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.     

Elderly sexual offenders admitted to a maximum-security forensic hospital

The purpose of the study was to determine the clinical and demographic characteristics of elderly sexual offenders at a maximum-security forensic hospital. Charts of male elderly patients charged with sexual offenses were reviewed to obtain clinical and demographic data. The majority of sexual offenders had mood or psychotic disorders. Almost one third had a history of violent or assaultive behavior. 57% had significant medical history. A history of violence and sexual assaultive behavior may be risk factors for future sexual offenses.     

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.     

Y-STR基因座应用于刑事案件的独特作用

目的探讨Y-STR基因座在刑事案件中的应用价值。方法采用Y-STR荧光标记复合扩增技术,结合案例应用。结果Y-STR基因座对于涉及男女混合、多名男性混合样本、性别鉴定、父权鉴定等案例中具有特有应用价值。结论Y-STR基因座可应用于法庭科学中的个体识别与同一认定,但在应用中要注意各种特例的发生。     

Approaches to the improvement of forensic medical expertise in the cases of sexual crimes and doubtful gender status

The authors analyzed the results of the forensic medical expertise of the cases of sexual assaults and covert sexual abuse. Special attention is given to the peculiarities of forensic-medical expertise in the cases of veneral diseases and HIV-infection, injuries to sexual organs in women and men. The specific approaches to the examination of corpses in the cases of atypical sexual behavior or a murder supposedly committed for sexual motives are considered.     

The New Trial by Ordeal: Rape Kits,Police Practices,and the Unintended Effects of Policy Innovation

One of the most highly touted improvements in the criminal justice response to rape has been the wide‐scale adoption of sexual assault nurse examiner (SANE) programs that provide specialized medical care and forensic evidence collection to victims. Though previous studies have emphasized the benefits of SANE programs in improving criminal case outcomes, this study illustrates how the post‐rape forensic examination can also discourage reporting, investigation, and prosecution. Interviews with local rape care advocates across the United States show how the increasing emphasis on forensic evidence collected through rape kits may provide an opportunity to reflect and enact persistent law enforcement stereotypes toward sexual assault complainants. Unless police resistance to taking rape seriously is confronted and addressed, even well‐intentioned policy reforms such as SANE programs may end up undermining—rather than enhancing—fair and thorough investigation of sexual assault allegations.     

Determination of sex from the clavicle and scapula in a Guatemalan contemporary rural indigenous population

The clavicle has been described as a useful bone for the metric determination of sex of human skeletal remains in a contemporary, predominantly white, North American forensic sample. In this article, measurements of clavicle and scapula are provided for a contemporary Guatemalan rural indigenous sample of forensic origin. Maximum length and circumference at midshaft of the clavicle, and height and width of the glenoid fossa of the scapula, were measured in 35 female and 62 male clavicles, and in 38 female and 65 male scapulae. Discriminant function analysis was used to study sexual dimorphism in this population with a classification purpose. Leave-one-out method (jackknife) matrices produced classification success rates ranging from 85.6% to 94.8%. A comparison with the North American forensic sample showed low percentages of correctly sexed Guatemalan male clavicles, ranging from 29.4% to 54.9%. The choice of an appropriate standard for the metric determination of sex is a crucial step in forensic anthropology.     

新生儿医疗纠纷相关因素的初探

目的　从法医学和管理学的角度初步探讨新生儿科医疗纠纷的防范与处理。　方法　收集华中科技大学同济医学院法医学系 1994— 2 0 0 2年 8年间 2 7例新生儿尸体解剖案例 ,进行回顾性分析研究。　结果　 2 7例新生儿尸体解剖案例中 ,男性患儿 12名 ,女性患儿 15名 ,平均年龄 18.2 2天。其中围产期 10例。其家属要求均为查明死因。经过鉴定 ,其中医疗事故为 0例 (3 7.0 3 % ) ,不是医疗事故 17例 (62 .97% )。　结论　新生儿医疗纠纷的防范应从医方、患方以及国家与社会 3方面努力进行防范 ;在处理方面 ,及时的尸体解剖和病理检查是解决医疗纠纷一种行之有效的方法。     

Clinical forensic examination findings and legal outcome in cases of suspected sexual child abuse

The clinical forensic examinations conducted at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected sexual abuse of children were evaluated retrospectively and analysed with regard to their legal outcome. In total, the study included 223 children (172 girls, 51 boys) with a median age of 8.6 years. In 34 children (15.2%), forensically relevant diagnostic findings due to anogenital injury and/or detection of semen were recorded. Perpetrators were convicted more often when they were not a member of the victim's family. In cases with victims aged seven years or older, conviction was more common. The study shows that medical findings can best be preserved by an immediate clinical forensic examination. Suspected sexual child abuse can often not be proved by medical examination results, but in some cases diagnostic findings are not mandatory for conviction.     

Case histories in forensic medicine

Case histories make up a great part of publications in forensic medicine, especially forensic pathology, although considered low on the hierarchy of evidence based medicine because of its inherent anecdotal nature. Meanwhile some journals exclude case histories categorically from publication. The boom of case histories in forensic medicine has not only opportunity reasons (easily [even mental] and cheap to do) but also structural reasons: due to its tasks in case work many items of forensic medicine can not be simulated experimentally for ethical reasons (violent death, traumatic injuries, sexual assault, poisonings, influence of alcohol and drugs on driving ability and legal responsibility, medical malpractice, adverse events during medical care). In these fields the role of case histories is mainly the augmentation of experience based knowledge. However, quality aspects have to be considered and case histories should be the basis for systematic or hypothesis based research.     

Self-reported versus diagnosed paraphilias in outpatient sexual offenders

Literature has repeatedly reaffirmed sexual deviance as a risk factor for sexual recidivism, making it an important subject to examine. Yet, not all studies confirm the relevance of sexual deviance and there is a lack of consensus regarding the assessment of it. In the current study, 499 Dutch adult male subjects, admitted for sexual misconduct (possession of child abuse material, child molestation and other types of inappropriate sexual behaviour) to an outpatient forensic treatment facility, were compared regarding sexual paraphilias using self-reports from clients and official DSM-IV-TR diagnoses assessed by professionals. Analyses revealed a relatively low similarity between self-reports and diagnoses, self-reports generating considerably more information. Furthermore, correlating the paraphilias revealed paedophilia associated minimally with the other paraphilias. Lastly, the different types of offenders varied significantly in number of self-reported and diagnosed paraphilias, with the miscellaneous group presenting the most. Considering these outcomes may help assessment and target treatment goals in forensic psychiatry.     

Medical Evidence and Expert Testimony in Child Sexual Abuse

Expert medical testimony in child sexual abuse cases can be critical to the outcome of a legal case. This article will review the development of the medical knowledge and clinical expertise in child sexual abuse. Since the passage of mandatory child abuse reporting laws, the forensic medical examination of a child for evidence of sexual abuse has become standard. Until recently, many myths regarding female genital anatomy existed but were based primarily on dogma and lack of empirical research. Over the past 25 years, many research studies and accumulating clinical evidence have expanded medical knowledge and debunked old myths. Physical evidence, even in cases of alleged genital or anal penetration is rare. Sexually transmitted infections are also uncommon and often require medical interpretation as to their significance in a prepubertal child. Specialized medical knowledge, training, and clinical expertise have developed in order to evaluate children presenting with allegations of sexual abuse. Such medical expertise provides invaluable service to courts. We review criteria for evaluating such expertise in light of current medical practice.     

Sexual assault examinations and forensic medical samples

Recent studies and a review in the United States have identified that tens of thousands of used but untested sexual assault examination kits containing medical examination specimens are to be found in police station evidence rooms, forensic science laboratories, hospitals and rape crisis centres. A 2007 survey undertaken by the National Institute of Justice in the United States explored some of the reasons why forensic specimens are not tested by forensic science laboratories. Many of these relate to lack of knowledge on the part of investigators as to how scientific information can assist the investigation process, even if not used subsequently at trial. Cost factors and laboratory casework overload were also identified as significant. For the medical practitioner, the lack of testing poses issues that include quality management of the forensic medical examination and informed consent in a setting requiring the balancing of public and private benefits for the examinee. Limiting scientific testing, even with intelligence-led triaging of sample testing, could have an adverse effect on both prosecution and defence decision-making and ultimately could adversely affect trial outcomes.     

90例医疗纠纷尸检分析

目的分析、讨论医疗纠纷中法医病理学尸体解剖的重要性。方法收集温州医学院法医学系2001—2008年涉及医疗纠纷尸体解剖案例90例,按照死者年龄、性别、死亡原因及临床诊断和法医病理诊断等要素进行分类整理和分析。结果死者年龄从新生儿至72岁,男女比例为1∶1,医院级别以县级医院较多（30例,33.33%）,临床诊断与法医病理死因诊断符合率为33.33%。结论尸体解剖对涉及死亡的医疗纠纷的正确处理和防范有重要作用。     

Iatrogenic conditions as an object of forensic medical studies

The author proposes an original definition of iatrogenic states and their forensic medical model based on the analysis of the causes underlying the development of these conditions. A rationale for the application of this model in the forensic medical practice is formulated.     

快速突变Y-STRs分子标记的法医遗传学研究进展

Y染色体短串联重复序列在性犯罪案件及父系亲缘关系鉴定中具有特殊的应用价值,但是,采用常规标准的Y-STRs尚不能区分同一父系来源的男性个体。13个快速突变Y-STRs被证明可以相对提高男性谱系分化的分辨率和同一父系男性个体的相对分离,拓展了Y-STRs在法庭科学领域的应用范围和价值。     

Legal aspects of sexual violence—Does forensic evidence make a difference?

A survey was done of 307 alleged victims of sexual violence reported to the police departments in Greater Aarhus, Denmark, in 1999–2004. The legal disposition was ascertained and related to victim and assault characteristics together with the forensic medical and laboratory findings. The police pressed charges in more than half of the cases and 11% turned out to be false allegations. Nineteen percent of all cases ended with sentencing of the defendant. Sperm was detected in 35% of the examined and analysed cases, and in 46% consumption of alcohol prior to the assault was reported. Information in the forensic report regarding injury documentation, intoxication, and detection of sperm and DNA match between victim and alleged assailant did not aid in the prosecution of the case. Severe coercion used by the assailant increased the likelihood of conviction. Intoxication estimation and sperm detection suffered from low sensitivity compared with laboratory analyses. Results suggest the need for new research and optimising the sexual assault examination protocol to strengthen the legal impact of forensic evidence.     

Swollen Lips After a Night of Partying—An Allergic Reaction to Ecstasy?

Ecstasy (MDMA) is a mood‐lifting drug with numerous somatic side effects, for example, dehydration or continuous chewing and biting. We describe the case of a young woman who underwent a forensic medical examination for suspected sexual assault. She claimed to have suffered from a memory lapse, and she had a painful swelling of her lips with a plaque‐like coating on her lips and buccal mucosa. The attending physician suspected that these findings might have been caused by strong sucking pressure on her lips within the context of a sexual assault. A toxicological examination of a blood specimen verified that she had been under the influence of an extremely high dose of ecstasy (1.456 mg/L MDMA and 0.0213 mg/L MDA). Pursuant to the forensic medical assessment, the described findings on her lips, and buccal mucosa were interpreted as an allergic and mechanical reaction (through continuous chewing and biting) to ecstasy.     

Violent women: a multicentre study into gender differences in forensic psychiatric patients

To gain insight into the relatively small, but increasing group of women in forensic psychiatry, a retrospective multicentre study was started gathering information from the files of 275 female patients of four Dutch forensic psychiatric hospitals on characteristics and violence risk factors. Overall, a picture emerged of severely traumatized women with complex psychopathology with multiple previous treatment failures and many incidents during treatment. The present study investigates specific psychiatric and criminal characteristics of female patients by comparing their data to those of 275 male forensic psychiatric patients. Various prominent differences were found, for example, women had more complex histories of victimization, were more often diagnosed with borderline personality disorder, were more likely to commit homicide and arson and less likely to commit sexual offenses, and were more often involved in inpatient aggression than their male counterparts. Several recommendations for gender-responsive treatment and directions for future research are provided.