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Enrico SILINGARDI
CULTORE DELLA MATERIA
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze,sede Istituti Anatomici (area Policlinico)
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Pubblicazioni
2023
- Cannabinoid Stability in Postmortem Brain Samples Stored at Different Temperatures
[Articolo su rivista]
Santunione, A L; Palazzoli, F; Verri, P; Vandelli, D; Chiapelli, F; Silingardi, E
abstract
Drug stability is an important concern of forensic toxicological testing, particularly postmortem samples that may be stored for an extensive period of time before analysis. In postmortem toxicology, the complex assessment of analyte stability in biological matrices can profoundly impact the interpretation of toxicological results and the outcome of forensic casework. The aim of this work is to assess the stability of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), 11-hydroxy-THC (11-OH-THC), 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH), and 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid glucuronide (THCCOOH-glucuronide) in brain stored at three different temperatures (4°C, -20°C and -70°C) up to over 12 months (390 days) in order to establish the best storage condition for preventing potential drug degradation during the storage period. Brain is suitable and useful for xenobiotic concentrations and a valuable specimen in the interpretation of postmortem toxicological results. In our study, pooled brain specimens were spiked at low and high concentrations to evaluate the change in concentration over time. Stable compounds were quantified within ±20% of the target concentration (the mean concentration resulting from the initial analysis). According to stability criteria, our preliminary findings revealed that all the cannabinoids studied are stable in frozen brain samples (-20°C and -70°C) for over 12 months: all the analytes' concentrations remained unaffected during storage over time, the analytical variation staying within ±20%. On the contrary, under refrigeration conditions (4°C), 11-OH-THC, THCCOOH and THCCOOH-glucuronide were instable. Authentic brain samples, collected from eight cases during the autopsy, were analyzed and the stability was evaluated. This study provided new data on cannabinoid stability in brain. The stability of the brain samples, both in spiked samples and authentical caseworks, highlights the importance of the brain as a valid testing matrix when retesting is required after a long period of time or when laboratories are faced with backlog.
2022
- Capitolo 11 "La tutela della riservatezza, il segreto professionale ed il segreto d'ufficio. Il trattamento dei dati riservati"
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2022
- Capitolo 12 'Il referto e la denuncia di reato'
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2022
- Capitolo 13 "Riflessi medico legali della pandemia da SARS-CoV-2"
[Capitolo/Saggio]
Silingardi, E.; Santunione, A. L.
abstract
2022
- Capitolo 24 "I delitti contro l'incolumità pubblica"
[Capitolo/Saggio]
Santunione, A. L.; Licata, M.; Silingardi, E.
abstract
2022
- La documentazione sanitaria: la cartella clinica, le certificazioni mediche
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2022
- Two caseworks for one gene: successful species identification from compromised bone materials with the 12S rRNA
[Articolo su rivista]
Ferri, Gianmarco; Corradini, Beatrice; Gianfreda, Denise; Ferrari, Francesca; Silingardi, Enrico
abstract
The availability of a reliable molecular assay in species recognition in forensic cases is of paramount importance when visual inspection or morphological methods are not exhaustive, especially from challenging samples. Here, two different caseworks involving bone samples founded during medico-legal outdoor investigations are presented. In order to exclude the human nature of the specimens and to determine the exact species they belong to, we proceeded with the molecular approach trying to generate sequences from the classical mtDNA markers cyt b and COI. However, they both gave critical results. For this reason, a short amplicon of ~ 150 bp of the 12S rRNA gene was used as an alternative.This short fragment was sufficient to identify the biological origin of the bone specimens with a high degree of certainty leading to the exclusion of their human nature. This work highlights the utility of the 12S rRNA and underlines the importance of deepen the choice of alternative shorter markers with respect to the classical ones, in order to achieve species identification even from challenging and degraded material in forensic criminal and wildlife caseworks.
2021
- Diagnosing coronary thrombosis using multiphase post-mortem CT angiography (MPMCTA): A case study
[Articolo su rivista]
Camatti, Jessika; Santunione, Anna Laura; Draisci, Stefano; Gangi, Bruno Giuliano; Bisceglia, Marco; Bini, Riccardo; Renzi, Riccardo; Silingardi, Enrico
abstract
While post-mortem angiography (PMA) is gradually establishing its role in Forensic Radiology, the available literature in Italy lacks a solid foundation, particularly regarding its use in criminal court proceedings. An illustrative example of multiphase post-mortem CT angiography (MPMCTA) is presented here to encourage the systematic implementation of PMA methods. To demonstrate concordance between MPMCTA and the reference standard (autopsy and histology) in a case of acute coronary thrombosis, we report a case where MPMCTA, autopsy, histological and toxicological analyses were performed on a previously healthy 51-year-old man. MPMCTA detected a right coronary artery filling defect that could be ascribed to coronary thrombosis, which was later confirmed by autopsy and histological examinations.
2021
- Post-mortem distribution of mephedrone and its metabolites in body fluids and organ tissues of an intoxication case
[Articolo su rivista]
Palazzoli, F.; Santunione, A. L.; Verri, P.; Vandelli, D.; Silingardi, E.
abstract
New psychoactive substances (NPS) are substances that continue to appear on the drug market to bypass controlled substance legislation. Mephedrone or 4-methylmethcathinone is becoming the most popular new psychoactive substance among youth as a recreational drug. The present study describes the optimization and validation of a sensitive method that combined clean up procedure and LC–MS/MS technique designed to simultaneously determine the presence of Mephedrone and its two metabolites (normephedrone as active metabolite and dyhidromephedrone) in post-mortem specimens (body fluids and organ tissues). To date, this is the first determination of Mephedrone metabolites in post-mortem specimens. The validated method was applied to a fatal Mephedrone intoxication case. The distribution of the three analytes in different post-mortem matrices was presented. The toxicological results of the studied case are discussed, along with autopsy, histopathological evidence and crime-scene information. The toxicological results presented in the study provide new data relative to mephedrone and the distribution of its metabolites in post-mortem specimens. In our opinion, the metabolite concentration database must be developed because the metabolites may be linked to toxicity. The pattern of parent drug and its metabolites can be helpful in the interpretation of fatal cases involving mephedrone, which will contribute to the currently limited knowledge about mephedrone and metabolites concentrations.
2020
- Cannabinoids Determination in Brain: A Supplemental Helpful in Postmortem Evaluation
[Articolo su rivista]
Palazzoli, F; Santunione, A L; Marchesi, F; Verri, P; Vandelli, D; Licata, M; Silingardi, E
abstract
The scientific interest in Cannabis has been documented by a wide literature but postmortem studies and interpretations of autopsy findings are lacking or limited to few cases, few matrices analyzed or a small number of analytes. The present study describes the development and full in-house validation of a sensitive and simple method based on an optimized rapid clean up procedure combined with a robust and highly sensitive LC-MS-MS technique, designed to simultaneous determination of Delta9-tetrahydrocannabinol (THC), cannabidiol (CBD), 11-hydroxy-Delta9-tetrahydrocannabinol (11-OH-THC), 11-nor-Delta9-tetrahydrocannabinol-carboxylic acid (THC-COOH) and 11-nor-Delta9-tetrahydrocannabinol-carboxylic acid-glucuronated (THC-COOH-glucuronide) in postmortem samples: central blood (CB), femoral blood (FB) and brain tissue (BR). The developed method was validated and applied to 24 postmortem cases involving cannabinoids. In this study, we presented a full optimization and validation of target analyses for each matrix. The procedure had proven to be reliable and accurate. This study adds new data, particularly about the cannabinoids concentrations in BR samples. Combined pattern (CB, FB, BR) can be used in the interpretation of postmortem cases, proving and strengthening the assessments made on blood data. BR matrix in a helpful supplement in the investigation of the role of cannabinoids as crucial or contributory factor in leading to death.
2019
- "I delitti contro l'incolumità pubblica" in Medicina legale per i corsi di laurea a orientamento giuridico e triennali
[Capitolo/Saggio]
Santunione, A. L.; Licata, M.; Silingardi, E.
abstract
2019
- Cap. 6: La Documentazione sanitaria: la cartella clinica, le certificazioni mediche in 'Medicina legale. Per studenti e medici di medicina generale'
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2019
- Capitolo 10: 'La tutela della riservatezza . il segreto professionale e il segreto d'ufficio. il trattamento dei dati riservati'. In Medicina legale per studenti e medici di medicina generale
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2019
- Capitolo 11 'Il referto e la denuncia di reato'. In Medicina legale. Per studenti e medici di medicina generale
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2019
- Capitolo 22: I delitti contro l'incolumità pubblica. In Medicina legale. Per studenti e medici di medicina generale
[Capitolo/Saggio]
Santunione, A. L.; Licata, M.; Silingardi, E.
abstract
2019
- Identification of driver and front passenger in traffic accidents through organ lesion injury pattern
[Articolo su rivista]
Solinas, M.; Silingardi, E.; Raschella, F.; Liciani, M.; Caggiano, B.; Marino, V.; Mauriello, S.; Potenza, S.; Marella, G. L.
abstract
Through a retrospective study, 328 bodies of deceased car drivers were examined (252 drivers and 76 passengers seated in the front seat). Specifically, lesions of the cranial, thoracic and abdominal organs were examined. The purpose of the study is to ascertain whether it is possible to identify, through the organ lesion injury pattern, who was driving at the time of the traffic accident. Statistical analysis was used to detect injuries that could discriminate between the driver and front passenger. Among the drivers, lesions of the thoracic organs were more frequently observed, in accordance with the greater skeletal lesivity (specifically in the sternal), due to the impact with the steering wheel; even the injury of the abdominal organs has more frequently affected the driver than the front passenger. The encephalic lesion effected the driver and front passenger in a similar percentage of cases. As it was imaginable to think, the thoracic lesions were the most effective to differentiate the driver from the front passenger. Abdominal lesion also plays an important role in the study, having been observed in the driver with a doubled frequency compared to the front passenger.
2019
- Seizures of illicit substances for personal use in two Italian provinces: analysis of trends by type and purity from 2008 to 2017
[Articolo su rivista]
Verri, Patrizia; Rustichelli, Cecilia; Ferrari, Anna; Marchesi, Filippo; Baraldi, Carlo; Licata, Manuela; Vandelli, Daniele; Palazzoli, Federica; Potì, Francesco; Silingardi, Enrico
abstract
Background: The use of illicit substances represents one of the most difficult problems to confront in the health
system. Drug use is a global problem but is not uniform throughout the world, within the same country and changes
over time. Therefore, knowing the illicit substances that are used in a territory is essential to better organize health
services in that specific geographical area. To this aim, we analysed 4200 samples confiscated from individuals who
held them for personal use by police forces in the Italian provinces of Modena and Reggio Emilia from 2008 to 2017.
Methods: The suspected samples were screened by gas-chromatography-mass spectrometry (GC-MS) and by
liquid chromatography-tandem mass spectrometry (LC-MS/MS); all samples were subsequently analysed by gas
chromatography-flame ionization detector (GC-FID) for quantitative analyses.
Results: Cannabis was the most seized illicit substance (70.7%). Over the study period, the number of seizures
of herb with a high content of Δ9-THC increased. The number of cocaine seizures remained stable (total 16.1%), but
the median purity of seized cocaine increased to 75% in 2017. Heroin seizures decreased over time, but the median
purity of seized heroin reached 16.8% in 2017. In almost all the years, heroin samples with a purity exceeding the 97.5 percentile were found. Especially from 2014, the range of seized substances increased and started to include synthetic cathinones, phenylethylamines, UR-144, LSD, psilocybe, prescription opioid and hypnotics. In two cases, tramadol together with tropicamide was seized. Most of the seizures involved male subjects and 82% of the seizures were from individuals younger than 35 years of age.
Conclusions: The persistence of old illicit drugs and the rapid emergence of new psychoactive substances represented a serious challenge for public health in the studied Italian area. Some useful interventions might be: informing mainly young people about the possible complications of cannabis use; implementing standardized procedures to diagnose and treat cocaine-related emergencies in hospitals; increasing the distribution of naloxone to antagonize possible heroin overdoses; equipping laboratories to be able to identify the new psychoactive substances.
2019
- The importance of forensic storage support: DNA quality from 11-year-old saliva on FTA cards
[Articolo su rivista]
Corradini, B.; Alu, M.; Magnanini, E.; Galinier, M. E.; Silingardi, E.
abstract
Storage conditions influence the integrity of the recoverable DNA from forensic evidence in terms of yield and quality. FTA cards are widely used in the forensic practice as their chemically treated matrix provides protection from the moment of collection to the point of analysis with current STR typing technology. In this study, we assess the recoverability and the integrity of DNA from 11-year-old saliva on FTA cards using a forensic quantitative real-time polymerase chain reaction (qPCR) commercial assay. The quality after long-term storage was investigated in order to evaluate if the FTA device could assure enough stability over time, applying some internally validated quality criteria of the STR profile. Furthermore, we used a 3D interpolation model to combine the quantitative and qualitative data from qPCR to calculate the minimum optimal DNA input (MODI) to add to the downstream PCR reaction based on the quantitative and qualitative data of a sample. According to our results, when saliva sample is properly transferred onto FTA cards and then correctly stored according to the manufacturer’s instructions, it is possible to recover sufficient amounts of DNA for human identification even after more than a decade of storage at ambient temperature. Degradation affected the quality of results especially when the Degradation Index exceeds the value of 2.12, requiring modifications of the standard internal workflow to improve the genotyping quality. Above this value, the application of a “corrective factor” to the PCR normalization process was necessary in order to adjust the recommended manufacturer’s PCR DNA input taking into account the degradation level. Our results demonstrated the importance to consider in predictive terms the parameters obtained with the real-time quantification assay, both in terms of quantity (DNA concentration) and of quality (DI, inhibition). Informatics predictive tools including qPCR data together with the variables of storage duration and conditions should be developed in order to optimize the DNA analysis process.
2018
- Appearance/Image- and Performance-Enhancing Drug Users: A Forensic Approach
[Articolo su rivista]
Lusetti, M.; Licata, M.; Silingardi, E.; Bonsignore, A.; Palmiere, C.
abstract
Image- and performance-enhancing drugs include a wide range of substances used to promote physical changes to enhance appearance. Anabolic androgen steroids are the most widely used image- and performance-enhancing drugs along with a wide variety of additional substances. The aim of this study was to identify the pathological changes pertaining to the cardiovascular system possibly involved in the death and characterize the substances associated with steroid use and their possible role in the death. A series of deaths involving image- and performance-enhancing drug users were selected. Nandrolone and testosterone were the most frequently identified steroids. The most commonly illegal drugs found were tetrahydrocannabinol, cocaine, and methadone. Antidepressants, opioids, benzodiazepines, and barbiturates were also found. These findings highlight that results obtained from postmortem investigations should be meticulously evaluated to understand the weight that each identified substance may have played in the death process and exclude any alternative causes of death.
2018
- Multi-phase postmortem CT angiography (MPMCTA): experiences of the Forensic Radiology Unit in the University Hospital of Modena - Italy
[Poster]
Amorico, M. G.; Drago, A.; Procicchiani, D.; Tore, E.; Vecchio, S.; Santunione, A. L.; Dominguez, A.; Silingardi, E.; Torricelli, P.
abstract
The collaboration between forensic science and radiology has been lasting and proficuous, and both the disciplines now learn from and support each other. Since the first use of conventional radiology in forensic science, every new technology developed in clinical radiology has been gradually absorbed in the forensic use. Multi-phase postmortem CT angiography (MPMCTA) is increasingly being recognized as a valuable adjunct medico-legal tool to investigate the vessels of the head, thorax and abdomen. We present the expreriences of the Forensic Radiology Unit of the University of Modena and Reggio Emilia.
2018
- The role of ethyl glucuronide in supporting medico-legal investigations: Analysis of this biomarker in different postmortem specimens from 21 selected autopsy cases
[Articolo su rivista]
Santunione, Anna Laura; Verri, Patrizia; Marchesi, Filippo; Rustichelli, Cecilia; Palazzoli, Federica; Vandelli, Daniele; Licata, Manuela; Silingardi, Enrico
abstract
Ethanol determination in postmortem blood is one of the most frequently requested analyses in legal medicine and forensic toxicology. Ethyl glucuronide is a non-oxidative ethanol metabolite. It is also a useful marker of ante-mortem alcohol ingestion when ethanol itself has been completely eliminated from the body and could be considered in autopsy cases to obtain more reliable indications. The aim of the present study was to investigate the ethyl glucuronide distribution in postmortem specimens from autopsy cases found to be positive for ethanol. We presented 21 autopsy cases in which central blood, peripheral blood and liver samples were available. Specimens were analyzed for ethyl glucuronide by liquid chromatography tandem mass spectrometry; we also recorded postmortem interval, case history, cause of death, use of drugs, metabolic disorders if present, putrefaction if present, history of ethanol abuse and information about ethanol intake before death. Our aim was to evaluate and to compare the ethyl glucuronide levels in different matrices taken from the same subject in order to provide a better understanding of the interpretation of postmortem ethyl glucuronide concentrations.
2017
- Monitoring of adherence to headache treatments by means of hair analysis
[Articolo su rivista]
Ferrari, Anna; Licata, Manuela; Rustichelli, Cecilia; Baraldi, Carlo; Vandelli, Daniele; Marchesi, Filippo; Palazzoli, Federica; Verri, Patrizia; Silingardi, Enrico
abstract
The aim of this study was to evaluate the potential of hair analysis to monitor medication adherence in headache patients undergoing chronic therapy. For this purpose, the following parameters were analyzed: the detection rate of 23 therapeutic drugs in headache patients' hair, the degree of agreement between the self-reported drug and the drug found in hair, and whether the levels found in hair reflected the drug intake reported by the patients.
2016
- Development and validation of a liquid chromatography-tandem mass spectrometric assay for quantitative analyses of triptans in hair
[Articolo su rivista]
Vandelli, Daniele; Palazzoli, Federica; Verri, Patrizia; Rustichelli, Cecilia; Marchesi, Filippo; Ferrari, Anna; Baraldi, Carlo; Giuliani, Enrico; Licata, Manuela; Silingardi, Enrico
abstract
Triptans are specific drugs widely used for acute treatment of migraine, being selective 5HT1B/1D receptor agonists. A proper assumption of triptans is very important for an effective treatment; nevertheless patients often underuse, misuse, overuse or use triptans inconsistently, i.e., not following the prescribed therapy. Drug analysis in hair can represent a powerful tool for monitoring the compliance of the patient to the therapy, since it can greatly increase the time-window of detection compared to analyses in biological fluids, such as plasma or urine. In the present study, a liquid chromatography-tandem mass spectrometric (LC–MS/MS) method has been developed and validated for the quantitative analysis in human hair of five triptans commonly prescribed in Italy: almotriptan (AL), eletriptan (EP), rizatriptan (RIZ), sumatriptan (SUM) and zolmitriptan (ZP). Hair samples were decontaminated and incubated overnight in diluted hydrochloric acid; the extracts were purified by mixed-mode SPE cartridges and analyzed by LC–MS/MS under gradient elution in positive multiple reaction monitoring (MRM) mode. The procedure was fully validated in terms of selectivity, linearity, limit of detection (LOD) and lower limit of quantitation (LLOQ), accuracy, precision, carry-over, recovery, matrix effect and dilution integrity. The method was linear in the range 10–1000 pg/mg hair, with R2 values of at least 0.990; the validated LLOQ values were in the range 5–7 pg/mg hair. The method offered satisfactory precision (RSD <10%), accuracy (90–110%) and recovery (>85%) values. The validated procedure was applied on 147 authentic hair samples from subjects being treated in the Headache Centre of Modena University Hospital in order to verify the possibility of monitoring the corresponding hair levels for the taken triptans.
2016
- Hair analysis for detection of triptans occasionally used or overused by migraine patients-a pilot study
[Articolo su rivista]
Ferrari, Anna; Baraldi, Carlo; Licata, Manuela; Vandelli, Daniele; Marchesi, Filippo; Palazzoli, Federica; Verri, Patrizia; Rustichelli, Cecilia; Giuliani, Enrico; Silingardi, Enrico
abstract
Purpose
The aim of this study is to evaluate the detection rate of almotriptan, eletriptan, frovatriptan, sumatriptan, rizatriptan, and zolmitriptan in the hair of migraineurs taking these drugs; the degree of agreement between type of self-reported triptan and triptan found in hair; if the concentrations in hair were related to the reported cumulative doses of triptans; and whether hair analysis was able to distinguish occasional use from the overuse of these drugs.
Methods
Out of 300 headache patients consecutively enrolled, we included 147 migraine patients who reported to have taken at least one dose of one triptan in the previous 3 months; 51 % of the patients overused triptans. A detailed pharmacological history and a sample of hair were collected for each patient. Hair samples were analyzed by liquid chromatography-electrospray tandem mass spectrometry (LC-MS/MS) by a method that we developed.
Results
All the triptans could be detected in the hair of the patients. The agreement between type of self-reported triptan and type of triptan found in hair was from fair to good for frovatriptan and zolmitriptan and excellent for almotriptan, eletriptan, sumatriptan, and rizatriptan (P < 0.01, Cohen’s kappa). The correlation between the reported quantities of
triptan and hair concentrations was statistically significant for almotriptan, eletriptan, rizatriptan, and sumatriptan (P
< 0.01, Spearman’ s rank correlation coefficient). The accuracy of hair analysis in distinguishing occasionally users from overusers was high for almotriptan (ROC AUC = 0.9092), eletriptan (ROC AUC = 0.8721), rizatriptan (ROC AUC = 0.9724), and sumatriptan (ROC AUC = 0.9583).
Conclusions
Hair analysis can be a valuable system to discriminate occasional use from triptan overuse.
2016
- Hair testing in clinical setting: simultaneous determination of 50 psychoactive drugs and metabolites in headache patients by LC tandem MS
[Articolo su rivista]
Licata, Manuela; Rustichelli, Cecilia; Palazzoli, Federica; Ferrari, Anna; Baraldi, Carlo; Vandelli, Daniele; Verri, Patrizia; Marchesi, Filippo; Silingardi, Enrico
abstract
Headache patients suffering from recurrent attacks are a population at risk of overuse and abuse of analgesic medications. Associated with triptans, the first-line drugs recommended for the acute treatment, these patients usually take other medications such as opioids analgesics for the attack treatment, antidepressants and antiepileptics for prophylaxis treatment and benzodiazepines, non-benzodiazepine hypnotics and antipsychotics for the treatment of comorbidities. Regular and frequent use of triptans, like of any other symptomatic analgesic, can cause chronic headache and medication-overuse headache (MOH). In these circumstances, a detoxification treatment is necessary and therefore the monitoring and follow-up of the patients are crucial to the success of the treatment. In the present study, a LC tandem MS method has been developed for the identification of 50 psychoactive drugs in human hair, including triptans, benzodiazepines and metabolites,
analgesics, antiepileptic, antidepressants and metabolites, a non-benzodiazepine hypnotic (z-drug),antipsychotics and metabolites. Hair samples were decontaminated, pulverized and incubated overnight in methanol; the extracts were then purified by a new and rapid QuEChERS procedure and analyzed by LC-MS/MS under gradient elution with positive ionization MRM mode. The procedure was fully validated in terms of selectivity, linearity, limit of detection and lower limit of quantitation, precision and accuracy, carry-over, matrix effect, recovery and dilution integrity. The validated procedure has been applied to 234 real hair samples collected from headache patients
with known type and dosage of the taken drugs; the obtained data could be of interest to evaluate the xenobiotic concentrations in patients with known therapy.
2016
- Postmortem diagnosis of anaphylaxis in presence of decompositional changes
[Articolo su rivista]
Radheshi, Erjon; REGGIANI BONETTI, Luca; Confortini, Annalisa; Silingardi, Enrico; Palmiere, Cristian
abstract
Eosinophil and activated mast cell identification in the spleen combined with mast cell tryptase determination in postmortem serum may diagnose fatal anaphylaxis with a high degree of certainty. Mast cell tryptase measurement and significance in corpses with decompositional changes remains however an issue of controversy. Analogously, immunohistochemistry in corpses with decompositional changes may be influenced by several mechanisms, including protein alteration, antigen diffusion and unspecific antibody binding to disrupted protein structures. The authors present an autopsy case involving a 55-year-old woman who unintentionally received clarithromycin. Due to difficult in administrative procedures, the postmortem examination was performed 96 h after death. Mast cell tryptase was measured in postmortem serum from femoral, aortic and right heart blood. The obtained results were consistent with mast cell activation. Histochemistry (Pagoda Red) and immunohistochemistry (anti-tryptase antibodies) allowed splenic eosinophils and mast cells to be detected. Based on the results of all postmortem investigations, the hypothesis of anaphylaxis following accidental clarithromycin administration was formulated.
2016
- Therapeutic and recreational methadone cardiotoxicity
[Articolo su rivista]
Lusetti, M; Licata, Manuela; Silingardi, Enrico; Reggiani Bonetti, L; Palmiere, C.
abstract
Several classes of drugs have been associated with an increased risk of cardiovascular disease and occurrence of arrhythmias potentially involved in sudden deaths in chronic users even at therapeutic doses. The study presented herein focuses on pathological changes involving the heart possibly due to methadone use. 60 cases were included in the study in total and were divided into three groups (therapeutic methadone users: 20 cases, recreational methadone users: 20 cases, and sudden death group in subjects who had never taken methadone: 20 cases). Autopsies, histology, biochemistry and toxicology were performed in all cases. Macroscopic and microscopic investigation results in therapeutic methadone users were similar to those observed in sudden, unexpected deaths in non-methadone users. In recreational methadone consumers, macroscopic and microscopic examination of the heart failed to provide results consistent with acute or chronic myocardial or coronary damage, thereby corroborating the hypothesis of death most likely following respiratory depression.
2015
- Cardiac Toxicity in Selective Serotonin Reuptake Inhibitor Users
[Articolo su rivista]
Lusetti, M; Licata, Manuela; Silingardi, Enrico; Reggiani Bonetti, L; Palmiere, C.
abstract
Several classes of recreational and prescription drugs have been associated with an increased risk of cardiovascular disease and the occurrence of arrhythmias, which may be involved in sudden deaths in chronic users even at therapeutic doses. The study presented herein focuses on pathological changes involving the heart, which may be caused by selective serotonin reuptake inhibitor use and their possible role in the occurrence of sudden cardiac death. A total of 40 cases were included in the study and were divided evenly into 2 groups: 20 cases of patients treated with selective serotonin reuptake inhibitors and 20 cases of sudden deaths involving patients void of any drug treatment. The first group included 16 patients treated with citalopram and 4 with sertraline. Autopsies, histology, biochemistry, and toxicology were performed in all cases. Pathological changes in selective serotonin reuptake inhibitor users consisted of various degrees of interstitial and perivascular fibrosis as well as a small degree of perineural fibrosis within the myocardium of the left ventricle. Within the limits of the small number of investigated cases, the results of this study seem to confirm former observations on this topic, suggesting that selective serotonin reuptake inhibitors may play a potential, causative role in the pathogenesis of sudden deaths in chronic users even at therapeutic concentrations.
2015
- Estimation of the time of death through the analysis of clock miRNAs expression in blood and vitreous humor
[Articolo su rivista]
Corradini, Beatrice; Alu', Milena; Radheshi, Erjon; Gabbolini, Valentina; Ferrari, Francesca; Santunione, Anna Laura; Silingardi, Enrico
abstract
Estimation of the time since death is a practical task in daily forensic casework but available methods lack reliability especially in complex deaths and after long PM period. MirRNA analysis should be ideally an useful ancillary tool as it proved to be sensitive in forensics especially for body fluid identification.
Here we analyzed 10 miRNAs with a supposed role in circadian rhythms through an RT-qPCR assay in postmortem samples of blood (n = 12) and vitreous humor (n = 12) from individuals died in the day or at night, in order to find those with an oscillating pattern of variation. The expression stability of four endogenous controls was also tested to find the most suitable for normalization.SNORD95 proved to be the best and was used in both body fluids. Four miRNAs showed significant differential expression between individuals died at daytime and at nighttime, mir-106b and mir-96 in vitreal samples and mir-142-5p and mir-219 in blood. Results are preliminary and limited to the small sample set. Future studies on more samples and with additional markers are needed to further elucidate the role of miRNA profiling in postmortem contexts and how useful they would be as “chronobiomarkers” for time of death determination
2015
- Pathological changes in anabolic androgenic steroid users
[Articolo su rivista]
Lusetti, M; Licata, Manuela; Silingardi, Enrico; Reggiani Bonetti, L; Palmiere, C.
abstract
Several classes of recreational and prescription drugs have additional effects on the heart and vasculature, which may significantly contribute to morbidity and mortality in chronic users. The study presented herein focuses on pathological changes involving the heart possibly due to anabolic androgenic steroid use. The role these hormones may play in their occurrence of sudden cardiac death is also investigated. 98 medico-legal cases including 6 anabolic androgenic steroid users were retrospectively reviewed. Autopsies, histology, immunohistochemistry, biochemistry and toxicology were performed in all cases. Pathological changes consisted of various degrees of interstitial and perivascular fibrosis as well as fibroadipous metaplasia and perineural fibrosis within the myocardium of the left ventricle. Within the limits of the small number of investigated cases, our results appear to confirm former observations on this topic and suggest anabolic androgenic steroid's potential causative role in the pathogenesis of sudden cardiac deaths in chronic users
2015
- investigation of erthquake related deaths using post-mortem multi detector computed tomography
[Abstract in Atti di Convegno]
Santunione, Anna Laura; Perini, Andrea; Radheshi, Erjon; Amorico, Maria Grazia; Tata, Cristina; Torricelli, Pietro; Silingardi, Enrico
abstract
Purpose: Post-mortem Multi-Detector Computed Tomography (MDCT) is now recognized as a valuable adjunct medicolegal tool. Beside its application for identification purposes, MDCT is used to assist pathologists in determining cause of death. Compared to conventional radiography MDCT offers advantages in detecting blunt force injury, and can quickly provide a guide to lethal injuries. Therefore, the use of MDCT for earthquake-related deaths is an obvious choice, as blunt force injuries are common in such victims. The purpose of this study was to evaluate the impact of MDCT on the assessment of causes of death, in a case series of fatal injuries after the 2012 Modena earthquake.
Methods and materials: 12 medicolegal cases underwent full-body CT-scan and external examination. The circumstances of death were collected and reviewed. Conventional autopsy was not authorized by the local Prosecutor for all cases.
Results: In all cases, post-mortem MDCT and external examination revealed lesions consistent with fatal blunt force injuries, and the absence of contrary evidence that could support another cause of death. These findings together with the circumstantial data were sufficient to assess cause and manner of death.
Conclusions: The results of this study confirm that post-mortem MDCT provides an important contribution to determining cause of death, especially when autopsy is not performed. Therefore, radiologists with experience in post-mortem imaging are needed to support forensic pathologists in establishing causes of death, without necessarily having to perform conventional autopsy.
2014
- Modalità di presentazione del disagio psichico nei migranti: accessi in pronto soccorso e comportamenti suicidairi.
[Abstract in Atti di Convegno]
Pizzirani, Margherita; Reggianini, Corinna; Bettelli, Margherita; Santunione, Anna Laura; Ferrari, Silvia; Rigatelli, Marco; Silingardi, Enrico; Galliani, Ivan
abstract
Dall'analisi degli accessi al PS dei due ospedali di Modena di italiani e stranieri e il numero di suicidi, gli AA fanno alcune considerazioni sulla difficoltà di individuare un percorso di presa in carico psichiatrica per i pazienti migranti che nel 59% dei casi presentano disturbi apsecifici, suggestivi di somatizzazione.
2014
- Pericolosità persistente e braccialetto elettronico
[Abstract in Rivista]
Pizzirani, Margherita; Galliani, Ivan; Silingardi, Enrico
abstract
Gli AA trattano delle prospettive di abolizione/revisione della pericolosità sociale dei soggetti giudicati imputabili alla luce del concetto di pericolosità persistente (Moore et al, 1984).
2014
- Un caso peritale di dissociazione: problematiche
[Abstract in Rivista]
Valentini, Valerio; Preti, Elisabetta; Galliani, Ivan; Rasi, Fabrizio; Silingardi, Enrico
abstract
Attraverso l'analisi di un caso peritale si sottolinea la difficoltà di individuare i disturbi dissociativi nel contesto peritale, laddove l'amnesia può essere contemporaneamente effetto di un fenomeno dissociativo o di menzogna.
2014
- Un complesso caso di omicidio
[Abstract in Rivista]
Bettelli, Margherita; Galliani, Ivan; Andrea, Carlo; Silingardi, Enrico
abstract
Partendo dall'analisi di un caso di omicidio, gli autori discutono della difficoltà a discriminare fra delitto d'impulso e delitto premeditato in presenza di disturbi di un personalità bipolare.
2013
- Sudden death related to myocardial tubercolosis
[Capitolo/Saggio]
V., Gabbolini; Santunione, Anna Laura; Silingardi, Enrico
abstract
sudden cardiac death is defined as death due to cardiac causes, in youngh adults myocarditis is the major causes of sudden unexpected death. Cases of sudden death from previously undiagnosed MTB have rarely been reported in the literature, the most probable mechanism for sydden cardiac death is arrhythmias
2012
- Come una cattiva legge può condizionare la pratica medica. Studio sull'incidenza di gravidanze multiple in rapporto al numero di embrioni trasferiti in utero, in pazienti sottoposte a tecniche di PMA nel decennio 2000-2010
[Articolo su rivista]
Vecchio, S.; Santunione, Anna Laura; Silingardi, Enrico
abstract
the aim of this retrospective study is assessing the impact of the law 40/04 on the results of the tecniques of medically assisted procreation, with regard to the variation in the incidence of multiple pregnancies in relation to the number of enmbryos tranferred
2012
- Subaortic stenosis and sudden death
[Articolo su rivista]
Santunione, Anna Laura; M., Bettelli; G., Carosielli; E., D'Antone; M., Lusetti; Silingardi, Enrico
abstract
The Authors present a casuistic on sudden Death due to membranous subaortic stenosis. The problems on pathologic diagnosis and forensic implicatins are discussed
2012
- pseudoaneurisma ventricolare sinistro e morte improvvisa
[Articolo su rivista]
Lusetti, M; Gabbolini, V.; Santunione, Anna Laura; Silingardi, Enrico
abstract
nel presente lavoro viene discusso il possibile meccanismo patogeneticodelle alterazioni strutturali riscontrate a livello della parete aneurismatica. vengono inoltre dettegliate le indagini anamnestiche e laboratoristiche necessarie a delibare correttamente questa tipologia casistica
2011
- Lateral saccular laryngeal cyst and unexpected asphyxial death
[Articolo su rivista]
Silingardi, Enrico; Sola, Naike; Santunione, Anna Laura; Trani, Nicoletta
abstract
We present the case of a 41-year-old man with a herniated saccular laryngeal cyst in the left cervical region who died unexpectedly at home from acute asphyxia. The laryngeal cyst manifested itself a few days before death under the form of an obvious palpable swelling in the cervical region.The autopsy showed, in the left cervical region, an oval-shaped mass originating on the wall of the larynx and herniated into the extralaryngeal region.The critical reduction of the laryngeal space originated from an intense edema of the laryngeal mucosa above the cysts, concurrent with a flogistic process of the cystic wall, with probable associated glottic laryngospasm mediated by the superior laryngeal nerve. The rapid evolution of edema was favored by the extreme relaxation of the connective of laryngeal mucosa in the supraglottic and aryepiglottic regions, and it explains the sudden death.The case is useful for delineating the problems related to the possible evolution of laryngeal cysts, the pathogenesis of asphyxial complications, the anatomo-pathological diagnosis and the medico-forensic aspects.
2009
- Unexpected intrauterine fetal death in parvovirus B19 fetal infection
[Articolo su rivista]
Silingardi, Enrico; Santunione, Anna Laura; Rivasi, Francesco; Gasser, B; Zago, S; Garagnani, Lorella
abstract
The AA. presents 5 cases of maternal-fetal infection from parvovirus B19. The aspects anatomopathologic, diagnostic, clinical and professional liability are discussed
2009
- il rifiuto anticipato dei trattamenti trasfusionali: la cassazione civile ancora in bilico tra un passato che non passa ed un futuro ipotetico
[Nota a Sentenza]
Silingardi, Enrico; Santunione, Anna Laura
abstract
commento alla sentenza 23676/2008 sul rifiuto alle trasfusioni di sangue dei pazienti testimoni di Geova
2008
- Spontaneous umbilical cord hematoma: An unusual cause of fetal mortality: A report of 3 cases and review of the literature
[Articolo su rivista]
Gualandri, G; Rivasi, Francesco; Santunione, Anna Laura; Silingardi, Enrico
abstract
Spontaneous hematoma of the umbilical cord represents a rare cause of fetal morbidity and mortality and the outcome is poor in half of the cases. There are many risk factors, such as infections, morphologic anomalies, alterations of the vessel walls, prolapses, twisting and traction of the cord, but in many cases the causes remain unknown. We present 3 cases of umbilical cord hematoma which took place at the end of the pregnancy and were followed by perinatal death of the fetus. In the 3 cases, which were autopsied including macroscopical and histopathologic examination of the placenta and the umbilical cord, a cordonal pathology was present; in all cases, there were alterations of the vascular wall, and in the third case inflammatory vasculopathy was found. In all 3 cases, the cause of death was attributed to acute anoxia due to the cordonal hematoma.
2007
- Chirurgia toracica: casistica e profili di rischio
[Articolo su rivista]
Silingardi, Enrico; Santunione, Anna Laura; N., Trani
abstract
la chirurgia toracica non cardiaca concerne un esteso e delicatissimo ambito di strutture anatomiche ed una rilevante quota di patologie, tra le quali prevalgono, tanto per importanza quanto per incidenza statistica quelle di natura neoplastica. Nel contributo si prendono in esame i profili di responsabilità in ambito chirurgico-toracico
2007
- Gli avvelenamenti nel settorato medico-legale modenese 1994- 2004
[Articolo su rivista]
Licata, Manuela; Santunione, Anna Laura; Silingardi, Enrico; Beduschi, Giovanni
abstract
gli autori presentano un'analisi casistica riguardante le intossicazioni acute letali nel settorato modenese dal 1994-2004, confrontando i dati con una precedente analisi casistica effettuata a Modena nel periodo 1983-1993. ciò ha permesso di evidenziare le modificazioni del trend delle intossicazioni acute dovute alle singole sostanze e di registrare un cospicuo aumento delle intossicazioni acute da farmaci , preminentemente suicidiarie, accanto ad una scomparsa quasi totale delle morti da intossicazione acuta da CO
2007
- Sudden cardiac death during anabolic steroid abuse: morphologic and toxicologic findings in two fatal cases of bodybuilders
[Articolo su rivista]
Fineschi, V; Riezzo, I; Centini, F; Silingardi, Enrico; Licata, Manuela; Beduschi, Giovanni; Karch, Sb
abstract
We report two cases of sudden cardiac death (SCD) involving previously healthy bodybuilders who were chronic androgenic-anabolic steroids users. In both instances, autopsies, histology of the organs, and toxicologic screening were performed. Our findings support an emerging consensus that the effects of vigorous weight training, combined with anabolic steroid use and increased androgen sensitivity, may predispose these young men to myocardial injury and even SCD.
2006
- Aspetti di responsabilità nel settore del doping
[Capitolo/Saggio]
Silingardi, Enrico; Licata, Manuela; Santunione, Anna Laura
abstract
affronta la tematica della responsabilità medica nel settore del doping
2006
- Chirurgia Toracica video-assistita. Aspetti medico-legali
[Capitolo/Saggio]
Silingardi, Enrico; Santunione, Anna Laura
abstract
puntualizzazione dei aspetti di interesse medico-legale connessi alla chirurgia toracica video-assistita, in particolare responsabilità professionale e consenso informato
2006
- Il consenso informato
[Capitolo/Saggio]
Silingardi, Enrico
abstract
l'autore discute gli aspetti fondamentali dell'informazione e del consenso in cardio-chirurgia con particolare riguardo alle specifiche implicazioni proprie delle pratiche di circolazione extra-corporea
2006
- La responsabilità professionale e gli aspetti medico-legali nella conduzione della circolazione extracorporea
[Capitolo/Saggio]
Silingardi, Enrico
abstract
vengono affrontate le questioni di vivo interesse e attualità nel campo della responsabilità professionale in cardiochirurgia con particolare riferimento allo specifico ambito delle metodiche di circolazione extra-corporea
2006
- Sudden death from tubercular myocarditis
[Articolo su rivista]
Silingardi, Enrico; Rivasi, Francesco; Santunione, Anna Laura; Garagnani, Lorella
abstract
Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.
2005
- L'organizzazione delle attività di Medicina Necroscopica in provincia di Modena: esperienza decennale (1994-2003).
[Articolo su rivista]
Pelosi, S; Gualandri, Giorgio; Davolio, Mg; Silingardi, Enrico; Beduschi, Giovanni
abstract
Gli Autori riportano il consuntivo dell'attività di Medicina necroscopica svolta dal Servizio di Medicina Legale dell'Azienda Ospedlaiero-Universitaria di Modena nel decennio 1994-2003
2004
- Morte improvvisa connessa all’assunzione di clozapina: contributo casistico
[Articolo su rivista]
Silingardi, Enrico; Licata, Manuela; G., Popoli; M. C., Magnolo
abstract
gli effetti collaterali della clozapina, antipsicotico atipico, sono miocarditi, trombosi venosi profonda, tromboembolia polmonare. Gli autori presentano un caso di morte improvvisa per trombo-embolia con infarto polmonare e miocardite connessa all'assunzione di clozapina. si discutono i profili diagnostici, medico-legali e le possibili applicazioni nel campo della responsabilità professionale
2004
- Suicidio mediante assunzione di clorochina: valutazioni medico legali e chimico tossicologiche
[Articolo su rivista]
Silingardi, Enrico; Licata, Manuela; M. C., Davolio
abstract
Gli autori descrivono due casi di intossicazione a scopo suicidiario con clorochina in soggetti extracomunitari. Vengono indicate le metodiche chimico-analitiche utilizzate per il rilievo dell'antimalarico e viene sottolineata la necessità di ampliare il protocollo analitico che includa tale farmaco tra le sostanze di possibile abuso in soggetti extracomunitari.
2004
- omicidio dissimulato vs omicidio combinato. Problemi di diagnostica differenziale medico-legale
[Articolo su rivista]
Silingardi, Enrico; Santunione, Anna Laura
abstract
l'omicidio mediante asfissia ed abbruciamento è di osservazione infrequente in ambito medico-forense; gli autori riportano due casi di omicidio combinato, rivelati all'autopsia per asfissia (soffocamento e strangolamento) ed abbruciamento incompleto. i metodi medico-forensi, istopatologici e tossicologici, si sono rivelati utili nella determinazione e nella conferma delle cause di morte
2000
- Interruzione di gravidanza e responsabilità professionale. Contributo casistico
[Articolo su rivista]
G., Gualandri; Silingardi, Enrico
abstract
Gli autori presentano e discutono un caso di responsabilità professionale ostetrica relativa ad un intervento di isterectomia praticato su di una paziente nell'ipotesi di patologia neoplastica, poi rivelatosi in realtà uno stato di gravidanza
1999
- Differenziazione fra lesioni vitali e post-mortali
[Articolo su rivista]
G., Beduschi; Silingardi, Enrico
abstract
Gli autori presentano i risultati di una review bibliografica internazionale sui metodi di indagine utili a documentare la vitalità di una lesione, approfondendo di ciascuno indicazioni e limiti
1999
- Gli infortuni mortali in itinere: opportunità di una interazione tra inchiesta penale e amministrativa
[Articolo su rivista]
Silingardi, Enrico
abstract
Sulla base di un'osservazione casistica di infortunio sul lavoro in itinere nella quale la chiusura precoce dell'inchiesta amministrativa ha impedito di considerare taluni dati derivati dall'indagine medico-legale e tossicologico forense, l'autore propone un coordinamento tra i due livelli, amministrativo e medico-legale, allo scopo di addivenire ad un giudizio più documentato in merito alla possibilità di riconoscere l'infortunio sul lavoro
1999
- Indicatori istologici, istochimici ed immunoistochimici di sopravvivenza su tessuto cerebrale in un caso di morte asfittica differita.
[Articolo su rivista]
G., Beduschi; G., Barbolini; Silingardi, Enrico
abstract
Gli autori presentano i risultati di una ricerca di carattere istomorfologico su possibili indicatori di morte avvenuta in tempi differiti in conseguenza di una asfissia meccanica
1999
- La nozione di atti sessuali con riferimento alle norme contro la violenza sessuale
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore discute la nozione di atti sessuali posta alla base della legge in tema di violenza sessuale, ponendo in evidenza in particolare i problemi applicativi che potrebbero derivarne nella pratica giudiziaria
1999
- La tutela dei diritti costituzionali del minore in caso di fecondazione assistita eterologa
[Nota a Sentenza]
Silingardi, Enrico
abstract
L'autore ricostruisce gli spazi giuridici di tutela del minore nato attraverso il metodo della fecondazione eterologa, puntando in particolare l'accento sulla irreversibilità del consenso prestato dal coniuge non donatore
1999
- Le rotture traumatiche dell'aorta addominale a distanza di tempo da un episodio traumatico
[Articolo su rivista]
Silingardi, Enrico
abstract
l'autore illustra un caso di rottura differita di aneurisma dell'aorta addominale a distanza di tempo da un episodio traumatica, soffermandosi in particolare sul problema della documentazione del nesso causale
1999
- Su di un caso di suicidio per autoinoculazione di un farmaco ad azione curarosimile
[Articolo su rivista]
Silingardi, Enrico; Licata, Manuela
abstract
Gli autori descrivono un caso di suicidio posto in atto da un infermiere mediante l'autoinoculazione di farmaco similcurarico, e commentano la connessione tra modalità suicidiaria e disponibilità diel mezzo legata allo status professionale
1999
- un caso di suicidio combinato da plastic bag ed inalazione di sostanze tossiche
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore presenta un caso di suicidio combinato mediante applicazione di un sacchetto di plastica intorno al collo ed inalazione di gas propano emesso da una piccola bombola inserita all'interno del sacchetto
1998
- L'errore diagnostico e la responsabilità professionale in senologia
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore illustra i profili teorici della responsabilità professionale del radiologo esporto in senologia, con particolare riguardo alla responsabilità nello screening mammografico
1997
- Giudelines for clinical use of local anaesthetics in minor ambulatory surgery with no anaesthetic's care
[Articolo su rivista]
G., Bettelli; E., Dall'Olmi; A., Buttazzi; E., Cantoni; Cavallini, Gian Maria; A., Cimitan; G., Cristiani; G., Dallari; L., Marchetti; L., Morselli; M., Monteleone; A., Segre; Silingardi, Enrico; R., Simonazzi; F., Tavoni; E., Torcia; Volpe, Annibale
abstract
The authors illustrates the giudelines on local anaesthetic's use in ambulatory surgery
1996
- La posizione della Chirurgia Plastica Ricostruttiva nel contesto delle discipline chirurgiche e nei rapporti con il Diritto e la Medicina Legale
[Articolo su rivista]
D., De Fazio; Silingardi, Enrico; L., Vaienti
abstract
Gli autori discutono il profilo ed il diverso ruolo della Chirurgia Plastica Ricostruttiva rispetto alle altre discipline chirurgiche, affrontando poi i problemi giuridici e medico-legale, con particolare riguardo alla responsabilità professionale del chirurgo plastico
1996
- La sindrome asfittica da bolo alimentare. Considerazioni su di un caso di morte differita.
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore illustra un caso di morte differita dopo inalazione di un bolo alimentare, descrivendo in particolare i reperti morfologici a carico dell'apparato respiratorio
1996
- La sindrome di Prader Willi. Implicazioni epidemiologiche, genetiche, cliniche e considerazioni in tema di responsabilità professionale
[Articolo su rivista]
Silingardi, Enrico
abstract
Un caso di osservazione peritale offre lo spunto per considerazioni sulla responsabilità professionale del pediatra, nei casi in cui una malattia intercorrente possa comportare una valutazione prognostica diversa in rapporto alla patologia costituzionale di base
1996
- Su di un caso di morte a grande distanza di tempo da un trauma cranico. Contributo casistico.
[Articolo su rivista]
Silingardi, Enrico; S., Stefanini
abstract
L'autore illustra un caso di morte differita a grande distanza di tempo da un trauma cranico, in esito al quale il paziente aveva contratto un epilessia. Viene discusso in particolare il problema di documentare il nesso di causa
1995
- Asfissia meccanica da bolo alimentare e "soccorso di necessità". Considerazioni medico-legali su di un caso di eccezionale osservazione
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore descrive un caso di eccezionale osservazione, nel quale un paziente psichiatrico, colto da una asfissia meccanica per inalazione di un bolo alimentare, veniva "soccorso" dal flglio, che cercava di praticargli una tracheotomia, realizzando nei fatti un vero e proprio sgozzamento.
1995
- Contributo casistico in tema di omicidio colposo connesso all'uso di armi da caccia. Aspetti medico-legali, balistico-forensi e criminologici
[Articolo su rivista]
Silingardi, Enrico; P., Romanini
abstract
Alla luce di una osservazione casistica relativa ad un omicidio colposo commesso con l'uso di una arma da caccia, gli autori ne illustrano i profili di indagine medico-legale, balistica e i possibili profili criminologici
1995
- Disabilità e concessione dei presidi protesici. VErifica di una prassi operativa.
[Articolo su rivista]
Silingardi, Enrico; E., Venturelli
abstract
Gli autori criticano la procedura che impone alle pazienti operate al seno di accedere all'istituto dell'invalidità civile quale unica possibilità per ottenere l'assegnazione delle protesi mammarie
1995
- Il certificato necroscopico. Contenuti e problemi.
[Articolo su rivista]
Silingardi, Enrico
abstract
La certificazione necroscopica rappresenta uno strumento fondamentale non soltanto per l'accertamento della realtà morte ai fini delle funzioni proprie dello stato civile. L'autore ne individua i profili ed i limiti, connessi soprattutto alla variabilità della modulistica in uso nelle diverse sedi amministrative.
1995
- Indagine comparativa in ordine alla prassi del consenso informato. Risultati di un'inchiesta internazionale svolta tramite questionari inviati alle società scientifiche
[Articolo su rivista]
Silingardi, Enrico; G. P., Rigo
abstract
Gli autori riferiscono di una inchiesta svolta in campo internazionale sulla prassi del consenso informato, attraverso la somministrazione di un questionario distribuito tramite le società scientifiche di Endoscopia Digestiva
1995
- Indagine medico-legale comparativa di una serie di omicidi con apparenti caratteri di serialità
[Articolo su rivista]
Silingardi, Enrico; F., Fregni; F., De Fazio
abstract
Gli autori indagano secondo i metodi della Medicina Legale integrati con i metodi della Criminologia una lunga serie di omicidi avvenuti in una area territoriali ristretta ed accomunati dalla identica tipologia sociale delle vittima
1995
- L'asfissia meccanica da bolo alimentare. Casistica ed aspetti di responsabiltà professionale.
[Articolo su rivista]
Silingardi, Enrico; G., Gualandri
abstract
Gli autori illustrano una esemplificazione casistica in tema di asfissia meccanica mortale da bolo alimentare, enucleando i possibili profili di assistenza clinica d'emergenza ed i connessi profili di responsabilità professionale
1995
- L'impiego dei mezzi di contrasto in Radiologia. Aspetti medico-legali.
[Articolo su rivista]
Silingardi, Enrico; G., Beduschi; F., De Fazio
abstract
Gli autori discutono i profili di responsabilità in radiodiagnostica, con particolare riguardo ai problemi della responsabilità professionale connessa all'uso dei mezzi di contrasto
1995
- La Chirurgia ambulatoriale. Profili normativi, organizzativi e medico-legali
[Articolo su rivista]
Silingardi, Enrico; D., De Fazio
abstract
Gli autori presentano una riflessione di ordine generale in tema di chirurgia ambulatoriale, una nuova modalità di approccio ai pazienti portatori di patologie di interesse chirurgico non gravi, e ne discutono i profili normativi, l'organizzazione e le responsabilità
1995
- Medicina legale, antropologia ed archeologia: un esempio applicato di operatività interdisciplinare.
[Articolo su rivista]
G., Beduschi; Silingardi, Enrico; G., Pierini
abstract
Alla luce dell'esperienza acquisita in occasione dello scavo di una fossa comune risalente al 1945, contenente i resti di numerose persone uccise negli ultimi giorni della guerra, gli autori illustrano il metodo di scavo e di repertazione dei resti, che ha consentito di svolgere la successive procedure di identificazione in base al confronto con le fotografie delle persone scomparse.
1995
- Programmazione sanitaria nazionale, Endoscopia Digestiva e VRQ.
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore presenta i risultati di una ricerca sui piani sanitari, e discute i criteri adottatti nella distribuzione territoriale della Unità operative di Endoscopia Digestiva, criteri che pongono problemi e presentano ricadute rilevanti sul piano medico-legale, con particolare riguardo ai profili di responsabilità professionale
1995
- Protocolli differenziati ai autopsia del cuore chirurgico
[Articolo su rivista]
Silingardi, Enrico; G., Beduschi; G., Gualandri; F., Fagandini
abstract
Gli autori presentano una vasta casistica di decessi successivi ad intervento cardiochirurgico, e discutono la diverse possibili tecniche autoptiche applicabili in funzione delle diverse tipologie chirurgiche
1995
- Riflession e proposte per un modello di polizza assicurativa per la copertura della responsabilità civile nel settore dell'Endoscopia
[Articolo su rivista]
Silingardi, Enrico; G. P., Rigo
abstract
Gli autori, alla luce di considerazioni sulla responsabilità civile in Endoscopia Digetsiva, propongono un modello di contratto assicurativo ad alto contenuto "tecnico" per la tutela dei professionisti
1995
- linee guida per una corretta gestione delle complicanze in Endoscopia Digestiva
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore, dopo avere passato in rassegna il problema delle complicanze in Endoscopia Digestiva, presenta una proposta di linee guida utili ai professionisti nell'interfaccia con i livelli istituzionali coinvolti
1994
- Aspetti medico-legali della gestione delle emergenze-urgenze cardiologiche e cardiochirurgiche
[Articolo su rivista]
G., Gualandri; F., Fagandini; Silingardi, Enrico; F., De Fazio
abstract
Gli autori discutono i profili di responsabilità professionale nella gestione dei casi di emergenza e urgenza in cardiologia e cardiochirurgia
1994
- I processi di vittimizzazione nei vissuti della parte offesa.
[Articolo su rivista]
A., Luzzago; Silingardi, Enrico; F., De Fazio
abstract
Gli autori discutono, con ricca esemplificazione casistica desunta dalla pratica professionale, i processi di vittimizzazione di soggetti vittime di reato
1994
- Programmazione nazionale e regionale: la storia dei piani sanitari.
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore ricostruisce la vicenda dei piani sanitari nazionali e regionali con particolare riguardo al settore dell'Endoscopia Digestiva, rilevandone profili e limiti
1994
- Tutela assicurativa ed esigenze di una adeguata riformulazione dei rischi inerenti alle diverse attività medico-chirurgiche
[Articolo su rivista]
Silingardi, Enrico
abstract
L'autore, alla luce di considerazioni generali inerenti la responsabilità professionale in ambito civile, illustra una proposta di riformulazione in senso "tecnico" dei rischi, ai fini della costituzione di un contratto assicurativo mirato
1994
- Urgenze psichiatriche mascherate e condotte delittuose
[Articolo su rivista]
N., Costa; A., Luzzago; Silingardi, Enrico
abstract
Gli autori discutono, alla luce di un'ampia casistica desunta dalla pratica professionale, il problema delle condotte delittuose connesse a condizioni psichiatriche d'urgenza mascherate
1993
- Aspetti medico-legali del suicidio: accertamenti delle cause di morte e loro attendibilità
[Articolo su rivista]
Silingardi, Enrico; G., Beduschi; A., Luzzago
abstract
Gli autori discutono gli accertamenti medico legali relativi alle cause della morte e dei mezzi di produzione in casi di presunto suicidio, ponendo in evidenza i non infrequenti limiti di attendibiltà della diangosi di tipologia siucidiaria
1993
- Psichiatria forense e psicofarmacologia clinica
[Articolo su rivista]
F., De Fazio; A., Luzzago; Silingardi, Enrico; P., Zavatti
abstract
Gli autori illustrano, con l'aiuto di esemplificazioni casistiche, il possibile influsso dei trattamenti psicofarmacologici praticati sugli autori di reato, ed i conseguenti riflessi sui profili valutativi in ambito psichiatrico forense
1993
- il collocamento obbligatorio degli invalidi civili. Esperienze a confronto.
[Articolo su rivista]
Silingardi, Enrico; A., De Palma; M., Lorenzetti; A, Minarini; G., Scanzani
abstract
Gli autori riferiscono gli esiti di una ricerca sull'applicazione dell'istituto del collocamento obbligtorio al lavoro in diversi ambiti locali, evidenziandone problemi e limiti applicativi
1992
- I decessi per eroina. Casistica del settorato medico-legale modenese (1981-1992).
[Articolo su rivista]
G., Beduschi; G., Pierini; Silingardi, Enrico
abstract
Gli autori illustrano una casistica di settorato relativa ai decessi connessi all'assunzione di eroina, e ne discutono i profili medico-legali, morfopatologici e chimico-tossicologici