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Iacoponi N, Del Duca F, Marcacci I, Occhipinti C, Napoletano G, Spadazzi F, La Russa R, Maiese A. Butane-related deaths in post-mortem investigations: A systematic review. Leg Med (Tokyo) 2024; 69:102442. [PMID: 38579662 DOI: 10.1016/j.legalmed.2024.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/24/2024] [Accepted: 03/30/2024] [Indexed: 04/07/2024]
Abstract
Volatile substance abuse is widespread among adolescents due to its easy availability and methods of consumption. Inhalant abuse represents a current problematic issue, causing significant morbidity and mortality due to direct toxicity on several target organs and displacement of gas which results in a lack of oxygen. This review aims to evaluate post-mortem and toxicological investigations in cases of suspected butane intoxication. We performed comprehensive research using the Preferred Reporting Items for Systematic Review (PRISMA) standards. Forty scientific papers fulfilled the inclusion criteria. A total of 58 cases of butane-related deaths were found. Among these, we found 11 cases of suicide (18%), 1 case of homicide (2%), 44 cases of accidental poisoning (76%), and 2 cases of work-related deaths (4%). Autopsy and post-mortem examinations were performed in 54 cases, whereas toxicological analyses were presented in 56 cases. In autopsy, pulmonary edema (51%) and poli-visceral congestion (59%) were the most common findings. When death by butane inhalation is hypothesized, autopsy and histological findings may be nonspecific, therefore toxicological investigations assume a crucial role along with attention to the methods used to collect biological samples.
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Affiliation(s)
- Naomi Iacoponi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.
| | - Ilaria Marcacci
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Carla Occhipinti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.
| | - Federica Spadazzi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy.
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Di Candia D, Franceschetti L, Giordano G, Merelli VG, Attisano GL, Boracchi M, Barbara G, Kustermann A, Cattaneo C. Toxicological analysis in victims of sexual and domestic violence: A retrospective study of a 3-year period (2018-2020). J Forensic Leg Med 2023; 99:102578. [PMID: 37659272 DOI: 10.1016/j.jflm.2023.102578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
This manuscript presents an epidemiological investigation carried out on abuse victims who accessed the Sexual and Domestic Violence Service (SVS&D) of IRCCS Ca' Granda in Milan, Italy. The focal point of this research was the detection of alcohol, prescription medications, and illicit substances in victims who solicited help from the SVS&D center between 2018 and 2020. Over this three-year span, biological samples of blood and urine were procured from 207 victims, out of a patient pool of 2470. All collected samples were analyzed via High Performance Liquid Chromatography - Tandem Mass Spectrometry (HPLC-MS/MS) and Gas Chromatography - Mass Spectrometry (GC-MS). Toxicological examination results demonstrated that 43% of the cases tested positive for substances in 2018, 39% in 2019 and 60% of the cases in 2020. Overall, 45% of the victims tested resulted positive to some substance over a 3-year period, equivalent to 3.6% of the overall cases (2470 victims). Substances of toxicological interest were detected in 104 samples (out of 377, corresponding to 27.6%) belonging to 94 patients. The most detected classes of drugs were stimulants, antidepressants, benzodiazepines and antipsychotics. Moreover, BAC (Blood Alcohol Concentration) indicated positivity in 25 cases (out of 184 cases analyzed - 14% of positive cases). Based on this study's findings, we recommend broadening the range of substances evaluated in drug-facilitated sexual assaults and establishing standardized protocols for both national and international implementation. Implementing procedures would significantly enhance forensic support provided to victims of abuse seeking healthcare services post-incident.
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Affiliation(s)
- Domenico Di Candia
- Section of Legal Medicine, Department of Biomedical Sciences for Health, Università Degli Studi Milano, Italy
| | - Lorenzo Franceschetti
- Section of Legal Medicine, Department of Biomedical Sciences for Health, Università Degli Studi Milano, Italy
| | - Gaia Giordano
- Section of Legal Medicine, Department of Biomedical Sciences for Health, Università Degli Studi Milano, Italy.
| | - Vera Gloria Merelli
- Section of Legal Medicine, Department of Biomedical Sciences for Health, Università Degli Studi Milano, Italy
| | - Giuseppe Lanza Attisano
- Section of Legal Medicine, Department of Biomedical Sciences for Health, Università Degli Studi Milano, Italy
| | - Michele Boracchi
- Section of Legal Medicine, Department of Biomedical Sciences for Health, Università Degli Studi Milano, Italy
| | - Giussy Barbara
- Department of Obstetrics and Gynecology, Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milano, Italy
| | - Alessandra Kustermann
- Department of Obstetrics and Gynecology, Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milano, Italy
| | - Cristina Cattaneo
- Section of Legal Medicine, Department of Biomedical Sciences for Health, Università Degli Studi Milano, Italy
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Scendoni R, Fedeli P, Cannovo N, Cingolani M. The "Magnificent Seven Errors" in Forensic Autopsy Practice: The Italian Context. Acad Forensic Pathol 2022; 11:208-214. [PMID: 35003452 DOI: 10.1177/19253621211056191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022]
Abstract
According to the Italian legal system, forensic autopsies are performed by a medical doctor specialized in legal medicine, otherwise known as a medicolegal expert (MLE), who has a range of very complex responsibilities. Indeed, the quality of forensic autopsy activity is always questioned in courts of law; incorrect assessments are dangerous because they can jeopardize the validity of a criminal investigation and thus affect the outcome so that a real culprit may be acquitted or an innocent person convicted. Nonconformities also discredit the professionalism of the specialist who performs the autopsy. The work of a MLE implies a series of assignments and duties that should be given constant consideration, but when certain aspects of this activity are underestimated or overlooked, this can lead the expert to make mistakes with irreparable consequences for the judicial investigation. In this article, for the first time, we present a summary of seven known errors related to autopsy activity following death by unnatural causes, with the purpose of alerting MLEs who work under the Italian judicial system to the potential dangers of such errors. These relate to: oversights in autopsy technique, incorrect collection of photographic and video material, unauthorized attendance at the autopsy, missing/mistaken reporting at any stage of the forensic activity, failure to notify the party forensic consultant, using histological or toxicological nonaccredited laboratories for forensic activities, and lack of observance of the chain of custody.
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