257 research outputs found
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)
Su di un caso di morte intrauterina da trauma contusivo: problematiche patologico-forensi in tema di nesso causale
No full textSu alcuni casi di rottura post-traumatica dell’aorta toracica a seguito di incidente stradale
No full text
DM 5.2.92, Tabella indicativa delle percentuali d’invalidità per le minorazioni e malattie invalidanti: immota manet?
No full textCase study of sudden cardiac death caused by lypomatous hypertrophy of the interatrial septum.
No full textLipomatous hypertrophy of the interatrial septum (LHIS) is a benign cardiac mass characterized by fat accumulation in the interatrial septum. It may represent an incidental autopsy finding or may be associated with atrial arrhythmias, obstructive symptoms or sudden death. The case described here is a peculiar case of sudden death secondary to LHIS
Malaria maligna: una diagnosi possibile anche nei paesi occidentali
No full textLa malaria è una malattia infettiva causata da un protozoo del genere Plasmodium, trasmesso all'uomo attraverso la puntura di zanzare del genere Anopheles. Il Plasmodium falciparum causa la forma più grave di malaria, definita come terzana maligna, con sindromi clinicamente severe che possono progredire rapidamente fino al decesso. Dagli anni ’50 i casi di malattia documentati in Italia sono importati da soggetti provenienti da Paesi in cui il microrganismo è endemico. L’odierna società globalizzata impone la massima attenzione verso il potenziamento della sorveglianza delle malattie trasmesse da vettori, sia sul territorio nazionale che europeo. In questo report descriviamo un particolare caso di fatale malaria maligna in un soggetto di ritorno dall’Africa. La paziente, affetta da mieloma multiplo non trattato, tornata da un recente viaggio in Centro Africa (senza aver effettuato profilassi anti-malarica), giunge in PS per astenia, cefalea e febbre di recente insorgenza; vigile, eupnoica, non distress respiratorio, obiettività nei limiti. Negativa la ricerca di SARS-CoV-2. Risultando positiva la ricerca di Plasmodium falciparum la paziente viene trasferita in altra struttura per l’isolamento e per la terapia con Artesunato. Durate il ricovero si assiste ad un repentino e inesorabile peggioramento delle condizioni generali con parestesie e dolore alle estremità evoluto poi in acrocianosi ed ischemia su vaste aree di arti e tronco; ipoglicemia severa; acidosi severa e iperlattacidemia; peggioramento della funzione respiratoria con necessità di trasferimento in rianimazione con sedazione, intubazione, emotrasfusioni ed emodinamica sostenuta da inotropi. Dopo 3 giorni dall’ingresso shock sistemico non responsivo ai trattamenti con noradrenalina ad alti dosaggi; IRA, acidosi metabolica severa, iperkaliemia. Completavano il quadro clinico terminale MOF, forte anemizzazione (Hb a 7 g/dl), necrosi alle estremità per grave compromissione del microcircolo. Parassitemia: 4.6% 167,383 trofozoiti/microl di P. Falciparum. Si constatava il decesso dopo 5 giorni dall’acceso in PS e si eseguiva esame necroscopico che evidenziava un quadro di CID massiva con vaste e polifocali emorragie intracraniche; scompenso cardiaco con plurime aree di ischemia miocardica acuta; edema polmonare con aree di addensamento parenchimale. L’istologia metteva in luce reperti tipici di infezione da di P. Falciparum: emorragie cerebrali multifocali con diffuso pigmento malarico e presenza di parassiti intraeritrocitari; granulomi di Durck; aree di necrosi emorragica del miocardio con note di miocardite; accumuli di pigmento malarico, emorragie e eritrociti parassitati diffusi anche a fegato, milza, reni e polmoni. Questo caso richiama il valore prognostico dell’interessamento cardio-vascolare e neuro-cerebrale dell’infezione malarica e le devastanti potenzialità lesive di una infezione da P. Falciparum e mette in luce l’importanza di una diagnosi repentina al fine di garantire un tempestivo approccio diagnostico-terapeutico in pazienti sintomatici provenienti da regioni dove la malaria è endemica
The genetics of anorectal malformations: A complex matter
No full textBecause the spectrum of anorectal malformations is wide, genetic investigations of these anomalies should include the study of multigenic models presenting variable penetrance and expressivity. Current knowledge in clinical genetics, cytogenetics, and molecular genetics of anorectal anomalies are reviewed. The analysis of associated anomalies (that are found in more than 60% of anorectal malformations) is an important aspect of the molecular study, because the association of anomalies with mendelian transmission or with a recognized causative gene can be an essential starting point for further investigations. In the present study, the authors focus on associated secret anomalies, urethral malformations, and intestinal dysganglionoses. In particular, associated sacral anomalies could be a partial expression of the Currarino syndrome, which represents the only association for which genetic evidence has been demonstrated by linkage analysis. The authors studied a four-generation pedigree with recurrence of the Currarino syndrome, and the haplotype reconstruction confirmed that the gene segregating in this family is located in the 7q36 region. The collection and study of families with multiple cases of anorectal malformations could show whether different phenotypes are caused by single genes.Because the spectrum of anorectal malformations is wide, genetic investigations of these anomalies should include the study of multigenic models presenting variable penetrance and expressivity. Current knowledge in clinical genetics, cytogenetics, and molecular genetics of anorectal anomalies are reviewed. The analysis of associated anomalies (that are found in more than 60% of anorectal malformations) is an important aspect of the molecular study, because the association of anomalies with mendelian transmission or with a recognized causative gene can be an essential starting point for further investigations. In the present study, the authors focus on associated secret anomalies, urethral malformations, and intestinal dysganglionoses. In particular, associated sacral anomalies could be a partial expression of the Currarino syndrome, which represents the only association for which genetic evidence has been demonstrated by linkage analysis. The authors studied a four-generation pedigree with recurrence of the Currarino syndrome, and the haplotype reconstruction confirmed that the gene segregating in this family is located in the 7q36 region. The collection and study of families with multiple cases of anorectal malformations could show whether different phenotypes are caused by single genes
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 traffic accident resulting in a degloving injury of the passenger: Case report and biomechanical theory
No full text- …
