Elisa Palazzo

The risk of misinterpreting genital signs of sexual abuse in cadavers: a case report

The significance of genital findings in a case of suspected child sexual abuse has been widely debated in the past decades, as shown by the different classifications available in literature. In the case of postmortem examination, the search for signs of sexual abuse is considerably more difficult because of the superimposition of postmortem modifications, which may determine tissue modifications that can be mistaken for traumatic lesions. This study aims at reporting a case where presumed findings of the first autopsy were denied by histological analysis; in detail, what looked like a possible bruise of the hymen was correctly recognized as hypostasis (livor) of the hymenal tissue by histological analysis. This case report suggests caution in the analysis and discussion of genital lesions found during postmortem examination since the superimposition of cadaveric modifications may radically modify the morphology of soft tissues.

Analysis of 16 Years of Homicides and Suicides Involving the Use of Weapons Recorded at the Milan Medicolegal Bureau

The criminal use of weapons is a very topical issue in the industrialized countries and worldwide, and a reconsideration of the legislation governing their possession is warranted. We retrospectively analyzed the homicides and suicides involving the use of firearms and piercing and/or cutting weapons recorded at the Medicolegal Bureau in Milan from January 1, 1993, to December 31, 2008. First we considered the clinical histories of the deceased and the circumstantial details of their deaths, then we examined the data relating to the cause of death recorded in the autopsy reports. Our case series consisted of 414 homicides (54.2%) and 350 suicides (45.8%). Firearms were responsible for more deaths (64%) than piercing and/or cutting weapons (36%). The firearms involved were legally licensed in 40% of cases (suicides) and illegal in 22% (homicides). Our findings suggest the need to review the criteria considered for the issue of firearms licenses, in Italy at least.

Release of metals from osteosynthesis implants as a method for identification: post-autopsy histopathological and ultrastructural forensic study.

Metal structures—especially of stainless steel, titanium and their alloys (biomaterials)—are widely used in orthopaedic practice and the subject of constant study in bioengineering and preventive medicine. This study presents the first experience of forensic research into the presence of permanent tissue variations around metal implants in various bone structures for the purpose of identification, with particular reference to skeletal remains or severely decomposed corpses in the absence of other identifying elements. The evaluation was conducted on 12 corpses who had undergone osteosynthesis intra-vitam, whose implants were still in place or had been removed, in comparison with five controls who had never undergone osteosynthesis. Bone fragments taken during autopsy were subjected to histopathological and scanning electron microscope–energy dispersive electroscopy examination in order to reveal and characterise any metal particles originating from osteosynthesis. The study enabled the discovery of intra-bone metal particles in tissues treated by osteosynthesis even in bone areas where the implants had been removed and even where there were no longer any radiological signs of their application. These results are therefore of considerable forensic importance, especially in the area of identification, providing a valid means of recognition beyond that of the well-established use of in situ metal implants.

Lethal Bochdalek hernia in a three-year-old: pathological findings and medicolegal investigation in accusation of malpractice.

Diaphragmatic hernias can be a pitfall for paediatric diagnostics, especially in the cases of late presentation, which can also have medico-legal ramifications as exposed. A three-year-old boy was taken to a childrens hospital after an episode of abdominal pain and vomiting of food. A physical examination proved normal, with mild ketonuria being found and he was discharged. Three months later for the same signs and symptoms, he was taken once more to hospital, where he arrived in a state of cardiac arrest and died. A lawsuit was begun against the doctors who had examined him three months earlier. The autopsy found herniation of the abdominal organs into the left pleural cavity through a defect in the left hemidiaphragm. The cause of death was identified as cardiac tamponade caused by mechanical compression of multiple herniated abdominal organs. The histopathological examination revealed marked atelectasis of the left lung, with non-expansion of 60-90% of the alveoli which suggested an acute mechanism that proved fatal, and the doctors were acquitted. The features of this disease and the possible difficulties in its diagnosis highlight the need for the utmost attention in differential diagnosis, even at an age where the discovery of a diaphragmatic hernia is exceedingly rare.

Train-related suicides in Milan, Italy: analysis of cases 1993-2008

Evidence of the frequent use of mainline and metropolitan trains as a means of suicide in and around Milan prompted the authors to analyse the occurrence of this event between 1993 and 2008 in Milan, examining data from the Institute of Legal Medicine. The 155 selected cases were analysed for various aspects, including the chronology and dynamics of the event, the personal, epidemiological and psychiatric profile of the victims and the features of the injuries found during autopsy.

The Adult Male Rape Victim: Forensic Description of a Series of 57 Cases

Abstract A retrospective analysis on 57 adult male victims of sexual violence has been performed. Age, nationality and anamnesis of the victims, location of the assault, type of violence, number and identity of the assailants, presence of physical injuries, lapse of time between the assault and the request of medical assistance, and toxicological and semen detection tests were analyzed. Victims were mostly in the 31- to 40-year age group. Ten victims referred themselves as either active homosexuals or bisexuals. Forced oral and/or anal penetration was registered in 86.8% of cases, mostly performed by a single assailant. Anogenital injuries were recorded in 61.4% of cases, whereas extragenital injuries in 35.1%: abrasions and perianal reddening were the most frequent acute anogenital marks, whereas the head and lower limbs were the body parts most commonly affected by blunt trauma. No clinically severe injuries were found. Anal and perianal swabs for semen detection tested positive in less than 20% cases, whereas oral swabs always tested negative. When performed, nearly 50% of cases tested positive in drug tests, above all for psychoactive substances. No definite forensic diagnosis in terms of confirmation of rape was possible on the basis of type and topography of injuries.

Histopathological findings of medico-legal significance in delayed death from ethylene glycol poisoning

In ethylene glycol poisoning, the substances toxicity is attributed to its metabolites, which are transformed in the body into calcium oxalate deposits. This case concerns a man who died five months after having attempted to commit suicide by swallowing an unknown quantity of ethylene glycol in the form of brake oil. The autopsy, ordered by the Judicial Authorities, revealed some interesting findings in the pericardium and visceral pleura. Chemical and toxicological tests were carried out on the bodily fluids and organs and proved negative of anything relevant, probably due to the time that had passed between the suicide attempt and the eventual death. Histopathological examination of the organs conducted using traditional techniques was the only technique that found signs of the previous poisoning, in the form of multiple microcalcifications of different sizes in various areas of the myocardium, glomeruli and renal tubules, associated with local necrosis of the renal parenchyma. The authors consider this case particularly interesting for its pathological/forensic profile, the rarity of this type of poisoning and the histopathological finding, at this later time, of calcium oxalate microcalcifications in the myocardium and kidneys, directly attributable to the harmful action of the ethylene glycol ingested five months earlier.

The detection of metallic residues in skin stab wounds by means of SEM-EDS: A pilot study

The morphological analysis of stab wounds may often not be accurate enough to link it with the type of wounding weapon, but a further evaluation may be performed with the search for metallic residues left during the contact between the instrument and the skin. In this study, Scanning Electron Microscopy-Energy Dispersive Spectroscopy (SEM-EDS) was applied to the study of cadaveric stab wounds performed with kitchen knives composed of iron, chromium and nickel, in order to verify the presence of metallic residues on the wounds edge. Two groups of 10 corpses were selected: group A, including victims of stab wounds and a control group B (died of natural causes). Samplings were performed on the lesions and in intact areas of group A, whereas in group B sampling were performed in non-exposed intact skin. Samples were then analysed with optical microscopy and SEM-EDS. In group A, optical microscopic analysis showed the presence of vital haemorrhagic infiltration, while SEM-EDS showed evidence of microscopic metal traces, isolated or clustered, consisting of iron, chromium and nickel. Moreover, in two cases organic residues of calcium and phosphate were detected, as a probable sign of bone lesion. Control samples (group A in intact areas and group B), were negative for the search of exogenous material to optical microscopy and SEM-EDS. The results show the utility and possible application of the SEM-EDS in theidentification of metallic residues from sharp weapons on the skin.

Lethal disseminated parasitosis from P. falciparum. Imported paludism in Milan : a case report

Background: In a case examined by the authors two victims withevidence of thermal damages have been found. A key issue in theinvestigation was the amount of accelerant and the time of combustionneeded to produce the observed pattern of thermal damages. We carriedout an exhaustive library search without finding any published resultgiving a contribution to the case. Therefore we decided to carry outsome experiments using an animal carcass with the aim of highlightingthe conditions necessary to produce the observed thermal damages. Method:The experiments were carried out in a quarry using a pigcarcass, petrol and an electrical remote ignition system. Six tests havebeen performed, using different fuel quantities on different regions ofthe carcass, in some tests the skin was covered with a cotton cloth. Authors used healthy appendages in some experiments and huskedones in the last part of the study, because the response of the humanbody is expected to be in between the two tested situation. Results:The six tests carried out showed that the flame action and the timeframe necessary to reproduce an injury, similar to our case, on an animalcarcass is influenced by many variables including the different anatomicalsubstrates (e.g. the body fat) and the different quantity of petrol. In five outof six tests the flames extinguished before forty minutes.The time before the flames extinguish does not depend on the quantityof petrol but it depends mainly on the depth of the pool of flammable liquid (approximately 2–3 mm/min). The studies performed enabled us to de-scribe the deepness of the damages that in the last test, conducted with tenliters of petrol, reached six centimeters similarly to the victim’slesions.Only the third test, involving the abdominal area, showed a very longduration of flame due to the artificial exposition of the abdominal adiposetissue caused by the sagittal cut of the animal. The molten fat from adiposetissue contributed to the maintenance of the flame, lasting for over an hour.The damages in this test involved the internal part of the carcass. Conclusion: In the test conducted with ten liters we have produced thelesions closer to the observed thermal damages on the victims of ourcase, and the flames extinguished after 28 minutes.POSTER PRESENTATIONS