Simone Cappelletti

Systematic review of the toxicological and radiological features of body packing.

Body packing is the term used for the intracorporeal concealment of illicit drugs, mainly cocaine, heroin, methamphetamine, and cannabinoids. These drugs are produced in the form of packages and are swallowed or placed in various anatomical cavities and body orifices. Basing on these two ways of transportation a distinction between body stuffers and body pushers can be made, with the former described as drug users or street dealers who usually carry small amounts of drugs and the latter as professional drug couriers who carry greater amounts of drugs. A review of the literature regarding body packing is presented, with the aim to highlight the toxicological and radiological features related to this illegal practice. Raising awareness about the encountered mean body levels of the drugs and the typical imaging signs of the incorporated packages could be useful for clinicians and forensic pathologists to (a) identify possible unrecognized cases of body packing and (b) prevent the serious health consequences and deaths frequently occurring after the packages’ leakage or rupture or the packages’ mass obstructing the gastrointestinal lumen.

Takotsubo Cardiomyopathy and Sepsis: A Systematic Review

Takotsubo cardiomyopathy (TTC) is characterized by a systolic dysfunction localized in the apical and medial aspect of the left ventricle. It is usually related to physical or emotional stress. Recent evidence highlighting the role of infection led us to analyze the links between TTC and sepsis. A systematic review of the literature was undertaken to assess any trends in clinical findings, diagnosis, and outcomes in such patients. We identified 23 selected papers reporting a total of 26 patients, having sepsis, in whom TTC occurred. For each case, we collected data identifying population characteristics, source of sepsis, clinical disease description, and the results of cardiovascular investigations. The majority of patients were females (n = 16), mean age was 62.8 (14.0 standard deviation) years, and clinical outcome was favorable in 92.3% of the cases once the management of sepsis was initiated. A better understanding of the mechanisms of sepsis-associated TTC may generate novel strategies to treat the complications of this cardiomyopathy and may even help predict and prevent its occurrence.

Drug-related deaths with evidences of body packing: Two case reports and medico-legal issues

Body packing is a general term used to indicate the internal transportation of drug packages, mainly cocaine, heroin, amphetamines, and methamphetamine, within the gastrointestinal tract. We described two cases of accidental drug intoxication, observed over the last year period, with evidence of intracorporeal drug concealment. The first case concerned a body packer transporting 69 drug packages of heroin adulterated with piracetam. The second body packer transported 16 drug packages of cocaine adulterated with levamisole. For both cases, forensic examination and toxicological analysis of drug packages and biological samples were carried out. Authors also wants to highlight the main medico-legal issues that commonly arise in cases of suspected or ascertained body packers.

Intrauterine fetal decapitation after a high-speed car crash.

Motor vehicle collisions are an important cause of blunt abdominal trauma in pregnant woman. Among the possible outcomes of blunt abdominal trauma, placental abruption, direct fetal trauma, and rupture of the gravid uterus are described. An interesting case of complete fetal decapitation with uterine rupture due to a high-velocity motor vehicle collision is described. The external examination of the fetus showed a disconnection between the cervical vertebrae C3 and C4. The autopsy examination showed hematic infiltration of the epicranic soft tissues, an overlap of the parietal bones, and a subarachnoid hemorrhage in the posterior part of interparietal area. Histological analysis was carried out showing a lack of epithelium and hemorrhages in the subcutaneous tissue, a hematic infiltration between the muscular fibers of the neck and between the collagen and deep muscular fibers of the tracheal wall. Specimens collected from the placenta and from the uterus showed a hematic infiltration with hypotrophy of the placental villi, fibrosis of the mesenchymal villi with ischemic phenomena of the membrane. The convergence of circumstantial data, autopsy results, and histological data led us to conclude that the neck lesion was vital and the cause of death was attributed to the motor vehicle collision.

Variability in findings of anogenital injury in consensual and non- consensual fisting intercourse: A systematic review

Fisting is an uncommon and potentially dangerous sexual practice. This is usually a homosexual activity, but can also be a heterosexual or an autoerotic practice. A systematic review of the forensic literature yielded 14 published studies from 8 countries between 1968 and 2016 that met the inclusion/exclusion criteria, illustrating that external anogenital (anal and/or genital) trauma due to fisting is observed in 22.2% and 88.8% (reported consensual and non-consensual intercourse, respectively) of the subjects, while internal injuries are observed in the totality of the patients. Establishing the reliability of the conclusions of these studies is difficult due to a lack of uniformity in methodology used to detect and define injuries. Taking this limit into account, the aim of this article is to give a description of the external and internal injuries subsequent to reported consensual and non-consensual fisting practice, and try to find a relation between this sexual practice, the morphology of the injuries, the correlation with the use of drugs, and the relationship with assailant, where possible. The findings reported in this paper could be useful, especially when concerns of sexual assault arise.

Fetal age determination through biparietal diameter: a simple method of cranial reconstruction using multipurpose silicone.

In forensic medicine, gestational age of fetal remains is a crucial information in several contests, but the classic methods are inadequate when early gestational age needs to be assessed. In the authors experience, the measurement of the biparietal diameter provides more accurate information for this purpose. The status of the fetal head is therefore critical. This work describes an easy technique that allows to reconstruct the cranial volume of the fetus using multipurpose silicone given both the flexibility of the fetal head structure and the inorganic nature of the silicone itself. In conclusion, the determination of the biparietal diameter achieved through the above‐described technique permitted a more accurate estimation of the dating of pregnancy in judicial cases where the fetal remains were incomplete and disrupted.

Weapon identification using antemortem CT with 3D reconstruction, is it always possible? - A report in a case of facial blunt and sharp injuries using an ashtray

An interesting case of homicide involving the use of a heavy glass ashtray is described. The victim, a 81-years-old woman, has survived for few days and died in hospital. The external examination of the victim showed extensive blunt and sharp facial injuries and defense injuries on both the hands. The autopsy examination showed numerous tears on the face, as well as multiple fractures of the facial bones. Computer tomography scan, with 3D reconstruction, performed in hospital before death, was used to identify the weapon used for the crime. In recent years new diagnostics tools such as computer tomography has been widely used, especially in cases involving sharp and blunt forces. Computer tomography has proven to be very valuable in analyzing fractures of the cranial teca for forensic purpose, in particular antemortem computer tomography with 3D reconstruction is becoming an important tool in the process of weapon identification, thanks to the possibility to identify and make comparison between the shape of the object used to commit the crime, the injury and the objects found during the investigations. No previous reports on the use of this technique, for the weapon identification process, in cases of isolated facial fractures were described. We report a case in which, despite the correct use of this technique, it was not possible for the forensic pathologist to identify the weapon used to commit the crime. Authors wants to highlight the limits encountered in the use of computer tomography with 3D reconstruction as a tool for weapon identification when facial fractures occurred.

Accidental death involving professional fireworks.

An interesting case of accidental death involving the explosion of professional fireworks in an apartment is described. The examination of the scene permitted to study several effects of the explosion on walls, ceiling, furniture and especially on a balcony where the victim was found. The external examination of the victim showed extensive thermal injuries, degloving injuries and extensive shrapnel wounds. The autopsy examination showed subarachnoid haemorrhage localized to the cerebellum, haemorrhage in the soft tissues of the neck and chest and fracture of one clavicle. Almost the entire surface of lungs showed blunt injuries and the liver showed tearing of parenchyma and multiple cavities. Histological analysis were carried out showing thickening of alveolar septae, enlargement of alveolar spaces and alveolar ruptures in lung sections while numerous, round, empty spaces were detected in the parenchyma of the liver. The examination of the scene and of the fragments found showed that at least eight pyrotechnical charges exploded on the balcony, in close proximity of the threshold with the living room of the apartment. According to the chemical findings, the charges were typical for professional use and were filled with a mixture of potassium perchlorate and aluminium. A conservative calculation results in more than 1.5 kg total mass of pyrotechnic composition exploding very close to the victim.

Caffeine-Related Deaths: Manner of Deaths and Categories at Risk

Caffeine is the most widely consumed psychoactive compound worldwide. It is mostly found in coffee, tea, energizing drinks and in some drugs. However, it has become really easy to obtain pure caffeine (powder or tablets) on the Internet markets. Mechanisms of action are dose-dependent. Serious toxicities such as seizure and cardiac arrhythmias, seen with caffeine plasma concentrations of 15 mg/L or higher, have caused poisoning or, rarely, death; otherwise concentrations of 3–6 mg/kg are considered safe. Caffeine concentrations of 80–100 mg/L are considered lethal. The aim of this systematic review, performed following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement for the identification and selection of studies, is to review fatal cases in which caffeine has been recognized as the only cause of death in order to identify potential categories at risk. A total of 92 cases have been identified. These events happened more frequently in infants, psychiatric patients, and athletes. Although caffeine intoxication is relatively uncommon, raising awareness about its lethal consequences could be useful for both clinicians and pathologists to identify possible unrecognized cases and prevent related severe health conditions and deaths.

Heroin–piracetam mixture: Suggested mechanisms of action and risks of misinterpretation for drug users:

Piracetam is a positive allosteric modulator of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor that has been frequently used in the treatment of cognitive disorders. Press and internet reports indicate that the use of piracetam, as a heroin adulterant, has spread rapidly in some countries, especially in Asia and Europe. Its use, as adulterant, is believed to produce more profound desirable effects, while decreasing hangover. Recent surveys demonstrated that piracetam protects neurons from heroin-induced apoptosis. The protective role of this adulterating substance may be related to restoration of beta-endorphin levels and to its neuroprotective effects. The aim of this paper is to review the relevant literature and suggest the main hypothetical mechanisms that justify its use as a heroin adulterant, try to understand if its use could help people who want to come off heroin by reducing withdrawal symptoms and, finally, give useful information that permit us to understand why drug trafficking organisations started to use piracetam as heroin adulterant.