二审程序中的法医学再鉴定

随着审判工作的日益科学化、规范化,作为一项诉讼行为的法医学鉴定,在审判活动中所显示的积极作用日渐得到社会的广泛肯定。特别是二审程序中的法医学活体损伤再鉴定的结论,为二审事实的认定和终审的改判提供了科学的依据。现就三例以资说明。例一,徐××,女,35岁,因邻里纠纷被一孕妇打伤。在地方医院作尿常规检验呈“血尿”,故诊断为“肾挫伤”。原法医仅就此鉴定其为“轻伤”。一审法院即以“故意伤害罪”判处被告人有     

20例活体损伤鉴定结论改变原因分析

我院近三年来共受理法医学活体损伤鉴定 4 32 8例 ,其中 2 0例经过二次以上鉴定而且结论前后不一 ,这既失去了法律的严肃性 ,又损害了法医的权威性。为了找出鉴定结论不一致的原因 ,总结工作中的经验教训 ,现将 2 0例活体损伤鉴定结论改变的原因分析如下 ,供同行参考。1　资料介绍　　 2 0例中男性 14例 ,女性 6例。刑事、民事、治安案件 16例 ,交通事故 4例。二次鉴定 16例 ,三次鉴定 3例 ,四次鉴定 1例。经市公、检、法三家法医联合鉴定 12例 ,经省公、检、法三家法医复核鉴定2例。鉴定结果 :原重伤改为轻伤 6例 ,原轻伤改为轻微伤 7例 ,…     

关于进一步规范法医学伤情鉴定的思考

近年来,在门头沟区人民检察院侦监处办理的涉及人身伤害的各类案件中,故意伤害案是最为常见的案件之一。故意伤害案有轻微伤、轻伤、重伤及伤害致死四种结果,而这四种结果均须由法医学鉴定人依法作出鉴定后,方能成为办案的依据。其中法医学鉴定人作出轻微伤、轻伤、重伤的鉴定称为伤情鉴定,不同的人体损伤程度将导致行为人不同性质、不同程度的处罚,也直接关系着采取逮捕强制措施的正确性。     

1例硬脑膜下积液法医学鉴定的探讨

颅脑外伤导致的外伤性硬脑膜下积液(Traumat-ic Subdural hygoroma TSE)在临床上和法医学鉴定中时常遇到,随着CT和核磁共振(MRI)的普及,轻微外伤出现硬膜下积液的病人越来越多[1],甚至无任何外伤而出现的硬膜下积液也时有报道。此病的形成机制尚未形成人们的共识,在临床法医学“轻伤”和“重伤”鉴定标准中也属空白,各地法医同行参照相关的鉴定标准条款做出的鉴定结论有轻微伤、轻伤、重伤、伤害致死,也有的不经鉴定直接调解处理结案,鉴定结论多种多样,处理结果相差甚远[2-4],亟需对此疾病的形成机制及法医学鉴定标准形成统一认识,以利…     

骨密度测定在外伤后骨折法医临床学鉴定中的意义

目的测定外伤后骨折者的骨密度,探讨骨折鉴定中骨质疏松和外伤的关系。方法应用双能X线骨密度吸收仪进行骨密度测定,参照世界卫生组织制定的骨质疏松症诊断标准和外伤参与度评定的一般原理,对15例外伤后骨折者的临床法医学鉴定进行分析。结果15例伤者:男6例,女9例,年龄在43~85岁之间;骨密度值在0.354~1.067 g/cm2之间;7例诊断骨质疏松症,外伤参与度为50%,其中5例评定为轻微伤,2例评定为轻伤;其余8例均为骨量减少,评定为轻伤。结论骨密度测量可预测骨折危险性,有助于骨折临床法医学鉴定的伤病关系分析。     

两地区医疗纠纷法医学尸检鉴定质量的比较研究

目的研究影响涉及医疗纠纷法医学尸检鉴定质量差异的原因。方法两个具有代表性的法医学尸检鉴定机构所涉及医疗纠纷的相关案例,进行字2检验、t检验等统计学研究。结果通过字2检验发现,在设定的10个指标中,有7个指标存在显著性差异,提示两鉴定单位在“涉及医疗纠纷的法医学尸检鉴定”中检验手段和标准、规范性等均存在极大的差异。结论通过研究,提示法医学鉴定人素质、尸检的标准化和规范化、尸检检材的提取标准化、死因或疾病的诊断标准、会诊制度及法医学鉴定书的书写规范化等是法医学尸检鉴定质量控制和管理的重要环节。     

急性闭合性颅脑损伤临床分型与伤情鉴定30例分析

目的 探讨急性闭合性颅脑损伤的临床分型与损伤程度鉴定结果 的相关性,以提高法医学鉴定结果 的准确性,为今后损伤程度鉴定标准的修订提供科学、合理的参考依据. 方法 选取急性闭合性颅脑损伤的鉴定案件30例,分别做出临床分型与损伤程度鉴定,比较两者结果 及相关依据的异同. 结果 轻型颅脑损伤相当于轻微伤或轻伤,中型颅脑损伤相当于轻伤或重伤,重型或特重型颅脑损伤多相当于重伤.结论 急性闭合性颅脑损伤的临床分型与损伤程度鉴定结果 有一定的相关性,在修订人体损伤程度鉴定标准时有必要参考临床分型标准,以提高鉴定标准的科学性和合理性.     

利用气泵伪造鼓膜穿孔致死2例

由于按照《人体轻伤鉴定标准（试行）》的规定，鼓膜穿孔在法医学司法鉴定中可鉴定为轻伤，部分不法分子利用种种手段为他人伪造鼓膜穿孔，获取非法收入。常见的是用尖锐利器刺伤而致鼓膜穿孔。但由于此类穿孔和间接外力所致穿孔在临床检验中有明显差异，近年来此类作案手法又有新的变化，我市就发现2例利用气泵伪造鼓膜穿孔而致死的案例。     

2004年《刑事技术》总目录（期：页）（第165～170期）

法医检验与鉴定　从同一面墙上血滴推断喷溅源位置 1 :30　X染色体与性别鉴定 1 :37　“7·1 6”爆炸案法医工作的体会 1 :48　强奸致阴道后穹隆穿孔 1例损伤程度鉴定 1 :31　两例 2 ,4二硝基酚中毒患者的法医学损伤评定 1 :53　几类特殊损伤的法医学鉴定探讨 1 :54　检验混合斑中女性成份DNA基因型 1例 1 :2 9　产褥期引发精神障碍自杀两例 1 :55　利用犬STR基因座检验认定犬精斑 1例 1 :56　冬季利用蝇蛆推断死亡时间 1例分析 1 :57　 1 91例眶内侧壁骨折损伤的法医学鉴定分析 1 :58　闭合性颅脑损伤致应激性胃溃疡出血死亡 1例 1 :59…     

86例鼻部复合性骨折的法医鉴定

目的探讨鼻部复合性骨折的认定、分型和损伤程度的法医学鉴定.方法对86例鼻部复合性骨折鼻骨CT片（轴扫＋冠扫）和有关病历资料进行观察分析.结果将86例伤者按骨折种类分成鼻骨并发鼻部非鼻骨骨折（81例）和鼻部非鼻骨复合性骨折（5例）两类,然后再进一步细分.结论86例伤者中轻伤80例（93%）,轻微伤6例（7%）.鼻部复合性骨折的损伤程度评定关键在于应按照《人体轻微伤的鉴定》（GA/T 146-1996）和《人体轻伤的鉴定（试行）》的有关规定或标准认定和分型,这样鉴定结论才会准确可靠.     

17例颈椎外伤合并颈椎退行性病变的伤病关系分析

目的研究颈椎外伤合并颈椎退行性病变的法医学鉴定案件特点,探讨如何利用临床资料,法医学检查和影像学检查等对损伤和病变参与程度进行认定等问题。方法收集17例颈椎外伤合并颈椎退行性病变的法医学鉴定案例,对其年龄分布、损伤方式、损伤程度、影像学表现等进行分析,综合评定伤病关系。结果 17例案件以中老年为主。所有案例均存在椎间盘突出,损伤以过伸性损伤为主。按照影像学表现,将损伤程度和脊椎退变程度进行分级,综合计算伤病参与程度。结论颈椎外伤合并颈椎退行性病变的法医学鉴定案件应综合运用临床资料、法医学体格检查和影像学检查结果进行评定。     

眼球钝挫伤后视网膜脱离的司法鉴定

目的分析眼球钝挫伤后视网膜脱离在法医临床学眼损伤及伤残鉴定中的致伤原因及因果关系。方法研究112例眼球钝挫伤后视网膜脱离案例,对其中视网膜裂孔类型、外伤至视网膜脱离时间、合并其他损伤或疾病进行分析。结果本组案例锯齿缘离断4.28%,黄斑裂孔12.50%,其他部位的裂孔(<90°)56.25%,巨大裂孔(>90°)5.00%,未发现裂孔的增殖性玻璃体视网膜病变(PVR)性视网膜脱离11.6%,其中45眼有不同程度的PVR。外伤至视网膜脱离的时间以1周～2个月为常见(61.60%)。合并中高度近视者83.93%,合并玻璃体混浊者52.68%。外伤与视网膜脱离存在直接因果关系者41.07%,存在间接因果关系者52.68%,外伤与视网膜脱离难以联系者6.25%。结论视网膜脱离与多种危险因素有关,外伤与视网膜脱离之间因果关系的分析是法医学眼损伤及伤残鉴定的重要内容。     

虚拟解剖技术的应用研究进展

尸体解剖是法医学传统的、经典的技术手段,但由于需破坏尸体,尸体解剖有时会遭到抵制和排斥。虚拟解剖技术为法医学检验提供了一种非侵入性的检验途径,可客观准确地反映骨折、软组织损伤、创道、器官损伤等,为法医学鉴定实践提供直观有力的证据。本文综合国内外最新文献资料,从虚拟解剖在法医损伤鉴定、机械性窒息、溺死、高低温死亡、疾病诊断及其在法医有限元损伤研究中的应用等方面进行综述,阐述了这一新的法医学研究方向。     

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.     

Teaching post-mortem external examination in undergraduate medical education--the formal and the informal curriculum

In undergraduate medical education, the training of post-mortem external examination on dead bodies might evoke strong emotional reactions in medical students that could counteract the intended learning goals. We evaluated student perception of a forensic medicine course, their perceived learning outcome (via self-assessment) and possible tutor-dependent influences on the overall evaluation of the course by a questionnaire-based survey among 150 medical students in Hamburg, Germany. The majority of students identified post-mortem external examination as an important learning objective in undergraduate medical education and did not feel that the dignity of the deceased was offended by the course procedures. After the course, more than 70% of the students felt able to perform an external examination and to fill in a death certificate. Respectful behavior of course tutors towards the deceased entailed better overall course ratings by students (p<0.001). Our findings highlight the importance of factors such as clearly defined learning goals and course standardization (formal curriculum) as well as tutor behavior (informal curriculum) in undergraduate education in forensic medicine. Furthermore, we suggest embedding teaching in forensic medicine in longitudinal curricula on death and dying and on the health consequences of interpersonal violence.     

宝鸡市358例法医送检器官的组织病理学分析

目的 分析法医尸体检验后送检器官的病理学特征,总结此类案件的特点.方法 对宝鸡市法医送检358例尸体解剖器官标本进行常规检查并进行组织病理学诊断. 结果 358例中以青壮年男性为主,死亡原因主要为创伤、猝死、中毒.组织学能明确死亡原因250例,无典型组织学病变101例,组织自溶腐败7例.病理诊断以心血管疾病为主,其次为呼吸、神经、消化系统疾病. 结论 法医解剖具有专业特点,与病理解剖不尽相同.组织病理学检验进行死亡原因诊断时,应积极与法医沟通,以充分掌握案情、死亡经过及特定的法医病理学特征.     

创伤科病历书写相关缺陷及其对司法鉴定的影响

病历是创伤病人进行司法鉴定的重要客观资料，病历书写中相关缺陷直接或间接影响着司法鉴定活动的正常进行。分析创伤科病历书写中的一些常见缺陷对司法鉴定带来影响，强调提高创伤科医务人员的法律意识及病历书写质量是保证司法鉴定结论客观公正的重要因素之一。     

The effect of ionizing gamma radiation on natural and synthetic fibers and its implications for the forensic examination of fiber evidence

Circumstances of criminal activities involving radioactive materials may mean fiber evidence recovered from a crime scene could have been exposed to materials emitting ionizing radiation. The consequences of radiation exposed fibers on the result of the forensic analysis and interpretation is explored. The effect of exposure to 1-1000 kGy radiation doses in natural and synthetic fibers was noticeable using comparative forensic examination methods, such as optical microscopy, microspectrophotometry, and thin-layer chromatography. Fourier transform infrared spectroscopy analysis showed no signs of radiation-induced chemical changes in any of the fiber structures. The outcome of the comparative methods highlights the risk of "false negatives" associated in comparing colors of recovered fibers that may have been exposed to unknown radiation doses. Consideration of such results supports the requirement to know the context, including the environmental conditions, as much as possible before undertaking a forensic fiber examination.     

A multidisciplinary investigation of chronic animal abuse: Collaboration between veterinary forensics and forensic anthropology

An unknown juvenile female mixed breed dog was found non‐ambulatory on a dead‐end street in an urban setting adjacent to a public park. During initial veterinary examination, she was assessed to have untreatable injuries and was humanely euthanized. The forensic veterinarian requested consultation from a forensic anthropologist to assist with documenting antemortem skeletal trauma. Analyses of skeletal tissues indicated numerous injuries in various stages of healing diagnostic of non‐accidental injuries. Veterinary forensic cases may benefit from collaborative analysis of bony remains by forensic anthropologists.