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Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: Drowning is the third leading cause of unintentional injury death worldwide, accounting for 7% of all injury related deaths[1]. The autopsy diagnosis of drowning is one of the major problems in forensic medicine, especially when there is delay in...

Gli autori effettuano una analisi delle caratteristiche che deve possedere il perito/consulente tecnico del Giudice nell'ambito dell'attività espletata nei casi di responsabilità professionale medica alla luce della Legge Balduzzi e di quanto dettato dal vigente Codice deontologico. Viene infine effettuato un escursus sul valore delle linee guida

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: The objective of virtopsy is not only to improve the objectivity of findings made by traditonal autopsy but also to solve those cases that are difficult to solve with conventional post-mortem examination. Modern cross-sectional imagingand...

In the past few years, contributions of molecular biology assays to the investigation of sudden juvenile death have permitted to clarify some of the pathogenetic aspects of sud-den arrhythmic death, opening the way to preventive action on victims’ relatives. We reviewed literature on the genetics of sudden juvenile death, and on molecular biol-ogy assays performed on autoptic samples. Biological investigation permits the detection of genetic mutations underlying the suscep-tibility to sudden cardiac death of individuals with rare inherited forms of arrhythmia (Long QT Syndrome, Brugada Syndrome, Lev’s disease etc.) through the analysis of criti-cal sequences codifying for ion channel subunits (HERG, KvLQT1, MinK, Mirp1, SCN5A, KCNQ1, KCNH2, KCNE1, KCNE2).The main objective of post-mortem investigation in sudden juvenile death is the detection of treatable monogenic inherited disorders, in order to prevent further deaths among the relatives of the deceased patient.

Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims. Sexual assault is a worldwide problem that has not yet been sufficiently acknowledged, as confirmed by analyses and studies carried out at different levels and in different contexts. Internationally, different approaches are taken to the collection of forensic evi- dence and to the clinical and psychological treatment of alleged victims. Italian law n.96, 1996, foreseeing norms regarding rape and abuse, finally gave signifi- cant relevance to sex crimes. In 2004, the European Commission for Justice Internal Affairs and Social Politics promoted the Daphne II pro- gram to support victims of rape and abuse, and the Ve.R.S.O. project - Network integration was incorporat- ed into our daily routine, and has been activated at the Policlinico “P. Giaccone” University Hospital of Palermo. Herein, we discuss the six years experience of a multidisciplinary team regarding application of the Ve.R.S.O. project protocol in the referral centre of Palermo, using the new guidelines for standard man- agement of victims. Our results start to give a per- spective on the frequency and type of population reaching our centre.

L’acido gamma-idrossibutirrico (GHB) è un neurotrasmettitore con effetti gaba-mimetici; si tratta di un composto endogeno, ma notoriamente usato per le applicazioni terapeutiche come anestetico per via endovenosa, come sedativo e per il trattamento della narcolessia. Dagli anni ‘80 è comune sostanza usata come doping, quindi emerge come droga da “tempo libero” nei rave-party; più recentemente, i supposti effetti afrodisiaci e la reale capacità di induzione di amnesia retrograda ne hanno indotto l’utilizzazione quale sostanza in grado di ridurre la capacità di resistenza della vittima di uno stupro annoverandola tra le cosiddette “date rape drugs” (Drug facilitated sexual assault, DFSA), e cioè sostanze psicoattive usate per lo stupro cosiddetto “dopo appuntamento”1. Nel presente contributo si riporta l’approccio metodologico relativamente a due differenti scenari di interesse forense: l’abuso del GHB con quadro di dipendenza patologica e l’uso del GHB come droga da stupro; gli Autori illustrano le modalità di indagine per determinare il GHB nelle differenti matrici biologiche. Conclusioni: gli scenari d’abuso qui presentati rafforzano il concetto che l’analitica tossicologica rivolta alla determinazione del GHB, per tutte le evenienze riguardanti l’uso/abuso e le possibili implicazioni legali, deve realizzarsi secondo canoni analitici convalidati.

Gli Autori esaminano gli apsetti salienti della quetione bioetica della nutrizione artificiale, facendo riferimento anche ai più recenti casi di spospensione dlla NA e approfondiscono gli correlati ad evntuali profili di responsabilità professionale

Gli Autori presentano il caso di una donna giunta alla 39,4 settimana di gestazione, regolarmente sottoposta ad esami clinici e strumentali che evidenziavano un decorso regolare della gravidanza eccetto oligoamnios. La paziente espletava il parto con feto nato vivo ma non vitale. L'esame esterno del cadavere evidenziava esclusivamente cianosi generalizzata. L'esame autoptico ha evidenziato cardiomegalia con incremento di tutte le cavità cardiache con rapporto cardio-toracico 6.5/8.5 ed un aspetto porcellanaceo delle pareti ventricolari di sinistra. All'istologia tale ispessimento era causato da fibroelastosi diffusa dell'endocardio associata a marcata miocitolisi colliquativa del miocardio subendocardico. Si sottolineano gli emergenti possibili profili di responsabilità inerenti l'errore nella diagnosi pre-natale e nell'approccio terapeutico nella fase immediatamente successiva al parto.

gli autori presentano due casi di displasia fibromuscolare (DFM) oggetto di indagine giudiziaria per ipotizzata responsabilità professionale nell'operato dei sanitari all'esordio clinico e nell'approccio chirurgico. Viene sottolineata la necessità di una rapida risoluzione chirurgica in ambiente specialistico e l'importanza delle linee guida che devono essere rispettate nell'approccio al pziente

Methadone (MTH) concentrations in those dying of MTH toxicity totally overlap concentrations where the presence of MTH is only an incidental finding, making it very difficult to make distinctions in actual cases. A biomarker, be it anatomical or biochemical for MTH toxicity is badly needed, particularly if that markers were known to disrupt effective ventilation. Because the brainstem houses the regulatory centers for cardiorespiratory-control enters, it would seem to be the most likely anatomical site to seek abnormalities in cardiorespiratory control. Objective To locate and describe the cells of nucleus of the solitary tract (TS)(NTS) in human brainstem and determine if neuronal cell death, either necrotic or apoptotic, within the TS of humans is more common in deaths due directly to MTH toxicity than with in the solitary tract itself. Design, setting, participants This was a single cohort study of MTH related decedents autopsied at a large university hospital. Each decedent had a recent history of non medical/illicit MTH use and had been pronounced dead in the field, prior to ever reaching the hospital. Complete autopsy and complete toxicology testing were performed on the formalin fixed brains of each individual. Multiple blocks were prepared of the area of interest, namely the tissue lying immediately between the inferior and the super colliculi. This volume, by definition, would have included the area of the Rostral Ventrolateral Medulla (RVLM), the location of the TS. Immunohistochemistry studies utilizing caspase-9 reaction (a protease enzyme involved in the process of preprogrammed death) were performed in order to estimate the degree and proportion of neuronal apoptosis, and also access the degree of classical necrosis within the NTS. Main outcomes and measures The primary outcome measure was the presence or absence of neuronal apoptosis and/or necrosis within the NTS. Results Cells displaying evidence of early apoptosis and advanced apoptosis, consisting primarily of nuclear fragmentation, admixed with other neurons displaying the features of classic necrosis were found. Evidence of classic necrosis was identifiable in most of the controls, though minor degrees of apoptosis were identifiable with Caspase staining and quantitative image analysis of immunohistochemical stains. Conclusions and Relevance: Our study shows that neurons, primarily along the TS, but occasionally in other cell nuclei (even controls) are vulnerable, both to direct MTH toxicity (via apoptosis) and indirectly (via hypoxia leading to classical cell necrosis). When MTH is found to be present in significant concentrations, but apoptotic lesions are absent, it would be reasonable to assume that MTH was not primarily the cause of cardiorespiratory arrest.