Alessia Viero

Looking at the missing brain: hydranencephaly case series and literature review.

Hydranencephaly is a severe congenital condition where most of the cerebral hemispheres are replaced by a membranous sac. Despite the growing amount of case reports, most pathogenic, phenotypic, and prognostic aspects of hydranencephaly remain controversial. By matching the recent literature data with the findings of our own series (four cases: two fetuses at the twelfth gestational week, a 32-year-old man, and a 14-year-old female), we attempted to date back the insult leading to hydranencephaly to understand its pathogenesis and to explain the basis of its protean phenotype. The variable detection of cerebral remnants seems to mirror the developmental pathway of cerebral arteries. Moreover, fetal and postnatal neuroimaging data and histopathologic findings point toward an early bilateral internal carotid artery occlusion, mostly occurring between the eighth and twelfth gestational weeks, as the main pathogenic mechanism of hydranencephaly.

Catalogue of Rainfall Events with Shallow Landslides and New Rainfall Thresholds in Italy

In Italy, rainfall-induced shallow landslides are frequent and harmful phenomena. The prediction of their occurrence is of social significance for civil protection purposes. For the operational prediction of rainfall-induced shallow landslides empirical rainfall thresholds based on the statistical analysis of past rainfall conditions that triggered slope failures are commonly used. The paper describes a catalogue of 1981 rainfall events, which caused 2408 shallow landslides in Italy in the period 1996–2012. Information on rainfall-induced landslides was collected searching chiefly online newspaper archives, blogs, and fire brigade reports. For each documented failure, we reconstructed the triggering rainfall conditions (rainfall duration D and cumulated rainfall E) using national and regional rain gauge networks. We analysed the rainfall conditions to determine new ED rainfall thresholds for Italy. The calculated thresholds can be implemented in a landslide forecasting system to mitigate landslide hazard and risk.

Micro computed tomography features of laryngeal fractures in a case of fatal manual strangulation

Cases of subtle fatal neck compression are often complicated by the lack of specificity of the post-mortem signs of asphyxia and by the lack of clear signs of neck compression. Herein we present a forensic case of a 45-year-old schizophrenic patient found on the floor of the bedroom of a psychiatric ward in cardiopulmonary arrest and who died after two days in a vegetative state. The deposition of the roommate of the deceased, who claimed responsibility for the killing of the victim by neck compression, was considered unreliable by the prosecutor. Autopsy, toxicological analyses, and multi-slice computed tomography (MSCT), micro computed tomography (micro-CT) and histology of the larynx complex were performed. Particularly, micro-CT analysis of the thyroid cartilage revealed the bilateral presence of ossified triticeous cartilages and the complete fragmentation of the right superior horn of the thyroid, but it additionally demonstrated a fracture on the contralateral superior horns, which was not clearly diagnosable at MSCT. On the basis of the evidence of intracartilaginous laryngeal hemorrhages and bilateral microfracture at the base of the superior horns of the larynx, the death was classified as a case of asphyxia due to manual strangulation. Micro-CT was confirmed as a useful tool in cases of subtle fatal neck compression, for the detection of minute laryngeal cartilage fractures, especially in complex cases with equivocal findings on MSCT.

Water and snow chemistry of main ions and trace elements in the karst system of Monte Pelmo massif (Dolomites, Eastern Alps, Italy)

Water and snow chemistry of a high-altitude karst environment, the Monte Pelmo massif in the Dolomites (Eastern Alps, Italy), was investigated by a multidisciplinary analytical approach using ‘clean’ trace-metal techniques. Main ions of environmental significance (F–, HCOO–, Cl–, NO2–, NO3–, SO42–, Na+, NH4+, K+, Ca2+, Mg2+, HCO3–) were analysed by high-performance ion chromatography (IC). Trace elements of natural (Li, B, Mn, Co, Cu, U) as well as anthropic (Cr, Ni, Zn, Pb) origin were investigated by inductively coupled plasma-mass spectrometry (ICP-MS). Analytical data on filtered samples indicated that snow chemistry is dominated by the dissolution of air-borne particulate matter, primarily red dust of Saharan origin, which appears to be a preferred vehicle of contaminant transportation. In water samples, dolomite weathering was the predominant chemical step in the presence of sulfate ions, leading to excess magnesium concentrations and to Mg:Ca ratios often exceeding unity. The combined use of ICP-MS for trace element determination and chemometric tools, such as principal component analysis (PCA) and cluster analysis (CA), provided evidence of the absence of local anthropic pollution sources, and the presence of divalent transition metal cations associated with gypsum deposits. Finally, the excess uranium content was found to be associated with karst waters, and it could possibly have been a ‘natural’ tracer to characterise deep circulations.

Micro-computed tomography of false starts produced on bone by different hand-saws

The analysis of macro- and microscopic characteristics of saw marks on bones can provide useful information about the class of the tool utilized to produce the injury. The aim of the present study was to test micro-computed tomography (micro-CT) for the analysis of false starts experimentally produced on 32 human bone sections using 4 different hand-saws in order to verify the potential utility of micro-CT for distinguishing false starts produced by different saws and to correlate the morphology of the tool with that of the bone mark. Each sample was analysed through stereomicroscopy and micro-CT. Stereomicroscopic analysis allowed the identification of the false starts and the detection of the number of tool marks left by each saw. Micro-CT scans, through the integration of 3D renders and multiplanar reconstructions (MPR), allowed the identification of the shape of each false start correlating it to the injuring tool. Our results suggest that micro-CT could be a useful technique for assessing false starts produced by different classes of saws, providing accurate morphological profiles of the bone marks with all the advantages of high resolution 3D imaging (e.g., high accuracy, non-destructive analysis, preservation and documentation of evidence). However, further studies are necessary to integrate qualitative data with quantitative metrical analysis in order to further characterize the false start and the related injuring tool.

Whiplash-Associated Disorders: Clinical and medico-legal guidelines on the methods of ascertainment

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.

Accuracy, precision and inter-rater reliability of micro-CT analysis of false starts on bones. A preliminary validation study

Micro computed tomography (micro-CT) has already been proposed as a useful technique for the qualitative analysis of false starts (FS) produced on human bones, although the reliability and the error rate of this technique have not been tested yet, neither for qualitative nor for quantitative assessments. The aim of the present study was to test the morphological agreement, accuracy, precision and inter-rater reliability of micro-CT analysis of FS on bones. The morphological agreement was assessed through the degree of concordance among the 3 independent blind raters in the identification of the shape of 24 FS manually produced on bones by 3 different saws (8 FS for each saw). The accuracy was calculated through the percentage of error in the automatic and manual measurement of the diameter of a reference object. The precision was calculated as CV% of multiple measurements performed by 3 independent blind raters on the reference object and one bone sample acquired 20 times. The inter-rater reliability was assessed as intraclass correlation coefficient (ICC) among measurements performed by 3 independent blind raters, assessing 24 FS produced using 3 different saws. The results demonstrated that both qualitative and quantitative analysis were reproducible and robust. Micro-CT analysis showed a 100% morphological agreement, a high level of accuracy (percentage error < 0,5%), precision (CV% < 5%) and inter-rater reliability (ICC > 0.995), when FS were analyzed by forensic pathologists and/or radiologists with adequate expertise. Obviously, further validation studies are needed, including a higher number of samples produced by a wider variety of saws and multiple operators.

TXT-tool 2.039-1.2: Rainfall Thresholds for the Possible Initiation of Landslides in the Italian Alps

Rainfall-induced landslides are frequent in the Italian Alps, where they cause severe economic damages and loss of life. The prediction of rainfall-induced slope failures is of utmost importance for civil protection purposes and relies upon the definition of physically based or empirical rainfall thresholds. Reliable empirical rainfall thresholds require a large amount of information on the geographical and temporal location of rainfall events that caused past mass movements. We have compiled a catalogue listing 453 rainfall events that have triggered 509 landslides in the Italian Alps in the 13-year period 2000–2012. For the purpose, we searched national and local newspapers, blogs, technical reports, historical databases, and scientific journals. In the catalogue, for each rainfall event that triggered one or more failures, the information includes: (i) landslide geographical position, (ii) date of the landslide occurrence, (iii) landslide type (if available from the source of information), and (iv) rainfall information. Using the available information, we calculated the cumulated amount (E) and the duration (D) of the rainfall that likely caused the documented slope failures. We exploited the catalogue to calculate new ED threshold curves and their associated uncertainties for the Italian Alps adopting a frequentist approach. To define seasonal rainfall thresholds, we also investigated the monthly distribution of the landslides. The new thresholds are compared with similar curves in the same general area. We expect the results of our study to improve the ability to forecast landslides in the Italian Alps and, more generally, in the wider Alpine region.

Crime scene and body alterations caused by arthropods: implications in death investigation

The activity of arthropods on corpses has been largely investigated, since they can produce information to reconstruct the peri-mortem events. However, the feeding/movement activity of insects around the crime scene, among the clothes and on the body, can also cause some alterations that can lead to wrong reconstruction and misinterpretations. This article summarises all the post-mortem arthropods artefacts related to the scene (i.e. fly artefacts and floor stripes) and the body (i.e. skin and other soft tissue alterations, bone alterations and hair alterations) that can mislead the forensic pathologist, discussing macroscopic and microscopic findings derived from forensic casework and from experimental laboratory studies, in order to provide a useful instrument to avoid misinterpretations and evaluation errors. Finally, some procedural notes for the documentation and the interpretation of findings are proposed.

Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges

Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.