Modern aspects of forensic medical diagnostics of the craniocerebral injury

The authors report the results of the investigations of craniocerebral injuries (CCI) including crystallographic studies of brain liquor obtained after the injury and non-traumatic pathological processes. The additional forensic medical criteria for the severity of craniocerebral injuries have been developed and the objective signs of CCI determined to be used for diagnostic purposes in the cases with concomitant diseases and also in the subjects of advanced and declining age. The diagnostic methods for the elucidation of the nature of chronic subdural hematomas and the estimation of the time of their formation have been improved.     

The morphological characteristics of chronic subdural hematomas

Preparations of chronic subdural hematomas (CSH) obtained during surgery from 29 patients aged 19-50 years are studied. Histological sections were stained with hematoxylin-eosin after van Gieson. Morphological criteria of CSH variants are defined, permitting forensic medical experts to make well-based conclusions on the nature (traumatic or not) of CSH (two types of capsules) and the time when it occurred.     

Morphometric diagnostics of the age of encapsulated subdural hematomas

The present morphometric investigation was carried out using dura matter preparations, capsules, and contents of 94 encapsulated subdural hematomas obtained from the corpses of subjects with a non-penetrating craniocerebral injury and the duration of the post-traumatic period ranging from 8 days to 2.5 years. The correlation analysis confirmed the necessity of differentiation between resorbed and unresorbed encapsulated subdural hematomas. The data obtained were used to construct 5 regression models for the estimation of the age of unresorbed encapsulated subdural hematomas and 1 regression model for the identification of the age of resorbed encapsulated subdural hematomas. The regression models included different combinations of three morphometric characteristics of the hematoma capsule as the independent variables, viz. maximum thickness, relative extent of hemosiderosis, and relative amount of macrophages in the cellular infiltrate. The amount of variability in the age of encapsulated subdural hematomas accounted for by the regression models is 62%. It is concluded that the results of the study can be used in the practical work of forensic medical experts.     

Hypernatremia and subdural hematoma in the pediatric age group: is there a causal relationship?

Several researchers in the 1950's proposed that hypernatremia causes water to leave brain cells, shrinking the brain, thus tearing the bridging veins and resulting in subdural hematomas. Although the old literature suggests mechanisms linking the two in a cause and effect relationship, there is controversy as to whether hypernatremia leads to subdural bleeding or whether the reverse is true. This issue is important for forensic pathologists who must distinguish natural disease from trauma. An etiologic link between hypernatremia and subdural hematomas was suggested recently, and was proposed originally before Kempe's 1962 paper "The Battered Child Syndrome" which widely disseminated the concepts of child physical abuse, and of subdural bleeding resulting from non-accidental injury. Our study is a multifaceted investigation of infants which includes: a literature review, retrospective chart reviews of both living and deceased hypernatremic infants, a retrospective review of infants hospitalized with subdural hematoma, and a prospective collection of head injured, hypernatremic children. We conclude that hypernatremia, if present in association with subdural hemorrhage, is most likely secondary to intracranial pathology, and that hypernatremia often develops in critically ill infants suffering from a variety of medical conditions.     

Forensic medical expertise of injuries in the anorectal region and rectum related to the sexual assault

Injuries to the anorectal region and rectum associated with sexual crimes require forensic medical assessment even though this issue remains to be poorly developed. The results of 84 forensic medical expertises are presented based on the materials obtained by examining both women and men who applied with complains of sexual abuse (anogenital penetration) to the Primorskoye territorial Bureau of forensic medical expertise during 5 years, from 2005 to 2009. The study has demonstrated correlation between dynamics of applications of the victims of either sex and the lack of a tendency toward a decrease in their frequency. The signs characteristic of acute injuries and chronic conditions are described. The causes of diagnostic errors during forensic medical expertise of sexual abuse are discussed.     

Histologic evidence of repetitive blunt force abdominal trauma in four pediatric fatalities

In cases of acute fatal child abuse, certain injuries, including cutaneous blunt force trauma, skull fractures, subdural hematomas, intra-abdominal hemorrhage, and retinal hemorrhages are common and well described in the pediatric and forensic literature. These gross findings at autopsy, when taken into consideration with scene investigation and interviews with caregivers, may indicate both a clear manner and cause of death. In such cases, the discovery of additional pathologic changes attributable to older abusive injuries helps support a conclusion of death due to inflicted trauma. We discuss four cases of fatal child abuse in which acute blunt force abdominal trauma was the cause of death. In each of these cases, careful examination with proper sectioning and microscopy of select abdominal tissues revealed that the acute tissue trauma was superimposed on a background of older, healing injury. This older trauma was characterized by classic histologic elements of tissue repair, including fibroblast proliferation, early scar formation, increased vascularity, and hemosiderin-laden macrophages. Iron and trichrome stains were used to confirm the presence of hemosiderin and fibrosis in all four cases, but the recognition of fibroblast proliferation and a reactive vascular pattern was best seen on routine hematoxylin and eosin stains. The gross and microscopic autopsy findings, along with available investigative information, established the diagnosis of chronic physical abuse.     

Forensic medical evaluation of harm severity inflicted to one's health by slight craniocerebral injuries in the remote period

A pressing problem is discussed: forensic medical evaluation of harm inflicted to health by slight craniocerebral injuries. Analysis of 2150 expert forensic medical and medico-social conclusions revealed serious organization and methodological errors in evaluation of harm inflicted to health by slight craniocerebral injuries. Approaches to improving the quality of such forensic medical expert evaluations are outlined.     

Injuries by chicken bills: characteristic wound morphology.

A 90-year-old woman, hampered in walking, was found dangerously wounded in a farm next to a chicken yard. On the occasion of forensic clinical investigation in hospital we found hematomas and many peculiar injuries of the epidermis and some defects even reaching the extremities of the subcutis and fascia. After experimental investigations we could show that these injuries were caused by the bills of chickens.     

Forensic medical expertise of injuries in the anorectal region and rectum unrelated to attempts at sexual abuse

The results of analysis of 46 commission forensic medical expertises are presented based on the materials concerning injuries and changes in the anorectal region and rectum unrelated to attempts at sexual abuse. The materials were collected and stored by the Primorskoye territorial Bureau of forensic medical expertise during 5 years, from 2005 to 2009. All injuries and changes were categorized into several groups in terms of their origin, viz. car accidents, inadequate medical care, insertion of foreign bodies, falls on sharp and protruding objects, gunshot wounds, chemical and thermal burns, sports training, etc. The occurrence of the injuries is illustrated by the examples from forensic medical practice. It is concluded that experts describing injuries and changes in the anorectal region and rectum must act in conformity with the order of the Russian Ministry of Health No 346 dated October 21, 2010) and use instrumental methods and terminology accepted in modern proctology. The severity of harm to health in subjects presenting with injuries and changes in the anorectal region and rectum should be evaluated in terms of both the degree of the threat to life and the outcome of the treatment with special reference to the duration of health impairment, severity of the trauma, and its consequences (anorectal dysfunction).     

Basic approaches to medical,forensic, and biomechanical studies in expert evaluation of a car injury

Modern approaches to forensic medical expert evaluation of car injuries are discussed. Many problems remain unsolved after examination of injuries in victims inside the car, which negatively tells on the versions suggested during criminal investigation of car accidents. The experts often neglect the most sensitive methods for evaluation of these injuries and many fundamental approaches to the problem: differential diagnosis of primary and secondary injuries; basic medical and biomechanical methods and studies of the clues; fundamentals of total systems evaluation of the results of forensic medical expert evaluation.     

Human remains sold to the highest bidder! A snapshot of the buying and selling of human skeletal remains on eBay, an Internet auction site

Internet auction sites have become increasingly popular, with diverse items up for sale to the public worldwide. The purposes of this paper are to inform the forensic community that human skeletal remains, old and new, are for sale on the eBay internet auction site, and to advise forensic scientists that eBay does not use a forensic anthropologist to assess photographs of these materials. Over the last few years, this website was "surfed," with numerous auctions during this period. After contacting eBay by email, representatives responded that they adhere to Native American Grave Protection and Repatriation Act (NAGPRA) and that their website indicates that auctions must state that sale of human remains is for instructional purposes only. Based on the photographs, the remains appear to be of prehistoric and modern origin. An unfortunate consequence of such sale may generate interest in stealing remains from graves, mortuaries, hospitals, or county morgues worldwide.     

The data on statistical surveillance of recording forensic medical expertises of the harm to human health collected by the Bureau of Forensic Medical Expertise (BFME) in Central Health Department of the Moscow region

This publication deals with the analysis of application of the "Medical criteria for the harm to human health" put into force on September 16, 2008, as exemplified by the work of the Bureau of forensic medical expertise (BFME), Central Health Department of the Moscow region, during the period from 2007 and 2010. The data were borrowed from the materials of departmental statistical reporting (F.42) on forensic medical examinations of the harm to human health carried out during the period between 2007 and 2010. In addition, the statistical report of BFME on the application of the medical criteria in 2010 was used. The number of forensic medical expertises for the estimation of the degree of harm to human health was shown to decrease by 9% but remain 3% higher than the average across the country. The number of expertises of severe harm to the health increased by 15% as in the whole of the country with the concomitant 20% reduction in the number expertises of mild and moderate harm. These trends are unrelated ether to the changes in the frequency of crimes leading to the serious harm to the health or to the number of subjects convicted of such crimes. It was found that p.p. 6.1.1 - 6.1.30 of the "Medical criteria" that list life-threatening injuries are most frequently (in 58% of the cases) used to document facts of severe harm to the health. The same is true of p.p. 6.11. - 6.11.11 listing the injuries responsible for the persistent loss of occupational capacity (by at least one third). The frequency of application of concrete paragraphs of the (Medical criteria, is determined within each group. The largest number of expert errors (3.2%) were committed while estimating serious harm to the health based on the paragraphs listing the injuries responsible for the persistent loss of occupational capacity (by at least one third). The minimal number of such errors (1%) were committed while estimating serious harm to the health from life-threatening injuries.     

Research in forensic neurotraumatology

Over the past 100 years forensic research in neurotraumatology was focusing on the genesis, e.g. biomechanis, and the origin of epidural, subdural, subarachnoidal, intracerebral and brain stem haemorrhage, particularly under aspects to enable the differential diagnosis of bleeding due to non-traumatic diseases. Moreover the estimation of the age of brain injuries has important criminological implications (survival time following traumatic forces to the head, alibi etc.). Beside these main fields of research, aspects of expertise in special areas such as head trauma due to child abuse, capability to act despite severe brain injuries and research on cervical trauma are reviewed.     

麻醉所致神经损伤的确定及损伤机制探讨

硬膜外麻醉后出现神经损伤常常引发医疗纠纷而形成诉讼．在对麻醉后神经损伤病例的鉴定档案资料进行回顾性研究,着重分析神经电生理检查对神经损伤的法医学客观检查与结果判定的作用,结合文献,对麻醉后神经损伤的形成机制进行了探讨,以促进对此类神经损伤法医学鉴定的规范检查、认定及理论探讨。     

Status and prospects in developing morphologic studies in forensic medicine

Modern state of forensic medical morphological studies is analyzed. Main trends of research are reviewed (personality identification, diagnosis of acute alcohol and narcotic poisoning, morphology of craniocerebral injury, development of criteria for identifying the time when injuries were inflicted). Shortcomings in these studies and in practical forensic medical histological service are discussed. Prospects for further studies are outlined.     

Multiple nails in the brain: an unusual suicidal attempt

We describe dangerous multiple self-inflicted brain-penetrating injuries caused by a nail gun device after a suicidal attempt for the first time in Iran. At the first forensic visit, we could not explain the manner of injuries. The authors reviewed the literature on the topics, and clinical presentation, radiographic findings, and forensic medical records are discussed.     

Peculiar approaches to the estimation of the severity of harm to health in children with non-fatal injuries

The medico-legal estimation of non-fatal injuries in the children and adolescents is presented. The data obtained have been used to develop and substantiate the algorithm of forensic medical expertise of such injuries. Scientifically sound criteria have been proposed to be used for the purpose of expert estimation of the severity of harm to health associated with non-fatal injuries taking into consideration their clinical manifestations. The procedures of forensic medical expertise for the estimation of the harm to health have been analysed with special reference to non-fatal injuries in children and adolescents. Main attention was given to the accompanying strategic, organizational, and methodological errors. The approaches to their prevention and correction are described.