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CONTRIBUTION OF ASTHMA IN OPIATE DEATHS
No full textSome studies have shown a connection between asthma deaths and opiate abuse, but the process in which opiates exacerbate asthma is still unclear. Opiates may impair judgment during an acute asthma attack, leading to inadequate treatment. Alterations in mental status may increase aspiration risk. Some studies have also demonstrated an opiate-induced bronchoconstriction. In the present study, data on opiate deaths in the Department of Forensic Sciences of Sapienza University of Rome and in Cook County Medical Examiner’s Office in Chicago (USA) have been collected. A comparison was performed between the opiate users who had a history of asthma and the opiate users who did not, regarding demographic, anamnestic, seasonal, autopsy, histological and toxicological findings. A histological grading of asthma changes was also performed. A history of asthma was found in 78 out of 855 cases of opiate deaths (9.12%). The majority of people who died due to opiate intoxication and had a history of asthma were males and African-American. Among asthma cases, the levels of morphine in blood ranged between 23-1,740 ng/ml (Mean: 209.51 ng/ml), the levels of blood 6-MAM ranged between 12-280 ng/ml (Mean: 80.6 ng/ml) and the levels of blood codeine ranged between 24-34 ng/ml (Mean: 26.6 ng/ml). Regarding the grading of asthma, we found 32 cases with severe asthma, 19 with moderate asthma and 27 with mild asthma. We randomly selected 80 opiate deaths without a history of asthma. The levels of morphine in blood ranged between 1,115-5,280 ng/ml (Mean: 3,450.89 ng/ml), the levels of blood 6-MAM ranged between 70-460 ng/ml (Mean: 321.1 ng/ml) and the levels of blood codeine ranged between 23-52 ng/ml (Mean: 45.7 ng/ml). Preliminary statistical analyses revealed that the levels of blood morphine were significantly higher in non asthma cases compared with asthma cases. These findings may support the hypothesis that the quantity of morphine needed to cause death in asthmatic can be lower than the quantity of morphine needed to cause death in non asthmatic: anatomic and physiologic changes of asthma can play a role in deaths due to opiate, maybe determining a higher susceptibility to the effects of these substances (bronchoconstriction, respiratory depression, etc)
La responsabilità professionale del chirurgo plastico nella mastoplastica additiva.
No full textRIASSUNTO
Il tema della responsabilità professionale del medico è apparso nel tempo in continua evoluzione in virtù dei continui indirizzi giurisprudenziali, sia civili che penali, che hanno determinato un incessante rimaneggiamento della dottrina in merito alle problematiche connesse all’operato medico. Negli ultimi anni infatti la classe medica è stata oggetto di innumerevoli battaglie legali inoltrate da pazienti insoddisfatti delle prestazioni mediche ottenute: prima fra tutte la branca della chirurgia plastica. Con riferimento a tale disciplina, il seguente lavoro trae spunto da una personale casistica inerente 44 richieste di risarcimento del danno, in seguito a presunta condotta medica erronea, da parte di donne sottoposte ad intervento chirurgico di mastoplastica additiva. Vengono così poste in risalto, le cause di insoddisfazione delle pazienti, gli errori professionali ricorrenti ed analizzati gli elementi costituenti l’errore, al fine di fornire al chirurgo plastico un’ampia prospettiva circa le motivazioni che inducono l’avvio di un’istanza risarcitoria. In relazione alla giurisprudenza attuale in tema di responsabilità professionale e consenso e dall’analisi degli errori intercorsi nella relazione medico- paziente si sottolineano alcuni aspetti da curare nella compilazione della cartella clinica.
SUMMARY
The jurisprudential evolution on matter of sanitary responsibility in civil and criminal worlds had produce continuous change of judge’s point of view of the problems connected to the doctor’s action. Often medical doctors are sued to the Court by unhappy patients, asking to justify their professional actions: among the specialists the plastic surgeons are frequently involved in medical litigation cases.
Aim of this paper is to present the Authors experience with 44 claims evaluated after an augmentation mammaplasty procedure. The unsatisfactory reasons leading to medical litigation are analyzed. In this article we report the recurrent causes of dissatisfaction of the patients and the professional errors when occurred with an analysis of the constituent elements of the error. The aim of this study is to supply to the plastic surgeon a wide perspective of the motivations that induce the patients to start the judicial procedure , as well as highlighting some elements asking for attention in the doctor- patient relationship
A simple depressed skull fracture in an old man with paget disease: forensic implications in a rare case
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A scream from the past. A multidisciplinary approach in a concealment of a corpse found mummified.
No full textAfter attending this presentation, attendees will understand the necessity of a multidisciplinary approach in solving difficult forensic cases such as mummified bodies. This presentation will impact the forensic science community by showing the methodological approach in cases in which mummified bodies are found. Mummification is a drying of the tissues in place of liquefying putrefaction. During mummification, water evaporates from tissues, preventing bacterial putrefaction. Mummification commonly occurs in a dry environment, preferably with a moving air current; this is usually, but not exclusively, a warm place with a specific degree of environmental oxygenation. More recently, the discovery of a mummified body in a domestic environment is rare and is generally due to the subject’s social isolation while alive. An 83-year-old white male was found mummified and sealed with tape, covered by two plastic bags, and walled within a masonry ledge built inside his bedroom. The mummification process occurred in an environment characterized by the rare process of the Anaerobiasis mummies. In this case, during the police investigation of an apartment in the suburbs of Rome, a silicon-sealed door on the 2nd floor was found. Upon opening the door, a messy bedroom with a silicon-sealed window was discovered. The floor was dirty, covered with white- colored dust and rubble. In one corner of the room, an abnormal protrusion in the wall was observed. Once the ledge was demolished, a dead body in a semi-supine position with the back on the floor and the legs on the wall was found inside. Two plastic bags covered the body. Once the plastic bags were removed, the body was entirely wrapped in brown adhesive tape. No microfauna near the body were observed. The apartment owner said the body was that of his father who died two years previously of cardiovascular disease. After the father’s death, the son concealed the corpse in order to obtain his annuity retirement benefits. Upon external examination, the skin showed a dry appearance with a yellow to brown color and a leathery consistency. No traumatic injuries were present on the body surfaces. Dewatering mold spores were observed on the body surface, especially on the feet. A postmortem computed tomography scan was performed before the traditional autopsy. The 3D rendering of the Digital Imaging and Communications in Medicine (DICOM) images using the open source software Osirix® on a MacOSX® computer was produced and revealed no traumatic injuries. At the postmortem examination of the heart, significant atherosclerosis involving left anterior descending and the left circumflex coronary arteries was present. Toxicological analyses on the organ samples were negative for drugs and alcohol. At the microscopic examination of the skin of the hand, forearms, and legs, no injuries or other anomalies were observed. At the microscopic examination of the heart, strongly decomposed tissue with interstitial fibrosis and wavy fibers was observed, consistent with an acute ischemic injury. The cause of death was due to atherosclerotic cardiovascular disease and the manner of death was pronounced as natural. A natural mummification process usually requires 6 to 12 months in adult subjects to be completed, and an environment with hot, dry, moving air is required. In this case, the body was completely mummified despite these environmental conditions not being present. As the body was completely wrapped in tape and walled in, an anaerobic environment could be inferred. Aufderheide underlines how exclusion of air would enhance preservation due to the inhibition of the putrefactive processes. At the same time, a casing that covers the corpse protects it from insects and scavengers. When a mummified body is found, the manner of death could be related to accident, suicide, homicide, and/or concealment of a corpse. On the one hand, forensic pathologists must know that a complete mummification process can occur in special environmental conditions, different from what is described in literature. On the other hand, when a mummified body is found, a multidisciplinary approach is required in order to reach the correct diagnosis. Thanks to the data concerning the crime scene, the autopsy findings, the radiological examination before the autopsy, and the histopathological and toxicological analyses, the resolution of a case can be possible even many years after the death of the subject
When the hidden features become evident: the usefulness of PMCT in a strangulation-related death
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When Life Makes No Sense — Suicide by More Than 150 Stab and Incised Wounds With Atypical Features.
No full textAfter attending this presentation, attendees will understand the difficulties in distinguishing between homicide and suicide when atypical sharp-force fatalities occur. This presentation will impact the forensic science community by demonstrating the relevance of a concrete methodological approach when the circumstances surrounding death are not clear. In these cases, a complete crime scene investigation should be always performed, followed by an autopsy examination and laboratory analyses. Deaths due to sharp force injuries are less common than other mechanisms of violent death. The most common manner of death associated with sharp force trauma is homicide, followed by suicide, while accidental fatalities are relatively rare. When a sharp force fatality with atypical features occurs, identifying the correct manner of death can be challenging for the forensic pathologists. At the crime scene, a large amount of blood is usually found due to the extensive blood loss from the skin injuries. Several features to distinguish between homicide and suicide are described in literature. The absence of the weapon, the presence of defensive wounds, and normally worn clothes are suggestive of homicide. The weapon at the crime scene and near the body, hesitation marks, and undressing are commonly related to suicide. Sometimes, it is possible for homicidal cases to have injuries that are indistinguishable from hesitation marks. A case of atypical sharp force suicidal death is presented. A 32–year-old White male was found unresponsive in the living room of his flat, in a supine position. A pool of blood surrounded the body, showing no signs of sliding or splashing. The postmortem changes were consistent with a time of death of approximately six hours before the discovery of the corpse. Clothes were worn only on the lower limbs. On the body surfaces, multiple, widespread sharp force injuries were observed. Near the right hand, a kitchen knife was present. During the examination of the house, multiple bottles of psychoactive drugs were found. According to the declaration of the victim’s parents, he had a history of bipolar disorder but no previous attempts of suicide were reported. No suicide note was found. More than 150 injuries, widespread stab and incised wounds, were present, involving different body regions. Most of the wounds were incised wounds. On the back, more than 20 incised wounds were present, even on the back of the neck. At the internal examination, the six deepest wounds that penetrated the body were identified. On the right supraclavicular region, one lesion went deep inside the soft tissue of the neck and involved the external jugular vein. Upon a layered in situ dissection of the anterior neck structures, a hemorrhage in the soft tissue surrounding the affected vessel was observed. On the left hemithorax, one lesion penetrated the thoracic cavity and perforated a rib, but no injuries to the internal organs were present. On the abdomen, four lesions penetrated the abdominal cavity and two of these injured the small intestine and the right common iliac artery. Toxicological analyses were negative for alcohol, medical drugs, and drugs of abuse. A 3D reconstruction of the dynamic was performed using the 3D rendering software Poser Debut® on a MacOSX® computer. Despite the scene circumstances and several aspects that were consistent with a suicidal death, the presented case combined several atypical aspects: the number of injuries — the total number was more than 150 considering cases of repeated incised wounds to the skin; the site of some wounds was not common (e.g., lesions observed on the back of the neck and the torso); there was a perforation of one rib by the knife; the toxicological analyses were negative, suggesting that the victim was in a state of manic psychosis characterized by dysphoria and paranoia and was determined to kill himself, despite being able to feel pain from the self-inflicted injuries. Suicides involving a large number of sharp force injuries have been described; however, when atypical features are present, distinguishing between homicide and suicide can be difficult. In such cases, the evaluation of all available data is necessary to find the correct manner of death
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