[Mandatory or voluntary vaccinations? Juridical and medico-legal aspects]. / Le vaccinazioni tra obbligo e scelta consapevole: aspetti medico-legali e giuridici.

The Italian juridical and legislative aspects of vaccination based on a compulsory system are presented considering the medico-legal questions. The prospective of a voluntary system, as anticipated by many normatives and other official documents, is examined. The experience of some local health authorities on cases of in observance of the vaccinal obligation are detailed Finally professional risks for vaccinal operators are examined and the need of specific guidelines for parents' consent to compulsory vaccination during infancy is prospected.

Incidence of xenobiotics among drivers killed in single-vehicle crashes.

The authors have performed a study of single-vehicle crashes (SVCs) in order to verify a correlation between the loss of vehicle control and the presence of drugs in the body. Overall, 129 cases were recorded and occurred in the catchment area of the Institute of Legal Medicine in Milan between 1986 to 1996. Among the 129 cases under study, respectively 121 men and eight women, 101 were car-drivers and 28 motor-cyclists. The median age was equal to 29 years, while the average age to 32.0 years (range 15-65 years). Fifty eight cases (45.0%) were "positive" for the presence of ethanol > or = 0.8 g/l or other drugs. The sample of "positive cases" was studied according to sex, age, day, hour and type of vehicle. Considering the cases with presence of ethanol, although under the legal limit (20 cases), the total amount of cases (78) becomes even more consistent. The amount of ethanol was found to be respectively 0.34 g/l in daily drivers and 0.87 g/l in nightly drivers (p < 0.01). Our considerations confirm the importance of toxicological analyses in the forensic investigation of traffic deaths being the sample under study recorded following criteria which minimised other possible factors effecting road accidents.

Prevalence of HIV and hepatitis C markers among a cadaver population in Milan.

AIMS: To examine the distribution of serological markers for HIV and hepatitis C virus (HCV) infection in a medicolegal population; to compare prevalence of HIV and HCV markers and cause of death; and to evaluate the risk of potential infection to personnel involved in medicolegal incidents and procedures. METHODS: Blood samples were collected at necropsy from 328 males and 69 females, aged 16 to 50 years at time of death, and tested for antibodies to HIV and HCV. The individuals were classified according to cause of death and whether there was known antemortem risk of infection. RESULTS: Overall, 134 subjects gave positive test results: 20 for anti-HIV, 69 for anti-HCV, and 45 for both. By cause of death, the total number of positives (and negatives) with the pairs of figures referring, respectively, to patients with and without known antemortem risks were: natural causes 3 (1), 8 (32); AIDS 2 (0), 0 (0); homicide 0 (2), 5 (24); suicide 3 (0), 9 (69); road traffic accidents 1 (0), 9 (81); other accidents 2 (3), 1 (12); drug overdose 74 (17), 7 (9); unknown causes 3 (2), 7 (11). CONCLUSIONS: The cases tested represented a predominantly young male population with a high prevalence of serological markers for HIV and HCV infection. The distribution of HIV and HCV positivity varied with the cause of death, probably reflecting the known association between high risk behaviour and infection. However, a substantial number of cases with no known risks also had markers for HIV and HCV, suggesting that there is a large unrecognised pool of potential infection in medicolegal practice.

[Anesthesiologic incidents from esophageal intubation. Presentation of three cases and medico-legal evaluation]. / Incidenti anestesiologici da intubazione esofagea. Presentazione di tre casi clinici e valutazione medico-legale.

Undiagnosed esophageal intubation is still prominently in anesthesia-related morbidity and mortality. Three cases of undiagnosed esophageal intubation taken into consideration for possible anesthesiologic malpractice are presented. A review of the international anesthetic-related morbidity and mortality statistics indicates that this misadventure remains a problem even among anesthesia personnel, a medical population specifically trained in such a procedure. It is not only the frequency of this misadventure but the potential catastrophic consequences for the patient that underline the importance of being able to recognise and correct an esophageal intubation. The reliability of commonly prescribed methods of assessing tracheal tube position is reviewed and the conclusion is drawn that continuous end-tidal carbon dioxide measurement during anesthesia is perhaps the most reliable means under all circumstances for determining proper tube position and should be employed routinely whenever possible.