The effect of the medico-legal evaluation on asylum seekers in the Metropolitan City of Milan, Italy: a pilot study.

In the present-day situation, the clinical forensic documentation of an asylum seeker's narrative and his or her examination, together with the physical and psychological findings, may have very important effects on the outcome of the request for political asylum. Since 2012, the Municipality of Milan, the University Institute of Legal Medicine, and other institutions have assembled a team with the task of examining vulnerable asylum seekers and preparing a medical report for the Territorial Commission for International Protection (Prefecture, Ministry of Interiors), who will assess the application. We compared medico-legal reports and outcomes of 57 cases which were evaluated by the Commission after having undergone a medico-legal evaluation through the Istanbul Protocol criteria and examined, in particular, which medico-legal variables seem associated to the outcome. The results show that forensic assessment seems to have a significant and interesting correlation with the final assessment given by the Commission. For example, the higher the level of consistency, according to the Istanbul Protocol, the more frequently protection is granted. These data show how important clinical forensic medicine can be in such scenarios and how the presence of clinical forensic experts should be encouraged in such evaluations, as has been recently enshrined in Italy in the guidelines of a Ministerial Decree of April 3rd, 2017 for the assistance and the rehabilitation as well as the treatment of psychiatric disorders in refugees and asylum seekers who have undergone torture, rape, and other severe forms of psychological, physical, or sexual violence.

Sensitivity of autopsy and radiological examination in detecting bone fractures in an animal model: implications for the assessment of fatal child physical abuse.

Skeletal injuries are often strong indicators of child abuse and their detection is therefore crucial. The aim of this study was to compare the sensitivity of three diagnostic approaches, namely autopsy, traditional (conventional) radiology, and computed tomography on "battered" piglets, in order to verify the sensitivity of each method, with respect to the true number of bone fractures assessed once the piglet was skeletonised (osteological control). Four newborn cadaver piglets who had died from natural causes were severely beaten post-mortem in every district of the body. Traditional radiography, computed tomography (CT) and autopsy were performed. The piglet was then macerated until skeletonised and the number of all fractures present recorded (osteological control). On the cranium, traditional radiology revealed only 35% circa of actual fractures, autopsy detected only 31% (P<0.01 for both comparisons versus osteological control), whereas CT imaging detected all fractures actually present. For ribs, radiology detected only 47% of all fractures present, and autopsy 65% circa (P>0.05 for both comparisons versus osteological control), while CT scans detected 34% (P<0.01). In suspected cases of fatal child abuse, we suggest that the bones of specific districts be directly analysed either at autopsy or by collecting specific diagnostic sites, such as parts of the rib cage, and subjecting them to maceration. The removed areas could be replaced with artificial material for cosmetic purposes. The authors stress the importance of combined radiological, CT scan, autopsy and osteological survey in the detection of perimortem bone fractures.

Event-related potentials and recognition memory: the effects of word imagery value.

Event-related potentials (ERPs) were recorded from 11 subjects during a recognition memory task. Subjects were auditorily presented with 160 target words and, after about 10 min, they were engaged in a recognition task. Subjects were required to determine on each of 320 trials if the word was 'new' (never before presented) or 'old' (heard previously). In the recognition test, 160 target words and 160 non-target words were used as stimuli. To assess the effect of word imagery value, 160 stimuli (80 target and 80 non-target) were high imagery words (HI) and the remaining 160 stimuli were low imagery words (LI). Word frequency was balanced across target and non-target words. Results showed that the old/new effect was reflected by a negative component (belonging to the N400 family, Cz maximum) which was larger for new words in the 400-700 ms range. The imagery effect was also present in the 250-550 ms range of the N400, which was larger for HI stimuli. The imagery effect was present at 400-550 ms only for target words. These results confirmed the hypothesis that negative components as N400, could reflect processes occurring during the memory retrieval of items.

Event-related potentials and recognition memory within the 'levels of processing' framework.

Event-related potentials (ERPs) were recorded from nine subjects during an incidental memory paradigm. During the study phase subjects were engaged in two tasks requiring semantic and rhyming decisions. During the test phase, subjects were required to decide on each of 320 trials if the word was 'new' (never before presented) or 'old' (seen previously). Results showed that semantic old words were more often recognized than rhyming ones. ERPs to new words were more negative than ERPs to old words in the 400-800 latency range. ERPs to semantic old words were more positive than ERPs to rhyming ones in the same latency range. The difference between ERPs to semantic and rhyming old words confirms a relationship between ERPs and memory.

Discussion on the causes of failure of surgical treatment of partial epilepsies.

Despite continuous improvement in diagnosis and surgery, persistence of seizures following surgical treatment of partial epilepsies still occurs in a relevant number of cases (30--40%). The analysis of personal material and of data from the literature appears to indicate that relevant causes of surgical failure are difficulties in delimitation of the epileptogenic zone and therefore of complete surgical removal. These difficulties are illustrated and discussed.

"Chronic" electrodes in SEEG exploration of partial epilepsies.

The advantages of the stereoelectroencephalographic study of epileptic patients prior to surgical treatment through "chronically" implanted multielectrodes are illustrated and discussed. The reliability of the information provided by the cerebral electrical activity is strengthened by recording the patient on different days, in different physiological conditions and under different pharmacological treatment. The consistency of some of the electrical abnormalities recorded gives them a strong diagnostic value.

[Research on the epileptogenic complex]. / Le problème de la recherche de la topographie d'origine de l'épilepsie

The great importance of a correct definition of the lesional-functional epileptogenic complex for the surgical treatment of the epileptic patient is stressed. The means utilizable to reach the knowledge of the topographic organizatif the latters are descri0ed and discussed in detail: the scalp EEG, the examinations based on the EEG effects of endocarotid injection of barbiturates and convulsants, the EEG during nocturnal sleep, the direct recording of electrocerebral activity from the cortical surface (electro-corticography) and from deep cerebral structures (stereoelectro-encephalography). The relative importance of the informations provided by the electrical activity of "lesional" type, by the interictal epileptic activity and by the ictal one is analyzed. The utilization of methodologies of automatic elaboration of the electrocerebral signals is reminded. Finally, the different modes of application of the means of analysis mentioned above in the different epileptic patients are discussed and exemplified.