Injuries during Laparoscopic Cholecystectomy: A Scoping Review of the Claims and Civil Action Judgements.

BACKGROUND: To define what type of injuries are more frequently related to medicolegal claims and civil action judgments. METHODS: We performed a scoping review on 14 studies and 2406 patients, analyzing medicolegal claims related to laparoscopic cholecystectomy injuries. We have focalized on three phases associated with claims: phase of care, location of injuries, type of injuries. RESULTS: The most common phase of care associated with litigation was the improper intraoperative surgical performance (47.6% ± 28.3%), related to a "poor" visualization, and the improper post-operative management (29.3% ± 31.6%). The highest rate of defense verdicts was reported for the improper post-operative management of the injury (69.3% ± 23%). A lower rate was reported in the incorrect presurgical assessment (39.7% ± 24.4%) and in the improper intraoperative surgical performance (21.39% ± 21.09%). A defense verdict was more common in cystic duct injuries (100%), lower in hepatic bile duct (42.9%) and common bile duct (10%) injuries. CONCLUSIONS: During laparoscopic cholecystectomy, the most common cause of claims, associated with lower rate of defense verdict, was the improper intraoperative surgical performance. The decision to take legal action was determined often for poor communication after the original incident.

A crossbow suicide.

The crossbow is an ancient ranged weapon originally conceived for war and hunting. Although nowadays its use in warfare has been surpassed by firearms, it continues to be used in hunting, sports and recreation. The authors present the case of a 40-year-old man who suffered from severe depression. When his condition further deteriorated, doctors ordered a forced hospitalization but, just a few hours before the measure became effective, the man committed suicide using a crossbow. The autopsy and police investigation showed possession of the crossbow darts which the man used to shoot himself in the head. The forensic pathologist found the dart stuck in the skull: the entry wound was in the suprahyoid region while the arrow tip emerged in the left parietal region meaning the arrow crossed the tongue, the middle fossa, the brain and the cranial wall. All the wounds presented a three-pointed star shape consistent with the three sharp blades of the dart. An extensive blood infiltration affected the subdural and subarachnoid space, particularly where the dart had passed. The severe brain injury, extensive subdural and subarachnoid bleeding and brain swelling following the trauma caused the death. Even though the use of the crossbow is only permitted in sporting/hunting contexts, the reported case highlights the sharp contrast between its potential for harm and the easy access to this kind of weapon, even for those affected by mental illness.

A fatal work-related poisoning by hydrogen sulfide: report on a case.

Hydrogen sulfide (H2S) is a colorless and potentially deadly gas that may cause rapid loss of consciousness and respiratory depression without warning. Although occupational exposure to H2S and the medical management of H2S-associated toxicity are widely established, it remains a problem in the sour gas industry and in other industrial settings, predominantly in new workers. In this article, the authors report a fatal case of a factory worker who died after breathing in H2S while undertaking a task that he was not trained to perform. Toxicological assessment supported by autopsy findings and circumstantial data was essential to clarify the cause of death, determined as H2S poisoning. This case emphasizes the need to develop work safety initiatives, improve on-the-job training, and introduce more consciousness to put on protective equipment for workers; indeed, correct training and education for workers regarding safety in the workplace may help to reduce worker fatalities.

Cytokines, chaperones and neuroinflammatory responses in heroin-related death: what can we learn from different patterns of cellular expression?

Heroin (3,6-diacetylmorphine) has various effects on the central nervous system with several neuropathological alterations including hypoxic-ischemic brain damage from respiratory depressing effects and neuroinflammatory response. Both of these mechanisms induce the release of cytokines, chemokines and other inflammatory mediators by the activation of many cell types such as leucocytes and endothelial and glial cells, especially microglia, the predominant immunocompetent cell type within the central nervous system. The aim of this study is to clarify the correlation between intravenous heroin administration in heroin related death and the neuroinflammatory response. We selected 45 cases among autopsies executed for heroin-related death (358 total cases); immunohistochemical studies and Western blotting analyses were used to investigate the expression of brain markers such as tumor necrosis factor-α, oxygen-regulated protein 150, (interleukins) IL-1ß, IL-6, IL-8, IL-10, IL-15, cyclooxygenase-2, heat shock protein 70, and CD68 (MAC387). Findings demonstrated that morphine induces inflammatory response and cytokine release. In particular, oxygen-regulated protein 150, cyclooxygenase-2, heat shock protein 70, IL-6 and IL-15 cytokines were over-expressed with different patterns of cellular expression.