred in 2mL Eppendorf capped tubes with and without preservatives as follow: with ethylenediaminetetraacetic acid (EDTA) 3%; with sodium fluoride/potassium oxalate (NaF/KOx) 1.67%/0.2%, respectively; without preservatives. All samples were stored at three different temperatures: -20°C, 4°C and 20°C and extracted and analyzed in duplicate by GC-MS according to a previously published method by Dickson et al., every other day during the first month and then weekly up to 6 months.Results and Conclusions: our study allow us to affirm that -20°C is the best storage temperature for mephedrone stability in ante-mortem and post-mortem blood samples in comparison to the other two tested temperatures (+4 and +20°C), showing higher values in both groups in samples stored with and without preservatives (p<0.0001). The comparison of Group 1 (samples coming from alive subjects) and Group 2 (post-mortem samples) highlights a better stability of mephedrone in Group 1 (p<0.001) at all tested storage conditions. Finally, the analysis of blood specimens stored with and without preservatives in both groups suggests that specimens stored with NaF/KOx maintain mephedrone stability better than those stored with EDTA (p<0.001) and those stored without preservatives (p<0.0001), therefore, we strongly recommend in order to maintain the highest mephedrone stability in blood, to store specimens at -20°C adding NaF/KOx as preservative. [ABSTRACT FROM AUTHOR]- Published
- 2015
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.