Riccardo Zoja

Padova Charter on personal injury and damage under civil-tort law Medico-legal guidelines on methods of ascertainment and criteria of evaluation

Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first “International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law”. This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM).

Transphobic Murders in Italy: An Overview of Homicides in Milan (Italy) in the Past Two Decades (1993-2012)

In Europe, 71 murders resulting in the death of transgendered persons were reported between 2008 and 2013, 20 of which perpetrated in Italy, the second highest rate in Europe after Turkey. We retrospectively analyzed the homicides of transgender people recorded at the Medicolegal Bureau in Milan from January 1993 to December 2012. First we considered the sociodemographic data of 20 victims and the circumstantial details of their deaths, then we examined the data related to the cause of death from the autopsy reports. Our data show that victims are mostly immigrants, biological males presenting with a feminine attire and with varying degrees of feminization. The large majority of the victims were sex workers from South America. As for murderers, they were unknown in 7 cases (35%); all the 13 murderers identified were males, aged between 17 and 63 (M age = 31 years). In 38% of the cases, the murderer was the victim’s current or former partner. For half of the homicides, it was possible to identify at least one primary indicator of lesbian, gay, bisexual, and transgender (LGBT) hate crime. Our findings call for the need to make explicit in Italian legislation that a crime perpetrated on the ground of sexual orientation and gender identity constitutes a hate crime.

Death with Complete Decapitation: Report of Four Suicides by Train

Suicide by train with complete voluntary decapitation is an extremely rare event, however, well known and reported in the scientific literature. The authors analyze 4 cases of suicide with complete decapitation by main line or underground train that were subjected to medico-legal autopsies at the Milan Institute of Legal Medicine between 1995 and 2006. Personal, circumstantial, autopsy, and toxicological data were analyzed to define the type and pathologic characteristics of the injuries (vital reaction of wound edges, absence of any signs of defense); alcohol and drug consumption was considered and the victims psychical profile was outlined.

Forensic Applications of Sodium Rhodizonate and Hydrochloric Acid: A New Histological Technique for Detection of Gunshot Residues

Abstract:  Demonstration of the presence of lead residues deriving from gunshot in skin and underlying tissues is essential for the correct forensic analysis of numerous legal cases. Optical microscopy remains the fastest, cheapest diagnostic technique, even though its sensitivity and specificity are poor because of the scarce quantity of histological tissue that can be examined and possible environmental lead pollution. To confirm the presence of lead from gunshot residues, we applied to histological sections of human skin a technique proposed by Owens and George in 1991 for macroscopic detection of lead on the clothing of shooting victims, involving a reaction with sodium rhodizonate and subsequent confirmation by color change on application of HCl. Our results demonstrate the technical possibility of using this macroscopic technique even on histological samples and support the need for further studies on a larger series of cases correlated with the type of ammunition and firing distance.

Detection of gunshot residues on cadaveric skin using sodium rhodizonate and a counterstain

We report a staining method for cadaveric tissue using sodium rhodizonate as a skin marker for gunshot residues and a counterstain for the surrounding connective tissue. We studied six well preserved subjects who had died of close range gunshot injury. Skin fragments were removed from the bullet entrance hole including both the disrupted area and adjacent macroscopically intact tissue. Because microscopic examination of postmortem material is difficult after histomorphologic alterations already have occurred as a consequence of postmortem tissue changes, it is necessary to use a staining method that, while detecting gunshot residues, can also make skin cell constituents recognizable from both qualitative and quantitative perspectives. Triphenylmethane dyes (acid fuchsin, aniline blue WS, light green SF yellowish, brilliant green and ethyl green) have proven appropriate for the purpose.

Preservation of histological structure of cells in human skin presenting mummification and corification processes by Sandison's rehydrating solution

INTRODUCTION To overcome the difficulties of construction and interpretation of microscopic material from corpses presenting mummification and corification processes, a variety of techniques and tricks are used: in this research the results of applying the Sandisons rehydrating solution are presented, generally used in archeological field on Egyptian mummies of different ages, in human cadaveric material in an advanced state of decomposition. MATERIALS AND METHODS Nineteen skin specimens were taken from corpses presenting corification and mummification processes, discovered in a time ranging between one and four months and exhumed after 11 years. Each biological sample was divided into two parts: one, directly fixed in buffered formalin 10%; the other, preliminarily treated with the Sandisons rehydrating solution and, therefore, post-fixed in 10% buffered formalin. All samples were then carried out the routine histological preparation, and the sections were stained by hematoxylin-eosin and by other histochemical stains. RESULTS Under the microscope, the samples placed directly into formalin, showed marked structural changes of the various components, while those previously rehydrated with the Sandisons rehydrating solution allowed the clear recognition of different structures. CONCLUSIONS The use of the Sandisons rehydrating solution on skin samples presenting corification and mummification processes, preserving significantly its general setting, stands as an indispensable procedure in the study of such cases.

One Hundred and One Cases of Plastic Bag Suffocation in the Milan Area Between 1993 and 2013-Correlations, Circumstances, Pathological and Forensic Evidences and Literature Review.

Plastic Bag Suffocation is a rare cause of death in developed countries and almost unknown in the rest of the world. This study aims to retrospectively evaluate cases of PBS _asphyxia in Milans Department of Legal Medicine from 1993 to 2013. Cases were selected from the database of 21,472 autopsies performed in the considered timeframe. One hundred and one cases were considered to be cases of Plastic Bag Suffocation, comprised of 100 suicides, no accidental events and 1 homicide. The most relevant elements pertaining to this type of death were evaluated for both the corpses and the crime scenes. From this study the typical PBS victim is an adult male, aged 52.3 years on average, depressed or afflicted by chronic or terminal diseases, and found at home. In 42.6% of cases, the victims were found with the plastic bag still positioned over their head, fastened by tying. Also common among these cases are drugs, alcohol and chemical abuses. According to the collected data, it is impossible to outline a pathognomonic detrimental background that leads to this cause of death. Crime scene investigation is, therefore, the one and only technical resource for evaluating these cases.

Technical note: Improvement of cadaveric skin samples (with severe morphological alteration connected to putrefaction or injury) by an extended histological processing

INTRODUCTION The microscopic study and the interpretation of skin samples with advanced post-mortal phenomena or with particular destructive injuries is problematic for the forensic pathologist. In an attempt of restoring the histological architecture of cadaveric skin and overcoming these types of problem, the Authors performed a histological processing that was longer than the standard: it was extended until 62 days to evaluate the improvement of the microscopic morphological aspect. MATERIALS AND METHODS Cutaneous samples were taken from 25 cadavers (5 typologies of skin: charred, putrified, corifed, mummified and partially skeletonized), fixed with a 10%-buffered formalin and then processed in two different ways: one half of the samples was routinely addressed to the standard-time automatic technique, while the other half was manually processed with prolonged times. All the slides were then stained in Hematoxylin-Eosin. RESULTS The standard-processed slides demonstrated marked morphological alterations and artefacts at the microscopic observation; conversely, those processed with the prolonged manual technique showed an improvement in the morphological structure, sometimes permitting the identification of the anatomical components. CONCLUSION Though it is characterized by the inconvenience of protracted times, the application of a long-term manual histological processing to cadaveric skin samples with advanced post-mortal alteration permits to better observe the anatomical architecture of skin and it could be useful and helpful in the evaluation of such cases.

An unusual case of homicide with a crossbow and a hunting knife

Traumatic lethal injuries caused by crossbows are a rarity in forensic pathology. They occur as accidents, suicide and, more rarely, as murders. We report a case of murder received at the Institute of Legal Medicine in Milan carried out by two weapons – a crossbow and a hunting knife – that resulted in multiple thoraco-abdominal wounds. The case is also rare because of the unique circumstances involving the victim – a local service psychiatrist – and the perpetrator – a former medical specialist in psychiatry, suffering from a delusional psychotic disorder. The crossbow was the decisive instrument in the realization of the murder; it was chosen with premeditation for its high destructive capacity and the fact that it was easily obtainable, and it was used with darts that were specially modified to increase its harmful capacity. The presented case, as well as providing an opportunity to highlight the damaging effects of a rarely used weapon, stresses the problems inherent with access to tools such as the crossbow that are used in sport, and which are potentially dangerous but easily accessible, even to those with serious mental disorders, rendering them legally unfit for using firearms.

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.