Spontaneous fractures in the differential diagnosis of fractures in children

A four-year-old male with cerebral palsy and spasticity, as a result of a non-accidental head injury sustained when he was two years old, died of pneumonia. Postmortem full body X-rays revealed fractures of varying ages of the left humerus and both femora, tibiae, and fibulae. This led to a thorough investigation of the case by the Office of the Chief Medical Examiner. Child abuse, accidents, metabolic bone disorders, other primary or secondary diseases of the bones, and pathological fractures were ruled out. The final diagnosis was spontaneous fractures secondary to osteopenia. The term spontaneous fractures is used to define fractures that occur without any known external cause, especially in cerebral palsy patients with spasticity.     

Differential diagnosis of accident and resuscitation traumas

The purpose of this paper is to define the criteria for the differential diagnosis of trauma following resuscitation and road accidents. To this end, 311 cases of thoracic and epigastric trauma were selected from the 2893 medico-legal autopsies carried out between 1979 and 1982 at the Institute of Forensic Medicine of the University of Heidelberg. Cardiopulmonary resuscitation had to be considered as the cause of trauma in 140 of these, but 45 of this group were excluded from further evaluation as they had been the victims of blunt trauma and no clear-cut distinction was possible between trauma resulting from an accident and trauma resulting from resuscitation. Thus, we were left with 95 cases of internal injury that presented as emergencies and in whom death followed resuscitation, as a group for comparison with 171 road accident victims who had not received cardiopulmonary resuscitation. Rib fractures, predominantly on the left side, were established in half the cases resuscitated, sternal fractures also being found in one-third of these victims. Bleeding at various sites, including hemato-thorax, was rare, with an incidence of 15%, thus making it highly unlikely that serious traumas caused by resuscitation were a major factor in the cause of death. This paper encompasses an extensive discussion on serious injuries, such as aortic and gastric ruptures, in this connection.     

论边缘腐败行为——重温江泽民同志以德治国的论述

无论是传统意义上还是一般社会民众的心理上,法律的制裁是惩治腐败的第一要素,尤其是刑事法律高压手段是惩治腐败的最为有力的工具。人们衡量国家惩治腐败的力度,控制腐败的标准,往往是某一阶段我国检察机关所查办的职务犯罪案件的数量。正是基于此,近十年来,人们对不断增长的职务犯罪案件的数量和腐败行为所破坏的社会公平机制,颇有微词。人们往往将惩治腐败不力的原因,较多地自然归为承担查办职务犯罪案件重要职责的检察机关的打击力度不够,或党和国家惩治腐败的决心不     

中国汉族女性腰椎的身高推断

测量中国汉族女性腰椎,建立腰椎推断身高的方法。按人体骨骼测量方法,对第一至第五腰椎的10项指标进行测量,并将各腰椎的测量数据与身高进行相关分析,建立中国汉族女性腰椎推断身高的回归方程。获得的推断身高的5个回归方程,其相关系数(r)和标准差(s)分别为 r_1=0.751,s=45.0171;r_2=0.698,s=48.2804;r_3=0.758,s=43.3508;r_4=0.497,s=56.0890;r_5=0.606,s=53.3158。本研究建立的方法误差小,可以用于中国汉族女性腰椎的身高推断。     

Differential diagnosis of vital and postmortem processes in burn cadavers

After presenting the most important intravitam reactions in 114 burnt corpses of the G?ttingen autopsy material covering the years 1969-83 two cases are described with a) a so called burn haemorrhage in the stomach b) an extremely wide spreading of the upper thighs. Differential diagnosis and forensic significance of these findings according to chemical, histopathological and experimental examinations are discussed.     

基于化学计量法的FTIR鉴别心源性猝死

目的联合应用傅里叶变换红外光谱技术及化学计量法对心源性猝死的大鼠进行鉴别分析。方法注射药物或空气分别诱导大鼠的心源性猝死及空气栓塞死亡模型。应用Nicolet i Z10 FTIR光谱仪采集血清样本的红外光谱,联合OMNIC及Unscrambler软件,基于光谱不同分子吸收区间建立偏最小二乘回归模型。结果基于指纹区(1 200~900cm-1)建立PLS模型,均方根误差和决定系数分别是0.068 3、0.981 3,预测均方根偏差和预测决定系数分别是0.104 8、0.956 1;基于蛋白质酰胺区间(1 720~1 480cm-1)建立PLS模型,RMSE和R2分别是0.058 6,0.986 2,RMSEP和预测R~2分别是0.079 4、0.974 7。综合分析两种模型,蛋白质酰胺区间的RMSEP更小,且预测R2更大,提示其预测效果略好于指纹区间。结论联合FTIR及化学计量法,基于蛋白质及指纹区的分子特征均可有效鉴别大鼠的心源性猝死,其中两种不同死因引起的蛋白质差异更为显著。     

Differential diagnosis SIDS/non-SIDS on the basis of histological findings of petechial thymus hemorrhages

Petechial thymus hemorrhages are found most frequently in SIDS (87%), and very much more rarely in fetuses after abortion and stillbirths (55%) as well as in perinatal deaths (40%). In these groups, there was a uniform histological bleeding pattern with emphasis on the cortical zone. In non-SIDS deaths of natural causes or extrinsic suffocation in babies and infants, it could be demonstrated in 39%. In extrinsic suffocation, the thymus hemorrhages were mostly less pronounced in quantitative terms than in SIDS. In non-SIDS (without extrinsic suffocation), a hemorrhage pattern different from SIDS could be detected with hemorrhagias of different sizes and irregularly distributed over the cortex and medulla.     

Differential diagnosis: blue gastric mucosa. Post-mortem staining of the gastric mucosa with methylene blue

An intense discoloration of the gastric mucosa or the gastrointestinal tract found at autopsy gives rise to the question of its cause. Such discolorations are mostly described in the context of intoxications. However, traditional foods and diagnostic procedures using indicator dyes can also lead to an unusual discoloration of the mucous membranes. The authors report on the autopsy findings in a man who died from a bleeding gastric ulcer and whose gastric mucosa showed intense blue discoloration. Experimental postmortem examinations (on stomachs) were performed with methylene blue, a dye used in gastroenterology, resulting in a blue discoloration resembling the appearance of the stomach in the autopsy case. Together with the outcome of the toxicological analyses, the experiments pointed to a diagnostic procedure using methylene blue (chromoendoscopy).     

Differential diagnosis of traumatic skull findings in infants: residues after vacuum extraction

If autopsy findings in an infant show traumatic changes on the skullcap, these are not always the result of a postnatal trauma due to child abuse, a fall or another accidental event. With regard to differential diagnosis a birth trauma should also be kept in mind, so that the history of the delivery is important. The spectrum of possible residues after vacuum extraction (circular fracture and/or elevation of the outer table of skull bones, subperiostal and intraossal haematoma, extradural and subdural haemorrhage) is demonstrated by means of three examples from the forensic autopsy material.     

Radiographic age estimation based on degenerative changes of vertebrae

Age estimation is an important component of decedent identification. When assessing adult remains, anthropologists frequently use gross examination of skeletal elements, such as clavicles, ribs, and pubic symphyses. For fleshed bodies, this requires the removal of these elements and maceration prior to analysis. A new method was developed using radiographic imaging to estimate age from degenerative changes of the lower thoracic and upper lumbar vertebrae. This technique will complement anthropological age estimation methods in young and middle-aged adults and may serve as a stand-alone method for older individuals. Digital radiographs from 240 medical examiner cases were evaluated. The sample included 120 females and 120 males between the ages of 18 and 101 years. A 3-phased scoring system was used for the target vertebrae. Transition analysis was conducted on binned average scores and a Bayesian approach was used to assign age intervals. At the 90% credible interval, individuals in Bin 1 were under 36 years of age while those in Bin 3 were over 47 years of age. Individuals in Bin 2 showed too much age variation to be informative. No significant differences were found between males and females. These findings will be especially useful in the age estimation of older adults and may eliminate the need for skeletal sampling in medicolegal cases where advanced degenerative changes are radiographically observed in the lower thoracic and/or upper lumbar vertebrae. This method was developed for use on fleshed individuals but may also be applicable to skeletonized remains.     

Bilateral fractures of the coronoid processes: differential diagnosis of intra-oral gunshot trauma and scavenging using a sheep crania model

Approximately half of the skeleton of an adult male (minus the cranium) was found in a forested part of Greater Vancouver, Canada, in August 2000 by the Royal Canadian Mounted Police (RCMP). Authorities ruled the death as suicide. The only compelling signs of perimortem trauma were symmetrically fractured coronoid processes of the mandible, which can be attributed to a gunshot in the mouth. However, the remains had also been scavenged by canids, raising a problem in differential diagnosis. Could canid scavenging produce bilateral fracturing of the mandible indistinguishable from gunshot wounds to the mouth? We found that canid scavengers could not mimic the type of damage to the mandible caused by intra-oral gunshot wounding using a sheep model (n = 20). Bilateral fracturing of the coronoid processes was found to be characteristic of intra-oral gunshot wounding, while canid scavengers typically ignore this region of the mandible.