The Multidisciplinary Approach for the Diagnosis of Laryngohyoid Lesions: a Systematic Literature Review and Meta-Analysis

Background

The diagnosis of neck lesions remains a medico-legal diagnostic challenge because of the complexity of the anatomical relationship of the neck's organs and their anthropometric morphological variability. We compared the multidisciplinary approach using autopsy and postmortem computed tomography (PMCT), postmortem fine preparation (PMFP), postmortem micro-computed tomography (micro-CT), and postmortem magnetic resonance (PMMR) with the performance of a single diagnostic method among them evaluating the significance of different results. The multidisciplinary approach significantly reduced the number of unidentified neck lesions. The analysis demonstrates the need to better define the scan protocols and compose forensic guidelines for radiological application. The results of this study point out the need to compare the different diagnostic approaches in deceased subjects to better define the radiological scan protocol based on a multidisciplinary approach, including autopsy and radiological methods and the radiological scan protocols.

Methods

We performed a systematic electronic search of retrospective scientific articles in PubMed, the Scopus database, and the Cochrane Library. The following combinations of words were used: "hyoid fracture"; "comparison between PMCT AND autopsy"; "hyoid fracture PMCT AND autopsy"; "hyoid bone fracture AND forensic imaging"; "hyoid fracture AND PMCT"; "neck fracture PMCT AND autopsy"; "laryngohyoid lesions"; "postmortem CT AND autopsy in strangulation"; "postmortem AND strangulation Signs "; "strangulation virtopsy"; and "strangulation AND MRI". We selected 16 articles that were published between March 2003 and June 2020. We conducted a meta-analysis with R software to evaluate the rates. We obtained related confidence intervals and a forest plot.

Results

Thyroid cartilage damages were significantly more common than hyoid bone fractures (61.7% vs 42.2%) in a sample of 128 subjects. The synergic uses of autopsy/PMCT, autopsy/PMFP, autopsy/microCT, and autopsy/PMMR revealed significantly higher rates than a single investigation. We analyzed the PMCT scan data. The scan parameters evaluated were as follows: row, scan sample, reconstruction, kernel, slice thickness, kVp, and mAs. A lack of uniformity in the application of the protocol was observed.

Conclusion

Further studies are needed to better define the radiological scan protocols and to draw guidelines to identify the appropriate radiological methods in relation to the specific case.

Telehealth modulation and new proposals during the Covid-19 pandemic: a literature review

The Covid-19 pandemic has completely modified the Healthcare organization. This review aims to analyze the evolution of the different Telemedicine areas during pandemic. Electronic Health Records allows accelerating the study of patients suffering from Covid-19 disease, supporting their clinical assistance. The decreasing rehabilitation programs have determined a deterioration of the patient quality of life. Teleradiology was necessary to discard the increased requests and dab the shortage of staff, and to guarantee the interaction between specialist and patient. Telecardiology was fundamental determining a reduced of secondary mortality for cardiological complications of the infection. Teledermatology has permitted an early identification of the patients affected through diagnoses of cutaneous signs, reducing clinical visits. Telelegal-medicine changed through a law, that was introduced allowing a remarkable use of videoconferencing in the different stages of judicial and extrajudicial process. The digital consultations and home drug delivery were implemented in telepharmacy area. Artificial Intelligence allows an early diagnosis of the infection, monitoring the treatment through an intelligent platform. Robotic assisted telemedicine minimizes the risk of exposure allowing the disinfection of the places, drugs and meals delivery, the measurement of vital signs. Mobile Health facilitated the collection and the automatic transfer of the patient's parameters. Telemedicine would constitute still today as complementary but not substitutive to the traditional medicine. During the pandemic telemedicine has resulted important to guarantee continuity cures. Radiology and Dermatology showed a major telemedicine application.

Pre-operative leukocytosis: a potential poor prognosis risk factor in cardiac device implantation: a case report

INTRODUCTION

Despite the benefits of the implantation of cardiac rhythm management devices cardiac implantable electronic device (CIED) infection is an emerging problem New debate emerged about the unclear role of the pre-operative alteration of pro-inflammatory parameters, such as leukocytosis, in the development CIED infection and/or heart failure, and its consequent impact on the timing of ICD implantation/reimplantation.

CASE REPORT

A 65 years old patient with a history of Diabetes Mellitus (DM) type II, ventricular and supraventricular arrhythmias, chronic myocardial ischemia, heart failure was admitted to hospital. Healthcare workers opted for ICD implantation despite the presence of a persistent leukocytosis with normothermia. Five days later the implantation, patient showed fever and heart failure; blood culture resulted positive for Staphylococcus Aureus. Patient died for sepsis syndrome due to a cardiac device-related infection after a few days, despite the device extraction.

DISCUSSION

Cardiac device implantation remains a necessary surgi-cal procedure in order to reduce sudden cardiac death's rate in patients with heart failure. Leukocytosis is a new potential poor prognosis risk factor. The relationship between pro-inflammatory markers', such as CRP and white blood cell count, and device implantation is still not entirely clear. Pro-inflammatory markers could facilitate an infection development; recent study hypothesized that these markers could promote the development of heart failure.

CONCLUSION

Leukocytosis could represent a poor prognosis risk factor favoring the development of CIED infection and/or heart failure.

When a virus (Covid-19) attacks human rights: The situation of asylum seekers in the medico-legal setting

The Covid-19 pandemic is a global health emergency that requires immediate, effective action by governments to protect the health and basic human rights of everyone's life. Refugees and migrants are potentially at increased risk because they typically live in overcrowded conditions often without access to basic sanitation. Since the beginning of the official lockdown for Covid-19, the medico-legal assessment of physical violence related to obtaining status or other forms of human protection has been frozen.

Fatal complication of sickle cell anemia in an immigrant patient rescued from the mediterranean sea

The aim of this case report is to share with the forensic science community the experience of a rare complication of sickle cell anemia: acute chest syndrome. In October 2016, at the port of the city of Trapani (Sicily, Italy), the landing of an ONG "Médecins Sans Frontières" ship took place with 548 non-EU citizens and a corpse on board. The man, in the hours before his death, complained of severe chest pain and respiratory difficulties, and, despite of the therapeutic aids and resuscitation maneuvers, lastly died. The Public Prosecutor ordered that autopsy be executed on the corpse of the young Ghanaian, and it was to be supplemented by histological, toxicological, genetic investigations, and the dating of the biological age. The autoptic examination findings were indicative of bilateral bronchopneumonia, and were also confirmed by the histological findings, which identified a condition of massive adipose pulmonary embolism, due to the presence of extramedullary hematopoietic tissue, site of endovascular thrombosis secondary to hemolysis of sickle cells. The spleen appeared of small volume, with fibrotic phenomena. The predisposition to infections, thrombosis, extramedullary hematopoiesis are all complications of sickle cell anemia. The severe pulmonary condition characterized by vaso-occlusive findings and pulmonary inflammation with infiltrate, symptoms like fever, chest pain and severe systemic hypoxia allowed to ascribe the plausible cause of death as acute chest syndrome, a rare complication of sickle cell anemia. The peculiarity of this clinical case is also related to the methods of medical intervention (boat with non-governmental medical support for assistance to migrants).

Oral cancer and treatment information involved in therapeutic decision-making

BACKGROUND

Early detection of oral cancer improves survival after treatment and the quality of life. The adoption of standardized methodological protocols of screening has increased the possibilities for early identification and appropriate treatment. The informed consent must be obtained by patients before any treatment and/or surgical procedure. The clinical and surgical details must be discussed with the patient, as well as potential risks and benefits. Consent must be documented in the medical record and consent forms may serve to document the physician's discussion with the patient.

OBJECTIVES

all dentists are trained to detect the early signs of oral cancer. The health professional have a key role in identify the early signs of oral cancer in order to plan the treatment and management of the disease. The work aims to provide simple practical information to collect the patient's consent and encouraging him to improve healthy behaviors.

MATERIALS AND METHODS

are analyzed the critical issues of clinical practice in order to improve the management of oral cancer.

RESULTS AND CONCLUSIONS

Identify effective information approaches documented in the medical record as a tool of close communication between the patient and the physician.

Homicide with post mortem dismemberment of the victim with previous amputation of right lower limb: Case report and review of the literature

The dismemberment of a corpse is comparatively rare in forensic medicine and usually performed with different types of sharp tools. The victim is always the victim of a homicide. Dismemberment usually occurs where the killing took place without prior planning by the perpetrator. We report a case of homicide with post mortem mutilation of the victim's body with previous amputation of right lower limb in which the perpetrator was not identified. At autopsy, several fractures were detected on the cranial vault, and the cause of death was due to skull and brain injuries from multiple blunt force traumas.

Cardiac rupture caused by traffic accident: Case reports and a literature review

The commonest cause of blunt cardiac injuries is from traffic accidents followed by violent falls, sport activities, accidents or a fight but rupture of the heart is rare and lethal. The precise incidence of cardiac injury after a blunt chest trauma is unknown as rates vary greatly in the literature from between 7% and 76% of cases. Autopsy studies have shown that the right ventricle is the most frequently ruptured, followed by the left ventricle, right atrium, intraventricular septum, left atrium and interatrial septum with decreasing frequency. Post-mortem imaging is a rapidly advancing field of post-mortem investigations of trauma victims. The available literature dealing with the comparison of post-mortem computed tomography results with forensic autopsy indicates that conventional autopsy remains superior for the detection of organ and soft tissue injuries in all body regions.

Legal aspects of sexually transmitted diseases: abuse, partner notification and prosecution

Sexually transmitted diseases (STDs), with special emphasis to HIV infection, involve legal and ethical issues regarding informed consent to submit to a diagnostic, observance of professional secrecy in regard to partner(s) and community; legal troubles of particular difficulties are related to STD involving minors; lastly, physicians must be able to recognize the state of so called medical necessity. Knowledge and awareness of these related obligations are crucial to STD in medical practice; it is also important to allow for proper protection of victims of suspected sexual abuse under observation of healthcare. With regard to this aspect should be emphasized that violence against women and minors is a worldwide problem that has not yet been sufficiently acknowledged. Italian legislation (Law n. 96/1996) against rapes finally gave significant relevance to sex crimes. When sexual abusers have to be evaluated some obstacles may arise for lack of appropriate interdisciplinary approach, with insurance of the collection of biological samples, also related to STD diagnosis and alerts of legal authorities. Personal preconceptions may interfere with investigation if the biological evidences in children are few. In this regard, rules of document "Carta di Noto" drafted in 1996 and reviewed in July 2002 include some specific indications aiming to grant the reliability of the results of technical investigations and authenticity of the statements of the alleged victims.

[Informed consent for HIV diagnostic tests: what to do in case of minors]

AIDS is a clinical picture related to Human Immunodeficiency Virus (HIV) infection. In the last 20 years this infection has spread progressively, with approximately 2.4 million children under 15 years old now infected. The HIV antibody test is generally used to reveal the infection. In most European countries the test is voluntary; in Italy, implementation of the test is now regulated by Law 135/90. Art. 5 of the law states that the test is voluntary while informed consent is obligatory. However, nothing is stated concerning the child's consent. By contrast, other Italian laws (e.g., Law 194/78, Law 194/96 and DPR 309/90) establish that the physician should only accept the wishes of minors after first appraising the maturity of the child and his/her age. Physicians must inform the minor about testing risks, about the meaning of its result, and about the most important aspects of sexual education.. They may then decide to inform the parents if they feel that the child would be unable to take future decisions in the event of a positive HIV antibody test.

[Axillary blockade of the brachial plexus. A prospective evaluation of 1133 cases of plexus catheter anesthesia]

The results of 1133 axillary catheter brachial blocks are reported. Effectiveness and side-effects were monitored in a prospective manner over a period of 1 year.

METHOD

The puncture was performed with an 18-gauge plastic cannula fitted with a solid steel stylet. The stylet has a 45 degrees, short bevel with rounded edges. When puncturing the axillary neurovascular sheath, no attempt was made to elicit paresthesias with the needle. A distinct "click" and very easy advancement of the plastic cannula were signs of being well inside the neurovascular sheath. To confirm the correct positioning, 0.5-3 ml refrigerated saline solution were injected. If no paresthesias could be produced, a new puncture was performed using a nerve stimulator. The plastic cannula was fixed to the skin. For long-lasting operations or if postoperative analgesia or sympatholysis was required, a more flexible catheter was introduced through the plastic cannula. As an initial dose 40 ml 1% mepivacaine was injected via the cannula. If there was an insufficient block after 20 min, another 20 ml 1% mepivacaine was given. For long-lasting operations, 40 ml 1% mepivacaine was injected every 2 h.

RESULTS

Surgery was completed in 72% of patients; 24% required some form of supplementation including 17.2% of patients who received a "top-up" after 20 min (Table 1). In 3.8% of cases the technique was considered to be a complete failure, meaning that patients needed some type of general anesthesia including the use of i.v. ketamine.(ABSTRACT TRUNCATED AT 250 WORDS)