The forensic medical classification of rib fractures

Classification of rib fractures in thoracic blunt trauma is suggested. Classification accounts for environmental conditions, types of thoracic lesions as well as differential features of fractures. Systematization provides for single terminology to define fractures, it helps to determine mechanogenesis of thoracic trauma and may serve as the basis for compiling diagnostical computer program.     

Diagnostic imaging in cases of suspected child abuse--focus craniocerebral trauma divergent guidelines and resulting problems

For the clinical diagnosis of non-accidental craniocerebral trauma in children there are different recommendations and guidelines, which are not completely consistent. Depending on the examiner, the focus may be on therapeutic relevance, minimization of the exposure to radiation or potential conclusions as to the course of events. Under certain circumstances it may be difficult for the responsible institution to deal with all three perspectives, as is shown by the presented case. From the authors' point of view it would be desirable to work out a common guideline taking into account paediatric radiological and medicolegal aspects.     

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。     

Assessment of hemorrhagic syndrome of the digestive tract in acute poisoning evaluation

Morphologic features and differential diagnostical signs of hemorrhagic syndrome variants in the digestive tract in acute poisonings are described. Medicolegal value, conditions of occurrence as well as some possibilities to prevent gastro-intestinal hemorrhage occurring due to defects when providing medical care in case of poisoning are presented.     

Urgent problems of forensic medical expert evaluation of disability in civil suits

The author discusses urgent medicolegal problems related to evaluation of the degree of occupational disability, necessity of additional diet for victims, which arise in connection with civil actions of persons who underwent non-occupational trauma.     

外伤与流产关系的法医学鉴定

外伤后流产的案例在法医鉴定工作中屡见不鲜,而外伤与流产之间的关系及外伤的参与度问题常常是案件争论的焦点。一方面流产受较多因素影响,尤其是早孕期发生率高,另一方面案情具有复杂性和待推定的特点如外力未直接作用于腹部,外伤轻微通常不至于引起流产、流产儿出现畸形,案情不确定或资料不完整等情况给外伤后流产鉴定带来一定难度。通过对证实已孕、外力作用方式作用机制、伤后症状体征出现的时间特点、孕妇自身流产史及病理基础、流产物病理检查相互佐证分析流产与外伤的关系,得出合理结论。     

The forensic medical diagnosis of the types of vehicle-caused trauma by using mathematical methods and programming systems]

Urgent problems of scientific research on medicolegal evaluation of vehicle trauma were studied. One of perspective ways of increasing scientific control and evidential value of expert conclusion is pointed out. Use of mathematical methods and personal computers in expert evaluation of vehicle trauma is recommended. Expert differential diagnostic system (impact-overrun) developed is described and operating condition of personal computer is given.     

Pitfalls in the Interpretation of Traumatic Socioethnic Practices

The purpose of this case study was to raise awareness among forensic pathologists and medicolegal death investigators regarding two unique socioethnic practices and regional customs that have significant forensic implications. We present two cases involving coining (gua sha) and bloodletting (sapi) that represent two forms of traditional customs that involve the use of blunt force and sharp force trauma, respectively. In coining, the skin lesions are produced as a result of dermabrasion with oils and oval objects such as coin. In sapi, multiple superficial linear scrapes are made in the skin as part of a bloodletting ceremony. The identification of these lesions will prevent the interpretation of them as non‐voluntary‐inflicted trauma.     

Peculiarities of the forensic medical expertise of the head trauma in children

One hundred and forty (140) medicolegal reports were analyzed in cases of non-lethal trauma of the head in children and teenagers. The specificity of the clinical pattern related with the anatomic-and-physiological peculiarities of child's body was defined. The forensic-medical expertise in such damages needs an elaboration of diagnostic criteria (e.g. an interim stage in craniocerebral trauma) that would be valuable both for medico-legal experts and for neurologists; besides, there is also a need in using the modern methods of neuro-visualization.     

Mechanism of formation of spinal injuries

It was stipulated that in medicolegal examination of deaths due to mechanical trauma accompanied by vertebral column separation it is necessary to investigate the surface of separation, which as a rule passes along the verge of the osseous and cartilagnous locking laminae. At the initial stage of avulsion a fragment of osseous lamina of the adjacent vertebral corpus remains fixed to cartilaginous lamina. Taking into account the localization of this fragment one may judge upon the direction of spine flexure.     

Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease

In forensic medicine, there is a need for more sensitive biochemical markers for the post-mortem diagnosis of acute myocardial infarction. A study of the distribution of biochemical markers in different fluids is of great significance in post-mortem diagnosis, because their distribution depends on the location of tissue damage and release kinetics. The aim of this study is to compare the sensitivities and specificities of creatine kinase-MB (CK-MB), myoglobin and cTnI in serum and pericardial fluid for the post-mortem diagnosis of acute myocardial infarction (AMI). We studied 188 cadavers selected during 1 year from medicolegal autopsies. The groups were as follows: (1) myocardial infarction (n = 52); (2) asphyxia (n = 59); (3) multiple trauma (n = 41); (4) natural deaths excluding myocardial infarction (n = 36). We obtained statistically significant differences in pericardial fluid for all the biochemical markers, the highest levels being obtained in the group of cadavers who had died from myocardial infarction. A common factor is the high negative predictive value found in biochemical markers, which is contrary to the findings obtained in clinical practice, when the percentages of sensitivity are very high.     

Is routine histopathologic examination beneficial in all medicolegal autopsies?

Postmortem examinations are performed for a number of reasons. Medical autopsies are performed at the request of and with the consent of the next of kin of a decedent and are often requested to determine the extent of a disease process or to evaluate therapy. In contrast, medicolegal autopsies are performed by a forensic pathologist primarily to determine cause and manner of death but also to document trauma, diagnose potentially infectious diseases and report them to the appropriate agencies, provide information to families about potentially inheritable diseases, provide information to family members and investigative agencies, and testify in court. As medicolegal and hospital autopsies differ in their purpose, so do they differ in procedure. Medicolegal autopsies often include histologic analysis, but not always, as with medical autopsies. We designed a prospective study to address the question of whether or not routine histologic examination is useful in medicolegal cases, defining a routine case as one where histology would not normally be performed and where the cause and manner of death were readily apparent during the gross autopsy. We reviewed brain, heart, liver, kidney, and lung sections on 189 routine forensic cases and compared the results to the gross anatomic findings. Of the 189 cases, in only 1 case did microscopic examination affect the cause of death and in no case did microscopic examination affect the manner of death. Thus, we feel that routine microscopic examination (performing histologic examination in all cases regardless of cause and manner of death) in forensic autopsy is unnecessary. Microscopic examination should be used, as needed, in certain circumstances but is not necessary as a matter of routine.     

An unusual occupational accident: fall into a sewage plant tank with lethal outcome

Occupational accidents, often presenting with lethal outcomes, are a rarely reported issue in forensic literature. However, these incidents are part of medicolegal casework with special regard to reconstruction, liabilities and insurance law-related issues, respectively. We report on a lethal occupational accident in a metropolitan sewage plant. When performing routine controls, a technician fell into an overflow sewer and was immediately pulled into a 30 cm diameter drain. Rescue efforts were initiated immediately, but had to be terminated due to gas warning. Rescue teams continued the search, however, the body remained undiscoverable. Forty-eight hours later, the cadaver was found in an adjacent digester tank, from where it was finally rescued. It was concluded, that the body had been transported between the overflow sewer and the digester tank through a 120 m pipeline with several 90 degrees bendings and branch connections with a minimum diameter of 25 cm at the discharge valve. On medicolegal examination, the cadaver showed marked signs of advanced decomposition caused by anaerobic microorganisms in the 37 degrees C biomass environment. Moreover, as a consequence of the passage of the pipeline system, signs of massive trauma (several comminuted and compound fractures) were disclosed at autopsy. To us, this is the first report on a lethal occupational accident in a sewage plant; our observations demonstrate the rapid progress of putrefaction in a warm anaerobic bacterial environment and the massive trauma sustained.     

An analysis of the medicolegal autopsies performed in Adana, Turkey, in 1983-1988.

Data on 1,000 medicolegal autopsies have been compiled by the Morgue Department of the Adana branch of the Council of Forensic Medicine of Turkey, and have been reviewed to determine the local differences in causes of death, as well as age and sex distributions of decedents, in medicolegal deaths in this region. This is the first report on this subject in this region of Turkey. Unusual categories of death and incidences of death are also discussed. The results of this study show that the number of medicolegal autopsies and the rate of natural death in Adana are quite close to those of some other cities of Turkey and some foreign countries. Contrary findings are revealed in the frequencies of the causes of death.     

Primary intimal sarcoma of the pulmonary artery misdiagnosed as pulmonary thromboembolism: A case confirmed at medicolegal autopsy

Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54‐year‐old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.     

Sudden infant death syndrome (SIDS): a burgeoning medicolegal problem.

This Article presents a summary analysis of the administrative and statutory bases for the documented, prevalent mismanagement of Suddern Infant Death Syndrome (SIDS) cases by a majority of local death investigation agencies in the United States. Herein, Alan P. Cleveland, J.D. advances the theory that the unsatisfactory handling of cases of SIDS by the medicolegal community is the inevitable outgrowth of state laws that expressly require investigative agencies to approach a sudden, unexplained death from the direction of determining first whether or not a criminal act has occurred. In so doing, most statutorily mandated autopsy procedures are socially counterproductive since, in ignoring an acute medical need for supportive family counselling, they often constitute an insuperable obstacle to the effective management of SIDS as a public health problem. The author recommends that a requisite first step in implementing an SIDS management program at the state level is to insulate surviving family members form criminal investigative procedures by appropriate amendment of state laws governing local death investigation systems.     

Death caused by a signal rocket--not an isolated case*

Fatalities related to sporting events are predominantly caused by blunt force injuries especially due to the emotional involvement of crowd, but occasionally other types of trauma are reported as well. A case of very rare trauma caused by shooting with a hand-held parachute signal rocket during a football match is presented. A 17-year-old football fan sustained fatal injuries, a combination of mechanical trauma caused by rocket penetration, as well as extensive thermal burning of the thoracic viscera. Analysis of the event was based on autopsy findings and evidence produced by medicolegal and ballistic experts. Improper use of a hand-held signal rocket, designed for marine distress signals, may cause serious injuries either mechanically, due to explosion, or as a result of thermal discharge. In the reported case, pattern of injuries is discussed, and medical finding corroborated to other available evidence. The presented case is a reminder that the forensic pathologist should be informed accordingly on the type and features of weapon suspected to produce injury, to be able to understand traumatic changes, and look for potential presence of foreign bodies at postmortem examination.     

Medicolegal anthropology in France.

Medicolegal anthropology has a very long history in France. Basic studies on human skeletal remains started as early as the 18th century. The 19th century produced many medical theses and research papers on age, sex, as well as stature estimation. The research proliferated in the first 60 years of the 20th century, much of which is still in use in France and abroad. The later half of the 20th century, however, was dormant in research on human skeletal biology at a time when forensic anthropology was becoming an active field worldwide. In the last decade, medicolegal anthropology took a different perspective, independent of its traditional roots. Research and practice have both been in the professional domain of forensic physicians unlike the situation in many other countries. Population based studies requiring large databases or skeletal collections have diminished considerably. Thus, most research has been on factors of individualization such as trauma, time since death, crime scene investigation, and facial reconstruction. It is suggested that there is a need for cooperation between the forensic physician and anthropologist to further research. This also encourages anthropologists to carry out research and practice that can fulfill the needs of the medicolegal system of the country.     

Correlation of trauma and cause of death to accident reconstruction: a case of a flight accident report.

This paper reports on the disaster that occurred after a flight was hijacked at Baiyuen International Airport in Guangzhou, China, on Tuesday, 2 Oct. 1990. The authors show the results of analyses for the causes of death and trauma and compare the disaster with several previous flight accidents that have occurred in China. The authors show, with the analysis on this accident, the possibility and reliability of reconstructing a disaster by medicolegal investigation.