New method in the age estimation by the spheno-occipital suture. 3D cone-beam CT application

The aim of the present study was to determine the sequence and timing of closure of the spheno-occipital synchondrosis for a large sample of a modern Italian population to assess if this age marker is a useful tool for age estimation for individuals. The sample consisted of 494 individuals in the age range 0-22 years, who were admitted to the Department of Radiology, Oncology and Anatomo-Pathology of "Sapienza" University of Rome - UOC Head and Neck Radiology - and the Department of imaging, University of L'Aquila, and who had undergone multi-slice CBCT imaging. The average age of the spheno-occipital closure in men is 18.3 years, whilst in women is 16.6. Therefore, it is evident that the closure in female people is faster than 1.7 years. The timing of closure of spheno-occipital suture can be used to understand the age, even if the research has to be implemented

Death connected to paralytic ileus due to the intake of antipsychotic drugs. Case report

Abstract: The aim of this article is to enlarge furtherly the case-studies on the potentially lethal side-effects of second generation atypical antipsychotic drugs. We report the case of a 40-years-old man, under treatment with quietiapine and clozapine because of a psychotic upset, presenting persistent constipation, who died few hours after his arrive at the ER. The autopsy, together with toxicological an histologic exams, allowed to hail the cause of the death from a cardiac upset, fostered by hydroelectric imbalance connected to the sub-occlusion context. This evaluation has been related to the side-effects of these drugs -even if used with therapeutic dosages -that are able to cause in predisposed people, the onset of disorder within the cardiac rhythm, provoking ventricular fibrillation and death. Because of this reason, a constant patients' monitoring -from the first treatment administration through all the therapy -is beneficial, to prevent the onset of these potential lethal episodes

Death connected to paralytic ileus due to the intake of antipsychotic drugs. Case report

Abstract: The aim of this article is to enlarge furtherly the case-studies on the potentially lethal side-effects of second generation atypical antipsychotic drugs. We report the case of a 40-years-old man, under treatment with quietiapine and clozapine because of a psychotic upset, presenting persistent constipation, who died few hours after his arrive at the ER. The autopsy, together with toxicological an histologic exams, allowed to hail the cause of the death from a cardiac upset, fostered by hydroelectric imbalance connected to the sub-occlusion context. This evaluation has been related to the side-effects of these drugs -even if used with therapeutic dosages -that are able to cause in predisposed people, the onset of disorder within the cardiac rhythm, provoking ventricular fibrillation and death. Because of this reason, a constant patients' monitoring -from the first treatment administration through all the therapy -is beneficial, to prevent the onset of these potential lethal episodes

About a case of missed diagnosis of a post-traumatic aneurysm in the ulnar artery. Medical-legal aspects in respect to the professional liability

Compartment syndrome of the left hand from a late diagnosed post-traumatic ulnar artery pseudoaneurysm. We report the case of 27 years old boy with a tipping and cutting wound on his left wrist, generating an ulnar artery pseudoaneurysm, that was late diagnosed, and therefore complicated by a compartment syndrome in the wrist. Immediately after the trauma the subject went to the emergency room where the severity of the injury was undestimated; in fact, it was sutured and medicated, without further investigation. When he went to the same hospital for the second time, symptoms (pulsatile mass, redness and irritation of the skin) were interpreted as an infectious process and treated in an incongruous way. Then, when he went to another hospital in which imaging studies (ultrasound) were performed, the pseudo- aneurysm of the ulnar artery was diagnosed and surgically treated. The delay in diagnosis led to a compartment syndrome that is still appreciable as a sensory-motor deficit of the hand, especially of the fourth and fifth finger. This pseudo- aneurysm complication and its debilitating outcomes are known in literature, so the diagnostic delay makes the sanitary staff guilty of the suffered damage

A new formula for assessing skeletal age in growing infants and children by measuring carpals and epiphyses of radio and ulna

The aim of this study is to develop a specific formula for the purpose of assessing skeletal age in a sample of Italian growing infants and children by measuring carpals and epiphyses of radio and ulna. A sample of 332 X-rays of left hand-wrist bones (130 boys and 202 girls), aged between 1 and 16 years, was analyzed retrospectively. Analysis of covariance (ANCOVA) was applied to study how sex affects the growth of the ratio Bo/Ca in the boys and girls groups. The regression model, describing age as a linear function of sex and the Bo/Ca ratio for the new Italian sample, yielded the following formula: Age = -1.7702 + 1.0088 g + 14.8166 (Bo/Ca). This model explained 83.5% of total variance (R2 = 0.835). The median of the absolute values of residuals (observed age minus predicted age) was -0.38, with a quartile deviation of 2.01 and a standard error of estimate of 1.54. A second sample test of 204 Italian children (108 girls and 96 boys), aged between 1 and 16 years, was used to evaluate the accuracy of the specific regression model. A sample paired t-test was used to analyze the mean differences between the skeletal and chronological age. The mean error for girls is 0.00 and the estimated age is slightly underestimated in boys with a mean error of -0.30 years. The standard deviations are 0.70 years for girls and 0.78 years for boys. The obtained results indicate that there is a high relationship between estimated and chronological ages

Revaluation of traditional methods for forensic identification by the frontal sinuses: critical comparison of case studies with literature

BACKGROUND: Body identification is an important activity in the forensic field both for ethical, juridical and civil reasons. It consists of a comparison between the biological data obtained from the body and the ante-mortem material of one or more unidentified deceased or missing person. METHODS: Radiographic images of the skull of 100 Italians people were analyzed through X-rays scans and a graphic software (Adobe Photoshop 6; Adobe, Mountain View, CA, USA). The images were digitalized and stored as computer files. The subjects were classified into 6 levels with 5 lobes and the data obtained were evaluated with statistical methods: the F-test was performed to verify the equality of the variance; the Pearson correlation coefficient was used for the evaluation of the variables that characterize the frontal sinus models, the Fisher’s Exact test and the χ2 test were used for the comparisons between groups and the t-test for the one between genders. RESULTS: The F-test was applied to verify the distribution of the asymmetry index between the two genders observing that P=0.284; Pearson correlation index showed that the correlations between right border and asymmetry index (inverse) and between right border and left border, between septa and left border, between septa and right border (direct) are significant. CONCLUSIONS: The main finding shown in the study is a statistically significant correlation between right edge and asymmetry index, between right edge and left edge, between septa and left edge and between septa and right edge. We can therefore affirm that the morphology, the presence of septa and the size of the area, are an excellent basis for personal identification, though the asymmetry index of the area of the frontal sinuses (easy to perform in daily practice) is in our opinion the method worthy of further investigation, so as to apply it methodologically homogeneously in forensic practice