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Introduction: The analysis of saw mark characteristics on bones can provide useful information about the type of saw used to produce the injury/mark. This study aims at testing micro-computed tomography (micro-CT) analysis of false start saw marks produced on human bones by different types of saws in order to correlate the metrical characteristics of the saw with those of the mark. Material and Methods: This study was performed on 40 human defleshed metacarpal, metatarsal and phalanx bones, collected from individuals who donated their body to the University of Padua for research purposes. The saw marks examined in this study were generated using 5 new saws, including: 3 saws with alternating set and different teeth per inch (TPI; 5, 8 and 10, respectively) and 2 saws with wavy set and different TPI (18 and 24, respectively). All marks were inflicted manually by the same operator, holding the saw perpendicularly to the long axis of the bone, applying a single unidirectional stroke with an excursion of 15 cm in length, in order to simulate a false start. Each bone sample was scanned by a Skyscan 1172 HR micro-CT (Skyscan, Aartselaar, Belgium) with the following parameters: 14 μm isotropic voxel size, 51 Kv, 194 uA, exposition time 6050 ms, rotation step 0.7, frame averaging 2, 1280 x 1024 pixel Field of View. Reconstructions were performed by N-Recon Software (Skyscan, Aartslaar Belgium), subsequently, the bitmap files were converted in DICOM using the DICOM Converter® Software. Osirix (Open Source Software, Version 7.0.1) was used to perform all the measurements and elaborate the multiplanar (MPR) and 3D volumetric reconstructions. For each bone sample, on the MPR images, the following features were assessed: number of isolated marks on each bone, shape of the mark on the sagittal plane (rectangular or triangular), maximal depth and height measured on the sagittal plane and presence of metal residues. Results: All saw marks were detected by micro-CT. Marks produced by saws with 5, 8 and 10 TPI showed two incisions with different shapes and dimensions, which were in some cases in continuity one with the other. Saw marks produced by saws with 18 and 24 TPI showed a single mark with rectangular shape and different dimensions. Metallic residues were observed in several cases. Conclusions: The preliminary results of the study suggest that micro-CT could be a useful tool for the analysis of saw marks produced on human bones. The possibility to assess the morphometric features of each lesion indicates that this technique might provide accurate and precise information about the characteristics of the type of saw used. However, further studies including a wider number of samples and using a higher variety of cutting weapons need to be performed to fully assess the potentiality of the presented radiological technique.

Background. A review of the literature reveals many cases involving gunshot wounds altered by fire. The burning process can cause severe morphostructural changes (such as splits, shrinkage, crumbling) that are capable of altering or obscuring gunshot residue evidence and of producing post-mortem heat lesions on the skin, similar to gunshot wounds. Aim of the study. The present study is aimed at evaluating and comparing the amount and differential distribution of gunshot residue (GSR) through the analysis of unburned and burned gunshot wounds, performed with a microcomputed tomography (Micro-CT) technique. Materials and methods. Thirty-six experimental shootings at three different firing distances (5,15 and 30 cm) and 12 stab wounds, produced by a pointed instrument, were inflicted on human calves. Twenty-four specimens (6 for each tested distance and 6 for the stab wounds) were formalin-fixed, while the other were placed inside a wood-burning stove (4 minutes, 400°C), before formalin fixation. Each entrance and exit wound was sampled, cutting a parallelepiped specimen (1 x 1 x 2,5 cm) of epidermis, dermis and subcutaneous fat, surrounding and including the substance defect. All specimens were scanned using a Skyscan 1172 High Resolution Micro-CT, analyzing only particles with a density higher than 1000 HU, assumed to be GSR. Each sample was stained with hematoxylin–eosin and examined with a Leica DM-4000B optical microscope. Statistical analyses were performed using a two-way- and a one-way-ANOVA test. Results. As the unburned samples were easily recognizable, the visual and histological investigation on the burned samples cannot distinguish the entrance gunshot wounds from the stab wounds or the exit wounds. In the unburned specimens the Micro-CT analysis detected particles with a density higher than 1000 HU on the epidermis layer around the hole and on the dermis layer. In burned samples the GSR was detected only in the dermis layer. In burned and unburned samples GSR particles were not detected in either the stab wounds or in the exit holes. Statistical analysis reveals that GSR percentage was in inverse ratio to firing distance with a non-linear fashion and was abated after the burning process. Discussion and Conclusions. Micro-CT is a useful screening for the study of charred wounds, capable of distinguishing gunshot entrance wounds from the exit wounds or other similar lesions. Further examinations, even in different experimental conditions (temperature, time of exposure), are necessary in order to corroborate the correlation between firing distance and GSR percentage on samples damaged by fire.

INTRODUCTION. The two presented cases of forensic interest demonstrate the important role of cardio-pathological examination in ascertaining cause of death. Case 1. A man of 25 was found dead inside his car, while changing a tyre. As there was reason to suspect third-party liability, a forensic autopsy was ordered, to identify the cause, means and dynamics of death. Case 2. A man of 43, stopped by police in a state of acute drunkenness, was detained in the police station and later underwent compulsory hospitalisation in a hospital. He was treated with psychoactive drugs, and died few hours later. A forensic autopsy was ordered to ascertain the professional liability of doctors or of police, regarding possible maltreatment in the police station. METHOD. In both cases, procedures for circumstantial-clinical-documentary and necroscopic ascertainments were applied, including external examination, autopsy, histopathological and chemico-toxicological analyses. RESULTS AND DISCUSSION. Neither necroscopic ascertainments revealed extra-cardiac pathologies which might have caused the deaths. Macroscopic examination of both hearts revealed floppy and thickened mitral valve leaflets. The chordae tendineae were elongated, thickened but not ruptured. Hystopathologic examination revealed thickening of both spongiosa and fibrosa layers due to myxomatous infiltration and patchy fibrosis of the papillary muscles and of subendocardium. Chemico-toxicological analysis was negative in case 1, and showed therapeutic concentrations of psychoactive drugs in case 2. Analysis of circumstantial and clinical records showed that arrhythmia was triggered by physical effort in case 1 and by a combination of physical effort and emotional stress in case 2. Comparative analysis of the clinical, autoptic and chemico-toxicological results, in both cases, revealed arrhythmia due to ventricular fibrillation. CONCLUSIONS. Sudden cardiac death is the result of interaction between pathological substrate and an acute functional change, or trigger, eligible to cause an autonomic imbalance with increased adrenergic tone. In these cases, the pathological substrate, consisting of patchy-fibrosis of the myocardium, typical of mitral valve prolapse, involved dispersion of ventricular repolarisation. The trigger, acting on this substrate, led to a delayed after-depolarization and inhomogeneus electric cardiac response, with ventricular fibrillation and sudden death. In the ascertained absence of data indicating natural extra-cardiac, traumatic and/or toxic pathologies, these two cases demonstrate the important role of cardio-pathological examination in defining cause of death. In these contexts, it is essential to recognise mitral valve prolapse as the substrate eligible to trigger a lethal arrhythmia and to identify the triggers, their interaction, and the possible correlation with criminal dynamics.

After attending this presentation, attendees will understand the diagnosed lesion. This presentation will impact the forensic science community by stressing the importance of performing histological examination in any iatrogenic deaths to recognize underlying diseases and their eventual causal role in determining the fatality. Percutaneous tube thoracostomy is a standard therapy for a number of pulmonary disorders. Even if it remains the most widely performed procedure to manage blunt or penetrating chest traumatism, and it is generally considered a simple procedure, this life-saving maneuver can be frequently associated with several complications, such as lung or heart perforations, arterial or venous injuries, neurological dysfunctions, injuries to the oesophagus, phrenic nerve and abdominal organs, bronchocutaneous fistula, and perforations of the mediastinal pleura with subsequent contralateral pneumothorax. A case of a 76-year-old man, admitted to a peripheral hospital after a car accident, presenting bilateral flail chest, and subcutaneous emphysema is presented. Bilateral chest tubes were placed between the anterior and the mid-axillary lines. On the 3rd and 9th day of hospitalization the patient underwent surgical stabilization of bilateral flail chest with Kirshner wires and metal plates. The postoperative recovery was characterized by multiple recurrences of pneumothorax and subcutaneous emphysema with oxygen desaturation. For these reasons several bilateral drains were inserted with the trocar technique, the last one on the 25th day of hospitalization. A control CT scan showed that the tip of the chest tube, inserted between the anterior and the midaxillary line, was located in the parenchyma of the left lung. Immediately after the withdrawal of the drainage tube the patient became unstable with low blood pressure and tachycardia, and was intubated with a double-lumen tracheal device. A fibrobronchoscopy performed through the tracheal tube revealed profuse hemorrhagic secretions. Because of the severe clinical conditions, the patient was transferred to our hospital where, despite multiple blood transfusions, he arrived pulseless and died after 60 minutes of cardiopulmonary resuscitation. At autopsy the victim was found to be affected by an extensive hemothorax resulting from the laceration of a dilated vessel on the anterior surface of the inferior lobus of the left lung. Histology revealed that the vessel consisted of an “angiomatoid lesion,” the distal component of a plexiform complex, the hallmark of plexogenic pulmonary arteriopathy, an idiopathic disease that may accompany primary pulmonary hypertension. The risk of lung perforation during tube thoracostomy depends on several factors related to the patient (pulmonary contusion, pleural adhesion, adult respiratory distress syndrome, age above 60, mechanical ventilation) or to the method used for the insertion of the chest tube. Particularly, lung perforations have been reported more frequently with the trocar technique, where the insertion is determined by a metal rod projecting slightly from the tip of the tube, rather than the blunt dissection technique, where the penetration of the tube through the chest wall is prepared with a Kelley clamp. In the reported case, even if the trocar insertion procedure was performed correctly, the penetration of the metal rod into the lung parenchyma produced a tear of a sub-pleural angiomatoid lesion. Initially the catheter blocked the blood flow through the iatrogenic injury, but its removal generated a profuse and extensive bleeding into the pleural space. The treatment of choice in such cases is an emergency resuscitative thoracotomy, defined as a thoracotomy performed immediately in the emergency room/department or in the operating room, because it enables a fast identification and suture of the vascular injury. However, when huge and dilated vessels are lacerated with subsequent extensive pleural hemorrhage (as in the reported case), the outcome is very poor. Thus, the most important thing is to prevent similar emergency conditions by choosing the blunt dissection technique instead of the more dangerous trocar insertion method, particularly in patients affected by adult respiratory distress syndrome or pulmonary hypertension that show an increased incidence of peripheral venous ectasias. It is believed that the case could be of interest for the forensic community not only for the singularity of the reported lesion, but also for underlining once again the importance of performing histological examination in any iatrogenic deaths to recognize underlying diseases and their eventual causal role in determining the fatality.

Introduzione Ad oggi, tutte le procedure di analisi impiegate nella stima della distanza di sparo prevedono la valutazione della distribuzione, sulla superficie bersaglio, del gunshot residue (GSR). Presentiamo un approccio alla determinazione del firing range basato sull’applicazione della TC spirale multi-slice su ferite d’arma da fuoco prodotte sperimentalmente su cute umana. Materiali e metodi Campione casistico: 6 gambe umane di soggetti sottoposti in vita ad amputazione chirurgica, sezionate in segmenti di circa 6 cm di lunghezza. Prove di sparo: sono state eseguite utilizzando una pistola semiautomatica Beretta Mod.81 calibro 7.65mm; mediante supporti rigidi dell’altezza di 5 cm, 15 cm e 30 cm, sono state effettuate 6 prove di sparo per distanza, per un totale di 18 prove. Ogni prova è stata eseguita su di un differente segmento di arto. Analisi radiologica: ogni segmento è stato scansionato con TC spirale multi-slice a 64 strati; le acquisizioni TC sono state ricostruite in 3D secondo diverse tecniche. Risultati: Nei colpi sparati a 5 cm di distanza è stato rilevato materiale radio-opaco localizzato concentricamente rispetto al foro d’entrata; nei colpi sparati a 15 cm di distanza sono state rilevate aree radio-opache di aspetto puntiforme nell’area circostante il foro d’ingresso. Nei colpi sparati da 30 cm e in tutti i fori d’uscita non sono stati rilevati residui radio-opachi. Le immagini 3D hanno permesso la ricostruzione dei tramiti prodotti dai proiettili. Conclusioni: L’analisi con TC multi-slice consente di discriminare i colpi sparati a 5 cm da quelli sparati a 15 cm in base all’entità e alla morfologia dei depositi radio-opachi di GSR; costituisce, inoltre, un valido ausilio nell’identificazione del foro d’entrata. Tuttavia, già a 30 cm non è in grado di rilevare residui di sparo. Trattasi, pertanto, di una tecnica rapida e di facile esecuzione, spendibile nella determinazione della distanza di sparo per colpi d’arma da fuoco esplosi da distanze ravvicinate, nonchè nella diagnosi differenziale tra foro d’entrata e di uscita, sebbene presenti sensibilità e specificità inferiori rispetto ad analisi istochimiche, di microscopia elettronica e radiologiche.

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A 54-year-old Caucasian male presented to our emergency department because he had self inserted a transparent plastic and flexible tube into the urethral meatus, during erotic games. A plain pelvic x-ray film and an abdominal ultrasound were executed to determine the size, shape, orientation and location of the foreign body, and any eventually associated visceral injuries or complications. As results, a long tube of about 50 cm was described entering the urethra and reaching the bladder cavity in which the tube was folded and wrapped, in absence of any visceral complication. The patient underwent an urgent urethrocystoscopy resulting in the retrieval of both the two recognized foreign bodies by an endoscopic basket extraction. To complete the therapeutic approach, we focused also on the possible psychiatric implications of the self insertion of a foreign body into the urethra, and the initial evaluation reached the diagnosis of depression. The self introduction of a foreign body into the urinary tract represents an index of potentially harmful "self-destructive" behaviors. If the self destructive and/or suicidal ideations are not recognized in the clinical setting and the patient subsequently self inflicts an injury or commits suicide, the urologist may face legal problems related to the lack of diagnosis and treatment, potentially interpretable as a medical error, and thus as a reckless conduct.

We report the case of a 53-year-old man suffering from the contemporary onset of penile Mondor's disease and high-flow priapism 10 days after a transrectal prostate biopsy. We analyzed whether these pathological conditions were causally related to the biopsy, and the role of urologist regarding the onset of one or both the diseases. Critically evaluating the clinical picture and the procedure used for the biopsy, we were able to recognize a connection between the office procedure and the onset of the high-flow priapism, otherwise than for penile Mondor's disease. Our report is of value for urologists, making them aware of such possible complications, and for forensic experts that might have to deal with similar cases, as it demonstrates only a partial involvement of urologist in this clinical setting.

In Italy, recent legislation (Law No. 10/2020) has tuned regulations concerning the donation of one's postmortem body and tissues for study, training, and scientific research purposes. This study discusses several specific issues to optimise the applicability and effectiveness of such an important, novel regulatory setting. Some of these unsolved issues may involve the grantees of teaching and training activities, the role of academic anatomical institutes, the role of family members in the donation process, the universal time limit indicated for any donation, the handling of corpses, and the limited body donation and its subordination to the donation of organs and tissues. Critical issues arise concerning the learners, the type of training and teaching activities that can be planned, the position of academic anatomy institutes, the role of family members in the donation process, the time frame of the donation process, the eligibility of partial donation, or the simultaneous donation of organs and tissues to patients awaiting transplantation. In particular, a universal time limit for donations (i.e., one year) makes it impossible to plan the long-term use of specific body parts, which could be effectively preserved for the advanced teaching and training of medical students and surgeons. The abovementioned conditions lead to the limited use of corpses, thus resulting in the inefficiency of the whole system of body donation. Overall, the donors' scope for the donation of their body could be best honoured by a more flexible and tuneable approach that can be used on a case-by-case basis. Furthermore, it is deemed necessary to closely monitor the events scheduled for corpses in public nonacademic institutions or private enterprises. This paper presents useful insights from Italian anatomists with the hope of providing inspiration for drafting the regulations. In conclusion, this paper focuses on the critical issues derived from the recently introduced Italian law on the donation and use of the body after death and provides suggestions to lawmakers for future implementations.

Purpose The decomposition process of human bodies in marine environment is not well understood, and it is influenced by external variables related to the geographical area where the body is submerged. We report the application of two decomposition scores, the Heaton’s score and the van Daalen’s score, on a casuistry of human bodies recovered from the Northern Adriatic Sea. The aims of this study are to verify whether the marine environment of a Mediterranean climate area may affect the applicability of both scores and to develop a prediction model that can be applied on bodies recovered in salt water. Methods A retrospective study was performed on 61 human bodies recovered between 2005 and 2019 from coastal water of the Northern Adriatic Sea nearby the Italian regions Emilia-Romagna and Marche. For each of the 61 cases included, the Total Aquatic Decomposition Score (TADS) was calculated with the Heaton’s score and the Van Daalen’s score. The prediction model was assessed through multiple regression analyses, and the determination coefficients (r2) between TADS and PMSI (expressed in days) and between TADS and Accumulate Degrees Days (ADD) were studied. The prediction model was applied to the entire case sample, to bodies recovered during the warm season and to bodies recovered during the cold season. Results All bodies were recovered floating, and a very poor scavenging activity was observed. The regression analyses showed a strong correlation between the TADS and the total case sample using both scores and both independent variables (PMSI and ADD). The determination coefficients were greater than 0.95 also when considering the total case sample. Discussion The proposed prediction models are not significantly influenced by seasonality, contrarily to what observed on bodies recovered in fresh water in the same climate area. However, the ADD model, which also consider the water temperature, should be preferred for higher decomposition stages. This study helps increase the accuracy of PMSI estimation in bodies recovered from a marine environment of the Northern Adriatic Sea.

Purpose The methods developed in recent years for the assessment of the Postmortem Submersion Interval (PMSI) have proven to be promising, but are strictly related to specific geographical areas or climates. The aim of this study is to assess the suitability of two of the most recent total aquatic decomposition scores (TADS) for the determination of the PMSI in bodies recovered from fresh water in an area of Mediterranean climate in the last 15 years. To do this, the correlation coefficient (r2) between PMSI and Accumulate Degrees Days (ADD) or PMSI and days was studied. Methods The correlation between PMSI (expressed in days or in ADD) and the TADS was evaluated considering: (a) bodies recovered during the entire period; (b) bodies recovered during the cold season; (c) bodies recovered during the warm season. A linear regression analysis was set comparing the statistical significance of a model plotting TADS versus ADD, and another model plotting TADS versus PMSI (expressed in days) for both scores. Results Scores were scarcely applicable when considering the entire casuistry, as regression models showed low r2 values, but both scores showed high correlations after dividing the cases into 2 groups. In fact, after performing the seasonal partition, we observed a strong correlation between PMSI and TADS, using either of the scores. Conclusion This study helps increase the accuracy, reliability, and validity of PMI estimation in bodies recovered from freshwater in an area of temperate climate, such as Northern Italy, supporting the need to establish regionally-specific equations for estimating PMI in a forensic context.

Introduction Among the several techniques proposed for the estimation of the Post Mortem Interval (PMI), the analysis of odorous amines has been applied in the past, with conflicting results. The aims of this study are: (i) to develop and validate a GC–MS method for the determination of putrescine (PUT) and cadaverine (CAD) in the human brain (validation study) and (ii) to study the relation of PUT and CAD concentration in the human brain and the PMI (decomposition study). Materials and methods Validation study. Analysis has been performed through GC–MS after a liquid-liquid extraction and a single step-derivatization for the identification and quantification of odorous amines in brain cortex samples. The standard protocol used in forensic toxicology, slightly modified for endogenous compounds according to recent guidelines, was used for validation. Decomposition study. Three uninjured human brains were sampled during the autopsy of three fatal traumatic cases. Along a 120-hour period of decomposition under experimental conditions, each brain was sampled along predetermined time intervals. Results Validation study. Both PUT and CAD validation parameters were within the acceptable values defined by the Scientific Working Group for Forensic Toxicology (SWGTOX), with better selectivity, linearity, accuracy and precision values for PUT. Decomposition study. A significant relationship between PUT and CAD levels and PMI has been demonstrated through statistical analysis with a correlation coefficient of 0.98 for PUT and 0.93 for CAD (p Conclusion Although further experimental studies on a wider number of samples are necessary, the results of this study suggest a possible role of polyamine levels in brain cortex for the estimation of PMI.

Item does not contain fulltext CONTEXT: Live surgery is an important part of surgical education, with an increase in the number of live surgery events (LSEs) at meetings despite controversy about their real educational value, risks to patient safety, and conflicts of interest. OBJECTIVE: To provide a European Association of Urology (EAU) policy on LSEs to regulate their organisation during urologic meetings. EVIDENCE ACQUISITION: The project was carried out in phases: a systematic literature review generating key questions, surveys sent to Live Surgery Panel members, and Internet- and panel-based consensus finding using the Delphi process to agree on and formulate a policy. EVIDENCE SYNTHESIS: The EAU will endorse LSEs, provided that the EAU Code of Conduct for live surgery and all organisational requirements are followed. Outcome data must be submitted to an EAU Web-based registry and complications reported using the revised Martin criteria. Regular audits will take place to evaluate compliance as well as the educational role of live surgery. CONCLUSIONS: This policy represents the consensus view of an expert panel established to advise the EAU. The EAU recognises the educational role of live surgery and endorses live case demonstration at urologic meetings that are conducted within a clearly defined regulatory framework. The overriding principle is that patient safety must take priority over all other considerations in the conduct of live surgery. PATIENT SUMMARY: Controversy exists regarding the true educational value of live surgical demonstrations on patients at surgical meetings. An EAU committee of experts developed a policy on how best to conduct live surgery at urologic meetings. The key principle is to ensure safety for every patient, including a code of conduct and checklist for live surgery, specific rules for how the surgery is organised and performed, and how each patient's results are reported to the EAU. For detailed information, please visit www.uroweb.org.

Percutaneous tube thoracostomy (PTT) remains the most widely performed procedure to manage blunt or penetrating chest traumas. This life-saving manoeuvre can be frequently associated with complications. We present the case of a 76-year-old man, admitted to a peripheral hospital after a car accident and treated by PTT, who died shortly after the withdrawal of the chest tube. At autopsy, the victim was found to be affected by an extensive haemothorax resulting from the perforation of a subpleural angiomatoid lesion. The histopathological characteristics and the pathogenesis of the iatrogenic injury involving the vascular abnormality, along with its causal role in determining the fatal haemothorax, are critically discussed under both clinical and forensic points of view.