Anorectal trauma. Medicolegal and forensic aspects

A review of both deliberate and accidental anorectal trauma is presented. The mechanisms and types of injuries as well as the complications are discussed. Injuries resulting from sexual assaults are discussed in detail.     

Audit in forensic pathology

Autopsy numbers in Australian hospitals have declined markedly during the past decade despite evidence of a relatively static rate of demonstrable clinical misdiagnosis during this time. The reason for this decrease in autopsy numbers is multifactorial and may include a general lack of clinical and pathologic interest in the autopsy with a possible decline in autopsy standard, a lack of clinicopathologic correlation after autopsies, and an increased emphasis on surgical biopsy reporting within hospital pathology departments. Although forensic autopsies are currently maintaining their numbers, it is incumbent on forensic pathologists to demonstrate the wealth of important information a carefully performed postmortem examination can reveal. To this end, the Pathology Division of the Victorian Institute of Forensic Medicine has instituted a program of minimum standards in varied types of coroner cases and commenced a system of internal and external audit. The minimum standard for a routine, sudden, presumed natural death is presented and the audit system is discussed.     

Computer-assisted systems for forensic pathology and forensic toxicology

A computer software, R?ttsBASE (RB), was developed for all forensic pathology units in Sweden and introduced in 1992. Simultaneously, a corresponding software, ToxBASE (TB), was developed for the Department of Forensic Toxicology, where all forensic toxicology in Sweden is managed. Both of the databases were created using dBASE IV, and the programming was carried out according to specifications from the staff at the forensic toxicology and forensic pathology units. since the development or RB and TB was coordinated, the systems can run together smoothly. The purpose of both systems was to automate the offices and to enable compilation of detailed statistics. Installation of Novell Netware and ISDN-connections (Integrated Service Digital Network) has enabled rapid communication between the units and easy compilation of nationwide statistics of forensic pathology and forensic toxicology. the systems offer a wide spectrum of reports and include a simple module for evaluation of the importance of the forensic efforts for th whole death investigation. The configuration of the softwares has also enabled processing of a large amount of related toxicological and autopsy data that in turn has yielded a base for compilation of toxicology interpretation lists. This article includes a summary of the features of the software and a discussion of its benefits and limitations.     

Introduction to the forensic pathology of cocaine.

During the last several years, a clearer understanding of cocaine's effects on the body has emerged. Metabolism and tissue distribution are better understood. A diverse group of cocaine-related illnesses have been reported, but many appear to share the underlying mechanism of catecholamine toxicity. Knowledge of cocaine's metabolism makes possible certain conclusions about route of ingestion, time of use, and patterns of abuse in general. Knowledge of the histologic alterations known to be associated with cocaine use can pinpoint cocaine as the cause of death, even in cases where there are negligible blood levels. What follows is a brief review of recent observations that bear on the forensic aspects of cocaine abuse.     

Comparison of the battles at the Little Bighorn and at Isandhlwana. Medicolegal and forensic aspects.

Compared are two great and remarkably similar battles that occurred less than 3 years apart: the U.S. Cavalry versus the Plains Indians in the battle at the Little Bighorn in Montana Territory of the United States, and the British-Zulu battle at Isandhlwana in the Natal Province of South Africa. Computer evaluation, which was especially helpful in evaluating artifacts at the Montana site, could be an excellent tool to use in other such large-scale investigations.     

Estimation of time in forensic biology and pathology. An introductory review

Timing is an extremely important factor in the practice of forensic biology and pathology. This review offers an opportunity for evaluating the time at which an injury could have taken place and thus its chronologic age. Both the macroscopic and microscopic aspects of the injury are discussed. The use of histochemical techniques using the study of enzymes as a basis of the technique is discussed. Histamine and serotonin techniques are also discussed and their applications in practical cases including a traffic accident are presented. The field is discussed and references given in large numbers.     

A proposed dissection procedure for vertebral arteries in forensic pathology

Vertebral artery removing constitutes a significant forensic pathology challenge. Dissection techniques during head-neck autopsy are based on anterior approach, a difficult method, which is unable to assess the transverse part of the artery. This work presents an original and simple method for dissecting vertebral arteries by a posterior approach, opening the vertebroarterial canal through the spinal canal without any special equipment. Once the spinal cord is removed, the transversarium foramens are opened by an internal cut at the pedicle and an external cut at the transverse process. This enables us to visualize vertebral arteries in its entirety. The method improves both the examination of the upper extracranial segment of the vertebral artery and the neuropathological study when arterial injury is suspected. Applying this method routinely is both feasible and useful in suspected cases of vertebral artery trauma and could contribute to assess more precisely the actual incidence of this injury.     

Microwave processing and ethanol-based fixation in forensic pathology

An ethanol-based fixative (FineFIX) has been used, together with rapid microwave-stimulated processing, in postmortem material, resulting in a rapid fixation and processing of the tissues with morphology, histochemical stains, and immunocytochemistry comparable to formalin-fixed material. Furthermore, this alternative fixation gives better DNA recovery in higher amounts if compared with DNA extracted from formalin-fixed tissue, particularly advantageous in forensic pathology.     

Cardiac pathology in 470 consecutive forensic autopsies

Cardiovascular disease continues to be the single most common generic cause of sudden and unexpected deaths. Atherosclerotic coronary heart disease and acute myocardial infarction are the most prevalent forms of fatal cardiac disease observed at autopsy. Other cardiac lesions are frequently listed as causes of death, but the prevalence of such lesions as incidental findings in the general population is unknown. In this study, 470 consecutive forensic autopsies were evaluated for minor and major anomalies. The most frequently observed major congenital finding was floppy mitral valve (5%). Tunneled coronary arteries, considered minor congenital findings, were seen in 29%. Atherosclerotic coronary heart disease was the most common major acquired finding, observed in 16% of cases. Of the 470 hearts, only 8% were considered normal.     

Diseases associated with asbestos exposure. Diagnostic perspectives in forensic pathology

Asbestos, a fibrous mineral, has unique physical and chemical properties, including resistance to heat, acids, and other chemicals; flexibility; and great tensile strength. The fibers subdivide into unit fibrils of molecular dimensions, resulting in a vast mineral surface area which has a direct bearing on its unusual features and its numerous applications. Its biological effects, which include fibrogenesis and carcinogenesis, may be related to the cellular reaction, to its large specific surface, or to the size and shape of the fibers. Its oncogenic action may be multiplied by other carcinogens, principally cigarette smoking. There is clinical, pathologic, and epidemiologic evidence that exposure to asbestos, following a long latent period, constitutes an important health hazard. Direct occupational exposure, followed by a long lapsed period after the initial exposure, is associated with pleural plaques and pleural effusion, pulmonary parenchymal fibrosis (asbestosis), pulmonary carcinoma, pleural and peritoneal mesothelioma, and other neoplasms. Indirect exposure may also entail an increased risk of lung disease or mesothelioma or both. Medicolegal investigation of suspected cases includes a lifetime occupational history, clinical history including smoking habits, radiological findings, clinical evidence of asbestosis, and may require detection of asbestos tissue burden.     

Earlobe creases and coronary atherosclerosis. The view from forensic pathology

In several clinical studies, the diagonal earlobe crease has been statistically related to the presence of ischemic heart disease. Only one study of a relatively small number of hospitalized patients attempts to relate the earlobe crease with amount of stenotic coronary atherosclerosis demonstrated at necropsy. We examined the relationship between the degree of coronary atherosclerosis and the presence of a diagonal earlobe crease in 800 consecutive autopsies performed for medicolegal reasons and thus including a wide spectrum of subjects. Statistical analysis by the chi 2 test demonstrated a positive correlation (p less than 0.01) between the presence of the diagonal earlobe crease and obstructive coronary atherosclerosis narrowing on at least one major coronary artery greater than 75%. We conclude that the autopsy findings support the clinical observations that the diagonal earlobe crease is a cutaneous sign of obstructive coronary atherosclerosis and that the sign should be used accordingly.     

虚拟现实技术在法医病理学中的应用

对虚拟现实技术的概况及其在法医病理中的运用、发展前景进行了综述。文献资料表明:随着手术导航系统、虚拟尸检、显微影像技术等虚拟现实技术的产生发展,这必将对法医病理学的教学、实验、科研及其实际运用产生深远的影响,并将极大推动本学科的发展。但由于软硬条件、成本、费用等的限制,这一技术要真正进入实践运用还需要进一步改进、完善。     

260例“临床医学顾问”会诊案例分析

1992年底,我局在潍坊市益都中心医院成立法医门诊,为了协调与医院各科室的关系,解决临床医学特别是影像学方面的问题,经与医院协商,法医门诊与医院医务科牵头,成立了由医院急诊科、外科、放射科、CT室、检验科、心内科、神经内科、五官科等科室主任组成的 "法医门诊临床医学咨询小组".主要采取预约有关科室专家共同会诊的方式解决法医工作中遇到的疑难问题.1994年、1995年相继在青州市人民医院、青州市中医医院设立了法医门诊,并按照上述模式成立了相关组织并开展工作.1997年为适应新<中华人民共和国刑事诉讼法>(以下简称为<刑诉法>)实施后法医工作面临的新问题,经医院推荐、专家本人同意、法医门诊备案确定人员,由公安局正式行文成立了"青州市公安局法医门诊临床医学顾问小组",由3家医院的与法医工作关系密切的科室的60名专家组成.公安局分管刑侦工作的副局长任组长,并制定了章程,规定了会诊方式,明确了权利、义务和责任.近年来共会诊各种案件260例,取得了较好的成效.现将有关情况报告如下.     

260例"临床医学顾问"会诊案例分析

1992年底 ,我局在潍坊市益都中心医院成立法医门诊 ,为了协调与医院各科室的关系 ,解决临床医学特别是影像学方面的问题 ,经与医院协商 ,法医门诊与医院医务科牵头 ,成立了由医院急诊科、外科、放射科、ＣＴ室、检验科、心内科、神经内科、五官科等科室主任组成的“法医门诊临床医学咨询小组”。主要采取预约有关科室专家共同会诊的方式解决法医工作中遇到的疑难问题。 1994年、1995年相继在青州市人民医院、青州市中医医院设立了法医门诊 ,并按照上述模式成立了相关组织并开展工作。 1997年为适应新《中华人民共和国刑事诉讼法》(以下简称…