Homicide with post mortem dismemberment of the victim with previous amputation of right lower limb: Case report and review of the literature.

The dismemberment of a corpse is comparatively rare in forensic medicine and usually performed with different types of sharp tools. The victim is always the victim of a homicide. Dismemberment usually occurs where the killing took place without prior planning by the perpetrator. We report a case of homicide with post mortem mutilation of the victim's body with previous amputation of right lower limb in which the perpetrator was not identified. At autopsy, several fractures were detected on the cranial vault, and the cause of death was due to skull and brain injuries from multiple blunt force traumas.

Legal aspects of sexually transmitted diseases: abuse, partner notification and prosecution.

Sexually transmitted diseases (STDs), with special emphasis to HIV infection, involve legal and ethical issues regarding informed consent to submit to a diagnostic, observance of professional secrecy in regard to partner(s) and community; legal troubles of particular difficulties are related to STD involving minors; lastly, physicians must be able to recognize the state of so called medical necessity. Knowledge and awareness of these related obligations are crucial to STD in medical practice; it is also important to allow for proper protection of victims of suspected sexual abuse under observation of healthcare. With regard to this aspect should be emphasized that violence against women and minors is a worldwide problem that has not yet been sufficiently acknowledged. Italian legislation (Law n. 96/1996) against rapes finally gave significant relevance to sex crimes. When sexual abusers have to be evaluated some obstacles may arise for lack of appropriate interdisciplinary approach, with insurance of the collection of biological samples, also related to STD diagnosis and alerts of legal authorities. Personal preconceptions may interfere with investigation if the biological evidences in children are few. In this regard, rules of document "Carta di Noto" drafted in 1996 and reviewed in July 2002 include some specific indications aiming to grant the reliability of the results of technical investigations and authenticity of the statements of the alleged victims.

[Informed consent for HIV diagnostic tests: what to do in case of minors]. / Il consenso informato per l'effettuazione del test per la diagnosi di infezione da HIV: come comportarsi in caso di minori.

AIDS is a clinical picture related to Human Immunodeficiency Virus (HIV) infection. In the last 20 years this infection has spread progressively, with approximately 2.4 million children under 15 years old now infected. The HIV antibody test is generally used to reveal the infection. In most European countries the test is voluntary; in Italy, implementation of the test is now regulated by Law 135/90. Art. 5 of the law states that the test is voluntary while informed consent is obligatory. However, nothing is stated concerning the child's consent. By contrast, other Italian laws (e.g., Law 194/78, Law 194/96 and DPR 309/90) establish that the physician should only accept the wishes of minors after first appraising the maturity of the child and his/her age. Physicians must inform the minor about testing risks, about the meaning of its result, and about the most important aspects of sexual education.. They may then decide to inform the parents if they feel that the child would be unable to take future decisions in the event of a positive HIV antibody test.

Typical homicide ritual of the Italian Mafia (incaprettamento)

Certain methods of homicide used by the Italian Mafia are intended to have an admonitory significance. One such method is the so-called "incaprettamento." This study analyzes 18 cases of homicidal ligature strangulation in which the body was found in this typical position. The circumstances of the crime and the macroscopic and microscopic evidence were evaluated to determine whether or not the ligatures on the wrists and ankles were placed antemortem or postmortem.

Evaluation of pulmonary perfusion following an acute heroin overdose in dogs.

This research was designed to analyze the effects of heroin overdose on pulmonary perfusion in dogs. In view of this pulmonary perfusion by radionuclide method, arterial blood pressure by the femoral artery, mean right ventricular pressure and pulmonary wedge pressure by Swang-Ganz catheter were detected in 7 medium sized healthy dogs. In addition PaO2, SaO2, PaCO2 and blood pH were also determined by current methods. All the dogs received an acute bolus of purified heroin at dosage of 12.5 mg/Kg. All the measurements were made at baseline and at 30 seconds, 10 minutes, 20 minutes and 30 minutes after heroin administration. Our data indicated an impaired pulmonary perfusion by the analysis of the slope and the area under the time/activity curve following heroin overdose. In addition a significant reduction (p < 0.001) in blood pressure and a significant rise (p < 0.01) in mean right ventricular pressure and in pulmonary wedge pressure were observed after 30 seconds by heroin overdose. Moreover heroin administration promoted a significant increase (p < 0.001) in PaCO2 and a significant decrease (p < 0.001) in both PaO2 and SaO2. These results indicated that early pulmonary perfusion abnormalities may be recognized in dogs receiving an acute heroin overdose and they were associated with impaired gas-exchange. These changes in respiratory function could represent and important mechanism of clinical manifestations following heroin overdose.

[Anomalous origin of the right coronary from the left sinus of Valsalva. A possible cause of juvenile sudden death]. / Origine anomala della coronaria destra dal seno di Valsalva sinistro. Una possible causa di morte improvvisa giovanile.

Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital anomaly classified as a "minor" anomaly of no clinical importance. Recently, manifestations of myocardial ischemia (angina pectoris, myocardial infarction, nonfatal ventricular fibrillation, sudden death) have been described in patients with this anomaly in the absence of atherosclerosis or other. Sudden death occurs frequently in symptomatic patients and rarely in asymptomatic patients (sudden unexpected death). In this study we report two cases of juvenile sudden death observed in asymptomatic patients with anomalous origin of the right coronary artery from the left sinus of Valsalva. In both cases the sudden death was exertion-related. In case 1 the coronary anomaly was the cause of death, since it was the only significant anatomic abnormality at necropsy; the microscopic findings revealed ischemic lesions only in the myocardium supplied by the anomalous right coronary artery. In case 2 the coronary anomaly was connected to other cardiac and non cardiac diseases (lymphocytic active myocarditis, chronic portitis, encephalitis, medullary adrenalitis). Since these morphologic lesions were extremely slight and there was no adrenal catecholamine damage in the myocardium, we consider negligible their possible role in determining death, which in this case was induced by the congenital coronary anomaly. The cardiac microscopic findings, also in this case, revealed ischemic lesions in the myocardium supplied by the anomalous right coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of heroin and morphine on cardiac performance in isolated and perfused rabbit heart: evaluation of cardiac haemodynamics, myocardial enzyme activity and ultrastructure features.

In the present study the effects of heroin and morphine administration on cardiac function, myocardial enzyme activity and cardiac ultrastructure features have been evaluated in isolated and perfused rabbit hearts. In 24 male rabbits the hearts were excised and immediately perfused in a retrograde non recirculating Langendorff apparatus. Successively, heroin 1 x 10(-5) or 1 x 10(-4) M or morphine at 1 x 10(-4) M were individually administered in 18 rabbits for 45 min. In 6 rabbits, used as controls, the isolated hearts were perfused with perfusion fluid for the same time. At the end of perfusion period the hearts were removed and histology was studied. During the perfusion period, creatine phosphokinase (CPK), lactic dehydrogenase (LDH) activity, heart rate (HR), derivative of intraventricular pressure time ratio (dP/dt) and changes in systolic ventricular pressure (SVP), diastolic ventricular pressure (DVP) and in coronary blood flow (CBF) were also evaluated. At the end of perfusion period no significant changes in CPK, LDH, HR, dP/dt ratio, SVP, DVP and CBF in comparison with basal values were observed in all groups. Histological specimen were characterized by slight derangements in atrial and ventricular structure both after heroin and after morphine administration. In conclusion our data suggest that alterations following opioids administration might rather be related to a systemic action involving only indirectly the heart.

[Right ventricular dysplasia and sudden death in young people]. / Displasia del ventricolo destro e morte improvvisa giovanile.

In this study two autoptic cases of right ventricular dysplasia, observed in young and asymptomatic subjects who died suddenly are reported. In these patients, the "primary" myocardial atrophy involved the right ventricle, the right atrium and the conduction system: the sinoatrial node and the internodal pathways (in both cases) and the hisian bifurcation (only in the second case). The primary ventricular dysplasia was always associated with "secondary" transmural hyperplasia of the sub-epicardial fat tissue except for the anterior wall of the pulmonary infundibulum. According to the findings observed, we think that: 1) in all cases of right ventricular dysplasia a careful examination of the conduction system must be performed due to the fact that the lethal arrhythmias can be not only "hyperkinetic" but also "hypokinetic" arrhythmias; 2) right ventricular dysplasia is a dysplastic-congenital disease and transmural fatty hyperplasia depends both on "primary" myocardial atrophy and on the presence of sub-epicardial fat tissue; the latter is related to the age of the patient.