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Toma L, Vignali G, Maffioli E, Tambuzzi S, Giaccari R, Mattarozzi M, Nonnis S, Milioli M, Franceschetti L, Paredi G, Negri A, Riccardi B, Cattaneo C, Careri M, Tedeschi G, Bruno S. Mass spectrometry-based proteomic strategy for ecchymotic skin examination in forensic pathology. Sci Rep 2023; 13:6116. [PMID: 37059833 PMCID: PMC10104867 DOI: 10.1038/s41598-023-32520-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023] Open
Abstract
Mass spectrometry (MS)-based proteomics has recently attracted the attention from forensic pathologists. This work is the first report of the development of a shotgun bottom-up proteomic approach based on rapid protein extraction and nano-liquid chromatography/high-resolution mass spectrometry applied to full-thickness human skin for the differential analysis of normal and ecchymotic tissues to identify new biomarkers for bruise characterization and dating. We identified around 2000 proteins from each pooled extract. The method showed excellent precision on independent replicates, with Pearson correlation coefficients always higher than 95%. Glycophorin A, a known biomarker of vital wounds from immunochemical studies, was identified only in ecchymotic tissues, as confirmed by Western blotting analysis. This finding suggests that this protein can be used as a MS-detectable biomarker of wound vitality. By focusing on skin samples from individuals with known wound dating, besides Glycophorin A, other proteins differentially expressed in ecchymotic samples and dependant on wound age were identified, although further analysis on larger datasets are needed to validate these findings. This study paves the way for an in-depth investigation of the potential of MS-based techniques for wound examination in forensic pathology, overcoming the limitations of immunochemical assays.
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Affiliation(s)
- Lorenzo Toma
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124, Parma, Italy
| | - Giulia Vignali
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Elisa Maffioli
- Department of Veterinary Medicine and Animal Science, University of Milan, 26900, Lodi, Italy
| | - Stefano Tambuzzi
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Roberta Giaccari
- Food and Drug Department, University of Parma, 43124, Parma, Italy
| | - Monica Mattarozzi
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124, Parma, Italy.
| | - Simona Nonnis
- Department of Veterinary Medicine and Animal Science, University of Milan, 26900, Lodi, Italy.
- CRC Innovation for Well-Being and Environment (I-WE), University of Milan, 20133, Milan, Italy.
| | - Marco Milioli
- Department of Pharmacokinetic, Biochemistry and Metabolism, Global Research and Preclinical Development, Chiesi Farmaceutici Spa, 43122, Parma, Italy
| | - Lorenzo Franceschetti
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Gianluca Paredi
- Food and Drug Department, University of Parma, 43124, Parma, Italy
| | - Armando Negri
- Department of Veterinary Medicine and Animal Science, University of Milan, 26900, Lodi, Italy
| | - Benedetta Riccardi
- Department of Pharmacokinetic, Biochemistry and Metabolism, Global Research and Preclinical Development, Chiesi Farmaceutici Spa, 43122, Parma, Italy
| | - Cristina Cattaneo
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Maria Careri
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124, Parma, Italy
| | - Gabriella Tedeschi
- Department of Veterinary Medicine and Animal Science, University of Milan, 26900, Lodi, Italy
- CRC Innovation for Well-Being and Environment (I-WE), University of Milan, 20133, Milan, Italy
| | - Stefano Bruno
- Food and Drug Department, University of Parma, 43124, Parma, Italy
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Vignali G, Franceschetti L, Attisano GCL, Cattaneo C. Assessing wound vitality in decomposed bodies: a review of the literature. Int J Legal Med 2023; 137:459-470. [PMID: 36550324 DOI: 10.1007/s00414-022-02932-9] [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: 08/16/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
The capability of discriminating between a vital and a post-mortem injury has always been a central theme in forensic pathology, particularly when the corpse is an advanced state of decomposition. Post-mortem decay of the body can mask or disrupt the classical features of a skin lesion, making it difficult to establish the cause and manner of death. Taphonomically challenging situations pose several interpretative issues of skin lesions which need to be addressed with scientifically recent methods that are still limited in the forensic literature. For that reason, the present research aims at resuming what is currently available in the attempt to provide some insight regarding this topic. This review considers only original researches, in which the markers of vitality were studied a significant amount of time after death, in order to test post-mortem persistency of these markers over time. A number of 132 original articles and reviews were considered, and the most significant results are resumed in an overview table and in two intuitive figures. Though many researchers tried to establish the vitality of lesions in specimen, few analysed samples from bodies when a significant degree of putrefaction or burning had occurred. The most significant marker proved to be GPA, which sowed a satisfying persistence over time (up to 6 months in air putrefaction and 15 days in water). However, what clearly emerged is that further studies are needed to address the challenges of taphonomically transformed specimen and to possibly neutralize the variability of experimental conditions, which affect the reproducibility of results. In conclusion, this study could be a starting point for providing food for thoughts about the most useful markers to search for in unusually tricky autopsy cases.
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Affiliation(s)
- Giulia Vignali
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Lorenzo Franceschetti
- LABANOF (Laboratorio Di Antropologia E Odontologia Forense), Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe Carlo Lanza Attisano
- LABANOF (Laboratorio Di Antropologia E Odontologia Forense), Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Cattaneo
- LABANOF (Laboratorio Di Antropologia E Odontologia Forense), Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Vignali G, Blandino A, Rossetto I, Merzagora I. Intra-familiar homicides: From 2006 to 2021 in the judicial district of Milan. J Forensic Leg Med 2023; 93:102453. [PMID: 36495782 DOI: 10.1016/j.jflm.2022.102453] [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: 08/19/2022] [Revised: 10/16/2022] [Accepted: 11/12/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION The present research aims at analyzing criminological and medico-legal characteristics of intra-familiar homicides occurred in two major Italian cities (Milano and Monza) from the beginning of 2006 to the end of 2021. METHODS Cases were identified using the Institutional database of the Institute of Legal Medicine of Milan, where all the autopsies of victims were performed. Data about these cases were obtained from autopsies findings, preliminary investigation reports, local papers and victim relatives' interviews. In this period 11,480 autopsies were performed: 392 were homicides and, among these, 94 were confirmed as intra-familiar homicides (as a result of 84 events). Cases were classified according to the classic definition of intimate partner violence (referring only to an intra-familiar context), parricides, filicides, fratricides, familicides and grannicides. Age, sex, nationality and risk factors of the victims and perpetrators, as well as methods of murder were registered for each case. Only in some cases, motives for murder were known. RESULTS The most frequent type of intra-familiar homicides was intimate partner violence (41.5%), followed by parricides (16%, mainly matricides), filicides (10.7%) and fratricides (6.4%). 9.6% of the total number of events were familicides. Risk factors were frequently involved, in particular among perpetrators and in the group of parricides, while among siblicides they showed minimal relevance. Overall, psychiatric pathologies were the main risk factors involved (at least 23.8%), unlike extrafamiliar homicides, where previous criminal report or involvement in illicit traffics are frequently reported among perpetrators. This finding enlightens the difficulties of caring for a relative with a mental disorder, who can become dangerous for the domestic caregiver. Furthermore, the high number of physical illness and the advanced age of victims points out the tragical consequences of the lack of social support system for these categories of people. METHODS of murder were mainly cold steel (30-31.9%) and firearms (21-22.3%). However choking/manual ligature (9-9.6%), blunt force trauma inflicted using objects found on the scenario or bare handed (16-17%) and combined methods (11-11.7%) were frequently represented confirming the expected high level of impulsivity related to this kind of crime.
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Affiliation(s)
- Giulia Vignali
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Alberto Blandino
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ilaria Rossetto
- Poli-REMS Castiglione Delle Stiviere, ASST Mantova, Mantova, Italy
| | - Isabella Merzagora
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Blandino A, Maggioni L, Chiaffarino F, Parazzini F, Capano D, Florio EM, Margherita M, Bertelle GM, Franceschetti L, Amadasi A, Vignali G, Ciprandi B, Crudele GDL, Merelli VG, Collini F, Muccino EA, Nicolò P, Barbara G, Kustermann A, Cattaneo C, Gentilomo A. Sexual assault and abuse committed against family members: An analysis of 1342 legal outcomes and their motivations. PLoS One 2021; 16:e0253980. [PMID: 34185821 PMCID: PMC8241090 DOI: 10.1371/journal.pone.0253980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background Over the past years medical centres specifically addressed in gender-based violence have developed protocols for the collections of evidence useful in the courtroom, including accurate documentation of physical and psychological states of the victim and collection of samples. Previous studies showed an association between documented physical trauma and conviction but unfortunately, few studies in the recent literature analysed the factors that influence the legal outcome and final judgement. The present study focused on the elements that appeared of significance in the legal outcome, including medico-legal evaluation, source of the crime report and circumstance of the assault. Methods It was conducted a retrospective analysis of all the judgments issued by the Public Prosecutor’s Office at a Court of a Metropolitan Italian city regarding sexual and domestic violence, from January 1st 2011 to 31st December 31st 2015. Examination regarded the demographic information of the victim and of the defendant, information on the crime, the circumstances of the aggression and medical information retrieved. Sentences were subsequently divided into two categories based on the legal outcome (conviction vs acquittal) and the different characteristics of the two sub-populations were compared to verify if there were variables significantly associated to the judge’s final judgment. Results Over the 5 years taken into consideration, there have been 1342 verdicts regarding crimes of sexual violence (374 cases) and regarding abuses against family members or cohabitants (875): other 93 cases regarded both sexual violence and abuse. 66.3% ended in conviction of the offender and 33.7% in acquittal of the accused. Cases of conviction were more frequent when they involved: use of a weapon by the assailant, as well as if the assailant had a criminal record and had a history of drug abuse or other addictions; duration of proceeding less 22 months and a civil party involved; presence of clinical documentation together with other deposition in addition to victim’s deposition; also frequent episodes of violence and application of precautionary measures were associated to conviction. Conclusions Many factors seem able to influence the judge’s judgment, although clearly each case must be singularly evaluated. The mere presence of medical documentation, without the support of other sources of evidence, such as the victim’s statement or further declarations, however, is almost always not definitive for the verdict. Despite so, in cases where there are multiple sources of evidence, clinical documentation can provide useful elements and can give clues on the consistency between the history told and injuries observed.
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Affiliation(s)
- Alberto Blandino
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
- * E-mail:
| | - Lidia Maggioni
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Francesca Chiaffarino
- Department of Woman, Newborn and Child, Gynaecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, Università Degli Studi, Milan, Italy
| | | | - Elena Maria Florio
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Manuela Margherita
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Gian Marco Bertelle
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Lorenzo Franceschetti
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Alberto Amadasi
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Giulia Vignali
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Barbara Ciprandi
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | | | - Vera Gloria Merelli
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Federica Collini
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Enrico Angelo Muccino
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | | | - Giussy Barbara
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Cattaneo
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Andrea Gentilomo
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
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Margherita M, Franceschetti L, Maggioni L, Vignali G, Kustermann A, Cattaneo C. Male victims of sexual abuse and domestic violence: A steadily increasing phenomenon. Med Sci Law 2021; 61:54-61. [PMID: 33591863 DOI: 10.1177/0025802420947003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Violence perpetrated on male victims is a phenomenon that is currently underestimated by both national and international scientific communities, since males are historically (and stereotypically) considered the perpetrators rather than the victims of violence. As a consequence, the available literature lacks data which would allow a better understanding of this issue and its presenting features. We undertook a retrospective analysis of 231 medical files of male victims of violence over a five-year-period (2014-2018) at the Soccorso Violenza Sessuale e Domestica Centre in Milan, Italy. The sample included 112 victims of sexual violence and 119 victims of domestic violence, most of whom were younger than 18 years of age. The main aim of this study was to describe the presentations of male victims of violence in order to understand the phenomenon better, increase awareness of the issue and enable improved health-care management. The need to pay more attention to this vulnerable part of the population is mandatory in health-care services, and it includes: the provision of management guidelines, training to attending physicians and a supportive service to male survivors. Understanding which risk factors are related to male abuse can help with the development of programmes that identify, prevent and minimise violence - this being especially useful for primary-care clinicians. This is the first Italian study to deal with domestic and sexual violence involving male victims.
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Affiliation(s)
- Manuela Margherita
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
| | - Lorenzo Franceschetti
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
| | - Lidia Maggioni
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
| | - Giulia Vignali
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
| | - Alessandra Kustermann
- Service for Sexual and Domestic Violence (SVSeD), Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
| | - Cristina Cattaneo
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
- Service for Sexual and Domestic Violence (SVSeD), Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
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Franceschetti L, Di Candia D, Giordano G, Carabelli I, Vignali G, Cattaneo C. Drugs in bone: Detectability of substances of toxicological interest in different states of preservation. J Forensic Sci 2020; 66:677-686. [PMID: 33227173 DOI: 10.1111/1556-4029.14636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/24/2020] [Revised: 10/10/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
In forensic contexts of advanced decomposition, when conventional matrices are no longer available for toxicological analyses, finding alternative matrices is necessary. The skeleton, which is fundamental for anthropologists and geneticists, could be useful also for toxicological purposes. The present study aims to examine what kind of information toxicological analysis performed on bones (the cranium and the ribs) in different states of preservation could provide to the forensic practitioner. Thirty cadavers with known pharmacological history, subjected to forensic autopsy at the Institute of Legal Medicine of Milan, were selected. Rib and cranium samples were collected from each body and separated into two parts in order to create two different states of preservation: One was cleaned from soft tissues and analyzed as a well-preserved bone sample; the other was submitted to a long maceration process, simulating complete skeletonization. All specimens were then processed with accelerated solvent extraction and the eluates analyzed using Q-Exactive™ Orbitrap™ Mass Spectrometer. The analysis of blood and skeletal matrices showed positive results for the tested substances in 63% of cases, mainly benzodiazepines, antidepressants, and drug abuse. Significant Pearson correlations were observed between non-macerated vs. macerated bone samples: r = 0.79 for rib samples, r = 0.61 for cranium samples, and r = 0.69 for all bone samples. As a consequence, the positive results confirm the potential of the bone tissue as an alternative matrix in forensic toxicology, even in cases of extremely decomposed bodies. This study also highlighted important elements for reconstructing the biological profile in cases of forensic anthropological concern.
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Affiliation(s)
- Lorenzo Franceschetti
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Domenico Di Candia
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Gaia Giordano
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Irene Carabelli
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Giulia Vignali
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
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Piccinini A, Bailo P, Vignali G, Barbara G, Gennari G, Di Candia D, Albertini V, Kustermann A. How many DNA analyses are performed on adult sexual assault victims in Milan (Italy): A ten-year review. Forensic Science International: Genetics Supplement Series 2019. [DOI: 10.1016/j.fsigss.2019.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Piccinini A, Vignali G, Bailo P, Barbara G, Gennari G, Di Candia D, Albertini V, Kustermann A. Management of DNA evidence collected on adolescents in sexual assault investigations: A 10-year review from a large Italian rape centre. Med Sci Law 2019; 59:232-239. [PMID: 31248321 DOI: 10.1177/0025802419858538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Little research is available on the actual forensic use of genetic analyses performed in sexual violence cases, despite their relevant role in legal processes. The present retrospective study aimed to contribute to filling this gap in research, evaluating the actual number of serological/DNA analyses that followed medical examination of female adolescent victims of sexual violence. The study was performed in a large rape centre in Milan (North Italy) by analysing all medical records of female victims of sexual violence aged 13–19 years in the period from January 2006 to December 2015. The total number of sexual assault victims examined aged 13–19 years was 599. In 473 of the cases, biological evidence had been collected. The gathering of biological evidence was accurately performed (double swab technique) in multiple anatomical regions on the victims’ bodies, and clothes were acquired when biological stains were present or could be present. Proper handling under chain of custody for all the items collected followed in every case. Despite all of this, serological/DNA analyses were requested in only 9/473 (1.9%) cases. Procedural issues possibly affecting the magistrates’ decisions not to use DNA extensively as an investigative tool are also discussed.
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Affiliation(s)
- Andrea Piccinini
- Forensic Genetics Laboratory, Department of Biomedical Sciences for Health - Università degli Studi di Milano, Italy
- Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Giulia Vignali
- Department of Biomedical Sciences for Health - Università degli Studi di Milano, Italy
| | - Paolo Bailo
- Forensic Genetics Laboratory, Department of Biomedical Sciences for Health - Università degli Studi di Milano, Italy
| | - Giussy Barbara
- Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | | | - Domenico Di Candia
- Department of Biomedical Sciences for Health - Università degli Studi di Milano, Italy
| | - Valentina Albertini
- Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Alessandra Kustermann
- Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
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Casali MB, Blandino A, Del Sordo S, Vignali G, Novello S, Travaini G, Berlusconi M, Genovese U. Alleged malpractice in orthopaedics. Analysis of a series of medmal insurance claims. J Orthop Traumatol 2018; 19:7. [PMID: 30112637 PMCID: PMC6093819 DOI: 10.1186/s10195-018-0500-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 01/23/2018] [Indexed: 11/29/2022] Open
Abstract
Background Medical malpractice is an important topic worldwide, and orthopedics is a clinical branch that is considered to be at a high risk for claims. The analysis of a series of medmal insurance claims allows forensic pathologists, clinicians, and insurance companies to probe the risk of a specific clinical branch for medical malpractice claims and highlights areas where care may be improved. We investigated the main features of a major Italian insurance broker’s archive in order to identify recurrent pitfalls in this field. Materials and methods A retrospective study was carried out on orthopedics claims. The archive covered claims from 2002 to 2013 that targeted 1980 orthopedists. Results 635 claims were found and analyzed with a focus on the clinical activity invocked in the claim, the presence of alleged team malpractice, the clinical outcome of the case, and the final forensic decision regarding the claim. 299 orthopedists had at least one malpractice claim made against them during the available period; 146 orthopedists were subject to more than one malpractice claim. Most of the claims regarded perioperative and operative cases, usually originating from civil litigation. The anatomical sites most commonly involved were the hip or knees, and sciatic nerve lesions were the main contributor. Conclusions Orthopedics is a medical specialty with a high risk for malpractice claims. In our study, medical malpractice was observed in nearly 50% of the cases—typically in surgery-linked cases resulting in permanent impairment of the patient. Death from orthopedics malpractice seemed to be rare. Level of Evidence IV.
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Affiliation(s)
- M B Casali
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
| | - A Blandino
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - S Del Sordo
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - G Vignali
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - S Novello
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - G Travaini
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - M Berlusconi
- Humanitas Research Hospital, Trauma, Milan, AO, Italy
| | - U Genovese
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
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Solari F, Girolimetti G, Montanari R, Vignali G. A New Method for the Validation of Ultraviolet Reactors by Means of Photochromic Materials. FOOD BIOPROCESS TECH 2015. [DOI: 10.1007/s11947-015-1581-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Piramuthu S, Rizzi A, Vignali G, Volpi A. Benchmarking of RFID devices for apparel applications: An experimental approach. International Journal of RF Technologies 2015. [DOI: 10.3233/rft-140064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S. Piramuthu
- Information Systems and Operations Management, University of Florida, Gainesville, FL, USA
| | - A. Rizzi
- RFID Lab, Department of Industrial Engineering, University of Parma, Italy
| | - G. Vignali
- RFID Lab, Department of Industrial Engineering, University of Parma, Italy
| | - A. Volpi
- RFID Lab, Department of Industrial Engineering, University of Parma, Italy
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13
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Sardella M, Navone F, Rocchi M, Rubartelli A, Viggiano L, Vignali G, Consalez GG, Sitia R, Cabibbo A. KIF3C, a novel member of the kinesin superfamily: sequence, expression, and mapping to human chromosome 2 at 2p23. Genomics 1998; 47:405-8. [PMID: 9480755 DOI: 10.1006/geno.1997.5123] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Kinesins are microtubule-dependent molecular motors involved in intracellular transport and mitosis. Here, we report the cloning, sequencing, mapping, and expression of a novel member of the kinesin superfamily. The sequence of this newly identified human cDNA reveals an open reading frame encoding a putative protein of 792 residues. Based on its high sequence similarity to the kinesin-like molecule KIF3B, we named this protein KIF3C. KIF3C is encoded by transcripts that are distinct from the KIF3B mRNA in human, rat, and mouse and is preferentially expressed in the brain. Fluorescence in situ hybridization reveals that, in the human genome, the KIF3C gene maps to chromosome 2 at 2p23. The sequence of KIF3C predicts an unusually long insertion in the proximity of L11, a region thought to mediate microtubule binding. Taken together, these findings suggest that KIF3C is a novel kinesin-like protein that might be specifically involved in microtubule-based transport in neuronal cells.
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Affiliation(s)
- M Sardella
- DIBIT-HSR, Via Olgettina 58, Milan, 20132, Italy
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14
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Vignali G, Lizier C, Sprocati MT, Sirtori C, Battaglia G, Navone F. Expression of neuronal kinesin heavy chain is developmentally regulated in the central nervous system of the rat. J Neurochem 1997; 69:1840-9. [PMID: 9349526 DOI: 10.1046/j.1471-4159.1997.69051840.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The kinesin family of motor proteins comprises at least two isoforms of conventional kinesin encoded by different genes: ubiquitous kinesin, expressed in all cells and tissues, and neuronal kinesin, expressed exclusively in neuronal cells. In the present study, we have analyzed the expression of the two kinesin isoforms by immunochemistry at different stages of development of the rat CNS. We have found that the level of expression of neuronal kinesin is five to eight times higher in developing than in adult rat brains, whereas that of ubiquitous kinesin is only approximately 2.5 times higher in maturing versus adult brains. Moreover, we have studied the distribution of neuronal kinesin by light microscopic immunocytochemistry in the rat brain at different postnatal ages and have found this protein not only to be more highly expressed in juvenile than in adult rat brains but also to show a different pattern of distribution. In particular, tracts of axonal fibers were clearly stained at early postnatal stages of development but were markedly unlabeled in adult rat brains. Our results indicate that the expression of at least one isoform of conventional neuron-specific kinesin is up-regulated in the developing rat CNS and suggest that this protein might play an important role in microtubule-based transport during the maturation of neuronal cells in vivo.
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Affiliation(s)
- G Vignali
- Department of Medical Pharmacology, CNR Cellular and Molecular Pharmacology Center, University of Milano, Italy
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15
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Vignali G, Niclas J, Sprocati MT, Vale RD, Sirtori C, Navone F. Differential expression of ubiquitous and neuronal kinesin heavy chains during differentiation of human neuroblastoma and PC12 cells. Eur J Neurosci 1996; 8:536-44. [PMID: 8963445 DOI: 10.1111/j.1460-9568.1996.tb01238.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Kinesin is a microtubule-based motor protein involved in intracellular organelle transport. Neurons are characterized by the presence of at least two isoforms of conventional kinesin: ubiquitous kinesin, expressed in all cells and tissues, and neuronal kinesin, whose pattern of expression is confined to neuronal cells. In order to investigate whether the two kinesin motors, which are encoded by different genes, may play distinct biological roles in neurons, we studied their expression during neuronal differentiation. Human neuroblastoma SH-SY5Y and IMR32 cells and rat phaeochromocytoma PC12 cells were used as an in vitro system for neuronal differentiation and were induced to differentiate in the presence of retinoic acid, a combination of dibutyryl cAMP and 5-bromodeoxyuridine, and nerve growth factor respectively. The expression level of each kinesin isoform was evaluated by quantitative immunoblot before and after pharmacological treatment. We found that in all cell types the expression level of neuronal kinesin, but not of ubiquitous kinesin, is stimulated during differentiation. In particular, SH-SY5Y cells show a 4.5-fold, IMR32 cells a 3-fold and PC12 cells a 7-fold increase in the level of expression of neuronal kinesin. By Northern blot analysis we found that the selective increase in the expression of neuronal kinesin is paralleled by an increase in its mRNA, indicating that there is a transcriptional control of the expression of this kinesin isoform during differentiation of neuroblastoma and PC12 cells. Our results suggest that these cells represent an adequate model to study the function of conventional kinesin and its isoforms.
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Affiliation(s)
- G Vignali
- CNR Cellular and Molecular Pharmacology Centre, Department of Medical Pharmacology, University of Milano, Italy
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16
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Guadagnucci A, Tornaboni D, Vignali G, Mariotti M, Cincinelli A, Vignale L. [Neuroleptic malignant syndrome. A case report]. Minerva Med 1995; 86:327-30. [PMID: 7478078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A lethal case of neuroleptic malignant syndrome in a 42-year-old woman with a history of bipolar psychiatric disorder under treatment with haloperidol is reported. The patient, hospitalized many times in the past for psychiatric treatment, was then admitted for treatment of a relapse of the disease during a exceedingly hot period. The patient complained of hallucinations and stomach ache. It was necessary to increase the dose of haloperidol to 2 mg, 3 times a day, and to give a single dose of perphenazine enanthate 100 mg. All tests proved normal except for CPK 274 U/l and urea 14 mg/dl. On hospital day 2, went into coma with high temperature, diaphoresis, polyuria, leucocytosis (WBC count 15,440 U/mm3), urea 7 mg/dl, LDH 425 U/l, Na 114 mEq/l, K 2.5 mEq/l. The rapid improvement following hypertonic saline treatment encouraged a diagnosis of water intoxication. On hospital day 7, continuing with the haloperidol treatment, the patient developed a high temperature and deterioration torpor. On hospital day 9, the patient went back into coma with temperature over 40 degrees C (104 degrees F), with fine myoclonia most visible on the face, and muscular rigidity. The CPK, rose from 5,169 to 28,060 U/l in less than 24 hours; the serum myoglobin rose to 41,000 ug/l. On day hospital 11 developed renal, cardiac and respiratory insufficiency. The picture deteriorated and dantrolene was no longer of use in controlling the fever. Then with a fever of over 42 degrees (108 degrees F) and the CPK at 50,000 the patient died. The autopsy demonstrated widespread rhabdomyolysis, a picture of widespread aspecific shock in all organs and picture of myoglobin-induced tabular necrosis of the kidney.
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Affiliation(s)
- A Guadagnucci
- U.O. Anestesia e Rianimazione, Ospedale SS. Giacomo e Cristoforo-Massa
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17
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Houri JJ, Falbo A, Vignali G, Codogno P, Ghidoni R. The metabolic processing of glycosphingolipids in HT-29 cells is differentiation-dependent. Biochem Biophys Res Commun 1994; 202:992-1000. [PMID: 8048973 DOI: 10.1006/bbrc.1994.2027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The metabolism of two radiolabelled glycosphingolipids, lactosylceramide and GM1 ganglioside, in differentiated and undifferentiated HT-29 cells is reported. Both lactosylceramide and GM1 ganglioside were demonstrated to be extensively catabolized in undifferentiated cells, as deduced by the relative amount of the compounds formed along the degradative pathway. Conversely, in differentiated cells both precursors were utilized as substrates for sugar-chain elongation. Furthermore we were unable to detect any significant difference in the activity of CMP-NeuAc:GM1 alpha 2-->3 sialyltransferase, a Golgi key enzyme for the glycosylation of glycosphingolipids, between the two cell populations. Taken together with our previous results on the differentiation-dependent trimming of high-mannose N-linked glycoproteins in HT-29 cells, one can suggest that common steps control the anabolic/catabolic balance of these two classes of glycoconjugates as a function of differentiation.
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18
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Guadagnucci A, Vignali G, Mondello V, Tulli G, Leonardi F. [The estimation of p50 by the algorithm proposed by Siggard-Andersen. Its experimental assessment in critical patients]. Minerva Med 1992; 83:451-5. [PMID: 1522969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To determine the ability of O. Siggaard-Andersen algorithm in the estimation of the "in vivo" p50 and standard p50 values from a single blood sample with sO2% less than or equal to 97. DESIGN comparison between measured and calculated standard p50 values. SETTING Intensive care unit. PATIENTS thirteen cardio-pulmonary critical ill patients. Mean age of seventy-four years (range 53-84 years). MEASUREMENT The experimental measurement of p50 standard (p50st sper) was performed tonometering the venous blood samples (60 specimens) using an IL-237 tonometer at 37 degrees C, with two different gas mixtures to obtain pCO2 at 5.33 kPa (DS = 0.06), and pO2 at levels to achieve sO2% values close to 50%. The gases's complete equilibration was not deemed important. The pO2 values were corrected to a pH of 7.40 using a Bohr factor = -0.48 and the p50 was taken by simple interpolation of points on the sO2%/pO2 diagram. Calculated standard p50 (p50st calc) and calculated "in vivo" p50 on the venous specimens (No. 60) and the correspondent arterial specimens with sO2% less than or equal to 97 (No. 40) were obtained by Siggaard-Andersen's computerized algorithm. Blood specimen analysis was performed by means of an ABL3 Radiometer gas analyzer and an OSM3 Radiometer oximeter. Statistical analysis was made by Anova test for liner regression. RESULTS There was excellent correlation between the 60 experimental p50st determined by Siggaard-Andersen's oxygen dissociation curve on the same blood samples. The regression equation was: p50st sper = -0.79 + 1.21 x p50st calc, r = 0.90, R2 = 81.1%; with F = 249.5 and less than 10(-5). No good correlation was found between p50st and standards p50 calculated on arterial specimens (p50st calc art): p50 = 1.38 + 0.52 x p50st calc art, r = 0.52, R2 = 26.6%, F = 14 e P less than 10(-3). Regression of in vivo P50 calculated on correspondent venous samples (p50 ven) was: p50 ven = 0.79 = 0.77 x p50 art, r = 0.93, R2 = 87.2%, F = 256 and P less than 10(-5). CONCLUSION Our results suggest that the curve describes the curve also at high saturation when it is not longer linear. Accurate measurement (including dishemoglobin percentage) and sO2% less than or equal to 97 are necessary. We did not perform experimental measurements of "in vivo" p50 but we postulate that as the p50st was well calculated so too would be the p50 "in vivo" at 37 degrees C.
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Affiliation(s)
- A Guadagnucci
- Ospedale Ss. Giacomo e Cristoforo, Regione Toscana, USSL n. 2, Massa
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19
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Tulli G, Vignali G, Guadagnucci A, Mondello V, Pacciani S, Pappagallo S. [Hypoxia and oxygen content during dialysis]. Minerva Anestesiol 1992; 58:77-81. [PMID: 1589077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a study of 72 patients treated with acetate and bicarbonate dialysis, the Authors verified if hypoxic hypoxia caused by dialysis depends on a deficit in oxygen content with an inherent risk of tissue hypoxia. PO2uv (uncompensated venous oxygen partial pressure) and CQ (cardiac compensation factor) derived from the oxygen absorption curve were studied by a new Ole Siggard-Andersen algorithm. The results do not show a risk of tissue hypoxia in the postdialytic period.
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Affiliation(s)
- G Tulli
- U.O. Anestesia e Rianimazione, USL n. 18, Empoli Firenze
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20
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Vignali G, Tulli G, Guadagnucci A. [Role of mixed venous oxygen saturation monitoring in critical patients in intensive care]. Minerva Anestesiol 1991; 57:45-7. [PMID: 1806833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- G Vignali
- U.O. Anestesia-Rianimazione, Presidio Ospedaliero Massa, Unita Sanitaria Locale N.2 Massa-Carrara
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21
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Tulli G, Vignali G, Guadagnucci A, Mondello V. [Role ++of mixed venous oxygen saturation monitoring in patients in intensive therapy]. Minerva Anestesiol 1991; 57:33-43. [PMID: 1806832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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22
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Vignali G, Guadagnucci A, Mondello V, Leonardi F, Tulli G. [Clinical evaluation of new indices of tissue perfusion]. Minerva Anestesiol 1991; 57:910-1. [PMID: 1961548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- G Vignali
- U.O. Anestesia e Rianimazione, USL N. 2 Massa e USL N. 18, Empoli
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23
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Guadagnucci A, Vignali G, Mondello V, Tulli G, Leonardi F. [Evaluation of the disassociation curve of hemoglobin with a new mathematical model: comparison with experimental data]. Minerva Anestesiol 1991; 57:926-7. [PMID: 1961555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A Guadagnucci
- Servizio di Anestesia e Rianimazione, USL n. 2, Toscana
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24
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Guadagnucci A, Tulli G, Vignali G, Mondello V, Vignali F. [Oxygen status of arterial blood in patients in critical intensive care: clinical cases]. Minerva Anestesiol 1990; 56:1225-7. [PMID: 2290546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A Guadagnucci
- U.O. Anestesia-Rianimazione Presidio Ospedaliero Massa, Unità Sanitaria Locale N. 2, Massa-Carrara
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25
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Tulli G, Vignali G, Guadagnucci A. [Arterial oxygen status determined by routine blood gas analysis and multiple wavelength blood oximeter. Evaluation of a new algorithm in critical patients: theory]. Minerva Anestesiol 1990; 56:1217-20. [PMID: 2290544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- G Tulli
- U.O. Anestesia-Rianimazione Presidio Ospedaliero di Massa, Unità Sanitaria Locale N. 2, Massa-Carrara
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26
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Tulli G, Vignali G, Guadagnucci A. [Oxygen status of arterial blood in critical patients: statistical analysis]. Minerva Anestesiol 1990; 56:1221-4. [PMID: 2290545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- G Tulli
- U.O. Anestesia-Rianimazione Presidio Ospedaliero Massa, Unita Sanitaria Locale N. 2, Massa-Carrara
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27
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Vignali G, Tulli G, Guadagnucci A. [The role of O2 saturation monitoring in patients in critical intensive care]. Minerva Anestesiol 1990; 56:1229-31. [PMID: 2290547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- G Vignali
- U.O. Anestesia-Rianimazione Presidio Ospedaliero Massa, Unità Sanitaria Locale N. 2 Massa-Carrara
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28
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Vignali G, Guadagnucci A, Tulli G. [Clonidine abstinence syndrome. A clinical case]. Minerva Med 1990; 81:645-7. [PMID: 2234489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
During hospitalization a patient with acute pulmonary oedema caused by myocardial dilation and chronic kidney failure presented high blood pressure and repeated episodes of supraventricular tachycardia. The complication was attributed to the withdrawal of clonidine and was treated by reintroduction of the drug combined with nifedipine, nitroderivates and antiarrhythmic drugs.
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Affiliation(s)
- G Vignali
- U.S.L. n. 2, Massa-Carrara, Università degli Studi di Siena
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29
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Abstract
In Critical Care medicine the concepts of Oxygen Delivery, Oxygen Consumption and Tissue Oxygenation have become fundamental in clinical practice but measurements of Oxygen Content and O2 Transport variables require invasive procedures that could be dangerous for critically ill patients and trigger a septic process. Derived indices obtained combining data from a Blood Gas Analyzer with the data from a multi-wavelength spectrophotometer and using the Ole Siggaard-Andersen pH/Blood Gas computerised algorithm might be the non-invasive answer. On 115 arterial blood samples from critically ill patients, we measured pH, pCO2, pO2, oxygen saturation, total hemoglobin concentration and fractions of carboxy- and methemoglobin. The new algorithm was used to calculate: active hemoglobin concentration, total oxygen concentration, actual half-saturation tension, 2,3-diphosphoglycerate concentration, estimated functional shunt, uncompensated mixed venous pO2 (assuming an arterio-venous oxygen difference of 2.3 mmol/L based on a standard oxygen consumption of 11.2 mmol/min and a standard cardiac output of 4.9 L/min) and the cardiac oxygen compensation factor. In Intensive Care all the oxygen parameters may be determined with sufficient accuracy and precision provided the oxygen saturation level is less than 0.97 and provided the definition of oxygen saturation is properly settled and measurements are performed according to the highest state of the art. However, in critically ill patients in evolution our aim is to maintain an 'optimal' paO2 on the plateau of the Oxygen Dissociation Curve (ODC) and the use of mechanical ventilation, high FIO2, fluid challenges and the rapid improvement of the patient's conditions can cause a value for sO2 greater than or less than 0.97 and an improvement or worsening of the paO2. The p50 calculation both in simultaneously drawn arterial and venous blood permits utilisation of derived indices (pO2uv-, CQ) for sO2 greater than 0.97. The Ole Siggaard-Andersen algorithm seems to give correct p50 values, at high saturation values, particularly when discarding unrealistic values for calculated cDPG. The correlation between p50 calculated by the Ole Sigaard-Andersen algorithm with that derived from classical formula shows the superiority of the findings obtained by means of the new algorithm. In critically ill patients the ODC is usually shifted to the right. The new parameters, pO2uv- and CQ, contain useful informations for clinical practise; but rapid changes in Cardiac Index (CI) and VO2/m2 can be ignored by the new algorithm, if these changes are not associated with a rise in ctO2 or pH and pCO2 changes.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- G Tulli
- Unità Operativa di Anestesia e Rianimazione, Presidio Ospedaliero San Giacomo e Cristoforo di Massa, Unità Sanitaria Locale, Regione Toscana, Italy
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30
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Vignali G, Rogato G, Mondello V, Vignale L, Guadagnucci A, Vignali F, Tulli G. [ARDS in MOFS (multiple organ failure syndrome). How to direct the therapy? A case report of MOFS in AIDS]. Minerva Anestesiol 1990; 56:1-5. [PMID: 2215976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A young AIDS patient was admitted to the Intensive Therapy ward of our hospital with ARDS. The case raised the question of how medical and nursing personnel should face the problem of "suitable treatment for a terminally ill patient". Therapy was based on invasive methods such as mechanical ventilation and the insertion of catheters to monitor vital parameters. The evolution of ARDS in MOFS revealed the difficulty of sustaining vital parameters and avoiding pluriorganic damage.
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Affiliation(s)
- G Vignali
- Istituto di Anestesiologia e Rianimazione, Università degli Studi di Siena
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31
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Tulli G, Gabini R, Feri M, Maurizi P, Nannoni S, Vignali G. [Multiple organ failure syndrome in infection caused by ictero-hemorragic Leptospira. Description of a clinical case]. Minerva Anestesiol 1989; 55:423-6. [PMID: 2633075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 53 years old fisherman was admitted to General Intensive Care Unit in Arezzo with signs and symptoms of Weil disease. An early acute respiratory failure developed. Radiological and haemodynamic findings confirmed a diagnosis of ARDS. The patient developed a severe jaundice, acute renal failure and ARDS (MOF multiple organs failure). To support different failures of the organs, CMV (continuous mandatory ventilation: CPPV with PEEP max 10 cm H2; IRV max 2:1) and AMV (assisted mandatory ventilation: Pressure Support Ventilation), haemofiltration, haemoperfusion and plasmapheresis were simultaneously used, that got better and better renal and respiratory performances. Haemodynamic worsening by PEEP during extracorporeal treatment was overcome by PSV very useful new ventilatory procedure even during weaning period. The patient treated in such manner survived without important disabilities. This care confirms that ARDS (non cardiogenic edema) and MOF can develop during Icterohaemorrhagic Leptospirosis.
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