246例高坠案件中坠落高度与损伤分析

目的对高坠案件进行统计分析,为相关鉴定研究提供参考。方法收集上海市浦东地区最近十年来记录有坠落距离的246例高坠案件,对人体损伤的特点进行比较分析。结果自杀高坠的高度显著高于意外高坠的高度(25.70m:13.98m);所有高坠中,头部损伤概率较高(75.2%),颈部损伤概率较低(6.5%);意外高坠的头部损伤概率高于自杀组(89.4%:75.2%)。结论意外高坠的死者比自杀高坠的死者更缺乏四肢对于头部的保护;过低的颈部损伤发现率提示国内法医工作者应该更加重视在高坠案件中的对于颈部损伤的检查。     

Decapitation as a result of suicidal hanging

A report is presented on a 47 year old man who committed suicide by hanging himself from a staircase bannister of an apartment house. The man, weighing 144 kg jumped with the noose of a 2 cm thick and 2 m long hemp rope around his neck and was completely decapitated. Death from typical "normal" suicidal hanging is usually due to cerebral ischaemia caused by compression of the carotid (and vertebral) arteries. Except for bleeding at the clavicular insertions of the sternocleidomastoid muscles there are only occasional injuries to the cervical soft parts or hyoid bone and/or laryngeal cartilage. A fall with a noose around the neck, on the other hand, is associated with more frequent injuries to cervical structures through additional axial traction and radial shearing forces of the tightening noose. Complete decapitation can occur in rare cases under extreme conditions (heavy body weight, inelastic and/or thin rope material, fall from a great height).     

Frequency of laryngeal and hyoid bone trauma in nonhomicidal cases who died after a fall from a height

A retrospective study was carried out on 93 autopsy cases who died after a fall from a height. For each case, following parameters were reported: age, sex, manner of death, estimated height of fall, ground type, estimated site of primary impact, type of laryngeal and hyoid bone trauma, presence of associated local trauma in the neck and cephalic region. Mean age of the studied population was about 33 years. Sex ratio (men/women) was 1.8. Mean height of fall was about 15 m. Manner of death was, respectively, suicide and accident in 70 and 23 cases. The type of ground was concrete in 94% of the cases. The site of primary impact was, respectively, head, front of the body, back of the body, feet/lower limbs, and lateral body in 31, 26, 19, 12, and 5 cases. Cervical soft tissue bruising without laryngohyoid fractures was found in 5 cases. Laryngohyoid fractures were found in 5 cases. These fractures could be explained by direct impact of the neck structures against the ground. The mechanism of these fractures could also be indirect fractures due to high muscle strains on the hyoid bone or thyroid cartilage due to cervical hyperflexion or hyperextension or secondary to mandible or cervical vertebral column fractures.     

Esophageal injury in fatal rear-impact collisions

Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma.     

Site of injuries in falls on staircases]

52 autopsy cases in combination with falls on staircases examined in the Bonn Institute of Legal Medicine in 1992 to 2000 were evaluated with respect to the query whether the morphological criteria were valid for reconstruction of the fall, in what way facial injuries were involved and whether isolated trunk injuries caused the death. In 80 per cent of all cases the localization of impact on skull and trunk could be deliminated in regards to heaviness of injuries with fractures and involvement of inner organs. Facial injuries were noticed in 50 per cent and were--as well as arm and leg injuries--caused by strike in fall or after impact. In only two cases in consequence of falls on staircases trauma of the trunk led to death by bleeding.     

Frequency and severity of injuries in correlation with the height of fall

The main aim of this study was to examine the correlation between the height of fall and the frequency, extensiveness, and type of injuries of certain body regions and organs. The specific objective was to determine characteristic injuries of the analyzed body regions in relation to the certain height of fall. The study included 660 cases of fatal falls from height (469 males and 191 females). Results support the hypothesis that the frequency and extent of the injured body regions and organs are related to the fall height. Head injuries are characteristic of the falls from heights up to 7 m and beyond 30 m. Brain injuries in high falls from heights beyond 30 m show an absence of contre coup contusions and macroscopically evident intracranial bleeding. The extensiveness of chest injuries is significantly statistically associated with fall height. In cases of high falls, the frequency of abdominal injuries is not significantly statistically related to the height of fall. Liver injuries are the most common abdominal injury and the critical height of fall at which the liver injury occurs is 15 m. Injuries of liver and spleen are concomitant in high falls from heights beyond 24 m, irrespective of the manner of impact. The height of fall over 15 m appears to be a reasonable boundary height beyond which the injuries of two or three body regions are generally associated.     

Cervical findings and petechial hemorrhages in falls from high positions

Cases of combined suicide are infrequent findings, especially cases in which each method can be lethal. In interpretation of cases with a multitude of serious injuries it might be impossible to discover minor injuries which had occurred in the course of a preceding confrontation, because they may be masked by the general traumatization. In two cases of suicidal fall from a height neck injuries and petechial bleedings were found. The first case (woman 53 years) was a combination suicide (strangulation by ligature, deep incisions into her wrists, jump out of the window). The intensive petechial bleedings in the face could be explained as a result of ligature strangulation and the fracture of a lower thyroid horn as an indirect fracture resulting of the head traumatization. In the second case (girl, 14 years) petechial bleedings in the face were found. Furthermore the victim had marks on her neck-skin, consisting of well-lined bleedings and scratches, presenting a clear pattern, which could be related to a necklace. An explanation of these injuries as a result of a direct impact could not be given. Something must have happened prior the fall. Informations concerning the last hours before her suicide could not be obtained but a strangulation-attempt (by herself? by others?) must be ascertained. The histological investigation of the skin of this region arised a negative vital reaction, therefore a very short interval between that event and the death was assumed.     

Neck injuries caused by automatic two-point seat belts: an analysis of four cases

Although seat belts significantly reduce the extent and severity of injuries sustained by motor vehicle occupants, seat belts are known to be associated with chest and abdominal trauma. Less commonly understood are severe neck injuries caused by the use of two-point automatic shoulder harnesses without concurrent use of a manual lap belt. Such injuries may include cervical spine fractures, craniocervical dislocations and rarely decapitation. Recognizing patterned injuries caused by seat belts and the ability to correlate autopsy findings with the circumstances surrounding the death will allow for correct interpretation of seat-belt related trauma. The four cases described detail fatal neck injuries as a result of improper seat belt use in which an automatic two-point shoulder harness was used without a manual lap restraint. In two of the cases, the victims were decapitated.     

Histologic appearance of fractured thyroid cartilage and surrounding tissues

Histological appearances of the fractured superior horns (SH) of the thyroid cartilage and their surrounding tissues were reviewed, with particular reference to signs of vital origin of the fracture. Twenty-nine autopsies with either histories or findings indicating asphyxial neck compression, with a total of 39 fractured SHs, and three autopsies with history of suicidal jump from height with a total of two SH fractures, were examined. Fifteen autopsies with finding of 19 artefactually fractured SHs while removing neck organs at autopsy were used as controls. In the cases of neck compression and victims of jump from height haemorrhages, retraction of fractured SH fragments with invagination or squeezing of the perichondrium, contraction bands, contraction band necrosis and 'opaque fibres', in the adjacent muscle fibres could be seen. Fibrin deposition and/or leucocytic reaction were noted in cases where circumstances of death indicated prolonged death struggle (as in incomplete hanging, resuscitation or homicidal neck compression). However, retraction of fractured fragments and invagination of perichondrium between artefactually fractured SH fragments were observed in both control cases and cases with antemortem trauma to the larynx. Many of these histological findings, including haemorrhages and fractures had not been evident at gross examination. We conclude that histological examination of SHs may not only uncover macroscopically overlooked injuries but also may facilitate the clarification of an injury's vital origin.     

Azygos vein laceration due to blunt trauma

The azygos vein ascends along the thoracic spine through the mediastinum and drains into the superior vena cava at the level of the fourth thoracic vertebra. Fracture-dislocation of the mid-thoracic spine, as a result of blunt thoracic trauma, can tear the azygos vein. Four such fatal cases (three motor vehicle accidents and one fall) were studied, only one of which was recognized prior to death. The vein can also be torn, in the absence of skeletal injuries, by horizontal acceleration/deceleration forces. The pathologist must consider azygos vein laceration as a possible cause of either hemothorax or hemomediastinum or both in a victim of a blunt chest trauma, if that individual had persistent hypotension during the few hours before death and no identifiable source of hemorrhage can be found postmortem in sites such as the heart, great vessels, lung, and chest wall. A fracture-dislocation of the thoracic spine may not necessarily be present. Azygos vein laceration seems to be an uncommon cause of hemothorax and hemomediastinum; however, this injury is probably more frequent than is implied by the few cases described in the medical literature.     

Fall from height--surprising autopsy diagnosis in primarily unclear initial situations

External post-mortem examination and first police assessments are often not consistent with subsequent autopsy results. This is all the more surprising the more serious the injuries found at autopsy are. Such discrepancies result especially from an absence of gross external injuries, as demonstrated by four examples. A 42-year-old, externally uninjured male was found at night time in a helpless condition in the street and died in spite of resuscitation. Autopsy showed severe polytrauma with traumatic brain injury and lesions of the thoracic and abdominal organs. A jump from the third floor was identified as the cause. At dawn, a twenty-year-old male was found dead on the grounds of the adjacent house. Because of the blood-covered head the police assumed a traumatic head injury by strike impact. The external examination revealed only abrasions on the forehead and to a minor extent on the back. At autopsy a midfacial fracture, a trauma of the thorax and abdomen and fractures of the spine and pelvis were detected. Afterwards investigations showed that the man, intoxicated by alcohol, had fallen from the flat roof of a multistoried house. A 77-year-old man was found unconscious on his terrace at day time; a cerebral seizure was assumed. He was transferred to emergency care where he died. The corpse was externally inconspicuous. Autopsy revealed serious traumatic injuries of the brain, thorax, abdomen and pelvis, which could be explained by a fall from the balcony. A 47-year-old homeless person without any external injuries was found dead in a barn. An alcohol intoxication was assumed. At autopsy severe injuries of the brain and cervical spine were found which were the result of a fall from a height of 5 m. Conclusion: On the basis of an external post-mortem examination alone gross blunt force trauma cannot be reliably excluded.     

Fatal trauma to the neck: immunohistochemical study of local injuries

As fatal trauma to the neck is often associated with short survival times, proof of vitality may often be difficult using standard histochemical techniques. Soft tissue neck injuries resulting from strangulation by ligature or manual strangulation were examined immunohistochemically using antibodies to myoglobin, fibronectin, C5b-9 and MRP14, and compared to controls consisting of accidental soft tissue neck injuries as well as undamaged neck soft tissue. Although survival times in the study and control groups were unknown and certainly some individual variation may be expected in the time course of normal wound development, both the study and control groups demonstrated similar time courses in the immunohistochemical detection of antigen. Myoglobin was always found in those samples in which only one antigen was shown to be involved in an injury-specific pattern; myoglobin and fibronectin were found in samples with dual antigen involvement. Samples involving three antigens always included C5b-9 in addition to myoglobin and fibronectin. The single positive MRP14 sample in the study and control groups was simultaneously positive for the other markers used. Myoglobin, fibronectin, C5b-9 and MRP14 are therefore suitable for immunohistochemical detection of vital reactions and estimation of temporal relationships in the early posttraumatic period after neck trauma.     

行政处罚第三人研究——对一个行政处罚案件的展开

在行政处罚案件中,涉及到第三人的案件大量存在。但是现行行政处罚法中并没有明确地设定第三人制度,这对案件的处理带来诸多障碍。设立第三人制度有利于案件的正确处理,有利于维护第三人的合法权益,有利于处罚决定的接受和执行。第三人的设立符合法律公平正义原则和行政法基本原理,可以降低执法成本及节约社会资源。在行政处罚案件中,法律应赋予第三人具有参与权和救济权等权利,这样便于第三人积极参与行政处罚程序,保证其合法权益的实现。     

Knitted fractures of the laryngopharynx framework as a medico-legal matter

The article presents the analysis of knitted trauma to the hyoid bone and laryngeal cartilages, revealed while searching for fresh fractures of the laryngopharynx skeleton for medico-legal purposes. Neck organocomplexes (n = 440) were completely prepared after fixation in formalin. Old injuries were found in 17.3% of cases, and in 3.2% of cases two elements of the complex were formerly broken. More often there was consolidated trauma to the thyroid (11.4% of cases) and cricoid cartilages (7.3%) and, rarely, to the hyoid bone (1.6%) and cervical part of the trachea (0.2%). These injuries occurred twice as often in men (20.3% of cases) than in women (P < 0.01). Substantiated conclusions are: (1) people of working age are most prone to neck trauma; and (2) from the 1960s the percentage of such traumas in the St. Petersburg region has grown due to urbanization. This article presents data on the localization and morphology of the injuries, as well as a review of symptoms and the course of blunt neck trauma. Despite the difficulties associated with the complete regeneration of injured tissues, forensic pathologists can obtain certain information which police officials may be interested in.     

Traumatic bilateral vertebral artery dissection

Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death.     

Injury pattern on the hand after slipping onto the blade during a knife attack--a contribution to the differential diagnostic classification of sharp force injuries of the upper extremities

Differential diagnosis of injuries caused by accidental slipping of the hand onto the blade of a knife includes self-inflicted injuries (e.g. to simulate an offense) as well as active and passive defense injuries indicative of the involvement of another party. The injury pattern on the hands of five perpetrators who suffered accidental cuts during knife attacks, as seen by the authors during the clinical forensic examination, is presented. The injuries were localized on the ulnar aspect of the thumb facing the index finger, the radial aspect of the index finger facing the thumb and variable sites on the flexor or extensor side of the middle and ring fingers. Especially in those cases in which the injuries of the victim (e.g. involvement of bony structures) and the dominant hand of the perpetrator are known, additional information for the reconstruction of the course of events may be derived from the cut wounds occurring during the knife attack as the hand slipped onto the blade.     

论第三者侵犯配偶权的法律责任

第三者破坏他人的婚姻家庭,影响社会的和谐稳定.但是目前我国法律仅有关于第三者刑事责任的规定,且不尽完善,而尚无关于第三者侵犯配偶权的民事责任和行政责任的规定.第三者的行为符合一般侵权行为的构成要件,应当承担侵权的民事责任.第三者与有配偶者的姘居行为具有严重的社会危害性,应当以破坏婚姻罪论处.此外,第三者与有配偶者的通奸行为扰乱了社会治安秩序,应当承担行政责任.建议我国立法机关尽快修订相关法律,明确规定第三者侵犯配偶权的民事责任和行政责任,完善第三者的刑事责任.     

Skeletal Trauma Resulting From Fatal Low (≤3 m) Free Falls: An Analysis of Fracture Patterns and Morphologies

The skeletal trauma resulting from fatal low (≤3 m) free falls is poorly researched and understood by forensic practitioners. The aim of this study was to identify the types of skeletal trauma resulting from low falls through investigating fracture patterns and morphologies. Skeletal trauma was analyzed using full‐body postmortem computed tomography scans of 145 individuals who died from a low free fall. Trauma was then contextualized to the variables that influence how a person falls using multiple logistic regression. Results showed fracture patterning primarily involved the axial skeleton and that there were a number of patterns significantly associated with the height fallen, pre‐existing health conditions, and age. Analysis of fracture morphologies showed 108 possible fracture types, six of which were significantly associated with the height fallen. Understanding the skeletal trauma characteristic of low free falls will further inform anthropological interpretations of trauma in cases where a fall may be considered the possible mechanism.     

Fulfilling the bargain: how the science of ergonomics can inform the laws of workers' compensation

In the last decade, cumulative trauma disorders have become a significant percentage of reported workplace injuries and litigated workers' compensation claims. Arising from the accumulated impact of daily work activities on the body, these injuries do not fall neatly within either the "accident" or "disease" categories which comprise workers' compensation laws. As a result, courts and legislatures have struggled to properly evaluate workers' compensation claims for these injuries. This Note looks at the legal treatment of cumulative trauma injuries in light of the "original bargain" of workers' compensation, where workers give up a tort remedy against their employers in exchange for guaranteed, but limited, compensation for work-related injuries. In doing so, this Note undertakes a comprehensive comparison of litigated cumulative trauma cases in the tort and workers' compensation systems. Ultimately, this Note argues that judges must use the original bargain as an interpretive less when deciding cumulative trauma cases, and points to ergonomics--the science of the workplace--as a significant new tool for determining whether such injuries are work-related.     

Neck injuries as a reconstructive parameter in car-to-pedestrian accidents

The study has assessed the usefulness of injuries to the ligamentous, muscular and vascular neck structures for deducing about the presumable location of a pedestrian in relation to a motor vehicle at the moment of collision. The localisation of haemorrhagic suffusions in the lower insertions of the scalene (mainly) and sternocleidomastoid muscles has shown a correlation with the direction of the inertia force. No correlation has been observed between the direction of impact and damages to the cervical vascular bundles and the localisation of haemorrhagic suffusions in the upper insertions of the nape muscles. In some cases, injuries to the ligaments of the cervical vertebrae made up the complex characteristic of the direction of acting forces. The injuries of soft tissues and ligaments can, thus, facilitate the deductions about the direction of impact. However, the type of a car involved in the accident and the possibility that these injuries resulted from direct head or neck trauma should be considered.