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1.
Clin Anat ; 36(3): 465-470, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36514860

RESUMEN

Recent Italian legislation (Law No. 10/2020) establishes the legal, ethical and technical requirements governing how individuals can donate their bodies or tissues post-mortem for study, training, and scientific research purposes. A ministerial working group has recently approved some of the law's implementing rules relating to technical issues. The rules for implementing the new legislation, retrieved from the legal databases and translated into English, are discussed. For the first time in Italy, the law establishes compulsory requirements and minimum characteristics-in terms of logistics, safety, availability of staff, space, and equipment-for institutions to be recognized as reference centers for the conservation and use of bodies and tissues donated post-mortem for study, training and scientific research purposes. This makes it possible to standardize the features of such reference centers nationwide, and to coordinate their activities and potential future development, while ensuring basic operational efficiency and workplace safety, the provision of adequate facilities, buildings and equipment, and staff training. The law and its implementing rules discussed here are the first to establish criteria and compulsory requirements for centers receiving body and tissue donations in Italy. This is a step forward for the whole anatomy community, providing practical guidelines for body donation programs and related facilities in other countries too.


Asunto(s)
Obtención de Tejidos y Órganos , Humanos , Italia , Autopsia
2.
Artículo en Inglés | MEDLINE | ID: mdl-37222901

RESUMEN

Opening the foramen transversarium of the cervical vertebrae is necessary for accessing the vertebral vessels. There are no specialist tools for cutting the anterior lamina of the transverse processes, and alternatives lead to questionable results. A novel tool, the transversoclasiotome, is described and tested. The literature and patent databases were systematically reviewed. A blueprint of the transversoclasiotome was created, and the prototype was tested through autopsy on ten fresh-frozen cadavers within our Body Donation Program. The transversoclasiotome consists of two delicate branches mounted as a scissor, one a cutting jaw and the other a knocker with a rounded tip, both angled 30° to the principal axis. The jaws shut, facing each other in parallel. The cutting jaw corresponds to a slit on the knocker profile without protruding beyond it even when entirely closed. It acts by cutting and wedging. The testing autopsies demonstrated its suitability for its purpose, with an adequate response to the pressure exerted on the bone lamina. The section cut cleanly, without sliding off while closing on the bone. The vertebral vessels were not injured either during instrument insertion or cutting. Their morphological features are described. The transversoclasiotome has been proven appropriate for sectioning the anterior lamina of transverse processes of the cervical vertebrae. It meets the needs of clinical anatomy in teaching and training clinicians or surgeons, forensic clinical anatomy during medico-legal investigation, and research.

3.
Int J Mol Sci ; 23(20)2022 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-36292917

RESUMEN

Oxidized polyvinyl alcohol (OxPVA) is a new polymer for the fabrication of nerve conduits (NCs). Looking for OxPVA device optimization and coupling it with a natural sheath may boost bioactivity. Thus, OxPVA/chitosan sponges (ChS) as hybrid scaffolds were investigated to predict in the vivo behaviour of two-layered NCs. To encourage interaction with cells, ChS were functionalized with the self-assembling-peptide (SAP) EAK, without/with the laminin-derived sequences -IKVAV/-YIGSR. Thus, ChS and the hybrid scaffolds were characterized for mechanical properties, ultrastructure (Scanning Electron Microscopy, SEM), bioactivity, and biocompatibility. Regarding mechanical analysis, the peptide-free ChS showed the highest values of compressive modulus and maximum stress. However, among +EAK groups, ChS+EAK showed a significantly higher maximum stress than that found for ChS+EAK-IKVAV and ChS+EAK-YIGSR. Considering ultrastructure, microporous interconnections were tighter in both the OxPVA/ChS and +EAK groups than in the others; all the scaffolds induced SH-SY5Y cells' adhesion/proliferation, with significant differences from day 7 and a higher total cell number for OxPVA/ChS+EAK scaffolds, in accordance with SEM. The scaffolds elicited only a slight inflammation after 14 days of subcutaneous implantation in Balb/c mice, proving biocompatibility. ChS porosity, EAK 3D features and neuro-friendly attitude (shared with IKVAV/YIGSR motifs) may confer to OxPVA certain bioactivity, laying the basis for future appealing NCs.


Asunto(s)
Quitosano , Neuroblastoma , Ratones , Animales , Humanos , Alcohol Polivinílico/química , Ingeniería de Tejidos , Quitosano/química , Laminina , Porosidad , Polímeros/química , Andamios del Tejido/química , Materiales Biocompatibles
4.
Am J Otolaryngol ; 42(3): 102909, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33476974

RESUMEN

PURPOSE: Whiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. METHODS: 717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. RESULTS: Patients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). CONCLUSIONS: VNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.


Asunto(s)
Accidentes de Tránsito , Electronistagmografía/métodos , Movimientos Oculares , Náusea/diagnóstico , Náusea/etiología , Vértigo/diagnóstico , Vértigo/etiología , Grabación en Video/métodos , Lesiones por Latigazo Cervical/complicaciones , Lesiones por Latigazo Cervical/fisiopatología , Adolescente , Adulto , Anciano , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Náusea/fisiopatología , Vértigo/fisiopatología , Adulto Joven
5.
J Anesth ; 35(1): 102-111, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33340344

RESUMEN

PURPOSE: Erector spinae plane (ESP) block is an interfascial blockade used in different clinical scenarios. This study investigated the ventral extent of dye diffusion in ESP block. METHODS: The ultrasound-guided ESP block was bilaterally performed with an injection at the T5 vertebral level (21-Gauge, 50 mm needle), using diluted black tissue marking dye (20 mL; 1:4 ratio with standard saline solution) instead of local anesthetic on two fresh-frozen corpses within the body donation program of the University of Padova. Subsequently, the gross anatomical dissection was performed by a combined posterior plus anterior approach, and the histotopographic examination completed. RESULTS: Macroscopically by gross anatomical dissection, the dye spreading ranged on the dorsal side of the chest from T2/3 to T10/11 with an extension up to 10 cm laterally, and on the ventral side of the chest from T2/3-T9/10. Microscopically by histotopographic examination, the dye diffused ventrally to the intercostal spaces (2-3 and 5-6 spaces on the right and left, respectively) by following the blood vessels coupled to the dorsal nerve passing through the costotransverse foramen. CONCLUSIONS: The anterior pathway of dye diffusion from the site of injection within the erector spinae muscle group during an ESP block seems to follow the blood vessels and dorsal rami of spinal nerves, suggesting the passing through the costotransverse foramen to reach the anterior paravertebral space and the intercostal nerves. These findings display an anterior histotopographic diffusion of dye resembling a paravertebral block.


Asunto(s)
Bloqueo Nervioso , Vértebras Torácicas , Disección , Músculos Paraespinales/diagnóstico por imagen , Proyectos Piloto
6.
Surg Radiol Anat ; 43(4): 469-479, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32940718

RESUMEN

INTRODUCTION: Anatomy has traditionally been taught via dissection and didactic lectures. The rising prevalence of informatics plays an increasingly important role in medical education. It is hypothesized that virtual dissection can express added value to the traditional one. METHODS: Second-year medical students were randomised to study anatomical structures by virtual dissection (intervention) or textbooks (controls), according to the CONSORT guidelines. Subsequently, they applied to the corresponding gross dissection, with a final test on their anatomical knowledge. Univariate analysis and multivariable binary logistic regression were performed. RESULTS: The rate of completed tests was 76.7%. Better overall test performance was detected for the group that applied to the virtual dissection (OR 3.75 with 95% CI 0.91-15.49; p = 0.06). A comparable performance between groups in basic anatomical knowledge (p 0.45 to 0.92) but not muscles and 2D-3D reporting of anatomical structures was found, for which the virtual dissection was of tendential benefit (p 0.08 to 0.13). Medical students who applied to the virtual dissection were over three times more likely to report a positive outcome at the post-dissection test than those who applied to textbooks of topographical anatomy. This would be of benefit with particular reference to the understanding of 2D-3D spatial relationships between anatomical structures. CONCLUSION: The combination of virtual to traditional gross dissection resulted in a significant improvement of second-year medical students' learning outcomes. It could be of help in maximizing the impact of practical dissection, overcoming the contraction of economic resources, and the shortage of available bodies.


Asunto(s)
Anatomía/educación , Instrucción por Computador , Educación de Pregrado en Medicina/métodos , Curriculum , Disección , Evaluación Educacional/estadística & datos numéricos , Femenino , Humanos , Aprendizaje , Masculino , Evaluación de Programas y Proyectos de Salud , Estudiantes de Medicina/psicología , Estudiantes de Medicina/estadística & datos numéricos , Enseñanza , Adulto Joven
7.
Am J Physiol Lung Cell Mol Physiol ; 319(4): L620-L626, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32755325

RESUMEN

The carotid body (CB) plays a contributory role in the pathogenesis of various respiratory, cardiovascular, renal, and metabolic diseases through reflex changes in ventilation and sympathetic output. On the basis of available data about peripheral arterial chemoreception and severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), a potential involvement in the coronavirus disease 2019 (COVID-19) may be hypothesized through different mechanisms. The CB could be a site of SARS-CoV-2 invasion, due to local expression of its receptor [angiotensin-converting enzyme (ACE) 2] and an alternative route of nervous system invasion, through retrograde transport along the carotid sinus nerve. The CB function could be affected by COVID-19-induced inflammatory/immune reactions and/or ACE1/ACE2 imbalance, both at local or systemic level. Increased peripheral arterial chemosensitivity and reflex sympatho-activation may contribute to the increased morbidity and mortality in COVID-19 patients with respiratory, cardiovascular, renal, or metabolic comorbidities.


Asunto(s)
Cuerpo Carotídeo/metabolismo , Sistema Nervioso Central/virología , Infecciones por Coronavirus/patología , Peptidil-Dipeptidasa A/metabolismo , Neumonía Viral/patología , Enzima Convertidora de Angiotensina 2 , Betacoronavirus , COVID-19 , Seno Carotídeo/inervación , Seno Carotídeo/virología , Humanos , Pandemias , Sistema Renina-Angiotensina/fisiología , SARS-CoV-2
8.
Prostate ; 80(2): 153-161, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31746484

RESUMEN

BACKGROUND: The evidence of pelvic lymph node metastases after radical prostatectomy (RP) with pelvic lymph node dissection (PLND) is one of the strongest prognostic factors for poor oncologic outcome. The extent of PLND, although representing a crucial step in RP, is still controversial. Currently, there is a critical drawback in clinical practice due to the lack of congruence between the known lymphatic drainage and cancer dissemination despite defined management by a surgical approach. We hypothesized the existence of alternative pathways for the lymphatic drainage of the prostate currently not considered in clinical daily practice. METHODS: We carried out a literature review of the anatomic description of nodal drainage of prostate reported by online databases (MEDLINE/PubMed, EBSCO, Web of Science, Ovid, and Scopus) and the original texts since the 18th century, with an additional anatomical dissection on a human cadaver to confirm theoretical data. RESULTS: The anatomical dissection study converged with the historical anatomical treatises in describing three groups of lymphatics devoted to carrying out prostatic nodal drainage. Apart from the ascending ducts from the cranial gland leading to the external iliac nodes; the lateral ducts leading to the hypogastric nodes; small lymphatic vessels from the posterior surface of the prostate, directed to the pararectal lymphatic plexus, in the direction of the lateral sacral lymph nodes and those at the sacral promontory (ie, pararectal and presacral lymph nodes) were observed. CONCLUSIONS: Our preliminary findings demonstrate that lymphatic drainage of the prostate extends beyond standard nodal templates actually considered in surgical daily practice, despite the knowledge reported by historical anatomical treatises. Further anatomical and experimental evidence are needed to investigate anatomical variability in humans, as well as to add more topographical details.


Asunto(s)
Sistema Linfático/anatomía & histología , Próstata/anatomía & histología , Anciano , Cadáver , Disección , Humanos , Masculino
9.
Am J Otolaryngol ; 41(4): 102497, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32345445

RESUMEN

PURPOSE: Whiplash is a type of trauma typically caused by a rear end collision in a road accident. About one in two patients who experience whiplash report dizziness and balance problems, which can severely affect their activities in daily life. In industrialized countries, the number of elderly people with a driving license has increased in recent years. The aims of the present study were to describe the video-nystagmographic features in a consecutive series of elderly patients experiencing whiplash injury in a road accident, comparing them with similar injuries in a group of young adults. METHODS: Twenty-seven patients aged 65 years or more and a control group of 32 young adults between 18 and 21 years old were retrospectively selected. All patients underwent oto-vestibular assessment and video-nystagmography. RESULTS: After whiplash trauma, vertigo was more common in elderly patients with decreased peak velocity during the saccadic ocular motricity test (p = 0.017) and with evidence of bilateral vestibular hypofunction after caloric stimulation (p = 0.033). Comparing the two age groups, neck pain after the trauma was reported significantly more by young adults (p = 0.003), who also showed more frequently bilateral vestibular hypofunction (p = 0.025). CONCLUSION: Clinical and instrumental findings seem to support the hypothesis of a functional lesion to the brainstem regions after a whiplash injury. There is an undeniable need, however, for tools capable of objectively assessing the functional or anatomical damage resulting from whiplash-associated disorders, for both clinical and medico-legal reasons.


Asunto(s)
Accidentes de Tránsito , Electronistagmografía , Grabación en Video , Lesiones por Latigazo Cervical/diagnóstico por imagen , Adolescente , Anciano , Femenino , Humanos , Masculino , Dolor de Cuello/etiología , Equilibrio Postural , Lesiones por Latigazo Cervical/complicaciones , Adulto Joven
10.
Clin Anat ; 33(6): 950-959, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32427400

RESUMEN

INTRODUCTION: Recently, law No. 10 of February 10, 2020, entitled "Rules regarding the disposition of one's body and post-mortem tissues for study, training, and scientific research purposes" was introduced in Italy. Although its provisions respond to a constructive subject, some practical issues are evident in the approved text. MATERIALS AND METHODS: A systematic review of the literature was performed by searching online medical and juridical databases to identify publications and Italian law provisions related to body donation programs. RESULTS: The updated regulatory framework was outlined and compared to that in force previously, and the following features are discussed: (a) matter of law; (b) donors' information and consent; (c) reference centers and funding, and (d) procedural regulatory details. Several critical issues were detected in the approved wording with respect to teaching/training recipients, the role of university anatomy institutes, family members' exclusion from participating in the donation process in any capacity, the duration of donation, the management of corpses, partial donations, and the compatibility with organ donation. Suggestions are provided to overcome certain operational limitations in implementing the regulation, which is still being drafted to date. CONCLUSIONS: This article shares with the international scientific community the principles and controversies underlying a regulatory innovation introduced in Italy to allow legislative amendments to inadequate provisions of body donation, as well as draw the attention of the entire anatomic community to critical issues if other countries undertake the same legislative reform.


Asunto(s)
Anatomía/educación , Anatomía/legislación & jurisprudencia , Cadáver , Consentimiento Presumido/legislación & jurisprudencia , Donantes de Tejidos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Humanos , Italia
11.
Clin Anat ; 33(3): 355-364, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31576612

RESUMEN

Rachiotomy entails vertebral surgical incision, generally followed by exposure of the spinal cord, and is performed primarily for educational, research, or medicolegal purposes. Over time, several tools have been developed for this procedure, but Lodovico Brunetti designed the first effective prototypes in the mid-nineteenth century. To show the technical details of and the necessary maneuvers to be performed for Brunetti's rachiotomies to succeed, a computer-aided systematic literature review of online databases was performed to identify publications concerning Brunetti's chisels used for rachiotomy. Additional references from the studies and treatises included held in the Historical Section of the Medical Library at the University of Padova were checked manually for pertinent information. The known variants of Brunetti's chisels were reported in detail from the first to the third versions produced and intended for both posterior (first and third prototypes) and anterior (second prototype) vertebral dissection. Further evolution that led to the current commercialized model devoted to posterior use also was described. The models' strengths and weaknesses were assessed, as well as the nature of the changes Brunetti introduced over time and their motivation. In conclusion, these tools could represent an alternative to the use of electric saws, particularly for dissectors who prefer to have greater manual control in incising the vertebrae. Clin. Anat. 33:355-364, 2020. © 2019 Wiley Periodicals, Inc.


Asunto(s)
Columna Vertebral/cirugía , Instrumentos Quirúrgicos/historia , Historia del Siglo XIX , Humanos
12.
Int J Mol Sci ; 21(3)2020 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-31991838

RESUMEN

Partial oxidation of polyvinyl alcohol (PVA) with potassium permanganate turned out to be an efficient method to fabricate smart scaffolds for tissue engineering, endowed with biodegradation and protein delivery capacity. This work considered for the first time the use of halogens (bromine, chlorine and iodine) as less aggressive agents than potassium permanganate to perform controlled PVA oxidation, in order to prevent degradation of polymer molecular size upon chemical modification. Oxidized PVA solutions were chemically characterized (i.e., dinitrophenylhydrazine assay, viscosity measurements, molecular size distribution) before preparing physically cross-linked hydrogels. Scaffolds were assessed for their mechanical properties and cell/tissue biocompatibiliy through cytotoxic extract test on IMR-90 fibroblasts and subcutaneous implantation into BALB/c mice. According to chemical investigations, bromine and iodine allowed for minor alteration of polymer molecular weight. Uniaxial tensile tests demonstrated that oxidized scaffolds had decreased mechanical resistance to deformation, suggesting tunable hydrogel stiffness. Finally, oxidized hydrogels exhibited high biocompatibility both in vitro and in vivo, resulting neither to be cytotoxic nor to elicit severe immunitary host reaction in comparison with atoxic PVA. In conclusion, PVA hydrogels oxidized by halogens were successfully fabricated in the effort of adapting polymer characteristics to specific tissue engineering applications.


Asunto(s)
Halógenos/química , Oxidación-Reducción , Alcohol Polivinílico/química , Ingeniería de Tejidos , Animales , Materiales Biocompatibles , Biopsia , Espectroscopía de Resonancia Magnética con Carbono-13 , Inmunohistoquímica , Ensayo de Materiales , Fenómenos Mecánicos , Ratones , Estructura Molecular , Andamios del Tejido , Viscosidad
13.
Clin Anat ; 32(6): 744-748, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31050850

RESUMEN

Thanks to collaborations with anatomists and the possibility of performing public dissections during the Renaissance period, artists started to represent the human body more accurately and objectively in their drawings. This cultural change provided the basis for subsequent advances in education and learning as well as the institution of an obligatory anatomy course in the Academies of Arts. The encounter in Pavia between the eclectic artist Leonardo Da Vinci (1452-1519) and the physician Marco Antonio Della Torre (1481-1511), Professor of Theoretical Medicine at the University of Padova, who near the end of his short life founded the "Anatomical School" of the University of Pavia, could be considered a perfect example of this collaboration. According to the historian Giorgio Vasari, while Della Torre practiced dissection, Leonardo made a book of drawings with red chalk annotated by pen. All these anatomical drawings by Leonardo, preserved at Windsor Castle as the property of the Queen of England, date from 1513, after the death of Della Torre. During the same period, Leonardo started his own dissections in the crypt of Santa Maria Nuova in Florence with his anatomical knowledge already mature and consolidated. The aim of the present study is to present the life of Della Torre, his intense scientific activity between Padova and Pavia, and his relationship with Leonardo Da Vinci. In particular, we found the only available manuscript of Della Torre in the Marciana library of Venice. Clin. Anat. 32:744-748, 2019. © 2019 Wiley Periodicals, Inc.


Asunto(s)
Anatomía/historia , Disección/historia , Anatomía/educación , Personajes , Historia del Siglo XV , Historia del Siglo XVI , Medicina en las Artes/historia
14.
J Anat ; 232(6): 1031-1037, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29504141

RESUMEN

Estimating the post mortem interval (PMI) is still a crucial step in Forensic Pathology. Although several methods are available for assessing the PMI, a precise estimation is still quite unreliable and can be inaccurate. The present study aimed to investigate the immunohistochemical distribution and mRNA expression of hypoxia inducible factor (HIF-1α) in post mortem gingival tissues to establish a correlation between the presence of HIF-1α and the time since death, with the final goal of achieving a more accurate PMI estimation. Samples of gingival tissues were obtained from 10 cadavers at different PMIs (1-3 days, 4-5 days and 8-9 days), and were processed for immunohistochemistry and quantitative reverse transcription-polymerase chain reaction. The results showed a time-dependent correlation of HIF-1α protein and its mRNA with different times since death, which suggests that HIF-1α is a potential marker for PMI estimation. The results showed a high HIF-1α protein signal that was mainly localized in the stratum basale of the oral mucosa in samples collected at a short PMI (1-3 days). It gradually decreased in samples collected at a medium PMI (4-5 days), but it was not detected in samples collected at a long PMI (8-9 days). These results are in agreement with the mRNA data. These data indicate an interesting potential utility of Forensic Anatomy-based techniques, such as immunohistochemistry, as important complementary tools to be used in forensic investigations.


Asunto(s)
Autopsia/métodos , Biomarcadores/análisis , Patologia Forense/métodos , Encía/metabolismo , Subunidad alfa del Factor 1 Inducible por Hipoxia/análisis , Humanos , ARN Mensajero/análisis
15.
Clin Anat ; 31(6): 774-781, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29473213

RESUMEN

The Tauber procedure, i.e., antegrade sclerotherapy for varicocele, can lead to ischemic colitis. The pathogenesis can involve an atypical systemic-portal communication, which could represent an infrequently reported (rare) anatomical variant. The aim of this study is to review clinical cases from the literature to highlight the anatomical bases of such complications. A computer-aided and hand-checked review of the literature was used to identify relevant publications. Also, the computed tomography (CT) examination of a clinical case with medico-legal implications due to severe vascular complication following Tauber's procedure was reviewed. Although specific references to this complication have appeared since the 19th century, reports in the contemporary literature include only a few clinical cases of ischemic colitis following Tauber's procedure. The CT scan images of a filed lawsuit revealed traces suggesting a significant communication between the testicular and left colic veins, forming part of the systemic-portal anastomoses. An anatomical variation consisting of a communication between the testicular and left colic veins has been described from the clinical point of view, corresponding to a significant anatomical finding identified in the past that has been under-reported and its clinical importance subsequently underestimated. For the first time we have demonstrated its pathophysiological significance in a real clinical scenario, linking the anatomical variation to the clinical complication. This demonstrates the importance of raising scientific awareness on this issue to prevent possibly devastating complications in daily clinical practice. Clin. Anat. 31:774-781, 2018. © 2018 Wiley Periodicals, Inc.


Asunto(s)
Colitis Isquémica/etiología , Escleroterapia/efectos adversos , Varicocele/terapia , Adulto , Colitis Isquémica/diagnóstico por imagen , Colon/anomalías , Colon/irrigación sanguínea , Humanos , Masculino , Mala Praxis , Escleroterapia/métodos , Testículo/anomalías , Testículo/irrigación sanguínea , Varicocele/diagnóstico por imagen , Adulto Joven
16.
Am J Drug Alcohol Abuse ; 43(3): 341-349, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-27588338

RESUMEN

BACKGROUND: Clinical reliability of self-reported data for alcohol, caffeine, and nicotine consumptions is lacking, particularly in adolescents. OBJECTIVES: To compare a self-report questionnaire and hair analysis to assess the reliability and effectiveness of the self-report. METHODS: A cross-sectional study on 14-15-year-old Italian students (n = 874, 38% males, 62% females) was performed comparing self-reported data to hair analysis. The latter quantified hair concentrations of caffeine, nicotine, cotinine, ethyl glucuronide (EtG), and fatty acid ethyl esters (FAEEs) using mass spectrometry. RESULTS: Concordance between self-report and hair testing ranged from good to poor across substances and levels of use: poor for heavy alcohol intake (EtG: k = 0.36, 20 positive cases by hair analysis, false negative by self-report, 2.3% of total sample; FAEE k = 0.31, 25 positive cases, 2.9% of total sample); fair to poor for active smokers (k = 0.40, 125 positive cases, 14.3% of total sample); and moderate for caffeine (k = 0.57, 56 positive cases, 6.4% of total sample). CONCLUSIONS: Epidemiological studies on alcohol, caffeine, and nicotine consumption in adolescents may benefit from the inclusion of toxicological analysis on hair samples to overcome the under-reporting phenomenon of questionnaires and detect more cases of problematic substance use.


Asunto(s)
Cafeína/análisis , Cabello/química , Nicotina/análisis , Detección de Abuso de Sustancias/métodos , Adolescente , Consumo de Bebidas Alcohólicas/metabolismo , Cafeína/administración & dosificación , Cotinina/análisis , Estudios Transversales , Reacciones Falso Negativas , Femenino , Glucuronatos/análisis , Humanos , Italia , Masculino , Espectrometría de Masas/métodos , Nicotina/administración & dosificación , Reproducibilidad de los Resultados , Autoinforme , Fumar/metabolismo , Encuestas y Cuestionarios
17.
Int J Legal Med ; 130(5): 1257-64, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27325255

RESUMEN

The analysis of gunshot residue (GSR) on the clothing and the underlying skin of the victim may play an important role in the reconstruction of the shooting incident. The aim of the present study was to test micro-computed tomography (micro-CT) for the analysis of firearm wounds experimentally produced on human skin covered by textiles. Firing trials were performed on 60 sections of human calves enveloped by a single layer of fabric (cotton or jeans or leather or nylon) and 15 controls consisting of bare calves. Experimental firings were conducted in a ballistic laboratory at three different muzzle-to-target distances (5, 15, and 30 cm), using a .32 ACP pistol (Beretta Mod. 81) loaded with full-jacketed bullets coming from the same production lot (7.65 × 17 mm, Browning SR). The visual inspection revealed the classic pattern of GSR distribution on the fabrics and the skin of control samples, while only a dark ring around the entrance lesion was identified on the skin beneath the fabrics. Micro-CT analysis showed the presence of radiopaque material on all entrance wounds, with a statistically significant difference between cases and controls. No differences were found among specimens covered by fabrics, with regard to the firing distance and the type of clothing. No GSR-like deposits were detected in exit wounds. Our results suggest that micro-CT analysis may be a useful screening tool for differentiating entry from exit gunshot wounds when the covering textiles are contaminated, damaged, or missing.


Asunto(s)
Vestuario , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/patología , Microtomografía por Rayos X , Adulto , Estudios de Casos y Controles , Balística Forense , Humanos , Masculino , Persona de Mediana Edad , Piel/diagnóstico por imagen , Piel/patología , Adulto Joven
18.
Int J Legal Med ; 130(5): 1387-99, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27147416

RESUMEN

Personal injury is a legal term for a physical or psychic injury suffered by the plaintiff under civil and/or tort law. With reference to non-pecuniary damages, the evidence itself of physical and/or psychic injury is not sufficient for damage compensation. The process of ascertaining impairments and/or disabilities which pertain to the "personal sphere" of the individual, such as pain and suffering, loss of amenity, and/or psycho-existential damage, poses particular difficulties in relation to the obtainment of scientific evidence. The "immateriality" and the subjective connotation of the personal sphere are, in themselves, critical issues. The clinical data obtained from the neuropsychological ascertainment find their essential prerequisite in the active participation of the examinee who, in legally relevant contexts (criminal law, civil law, insurance), may be "affected" by personal interests. The present manuscript presents a novel interdisciplinary methodology, experimented on a series of judicial and extra-judicial cases, aimed at the attainment of objectivity and accuracy eligible in relation to the judicial settlement of cases and other matters involving the ascertainment of peculiar aspects of non-pecuniary damage.


Asunto(s)
Compensación y Reparación/legislación & jurisprudencia , Psiquiatría Forense/legislación & jurisprudencia , Trastornos Psicofisiológicos/diagnóstico , Derecho Penal , Humanos , Anamnesis , Examen Físico , Pruebas Psicológicas
19.
Int J Legal Med ; 130(1): 1-12, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26342285

RESUMEN

Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first "International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law". This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM).


Asunto(s)
Compensación y Reparación/legislación & jurisprudencia , Responsabilidad Legal , Humanos , Mala Praxis/legislación & jurisprudencia , Anamnesis/normas , Examen Físico/normas , Derivación y Consulta/normas
20.
Radiol Med ; 121(6): 494-501, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26747042

RESUMEN

OBJECTIVE: To analyze the morphology and depth of stab wounds experimentally produced on human legs amputated for medical reasons using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) after the instillation of a single contrast medium solution (CMS). MATERIALS AND METHODS: For morphological analysis, MSCT and MRI scans were performed before and after the instillation of CMS into the wound cavity. Depth measurements were performed on the sagittal view only after CMS instillation. Subsequently, each wound was dissected using the layer-by-layer technique and the depth was measured by a ruler. One-way between-groups pairwise analysis of variance (ANOVA) and Bland-Altman plot analysis were used for comparing radiological and anatomical measurements. RESULTS: Unenhanced MSCT images did not identify the wound channels, whereas unenhanced MRI evidenced the wound cavity in 50 % of cases. After the instillation of CMS, both MSCT and MRI depicted the wound channel in all the investigated stabbings, although the morphology of the cavity was irregular and did not resemble the shape of the blade. The radiological measurements of the wounds' depth, after the application of CMS, exhibited a high level of agreement (about 95 % at Bland-Altman plot analysis) with the anatomical measurements at dissection. A similar systematic underestimation, however, has been evidenced for MSCT (average 11.4 %; 95 % CI 7-17) and MRI (average 9.6 %; 95 % CI 6-13) data after the instillation of CMS with respect to wound dissection measurements. CONCLUSION: MSCT and MRI after the instillation of CMS can be used for depicting the morphometric features of stab wounds, although depth measurements are affected by a slight systematic underestimation compared to layer-by-layer dissection.


Asunto(s)
Medicina Legal/métodos , Traumatismos de la Pierna/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada Multidetector , Heridas Punzantes/diagnóstico por imagen , Medios de Contraste , Humanos , Técnicas In Vitro
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