Asphyxia protracted after shaking trauma

A case of "shaken baby syndrome" (SBS) is reported. A 3 1/2 months old female baby has been found by his mother death in bed. The circumstances predicted a case of Sudden Infant Death Syndrome (SIDS), but the father, a disc-jockey, who had to look for the baby, had left a notice: "Gitti--i didn't want it, I don't know what had happened, I'm sorry!". The corpse of the baby had no external signs of violence. At the medicolegal examination we found small subarachnoidal and subdural hemorrhage from ruptured bridge veins and signs of prolonged asphyxia. Few hours later the father could be arrested. He told that he had shaken the baby, because she didn't stop crying. The infant lost conscious and he layed him down to the bed with his face below. Then he looked TV for at least a few minutes. After insufficient reanimation he had left the house. The court found the man to be guilty of fatal infant child abuse and convicted him to detention of 8 months. The main signs of SBS are discussed (subarachnoidal and subdural hemorrhage, intraretinal and periretinal hemorrhages, brain edema). Especially in the german speaking Europe many medical examiners are not familiar with this form of infant child abuse.     

The forensic-medical expertise in craniofacial trauma

Archive materials of the recent 6 years, including 14720 death cases of victims, were analyzed for the purpose of detecting the general regularities of injuries within the craniofacial trauma (CFT). The diversity of CFT with injuries to skull bones and medullary substance was found not to interfere with establishing an actual type and mechanism of trauma provided all injuries are thoroughly and comprehensively examined. The trauma specificity must be evaluated with respect to a location and direction of traumatic force in order to define an actual impact that caused death. CFT is special variation of craniocerebral trauma, whose onset mechanism needs more research. The efficiency of forensic-medical examination of CFT cadavers directly depends on the coordination and logic of measure undertaken by expert as well as on his technical outfit and knowledge of such trauma. The diversity of variations of damage to anatomic head structures requires an interdisciplinary approach with the need to isolate a predominant chain that affects the course and outcome of trauma.     

肥大细胞与创伤

肥大细胞在创伤及愈合中起重要作用,其在创伤后随时间而呈现的一定规律的病理生理改变对于法医学中损伤时间及死亡时间的推断、生前伤或死后伤的鉴别方面具有重要的意义。本文对肥大细胞及其活性介质在创伤愈合、瘢痕疙瘩、烧伤后炎症反应、骨折愈合中的作用,以及在法医学中的应用和研究进展进行了综述。     

The significance of postmortem radiographs in infants

The radiographs of 108 infants were analyzed prospectively before autopsy to correlate radiographic findings with those found at the postmortem examination. There was poor correlation between radiographs and autopsy findings when pulmonary pathology was present, and there was no gut pathology when radiographs revealed portal venous air. The radiographs were most helpful when either bony abnormalities (that is, fractures or congenital abnormalities) or free air were found before autopsy.     

星形胶质细胞在脑外伤后的反应

本文对星形胶质细胞在脑外伤后的反应进行综述，包括对星形胶质细胞结构和功能的新认识，脑外伤后星形胶质细胞反应的研究模型、检测技术及其在脑外伤后星形胶质细胞发生形态学及代谢方面的变化。强调了星形胶质细胞在脑外伤后形态、蛋白表达和细胞因子表达变化的时间规律性，并对其在脑外伤后法医学鉴定中应用的意义做出展望。     

The forensic medical expertise in trauma of male genitals

A damage inflicted to genitals organs (GO) affects the copulative functions, the sperm fertilizing ability and, as a whole, the reproductive function. Injuries to the external genital organs (EGO) due to immediate trauma are more often the case in the forensic medical practice; they are less often encountered in operative interventions in organs, which are close to the prostate or those having immediate direct links with the testicles or with the cavernous bodies of the penis, i.e. in case of an indirect trauma or an mediated effect on the functions of GO. Even if there is a smallest damage to the EGO region, the man needs to consult the urologist in the out-patient or in-patient medical institution. It is always necessary to asses a degree of severity to the health both by signs of duration to health disorders and by an outcome of injury with regard for trauma severity and possible impact on the reproductive function.     

The rate and kinetic order of ethanol elimination

The rate and kinetic order of ethanol elimination was evaluated in human volunteers. Part I of the study involved dosing individuals with alcoholic beverages on two separate occasions. Breathalyzer tests were performed at 15-min intervals for a period of 5 h. Attention was focused on values obtained after peak blood ethanol levels had been reached. The second part of the study included having samples drawn from alcoholics at predetermined intervals during recovery from alcoholic intoxication. Blood ethanol concentration data was analyzed for kinetic order and a comparison of ethanol elimination rates of alcoholics and non-alcoholics was made. The predicative capability of estimating a BAC from both the zero and first order theories was also investigated.It was concluded that ethanol elimination is a zero order process. For subjects classified as non-drinkers (consume less than 6 ounces of ethanol/month), the mean ethanol elimination rate as determined in the study was 12 ± 4 mg/h. For subjects classified as social drinkers (consume more than 6 ounces but less than 30 ounces of ethanol/month), the mean ethanol elimination rate was 15 ± 4 mg%/h, and for alcoholics, the mean ethanol elimination rate was 30 ± 9 mg%/h. These results indicate that the rate of ethanol elimination increases with drinking experience.     

The role of retroperitoneal hematomas in thanatogenesis of pelvic trauma

A brief statistical analysis of the pelvic hematomas' evolution in traumas with various localizations is presented in the article. The current published data were made use of to describe the state-of-art for the time being. Finally, problems related with the forensic-medical aspects of the issue are defined, and methods to cope with them are appropriately suggested.     

The characteristics of gunshot and blast trauma in Moscow in 1997

Forensic medical, social, and criminological characteristics of 417 cases with gunshot and explosion injuries investigated at Bureau of Forensic Medical Expert Evaluations of Moscow in 1997 are presented. Public and social groups of victims and types of violent deaths are discussed.     

The biology of trauma: implications for treatment

During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis and can cause both short and long-term effects on many organs and systems of the body. Our expanding knowledge of the effects of trauma on the body has inspired new approaches to treating trauma survivors. Biologically informed therapy addresses the physiological effects of trauma, as well as cognitive distortions and maladaptive behaviors. The authors suggest that the most effective therapeutic innovation during the past 20 years for treating trauma survivors has been Eye Movement Desensitization and Reprocessing (EMDR), a therapeutic approach that focuses on resolving trauma using a combination of top-down (cognitive) and bottom-up (affect/body) processing.     

The relationship between trauma and violence in a jail inmate sample

Research suggests there is a link between trauma and violence, although the nature of the relationship is rather equivocal. This study explored this relationship by examining self-reported trauma as a predictor of self-reported violence in 93 jail inmates. Ninety-six percent of the sample reported experiencing a traumatic event, and 67% reported having been violent during the year preceding incarceration. Inmates reporting trauma were more than twice as likely to report having been violent than nonviolent. Stepwise multiple regression analyses suggested traumatic events, as a combined model, significantly contributed to violence perpetration. In addition, witnessing serious violence predicted perpetration of violence. Implications and limitations of the present study are discussed.     

The effect of childhood trauma on later psychological adjustment

This study examined whether adult attachment and cognitive distortion mediate the relationship between childhood trauma and psychological adjustment. The participants were 219 students (40 men and 117 women) enrolled in a university degree. Participants completed the Childhood Trauma Questionnaire, which assessed retrospective accounts of childhood trauma; the Relationships Scales Questionnaire, which measured two dimensions of adult attachment (model-of-self and model-of-other); the Cognitive Distortions Scale, which measured internal attributions and perceptions of controllability; and the Trauma Symptom Inventory, which assessed posttraumatic symptoms and was used in this study to measure psychological adjustment. Results supported the hypothesis that model-of-self and cognitive distortion are related constructs. The influence of model-of-self on psychological adjustment however was only via its effect on cognitive processes. In other words, a negative model-of-self influenced cognitive distortion, which in turn influenced the expression of symptoms in adults reporting a history of childhood trauma. The implications for therapy were considered.     

The forensic-medical diagnosis of lifetime burn trauma by changes in the brain

It is recommended in the paper to define the lifetime or postmortal nature of burn injury that should be made on the basis of differential diagnosis of cause of death. Criteria are suggested, which can be used to distinguish, on the basis of forensic-histological examination of the brain, between mechanical asphyxia and the most widespread types of mechanical trauma typical of murder with arson.     

Gas at postmortem computed tomography - An evaluation of 73 non-putrefied trauma and non-trauma cases

Postmortem computed tomography (PMCT) has become an important complement in investigating forensic cases allowing an accurate detection of gas accumulations. The present study investigated the presence and distribution of gas in a large number of non-putrefied cases of traumatic and non-traumatic deaths. Furthermore the possibility of pneumobilia secondary to blunt abdominal trauma was studied. Retrospectively, 73 cases, underwent a whole-body PMCT prior to autopsy. These were divided into four groups: penetrating trauma (20 gunshot cases, 13 stabbing cases), blunt abdominal trauma (20 cases) and a control group of 20 non-trauma cases. Exclusion criteria were visible signs of decomposition. Each group was screened for gas accumulations in the vascular system, internal organs, soft tissues and body cavities. Gas accumulations were present in 98% of the trauma cases, compared to 80% of the control group. The most affected structures and/or organs in the trauma group were soft tissues, vessels and the liver. In most cases of the trauma group gas was associated with open injuries and lacerations of vessels. Furthermore, in the gunshot group gas was frequently seen in the intracranial cavity. Pneumobilia occurred in one case of the blunt trauma group; in that control group gas was also seen, but less frequently. Gas accumulation showed a strong association with traumatic events, but even the majority of non-trauma cases showed gas accumulations. Despite the exclusion of cases with visible decomposition signs, a putrefactive origin of gas was assumed in some cases. Gas accumulations are a frequent finding in PMCT with a higher incidence in (open) trauma cases. Even though a differentiation between putrefactive and traumatic gas accumulations is still difficult, knowledge of the circumstance surrounding the case may help identify the origin of gas.     

外伤后视网膜脱离损伤参与度的法医学分析

目的　探讨外伤后不同类型视网膜脱离的损伤参与度。方法　对２３ 例我室检验的眼外伤后发生视网膜脱离的法医学鉴定案例进行回顾性分析。结果　穿通伤占２６ ％ , 钝挫伤占７０ ％ （ 其中钝挫破裂伤占２５ ％ , 单纯钝挫伤占７５ ％ ） , 无明确外伤史占４ ％ 。单纯钝挫伤后发生视网膜脱离眼均有不同程度的屈光不正, 其中－ ６－００ＤＳ以上的高度近视眼占５８ ％ 。外伤后视网膜脱离损伤参与度的评定为：眼球穿通伤（ 主要是眼球后段的穿通伤） 及钝挫破裂伤后发生视网膜脱离, 其损伤参与度为１００ ％ ; 锯齿缘离断的损伤参与度为７５ ％ ; 伤病共存的损伤参与度为２５ ％ ～５０ ％ ; 原有眼底视网膜、玻璃体变性,外伤为辅助或诱发因素时, 损伤参与度为１２－５ ％ ～２５％ ; 眼部无明确外伤史者损伤参与度为０ ％ 。结论　外伤后视网膜脱离的发生与高度近视眼视网膜、玻璃体发生退行性改变有关。损伤参与度的评定有助于损伤事件的性质分析和损害赔偿范围的确定     

Case analysis of brain-injured admittedly shaken infants: 54 cases, 1969-2001

The English-language medical case literature was searched for cases of apparent or alleged child abuse between the years 1969 and 2001. Three-hundred and twenty-four cases that contained detailed individual case information were analyzed yielding 54 cases in which someone was recorded as having admitted, in some fashion, to have shaken the injured baby. Individual case findings were tabulated and analyzed with respect to shaking as being the cause for the injuries reported. For all 54 admittedly-shaken-infant cases, the provided details regarding the shaking incidents and other events are reported. Data in the case reports varied widely with respect to important details. Only 11 cases of admittedly shaken babies showed no sign of cranial impact (apparently free-shaken). This small number of cases does not permit valid statistical analysis or support for many of the commonly stated aspects of the so-called shaken baby syndrome.     

The analysis of coercive chains between children,mothers, and siblings

The study examines coercive episodes observed between young children, siblings, and their mothers in two samples of families. One sample consisted of aggressive children, the other of nonaggressive children. Aggressive children initiated more coercive chains, especially when the mother and the sibling had been acting neutrally, and engaged in longer chains than normal children. The longest coercive chain occurred when sibling conflict took place in the aggressive group. Findings showed the level of coercive behavior within chains was a function of the initiator of the chain. The initiator had substantially higher levels of negative behavior throughout the chain, compared to the level shown by the recipients of the chains. This held across both samples. Moreover, the initiator was more likely than the recipient to terminate the chain by displaying the last negative response.     

颅脑外伤后假性癫痫的法医学鉴定

通过对2例颅脑外伤后假性癫痫的法医鉴定案例的分析,总结假性癫痫发作的临床特点及外伤后假性癫痫发作与外伤性癫痫发作的鉴别要点。其法医学鉴定应结合颅脑外伤的程度、部位、颅内有无后遗病灶及临床发作特点等综合分析。     

The forensic medical expertise of acute local radiation trauma]

Informative diagnostical criteria of medicolegal evaluation and prognosis of corporal lesion gravity in case of acute local radiation trauma as well as algorithm of medicolegal diagnostical process concerning these lesions with reference to external radiation exposure, kind of injuring factor, differential-diagnostical signs of acute local radiation trauma are suggested. They make it possible to formulate medicolegal diagnosis and can form the basis for developing diagnostical programmes.