Fungal cerebritis from intravenous drug abuse

Three intravenous drug abusers (predominantly cocaine) developed a fulminant fungal cerebritis without any other identifiable predisposing factor. Two died and one survived with a severe neurologic deficit. Zygomycetes (nonseptated fungi) were identified in the brain tissue of two victims and Acremonium alabamensis was cultured from the brain tissue of the third. Fulminant fungal cerebritis in intravenous drug abusers (in the absence of any predisposing illness) may represent a unique variant of the acquired immunodeficiency syndrome (AIDS). Future surviving patients should be evaluated for the possibility of a cellular immune deficiency state in order to confirm this impression.     

Thymus alterations related to intravenous drug abuse.

It has been noticed on forensic material that Hassall's corpuscles of the thymus are more often calcified in intravenous drug abusers than in healthy persons. Thymuses of 15 intravenous heroin addicts were histologically examined and compared with thymuses of 15 healthy persons. Acute bleeding and dystrophic calcification in the thymocyte's parenchyma were more common among intravenous drug abusers (p = .005 and p = .001, respectively). The degree of physiologic involution measured by fatty replacement and the clarity of border between cortex and medulla was equal. No significant diversity was found in the features of Hassall's bodies. Our study emphasizes the necessity for a defined criteria of morphologic changes in the thymus that could be expected in intravenous drug abusers. In that way it would be possible to complete the forensic findings as well as to examine immunologic system alterations of that risk population.     

Fatal pyomyositis: a report of 8 autopsy cases

Pyomyositis is an acute bacterial infection manifesting as pyemic abscess formation in the skeletal muscles. We examined 8 autopsy cases (seven males, one female; age range 21-75 years) of fatal nontropical pyomyositis to better describe individual case characteristics and pathologic features of this rare disease. The pathogen most frequently involved was Staphylococcus aureus. In most cases, there were several abscesses and multiple sites involved. The trunk, shoulder girdle, and thigh muscles were most frequently affected and involvement of multiple sites was a common finding. In 6 cases, a recent trauma had occurred to the anatomic location where the pyemic abscesses were found. Three deceased were known as intravenous drug abusers. Except for the presence of pyomyositis, liver diseases such as cirrhosis in 3 cases, and a fatty liver in 2 cases were the most frequent autopsy findings. Death was due to sepsis in all cases. Because pyomyositis may develop in association with intravenous catheterization in the clinical setting, the question whether pyomyositis was caused by an infected or improperly placed indwelling intravenous catheter may be of forensic importance in the light of alleged medical malpractice. According to our observations, severe underlying illnesses seem not always necessary for fatal outcome of pyomyositis. Because a detailed dissection of superficial as well as deep skeletal muscles during autopsy is a prerequisite for the diagnosis, the disease may be overlooked when this essential step is not performed.     

Jail Calls: What Do Kids Have to Do with It?

For many domestic violence victims, witness tampering continues throughout an abuser’s detention while awaiting court appearance and sentencing, often via phone calls made from jail. A common question we are asked when leading an investigation and providing expert testimony is how abusers involve their children (directly or indirectly) during jail calls. In this commentary, we use three case examples to illustrate how abusers involve their children (directly or indirectly) to further manipulate and tamper with their victim. As the three case examples illustrate, domestic abusers tend to use similar strategies with children during the jail calls as they do with their primary victim (e.g., minimizing the abuse, calling up images of a broken family due to impending charges and sentencing), and tend to triangulate their children against the victim.     

HIV-infection in forensic autopsy cases

Sudden and unexpected death and violent death of persons with a high risk of acquiring HIV-infections, especially homosexual males and intravenous drug abusers, have to be investigated by forensic autopsies. Therefore every forensic pathologist has to be aware of this infection and should try to make the proper diagnosis. Three typical cases are described: (1) suicide by hanging, (2) homicide by cutting the throat and (3) intravenous heroin overdose. Merely retrospectively it could be cleared up that the deceased were homosexual but did not manifestly suffer from AIDS. The morphological findings in the lymph nodes and the postmortem serological findings are described in detail.     

AIDS fatalities in Hamburg (status: February 1985)--legal medicine aspects

The registration of patients with acquired immune deficiency syndrome (AIDS) and AIDS deaths is centralized for medical research. A short review of the epidemiological state of AIDS in Hamburg is given (situation as of February 1985), and the autopsy results of seven postmortem examinations are referred to. Kaposi's sarcoma was seen in four patients and opportunistic infections in all cases, especially as a result of Pneumocystis carinii and cytomegalovirus. Due to the constellation of groups with an increased risk of acquiring AIDS--homosexual males, intravenous drug abusers and prostitutes--forensic implications have to be expected.     

Domestic Violence Abusers: A Descriptive Study of the Characteristics of Defenders in Protection from Abuse Orders in Sedgwick County,Kansas

Protection from abuse orders have been presented in the contemporary literature as one of many tools in protecting battered women. While protection from abuse orders provide legal protection from abuse, many abusers violate these court orders. The current study describes the characteristics of 1,873 alleged domestic violence abusers in Sedgwick County, Kansas. Data were collected from protection from abuse filings over a 12-month time frame. The data were used to examine the demographics of offenders as well as to assess the prior arrests of the offenders. Results showed that abusers were typically white males, average age of 33 with extensive past criminal arrest histories.     

Battered women who kill their abusers: an examination of commonsense notions, cognitions, and judgments

It has been argued that battered women who kill their abusers represent a special class of defendants being unfairly treated in the legal system. As a result, commentators have argued for reforms to permit the judicial system to respond more fairly. Researchers have investigated the influences of these prescribed legal modifications and the possible influence of various demographic and psychological factors on legal reforms. However, social scientists have not yet asked some fundamental, psychological questions. Is the law consistent with what society believes is right and just? Is there a commonsense notion of justice in these cases? What factors constitute cognitive decision rules and influence judgments in cases of battered women who kill their abusers? This study uses a basic, psychological method to identify psychological factors that are important in judgments regarding battered women who kill and to better understand commonsense notions of justice in these cases.     

Death caused by drug addiction: a review of the experiences in Hamburg and the situation in the Federal Republic of Germany in comparison with the literature

Based on criminological experiences and pathomorphological, serological and toxicological studies of more than 300 fatalities, an overview is given of drugs, their intravenous abuse and drug deaths in Hamburg and the Federal Republic of Germany. The number of drug deaths has increased dramatically in Hamburg, where there were more than 50 cases each year in 1987 and 1988. In the F.R.G. approximately 400 cases are registered per annum. The percentage of female intravenous drug abusers is growing and the age of the decedents is increasing. The mean was formerly 25 years, but is now 30 years. Among the histopathological findings, foreign-body granulomas are of special value; infectious diseases, especially hepatitis B and HIV-infection, have to be investigated serologically and morphologically. The prevalence of HIV-1 antibodies among drug deaths in Hamburg is approximately 15%, in comparison with approximately 50% in Berlin. The "supply" of heroin has apparently become so copious that nearly all deaths are caused by overdosage with this substance. An international agreement about a definition of a drug death is a prerequisite for nationwide analyses.     

Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002-2003

Compared with their contemporaries, individuals abusing illicit drugs suffer a higher risk of premature death. In Sweden, a simple protocol for registration of fatalities among abusers of alcohol, pharmaceuticals, illicit drugs, or other substances, has been used by the forensic pathologists since 2001. This routine was introduced to allow for an evaluation of the cause and manner of death, and patterns of abuse among different groups of abusers. We explored the data on drug abusers (i.e. abusers of illicit drugs) subjected to a forensic autopsy 2002-2003. The Swedish forensic pathologists examined 10,273 dead victims during the study period and 7% (743/10,273) of the cases were classified as drug abusers. Toxicological analyses were carried out in 99% (736/743) and illicit drugs were detected in 70% (514/736) of these. On average, 3.8 substances (legal or illegal) were found per case. The most common substances were ethanol and morphine, detected in 43 and 35% of the cases, respectively. When exploring the importance of the different substances for the cause of death, we found that the detection of some substances, such as fentanyl and morphine, strongly indicated a poisoning, whereas certain other substances, such as benzodiazepines more often were incidental findings. In total, 50% (372/743) died of poisoning, whereas only 22% (161/743) died of natural causes. Death was considered to be directly or indirectly due to drug abuse in 47% (346/743), whereas evidence of drug abuse was an incidental finding in 21% (153/743) or based on case history alone in 33% (244/743). We believe that this strategy to prospectively categorize deaths among drug addicts constitutes a simple means of standardizing the surveillance of the death toll among drug addicts that could allow for comparisons over time and between countries.     

Intersection between alcohol abuse and intimate partner's violence in a rural Ijaw community in Bayelsa State, South-South Nigeria

According to the 2008 National Demographic and Health Survey, the south-south zone of Nigeria had the highest prevalence of domestic violence. This study is to find out if this is related to the widespread consumption of alcohol in the region. The study was carried out in Okoloba, a rural Ijaw community in Bayelsa State, where alcohol is produced and consumed in large quantities; using a cross-sectional study design. The data was collected from married or cohabitating adults aged between 16 and 65 years, with a structured interviewer-administered questionnaire. A total of 346 subjects, comprising 187 males, and 159 females were studied. They had an average age of 41.4 ± 2.5 years, were mostly Christians (91.9%), farmers/fisher folk (52.3%), and had at most primary school education (64.2%). More than 90% of the subjects took alcohol in the preceding year, while 36% can be classified as alcohol abusers according to their AUDIT score. More than half (55.8%) were perpetrators of intimate partner violence during the preceding 12 months, with a male-to-female prevalence of 83.4%, and female-to-male prevalence of 23.3%. Out of these, 77.2% were under the influence of alcohol during the act. The violence was more likely to be perpetrated by male alcohol abusers (p-value < 0.001), but there were no significant differences in the educational levels and religion of the perpetrators (p-value > 0.05). The study therefore concludes that there is a link between intimate partner abuse and alcohol abuse in the study community.     

Predicting the occurrence of stalking in relationships characterized by domestic violence

A high correlation has been found between domestic violence and stalking. However, very few studies have examined what factors predict the occurrence of stalking in relationships characterized by domestic violence. Using in-depth interviews with victims of domestic violence whose cases have gone through the criminal justice system, this article explores this issue. It was found that experiences of stalking by their abusers were very prevalent in this group of domestic violence victims. In terms of predicting stalking, domestic violence victims who were not in a relationship with their abuser, whose abusers had an alcohol or drug problem, who experienced more controlling behaviors by their abusers, and who had experienced prior stalking by their abusers were at the greatest risk of experiencing more severe stalking. Implications for intervention are discussed.     

A multilevel comparison of child abusers with nonabusers

An integrative, ecological model developed by Belsky (1980) implies that to understand child abuse researchers must examine factors at four levels: the individual, the family, the environment, and the culture. This study compared abusive and nonabusive parents at three of these four levels. At the individual level, abusers were found to have lower self-esteem than controls. Also, male abusers were likely to be relatively impulsive and hostile. At the level of the family, abusers described their children as more troublesome than control parents, but they did not perceive them as developmentally delayed. At the level of the environment, abusers identified more intense life stressors than nonabusers. Results of this investigation supported Belsky's argument that child abuse involved multiple factors and levels.     

Examining the relationship among substance abuse, negative emotionality and impulsivity across subtypes of antisocial and psychopathic substance abusers

Growing evidence suggests that individuals with Antisocial Personality Disorder (ASPD) can be categorized into theoretically meaningful subtypes. This study builds on earlier cluster-analytic research (Poythress et al., 2010) that identified four subtypes of ASPD in a large sample of prison inmates and offenders ordered into mandatory substance abuse treatment. These four subtypes (primary, secondary, and “fearful” psychopathic and non-psychopathic ASPD) differed in theoretically important ways on various criterion measures. Of those participants in substance abuse treatment (N = 571), we compare the four clusters, as well as non-ASPD substance abusers, in terms of (a) the severity of their self-reported alcohol and drug problems and (b) whether the severity of their substance abuse is predicted by similar etiologically important correlates (i.e., negative emotionality, impulsivity). There were modest subgroup differences in abuse, although as expected secondary psychopaths reported more severe misuse than primary psychopaths. Associations between impulsivity and negative emotionality and drug use for the total sample were in the expected direction, though relatively modest in magnitude. Unexpectedly, these associations were weaker among psychopathic subtypes relative to the non-psychopathic subgroups. These findings suggest that the etiology of drug use may differ across subgroups of chronically antisocial individuals.     

A plan analysis of pedophile sexual abusers' motivations for treatment: a qualitative pilot study

Many authors have suggested adapting treatment programs to the specific needs of sexual abusers. However, little research has been conducted to understand what these patients seek in therapy or what elements play a key role in keeping them in treatment. In this pilot study, fifteen (N=15) pedophile sexual abusers from La Macaza clinic for sexual abusers were interviewed. Plan analysis was used to investigate the most prevalent components involved in staying in or leaving therapy. Results suggest that many components involved in the plans leading to doing and to avoiding treatment were similar. Differences were found in regards to the outcome of confrontations with the therapists, a tendency to isolate and overcomply, guilt related to the abuse, a need for a stable environment, and a need to be accepted. These results are discussed along with possible ways to improve the patients' involvement in treatment.     

Sudden suffocation by surgical sponge retained after a 23-year-old thoracic surgery

A 70-year-old male patient with a 23-year-old history of right lower lung lobectomy for primary pulmonary adenocarcinoma (T1 N0 M0) presented with recurrent bronchopneumonia and purulent sputum. Pleural callus, lung abscess, bronchopleural fistula, and stitch granulomas were confirmed by chest x-ray, computed tomography scan, and bronchoscopy in the background of his complaints. An attempt to remove the bronchial purulent discharge and tissue sampling was made by using a flexible bronchoscope. The area of the lower trachea suddenly became clogged during bronchoscopic removal of the suspected piece of tissue (which later turned out to be organizing surgical gauze). The resuscitation following ventricular fibrillation failed to save the patient's life. The forensic postmortem examination confirmed the position of the foreign body extending from the abscess cavity, crossing the midline at carina and obstructing the lower trachea. This foreign body was a remnant of the surgical gauze left behind during a thoracic surgery 23 years ago.     

The effect of sexual priming cues on emotional recognition in nonviolent child sexual abusers: a preliminary study

This article describes a study that used a computer-based task to investigate the emotional recognition skills of child sexual abusers. The experiment consisted of two phases (prime and probe) and measured both response time and error rates to facial expressions. The priming phase of the experiment consisted of the presentation of short phrases via computer of either sexual or neutral content. The probe phase of the experiment consisted of the presentation of adult facial expressions depicting either the emotion fear or surprise. Results showed child sexual abusers to be slightly less accurate overall. Furthermore, contrary to prediction, the effect of sexual priming appeared to make child sexual abusers actually better at recognizing fearful faces (p = .055). This result is discussed in relation to current victim empathy theory and treatment implications for sexual offenders.     

Incarcerated clients' perceptions of therapeutic change in substance abuse treatment: a 4-year case study

Therapeutic communities (TCs) are a primary approach for treating substance abusers in the criminal justice system. The transformation from residential treatment to a TC marked a significant change in the service delivery and organizational culture for one in-prison substance abuse treatment program. This longitudinal case study examines how clients perceived their treatment as a result of treatment and organizational changes. This is important because the scientific literature shows that client perceptions of their treatment impacts treatment retention and the benefit they gain from treatment. Data that were collected over 5 years are presented. Implications, including how the program's interim therapeutic milieu eased the transition to a therapeutic community, are discussed.     

Personality traits of convicted male batterers

The purpose of this investigation is to determine if select psychological variables are associated with abusive behavior of convicted male batterers. The sample included a treatment group of 75 court-referred abusers who were individually administered the Taylor-Johnson Temperament Analysis (T-JTA) instrument. Explored were: (1) the relationships among personality variables and sociological and demographic characteristics, (2) possible behavioral disorders in our study group of spouse abusers, (3) whether major bipolar personality variables could distinguish our study group from the general population. Results revealed the Taylor-Johnson behavioral disorder types were not useful in identifying distinctions among our spouse abusers. However, a two-factor rotation (Internal/Emotional Balance and Social Interaction) produced results which should be of interest to programs treating batterers as well as provide a suggestive lead for future research. Battering men were found to have a restless proclivity for interaction that will be competitive and conflict-oriented in style. Their impulsiveness further suggests that their interactions will be negative in terms of evocation.     

Japanese Sexual Offenders: A Descriptive Study

Young adult male offenders in Japanese correctional institutions were questioned confidentially about their history of sexual abuse. The self‐reported information showed that when the sexual abuse went undetected, the relationships between abuser and victim were closer, and more victims were reported to be under the influence of substances. At the same time, the nature of the sexual abuse was even more serious among self‐reported‐only (undetected) offenders in terms of direct sexual acts. In terms of unhealthy sexual preference and childhood sexual victimization, sexual abusers reported higher level of problems comparing to nonsexual abusers. Self‐reported‐only sexual abusers identified even more problems than officially identified sexual offenders. The results suggest that when we focus only on the characteristics shown by officially identified sexual offenders, we may overlook important risk and need factors that should be addressed in psychotherapy for preventing future reoffending.