STRATEGY TO MONITOR AND EVALUATE THE IMPACT OF FORMALDEHYDE IN ANATOMICAL PATHOLOGY LABORATORY – PART I: OCCUPATIONAL EXPOSURE AND CANCER RISK ASSESSMENT

Formaldehyde (FA) is a chemical compound commonly used in anatomical pathology laboratories as a tissue preservative, and it is common and epidemiologically related to cancer. Therefore, the personnel resident in the anatomical pathology laboratories is among the workers most exposed to FA and its related cancer and non-cancerogenic risk. Thus, risk assessment, cancerogenic and non-cancerogenic, and a careful occupational exposure assessment are recommended. In this study, FA was monitored in an Italian anatomical pathology laboratory to perform an occupational exposure assessment, according to the UNI EN 689:219, and to determine the Hazard Quotient (HQ) and the Lifetime Cancer Hazard Risk (LCHR) for carcinogenic and non-carcinogenic risk assessment, respectively. The exposure observed for pathologists and technicians is lower than the EU Occupational exposure limit mandatory (0.62 mg/m3), and both group of workers are in Compliance with it. Nevertheless, concerning the risk assessment, both the HQs and the LCHRs resulted in being higher (1.3 and 1.6 HQ and 3.2x10-5 and 3.9x10-5, for pathologists and technicians, respectively) than the ones observed in similar scenarios. This study shows how the exposure assessment to FA could face striving situations in terms of workers\u27 health safeguard, due to the differences among occupational limits recommended and the high health risks, especially in the healthcare field.Formaldehid je kemijski spoj koji se obično koristi u laboratorijima za anatomsku patologiju kao konzervans za čuvanje tkiva, a često ga se povezuje s rakom. Osoblje u takvim laboratorijima najizloženije je formaldehidu i s njim povezanom raku, a i nekancerogenom riziku. Stoga se preporuča procjena rizika, kancerogenih i nekancerogenih, a također i procjena izloženosti na radu. Ova studija pratila je formaldehid u jednom talijanskom laboratoriju za patologiju kako bi se procijenila izloženost na radu prema UNI EN 689:219 i utvrdio kvocijent opasnosti (HQ) kao i doživotnog rizika od raka (LCHR) te kancerogeni i nekancerogeni rizici. Izloženost patologa i tehničara bila je niža od Europske obvezne granice za izloženost na radu (0.62 mg/m3) i obje skupine bile su ispod te granice. No, ipak, što se tiče procjene rizika, oba parametra HQ i LCHR bila su viša (1.3 i 1.6 HQ, i 3.2x10-5 i 3.9x10-5 za patologe te tehničare, tj. viša od drugih zamijećenih u sličnim situacijama. Studija prikazuje kako procjena izloženosti formaldehidu može pomoći u očuvanju zdravlja radnika utvrđivanjem odstupanja od preporučenih graničnih vrijednosti i posljedično visokih rizika za zdravlje, posebno u zdravstvu

Identification of bullet entrance in different type of intermediate firearm wounds through micro-computed tomography analysis

Objectives: The aim of the study was to compare, by means of micro-computed tomography (micro-CT), intermediate gunshot wounds produced on human skin, in order to perform a differential diagnosis between entry (EntW) and exit (ExtW) wounds.Materials and methods: Thirty firing trials were carried out at a distance of 15 cm. Six shooting experiments were performed on human calves covered with a single layer of textile; the other 24 firing trials were carried out on bare skin sections.The bare skin specimens (n=6) and those covered by textile specimens (n=6) were immediately formalin-fixed. The remaining gunshot wounds were submerged in water for 1 day (n=6), or enclosed in a cowshed for 15 days (n-6) or placed inside a wood-burning stove for 4 min (n=6). The entrance and exit wounds were analyzed macroscopically and microscopically, as well as radiologically using a micro CT, and the results were compared by blinded investigators.Results: At visual inspection, the differential diagnosis between entrance and exit holes was possible only in fresh and submerged gunshot wounds, while the skin of the other types of lesions did not show any of the classical morphological features of entrance wounds.Micro-CT analysis detected radiopaque particles in each experimental sample only on the EntW, while on the ExtW no gunshot residue (GSR) deposits were evident.Conclusion: Micro-CT analysis detected GSR in EntW, allowing the performance of a differential diagnosis from the ExtW. This objective and rapid tool may furnish precious information for reconstructing the shooting incident in firearm fatalities. (C) 2015 Elsevier Ltd. All rights reserved

Determinazione di residui di sparo in ferite d\u2019arma da fuoco putrefatte mediante micro-TC

In cadaveri in avanzato stato di putrefazione l\u2019analisi ispettiva delle ferite d\u2019arma da fuoco pu\uf2 risultare confusa e difficoltosa a causa delle alterazioni indotte da fenomeni autolitici-putrefattivi. Nel presente studio gli Autori propongono l\u2019applicazione della Micro-TC all\u2019identificazione e quantificazione del GSR su ferite d\u2019arma da fuoco sottoposte a putrefazione standardizzata. La micro-TC risulta essere un valido strumento per la diagnosi differenziale tra foro di ingresso e foro di uscita, ma non per la determinazione della distanza di sparo

Studio istochimico di ferite cutanee putrefatte

In cadaveri in avanzato stato di putrefazione la diagnosi differenziale tra ferita vitale e post-mortale pu\uf2 apparire difficoltosa a causa delle alterazioni indotte da fenomeni autolitici-putrefattivi. Nel presente studio gli Autori propongono l\u2019applicazione di colorazioni istochimiche su ferite cutanee vitali di recentissima insorgenza (<30 minuti antecedenti il decesso) e post-mortali sottoposte a putrefazione standardizzata. Rispetto all\u2019ematossilina-eosina, le colorazioni di Giemsa e di Picro-Mallory, aumentando il contrasto tra eritrociti e tessuto connettivo, hanno permesso una migliore visualizzazione della dissociazione emorragica dei margini della ferita fino a due settimane dalla morte

La TC multi-slice nella determinazione della distanza di sparo

Le procedure di analisi attualmente impiegate nella stima della distanza di sparo, prevedono la valutazione della distribuzione, sulla superficie bersaglio, del gunshot residue (GSR). Nel presente studio proponiamo un approccio basato sull\u2019applicazione della TC spirale multi-slice a ferite d\u2019arma da fuoco prodotte sperimentalmente; tale metodica ha permesso la determinazione della distanza di sparo per colpi d\u2019arma da fuoco esplosi da distanze ravvicinate (< 15 cm), nonch\ue9 la diagnosi differenziale tra foro d\u2019entrata e di uscita. Inoltre, consente di ricostruire fedelmente la direzione del tramite del proiettile e di identificare proiettili o frammenti ritenuti

Histological Diagnosis of Myocardial Sarcoidosis in a Fatal Fall from a Height

The major issues of medico-legal relevance in fatal falls from a height are the manner of death and the reconstruction of the event. We present a peculiar case of a fatal fall from a height of about 9 m, involving a 27-year-old woman. At the death scene investigation, no suicide notes, housebreaking marks, or signs of fight were found, thus weakening both the suicide and homicide hypotheses. Combining circumstantial, autopsy and toxicology data, the kinematic analysis of the jump/fall, and the histological evidence of a myocardial sarcoidosis involving the left ventricle, we hypothesized that the young woman might have accidentally fallen from the window because of a sudden loss of consciousness related to cardiac disease undiagnosed during life. We believe that our brief report is a good example of the powerful additional information that histological investigations can offer for reconstructing the dynamics of the event in falls from a height and other traumatic fatalities

Micro-CT features of intermediate gunshot wounds severely damaged by fire

Incineration or extensive burning of the body, causing changes in the content and distribution of fluids, fixation and shrinking processes of tissues, can alter the typical macroscopic and microscopic characteristics of firearm wounds, hampering or at least complicating the reconstruction of gunshot fatalities. The present study aims at evaluating the potential role of micro-computed tomography (micro-CT) for detecting and quantifying gunshot residue (GSR) particles in experimentally produced intermediate-range gunshot wounds severely damaged by fire. Eighteen experimental shootings were performed on 18 sections of human calves surgically amputated for medical reasons at three different firing distances (5, 15 and 30\ua0cm). Six stab wounds produced with an ice pick were used as controls. Each calf section underwent a charring cycle, being placed in a wood-burning stove for 4\ua0min at a temperature of 400\ua0\ub0C. At visual inspection, the charred entrance wounds could not be differentiated from the exit lesions and the stab wounds. On the contrary, micro-CT analysis showed the presence of GSR particles in all burnt entrance gunshot wounds, while GSR was absent in the exit and stab wounds. The GSR deposits of the firearm lesions inflicted at very close distance (5\ua0cm) were mainly constituted of huge particles (diameter >150\ua0\u3bcm) with an irregular shape and well-delineated edges; at greater distances (15 and 30\ua0cm), agglomerates of tiny radiopaque particles scattered in the epidermis and dermis layers were evident. Statistical analysis demonstrated that also in charred firearm wounds the amount of GSR roughly correlates with the distance from which the gun was fired. The obtained results suggest that micro-CT analysis can be a valid screening tool for identifying entrance gunshot wounds and for differentiating firearm wounds from sharp-force injuries in bodies severely damaged by fire. \ua9 2012 Springer-Verlag Berlin Heidelberg

MicroCT detection of gunshot residue in fresh and decomposed firearm wounds

Gunshot residue (GSR) evidence may be altered or obscured by after-death events such as putrefaction, autolysis, and/or damage by animals. The present study aimed at evaluating and comparing the amount and differential distribution of GSR utilizing microcomputed tomography (microCT) analysis of fresh and decomposed gunshot wounds. A total of 60 experimental shootings at three different firing distances (5, 15, and 30 cm) were performed on human calves surgically amputated for medical reasons. Thirty specimens (10 for each tested distance) were immediately formalin-fixed, while the other 30 specimens were enclosed in a cowshed for 15 days, before formalin fixation (air temperature ranging from 11A degrees C to 38A degrees C). MicroCT analysis with three-dimensional image reconstruction detected GSR particles in all the investigated entrance wounds. In fresh specimens, GSR was concentrated on the skin surface around the entrance hole and in the epidermis and dermis layers around the cavity, while in decomposed specimens, the high density particles were detected only in the dermis layer. No GSR was detected in exit wounds of both fresh and decomposed specimens regardless of the tested firing distance. Statistical analysis demonstrated that also in decomposed wounds the amount of GSR roughly correlated with the distance from which the gun was fired, exhibiting, however, a higher variability than in fresh samples. The obtained results suggest that microCT analysis can be a valid screening tool for differentiating decomposed entrance and exit gunshot wounds

[World Health Organization (WHO) Guidelines for coastal and fresh waters: Italian translation by the Society of Hygiene, Preventive Medicine and Public Health (SItI) Working Group "Movement Sciences for Health"]

The Working Group "Movement Sciences for Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health has promoted the Italian translation of the WHO Guidelines for Safe Recreational Water Environments, relating to coastal and freshwater environments. In this article the authors briefly summarize the main areas covered in the guidelines, namely drowning and injury, exposure to cold, heat and sunlight, water quality, contamination of beach sand, exposure to algae and their products, aesthetic issues, exposure to chemical and physical agents, dangerous aquatic organisms, monitoring and assessment hazards and risks