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ABSTRACT: Diaphragmatic hernias can be a pitfall for paediatric diagnostics, especially in the cases of late presentation, which can also have medico-legal ramifications as exposed. A three-year-old boy was taken to a children's hospital after an episode of abdominal pain and vomiting of food. A physical examination proved normal, with mild ketonuria being found and he was discharged. Three months later for the same signs and symptoms, he was taken once more to hospital, where he arrived in a state of cardiac arrest and died. A lawsuit was begun against the doctors who had examined him three months earlier. The autopsy found herniation of the abdominal organs into the left pleural cavity through a defect in the left hemidiaphragm. The cause of death was identified as cardiac tamponade caused by mechanical compression of multiple herniated abdominal organs. The histopathological examination revealed marked atelectasis of the left lung, with non-expansion of 60-90% of the alveoli which suggested an acute mechanism that proved fatal, and the doctors were acquitted. The features of this disease and the possible difficulties in its diagnosis highlight the need for the utmost attention in differential diagnosis, even at an age where the discovery of a diaphragmatic hernia is exceedingly rare.
Medicine, science, and the law 08/2012; · 0.45 Impact Factor
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ABSTRACT: The criminal use of weapons is a very topical issue in the industrialized countries and worldwide, and a reconsideration of the legislation governing their possession is warranted. We retrospectively analyzed the homicides and suicides involving the use of firearms and piercing and/or cutting weapons recorded at the Medicolegal Bureau in Milan from January 1, 1993, to December 31, 2008. First we considered the clinical histories of the deceased and the circumstantial details of their deaths, then we examined the data relating to the cause of death recorded in the autopsy reports. Our case series consisted of 414 homicides (54.2%) and 350 suicides (45.8%). Firearms were responsible for more deaths (64%) than piercing and/or cutting weapons (36%). The firearms involved were legally licensed in 40% of cases (suicides) and illegal in 22% (homicides). Our findings suggest the need to review the criteria considered for the issue of firearms licenses, in Italy at least.
Journal of Interpersonal Violence 08/2012; · 1.64 Impact Factor
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ABSTRACT: Demonstration of the presence of lead residues deriving from gunshot in skin and underlying tissues is essential for the correct forensic analysis of numerous legal cases. Optical microscopy remains the fastest, cheapest diagnostic technique, even though its sensitivity and specificity are poor because of the scarce quantity of histological tissue that can be examined and possible environmental lead pollution. To confirm the presence of lead from gunshot residues, we applied to histological sections of human skin a technique proposed by Owens and George in 1991 for macroscopic detection of lead on the clothing of shooting victims, involving a reaction with sodium rhodizonate and subsequent confirmation by color change on application of HCl. Our results demonstrate the technical possibility of using this macroscopic technique even on histological samples and support the need for further studies on a larger series of cases correlated with the type of ammunition and firing distance.
Journal of Forensic Sciences 05/2011; 56(3):771-4. · 1.23 Impact Factor
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ABSTRACT: We describe a case of complete decapitation following a motorcycle accident in which the victim was wearing a full face helmet. A young man lost control of his motorcycle and was thrown about 20 m, hitting his head against the barrier separating a tramline from the road. The resulting trauma caused his decapitation, the only fatal wound ascertained by the various forensic investigations. The authors present this rare case and compare it against the other two cases reported in the literature, providing some observations on the ways in which this injury can come about. The absence of abrasions or signs that the wound edges came into contact with a metal structure, the presence of signs of impact on the side of the helmet and the finding of a transversal fracture at the base of the skull point to the violent action of a side-to-side opposite force, due to the resistance provided by the lower edge of the protective helmet.
Forensic science international 01/2011; 207(1-3):e48-50. · 2.10 Impact Factor
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ABSTRACT: To see whether in acute lung injury 1) compression of the lungs caused by thoracoabdominal constriction degrades lung function and worsens ventilator-induced lung injury; and 2) maintaining end-expiratory transpulmonary pressure by increasing positive end-expiratory pressure reduces the deleterious effects of chest wall constriction.
Experimental study in rats.
Physiology laboratory.
Acute lung injury was induced in three groups of nine rats by saline lavage. Nine animals immediately killed served as a control group. Group L had lavage only, group LC had the chest wall constricted with an elastic binder, and group LCP had the same chest constriction but with positive end-expiratory pressure raised to maintain end-expiratory transpulmonary pressure. After lavage, all groups were ventilated with the same pattern for 1½ hrs.
Transpulmonary pressure, measured with an esophageal balloon catheter, lung volume changes, arterial blood gasses, and pH were assessed during mechanical ventilation. Lung wet-to-dry ratio, albumin, tumor necrosis factor-α, interleukin-1β, interleukin-6, interleukin-10, and macrophage inflammatory protein-2 in serum and bronchoalveolar lavage fluid and serum E-selectin and von Willebrand Factor were measured at the end of mechanical ventilation. Lavage caused hypoxemia and acidemia, increased lung resistance and elastance, and decreased end-expiratory lung volume. With prolonged mechanical ventilation, lung mechanics, hypoxemia, and wet-to-dry ratio were significantly worse in group LC. Proinflammatory cytokines except E-selectin were elevated in serum and bronchoalveolar lavage fluid in all groups with significantly greater levels of tumor necrosis factor-α, interleukin-1β, and interleukin-6 in group LC, which also exhibited significantly worse bronchiolar injury and greater heterogeneity of airspace expansion at a fixed transpulmonary pressure than other groups.
Chest wall constriction in acute lung injury reduces lung volume, worsens hypoxemia, and increases pulmonary edema, mechanical abnormalities, proinflammatory mediator release, and histologic signs of ventilator-induced lung injury. Maintaining end-expiratory transpulmonary pressure at preconstriction levels by adding positive end-expiratory pressure prevents these deleterious effects.
Critical care medicine 09/2010; 38(12):2358-64. · 6.37 Impact Factor
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ABSTRACT: Metal structures--especially of stainless steel, titanium and their alloys (biomaterials)--are widely used in orthopaedic practice and the subject of constant study in bioengineering and preventive medicine. This study presents the first experience of forensic research into the presence of permanent tissue variations around metal implants in various bone structures for the purpose of identification, with particular reference to skeletal remains or severely decomposed corpses in the absence of other identifying elements. The evaluation was conducted on 12 corpses who had undergone osteosynthesis intra-vitam, whose implants were still in place or had been removed, in comparison with five controls who had never undergone osteosynthesis. Bone fragments taken during autopsy were subjected to histopathological and scanning electron microscope-energy dispersive electroscopy examination in order to reveal and characterise any metal particles originating from osteosynthesis. The study enabled the discovery of intra-bone metal particles in tissues treated by osteosynthesis even in bone areas where the implants had been removed and even where there were no longer any radiological signs of their application. These results are therefore of considerable forensic importance, especially in the area of identification, providing a valid means of recognition beyond that of the well-established use of in situ metal implants.
Deutsche Zeitschrift für die Gesamte Gerichtliche Medizin 12/2009; 125(1):21-6. · 2.59 Impact Factor
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ABSTRACT: Suicide by train with complete voluntary decapitation is an extremely rare event, however, well known and reported in the scientific literature. The authors analyze 4 cases of suicide with complete decapitation by main line or underground train that were subjected to medico-legal autopsies at the Milan Institute of Legal Medicine between 1995 and 2006. Personal, circumstantial, autopsy, and toxicological data were analyzed to define the type and pathologic characteristics of the injuries (vital reaction of wound edges, absence of any signs of defense); alcohol and drug consumption was considered and the victim's psychical profile was outlined.
The American journal of forensic medicine and pathology: official publication of the National Association of Medical Examiners 10/2009; 30(3):303-6. · 0.71 Impact Factor
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ABSTRACT: Evidence of the frequent use of mainline and metropolitan trains as a means of suicide in and around Milan prompted the authors to analyse the occurrence of this event between 1993 and 2008 in Milan, examining data from the Institute of Legal Medicine. The 155 selected cases were analysed for various aspects, including the chronology and dynamics of the event, the personal, epidemiological and psychiatric profile of the victims and the features of the injuries found during autopsy.
Medicine, science, and the law 07/2009; 49(3):185-90. · 0.45 Impact Factor
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ABSTRACT: The mechanisms involved in the fall of exhaled nitric oxide (NOe) concentration occurring in normal, anesthetized open chest rabbits with prolonged mechanical ventilation (MV) at low lung volume have been investigated. NOe, pH of exhaled vapor condensate, serum prostaglandin E(2), and F(2alpha), tumor necrosis factor (TNF-alpha), PaO(2), PaCO(2), pHa, and lung mechanics were assessed before, during, and after 3-4h of MV at zero end-expiratory pressure (ZEEP), with fixed tidal volume (9 ml kg(-1)) and frequency, as well as before and after 3-4h of MV on PEEP only. Lung histology and wet-to-dry ratio (W/D), and prostaglandin and TNF-alpha in bronchoalveolar lavage fluid (BALF) were also assessed. While MV on PEEP had no effect on the parameters above, MV on ZEEP caused a marked fall (45%) of NOe, with a persistent increase of airway resistance (45%) and lung elastance (12%). Changes in NOe were independent of prostaglandin and TNF-alpha levels, systemic hypoxia, hypercapnia and acidosis, bronchiolar and alveolar interstitial edema, and pH of exhaled vapor condensate. In contrast, there was a significant relationship between the decrease in NOe and bronchiolar epithelial injury score. This indicates that the fall in NOe, which occurs in the absence of an inflammatory response, is due to the epithelial damage caused by the abnormal stresses related to cyclic opening and closing of small airways with MV on ZEEP, and suggests its use as a sign of peripheral airway injury.
Respiratory Physiology & Neurobiology 03/2008; 160(2):215-23. · 2.24 Impact Factor
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ABSTRACT: Lung morpho-functional alterations and inflammatory response to various types of mechanical ventilation (MV) have been assessed in normal, anesthetized, open-chest rats. Measurements were taken during protective MV [tidal volume (Vt) = 8 ml/kg; positive end-expiratory pressure (PEEP) = 2.6 cmH(2)O] before and after a 2- to 2.5-h period of ventilation on PEEP (control group), zero EEP without (ZEEP group) or with administration of dioctylsodiumsulfosuccinate (ZEEP-DOSS group), on negative EEP (NEEP group), or with large Vt (26 ml/kg) on PEEP (Hi-Vt group). No change in lung mechanics occurred in the Control group. Relative to the initial period of MV on PEEP, airway resistance increased by 33 +/- 4, 49 +/- 9, 573 +/- 84, and 13 +/- 4%, and quasi-static elastance by 19 +/- 3, 35 +/- 7, 248 +/- 12, and 20 +/- 3% in the ZEEP, NEEP, ZEEP-DOSS, and Hi-Vt groups. Relative to Control, all groups ventilated from low lung volumes exhibited histologic signs of bronchiolar injury, more marked in the NEEP and ZEEP-DOSS groups. Parenchymal and vascular injury occurred in the ZEEP-DOSS and Hi-Vt groups. Pro-inflammatory cytokine concentration in the bronchoalveolar lavage fluid (BALF) was similar in the Control and ZEEP group, but increased in all other groups, and higher in the ZEEP-DOSS and Hi-Vt groups. Interrupter resistance was correlated with indexes of bronchiolar damage, and cytokine levels with vascular-alveolar damage, as indexed by lung wet-to-dry ratio. Hence, protective MV from resting lung volume causes mechanical alterations and small airway injury, but no cytokine release, which seems mainly related to stress-related damage of endothelial-alveolar cells. Enhanced small airway epithelial damage with induced surfactant dysfunction or MV on NEEP can, however, contribute to cytokine production.
Journal of Applied Physiology 02/2008; 104(1):41-9. · 3.75 Impact Factor
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ABSTRACT: To evaluate the role of pulmonary surfactant in the prevention of lung injury caused by mechanical ventilation (MV) at low end-expiratory volumes, lung mechanics and morphometry were assessed in three groups of eight normal, open-chest rabbits ventilated for 3-4 h at zero end-expiratory pressure (ZEEP) with physiological tidal volumes (Vt = 10 ml/kg). One group was left untreated (group A); the other two received surfactant intratracheally (group B) or aerosolized dioctylsodiumsulfosuccinate (group C) before MV on ZEEP. Relative to initial MV on positive end-expiratory pressure (PEEP; 2.3 cmH(2)O), quasi-static elastance (Est) and airway (Rint) and viscoelastic resistance (Rvisc) increased on ZEEP in all groups. After restoration of PEEP, only Rint (124%) remained elevated in group A, only Est (36%) was significantly increased in group B, whereas in group C, Est, Rint, and Rvisc were all markedly augmented (274, 253, and 343%). In contrast, prolonged MV on PEEP had no effect on lung mechanics of eight open-chest rabbits (group D). Lung edema developed in group C (wet-to-dry ratio = 7.1), but not in the other groups. Relative to group D, both groups A and C, but not B, showed histological indexes of bronchiolar injury, whereas all groups exhibited an increased number of polymorphonuclear leukocytes in alveolar septa, which was significantly greater in group C. In conclusion, administration of exogenous surfactant largely prevents the histological and functional damage of prolonged MV at low lung volumes, whereas surfactant dysfunction worsens the functional alterations, also because of edema formation and, possibly, increased inflammatory response.
Journal of Applied Physiology 02/2007; 102(1):174-82. · 3.75 Impact Factor
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ABSTRACT: The mechanisms involved in the fall of exhaled nitric oxide (NOe) concentration occurring in normal, anesthetized open chest rabbits with prolonged mechanical ventilation (MV) at low lung volume have been investigated. NOe, pH of exhaled vapor condensate, serum prostaglandin E2, and F2α, tumor necrosis factor (TNF-α), PaO2, PaCO2, pHa, and lung mechanics were assessed before, during, and after 3–4 h of MV at zero end-expiratory pressure (ZEEP), with fixed tidal volume (9 ml kg−1) and frequency, as well as before and after 3–4 h of MV on PEEP only. Lung histology and wet-to-dry ratio (W/D), and prostaglandin and TNF-α in bronchoalveolar lavage fluid (BALF) were also assessed. While MV on PEEP had no effect on the parameters above, MV on ZEEP caused a marked fall (45%) of NOe, with a persistent increase of airway resistance (45%) and lung elastance (12%). Changes in NOe were independent of prostaglandin and TNF-α levels, systemic hypoxia, hypercapnia and acidosis, bronchiolar and alveolar interstitial edema, and pH of exhaled vapor condensate. In contrast, there was a significant relationship between the decrease in NOe and bronchiolar epithelial injury score. This indicates that the fall in NOe, which occurs in the absence of an inflammatory response, is due to the epithelial damage caused by the abnormal stresses related to cyclic opening and closing of small airways with MV on ZEEP, and suggests its use as a sign of peripheral airway injury.
Respiratory Physiology & Neurobiology.
