Santo Davide Ferrara

Forensic application of ESEM and XRF-EDS techniques to a fatal case of sodium phosphate enema intoxication

Sodium phosphate enemas and laxatives are widely used for the treatment of constipation, even if a number of cases of significant toxicity due to alterations of the fluid and electrolyte equilibria (hypernatremia, hyperphosphatemia, and hypocalcemia) have been reported. We present the case of an 83-year-old man who died of fecal and chemical peritonitis secondary to an iatrogenic colon perforation (produced performing a Fleet® enema through the patient’s iliac colostomy) with peritoneal absorption of sodium phosphate. Environmental scanning electron microscopy coupled with an X-ray fluorescence energy dispersive spectrometry discovered multiple bright crystals formed of calcium, phosphorus, and oxygen in the brain, heart, lung, and kidney sections of the victim. The absence of these kinds of precipitates in two control samples chronically treated with Fleet enemas led us to assume that the deceased had adsorbed a great quantity of phosphorus ions from the peritoneal cavity with subsequent systemic dissemination and precipitation of calcium phosphate bindings.

Stability of cocaine in formalin solution and fixed tissues.

Embalming and formalin fixation are common, and yet they can create problems for the forensic scientist if a drug has been the cause of death and if the only available specimens to be analyzed are formalin-fixed tissues. Previous studies have demonstrated that during fixation xenobiotics are extracted into formalin according to tissue and fixing solution characteristics. In some cases formalin can react with the analyte resulting in the production of new chemical entities. Regarding cocaine and its metabolites, Cingolani et al. have reported that formalin-fixation extracts benzoylecgonine (BE) from tissues and that BE is stable in the fixing solution. However, the stability and kinetic properties of cocaine remain so far unexplored. Our data show that in buffered formalin (pH 7.4) cocaine is hydrolyzed to BE in agreement with a pseudo first-order reaction kinetic (half-life time approximately 7 days), whereas in unbuffered formalin (pH approximately 3.5) it is relatively stable over a period of 30 days. The analysis of brain and liver samples at different fixation times indicates that during fixation an extraction process occurs for both analytes and that the extraction is more efficient in the liver than in the brain, probably because of a greater lipophilicity of the brain tissue. In conclusion, our study demonstrates that formalin-fixed tissues and their fixing solutions can be used for cocaine analysis only if a short time period has passed since the fixation beginning. The rapid extraction process of cocaine into formalin and the concomitant hydrolysis to BE occurring in buffered formalin may prevent the identification of cocaine in both tissues and formalin solution already at 15-30 days after fixation. Moreover, the unpredictable extraction rate of both analytes, along with the hydrolysis of cocaine into BE significantly affects tissue concentrations, thus complicating the interpretation of quantitative results.

Psychic trauma as cause of death

Aim of study Psychic trauma is described as the action of ‘an emotionally overwhelming factor’ capable of causing neurovegetative alterations leading to transitory or persisting bodily changes. The medicolegal concept of psychic trauma and its definition as a cause in penal cases is debated. The authors present three cases of death after psychic trauma, and discuss the definition of cause within the penal ambit of identified ‘emotionally overwhelming factors’. Materials and methods The methodological approach to ascertainment and criterion-based assessment in each case involved the following phases: (1) examination of circumstantial evidence, clinical records and documentation; (2) autopsy; (3) ascertainment of cause of death; and (4) ascertainment of psychic trauma, and its coexisting relationship with the cause of death. Results The results and assessment of each of the three cases are discussed from the viewpoint of the causal connotation of psychic trauma. In the cases presented, psychic trauma caused death, as deduced from assessment of the type of externally caused emotional insult, the subjects’ personal characteristics and the circumstances of the event causing death. Conclusions In cases of death due to psychic trauma, careful methodological ascertainment is essential, with the double aim of defining ‘emotionally overwhelming factors’ as a significant cause of death from the penal point of view, and of identifying the responsibility of third parties involved in the death event and associated dynamics of homicide.

P5 medicine and justice: the future is now

The recent and rapid evolution of science, in its various connotations and in all its many forms, typical of the ‘postmodern society of risk’, at once globalized and glocalized, have not failed to influence legal medicine and the actions that characterize the professional scientific community, which fosters it with important, albeit undervalued, routine work. From reflections on this evolutionary stem, the considerations proposed for the attention of the readers, in the logical order set out, are as follows, from point 1 to point 9, with the hope of fostering a collegial exchange of ideas and actions.

Onset and progression of fatal coronary dissection during angiography.

Coronary angiography was performed in a 43-year-old man admitted to hospital for chest pain. The first frames after the injection of contrast medium showed plaque in the left main coronary artery and subtotal stenosis of the mid-left anterior descending coronary artery. Dissection of the left main coronary artery appeared, with intimal flaps at the proximal segment of the main trunk and the origin of the left anterior descending artery. Dissection rapidly progressed into the circumflex artery and left anterior descending coronary artery. Although two stents were deployed in the left main coronary artery, the patient died of ventricular fibrillation.

Photostability of 6-MAM and morphine exposed to controlled UV irradiation in water and methanol solution: HRMS for the characterization of transformation products and comparison with the dry state.

The UVA and UVB light-induced behaviour of 6-monoacetylmorphine (6-MAM) and morphine, the main metabolites of heroin, was studied in methanol, aqueous solution and in the dry state. UVA and UVB irradiations were performed for different times (radiant energies of 20-300J/cm(2)). UV spectra of irradiated samples were compared with samples kept in the dark. To estimate the extent of photolysis, positive ion electrospray ionization experiments were performed on the irradiated samples by LC-HRMS. Tentative identification of photoproducts was performed on the basis of their elemental formula as calculated by HRMS results. Morphine and 6-MAM demonstrated to be quite stable under UVA light but very sensitive to UVB irradiation. In methanol solutions they undergo a similar pattern, both reaching 90% photodegradation after 100J/cm(2) of UVB, with a slightly faster kinetic for morphine at lower doses. In water, the yields of photodegradation are nearly one third lower than in methanol. In the solid state, the yield of photodegradation is lower than in solution. The structures of some UVB-induced degradation products are proposed. Photoaddition of the solvent and photooxidation seem the main pathways of phototransformation of these molecules. Moreover, both compounds revealed to generate singlet oxygen under UVB exposure.

Asylum Seekers and Methodology of Ascertainment

The protection of the right to seek asylum is one of the core functions of the United Nations, and a common International Asylum System is a constituent part of the United Nation’s objective. Forensic medicine plays an important role in this field, and in particular in the medical assessment of vulnerable asylum seekers. Therefore, there is the need for a shared medico-legal algorithm, based on the national and international regulatory framework and the protocols currently used for the medico-legal assessment of asylum seekers. After a systematic overview of the relevant and multi-disciplinary scientific evidence, the flow-chart on the Methods of Ascertainment and the Criteria of Evaluation has been set out in this chapter and proposed for the application of the International Medico-Legal community.