Medico-legal assessment of personal damage in older people: report from a multidisciplinary consensus conference

Ageing of the global population represents a challenge for national healthcare systems and healthcare professionals, including medico-legal experts, who assess personal damage in an increasing number of older people. Personal damage evaluation in older people is complex, and the scarcity of evidence is hindering the development of formal guidelines on the subject. The main objectives of the first multidisciplinary Consensus Conference on Medico-Legal Assessment of Personal Damage in Older People were to increase knowledge on the subject and establish standard procedures in this field. The conference, organized according to the guidelines issued by the Italian National Institute of Health (ISS), was held in Bologna (Italy) on June 8, 2019 with the support of national scientific societies, professional organizations, and stakeholders. The Scientific Technical Committee prepared 16 questions on 4 thematic areas: (1) differences in injury outcomes in older people compared to younger people and their relevance in personal damage assessment; (2) pre-existing status reconstruction and evaluation; (3) medico-legal examination procedures; (4) multidimensional assessment and scales. The Scientific Secretariat reviewed relevant literature and documents, rated their quality, and summarized evidence. During conference plenary public sessions, 4 pairs of experts reported on each thematic area. After the last session, a multidisciplinary Jury Panel (15 members) drafted the consensus statements. The present report describes Conference methods and results, including a summary of evidence supporting each statement, and areas requiring further investigation. The methodological recommendations issued during the Conference may be useful in several contexts of damage assessment, or to other medico-legal evaluation fields

Iatrogenic Horner Syndrome after a mini-invasive thyroidectomy procedure: case report and medico-legal implications of a rare complication in neck surgery

We report the case of a 36-year-old man with papillary thyroid carcinoma that infiltrated the trachea, who suffered damage to the sympathetic innervation during total thyroidectomy. The case was referred for medico-legal evaluation owing to the onset of iatrogenic Horner Syndrome. Although the informed consent form signed by the patient provided an exhaustive list of the main complications of thyroidectomy, it did not report the risk of damage to the sympathetic pathway. Moreover, immediately after being roused from anaesthesia, the patient complained of symptoms attributable to the syndrome; these were underestimated by physicians and the pathology went unrecognised. However, the symptoms caused by the definitive lesion of the sympathetic pathway persisted, and the diagnosis was made two months after surgery. Horner Syndrome is a rare complication in thyroid surgery. Nevertheless, given the close and variable anatomical relationships with the thyroid, care must always be taken to preserve the sympathetic nerve pathways, and patients should be informed of the risk of possible damage. Finally, any signs and symptoms of damage warrant prompt neuro-ophthalmological investigation

An unusual case of functional neurological disorders and psychogenic coma following physical assault: Clinical and medico-legal considerations

Functional neurological disorders can have different clinical manifestations, including coma, in the setting of an unknown etiology. In this article, we present a case of a young man affected by intellectual disabilities who, after a physical assault reported serious neurological alterations and a functional coma. This case shows how a stressful psychophysical event can bring acute and variable neurological manifestations of functional significance to a victim with previous intellectual disabilities. Despite the growing interest in this field, research is still very limited and studies in this field could better explain the nature of the psychogenic coma. From a medico-legal point of view, problems of evaluation may emerge for these disorders emerge as a result of acute psycho-physical stress and without any detectable structural alterations

Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as \u201ccaput medusae.\u201d Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension