Diagnostic value of post-mortem examination of the cardiac conduction system

Introduction (Aim)

Sudden unexplained death (SUD) is a common problem in forensic pathology. In many of these cases, the autopsy findings, toxicological examinations and patient history are inconclusive. Many studies suggest that in such cases, the cardiac conduction system (CCS) should be histologically examined. We decided to determine the diagnostic value of histological examination of the CCS.

Methods

We reviewed autopsy files from the period 2005–2007 and selected those cases in which the CCS had been sampled. These were divided into two groups, the first comprising cases with an obvious cardiac pathology (e.g. severe coronary disease, myocardial infarction, significant myocardial hypertrophy/dilatation, valvular disease, etc.) and the second comprising cases without obvious cardiac pathology (i.e. fatal injuries, intoxications and deaths unexplainable by routine procedures). The CCS was sampled according to a detailed protocol and examined under a light microscope. On the basis of the findings of histological examination of CCS, we formed subgroups of the aforementioned main groups.

Results

We analyzed 118 cases, of which 83 were males and 35 females. In 57% of cases, autopsy revealed gross pathological abnormalities of the heart. In 10 (15%) of them, examination of the CCS showed significant pathological changes (narrowing of the nodal artery and its branches, moderate to severe interstitial fibrosis, calcifications in the central fibrous body impinging upon CCS). In some, especially those with no acute findings, CCS disease can be considered to have been the cause of fatal arrhythmias. In 43% of cases, autopsy revealed no gross abnormalities of the heart, while histological examination of the CCS disclosed significant pathological changes in 4 (8%). Among them, CCS disease was regarded as the cause of death in one case and as a possible cause in another case.

Conclusion

As with other similar studies, our study showed that examination of the CCS can provide valuable information on the cause of death. We therefore consider that examination of the CCS should be performed in all SUD cases, especially those in which the cause of death cannot be established by routine procedures. Although we had only 1 confirmed cause of death linked to CCS disease and one possible, we had 14 cases with significant pathological CCS changes. This leads us to the conclusion that post-mortem examination of the CCS is of diagnostic value.     

Reactions to flag desecration in American society: Exploring the contours of formal and informal social control

Although flag burnings today rarely draw the amount of attention they received in the late 1980s, efforts to protect the flag have persisted for nearly a decade. Accordingly, the flag protection campaign has captured the interest of intellectuals from various academic backgrounds, including political scientists, egal scholars, and journalists. Conspicuously absent from the literature on flag desecration, however, are sociologists and criminologists. Combining historical evidence with recent cases, this article unveils key sociological aspects of social control, including formal and informal responses to flag desecration.     

Correlates of formal and informal social/crime control in China: An exploratory study

There are two major ways for a society to control its members, formal and informal. A major goal of both forms of control is to curb criminal behavior. Formal criminal justice control uses the law and official government agencies (e.g., police, courts, and corrections) to ensure compliance. Informal criminal justice control uses morals and social institutions (e.g., family, peers, and neighbors). China has a long history of using informal criminal justice controls. Nevertheless, there has been a movement during the past several decades towards use of formal criminal justice controls. This study examined the level of agreement with both forms of control and the correlates of each form using a survey of Chinese college students. Findings from multivariate analysis indicated that those who held a Confucian belief in law and punishment, those who had a higher distrust of strangers, and those who grew up in rural areas were more supportive of informal control, while those who were majoring in the area of law and male respondents were more supportive of formal control.     

Predictors of desistance among sex offenders: The interaction of formal and informal social controls

Increasing attention is being given to the issue of desistance or cessation in adult criminal careers. We contribute to this research by considering how informal and formal social controls affect recidivism among 556 sex offenders placed on probation in 1992. We conduct an event history analysis of reoffense, based on the predictions of Sampson and Laub's and Gottfredson and Hirschi's control theories. We build on these perspectives by examining how informal social controls condition the effects of formal social controls generally and across offense types. We find less recidivism among offenders with stable job histories, particularly among those in court-ordered sex offender treatment. The results add both to theoretical formulations concerning desistance and recidivism and to policy formulations directed at growing prison populations.     

Forensic medical examination in cases of sexual abuse

The article presents the analysis of forensic medical expert practice in the field of sexual abuse. Drawbacks in expert examinations, official decisions on such examinations, low expertise of forensic medical personnel in sexual crime, lack of tools for genital and anal examination are analysed and methods of correction of this situation are proposed.     

Teaching medical ethics and law

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.     

鼻骨骨折的CT检查及法医学鉴定

鼻骨骨折在头面部损伤中多见 ,以往鼻骨骨折主要依赖于临床检查和Ｘ线拍片确诊。但由于鼻骨两侧对称 ,在侧位Ｘ线片上因影像重叠 ,往往容易漏诊 ,给法医学鉴定带来一定困难。自 1 998年以来 ,我们对于临床及Ｘ线检查疑有鼻骨骨折或骨折移位不明显的伤者 ,进行ＣＴ检查 ,其结果影像清晰 ,诊断明确 ,更容易显示骨折的部位和程度。现将我们检查鉴定的 1 6例报告如下 :方法与结果1 资料 :本组鼻骨骨折 1 6例 ,其中男 1 2例 ,女 4例 ;致伤物均系钝器 ;全部为直接外力作用于外鼻所致。2 ＣＴ检查的方法、体位及影像特点 :(1 )ＣＴ检查鼻骨采用冠…     

鼻骨骨折的CT检查及法医学鉴定

鼻骨骨折在头面部损伤中多见,以往鼻骨骨折主要依赖于临床检查和X线拍片确诊.但由于鼻骨两侧对称,在侧位X线片上因影像重叠,往往容易漏诊,给法医学鉴定带来一定困难.自1998年以来,我们对于临床及X线检查疑有鼻骨骨折或骨折移位不明显的伤者,进行CT检查,其结果影像清晰,诊断明确,更容易显示骨折的部位和程度.现将我们检查鉴定的16例报告如下:     

Forensic medical examination of abrasions in the study of mummified tissues in experiment

Morphological and biophysical characteristics of abrasions and intact skin were studied during the process of their mummification at temperatures from 40 to 70 degrees C. The time after which the injuries become undetectable because color of the skin and injuries coincides, was determined. Changes in configuration and area of abrasions while drying are described. The rate of mummification and duration of the latter were established by dielectric indices of abrasions and skin at 10 cm wave length.     

浅谈人身损害赔偿的医疗费审定

一、医疗费审定在人身损害赔偿案件中的作用在我市的民事审判中,损害赔偿案件要求进行医疗费审定呈上升趋势.从我院法医室三年来进行人身损害、医疗费赔偿审查的案件来看,1995年33例,1996年64例,1997年为96例,共193件,经回执调查结果,原被告均服从鉴定者145例.     

浅谈人身损害赔偿的医疗费审定

一、医疗费审定在人身损害赔偿案件中的作用在我市的民事审判中，损害赔偿案件要求进行医疗费审定呈上升趋势。从我院法医室三年来进行人身损害、医疗费赔偿审查的案件来看，1995年33例，1996年64例，1997年为96例，共193件，经回执调查结果，原被告均服从鉴定者145例。有异议，办案人员进行部分调解顺利结案30例。7例得知鉴定主动放弃或降低原要求赔偿额，尚未采用鉴定即调解结案。余11例未得知最后处理结果。从以上可看出，要求医疗费审查，在民事案件中逐年成倍上升。在提高人身损害赔偿案件的审理水平，客观公正及时地审判好这类案件，…     

中医医疗技术损害侵权鉴定中的证据审查分析简

近些年,随着全民养生保健意识的逐步提高,选择中医治疗的患者越来越多,接踵而来的是因中医医疗技术损害引起纠纷的案件数量的攀升。但目前国内外大多数都是按照西医治疗的标准进行鉴定,一直未形成具有针对性、系统性、统一性的中医医疗纠纷鉴定的标准与原则。本文中,作者旨在结合《侵权责任法》中医疗技术损害责任的相关规定,阐述中医辨证论治的特点,审查分析中医医疗技术纠纷鉴定中的相关证据。     

眼眶骨折的法医学鉴定研究(附50例分析)

目的 研究眼眶骨折的法医特点。方法 从３６５３例损伤程度的法医学鉴定中筛选出涉及眼眶骨折的案例,分成３组：Ⅰ组：爆裂性骨折,眼眶骨折而眶缘无骨折;Ⅱ组：直接骨折,合并眶缘骨折;Ⅲ组：复合骨折,上述两种骨折兼而有之。结果 涉及眶骨骨折５０例。Ⅰ组２６例,占５２％;Ⅱ组１９例,占３８％;Ⅲ组５例,占１０％。爆裂性骨折以内、下壁多见,占９６％,致伤物以钝性工具多见占６３％,视力和眼球结构损伤较重。复合骨