Asphyxiating death due to basal lingual cyst (thyroglossal duct cyst) in two-month-old infant is potentially aggravated after central catheterization with forced positional changes

There are various causes of possible upper airway obstruction in infants. Particularly, large cysts on the base of tongue may cause severe airway obstruction by a mass effect on the hypopharynx and by displacing the epiglottis. Of these basal lingual cysts, thyroglossal duct cyst is rare but occasionally its remnants can be found at the base of the tongue. Although they are pathologically benign, basal lingual cysts may result in death by asphyxia. There are a few reported cases of asphyxia caused by basal lingual cyst. All died suddenly in the bed or cot while sleeping without any significant symptoms and signs. The authors experienced a unique case of death due to airway obstruction by basal lingual cyst (thyroglossal duct cyst), confirmed by postmortem examination, probably aggravated after central catheterization in 2-month-old infant who had open heart surgery for atrial and ventricular septal defect and report with a literature review.     

The concept of forensic emergency medicine as illustrated by an unusual complication of pulmonary artery catheterization

Forensic pathologists are regularly confronted with emergency and invasive medical procedures performed on critically ill or traumatized patients. Basic knowledge of such procedures and their possible complications is therefore mandatory in medico-legal practice. In this article, we describe a very unusual complication of pulmonary artery catheterization: through-and-through perforation of the carotid artery, initially without hemodynamic consequence. Death resulted from an aggravation of the preexisting cerebral edema (secondary to a craniocerebral trauma). The misplacement of the pulmonary artery catheter was clinically missed because the guidewire was initially deflected on the cervical spine towards the subclavian vein where the catheter--by chance--entered the circulatory system and followed its normal route further. The forensic importance of leaving all invasive medical devices in situ on a deceased person when a medico-legal autopsy is to be expected and the mutual interaction between emergency and forensic medicine (forensic emergency medicine) are discussed.     

Death Due to an Unusual Angio‐Seal‐Related Complication: Case Report and Literature Review

Angio‐SealTM is a vascular closure device (VCD) that can be applied to the femoral artery following cardiac catheterization to achieve hemostasis. Although it has been demonstrated to be superior to conventional manual pressure and to reduce time to hemostasis and patient ambulation, the use of this VCD is not without its complications. In this report, we describe the case of a 55‐year‐old man who died due to an extremely rare event that occurred several hours after the deployment of an Angio‐SealTM VCD: acute complete transverse laceration of the femoral artery that occurred because of the particular fragility of the vessel due to an unrecognized and asymptomatic arteriosclerotic disease. Few data are available in the literature about the incidence of such events, and much more remains to be done to determine how to prevent and manage its occurrence.     

Fatal pyomyositis: a report of 8 autopsy cases

Pyomyositis is an acute bacterial infection manifesting as pyemic abscess formation in the skeletal muscles. We examined 8 autopsy cases (seven males, one female; age range 21-75 years) of fatal nontropical pyomyositis to better describe individual case characteristics and pathologic features of this rare disease. The pathogen most frequently involved was Staphylococcus aureus. In most cases, there were several abscesses and multiple sites involved. The trunk, shoulder girdle, and thigh muscles were most frequently affected and involvement of multiple sites was a common finding. In 6 cases, a recent trauma had occurred to the anatomic location where the pyemic abscesses were found. Three deceased were known as intravenous drug abusers. Except for the presence of pyomyositis, liver diseases such as cirrhosis in 3 cases, and a fatty liver in 2 cases were the most frequent autopsy findings. Death was due to sepsis in all cases. Because pyomyositis may develop in association with intravenous catheterization in the clinical setting, the question whether pyomyositis was caused by an infected or improperly placed indwelling intravenous catheter may be of forensic importance in the light of alleged medical malpractice. According to our observations, severe underlying illnesses seem not always necessary for fatal outcome of pyomyositis. Because a detailed dissection of superficial as well as deep skeletal muscles during autopsy is a prerequisite for the diagnosis, the disease may be overlooked when this essential step is not performed.     

Iatrogenic deaths following treatment for hypertrophic obstructive cardiomyopathy: case reports and an approach to the autopsy and death certification

Hypertrophic cardiomyopathy (HCM) is a disease process which results in a large, heavy heart, with hypertrophy of the interventricular septum (IVS) and left ventricle. HCM accounts for a significant number of cases of sudden cardiac death each year, most infamously in young athletes. The prevalence of the disease has increased over the past several years due to advances in clinical diagnosis and molecular genetic studies. Over this same period, new forms of treatment also have emerged. One such treatment is alcohol septal ablation (ASA). ASA is a procedure performed by a cardiologist, via cardiac catheterization, by injecting pure ethanol into selected arteries which supply the IVS, resulting in a targeted myocardial infarction. This infarct then retracts and forms a scar, decreasing the outflow obstruction and improving the patient's clinical symptoms.The authors report 2 cases of death following ASA treatment of HCM. The first, a 56-year-old male, had his ASA procedure 10 days prior to death. The second decedent, a 76-year-old female, had her procedure only 30 hours before death. These case reports are followed by a discussion about HCM, including pathology, treatments, and treatment-related pathology, before closing with a discussion about death certification in the cases presented and therapy-related deaths in general.     

HLA—A基因座分步PCR—SSP分型研究

目的使HLA基因分型能应用于法医常见检材的个人识别。方法 建立检测HLA—A基因座的分步PCR—SSP方法。先用一对HLA—A基因座特异的引物作第一次扩增,以所得产物为模板,分别用对HLA—A30、A31、A33特异的3对引物作第二次扩增,二次扩增的产物经电泳判型。结果 1130例血清分型为HLA—A30、A31、A33的血痕,其PCR—SSP分型和血清分型的不符合率为29％;室温保存2年的精斑、唾液斑,保存18年的血痕第一次扩增均获得满意的结果。结论法医亲子鉴定和个人识别宜用基因分型替代血清分型。HLA—A基因座分步PCR—SSP基因分型适用于法医检材。     

International Conference on Harmonisation; Stability Data Package for Registration Applications in Climatic Zones III and IV; Stability Testing of New Drug Substances and Products; availability. Notice

The Food and Drug Administration (FDA) is announcing the availability of two guidances prepared under the auspices of the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The first is a guidance entitled "Q1F Stability Data Package for Registration Applications in Climatic Zones III and IV' (the Q1F guidance). The second is a revised guidance entitled "Q1A(R2) Stability Testing of New Drug Substances and Products' (the Q1A guidance). The Q1F guidance, which is an annex to the Q1A guidance, defines an approach for broader use of the Q1A guidance for territories in climatic zones III and IV. The revised Q1A guidance incorporates relevant Q1F recommendations.     

THE MEDIATOR'S ASSESSMENT OF SAFETY ISSUES AND CONCERNS (MASIC): A SCREENING INTERVIEW FOR INTIMATE PARTNER VIOLENCE AND ABUSE AVAILABLE IN THE PUBLIC DOMAIN

Screening for intimate partner violence and/or abuse (IPV/A) in family mediation is important, perhaps particularly among cases without attorney representation. While most mediators agree that it is ideal to consider IPV/A in case planning, there is less agreement regarding the need to universally and systematically screen for IPV/A among all cases. Such attitudes are of concern, given research in other fields (e.g., medicine, couples therapy) and our own research in a family mediation clinic, which documents that the lack of consistent and formal IPV/A assessment results in underdetection of IPV/A. While a variety of IPV/A screening measures exist, each has shortcomings. Thus, our research and clinical experience led us to develop a new IPV/A screening measure, the Mediator's Assessment of Safety Issues and Concerns (MASIC). We discuss features of the MASIC and provide the full measure in the Appendix. The MASIC is a behaviorally specific IPV/A screen that assesses various types of abuse (e.g., coercive control, stalking, physical violence) over the course of the relationship and in the past year. It is administered as an interview to build rapport and assesses lethality indicators and offers optional recommendations for procedural changes in mediation based on IPV/A. Although we have begun relevant research, it is important to note that the MASIC has not yet been validated. Nonetheless, we recommend the use of systematic IPV/A screens in family mediation and suggest that such measures may prove especially important in providing unrepresented parties a safe and appropriate environment for mediation.     

Analysis of DNA multilocus profiles in a paternity case in which the child's profile may be partial

This report describes a simple approach to multilocus paternity analysis for cases where the child's sample may be inadequate leading to a partial profile. A specimen calculation is given. A previous paper described how the various band sharing configurations in the DNA multilocus profiles of a mother-child-putative father trio could be combined in a comprehensive mathematical analysis to give an overall Bayesian likelihood ratio. In that paper, it was assumed that all three members of the trio gave full DNA profiles. In some cases that assumption may not be valid but it is possible to extend the analysis to allow for partial profiles. This paper demonstrates how this may be done by considering the case where the child's profile may be partial for one reason or another. A specimen calculation is given.     

ABO基因分型与多重STR联合检测在法医学中的应用

目的建立ABO基因型和Goldeneye16A试剂盒联合检测的方法,并评价其在法医学实践中的应用价值。方法将6种ABO基因型(A/A,A/O,B/B,B/O,A/B,O/O)的序列特异性引物(PCR-SSP)检测方法与Goldeneye16A试剂盒相整合进行同步分型。通过对460份男性个体血痕样本、9947A DNA及90份案件样本进行检测,考察方法的一致性、灵敏度及对法庭科学检材的适用性。结果应用本文方法可同时检出6种ABO基因型和15个常染色体STR基因座及性别决定基因座,检测灵敏度为125pg,其中ABO基因检测灵敏度达63pg。460份男性血痕和90份案件检材证实该联合分型方法用于各类检材结果准确、稳定。结论本文ABO基因分型与多重STR联合检测方法,适用于各类含有核细胞的生物检材,在法庭科学DNA鉴定中有较好的应用前景。     

Antigenic differentiation of blood stains by the Lewis system in practical forensic medical expert evaluation

A modification of quantitative absorption and absorption elution tests with blood stain washing before the absorption phase is presented. Due to washing, the effect of carrier object on anti-Le(a) and anti-Le(b) sera is decreased and the sensitivity of the method is increased. Additional adsorption of the sera and elution into test erythrocytes treated with protease C is suggested for increasing the number of standard sera fit for the absorption-elution test. A new technology for preparing anti-Le(a) and anti-Le(b) immunoreagents is described.     

Classification of human breast morphology important to bite mark investigation

There is a great range of variability in human breast size and resiliancy that may have an effect upon the interpretation of bite marks. A proper understanding of the normal range of breast morphology and a system of classification is necessary for an understanding of distortion effects, as well as the precise communication of those effects to others. A classification is given for the morphology of the female human breast following a review of the literature.     

International Conference on Harmonisation; evaluation of stability data; availability. Notice

The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "Q1E Evaluation of Stability Data." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). This guidance is a supplement to an ICH guidance entitled "Q1A(R2) Stability Testing of New Drug Substances and Products," which was revised from Q1A(R) and published in the Federal Register of November 21, 2003 (68 FR 65717). It is intended to provide guidance on how to use stability data, generated in accordance with the principles outlined in Q1A(R2), to propose a retest period for the drug substance and a shelf life for the drug product.     

A practical technique for the fabrication of transparent bite mark overlays

A quick, inexpensive, and accurate technique for generating transparent overlays, using office photocopy machines, for use in bite mark case analysis is presented. The critical step in the fabrication process involves determination of the accuracy of the product produced by the photocopy machine. A reliable method for making such a determination is discussed.     

Does Level of Intimate Partner Violence and Abuse Predict the Content of Family Mediation Agreements?

This study investigated whether reported levels of intimate partner violence (IPV) and/or abuse (IPV/A) victimization are related to reaching agreement and to the content of mediation agreements of parties seeking to resolve family‐ and child‐related issues. Whether or not parties reached agreement was analyzed for 105 cases at a law school mediation clinic. Agreement content was coded for the 71 cases that reached agreement. Levels of IPV and IPV/A were determined separately for males and females, using a standardized measure. Regression models were utilized to examine reports of IPV or IPV/A as predictors. Results indicated that mediation may help families with a reported history of IPV and IPV/A address a variety of concerns; levels of partner violence/abuse predicted numerous issues in mediation agreements, including arrangements regarding legal custody, parenting time, holidays, child exchanges, interparental communication, safety restrictions, counseling referrals, child support, financial arrangements, and other miscellaneous topics (e.g., relocation). However, some findings were consistent with concerns raised about the use of mediation with parties reporting IPV and IPV/A; for example, increasing levels of male‐perpetrated IPV/A predicted increased likelihood of making an agreement to share legal custody. Further research is needed to resolve the longstanding debate of whether divorce mediation is an effective and safe process for parties demonstrating IPV/A.

Key Points for the Family Court Community
• This study adds to the debate of whether divorce mediation is an effective and safe process for parties demonstrating IPV/A.
• It examines whether reported levels of IPV and IPV/A victimization are related to reaching agreement and to the content of mediation agreements of parties seeking to resolve family‐ and child‐related issues.
• Results provide some evidence that mediation may help families with a reported history of IPV and IPV/A address a variety of concerns.
• However, some findings are consistent with concerns raised about the use of mediation with parties reporting IPV and IPV/A.
• Findings have implications for the practice of family mediation with parties reporting a history of IPV or IPV/A.

     

Distribution of the AMPFLPs YNZ22, 3′APOB and COL2A1 in the population of Galicia (NW Spain)

Two different electrophoretic methods were used for typing three amplified fragment length polymorphisms (AMPFLPs), (3′ApoB, YNZ22 and COL2A1) in a Galician (NW Spain) population sample. Because of the problems of anomalous mobility for the 3′ApoB system and the intermediate alleles found in the COL2A1 system, the use of automated sequencers and denaturing conditions is recommended for typing these two systems. Nevertheless, simple electrophoretic methods, such as the PhastSystem, can be used for YNZ22 typing. Although intermediate COL2A1 alleles can be distinguished with the sequencers, a binning approach was adopted for comparison purposes. The population sampled was in Hardy-Weinberg equilibrium for the three systems using an exact test. This type of statistical analysis is more appropriate when the number of alleles in a system is high. No significant differences with other Caucasian populations were found for the three systems studied. The characteristics of the polymorphisms, shown by 3′ApoB, YNZ22 and COL2A1, reflected in the statistical parameters studied, demonstrate that these AMPFLPs are of considerable interest for forensic purposes.     

Determination of ABO blood groups by radioimmunoassay using 125I-protein A

Since the crystallizable fragment (Fc) portion of the immunoglobulin G (IgG) molecule is the binding site of Protein A, a radioimmunoassay procedure using 125I-Protein A was developed for identification of the ABO blood groups. The isotope level bound to Group A, B, or AB red cells decreased with the dilution of anti-A or -B, respectively. After sensitization by anti-A plus B in Group O serum, the isotope bindings were observed in Groups A, B, and AB cells, while no significant radioactive count appeared in Group O cells. Furthermore, there was little significant isotope binding in both Group A and B red cells sensitized by the serum from Group A or B blood containing mainly IgM anti-A or -B. A radioimmunoassay using 125I-Protein A is an excellent method for identifying ABO blood groups.     

DNA甲基化检测方法及其法医学应用研究进展

DNA甲基化是表观遗传标记的重要组成部分,参与基因表达的调控,在生物发育、衰老以及肿瘤学等领域受到广泛关注。由于具有相对稳定性、可遗传、含量丰富、随龄变化等特点,在法医学领域,DNA甲基化可以作为DNA序列相关经典遗传标记的有效补充,用于年龄推断、组织体液来源检测、同卵双生子的鉴定等。DNA甲基化的检测方法主要有基于甲基化敏感限制性内切酶、重亚硫酸盐转化以及甲基化CpG结合蛋白等原理而建立的一系列方法,近年研究表明,第三代测序技术也可用于DNA甲基化检测。本文就DNA甲基化检测方法及在法医学领域的应用研究进行回顾与综述,以期为法医学实践提供参考。     

Hair combing to collect organic gunshot residues (OGSR)

A protocol is presented for the collection and analysis of gunshot residues (GSR) from hair. A fine-toothed comb is used for collection of the residues. A small zip-closure bag serves as a container for both sample storage and extraction of the characteristic organic powder additives. The success of this residue recovery approach was tested on simulated shooters and victims using mannequin-supported human wig hair as well as on human shooters. Residues were collected from four weapons: a revolver and semi-automatic pistol, rifle and shotgun. One characteristic additive, nitroglycerin, was detected by capillary electrophoresis (CE) in the majority of the collection experiments.     

A typology of incest and possible intervention strategies

Recent research on incest suggests that it is a complex phenomenon which assumes a variety of forms in different situations. A tentative typology based on prior research and clinical reports is presented. A preliminary framework for recognizing and dealing with various types of incest is outlined and a discussion of intervention and prevention strategies is provided.