Work-related fatal injuries in Brescia County (Northern Italy), 1982 to 2015: A forensic analysis.

Work-related deaths represent an important social problem. We report all the occupational fatal injuries recorded by the Brescia Institute of Forensic Medicine from 1982 to 2015. A total of 426 post-mortem examinations due to accidental work injuries were retrospectively analysed according to temporal distribution (year, month and day of the workplace accident); workers' characteristics (sex, age, nationality); type of occupation; cause of death; anatomical region of fatal injuries and timing of death. The accidental occupational events occurred with a mean of 12.5 cases per year. Almost all the workers were male (99%) and Italians (87%), aged between 35 and 49 years old (34.27%). The occupation with more fatalities was construction (36.62%), followed by mechanical industry (19.25%) and agriculture (13.15%). Most of deaths were connected to a mechanical trauma (77.69%) such as falls, machinery-related events, blunt forces or explosions. The predominant site of the lethal wound was the head (33.56%), with a high percentage of death resulting from a traumatic brain injury. In 30.75% of cases death occurred after a short period of hospitalization.

Hypochlorite accident during wndodontic therapy with nerve damage - A case report.

Endodontic therapy is a routinely practised clinical procedure with few reported complications but, as a bleaching agent, inadvertent spillage of sodium hypochlorite beyond the root canal system may result in extensive soft tissue or nerve damage, and even airway compromise. Although very rare, complications arising from hypochlorite extrusion beyond the root apex are described. NaOCl causes oxidation of protein and lipid membrane and causes necrosis, hemolysis and dermal ulcerations (2-4). Neurological complication are very rare. Paraesthesia and anaesthesia may affect the mental, inferior dental and infra-orbital branches of the trigeminal nerve and normal sensation may take many months to  completely resolve (6, 7). Nerve damage (the buccal branch) was described in 2005 by Witton et al. (8) and patients exhibited a loss of the naso-labial groove and a down turning of the angle of the mouth and the motor function was regained after several months. We present a case in which the extrusion of NaOCl solution during endodontic therapy led to important destructive effects on soft tissues and nerves. The arisen medico legal issues are discussed.

Sudden death due to a hypopharyngeal mass during sleep: a case report.

It is not frequent to find during the autopsy a lymphoid hyperplasia located in the hypopharynx. The literature reports numerous cases characterized by the presence of a mass, non-malignant too, in this particular anatomical district; in these cases the neoformation plays an important role in explaining the cause of death through different asphyxial mechanisms. We present a case of a 44-year-old man, in apparent good health, who suddenly died during sleep. The autopsy revealed an hypopharyngeal lymphoid hyperplasia that can provide the asphyxial mechanisms as cause of death. Furthermore, the anatomical finding could be integrated by a circumstantial piece of evidence: the death occurring during sleep. Some studies, in fact, have highlighted the physio-pathological mechanisms to explain sleep-disordered breathing, particularly the muscular and neural changes involving the pharynx. The asphyxial mechanism was also studied by an immunohistochemical analysis with the anti-Human Surfactant Apoprotein-A (SP-A) antibody.