Post-mortem decapitation by domestic dogs: three case reports and review of the literature.

Post-mortem animal depredation is not an uncommon phenomenon in routine forensic autopsies. We present three cases of complete post-mortem decapitation by domestic German shepherd dogs. In two cases, the head had been bitten off, defleshed and left lying near the body, while in one case it had been completely devoured by two dogs; only small skull fragments and crowned teeth could be found. Two of the three bodies were putrefied; all dog bite injuries had been inflicted after death. The cause of death was drug toxicity in two cases and fatal hemorrhage from ruptured esophageal varices in one case. These rare injuries due to post-mortem animal depredation are discussed in the light of earlier studies and case reports.

Dissection of the V3-V4 due to whiplash injury: description of a non-fatal case.

Whiplash injuries, a common sequel of road traffic accidents, may be defined as a musculo-ligamentous sprain resulting from forced acceleration/deceleration and flexion/ extension neck injury. We report a non-fatal case of vertebral right artery dissection after a minor rear-lateral collision. The injury was detected twenty-four days after trauma when a computerized tomography (CT) scan and cerebral angiography revealed multiple ischemic lesions of the right cerebellum. Digital subtraction angiography (DSA) has been the most sensitive imaging modality to describe the types and degree of vascular injury. The accuracy of such imaging allows linking several injuries with minor car crash avoiding patients seeking litigation for correct financial compensation.

Medical Legal Aspects of Telemedicine in Italy: Application Fields, Professional Liability and Focus on Care Services During the COVID-19 Health Emergency.

Telemedicine services can be classified into the macro-categories of specialist Telemedicine, Tele-health and Tele-assistance. From a regulatory perspective, in Italy, the first provision dedicated to the implementation of Telemedicine services is represented by the Agreement between the Government and the Regions on the document bearing "Telemedicine-National guidelines," approved by the General Assembly of the Superior Health Council in the session of 10th July 2012 and by the State Regions Conference in the session of 20th February 2014. Scientifically, several studies in the literature state that information and communication technologies have great potential to reduce the costs of health care services in terms of planning and making appropriate decisions that provide timely tools to patients. Another clear benefit is the equity of access to health care. The evolution of telemedicine poses a series of legal problems ranging from the profiles on the subject of authorization and accreditation to those concerning the protection of patient confidentiality, the definition and solution of which, in the absence of specific regulatory provisions, is mainly left to the assessment of compatibility of the practices adopted so far, with the general regulatory framework. In terms of professional liability, it is necessary to first clarify that the telemedicine service is comparable to any diagnostic-therapeutic health service considering that the telemedicine service does not replace the traditional health service, but integrates the latter to improve its effectiveness, efficiency and appropriateness.

Radiological and forensic medicine aspects of traumatic injuries in child abuse.

Child abuse is a topical issue in modern society and has social and medical implications which directly concern the doctor, both as a private citizen and as a health professional. Abuse injuries can be of very different types, e.g. physical, psychological or sexual. Hence they require a multidisciplinary and multispecialty approach, which must begin with an accurate medical examination, conducted in compliance with the lege artis principles and with respect for the victim's dignity. Diagnostic imaging becomes essential, together with epicrisis, which is useful to distinguish between accidental and abusive injuries. This paper describes the radiologist's key role in identifying physical injuries due to child abuse, in accordance with current regulations.

Child abuse and dental neglect: the dental team's role in identification and prevention.

Health, education and social services are placing increasing emphasis on preventing abuse and neglect by early intervention to support families where children and young people may be at risk. Dental hygienist and dental assistants, like all other health professionals, can have a part in recognizing and preventing children from those who would cause them harm. They should be aware of the warning signs, recognizing what to consider as abuse or dental neglect and know how to deal with these young patients, and to fulfil their legal and ethical obligation to report suspected cases. The purpose of this report is to review the oral and dental aspects of child abuse and dental neglect thus helping the dental team in detecting such conditions. In particular, this report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, early childhood caries and diseases that may be indicative of child abuse or neglect. Emphasis is placed on an appropriate protocol to follow in the dental practice to best treat and protect children who may have suffered abuse, helping the team in the diagnosis and documentation.

Occupational asphyxiation by unknown compound(s): environmental and toxicological approach.

During a routine truck-tank washing operation, five healthy workers were found motionless inside an empty tanker. Four of them died inside the tanker while the fifth died the following day in hospital. Since the true nature of the fatal compound(s) were not known, a rigorous environmental and toxicological approach supported by autopsy findings was essential to clarify the cause of death. Environmental results indicated that H(2)S fumes arising from the liquid sulfur previously shipped were responsible for the serial deaths, also confirmed by a simulation performed on two similar truck-tanks. These environmental findings were supported by toxicological analyses through the measurement of thiosulfate, one of the main H(2)S metabolites. Abnormal thiosulfate concentrations from 1.1 to 186.2 mg/kg were revealed in all post-mortem biological samples (blood, lung, liver, kidney, brain and fat). Finally, the cluster analysis performed on thiosulfate body distribution contributed to establishing the time of death according to the accident scene reconstruction. This report presents valuable findings in correctly identifying the cause of death in gas asphyxiation cases by unknown compound(s).

Radiographic dental implants recognition for geographic evaluation in human identification.

Dental implants for prosthetic rehabilitation with fixed crown or mobile partial/total dentures is a very common oral treatment among the population in Italy as elsewhere. There is a great number of implant systems of different designs. However, a catalogue of radiographic images and a description of the dental implants available in Italy would be useful in order to identify the manufacturer and the type of implant encountered in forensic casework. When an unidentified body is found with one or more implants in the jaws, and no dental record is available, clues gleaned from the type of implants used could give direction to the investigation. In this study Italian implant manufactures were contacted and asked to provide specimen implants. Digital radiographs were taken of all the implants donated at 0º, 30º, and 60º horizontal rotation, combined with -20º, -10º, 0º, +10º, and +20º vertical inclination relative to the radiographic beam and the X-ray sensor. A total of 15 images per implant were taken and examined to identify consistent, unique features that would aid in implant recognition. Only those observations made from radiographs between -10º and +10º vertical inclination would ever be used for definite identification of any implant. The information from this study should be considered a survey of the commercial distribution of dental implants in Italy through their digital radiographic images. It is also a starting point for a wider geographical evaluation of different manufacturers in other countries and continents. The radiographic images provided should help both the forensic odontologist and the prosthodontist to identify pre-existing implants which they may discover from their radiographic images.