RESUMO
Depressed skull fractures occur when broken bones displace inward, meaning that a portion of the outer table of the fracture line lies below the normal anatomical position of the inner table. They typically result from force trauma, when the skull is struck by an object with a moderately large amount of kinetic energy but a small surface area, or when an object with a large amount of kinetic energy impacts only a small area of the skull. In the present case, a depressed fracture of the frontal bone was detected at the autopsy of a 52-year-old man who, according to the belated confession of the assailant, was kicked in the head. The assailant was wearing sneakers. Could such a fracture be caused "just" by a kick? In this case it was possible due to an extraordinarily thin cranial vault (0.2 cm frontal, 0.3 cm occipital), which allowed the fractures to occur from a kinetic force that might not have been sufficient with a normal cranial vault thickness. An important role in the forensic analysis of the case was played by the 3D CT reconstruction.
Assuntos
Imageamento Tridimensional , Fratura do Crânio com Afundamento , Tomografia Computadorizada por Raios X , Humanos , Masculino , Pessoa de Meia-Idade , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/patologia , Autopsia/métodos , Crânio/diagnóstico por imagem , Crânio/lesões , Crânio/patologia , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/patologia , Patologia Legal/métodosRESUMO
The determination of the postmortem interval is a topic of great forensic interest. The possibility of using new technologies has allowed the study of postmortem decay of biomolecules in the determination of PMI. Skeletal muscle proteins are promising candidates because skeletal muscle exhibits slower postmortem decay compared to other internal organs and nervous tissues, while its degradation is faster than cartilage and bone. In this pilot study, skeletal muscle tissue from pigs was degraded at two different controlled temperatures, 21 °C and 6 °C, and analysed at predefined times points: 0, 24, 48, 72, 96, and 120 h. The obtained samples were analysed by mass spectrometry proteomics approach for qualitative and quantitative evaluation of proteins and peptides. Immunoblotting validation was performed for the candidate proteins. The results obtained appeared significant and identified several proteins useful for possible postmortem interval estimation. Of these proteins, PDLIM7, TPM1, and ATP2A2 were validated by immunoblotting at a larger number of experimental points and at different temperatures. The results obtained are in agreement with those observed in similar works. In addition, the use of a mass spectrometry approach increased the number of protein species identified, providing a larger panel of proteins for PMI assessment.
Assuntos
Proteínas Musculares , Mudanças Depois da Morte , Suínos , Animais , Proteólise , Projetos Piloto , Proteômica , Espectrometria de Massas , Músculo Esquelético/metabolismo , Patologia Legal/métodosRESUMO
Commuting road traffic collisions (RTCs) are one of the main causes of occupational death worldwide, including Italy. Among the prominent yet relatively understudied personal risk factors in the subpopulation of workers, there is the use of psychoactive substances. Since the phenomenon of driving under alcohol and drugs effects in the commuter sub-population has so far been poorly studied, we carried out a study by comparing results obtained from the analysis of commuters and non-commuters. The percentage of commuting RTCs victims was 10.4% out of all the RTCs. Commuter victims were mostly men, 51-60 years-old, motorcyclists (32.1%) or car drivers (28.6%), employees, deceased during Fridays and Saturdays, in the afternoon (35.7%) and in the evening (32.1%). It was possible to perform toxicological analyses in 60.7% of commuter cases: approximately 40% tested positive, always and only for ethanol (median Blood Alcohol Concentration, BAC, of about 1.03â g/L). Values above the legal limit were observed in 23.5% of the toxicological samples analyzed from commuter accidents. Our findings contribute to bridging the gap in knowledge in the area of RTCs and commuting and emphasize the importance of carrying out toxicological investigations, with possible repercussions on both insurance issues and public health strategies, which are relevant for analyzing the phenomenon structurally.
Assuntos
Condução de Veículo , Transtornos Relacionados ao Uso de Substâncias , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Concentração Alcoólica no Sangue , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Acidentes de Trânsito , Etanol , Meios de TransporteRESUMO
In this study, we analyzed blood samples obtained from 169 cadavers subjected to an autopsy from 1 October 2019 to 27 March 2020. The presence of anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) antibodies was searched by lateral flow immunochromatographic assay (LFIA) and ELISA tests and the SARS-CoV-2 RNA was tested in blood and available lung tissues by real-time PCR (RT-PCR) and droplet digital PCR (ddPCR). Five cases resulted in positives at the serological screening for anti-SARS-CoV-2. Three results were weakly positive for IgM while only one showed strong reactivity for IgG antibodies. The fifth subject (who died in December 2019) resulted positive for the ELISA test. The detection of SARS-CoV-2 RNA resulted in positive only in the blood and lung tissues of such cases. These data suggest that cadaveric blood may be a suitable substrate for the assessment of SARS-CoV-2 infection; moreover, they extend the observations of sporadic cases of SARS-CoV-2 infection in North Italy prior to the first confirmed cases.
RESUMO
This study reviews autopsies performed by the Legal Medicine department of the University of Milan from 1990 to 2018. In particular, the characteristics of the perpetrator, the victim and the type of existing relationship, the means used, and the place and time of the crime. A retrospective analysis was conducted, extracting data from the Milan Institute of Legal Medicine database, selecting cases of murder-suicide from the archive between 1990 and 2018 (a total of 75 cases with 84 murder victims). Available data was processed statistically. Univariate and bivariate analysis techniques were mainly used. Significance tests (Chi-square) and correlation studies (Pearson's R) were also conducted, the results of which were then examined and discussed in light of legal, medical and criminological expertise.In almost all cases, suicide followed immediately after the murder, at home and in the context of an emotional relationship. The murderer and person committing suicide is almost always male and the victim female. A firearm was the most common weapon in cases of both murder and suicide.The results indicate that the issue of gender is relevant in murder-suicides as indicated by international and national literature on homicides. Furthermore, the use of firearms endorses the importance of limiting their availability through more restrictive laws.
RESUMO
We present a case of a 48-year-old man's unexpected death affected by a relapsed clivalchordoma. After partial excision surgery of the neoplasm, he manifested 5 days later, in conditions of well-being, a sudden lethal extracranial hemorrhage from nose and mouth. The autopsy examination and the subsequent histological investigations did not allow us to clarify the exact origin of the bleeding. Based on the negativity of the accurate examinations performed, the extent of the bleeding, and the findings highlighted by the means of the nuclear magnetic resonance (NMR) carried out a few days before death, we have considered reasonable to localize the source of hemorrhage in the intrapetrous tract of the left internal carotid artery. Since this is a unique event, never previously documented, we believe that our report may be of interest to the scientific community.
Assuntos
Cordoma/cirurgia , Morte Súbita , Hemorragia/mortalidade , Choque Hemorrágico/mortalidade , Autopsia , Artéria Carótida Interna/patologia , Cordoma/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Notocorda/patologia , Base do Crânio/patologia , Base do Crânio/cirurgiaRESUMO
Scanning electron microscopy with energy-dispersive x-ray (SEM/EDX) analysis is an investigation whose potential has become increasingly important in the field of forensic research and diagnosis. We present the procedure to perform a well-carried-out SEM/EDX analysis on corpses affected by different types of injuries, such as blunt force trauma, ligature strangulation, electrocution, sharp force trauma, gunshot wounds, and intoxication. After the areas of forensic interest have been macroscopically identified, the sampling can be performed in 2 different ways: apposition of the double-sided graphite tape on the damaged area or performing the excision of a biological sample. In both cases, a proper negative control sample is required. In all cases, SEM/EDX analysis can detect exogenous microtraces consistent with the types of injuries involved. In blunt force trauma, microparticles of different nature deriving from the contact of the blunt instrument with the victim may be observed; in sharp force trauma, metal microtraces (Fe, Cr, Al, Ti) can be identified. In ligature strangulation, exogenous microtraces may be found in the cutaneous furrow. In electrocution, it allows to identify the pathognomonic metal pattern (Cu, Zn, Fe) of the "electric mark." In gunshot wounds, the main applications regards the detection of metal particles (Pb, Ba, Sb) of gunshot residues. Finally, in the analysis of intoxicants, it may identify traces of toxic substances. Thus, the authors conclude that SEM/EDX analysis can provide essential information to assist in the medicolegal investigation of death.
Assuntos
Medicina Legal/métodos , Microscopia Eletrônica de Varredura , Asfixia/patologia , Osso e Ossos/química , Osso e Ossos/patologia , Traumatismos por Eletricidade/patologia , Elementos Químicos , Humanos , Metais/análise , Lesões do Pescoço/patologia , Intoxicação/patologia , Pele/química , Pele/patologia , Ferimentos Penetrantes/patologiaRESUMO
The banning of the heavy metal thallium (Tl) in many Countries, because of its toxicity, led to a remarkable reduction of the number of cases of poisoning both accidental and homicidal forcing us to better study the pharmacokinetics of this poison using new technologies. The Authors, in this work, are reporting the case of a collective thallium toxicosis caused by voluntary adulteration of an infusion with thallium sulfate, occurred in 8 members of the same familial nucleus; the administration of Prussian Blu resulted to be ineffective for 3 of these members that died at a later time. The most peculiar aspects of this rare manner of poisoning are discussed; the analytical procedures used, Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in particular, resulted to be fundamental in the forensic diagnosis process of acute poisoning cause by thallium.
Assuntos
Família , Medicina Legal , Homicídio , Tálio/intoxicação , Tálio/toxicidade , Idoso , Idoso de 80 Anos ou mais , Autopsia , Feminino , Humanos , Masculino , Espectrometria de Massas/métodos , Pessoa de Meia-Idade , Tálio/administração & dosagemRESUMO
In forensic evaluation of charred corpses, internal detrimental signs may result as more significant of those observed during external examination and is often arduous to state if a victim was exposed to fire before or after death. When the histological analysis of the remaining internal viscera is necessary, the massive destruction caused by the lesion, the charring and the coarctation of the samples don't allow to give further information or to determine the remaining organic components of the viscera. This limit is determined by the intrinsic characteristics of this thermal lesivity of self-maintenance even after the exitus of the subject, worsening the initial detrimental framework. The Authors, with the purpose of improving the microscopic visualization of the samples collected from cadavers with peculiar deterioration, as in case of carbonization, suggest the use of a specific technical protocol based on the use of Sandison's rehydrating solution since the samples treated with this solution showed, at microscopic examination, a substantial histological-morphological improvement.
Assuntos
Incêndios , Patologia Legal/métodos , Soluções para Reidratação , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/patologia , Encéfalo/patologia , Cadáver , Dura-Máter/patologia , Esôfago/patologia , Feminino , Humanos , Intestino Delgado/patologia , Rim/patologia , Fígado/patologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Pele/patologia , Baço/patologia , Adulto JovemRESUMO
Most murder victims in a romantic relationship are women but sometimes they will kill their husbands or partners (mariticide). This paper focuses on these rarer cases using a sample taken from the autopsy reports of the Department of Legal Medicine of the University of Milan whose territory includes the municipality of Milan and part of the province of Milan and Monza - approximately four million inhabitants.
Assuntos
Vítimas de Crime/classificação , Homicídio/estatística & dados numéricos , Parceiros Sexuais , Adulto , Idoso , Vítimas de Crime/estatística & dados numéricos , Feminino , História do Século XX , História do Século XXI , Homicídio/história , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Abdominal apoplexy, also known as idiopathic spontaneous hemoperitoneum, is a rare event related to sudden death, whose diagnosis and treatment is extremely challenging and whose pathologic mechanisms are still mainly unknown. It is frequently associated with vascular disorders (alterations in the vascular structures) and mainly linked to liver cirrhosis. However, the presence of hemoperitoneum may in such cases pose many challenges to forensic post-mortem examinations since the source of bleeding remains often unknown even after a careful and thorough dissection. The Authors present two cases of sudden death related to massive hemoperitoneum (4,650ml in case 1 and 5,100ml in case 2) occurred in two cirrhotic males aged 49 and 51: no traumatic injuries were detected and the source of bleeding was not identified although a careful dissection of organs and vascular structures was performed. Rare cases have been already described in the literature, only as case reports, and no systematic studies have been performed on this issue. Nevertheless, this event ought to be taken into account asa cause of sudden death in people with advanced liver disease. A general glimpse is provided among the different causal mechanisms and the challenges within forensic pathology.
Assuntos
Abdome/patologia , Hemoperitônio/patologia , Ruptura Espontânea , Acidente Vascular Cerebral , Autopsia , Patologia Legal , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A retrospective analysis on 57 adult male victims of sexual violence has been performed. Age, nationality and anamnesis of the victims, location of the assault, type of violence, number and identity of the assailants, presence of physical injuries, lapse of time between the assault and the request of medical assistance, and toxicological and semen detection tests were analyzed. Victims were mostly in the 31- to 40-year age group. Ten victims referred themselves as either active homosexuals or bisexuals. Forced oral and/or anal penetration was registered in 86.8% of cases, mostly performed by a single assailant. Anogenital injuries were recorded in 61.4% of cases, whereas extragenital injuries in 35.1%: abrasions and perianal reddening were the most frequent acute anogenital marks, whereas the head and lower limbs were the body parts most commonly affected by blunt trauma. No clinically severe injuries were found. Anal and perianal swabs for semen detection tested positive in less than 20% cases, whereas oral swabs always tested negative. When performed, nearly 50% of cases tested positive in drug tests, above all for psychoactive substances. No definite forensic diagnosis in terms of confirmation of rape was possible on the basis of type and topography of injuries.
Assuntos
Vítimas de Crime/estatística & dados numéricos , Estupro/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Adolescente , Adulto , Amnésia/epidemiologia , Canal Anal/lesões , Bissexualidade/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Estudos Retrospectivos , Detecção do Abuso de Substâncias/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto JovemRESUMO
Fatal air embolism related to endoscopic retrograde cholangiopancreatography is a very rare phenomenon. The authors describe the case of a 51-year-old female patient who developed this mortal complication; a computed tomography (CT) examination was performed in articulo mortis by the physicians. Autopsy was unreliable because of bizarre post-mortem changes (reabsorption of intra-cardiac gas vs. conservation of intra-cranial gas) and a lack of strong diagnostic value of histological findings. The right diagnosis was possible thanks only to the CT examination that permitted the assumption of this possible cause of death before the autopsy and to prepare the necessary procedures to recognise and probe air embolism. This case exemplifies how early post-mortem imaging can be crucial to avoid a wrong diagnosis.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Embolia Aérea/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Embolia Aérea/etiologia , Evolução Fatal , Feminino , Patologia Legal , Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-IdadeRESUMO
The application of the histochemical stain of sodium rhodizonate to the entrance wound for the detection of the lead (Pb) residues coming from the gunshot may be affected by false positive cases due to the contamination of the environmental Pb. The aim of the Authors is to histochemically search the Pb of GSR in a region which should be more protected by the contamination: the intracorporeal channel. Two hundreds and eighteen serial histological specimens of the intracorporeal channels coming from 25 subjects (dead due to gunshots and being autopsied at the Section of Legal Medicine of the Milan University, in the years 2013-2014) were stained with the sodium rhodizonate and sodium rhodizonate in acid environment (HCl 5%), and then observed by the microscope. The sodium rhodizonate showed a positivity for the Pb residues in the intracorporeal channel, with the detection of the particles within the first 2 cm beyond the entrance wound in 6 cases over the total number of 25 (24%). Victims were characterized by common features: short-barreled weapon; contact shots or short-distance shots; involvement of regions that were not covered by clothing; preservation of the microscopic structure of organs interested by the intracorporeal channel. The searching of GSR in the intracorporeal channel, even in conditions securing a high sensitivity, could represent an important test for the discrimination between an environmental contamination of Pb and the presence of Pb residues by GSR: once confirmed the presence of GSR in the intracorporeal channel by the histochemical analysis, the diagnostic process should require the application of the SEM-EDX for the confirmation of the results. Although not yet studied, this combination could be applied to cadavers exposed to the environment, with advanced post-mortal phenomena permitting at least the suspects of the existence of gunshot wounds at the macroscopic autopsy evaluation. Indeed, in some cases, the putrefaction is so advanced that no suspect of gunshot injuries could be derived from the soft tissue.
Assuntos
Chumbo/análise , Ferimentos por Arma de Fogo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cicloexanonas , Dura-Máter/química , Dura-Máter/patologia , Feminino , Patologia Legal , Humanos , Masculino , Pessoa de Meia-Idade , Coloração e Rotulagem , Músculo Temporal/química , Músculo Temporal/patologia , Língua/química , Língua/patologia , Adulto JovemRESUMO
Falls from a height are a common cause of suicidal death in urban settings. The aim of the present work is to describe and discuss a specific set of 307 autopsies performed in a metropolitan city such as Milan, Italy from 2006 to 2011, with a special focus on the relationship between the injury pattern and height of the fall, age at death and weight at death. The rib cage (92%), the lungs (76%), the heart (53%) and the liver (58%) turned out to be the most injured structures in the whole population. Age resulted statistically significant for heart, thoracic aorta, mesentery, kidney hilus, hip bones and right forearm injuries. Weight resulted statistically significant for subtentorial brain, facial skull, rib cage, lungs and liver injuries. Height was significant for the facial skull (including the jaw), lungs, heart, thoracic aorta, diaphragm, liver, cervical spine, sacroiliac joints, pubic symphysis, right arm and left leg. A simple Injury Extension Score was also calculated which showed a correlation with height. A great variability does exist across all the available forensic literature concerning falls from a height. As a strong common denominator for the injury pattern across all the available literature there is however the very low prevalence of neck injuries, the very high prevalence of rib cage fractures and a definite thorax and upper abdomen injury.
Assuntos
Suicídio , Ferimentos e Lesões/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Patologia Legal , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Murder-suicide is a relatively rare event, and familicide is rarer still. However, it is certainly not unknown, and has been described in the scientific literature from both a socio-criminological and pathological-forensic perspective since the last century. In a civilized urban area such as Milan and province, where there is a general reduction in the homicide rate, homicide-suicide occurs almost exclusively within the family, and has specific features that differentiate it from other types of homicide, whether connected with general criminality or organized crime. This article analyses the quantitative and qualitative features of cases of homicide-suicide occurring in Milan and province between 1990 and 2009 (20 years), considering temporal aspects and the development of the events, the weapons used, and the epidemiological and psychopathological features of the perpetrators and their victims.
Assuntos
Homicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , População Urbana , Armas/estatística & dados numéricos , Adulto JovemRESUMO
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.
RESUMO
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.
Assuntos
Osso e Ossos/química , Osso e Ossos/ultraestrutura , Metais/análise , Próteses e Implantes , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Patologia Legal , Fraturas Ósseas/cirurgia , Humanos , Masculino , Microscopia Eletrônica de Varredura , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Ferrovias , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Patologia Legal , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/patologiaRESUMO
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.