Alessandro Bonsignore | Università degli Studi di Genova (original) (raw)
Papers by Alessandro Bonsignore
PubMed, 2019
Introduction: The access to sex-reassignment surgery is based on the existence of an unequivocal ... more Introduction: The access to sex-reassignment surgery is based on the existence of an unequivocal dyscrasia between the morphological sex and the objective evidence that emerges from in-depth analysis of the individual's personality. In Italy, such type of surgical intervention is subject to the authorization of a judge. Material of study: Authors examine the recent Italian Constitutional judgement which has addressed the right to change legal sex status without the need for sex-reassignment surgery. Discussion: The Italian approach is in line with scientific evidence that the physical and mental well-being of an individual does not always require the surgical rectification of primary sexual features. Thus, sex reassignment surgery is not to be considered mandatory; rather, it should be aimed at ensuring the transsexual individual's stable psychological and physical good. From an ethical point of view, the Court's decision is very important, since it does not subordinate such fundamental rights as gender identity, healthcare and equality to prior, highly invasive surgery. Conclusions: The authors point out that critical issues and obstacles to the full implementation of the right to gender identity remain, in that this right is still subject to the authorization of a judge. This approach does not seem to be in line with the recent World Health Organization (WHO) decision to remove the "gender incongruity" from the list of mental and behavioural disorders (as it is in the current International Classification of Diseases-10, so far), to decrease the stigma surrounding such a condition. Key words: Gender identity, Sex reassignment, Surgery, Stigma, Transsexualism, Transgender.
Romanian Journal of Legal Medicine, Sep 1, 2019
Prompted by a particularly brutal case of homicide, in which the victim was completely decapitate... more Prompted by a particularly brutal case of homicide, in which the victim was completely decapitated, the authors provide some suggestions for reflection on the theme of narcissistic aggressiveness. Starting from the pathological-forensic analysis of the lesions inflicted, they then examine the role of narcissism from a criminological standpoint, with particular regard to threatened egotism and grandiosity as a trigger of murder. This point of view could help forensic pathologists to understand the psychological aspects of homicide cases.
Diagnostics, Aug 4, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
American Journal of Forensic Medicine & Pathology
Sudden death due to massive hemorrhage after a mini-invasive ambulatory diagnostic procedure is e... more Sudden death due to massive hemorrhage after a mini-invasive ambulatory diagnostic procedure is extremely rare. Fine-needle aspiration (FNA) of thyroid nodules is very safe, displaying a low rate of complications, all of which mild and often self-limiting. In few cases do these complications necessitate surgical decompression, and rarely does FNA of a thyroid nodule lead to the death of the patient. We report a case of sudden death caused by respiratory insufficiency after compression of the vascular and nervous structures of the neck and obstruction of the upper airways by hemorrhages dissecting the thyroidal and perithyroidal tissues in a 78-year-old woman. These hemorrhages were the result of vascular lacerations caused during diagnostic FNA of a nodule suspected of malignancy. In such cases, it is important to conduct a complete autopsy and histological analysis to ascertain the origin of massive hemorrhage involving the structures of the neck and to attribute the cause of death...
Frontiers in Immunology
We report a case of inflammatory colitis after SARS-CoV-2 infection in a patient with no addition... more We report a case of inflammatory colitis after SARS-CoV-2 infection in a patient with no additional co-morbidity who died within three weeks of hospitalization. As it is becoming increasingly clear that SARS-CoV-2 infection can cause immunological alterations, we investigated the expression of the inhibitory checkpoint PD-1 and its ligand PD-L1 to explore the potential role of this axis in the break of self-tolerance. The presence of the SARS-CoV-2 virus in colon tissue was demonstrated by qRT-PCR and immunohistochemical localization of the nucleocapsid protein. Expression of lymphocyte markers, PD-1, and PD-L1 in colon tissue was investigated by IHC. SARS-CoV-2-immunoreactive cells were detected both in the ulcerated and non-ulcerated mucosal areas. Compared to healthy tissue, where PD-1 is weakly expressed and PD-L1 is absent, PD-1 and PD-L1 expression appears in the inflamed mucosal tissue, as expected, but was mainly confined to non-ulcerative areas. At the same time, these mark...
Giuffre Editore SpA, 2014
The authors present the results of a retrospective study on falls performed at "Policlinico&... more The authors present the results of a retrospective study on falls performed at "Policlinico" Hospital of Bari, Italy, in the period 1st March 2011-31st December 2012. A systematic approach was performed to estimate the average hospital cost and length of stay (LOS) associated with injurious falls in our hospital. Particularly, a surveillance system based on the distribution and filing of "Fall of the Patient" record cards has long been in place. The study revealed 175 falls, accounting for the 0.1 % of the admissions to the Policlinico Hospital in the examined period, which had both human and financial costs, the latter related to extra-treatment (medical investigations-both instrumental and clinical- A nd therapies), increased lengths of stay, complaints and, in some cases, litigations. All these aspects produced an outlay of 159.108,53 (up to 31st) December 2013). Accordingly, even though it is unrealistic to consider all falls to be preventable, the authors hypothesize that a system-based fall-prevention program targeting high-risk situations would result in fewer falls. As the model actually in use in Bari is certainly exportable to other national entities, Hospital General Directions should have a leading role in creating effective programs of monitoring and prevention, consequently reducing hospital costs
Mattioli 1885, 2019
The profound social, ethical and juridical transformations that have invested the condition of ch... more The profound social, ethical and juridical transformations that have invested the condition of childhood have also affected the consideration of the existential interests of the minor in the care relationship and his role in the adoption of the therapeutic choices that concern him. If the history of children's rights is recent, that of children's rights in the health field is still at the outset. The legal status of the minor in the medical field expresses all the complexity of a status that, for a long time, has been subject to profound reconsiderations and which concerns various and different stages of growth and the formation of his personality. The participation of the child is an important factor to condition the therapeutic path and improve the curative results. However, the participation of the minor in his/her health path still has obstacles and shortcomings. The promotion of a specific communicative competence of health professionals can represent an important factor capable of contributing to the growing autonomy of the child and positively influencing the therapeutic path
Annals of Anatomy - Anatomischer Anzeiger, 2021
Anatomical dissection is considered a fundamental practice in the medical curriculum. Not only do... more Anatomical dissection is considered a fundamental practice in the medical curriculum. Not only does it help students to familiarize themselves with the various bodily organs and to refine their surgical practice, it also fosters an attitude of awareness and respect towards death and the values of solidarity. On 10th February 2020, the Italian Parliament passed a new law entitled "Rules on the disposition of one's own body and post-mortem tissues for study purposes, training and scientific research". Here, we outline the main ethical and legal aspects of this law and suggest initiatives to encourage body donation. Through careful analysis of the law, we intend to open a discussion on the main ethical issues and to make comparisons with the international situation. The new legislation fills serious gaps in an area of great ethical relevance; not only does it endorse fundamental ethical principles, it also provides important guidelines for strengthening body donation, such as: ensuring respect for the dignity of the deceased, providing express consent, appointing a trustee, promoting information for both doctors and the community, and banning all forms of trade in bodies or body parts. This law is certainly an important milestone on the road to overcoming the scarcity of bodies for study and research. However, it is also essential to promote a favourable attitude to body donation and to strive to overcome obstacles to this practice by supporting continuous dialogue between anatomical institutes and the community. Further studies are necessary in order to assess the impact of the new law.
Acta Bio Medica : Atenei Parmensis, 2019
The article published by Prof. Antonio Neviani in 1896 offered us an interesting opportunity to d... more The article published by Prof. Antonio Neviani in 1896 offered us an interesting opportunity to discuss about the teaching of human evolution in schools today. Already at the end of the nineteenth century, Neviani complained about the fact that the teaching of the theory of evolution was not present in schools. Here, we present the thought of Neviani and we invite to reflect on the prohibition, still present in some countries, of the teaching of Darwin’s theory. (www.actabiomedica.it)
Giornale italiano di medicina del lavoro ed ergonomia
Commuting accidents (CA) play an important role in many systems of workers' compensation insu... more Commuting accidents (CA) play an important role in many systems of workers' compensation insurance and with good reason, as they generally bring about more serious consequences in terms of permanent disablement and death than ordinary occupational accidents; this usually leads to high social costs. Nevertheless, research investigations aimed at studying the possible causes underlying the phenomenon are not available in medical literature. Objective of the present study is to evaluate whether excessive daytime sleepiness (EDS) might influence the occurrence of CA. 463 CA occurred to 411 police officers in northern Italy during the period 1999 - 2002 were collected; 51.9% of the subjects were working on shifts, 48.1% were non-shift workers. The study was carried out by submitting a self-administered questionnaire to gather information on age and physical characteristics, working conditions, sleep-related problems and accidents occurrence; EDS was measured by the Epworth Sleepiness...
![Research paper thumbnail of [Sleepiness, sleep disorders and risk of occupational accidents]](https://attachments.academia-assets.com/115428608/thumbnails/1.jpg)
](Giornale italiano di medicina del lavoro ed ergonomia
Sleepiness, a commonly symptom affecting up to one-fifth of the population chronically, is clearl... more Sleepiness, a commonly symptom affecting up to one-fifth of the population chronically, is clearly an important cause of accidents in industry and transport inducing deterioration in performance and attention. The reason for Excessive Daytime Sleepiness (EDS) is either sleep pathology, voluntary (non-pathological) sleep reduction, or activity during the circadian low. Most of the professional accidents reported refer to the obstructive sleep apnea syndrome (OSAS). Our data confirmed higher prevalence of OSAS in truck drivers than general population and we elaborated a feasible screening tool for OSAS based on data by clinical and anthropometric variables, some items of Sleep Disorders Score and complete polysomnography. About commuting accidents (CA) in shift and non shift workers we found a strict significant relationship between shift-work condition and the presence of EDS (p < 0.0001) suggesting that CA are significantly influenced by ED in the hypothesis of disruption of the ...
Journal of Interventional Cardiac Electrophysiology, 2021
There is a relative paucity of data on ante-mortem clinical characteristics of young (age 1 to 35... more There is a relative paucity of data on ante-mortem clinical characteristics of young (age 1 to 35 years) sudden death (SD) victims. The aim of the study was to characterize ante-mortem characteristics of SD victims, in a selected national cohort identified by a web search. A dataset of all SD (January 2010 and December 2015) was built from national forensic data and medical records, integrated with Google search model. Families were contacted to obtain consent for interviews. Data were obtained on ante-mortem symptoms. ECG characteristics and autopsy data were available. Out of 301 SD cases collected, medical and family history was available in 132 (43.9%). Twenty-eight (21.1%) had a positive family history for SD. SD occurred during sport/effort in 76 (57.6%). One hundred twelve (85%) SD cases had no prior reported symptoms. Autopsy data were available in 100/132 (75.8%) cases: an extra cardiac cause was identified in 20 (20%). Among the 61 cases with a cardiac diagnosis, 21 (34%) ...
American Journal of Forensic Medicine & Pathology, 2018
Image-and performance-enhancing drugs include a wide range of substances used to promote physical... more 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 performanceenhancing 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.
PubMed, 2019
Introduction: The access to sex-reassignment surgery is based on the existence of an unequivocal ... more Introduction: The access to sex-reassignment surgery is based on the existence of an unequivocal dyscrasia between the morphological sex and the objective evidence that emerges from in-depth analysis of the individual's personality. In Italy, such type of surgical intervention is subject to the authorization of a judge. Material of study: Authors examine the recent Italian Constitutional judgement which has addressed the right to change legal sex status without the need for sex-reassignment surgery. Discussion: The Italian approach is in line with scientific evidence that the physical and mental well-being of an individual does not always require the surgical rectification of primary sexual features. Thus, sex reassignment surgery is not to be considered mandatory; rather, it should be aimed at ensuring the transsexual individual's stable psychological and physical good. From an ethical point of view, the Court's decision is very important, since it does not subordinate such fundamental rights as gender identity, healthcare and equality to prior, highly invasive surgery. Conclusions: The authors point out that critical issues and obstacles to the full implementation of the right to gender identity remain, in that this right is still subject to the authorization of a judge. This approach does not seem to be in line with the recent World Health Organization (WHO) decision to remove the "gender incongruity" from the list of mental and behavioural disorders (as it is in the current International Classification of Diseases-10, so far), to decrease the stigma surrounding such a condition. Key words: Gender identity, Sex reassignment, Surgery, Stigma, Transsexualism, Transgender.
Romanian Journal of Legal Medicine, Sep 1, 2019
Prompted by a particularly brutal case of homicide, in which the victim was completely decapitate... more Prompted by a particularly brutal case of homicide, in which the victim was completely decapitated, the authors provide some suggestions for reflection on the theme of narcissistic aggressiveness. Starting from the pathological-forensic analysis of the lesions inflicted, they then examine the role of narcissism from a criminological standpoint, with particular regard to threatened egotism and grandiosity as a trigger of murder. This point of view could help forensic pathologists to understand the psychological aspects of homicide cases.
Diagnostics, Aug 4, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
American Journal of Forensic Medicine & Pathology
Sudden death due to massive hemorrhage after a mini-invasive ambulatory diagnostic procedure is e... more Sudden death due to massive hemorrhage after a mini-invasive ambulatory diagnostic procedure is extremely rare. Fine-needle aspiration (FNA) of thyroid nodules is very safe, displaying a low rate of complications, all of which mild and often self-limiting. In few cases do these complications necessitate surgical decompression, and rarely does FNA of a thyroid nodule lead to the death of the patient. We report a case of sudden death caused by respiratory insufficiency after compression of the vascular and nervous structures of the neck and obstruction of the upper airways by hemorrhages dissecting the thyroidal and perithyroidal tissues in a 78-year-old woman. These hemorrhages were the result of vascular lacerations caused during diagnostic FNA of a nodule suspected of malignancy. In such cases, it is important to conduct a complete autopsy and histological analysis to ascertain the origin of massive hemorrhage involving the structures of the neck and to attribute the cause of death...
Frontiers in Immunology
We report a case of inflammatory colitis after SARS-CoV-2 infection in a patient with no addition... more We report a case of inflammatory colitis after SARS-CoV-2 infection in a patient with no additional co-morbidity who died within three weeks of hospitalization. As it is becoming increasingly clear that SARS-CoV-2 infection can cause immunological alterations, we investigated the expression of the inhibitory checkpoint PD-1 and its ligand PD-L1 to explore the potential role of this axis in the break of self-tolerance. The presence of the SARS-CoV-2 virus in colon tissue was demonstrated by qRT-PCR and immunohistochemical localization of the nucleocapsid protein. Expression of lymphocyte markers, PD-1, and PD-L1 in colon tissue was investigated by IHC. SARS-CoV-2-immunoreactive cells were detected both in the ulcerated and non-ulcerated mucosal areas. Compared to healthy tissue, where PD-1 is weakly expressed and PD-L1 is absent, PD-1 and PD-L1 expression appears in the inflamed mucosal tissue, as expected, but was mainly confined to non-ulcerative areas. At the same time, these mark...
Giuffre Editore SpA, 2014
The authors present the results of a retrospective study on falls performed at "Policlinico&... more The authors present the results of a retrospective study on falls performed at "Policlinico" Hospital of Bari, Italy, in the period 1st March 2011-31st December 2012. A systematic approach was performed to estimate the average hospital cost and length of stay (LOS) associated with injurious falls in our hospital. Particularly, a surveillance system based on the distribution and filing of "Fall of the Patient" record cards has long been in place. The study revealed 175 falls, accounting for the 0.1 % of the admissions to the Policlinico Hospital in the examined period, which had both human and financial costs, the latter related to extra-treatment (medical investigations-both instrumental and clinical- A nd therapies), increased lengths of stay, complaints and, in some cases, litigations. All these aspects produced an outlay of 159.108,53 (up to 31st) December 2013). Accordingly, even though it is unrealistic to consider all falls to be preventable, the authors hypothesize that a system-based fall-prevention program targeting high-risk situations would result in fewer falls. As the model actually in use in Bari is certainly exportable to other national entities, Hospital General Directions should have a leading role in creating effective programs of monitoring and prevention, consequently reducing hospital costs
Mattioli 1885, 2019
The profound social, ethical and juridical transformations that have invested the condition of ch... more The profound social, ethical and juridical transformations that have invested the condition of childhood have also affected the consideration of the existential interests of the minor in the care relationship and his role in the adoption of the therapeutic choices that concern him. If the history of children's rights is recent, that of children's rights in the health field is still at the outset. The legal status of the minor in the medical field expresses all the complexity of a status that, for a long time, has been subject to profound reconsiderations and which concerns various and different stages of growth and the formation of his personality. The participation of the child is an important factor to condition the therapeutic path and improve the curative results. However, the participation of the minor in his/her health path still has obstacles and shortcomings. The promotion of a specific communicative competence of health professionals can represent an important factor capable of contributing to the growing autonomy of the child and positively influencing the therapeutic path
Annals of Anatomy - Anatomischer Anzeiger, 2021
Anatomical dissection is considered a fundamental practice in the medical curriculum. Not only do... more Anatomical dissection is considered a fundamental practice in the medical curriculum. Not only does it help students to familiarize themselves with the various bodily organs and to refine their surgical practice, it also fosters an attitude of awareness and respect towards death and the values of solidarity. On 10th February 2020, the Italian Parliament passed a new law entitled "Rules on the disposition of one's own body and post-mortem tissues for study purposes, training and scientific research". Here, we outline the main ethical and legal aspects of this law and suggest initiatives to encourage body donation. Through careful analysis of the law, we intend to open a discussion on the main ethical issues and to make comparisons with the international situation. The new legislation fills serious gaps in an area of great ethical relevance; not only does it endorse fundamental ethical principles, it also provides important guidelines for strengthening body donation, such as: ensuring respect for the dignity of the deceased, providing express consent, appointing a trustee, promoting information for both doctors and the community, and banning all forms of trade in bodies or body parts. This law is certainly an important milestone on the road to overcoming the scarcity of bodies for study and research. However, it is also essential to promote a favourable attitude to body donation and to strive to overcome obstacles to this practice by supporting continuous dialogue between anatomical institutes and the community. Further studies are necessary in order to assess the impact of the new law.
Acta Bio Medica : Atenei Parmensis, 2019
The article published by Prof. Antonio Neviani in 1896 offered us an interesting opportunity to d... more The article published by Prof. Antonio Neviani in 1896 offered us an interesting opportunity to discuss about the teaching of human evolution in schools today. Already at the end of the nineteenth century, Neviani complained about the fact that the teaching of the theory of evolution was not present in schools. Here, we present the thought of Neviani and we invite to reflect on the prohibition, still present in some countries, of the teaching of Darwin’s theory. (www.actabiomedica.it)
Giornale italiano di medicina del lavoro ed ergonomia
Commuting accidents (CA) play an important role in many systems of workers' compensation insu... more Commuting accidents (CA) play an important role in many systems of workers' compensation insurance and with good reason, as they generally bring about more serious consequences in terms of permanent disablement and death than ordinary occupational accidents; this usually leads to high social costs. Nevertheless, research investigations aimed at studying the possible causes underlying the phenomenon are not available in medical literature. Objective of the present study is to evaluate whether excessive daytime sleepiness (EDS) might influence the occurrence of CA. 463 CA occurred to 411 police officers in northern Italy during the period 1999 - 2002 were collected; 51.9% of the subjects were working on shifts, 48.1% were non-shift workers. The study was carried out by submitting a self-administered questionnaire to gather information on age and physical characteristics, working conditions, sleep-related problems and accidents occurrence; EDS was measured by the Epworth Sleepiness...
Giornale italiano di medicina del lavoro ed ergonomia
Sleepiness, a commonly symptom affecting up to one-fifth of the population chronically, is clearl... more Sleepiness, a commonly symptom affecting up to one-fifth of the population chronically, is clearly an important cause of accidents in industry and transport inducing deterioration in performance and attention. The reason for Excessive Daytime Sleepiness (EDS) is either sleep pathology, voluntary (non-pathological) sleep reduction, or activity during the circadian low. Most of the professional accidents reported refer to the obstructive sleep apnea syndrome (OSAS). Our data confirmed higher prevalence of OSAS in truck drivers than general population and we elaborated a feasible screening tool for OSAS based on data by clinical and anthropometric variables, some items of Sleep Disorders Score and complete polysomnography. About commuting accidents (CA) in shift and non shift workers we found a strict significant relationship between shift-work condition and the presence of EDS (p < 0.0001) suggesting that CA are significantly influenced by ED in the hypothesis of disruption of the ...
Journal of Interventional Cardiac Electrophysiology, 2021
There is a relative paucity of data on ante-mortem clinical characteristics of young (age 1 to 35... more There is a relative paucity of data on ante-mortem clinical characteristics of young (age 1 to 35 years) sudden death (SD) victims. The aim of the study was to characterize ante-mortem characteristics of SD victims, in a selected national cohort identified by a web search. A dataset of all SD (January 2010 and December 2015) was built from national forensic data and medical records, integrated with Google search model. Families were contacted to obtain consent for interviews. Data were obtained on ante-mortem symptoms. ECG characteristics and autopsy data were available. Out of 301 SD cases collected, medical and family history was available in 132 (43.9%). Twenty-eight (21.1%) had a positive family history for SD. SD occurred during sport/effort in 76 (57.6%). One hundred twelve (85%) SD cases had no prior reported symptoms. Autopsy data were available in 100/132 (75.8%) cases: an extra cardiac cause was identified in 20 (20%). Among the 61 cases with a cardiac diagnosis, 21 (34%) ...
American Journal of Forensic Medicine & Pathology, 2018
Image-and performance-enhancing drugs include a wide range of substances used to promote physical... more 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 performanceenhancing 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.