Comparing Outcomes for Diverted and Nondiverted Jail Detainees with Mental Illnesses

Jail diversion programs have been proposed for use with persons with mental illnesses. While much support exists for these programs in theory, little is known about their characteristics, the individuals they divert, or their effectiveness. The current study focuses on identifying the characteristics of persons diverted through a court-based program in one midwestern city and their outcomes during the first 2 months after diversion. Information on participants (n = 80) was gathered through detainee interviews, staff interviews, and record abstracts. Two factors appear to be important in diversion: (1) community risk and (2) availability of specialized programs for diverted offenders. Demographic, clinical, and social context variables appear to influence diversion decisions. Overall, the diverted and nondiverted groups did approximately the same upon release, but one third of the nondiverted group never got released during the follow-up.     

Sudden Death Due to Coronary Arteritis

We report the case of a middle‐aged man, without medical history, who suddenly died at his workplace. The autopsy highlighted a pathological heart macroscopically, with multiple small white areas on the left myocardium. Coronary dissection revealed a pseudotumoural fibromyxoid aspect within the anterior interventricular artery (AIVA) and the left main coronary trunk, including reduction in their diameter with tight stenosis. Microscopic examination of these arteries showed fibroinflammatory wall destruction. In the left myocardium, there were multiple focal ischemic areas at different stages of recovery. Our case is an illustration of primary ischemic heart disease due to coronary arteritis, with a pseudotumoural presentation, which was revealed by sudden death. We discuss the cause of death and the etiological diagnosis preceding coronary arteritis.     

Unexpected Death in Elephantiasis Due to an Abnormal Life-Style

Abstract:  A 22-year-old man was found dead after he had continued to sit on a reclining chair for 2 years. He had consumed an unbalanced diet, kept wearing the same pair of socks and never washed himself for the term. His skin of bilateral crura developed into elephantiasis with severely festered ulcers on its surface. At autopsy, subcutaneous edema was significant in his lower limbs, and chronic circulatory disturbance of lymphoducts and veins was observed histologically. There were no crucial findings to account for chronic edema in the lower limbs. It has been reported that maintaining a seated posture obstructs both lymphoducts and veins because of bending the groin, decreases their return flow by inducing muscular atrophy, and causes subcutaneous edema in the lower limbs. Oligotrophia and dirt on his limbs might have exacerbated the chronic edema in elephantiasis. We concluded that a long-term abnormal life-style had caused fatal elephantiasis.     

Death Due to Complications of Anhidrotic Ectodermal Dysplasia

Ectodermal dysplasia comprises a group of disorders affecting ectodermal tissues. Severity depends on the genetic aberration; hyperpyrexia secondary to absence of sweat glands is a common complication. Treatment is supportive. This case report describes a 1‐month, 27‐day‐old male infant with a diagnosis of X‐linked recessive anhidrotic ectodermal dysplasia. On the day of his death, his mother swaddled him in a blanket and placed him on the couch at 5:30 am. When she picked him up at 8:00 am, he was unresponsive. At the emergency department, his rectal temperature was 40°C. Postmortem blood culture was positive for group B streptococcus, a possible etiology for fever. It is vital to teach parents that close monitoring of children with ectodermal dysplasia is necessary, as an increase in body temperature can become life threatening.     

Youth Mental Health First-Aid: Juvenile Justice Staff Training to Assist Youth with Mental Health Concerns

Many youth in juvenile justice settings meet criteria for a mental health condition. Front line staff need to be able to recognize and respond to their needs, but training is often lacking. Youth Mental Health First Aid (YMHFA) is an 8-hour training for adults without mental health education to recognize and assist distressed youth. This study surveyed 1,279 [State blinded] DJS front-line staff trained in YMHFA. Of 338 returned surveys (26% response), 44% reported using YMHFA skills at work, 56% in preventing a crisis, 25% during crises. Respondents rated YMHFA as significantly improving their responsiveness to distressed young people.     

Sudden Death Due to Undiagnosed Rheumatic Heart Disease in a Child

We report the case of a 5‐year‐old boy who died from complications of rheumatic heart disease with atypical presentation. He was hospitalized for recent inflammatory and neurological symptoms. He was diagnosed with viral encephalitis. He died the day after he was discharged. The macroscopic autopsy findings were unremarkable. Histology revealed typical rheumatic heart disease. Neuropathology showed cerebral infarction due to an embolic event linked with the rheumatic valvulitis. The cause of death was determined as heart failure due to rheumatic heart disease secondary to an undiagnosed acute rheumatic fever. It is related to an autoimmune response to infection with group A streptococcus. It mainly affects children in developing countries. In our case, viral encephalitis was consistent with the medical history and the proper diagnosis was made on histological analysis. Forensic pathologists should consider this diagnosis facing a sudden unexpected death in childhood, even in industrialized countries.     

离子通道病所致的心源性猝死与死后基因检测技术

心脏疾病引起的猝死占人类各类疾病所致猝死的首位.多数心源性猝死案例通过尸体解剖、病理组织学检验可以明确死因为心源性疾病,但尚有少数案例虽经过详细检验并高度怀疑为心源性猝死,但仍不能明确检测到可说明死因的心脏疾病.随着现代分子生物学技术的进步,发现此类猝死者中相当一部分属于先天性心肌细胞离子通道疾病所致,主要包括Brugada综合征、长QT综合征、儿茶酚胺敏感性多形性室性心动过速、短QT综合征等.本文对此类疾病的分子遗传学、心电图所见、临床表现和猝死机制以及死后基因检测技术在死因鉴定中的作用进行了详细的阐述,以期为法医学实践中先天性心肌细胞离子通道疾病所致猝死原因的鉴定提供指导.     

精神障碍者受审能力评定量表的编制

目的研制符合中国法律体系的精神障碍者受审能力评定量表。方法从法学要件着手,提取出15个条目,编制出初步的精神障碍者受审能力评定量表,从决断值、条目与总分相关、校正条目与总分相关、条目删除后的α值、条目共同性、因素负荷量6个方面对量表进行条目分析,并以Logistic回归方程与ROC曲线划定界值两种方式进行诊断效能的判断。结果各条目极端组的决断值18.390~46.763,各条目与总分相关系数0.639~0.952,校正条目与总分相关系数0.582~0.944,条目共同性0.377~0.916,因素负荷量0.614~0.957。共7个条目进入回归方程,总样本的回判正确率为96.0%。ROC拟合曲线分析出宜以33分作为量表划界分,与专家鉴定意见的重叠率为95.8%,敏感性为0.938,特异性为0.966,阳性似然比为27.67,阴性似然比为0.06。结论量表编制合理,各条目符合同质性检验要求,诊断性评价指标较好。     

脑外伤所致精神障碍伤残鉴定时机

目的研究脑外伤所致精神障碍伤残相对合理准确的最佳鉴定时机。方法对93例交通事故脑外伤所致精神障碍患者进行伤残鉴定及随访调查,在伤后不同时间段（3、6、9、12月）分别收集患者颅脑影像学、脑电图及详细病史资料,并对患者家属进行调查和对患者进行精神检查及智力量表（Wechsler Intellegence Scale for Adult,WAIS）、社会功能缺陷筛选量表（Social Disability Screening Schedule,SDSS）和日常生活能力量表（Activity of Daily Living Scale,ADL）测验,据此进行诊断及评残。结果ADL、SDSS对不同等级伤残及不同时间段区分良好,整体样本显示患者ADL、SDSS平均值9月与12月无差别。轻度伤残ADL、SDSS平均值6、9、12月无差别,中度伤残ADL、SDSS平均值9月与12月无差别,重度伤残ADL平均值6、9、12月无差别。结论脑外伤所致精神障碍伤残鉴定轻度伤残以伤后6个月评定为宜,中度伤残以伤后9个月评定为宜,重度伤残统计结论显示评残时机为伤后6个月,但综合分析认为重度伤残以伤后9个月评定为宜。     

Sudden Unexpected Death Due to Graves' Disease During Physical Altercation

We report a case of a 30‐year‐old woman who suddenly collapsed after having a physical altercation with her husband. Despite immediate resuscitation, she died on arrival at the hospital. The victim's parents requested an autopsy because they believed that their daughter was killed by her husband. Postmortem examination revealed that the victim had a diffusely enlarged thyroid gland and cardiomegaly with left ventricular hypertrophy. There was no evidence of significant trauma on the body. Further postmortem thyroid function tests and review of her medical history indicated that her death was due to Graves' disease. To the best of our knowledge, this is the first case reported of sudden death due to cardiac arrhythmia from Graves' disease induced by physical and emotional stress associated with the criminal activity of another person. The autopsy findings are described. In addition, the literature is reviewed and the significance of postmortem evaluation of thyroid hormones in the cases of sudden death is discussed.     

Death Due to Isolated Jejunal Tear Following Blunt Abdominal Trauma

Small intestinal injury following blunt abdominal trauma has been widely reported. Isolated jejunal tear which is caused by blunt abdominal trauma is rare and is most often seen in road traffic accidents. Here, we report a case of isolated jejunal tear in a 24‐year‐old male truck driver. He was admitted to a tertiary care hospital in a South Indian Metropolitan city with complaints of acute abdominal pain and tiredness following alleged accidental blunt trauma sustained to abdomen due to steering wheel impact. An isolated jejunal tear and adjacent mesenteric contusion and tear were missed by the treating physician even after preliminary investigations, and thus, the conservative management was instituted. The condition deteriorated gradually, and he succumbed to death. The autopsy revealed transverse tear of jejunum almost involving whole of its circumference on the antimesenteric border and peritonitis. Proper use of radio‐diagnostic techniques and timely undertaken explorative laparotomy would have saved the life.     

Death Due to Coronary Artery Insufficiency Following Blunt Trauma to the Chest

There have been numerous reports of sudden cardiac death following blunt trauma to the chest, but there is lack of such references in forensic literature. It is the court of law which makes decision about trauma precipitating natural events. The forensic pathologist is scientifically trained in the medical field and would be in a better position to give clear picture about the victim's general status at the time of death, exact nature and severity of the illness he is suffering from if any. He can also assess the nature and severity of injuries sustained, and thus, his opinion as to the possible role played by the traumatic event in bringing about the death is valuable. This paper will discuss the mechanism of cardiac injury or possible cardiac injury and sudden death of an apparently healthy 36‐year‐old male following blunt chest trauma sustained during alleged assault by his neighbor.     

A Case of Sudden Infant Death Due to Incomplete Kawasaki Disease

Although Kawasaki disease (KD) is a self‐limiting disease, it may cause sudden cardiac death. Diagnosis of KD is principally based on clinical signs; however, some infant cases do not meet the criteria. Such cases are identified as incomplete KD. The sudden death risk in incomplete KD cases is similar to conventional KD. In our 5‐month‐old case, he had been admitted to a hospital for a fever and suppuration at the site of Bacille de Calmette et Guerin (BCG) vaccination. However, after discharge from the hospital, his C‐reactive protein (CRP) levels declined, he got indisposed and died suddenly. A medico‐legal autopsy revealed myocarditis, coronaritis, platelet‐aggregated emboli in coronary arteries, and myocardial degeneration, suggesting that the fatal myocardial infarction was due to thrombus emboli in the coronary arteries. Forensic pathologists therefore should pay attention to the cardiac pathology originated from incomplete KD as a potential cause in cases of sudden infant death.     

交通事故中脑外伤所致精神障碍与精神伤残相关因素分析

目的分析交通事故致颅脑损伤后精神伤残等级评定的相关因素。方法收集157例交通事故致颅脑损伤后精神伤残的鉴定案例,根据鉴定结论分为轻度组、中度组和重度组。对3组的一般人口学资料、临床病史资料、鉴定资料进行比较,并以上述资料为自变量,以组别为应变量,进行logistic回归分析。结果3组一般人口学资料的差异均无统计学意义（P〉0.05）,而昏迷时间、颅内出血区域大小、工作能力、家庭职能、社交功能、生活自理能力、智商的差异有统计学意义（P〈0.05）。颅内出血灶、家庭职能、社交功能、生活自理进入logistic回归方程。结论颅脑损伤的严重程度对后遗精神伤残有一定影响,鉴定时伤者的家庭职能、社交功能和生活自理是决定伤残等级的主要因素。     

Juvenile Mental Health Court: Rationale and Protocols

Under the sponsorship of the judiciary, the Santa Clara County, California Juvenile Court, in partnership with the Juvenile Mental Health Department and a technical assistance agency (SOLOMON), has pioneered a Juvenile Mental Health Court for seriously mentally ill children who have become involved in the criminal justice system. The judiciary, probation department, district attorney, public defender, county counsel, and service providers have collectively embarked upon the implementation of a modern approach to mental health diagnosis, triage, and treatment services for youth and families who come in contact with the justice system as a result of the combination of serious mental illness and juvenile delinquency. This article presents the court's rationale and protocols.     

Sudden Death Due to Recent Hemorrhage From an Intrathoracic Chronic Expanding Hematoma

Chronic expanding hematoma (CEH) is a rare disease that can develop in any region of the body, but it most frequently develops in the thorax. When intrathoracic CEH is left untreated, gradually expanding hematoma can be life‐threatening, leading to respiratory failure or hemoptysis. We encountered an 89‐year‐old man with cardiopulmonary arrest on arrival. He had been healthy, and it was unclear whether CEH had previously been detected. A very large mass was observed on chest computed tomography (CT), but the cause of death could not be determined. In the autopsy, this mass was identified as CEH and no malignant findings were noted. A fresh hemorrhage had occurred in the hematoma and perforated the bronchial lumen, which caused airway obstruction/asphyxia and resulted in sudden death. CEH should be suspected when a very large tumorous lesion occupying the entire hemithorax is observed on chest imaging, and it is important to recognize that sudden death can occur in the natural course of CEH.     

Sudden Death Due to Primary Intraventricular Hemorrhage: Report of Two Cases

Primary intraventricular hemorrhage (PIVH) is a rare type of stroke defined as bleeding within the ventricles of the brain without any associated parenchymal hemorrhage. Here, we reported two cases of sudden death due to PIVH. One of the patients was found dead under a highway bridge without witnesses, and the other patient was hospitalized with hemorrhage in the ventricular system, as revealed by a head computed tomography scan. In these two patients, autopsy and macroscopic examination only showed hemorrhages in the ventricular system without any traumatic brain injury or other intraparenchymal hemorrhage. The sources of bleeding for both patients were ultimately confirmed as ruptured brain arteriovenous malformations located in the subventricular zone. We reported these cases to broaden our understanding of sudden death associated with PIVH, especially when caused by brain arteriovenous malformation. We also summarized the essential details of the diagnoses and available technical methods for PIVH cases.