Traumatic spinal cord injuries – epidemiologic and medico-legal issues

Spinal cord injuries represent a special category of injuries in traumatic pathology, with high morbidity and mortality, which justify their analysis with the aim to identify useful aspects in order to prevent and treat them. We therefore performed a retrospective study on 426 cases in order to analyze epidemiology and medico-legal issues related to spinal cord injuries. The studied items regarded socio-demographic aspects (gender, age, home region), type of lesions (vertebral, spinal cord, association with other trauma), circumstances leading to trauma (cause of the injury, season), data regarding hospitalization (medical condition at the hospital admission, number of days of hospitalization, clinical diagnosis, imaging exploration level) and data resulting from autopsy (diagnosis, toxicological examination). Most of our results are consistent with literature data, except for some epidemiological items, which might be explained with cultural differences, life style and inhomogeneous population. Based on our results, the general conclusion is the need for prevention campaigns, focusing on road traffic accidents and falls (especially in elderly) as the main causes of spinal cord injuries

Biomarkers of the brain injuries - the future diagnosis standard in head trauma? Brief literature review

Acute head trauma is often a clinical challenge in diagnosing the brain damage, assessing its severity and prognosis, and establishing the optimal treatment. Different patients, with brain damage of apparent comparable severity according to the imaging examination, may have different neurological evolution or different response to therapy.Minor traumatic brain injuries can induce a brief loss of consciousness or confusion, are usually benign, but sometimes they cause persistent and progressive brain symptoms in the long run. However, at present, there are no reliable methods that can diagnose properly minor traumatic brain injuries.Biomarkers of the brain injuries allow the monitoring of both physiological and pathological processes. The identification of such biomarkers could allow a better understanding of the pathological processes involved in traumatic brain injuries, their diagnosis, prognosis and may facilitate the establishment of a better treatment regimen for these patients.In this article, the authors make a brief review of the literature in which they analyse the biomarkers of the lesions of the various brain structures identified so far, which can be detected in biological fluids (blood, cerebrospinal fluid) and the advantages and limitations of their use in the current medical practice

Physician-patient relationship in rare diseases: an ethical approach

Rare diseases are a special category of pathology recognized as such relatively recently, starting about 30 years ago in the USA and around the year 2000 in Europe. Rare diseases are clinically and therapeutically heterogeneous, being characterized by a number of common aspects that have a negative impact on patients’ evolution and quality of life, such as: delayed diagnosis, limited scientific knowledge about some of them, lack of treatment or limited availability of treatment. At the same time, information campaigns on rare diseases are limited, and the number of association of patients that promote their interests and rights is also reduced. The quality of physician- patient relationship is particularly important in the management of rare diseases, non-medical aspects, especially the ethical and moral aspects, being often more relevant to patients than the medical aspects. The ethical framework for the analysis of rare diseases encompasses a number of particular aspects, generated on the one hand by the need to properly approach patients suffering from rare diseases in the context of rising expectations for the medical system, and on the other hand, the pro-profit behavior of the pharma companies. This paper analyzes the particular ethical issues identified in the clinical approach on rare diseases, with a focus on the particularities of the physician-patient relationship in this context

Clinical diagnosis versus autopsy diagnosis in head trauma

The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1) to total discordance (C4) and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis- missing injuries in the autopsy reports) and C3 (partial discordance in favor of the necroptic diagnosis- missing injuries in the medical files). Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral hematoma and ventricular hemorrhage (21.6%). In C3 cases the most frequently omitted injuries were subarachnoidian hemorrhage and skull base fractures (17.9%). Conclusions: The clinical cause of death is not always concordant with the autopsy diagnosis. Autopsy may identify the inconsistencies in diagnosis, the injuries frequently skipped and the factors favoring the discordance rate between the clinical death diagnosis and the autopsy diagnosis, making it a valuable tool for improving the clinical care of the patients with head trauma

POST-MORTEM CHANGES IN TEETH- FORENSIC ISSUES

Teeth have an increased resistance to environmental factors and decomposition processes, which makes them highly valuable in forensic investigations. The either physical (wind, water, sun, soil type) or biological (plant roots, insects, animals) environmental factors and the decomposition processes induce post-mortem changes in teeth, which are relevant to forensic investigation in terms of estimating the post-mortem interval or of elucidating the conditions in which the body stood after death. In this paper, based on the data provided in the literature, the authors present the main changes induced by environmental factors and decomposition processes in teeth and refer to their relevance in forensic activity

Considerations on umbilical cord resistance to traction

Neonaticide represents a particular issue both to society and forensic field, being admitted nowadays as a crime all over the world. Apart from common gross and microscopic examination of the newborn cadaver, thorough examination of the umbilical cord during autopsy proved many times its major utility in solving neonaticide cases. Although by its constituents, the umbilical cord is a quite resistant structure to bending and compression, mechanical properties vary along its surface, with gestational age or various pregnancy disorders, as well as genetic anomalies of the fetus, so that a rupture may occur. The authors present the case of a newborn found dead in a sink – about whom mother states that he accidentally fell in the feces, the moment of the birth being a surprise – and discuss on the circumstances when the umbilical cord may rupture. This issue is most important when is a need to differentiate between a true accident and an intentional newborn homicide by the mother set forth as an accident

DEATH IN DENTAL MEDICINE- LITERATURE DATA

Death and emergencies in dental medicine are rare events, occurring most frequently during dental surgery. Their occurrence is favored by various patient-related factors, physician-related factors, procedures applied and medical instruments used by the dentists. In this article, the authors analyze the factors that can lead to major medical emergencies and death in the current dental practice and identify possible solutions to avoid and/or solve them according to the literature. The authors conclude that even if the incidence of emergencies and death in current dental practice is reduced, the dentist and the whole team in his/her office must recognize these incidents and treat them correctly