Clinica Terapeutica最新文献

{"title":"A Fistful of Lemons: Homicide or Self-Defense? A Multidisciplinary Approach in Forensic Sciences.","authors":"E Giglia, G Licciardello, C Barletta, A V M Failla, A Pallante, G Cocimano","doi":"10.7417/CT.2025.5180","DOIUrl":"https://doi.org/10.7417/CT.2025.5180","url":null,"abstract":"<p><strong>Abstract: </strong>In the context of medico-legal investigations, one of the main challenges lies in the correct distinction between murder and self-defense. Italian legislation requires that, in order to qualify as legitimate defense, the actions taken by the person in danger are indispensable and proportionate to the offense received, as well as motivated by a present danger.Through the presentation of a specific case, the importance of a multidisciplinary forensic approach in forensic medicine is highlighted, useful for reconstructing the dynamics of events and arriving at a precise definition of the nature of the crime. The integration of CT examinations, autopsies, and toxicological and histological investigations is essential to ensure an accurate analysis that can minimize uncertainties about the time, cause and means of death. The case report presented focuses on an episode of double murder in which two men, respectively 29 and 30 years old, caught in the act of carrying out a theft of lemons against a 72-year-old landowner, were drawn by multiple gunshots, fired by the latter. First, subject A (30 aa) was subjected to a CT scan; The eidological investigations thus revealed a continuous oval-shaped solution of the skull, fractures in the right frontal and occipital areas, as well as the presence of foreign bodies retained at the level of the subgluteal region and the glans. During the autopsy investigation, these injuries were confirmed and the bullet retained in the soft skin tissues was recovered. On subject B (29aa), the external examination revealed the presence of two continuous lesions, both at the level of the right axillary region and the left deltoid region, on the other hand, a fracture of the third rib, hemopneumothorax, pneumomediastinum and a tracheal lesion were documented;During the autopsy experiment, the findings highlighted previously were confirmed, the presence of full-thickness lesions of the lungs was ascertained, and thanks to the in-depth evaluation of the organs drawn, in both cases, it was possible to reconstruct what was the direction and means of the bullet.Finally, the subsequent histological investigations conducted on the skin samples, performed in correspondence with the continuous solutions, made it possible to ascertain, in addition to the \"vitality\" of the lesions, also which was the \"entrance hole\" and which was the \"exit hole\". The case illustrated underlines the importance of a multidisci-plinary approach in forensic sciences, in order to provide technical elements useful for the resolution of complex cases. Future studies could explore the use of new applications based on artificial intelligence capable of crystallizing the surveys performed during the judicial inspection in order to compare them with those of subsequent post-mortem investigations.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"19-23"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Philosophy and Medicine: an Aristotelian Reflection.","authors":"M Karaboue, G V Lacasella","doi":"10.7417/CT.2025.5174","DOIUrl":"https://doi.org/10.7417/CT.2025.5174","url":null,"abstract":"<p><strong>Abstract: </strong>The debate on the relationship between philosophy and medicine raised by both philosophers and physicians concerns the possibility of elaborating a practical philosophy of medicine as an autonomous discipline distinct from both philosophy and medicine as separate entities. Analysis reveals the close link between philosophy and medicine since its inception in ancient Greece as well as the difficulty of defining the epistemological status of medicine, which presents a dual character of science and practice. The impossibility of defining medicine as pure science, on a par with physics and mathematics, generates tensions between explanatory theories and therapeutic aims and between universal knowledge and understanding of the specific where medical science is confronted with the values that come into play in a clinical encounter. The doctor-patient relationship is the core of clinical medicine. The significant contribution that philosophical reflection (1) can offer to medical science is to be found in the practice of the therapeutic encounter and the analysis of the ethical dimensions involved in it. A practical philosophy, in the Aristotelian sense of the term, is understood as the expression of a form of rationality that differs from the scientific one, which does not seek knowledge as an end in itself but is directed towards an understanding that aims to guide actions. This reference is to that practical logic that allows the physician to deliberate on the most suitable means to achieve his end and the greatest good for the patient.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"114-117"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-colonoscopy pancreatitis: a case report and a systematic review of the literature.","authors":"I D Gkegkes, A P Stamatiadis","doi":"10.7417/CT.2025.5164","DOIUrl":"https://doi.org/10.7417/CT.2025.5164","url":null,"abstract":"<p><strong>Background: </strong>Colonoscopy represents a commonly performed endoscopic procedure for the study of large bowel. Even though, colonoscopy is considered a safe and well-tolerated procedure, in the literature, it has also been related with in a few cases of acute pancreatitis.</p><p><strong>Methods: </strong>A systematic PubMed and Scopus search was conducted, a propos of a case report.</p><p><strong>Results: </strong>Twelve patients were included from 11 case reports. The mean age of the patients was 57.4 years (range: 25 - 84). None of the included patients had a history of cholelithiasis or alcoholism. The principal indication for colonoscopy was cancer/polyp surveillance (7 out of 12, 58.3%). Polypectomy was performed in 9 patients (75%). In 4 out of 12 cases (33.3%) the procedure of colonoscopy was characterised as difficult and external manipulation was necessitated. The mean onset of symptoms was 8 hours after colonoscopy (range: 2 - >24). Hospitalization was necessary in 9 out of 12 patients (75%). Regarding the location of the pancreatitis, body/tail (3 out of 12, 25%), body (4 out of 12, 33.3%) and tail (4 out of 12, 33.3%) were most affected. The median duration of symptoms was 7 days (range: 3-12). No complications were reported. The mean follow-up period of the included patients was 15 months (range: 3-36). No fatalities were reported.</p><p><strong>Conclusion: </strong>Post-colonoscopy pancreatitis is an extremely rare complication of colonoscopy. After having excluded a surgical emergency, acute pancreatitis should be taken into consideration, especially when endoscopy is technically challenging. Conservative management is indicated in these cases, while no serious sequels have been reported in the literature.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of survival in patients with advanced non-small cell lung cancer treated with tyrosine-kinase inhibitors: Value of SUVmax or value of other factor?","authors":"T Pham-Van, T C Bui, C P Pham, L T Le, T K Mai, B D Nguyen, H T Vo-Thi, Q H Nguyen","doi":"10.7417/CT.2025.5165","DOIUrl":"https://doi.org/10.7417/CT.2025.5165","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to investigate the role of 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and other factors in prediction of response and survival following epithelial growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy in patients with advanced lung adeno-carcinomas and EGFR mutations.</p><p><strong>Methods: </strong>Patients having a diagnosis of non-small cell lung cancer (NSCLC) who received 18F-FDG PET/CT imaging for staging before therapy between November of 2018 and May of 2023 at the Nuclear Medicine and Oncology Centre, Bach Mai Hospital.</p><p><strong>Results: </strong>67 patients diagnosed with advanced EGFR-mutated adenocarcinoma, 25 (37.3%) were male, and 42 (62.7%) were female. During the following observation period, there were 42 cases (62.7%) of mortality attributed to cancer. We verified that the remaining 25 patients (37.3%) were still alive when writing this report. The mean SUVmax is 9.12 (±3.81), ranging from 1 to 18. The mean Progression-Free Survival (PFS) is 18.22 months (±13.38), ranging from 0 to 51 months. The mean overall survival (OS) is 27.43 months (±15.773), ranging from 2 to 59 months. SUVmax was not associated with survival status. The area under the curve = 0.624 with p-value =0.092. OS was higher in age < 70 years old and in patients with adverse events. PFS was higher in age < 70 years old and in female patients.</p><p><strong>Conclusion: </strong>SUVmax was not associated with survival status. OS was higher in age < 70 years old and in patients with adverse events. PFS was higher in age < 70 years old and in female patients.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"52-59"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Analysis of Cerebral Ventricular Dimensions in the Adult Population of Northern India: A Cross-Sectional Study Using Magnetic Resonance Imaging.","authors":"A Patra, H Kaur, P Chaudhary, K S Ravi, A Asghar, J Walocha, T Iskra, M Blaszczyk","doi":"10.7417/CT.2025.5160","DOIUrl":"https://doi.org/10.7417/CT.2025.5160","url":null,"abstract":"<p><strong>Purpose: </strong>This primary aim of the study was to establish the normative values of brain ventricles and indices in the adult North Indian population. Secondary aims were to evaluate sex and age-related differences, assess the applicability of widely cited normal ventricle size ranges in the study population, and explore the correlation between ventricular dimensions and anthropometric parameters.</p><p><strong>Methods: </strong>Magnetic resonance imaging (MRI) of 142 healthy individuals, aged between 18 to 72 years, was conducted and sagittal and axial images were utilized for brain ventricles measurements.</p><p><strong>Results: </strong>The study revealed following mean values for brain ventricles and indices in males: frontal horn width (FHW), third ventricle width (TVW), fourth ventricle anteroposterior width (FVWAP), fourth ventricle transverse width (FVWT) and the transverse inner diameter of the skull (TIDS) were 33.07 mm, 4.20 mm, 8.62 mm, 13.12 mm, and 117.6 mm respectively. In females, the corresponding dimensions were 30.20 mm, 3.65 mm, 8.20 mm, 12.62 mm, and 116.05 mm, respectively. Statistically significant differences between the sexes were observed only in TVW. The mean values of Evans' index were 0.25 ± 0.020 in females and 0.26 ± 0.024 in males.</p><p><strong>Conclusion: </strong>The findings contribute valuable insights into the normal values of brain ventricles and indices among healthy adult individuals of North Indian origin, as determined by MRI. The exploration of sex and age-related differences holds significance for facilitating the diagnosis and management of hydrocephalic patients. The calculated mean values of Evans' index provide a reliable metric for aiding the diagnosis of various neurological disorders, including the early detection of hydrocephalus and cerebral atrophy, and offer crucial follow-up information for affected patients.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"13-20"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The case of Kenneth Smith \"The war of a state against a citizen\".","authors":"R Rinaldi, F M Damato, S Libianchi","doi":"10.7417/CT.2025.5161","DOIUrl":"https://doi.org/10.7417/CT.2025.5161","url":null,"abstract":"<p><strong>Purpose: </strong>This paper aims to examine the ethical implications of capital punishment, with a focus on the recent use of nitrogen asphyxi-ation in the case of inmate Kenneth Eugene Smith. It seeks to reopen the discussion on the death penalty from a bio-ethical perspective, considering the sensory experience of death and its impact on both inmates and observers.</p><p><strong>Methods: </strong>To analyze the case of Kenneth Eugene Smith, an in-depth search was conducted on scientific databases and international newspapers. Sources were selected to support the analysis of the case, including discussions on previous death penalty debates. Additionally, an overview of nitrogen usage and its physiological effects was provided.</p><p><strong>Results: </strong>he execution of Kenneth Eugene Smith by nitrogen asphyxiation is described, highlighting observations made by witnesses and the prisoner's resistance. Discussion points include the prisoner's suffering, the execution method's lack of scientific study, and transparency.</p><p><strong>Conclusions: </strong>The paper, according to shared ethical principles, criticizes the execution method failure and calls for further research to analyze the psychic and physical distress experienced by the inmates. It advocates for a reevaluation of execution protocols to uphold human dignity and minimize suffering.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"21-26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliary cysts in children with biliary atresia after Kasai procedure.","authors":"T T Tran, T K Phan, L A T Le, P D Ho, N H Au, N T Pham","doi":"10.7417/CT.2025.5170","DOIUrl":"https://doi.org/10.7417/CT.2025.5170","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the treatment outcomes of biliary cysts in children with biliary atresia (BA) after undergoing the Kasai procedure.</p><p><strong>Methods: </strong>A case series study on all cases were diagnosed with biliary cysts following the Kasai procedure and treated at Children's Hospital 2 from January 2017 to December 2022.</p><p><strong>Results: </strong>A total of 29 pediatric patients were included in the study, of which 17 were female. The average time of biliary cyst detection post-Kasai procedure was 22.2 months. Solitary cysts accounted for 34.5% of the cases, while multiple cysts accounted for 65.5%. 26/29 patients (89.7%) presented with jaundice. A total of 93.1% (27/29) of cases presented with cholangitis, of which 12 responded well to intravenous antibiotics. 6/27 patients required percutaneous transhe-patic biliary drainage (PTBD) (three of which were successful, one patient underwent cyst-enteric anastomosis, one patient needed liver transplantation, and one case resulted in death due to infection). In total, six patients underwent liver transplantation, and five patients died due to infection-related complications.</p><p><strong>Conclusions: </strong>Biliary cysts after the Kasai procedure are frequently associated with jaundice and cholangitis and require treatment in the majority of cases. PTBD combined with intravenous antibiotics is an effective treatment for simple cysts and can be considered for more complex cysts when liver transplantation is not immediately feasible.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"91-96"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a Questionnaire to Assess Nursing Students' Knowledge in Critical Care.","authors":"T Colacci, F Bonavoglia, F Dibattista, V Gargaro, S Taborri, G La Torre","doi":"10.7417/CT.2025.5172","DOIUrl":"https://doi.org/10.7417/CT.2025.5172","url":null,"abstract":"<p><strong>Background: </strong>Acquiring nursing skills in critical care requires the planning and implementation of carefully structured educational interventions. These interventions must be based on proven teaching methods that support the achievement of the expected educational objectives for students. Integrating traditional classroom teaching with interactive methodologies, such as gamification and role-playing, is essential to enhancing students' knowledge. These knowledge levels need to be measured through structured tools. To validate the questionnaire needed to assess nursing students' knowledge in the critical care area, a feasibility pilot study was conducted.</p><p><strong>Materials and methods: </strong>A pilot study was carried out, enrolling a total of 30 third-year nursing students from the University of Rome \"La Sapienza\". The questionnaire was administered at two time points: T0 and 48 hours later (T1) in April 2024.</p><p><strong>Results: </strong>The results did not show significant differences in the questionnaire administration at T0 and T1. Based on statistical analysis of the data using Cronbach's alpha, which yielded a value of 0.606, an adequate level of reliability and good internal consistency of the tool was found. These findings demonstrate the usefulness of the tool in assessing the learning of nursing students regarding the care of critically ill patients.</p><p><strong>Conclusions: </strong>The results from the statistical analysis of the data allowed for the validation of the administered questionnaire.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"105-108"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of ultra-high frequency US with Contrast Enhanced MR Angiography and conventional US: evaluation of carotid atheromatous plaques and bioethical decision making.","authors":"M Karaboue, D Berritto, G V Lacasella","doi":"10.7417/CT.2025.5175","DOIUrl":"https://doi.org/10.7417/CT.2025.5175","url":null,"abstract":"<p><strong>Background and aim: </strong>The methods routinely used for the study of atherosclerotic plaque include conventional ultrasound (US) and Magnetic Resonance Imaging (MRI), and Computed Tomography (CT), each one with its own strength and weak points. The aim of this study is to investigate diagnostic capabilities of high frequency ultrasound (HFUS) in order to provide a close and accurate inspection of atherosclerotic plaque, evaluating the characteristics that can categorize it as stable or unstable.</p><p><strong>Method: </strong>A total of 20 subjects (10 male, 10 female) were enrolled in order to assess presence/absence of carotid plaque by the use of Conventional US. All enrolled patients resulting positive for plaques presence at Color Doppler US examination underwent to Ultra High-frequency ultrasound exam, using a linear-array 48 MHz transducer, and Contrast MRI Angiography examination of the carotid arteries using a 1.5 Tesla scanner.</p><p><strong>Results: </strong>HFUS could assess specific size ranges for the plaque and the lipid core. Conventional US and CEMRA failed the measurement of FC Thickness in 75% of cases, while HFUS could assess them precisely, experiencing specific values.</p><p><strong>Conclusion: </strong>HFUS has proved to be reliable in defining the qualitative and quantitative values of plaque, highlighting, in a finer way, the characteristics of vulnerability.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"118-126"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A wound index for hip and knee arthroplasty outcomes: a pilot investigation.","authors":"G Pesel, P Bailo, E Basello, G Nittari, G Pica, F Gibelli, G Ricci","doi":"10.7417/CT.2025.5168","DOIUrl":"https://doi.org/10.7417/CT.2025.5168","url":null,"abstract":"<p><strong>Background: </strong>Post-arthroplasty infections pose a challenge in surgery, often necessitating pro-longed antibiotic treatment, implant failure, and revision surgery. To optimize patient outcomes and resource allocation, the present study aimed at test whether the implementation of the ASEPSIS score (i.e., a prognostic indicator based on postoperative variables) would emerge as an effective index to foresee future post-arthroplasty infections and to guide targeted interventions.</p><p><strong>Methods: </strong>We conducted an evaluation of hip and knee replacement patients' progress during their hospital stay, utilizing the ASEPSIS score. Subsequently, we conducted telephone interviews to evaluate the outcomes of their surgical wounds.</p><p><strong>Results: </strong>A robust correlation was observed between this score and the incidence of post-operative infections. Notably, individuals with a lower score exhibited a reduced likelihood of infection, whereas those identified as high-risk were more predisposed to develop infections within 90 days of surgery.</p><p><strong>Conclusions: </strong>While these findings are preliminary, they demonstrate significant promise. As we progress with subsequent studies, employing the validated assessment method from this pilot study, we anticipate further validation of the ASEPSIS score and its potential integration into standard clinical practice.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 1","pages":"75-80"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}