Oral and dental signs of child abuse and neglect.

AIM: The aim of this report is to identify the main oral and dental aspects of physical and sexual abuse and dental neglect in childhood, contributing to the precocious identification and diagnosis in a dental practice. METHODS: The oral and dental manifestations were divided and classified according to the type of child abuse: physical abuse, sexual abuse, neglect. PHYSICAL ABUSE: Several studies in the literature have shown that oral or facial trauma occurs in about 50% of physically abused children; the oral cavity may be a central focus for physical abuse. Oro-facial manifestations of physical abuse include bruising, abrasions or lacerations of tongue, lips, oral mucosa, hard and soft palate, gingiva, alveolar mucosa, frenum; dental fractures, dental dislocations, dental avulsions; maxilla and mandible fractures. SEXUAL ABUSE: Although the oral cavity is a frequent site of sexual abuse in children, visible oral injuries or infections are rare. Some oral signs may represent significant indications of sexual abuse, as erythema, ulcer, vescicle with purulent drainage or pseudomembranus and condylomatous lesions of lips, tongue, palate and nose-pharynx. Furthermore, if present erythema and petechiae, of unknown etiology, found on soft and hard palates junction or on the floor of the mouth, can be certainly evident proofs of forced oral sex. DENTAL NEGLECT: Oral signs of neglect are easily identifiable and are: poor oral hygiene, halitosis, Early Childhood Caries (ECC), odontogenous infections (recurrent and previous abscesses), periodontal disease, aptha lesions as a consequence of a nutritional deficiency status. Moreover, it is analyzed the assessment of bite marks because often associated with child abuse, the identification and collection of clinical evidence of this type of injury. CONCLUSION: A precocious diagnosis of child abuse, in a dental practice, could considerably contribute in the identification of violence cases and in an early intervention.

[Guidelines and malpractice in obesity treatment]. / Orientamenti terapeutici e malpractice nel trattamento dell'obesità.

BACKGROUND: Obesity, is one of the most common nutritional disorder in developed countries. The association with several health disorders (i.e., type 2 diabetes mellitus, hypertension, hyperlipidemias, cholelithiasis, obstructive sleep apneas, coronary heart disease, cancer) is frequently present. DESIGN: Obesity is, actually, measured using body mass index (BMI) determination. However, BMI isn't useful to predict body fat content. Skin-fold thickness, bioelectrical impedance analysis and/or dual energy x ray absorptiometry are specific tools with different capability to measure body composition (i.e., fat mass and fat-free mass). All these methods need a large data-base of age, sex and population reference values. CONCLUSIONS: Obesity management (dietary treatment, monitoring of weight loss, pharmacologic approach, and surgery ) is associated with several complications and errors.

Dual X-ray absorptiometry for estimating the volume of the soft tissue in the human skull.

The aim of this study was to analyze the relationship between soft and hard tissue measurements of the head so as to identify the range of soft tissues parameters that should be applied in forensic facial approximation. The study was performed on 85 healthy female volunteers with an age range of 35-45 years. Total and regional body composition analysis was undertaken with subjects in a recumbent position using dual X-ray absorptiometry. The head was defined from the inferior part of the mandible to the vertex. We found the range of total head soft tissue weight to be between 3.02 and 4.96 kg. The quantity of soft tissue applicable to Caucasian female subjects in good health was estimated by subtracting the weight of the brain (approximately 1.17 kg in a typical adult female) from these values. Thus, the minimum and maximum values of the soft tissue are 1.85 and 3.79 kg, respectively.

Cerebellar agenesis in a suicide.

A case of a suicidal death associated with autopsy findings of right cerebellar and vermian agenesis is described. A review of the literature points out the various recurrence of agenesis, symptoms, and the likelihood of motor deficits. The singular coexistence of only behavioral and intellectual deficiency with suicidal inclination in an adult man with partial cerebellar agenesis is discussed.

Left ventricular aneurysm caused by blunt chest trauma.

A case of unexpected death associated with an aneurysm of the left ventricle caused by nonpenetrating chest trauma is described. A review of the more recent literature on the incidence, pathological course, and prognosis of the posttraumatic ventricular aneurysm pointed out the necessity of suspecting cardiac damage in cases of blunt chest trauma especially when major injuries may obscure heart involvement.

[Medico-legal aspects of the 89/931 act of the EEC]. / Gli aspetti medico legali della direttiva quadro 89/931 della CEE.

The act 391/89 which introduces some substantial news regarding the protection of public welfare and the safety of workers, will be taken in account in a next future. The A.A. examine these innovations and underline the way they will reassert the importance of a concrete application of the principles of primary prevention. Moreover, this act will have a large impact on forensic medicine as it will allow the acquisition of objective elements to asses the casual nexus between occupational exposure and injury, while evaluating the occupational etiology of the damage.