Ischemic colitis following left antegrade sclerotherapy for idiopathic varicocele: the role of forensic clinical anatomy

Introduction. The Tauber procedure, i.e. antegrade sclerotherapy for varicocele, can be complicated by ischemic colitis. Its possible pathogenesis is referred to the presence of an atypical kind of portal-systemic communication, which could represent an unfrequently reported anatomic variant. Aim of this study is to solve this anatomical controversy of utmost clinical usefulness. Materials and methods. A computer-aided and hand-checked systematic review of the literature was implemented to identify relevant publications on the topic. Moreover, we reviewed the computed tomography CT-scan of a clinical case with medico-legal implications due to severe vascular complication following Tauber’s procedure. Results. Despite specific References were made on the issue in more dated hardbacks since the 19th century, only a few clinical cases reporting an ischemic colitis following the Tauber’s procedure were found in contemporary literature. By reviewing the CT-scan images of a filed lawsuit we found traces suggestive for the presence of a significant communication between the internal spermatic and the left colic vein, as part of the portal-systemic anastomoses. Conclusions. A significant anatomical finding identified in the past have been under-reported and subsequently underestimated in its clinical value. For the first time we demonstrated its pathophysiological role in a real clinical scenario, coupling the anatomical variation to the clinical complication hence stressing that its knowledge is of utmost importance to raise the scientific awareness and to prevent possible devastating complication in clinical daily practice. Progress in the medical field coupled with increased medical-legal awareness has supported the ripening of clinical anatomy and forensic clinical anatomy, whose multidisciplinary represents the best way to recover and hand down the medical knowledge at risk of being forgotten

Malpractice and Medical Liability. European State of the Art and Guidelines

none3noneSanto Davide Ferrara;Rafael Boscolo-Berto;Guido VielFerrara, Santo; BOSCOLO BERTO, Rafael; Viel, Guid

Forensic implications in self-insertion of urethral foreign bodies

A 54-year-old Caucasian male presented to our emergency department because he had self inserted a transparent plastic and flexible tube into the urethral meatus, during erotic games. A plain pelvic x-ray film and an abdominal ultrasound were executed to determine the size, shape, orientation and location of the foreign body, and any eventually associated visceral injuries or complications. As results, a long tube of about 50 cm was described entering the urethra and reaching the bladder cavity in which the tube was folded and wrapped, in absence of any visceral complication. The patient underwent an urgent urethrocystoscopy resulting in the retrieval of both the two recognized foreign bodies by an endoscopic basket extraction. To complete the therapeutic approach, we focused also on the possible psychiatric implications of the self insertion of a foreign body into the urethra, and the initial evaluation reached the diagnosis of depression. The self introduction of a foreign body into the urinary tract represents an index of potentially harmful 'self-destructive' behaviors. If the self destructive and/or suicidal ideations are not recognized in the clinical setting and the patient subsequently self inflicts an injury or commits suicide, the urologist may face legal problems related to the lack of diagnosis and treatment, potentially interpretable as a medical error, and thus as a reckless conduct

Magnetic Resonance Angiography Findings of Penile Mondor's Disease

A 53-year-old male was admitted to our Emergency Department affected by a contemporary high-flow priapism and induration on the dorsal penile surface, in consequence of a prior transrectal prostate biopsy performed 2 weeks earlier on the basis of a suspicion of prostate cancer. We describe a penile Mondor's disease (penile superficial dorsal vein thrombosis) of uncertain pathogenesis involving the penile superficial vein, and employing a careful diagnostic pathway by using magnetic resonance angiography (MRA). In the literature many reports described pulsed- and color-Doppler ultrasonography classical findings about penile Mondor's disease. For the first time we report the pathognomonic features of penile Mondor's disease on MRA, which may be considered a useful and comprehensive tool to deepen the analysis only in the case of a complex clinical picture such as the one presented

Malpractice and Medical LiabilityEuropean State of the Art and Guidelines /

XXV, 368 p. 91 illus.online resource

Editorial for "Preoperative assessment for high-risk endometrial cancer by developing a MRI- and clinical-based radiomics nomogram: A multicenter study"

DOI: 10.1002/jmri.2728