Purpose To provide a comprehensive evidence-based assessment of the anatomical characteristics of... more Purpose To provide a comprehensive evidence-based assessment of the anatomical characteristics of the pyramidalis muscle (PM). Materials and methods A thorough systematic search of the literature through August 31st 2020 was conducted on major electronic databases PubMed, Scopus and Web of Science (WOS) to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaFor package in R and MetaXL. A random-effects model was applied. The primary outcome of interest was the prevalence of PM. The secondary outcomes were the dimensions (length and width) of the PM. Results A total of 11 studies ( n = 787 patients; 1548 sides) were included in the meta-analysis. The multinomial pooled prevalence estimate (PPE) for a bilateral absence of the PM was 11.3% (95% CI [7.2%, 16.2%], 82.3% (95% CI [76.2%, 87.6%]) for a bilateral presence, and 6.3% (95% CI [3.3%, 10.2%]) for a unilateral presence. Of four studies ( n = 37 patients) that reported the side of a unilateral presence, the PPE of a unilateral right-side presence was 42.2% (95% CI [23.0%, 62.3%]) compared to 57.8% for a unilateral left-side presence (95% CI [37.7%, 77.0%]). The mean length of the PM displayed high levels of heterogeneity, ranging from 3.12 to 12.50 cm. Conclusion The pyramidalis muscle is a rather constant anatomical structure being present in approximately 90% of individuals.
In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an e... more In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on th...
NSTI (Necrotizing Soft Tissue Infection) is an infection of any layer within the soft tissue comp... more NSTI (Necrotizing Soft Tissue Infection) is an infection of any layer within the soft tissue compartment that is rapidly progressive and often fatal. The authors describe a case of a 67-year-old man who developed a spontaneous NSTI and died of septic shock approximately 36 h after he was first admitted to the emergency room. The infection started from the chest as a result of a minimum muscle strain, in the absence of any cutaneous lesions or important risk factors such as immunosuppression. The infection was caused by Streptococcus pyogenes. The described case has many peculiarities that make it almost unique.
In ambito penitenziario il suicidio e l'autolesionismo rappresentano quasi una caratteristica... more In ambito penitenziario il suicidio e l'autolesionismo rappresentano quasi una caratteristica strutturale, rendendo la prevenzione un obiettivo primario. L'Amministrazione penitenziaria ha emanato in materia di prevenzione del suicidio un ampio spettro di provvedimenti. Il presente studio prende in esame la misura attualmente vigente in alcuni istituti di valutare i detenuti autorizzati all'utilizzo dello strumentario a gas, con monitoraggio delle condotte, da parte dello psichiatra.
BACKGROUND Dissection with subsequent ligation and resection of arteries at their origin (central... more BACKGROUND Dissection with subsequent ligation and resection of arteries at their origin (central vascular ligation, CVL) is essential for adequate oncological resection during right hemicolectomy (RH) with complete mesocolic excision (CME). This technique is technically demanding due to the highly variable arterial pattern of the right colon. Therefore, this study aims to provide a comprehensive evidence-based assessment of the arterial vascular anatomy of the right colon METHODS: A thorough systematic literature search through September 2020 was conducted on the electronic databases PubMed, SCOPUS, and Web of Science (WOS) to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaXl software. RESULTS A total of 41 studies (n= 4,691 patients) were included. The ileocolic artery (ICA), right colic artery (RCA) and middle colic artery (MCA) were present in 99.7% (95% CI 99.4-99.8), 72.6% (95% CI 61.3-82.5) and 96.9% (95% CI 94.2-98.8) of patients respectively. Supernumerary RCA and MCA were observed in 3.2% and 11.4% of all cases respectively. The RCA shared a common trunk with ICA and MCA in 13.2% and 17.7% of patients respectively. A retro-superior mesenteric vein (SMV) course of the ICA and RCA was observed in 55.1% and 11.4% of all cases respectively. CONCLUSION The vascular anatomy of the right colon displays several notable variations, namely the absence of some branches (RCA absent in 27.4% of cases), supernumerary branches, common trunks, and retro-SMV courses. These variations should be taken into consideration during RH with CME to ensure adequate oncological resection while minimizing intraoperative complications.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that is responsible for... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that is responsible for coronavirus disease 2019 (COVID-19), which has rapidly spread across the world, becoming a pandemic. The “cytokine storm” (CS) in COVID-19 leads to the worst stage of illness, and its timely control through immunomodulators, corticosteroids, and cytokine antagonists may be the key to reducing mortality. After reviewing published studies, we proposed a Cytokine Storm Score (CSs) to identify patients who were in this hyperinflammation state, and at risk of progression and poorer outcomes. We retrospectively analyzed 31 patients admitted to Infectious Disease Department in “St. Maria” Hospital in Terni with confirmed SARS-CoV-2 infections, and analyzed the “CS score” (CSs) and the severity of COVID-19. Then we conducted a prospective study of COVID-19 patients admitted after the definition of the CSscore. This is the first study that proposes and applies a new score to quickly identify COV...
Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It ... more Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods. In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. The purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results. The diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1–10 cm, SD 1.15 cm) and the length of the incarcerated small in...
The American Journal of Forensic Medicine and Pathology
BACKGROUND The incidence of taking selfies and sharing them on social media as well as selfie-rel... more BACKGROUND The incidence of taking selfies and sharing them on social media as well as selfie-related dangerous behaviors is increasing, particularly among young people, also leading to selfie-related trauma and death. This study was performed to obtain epidemiological characteristics of selfie-related mortality in Italy. METHODS Scientific literature and Italian media were reviewed. RESULTS Twelve victims from 11 events, from 2014 to 2018, were analyzed (sex, age, accident types, the nationality, the Italian region where the incident took place, if the person involved was indigenous or a tourist, the dynamics and the causa mortis, if other people have been involved in the selfie, and if other people were deceased). The majority of selfie victims were male teenagers, the average age was 23.6 years, the most preferred site of taking selfies was the natural environment followed by the railway one, the most frequently reported event or accident type was falling from a height, and the most frequent causes of selfie-related deaths were multitrauma and drowning. CONCLUSIONS Selfie-related deaths in Italy appear to be an issue and appear to be increasing. Particularly, male teenagers and young adults are at high risk for selfie-related deaths. Measures should be taken to reduce their incidence.
Abstract Dying in a head-down position is a not so common occurrence, and the cause of death may ... more Abstract Dying in a head-down position is a not so common occurrence, and the cause of death may not be immediately clear by the results of the autopsy. The authors describe a case of a six-months-old baby, previously healthy and asymptomatic, found in a head-down position, stuck between the bed and the wall. Despite the efforts to revive the baby, he was declared dead at the arrival of the ambulance. After the autopsy was carried out it was deemed that the cause of death was a cardio-respiratory failure caused by upside-down position of the baby, bilateral interstitial pneumonia and the immobilization of the thorax. This case shows how important it is, for the forensic pathologists, to take into account both autoptical, histological, toxicological results and the report of the scene, especially in the absence of decisive findings.
The American Journal of Forensic Medicine and Pathology
The authors report on the autopsy case of a 40-year-old primigravida without either coagulation d... more The authors report on the autopsy case of a 40-year-old primigravida without either coagulation disorders or anticoagulant/antiplatelet therapy, who developed a fatal intracranial subdural hematoma after spinal anesthesia (SA) for elective cesarean delivery for tocophobia.Intracranial subdural hematoma is the most dreaded complication of SA and is often misdiagnosed with postdural puncture headache.In this article, the authors discuss pathophysiological mechanisms and risk factors for the development of an intracranial subdural hematoma after SA and review the pertinent literature.
To provide a comprehensive evidence‐based assessment of the anatomical variations of the left col... more To provide a comprehensive evidence‐based assessment of the anatomical variations of the left colic artery (LCA).
BACKGROUND The Aberrant Left Hepatic Artery (ALHA) is replaced when it does not originate from th... more BACKGROUND The Aberrant Left Hepatic Artery (ALHA) is replaced when it does not originate from the hepatic artery proper and it is the only supply to that part of the liver, while an accessory artery coexists with a normal artery. The aim of this systematic review is to evaluate the incidence of ALHAs including the one arising from the Left Gastric Artery, also named Hyrtl's artery. METHODS A literature search in PubMed, SCOPUS, WOS and Google Scholar was performed. The risk of bias was assessed by means of the AQUA tool. The main outcome was the prevalence of ALHA. Secondary outcomes were the prevalence of the accessory and replaced left hepatic arteries. A subgroup analysis was conducted by geographic region and type of evaluation. RESULTS This review included 57 studies, with a total of 19,284 patients. The majority of the studies involved the use of radiological techniques -especially Angio-CT-and were performed in Asia. The overall risk of bias was moderate. The overall prevalence of the ALHA was 13.52%; the overall prevalence was 8.26% for the Replaced ALHA and 5.55% for the Accessory ALHA. In the 18 studies that employed Michels' classification, Type II had the lowest prevalence (0.36%) and Type VII the highest prevalence (6.62%). DISCUSSION Some of the studies included did not distinguish between the ''replaced'' and ''accessory'' ALHA (34.25%). Some surgical dissection techniques proved insufficient for the localization of other hepatic arteries. These results suggest that an accurate preoperative radiological evaluation is needed to localize replaced arteries.
INTRODUCTION The common hepatic artery (CHA) is the main arterial supply to the liver. Common cla... more INTRODUCTION The common hepatic artery (CHA) is the main arterial supply to the liver. Common classifications of the anatomical variations of the celiac trunk have only marginally described the CHA. Currently, the only classification addressing anatomical variants in cases of CHA absence from the celiac trunk is that reported by Huang et al. In this systematic review, the prevalence of these variations, according to Huang's classification, have been analyzed. METHODS The review was registered in PROSPERO (CRD 42018096679). The risk of bias was assessed using the AQUA tool. RESULTS Fifty-four articles were included in the review (26,250 participants). The overall pooled prevalence estimate (PPE) of an absent CHA was 3.1%. Of those participants who underwent preoperative radiological evaluation, the overall PPE of an absent CHA was 3.8% for subjects who were evaluated via angiography and 3.0% for participants who underwent angio-CT evaluation. The overall PPE of an absent CHA was 3.9% in cadavers and 3.2% in participants evaluated surgically. Type I or Type II aberrations were the most common; in participants with CHA aberrations, 65.4% of those participants had either Type I or Type II aberrations. CONCLUSIONS The overall PPE of an absent CHA was 3.1%, a result representing a significant, common anatomical variation. Our study revealed that an absence of a CHA was associated with a replaced CHA. The most common arterial variant was a replaced CHA originating from the Superior Mesenteric Artery and running across the anterior or posterior side of the pancreas (i.e., Types I and II).
The American Journal of Forensic Medicine and Pathology
To the Editor: The importance of media and digital exposure among the generation commonly known a... more To the Editor: The importance of media and digital exposure among the generation commonly known as “selfie generation” has become readily apparent. The popularity of clicking and posting selfies is so massive that “selfie” was declared as the word of the year in 2013 by Oxford Dictionaries, where selfie is defined as “A photograph that one has taken of oneself, typically one takenwith a smartphone or webcam and shared via social media.” Social media has also become of increasing relevance in the management of social relationships, where the appearance becomes of utmost importance along the need to be noticed. Daredevil selfies (or killfies) and extreme videos are the ultimate expression of this need, which is to be noticed and get a glimpse of popularity. As reported by numerous news reports, sometimes taking selfies, killfies, and extreme videos may have fatal outcomes. Although the scientific literature is lacking, media also reports on “extreme” behavior (such as running on the highway among the cars or jumping from an elevator to another one) in which the main trigger is the search for the adrenaline. In daredevil selfies and extreme videos, the search for the adrenaline rush goes together with the need to make the act visible by sharing it on social media. Although this issue is widespread all over the world, it is also occurring in Italy and was recently epitomized by a death investigated in Terni, Umbria. A group of teenagers decided to shoot an extreme video to be uploaded on social networks. To this end, a 16-year-old boy lay across the road with the head facing the center line while holding the smartphone in shooting mode. A second 16-year-old boy then attempted to drive a 50-cc moped as close as possible to the head of his friend lying on the ground, who was, again, recording the scene with his smartphone from below. At the same time, other teenagers present at the scene, arranged on the sides of the road, were also recording with their smartphones. However, the driver of the moped, blinded by the headlights of a car, accidentally hit his friend on the head causing death before crashing into a guardrail and being unharmed himself. The autopsy of the deceased teen who was struck by the moped revealed a
Purpose To provide a comprehensive evidence-based assessment of the anatomical characteristics of... more Purpose To provide a comprehensive evidence-based assessment of the anatomical characteristics of the pyramidalis muscle (PM). Materials and methods A thorough systematic search of the literature through August 31st 2020 was conducted on major electronic databases PubMed, Scopus and Web of Science (WOS) to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaFor package in R and MetaXL. A random-effects model was applied. The primary outcome of interest was the prevalence of PM. The secondary outcomes were the dimensions (length and width) of the PM. Results A total of 11 studies ( n = 787 patients; 1548 sides) were included in the meta-analysis. The multinomial pooled prevalence estimate (PPE) for a bilateral absence of the PM was 11.3% (95% CI [7.2%, 16.2%], 82.3% (95% CI [76.2%, 87.6%]) for a bilateral presence, and 6.3% (95% CI [3.3%, 10.2%]) for a unilateral presence. Of four studies ( n = 37 patients) that reported the side of a unilateral presence, the PPE of a unilateral right-side presence was 42.2% (95% CI [23.0%, 62.3%]) compared to 57.8% for a unilateral left-side presence (95% CI [37.7%, 77.0%]). The mean length of the PM displayed high levels of heterogeneity, ranging from 3.12 to 12.50 cm. Conclusion The pyramidalis muscle is a rather constant anatomical structure being present in approximately 90% of individuals.
In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an e... more In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on th...
NSTI (Necrotizing Soft Tissue Infection) is an infection of any layer within the soft tissue comp... more NSTI (Necrotizing Soft Tissue Infection) is an infection of any layer within the soft tissue compartment that is rapidly progressive and often fatal. The authors describe a case of a 67-year-old man who developed a spontaneous NSTI and died of septic shock approximately 36 h after he was first admitted to the emergency room. The infection started from the chest as a result of a minimum muscle strain, in the absence of any cutaneous lesions or important risk factors such as immunosuppression. The infection was caused by Streptococcus pyogenes. The described case has many peculiarities that make it almost unique.
In ambito penitenziario il suicidio e l'autolesionismo rappresentano quasi una caratteristica... more In ambito penitenziario il suicidio e l'autolesionismo rappresentano quasi una caratteristica strutturale, rendendo la prevenzione un obiettivo primario. L'Amministrazione penitenziaria ha emanato in materia di prevenzione del suicidio un ampio spettro di provvedimenti. Il presente studio prende in esame la misura attualmente vigente in alcuni istituti di valutare i detenuti autorizzati all'utilizzo dello strumentario a gas, con monitoraggio delle condotte, da parte dello psichiatra.
BACKGROUND Dissection with subsequent ligation and resection of arteries at their origin (central... more BACKGROUND Dissection with subsequent ligation and resection of arteries at their origin (central vascular ligation, CVL) is essential for adequate oncological resection during right hemicolectomy (RH) with complete mesocolic excision (CME). This technique is technically demanding due to the highly variable arterial pattern of the right colon. Therefore, this study aims to provide a comprehensive evidence-based assessment of the arterial vascular anatomy of the right colon METHODS: A thorough systematic literature search through September 2020 was conducted on the electronic databases PubMed, SCOPUS, and Web of Science (WOS) to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaXl software. RESULTS A total of 41 studies (n= 4,691 patients) were included. The ileocolic artery (ICA), right colic artery (RCA) and middle colic artery (MCA) were present in 99.7% (95% CI 99.4-99.8), 72.6% (95% CI 61.3-82.5) and 96.9% (95% CI 94.2-98.8) of patients respectively. Supernumerary RCA and MCA were observed in 3.2% and 11.4% of all cases respectively. The RCA shared a common trunk with ICA and MCA in 13.2% and 17.7% of patients respectively. A retro-superior mesenteric vein (SMV) course of the ICA and RCA was observed in 55.1% and 11.4% of all cases respectively. CONCLUSION The vascular anatomy of the right colon displays several notable variations, namely the absence of some branches (RCA absent in 27.4% of cases), supernumerary branches, common trunks, and retro-SMV courses. These variations should be taken into consideration during RH with CME to ensure adequate oncological resection while minimizing intraoperative complications.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that is responsible for... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that is responsible for coronavirus disease 2019 (COVID-19), which has rapidly spread across the world, becoming a pandemic. The “cytokine storm” (CS) in COVID-19 leads to the worst stage of illness, and its timely control through immunomodulators, corticosteroids, and cytokine antagonists may be the key to reducing mortality. After reviewing published studies, we proposed a Cytokine Storm Score (CSs) to identify patients who were in this hyperinflammation state, and at risk of progression and poorer outcomes. We retrospectively analyzed 31 patients admitted to Infectious Disease Department in “St. Maria” Hospital in Terni with confirmed SARS-CoV-2 infections, and analyzed the “CS score” (CSs) and the severity of COVID-19. Then we conducted a prospective study of COVID-19 patients admitted after the definition of the CSscore. This is the first study that proposes and applies a new score to quickly identify COV...
Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It ... more Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods. In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. The purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results. The diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1–10 cm, SD 1.15 cm) and the length of the incarcerated small in...
The American Journal of Forensic Medicine and Pathology
BACKGROUND The incidence of taking selfies and sharing them on social media as well as selfie-rel... more BACKGROUND The incidence of taking selfies and sharing them on social media as well as selfie-related dangerous behaviors is increasing, particularly among young people, also leading to selfie-related trauma and death. This study was performed to obtain epidemiological characteristics of selfie-related mortality in Italy. METHODS Scientific literature and Italian media were reviewed. RESULTS Twelve victims from 11 events, from 2014 to 2018, were analyzed (sex, age, accident types, the nationality, the Italian region where the incident took place, if the person involved was indigenous or a tourist, the dynamics and the causa mortis, if other people have been involved in the selfie, and if other people were deceased). The majority of selfie victims were male teenagers, the average age was 23.6 years, the most preferred site of taking selfies was the natural environment followed by the railway one, the most frequently reported event or accident type was falling from a height, and the most frequent causes of selfie-related deaths were multitrauma and drowning. CONCLUSIONS Selfie-related deaths in Italy appear to be an issue and appear to be increasing. Particularly, male teenagers and young adults are at high risk for selfie-related deaths. Measures should be taken to reduce their incidence.
Abstract Dying in a head-down position is a not so common occurrence, and the cause of death may ... more Abstract Dying in a head-down position is a not so common occurrence, and the cause of death may not be immediately clear by the results of the autopsy. The authors describe a case of a six-months-old baby, previously healthy and asymptomatic, found in a head-down position, stuck between the bed and the wall. Despite the efforts to revive the baby, he was declared dead at the arrival of the ambulance. After the autopsy was carried out it was deemed that the cause of death was a cardio-respiratory failure caused by upside-down position of the baby, bilateral interstitial pneumonia and the immobilization of the thorax. This case shows how important it is, for the forensic pathologists, to take into account both autoptical, histological, toxicological results and the report of the scene, especially in the absence of decisive findings.
The American Journal of Forensic Medicine and Pathology
The authors report on the autopsy case of a 40-year-old primigravida without either coagulation d... more The authors report on the autopsy case of a 40-year-old primigravida without either coagulation disorders or anticoagulant/antiplatelet therapy, who developed a fatal intracranial subdural hematoma after spinal anesthesia (SA) for elective cesarean delivery for tocophobia.Intracranial subdural hematoma is the most dreaded complication of SA and is often misdiagnosed with postdural puncture headache.In this article, the authors discuss pathophysiological mechanisms and risk factors for the development of an intracranial subdural hematoma after SA and review the pertinent literature.
To provide a comprehensive evidence‐based assessment of the anatomical variations of the left col... more To provide a comprehensive evidence‐based assessment of the anatomical variations of the left colic artery (LCA).
BACKGROUND The Aberrant Left Hepatic Artery (ALHA) is replaced when it does not originate from th... more BACKGROUND The Aberrant Left Hepatic Artery (ALHA) is replaced when it does not originate from the hepatic artery proper and it is the only supply to that part of the liver, while an accessory artery coexists with a normal artery. The aim of this systematic review is to evaluate the incidence of ALHAs including the one arising from the Left Gastric Artery, also named Hyrtl's artery. METHODS A literature search in PubMed, SCOPUS, WOS and Google Scholar was performed. The risk of bias was assessed by means of the AQUA tool. The main outcome was the prevalence of ALHA. Secondary outcomes were the prevalence of the accessory and replaced left hepatic arteries. A subgroup analysis was conducted by geographic region and type of evaluation. RESULTS This review included 57 studies, with a total of 19,284 patients. The majority of the studies involved the use of radiological techniques -especially Angio-CT-and were performed in Asia. The overall risk of bias was moderate. The overall prevalence of the ALHA was 13.52%; the overall prevalence was 8.26% for the Replaced ALHA and 5.55% for the Accessory ALHA. In the 18 studies that employed Michels' classification, Type II had the lowest prevalence (0.36%) and Type VII the highest prevalence (6.62%). DISCUSSION Some of the studies included did not distinguish between the ''replaced'' and ''accessory'' ALHA (34.25%). Some surgical dissection techniques proved insufficient for the localization of other hepatic arteries. These results suggest that an accurate preoperative radiological evaluation is needed to localize replaced arteries.
INTRODUCTION The common hepatic artery (CHA) is the main arterial supply to the liver. Common cla... more INTRODUCTION The common hepatic artery (CHA) is the main arterial supply to the liver. Common classifications of the anatomical variations of the celiac trunk have only marginally described the CHA. Currently, the only classification addressing anatomical variants in cases of CHA absence from the celiac trunk is that reported by Huang et al. In this systematic review, the prevalence of these variations, according to Huang's classification, have been analyzed. METHODS The review was registered in PROSPERO (CRD 42018096679). The risk of bias was assessed using the AQUA tool. RESULTS Fifty-four articles were included in the review (26,250 participants). The overall pooled prevalence estimate (PPE) of an absent CHA was 3.1%. Of those participants who underwent preoperative radiological evaluation, the overall PPE of an absent CHA was 3.8% for subjects who were evaluated via angiography and 3.0% for participants who underwent angio-CT evaluation. The overall PPE of an absent CHA was 3.9% in cadavers and 3.2% in participants evaluated surgically. Type I or Type II aberrations were the most common; in participants with CHA aberrations, 65.4% of those participants had either Type I or Type II aberrations. CONCLUSIONS The overall PPE of an absent CHA was 3.1%, a result representing a significant, common anatomical variation. Our study revealed that an absence of a CHA was associated with a replaced CHA. The most common arterial variant was a replaced CHA originating from the Superior Mesenteric Artery and running across the anterior or posterior side of the pancreas (i.e., Types I and II).
The American Journal of Forensic Medicine and Pathology
To the Editor: The importance of media and digital exposure among the generation commonly known a... more To the Editor: The importance of media and digital exposure among the generation commonly known as “selfie generation” has become readily apparent. The popularity of clicking and posting selfies is so massive that “selfie” was declared as the word of the year in 2013 by Oxford Dictionaries, where selfie is defined as “A photograph that one has taken of oneself, typically one takenwith a smartphone or webcam and shared via social media.” Social media has also become of increasing relevance in the management of social relationships, where the appearance becomes of utmost importance along the need to be noticed. Daredevil selfies (or killfies) and extreme videos are the ultimate expression of this need, which is to be noticed and get a glimpse of popularity. As reported by numerous news reports, sometimes taking selfies, killfies, and extreme videos may have fatal outcomes. Although the scientific literature is lacking, media also reports on “extreme” behavior (such as running on the highway among the cars or jumping from an elevator to another one) in which the main trigger is the search for the adrenaline. In daredevil selfies and extreme videos, the search for the adrenaline rush goes together with the need to make the act visible by sharing it on social media. Although this issue is widespread all over the world, it is also occurring in Italy and was recently epitomized by a death investigated in Terni, Umbria. A group of teenagers decided to shoot an extreme video to be uploaded on social networks. To this end, a 16-year-old boy lay across the road with the head facing the center line while holding the smartphone in shooting mode. A second 16-year-old boy then attempted to drive a 50-cc moped as close as possible to the head of his friend lying on the ground, who was, again, recording the scene with his smartphone from below. At the same time, other teenagers present at the scene, arranged on the sides of the road, were also recording with their smartphones. However, the driver of the moped, blinded by the headlights of a car, accidentally hit his friend on the head causing death before crashing into a guardrail and being unharmed himself. The autopsy of the deceased teen who was struck by the moped revealed a
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