Luigi Carlini

A fatal work-related poisoning by hydrogen sulfide: Report on a case

AbstractHydrogen sulfide (H2S) is a colorless and potentially deadly gas that may cause rapid loss of consciousness and respiratory depression without warning. Although occupational exposure to H2S and the medical management of H2S-associated toxicity are widely established, it remains a problem in the sour gas industry and in other industrial settings, predominantly in new workers.In this article, the authors report a fatal case of a factory worker who died after breathing in H2S while undertaking a task that he was not trained to perform. Toxicological assessment supported by autopsy findings and circumstantial data was essential to clarify the cause of death, determined as H2S poisoning.This case emphasizes the need to develop work safety initiatives, improve on-the-job training, and introduce more consciousness to put on protective equipment for workers; indeed, correct training and education for workers regarding safety in the workplace may help to reduce worker fatalities.

Laparoscopy for Trauma and the Changes in its Use From 1990 to 2016: A Current Systematic Review and Meta-Analysis.

Background: The role of laparoscopy in the diagnosis and treatment of stable abdominal trauma patients is still a matter of serious debate and only incomplete data are available. Materials and Methods: We performed a systematic review and meta-analysis of the literature between January 1990 and August 2016. Results: Overall, 9817 laparoscopies were performed for abdominal trauma; only 26.2% of the cases were converted to a laparotomy. The incidence of therapeutic laparotomies showed a reduction from 69% to 47.5%, whereas the incidence of therapeutic laparoscopies increased from 7.2% to 22.7%. The overall perioperative mortality rate was significantly lower in the laparoscopy group [odds ratio (M-H, random); 95% confidence interval, 0.35 (0.26-0.48)]. The same group showed shorter length of hospital stay [odds ratio (M-H, random); 95% confidence interval, −3.48 (−8.91 to 1.96)]. Conclusions: This systematic review shows a significant decrease in the use of laparoscopy in trauma patients. Most likely the widespread use of imaging techniques allows a more accurate selection of patients for diagnostic laparoscopy. Infact, a reduction in incidence of nontherapeutic laparotomies is evident in these selected patients undergoing diagnostic laparoscopy. Moreover, the literature reported an increasing trend of therapeutic laparoscopy, demonstrating that it is safe and effective. The small number and poor quality of the studies identified, the retrospective observational nature of the studies (low level of evidence), the high risk of bias, and the high heterogeneity of some outcomes make the applicability of the results of this meta-analysis unclear.

Hair testing for cocaine in living men: an epidemiological study on hair samples collected for various medico-legal purposes

Abstract The collection and analysis of hair samples offers higher chances of identifying people addicted to drugs than urine samples. In our study we propose hair analysis as a useful epidemiological indicator to identify the extent of cocaine use in different medico-legal situations: currently the epidemiological trends of substance abuse are estimated indirectly, mainly through large-scale surveys or through medical and crime statistics that may be too generic. We conducted a cross-sectional study, analysing hair samples, collected for various medico-legal purposes, from living men belonging to different categories, in order to complete a previous study conducted in 2016. Of 104 samples collected for different purposes, 55 were positive for drugs (52.88% of total) and, in this group, positivity for cocaine was found in 28 cases (26.92% of total), with a mean concentration of 4.58 ng/mg of hair, and a mean concentration of 0.75 ng/mg of hair of its major metabolite (benzoylecgonine). This datum is in line with the Italian Superior Health Institute reports, which declared a reduction in the use of cannabis and benzodiazepines, but a notable increase in cocaine use. Despite its limitations, this study adds further information to the previous one conducted in the same context, and furnishes an interesting picture of the phenomenon of cocaine addiction in Italy.

Instantaneous death due to transorbital reverse penetration of a screw in an accidental fall: unusual autopsy case report and review of the literature.

AbstractWe present a peculiar autopsy case of a transorbital penetrating head injury, in a male worker, after an accidental fall onto a screw not completely stuck into a wooden board.A 13-cm screw entered the cranium 9.5 cm deep, penetrating with the flat end, a condition defined in literature as “reverse penetration.” The death was instantaneous and caused by a neurogenic shock due to injuries to the brain stem and the right cerebellar hemisphere.These injuries, enabled by the length of the screw, are generally described in literature as due to nontransorbital penetrations, frequently associated with posterior entry and a large intracranial injury.The ocular globe has been, furthermore, perfectly preserved thanks to its mobility in the orbit.Even the dynamic of the incident is peculiar because of the stationary nature of the penetrating object, which the victim actively fell on by accident.To the best of our knowledge, the matter is therefore a very peculiar mortal case of transorbital intracranial penetration, whose verified injuries and dynamics are absolutely atypical.The case is now under discussion, and a review of pertinent literature is performed.

An unusual autopsy case of incomplete decapitation of a motorcyclist with herniation of thoracic organs through a helmet-related neck wound.

AbstractThe authors report an unusual autopsy case of a motorcyclist who wore a full-face type helmet and had incomplete decapitation and herniation of the heart and a portion of the right lung through an extensive lacerate wound on the front of the neck after his motorcycle crashed.The authors identified 2 main offensive dynamics that occurred simultaneously: First, partial decapitation with a extensive gaping wound on the neck caused by the chin strap after a violent angular movement of the head; second, the translocation of the abdominal organs into the thorax and the herniation of the thoracic organs through the neck wound generated by a compressive trauma of the thorax and abdomen.This singular case, like few others in forensic literature, shows the possibility of helmet chin strap–related traumas and highlights the limitations of modern protective helmets. If the postulated mechanism is confirmed despite the massive benefits derived from the compulsory use of protective helmets, the properties of the helmet chin strap would need to be reassessed to improve the protection of the soft tissue and bones in the neck.

Genetic identification by using short tandem repeats analysis in a case of suicide by self-incineration: a case report

AbstractSuicide by self-incineration is an uncommon method of suicide in the western world in contrast with Asian countries, where this type of suicide is more common. If there is a lack of witnesses, genetic analysis for identification is mandatory, especially when anthropologic or dental identification is barely significant.The authors report a case of self-incineration of a 55-year-old white man, which occurred near Siena, Tuscany, Italy.The recovered bones were classified according to the Crow-Glassman scale and assigned to category 5 (the highest extent of combustion according to this scale). Therefore, because of the extent of the bone damage, analyzing the residual soft tissue around the pelvic bones was the only way to reach a genetic identification.The authors report this case to emphasize that even if the highest level of burn injury to human body is reached, an accurate analysis of the findings may lead to a genetic identification. In these cases, an efficient cooperation among police, fire experts, and forensics is necessary, especially because it is the only way to determine if the modality of death was accidental, suicidal, or homicidal.

ABO, Rh and Kell Frequency Distribution in a Sample Population of Terni Province, Italy

We have typed ABO, Rh and Kell blood group systems in 1,267 voluntary blood donors native to the three districts into which Terni province is subdivided. By using the method of principal components, the Terni population was compared with those of other provinces of central Italy to disclose that (1) the Terni sample clustered with the Tyrrhenian rather than the Adriatic populations, and (2) there seems to be a positive relation with both the distribution of the languages spoken during the prehistoric period and the location of pre-Roman civilizations.