Atrophic pseudarthrosis of humeral diaphyseal fractures: medico-legal implications and methodological analysis of the evaluation.

Humeral shaft fractures account for 1- 3% of all fractures and about 20-27% of those involving the humerus. In the past they were often conservatively treated, with an acceptable consolidation rate. Open reduction and internal fixation (ORIF) is the best choice in polytrauma patients, in complex or pathological fractures and in those associated with vascular injuries.

The Italian neuromuscular registry: a coordinated platform where patient organizations and clinicians collaborate for data collection and multiple usage.

Background: The worldwide landscape of patient registries in the neuromuscular disease (NMD) field has significantly changed in the last 10 years, with the international TREAT-NMD network acting as strong driver. At the same time, the European Medicines Agency and the large federations of rare disease patient organizations (POs), such as EURORDIS, contributed to a great cultural change, by promoting a paradigm shift from product-registries to patient-centred registries. In Italy, several NMD POs and Fondazione Telethon undertook the development of a TREAT-NMD linked patient registry in 2009, with the referring clinical network providing input and support to this initiative through the years.

A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments.

Background: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network-based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication.

Mirtazapine fatal poisoning.

Mirtazapine is a noradrenergic and specific serotoninergic antidepressant agent that stimulates norepinephrine and serotonin release while also blocking serotonin receptors (5-HT2 and 5-HT3). Although the drug is used extensively, at present we do not know of any fatal cases due to mirtazapine alone. On the contrary, the published literature describes several fatal poisoning cases related to the intake of mirtazapine together with other drugs.

Planking or the "Lying-Down Game:" Two Case Reports.

Background: The monitoring and management of risks regarding children and young people admitted to the emergency department as a result of dangerous behaviors distributed via the Internet should be based on clinical reasoning and knowledge about these social media-related phenomena. Here we examine 2 cases of teenagers who reported severe injuries while performing the "planking" craze, a challenge that consists in lying face-down stiffly like a board on any kind of surface.

Objective: Our objective is to examine and describe the Internet craze called planking, also known as the "lying-down game," through 2 case reports from our experience, enriching this study with information gained through discussions with secondary school teenagers.

The Active Metabolite of Warfarin (3'-Hydroxywarfarin) and Correlation with INR, Warfarin and Drug Weekly Dosage in Patients under Oral Anticoagulant Therapy: A Pharmacogenetics Study.

Objectives: Warfarin oral anticoagulant therapy (OAT) requires regular and frequent drug adjustment monitored by INR. Interindividual variability, drug and diet interferences, and genetics (VKORC1 and CYP2C9) make the maintenance/reaching of stable INR a not so easy task. HPLC assessment of warfarin/enantiomers was suggested as a valid monitoring-tool along with INR, but definite results are still lacking.

The perils of dental vacation: possible anaesthetic and medicolegal consequences.

Introduction: The aim of this paper is to emphasize anaesthesiologists' difficulty in detecting poor dentition in cases of poorly applied prostheses and/or advanced periodontal disease, and to establish whether it is possible, and in which conditions, to calculate compensation in cases of dental damage postlaryngoscopy and/or intubation. The main complex problem here lies in trying to reconstruct exactly what the dental situation was before the teeth were damaged. For this reason the important preoperative factors (dental prostheses, crown fractures, parodontal disease, etc.

A fatal case of anaphylactic shock during paragliding.

The growth in popularity of flying ultralight aircraft and paragliding has been associated with an increased involvement of Emergency Medical Services because of various types of trauma suffered from both inexperienced and skilled individuals. This case presentation reports on a paraglider pilot, who was seen spinning "unusually" rapidly toward the ground, without visible attempts to regain control of the aircraft. Besides the bilateral mydriasis and the absence of any ECG activity, there was a significant swelling of face, lips, neck, and tongue.

Traumatic dental injuries during anaesthesia. Part II: medico-legal evaluation and liability.

Introduction: Claims for tooth damage following intubation are increasing. An anaesthetic chart (AC) has been proposed to describe patient's pre-existent dental diseases and any possible lesions caused during intubation and extubation.

Materials And Methods: We conducted a retrospective study of 235 cases of dental lesions reported in litigation files from January 2000 to June 2009.

Unusual Displacement of a Mobilised Dental Bridge during Orotracheal Intubation.

Dental trauma during tracheal intubation mostly happens in case of poor dentition, restricted mouth opening, and/or difficult laryngoscopy. 57-year-old man undergoing laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma had his dental work detached at induction of anesthesia. Oropharyngeal direct view, manual inspection, fibreoptic nosendoscopy, tracheobronchoscopy, and fiberoptic inspection of the esophagus and stomach were unsuccessful in locating the dislodged bridge.

Impact of alcohol consumption on winter sports-related injuries.

Introduction: This study was carried out to evaluate data about trauma-related winter sports, including risk factors such as high speed, gender, age, alcohol consumption, details about the accident and snow conditions.

Methods: A retrospective review was conducted to determine the injury patterns and crash circumstances in holiday skiers and snowboarders. The data recorded were obtained from the database of the Pre-Hospital Emergency Registry of six skiing areas in the Dolomite mountains during the winter seasons November 2004-May 2009, injury data for major traumas from Ski Patrol Injury reports (helicopter, ambulance or ski slopes' patrol reports), and intrahospital Emergency Department data.

Traumatic dental injuries during anaesthesia: part I: clinical evaluation.

Unlabelled: Dental injuries represent the most common claims against the anaesthesiologist. Dental lesions are frequent complications of oro-tracheal intubation and major causal factors are (i) poor dentition, (ii) aggressive laryngoscopy, (iii) insufficient anaesthesia and curarization, (iv) emergency interventions and (v) lack of experience by the anaesthesiologist.

Materials And Methods: We conducted a retrospective analysis of 83 cases of dental lesions occurring during elective, emergent and urgent surgery requiring general anaesthesia with tracheal tube placement in the years between 2000 and 2008.

Serum thymidine kinase in monoclonal gammopathies. A prospective study. The Cooperative Group for Study and Treatment of Multiple Myeloma.

Between January 1986 and March 1990, the serum levels of thymidine kinase (TK) were evaluated at diagnosis in 97 patients with monoclonal gammopathy of undetermined significance (MGUS) and 149 patients with multiple myeloma (MM) enrolled in a prospective protocol for treatment of MM. At presentation, patients with MGUS had lower TK levels than those with Stage I MM (P less than 0.05) and the overall population of those with MM (P less than 0.

Red cell and serum polymorphisms in the Oltrepò Pavese population (northern Italy).

A sample of about 300 subjects from the Italian population of the Oltrepò Pavese, in Lombardy, was studied for 6 polymorphic genetic markers: ACP1, ADA, ESD, GLO1, PGM1 subtyping and HP. The observed gene frequencies were: ACP1*A = .267, ACP1*B = .

Lethal poisoning by zipeprol in drug addicts.

Two cases of lethal intoxication involving or due to oral ingestion of zipeprol are described. The two cases concerned abusers of the substance for nonmedical purposes. Data regarding the distribution of the unmodified drug in biological fluids and tissues are presented.

[The central nervous system and inflammation: the role of opioid peptides].

Inhibition of human granulocyte aggregation was observed in the presence of morphine in a naloxone stereoselective way, while the opioid peptides were ineffective. In comparative studies Ca(+)+ (A23187) and dynorphin 1-9, per se, induced stimulation of arachidonic acid metabolites from granulocytes. In this regard dynorphin 1-9 may function as a mediator between the central nervous system and the inflammation.

Hepatocellular carcinoma in thalassemia major.

The occurrence of hepatocellular carcinoma in a 22-year-old man with thalassemia major is reported. As a result of transfusional hemochromatosis, this patient had already developed diabetes, hypogonadism, heart failure, and the sicca syndrome; he was serum and tissue HBsAg negative. Liver iron concentration measured postmortem was found to be 50 times normal.

Spleen iron content is low in thalassemia.

We measured the iron content of the spleen in 12 patients with thalassemia major, three with thalassemia intermedia, and one with sickle-thalassemia. The iron content was unexpectedly low in all patients (0.25-2.

Internal distribution of excess iron and sources of serum ferritin in patients with thalassemia.

Liver and spleen iron concentrations, serum ferritin level and binding of S-ferritin to concanavalin A (Con A) were measured in 12 patients with thalassaemia major or intermedia at the time of splenectomy. All these subjects had increased liver iron concentration, most of them had hepatic fibrosis but none of them had histological evidence of chronic hepatitis. No patient had ascorbic acid deficiency.