Disorders of sexual preference and medicolegal issues thereof

Disorders of sexual preference or paraphilias are bizarre patterns of sexual behavior that have diverse manifestations and are of complicated sexual orientations. Some of these are harmless, while others are not, robbing sufferers and possibly their partners of loving sexual relationship. At least 40 paraphilias have been named, but the full extent of the field, perhaps, is still undiscovered. Recent studies have reported many paraphilias as long-term effects of sexual abuse in childhood, and the more frequent and persistent the abuse is, the worse the long-term psychologic, behavioral, and relationship problems. Psychopathology within this group of disorders may lead to criminal behavior, ranging from infringement of decency to some of the most heinous crimes known.     

The narrow spinal canal - medicolegal aspects (author's transl)]

The constitutional anomayl of a narrow spinal canal was found in a neuroradiological department in 31 cases. The cervical stenosis can be defined in the following way: Inside diameter of cervical canal (anterior-posterior) in relation to diameter of vertebral body. In normal cases the quotient is over 1 - in pathological narrowing under 1. Clinical symptoms mainly appear from 45th year onwards, when reactive-degenerative changes increase the space problem. In wiplash injuries or other adequate cervical trauma 7 cases were seen and described with acute incomplete tetraplegia or/and multilocular lesions of cervical roots, resulting from cervical stenosis combined with degenerative changes in 6 patients. Myelography revealed multilocular deformities of the spinal subarachnoidal space in the abnormal narrow cervical canal. The referred cases were not complicated with forensic aspects. The prognosis quod sanationem was poor. A chronic cervical myelopathy results. Pretraumatic clinical alterations of cervical roots and/or the myelon in the referred cases were absent, existing in other patients. Predominantly men and hard working people with narrow cervical canal became ill. Early symptoms were pain in extremities. Dysesthesia and loss of sensation combined with signs of pyramidal lesion occured later. Defects in nerve roots sometimes overlayed the myelon symptoms. Unspecific CSF-Alterations were common. The EMG showed abnormalities in cases of root involvement. Operative treatment was tried to remove the reactive processes, but could not alter the constitutional anomaly. The resulting immobilisation of myelon and nerve roots involves in the case of trauma a direct mechanical lesion and secondary vascular complications via Arteria vertebralis, spinalis anterior and radicularis, namely in patients with degenerative alterations of the cervical spine, these including a further narrowing behind the constitutional anomaly. Our experience seems to recommend that more attention should be paid a cervical narrow spinal canal in medicolegal implications.     

Acid violence: a burning issue of Bangladesh--its medicolegal aspects

Throwing acid on others' face and body to cause grievous injuries is a barbaric act of vengeance. For the last few years, it has been on the rise in both urban and rural areas of Bangladesh. The perpetrators are mostly men and adolescent boys. The victims are girls and young females. The reasons for attacks are sexual advances from man, refusal of marriage proposal, and vengeance. Cheap and easy availability of acids makes it the most effective weapon for man to use against girls' or young women's faces to prove that they have no right to deny a man's proposal and is one of the extreme forms of repression and violation of women's right. The consequence of acid attacks on survivors brings dramatic change in their lifestyle. Most of them have to give up their education or work. Social isolation, fear of further attacks, and insecurity damage their self-esteem and confidence. Illiteracy, poverty, threats to further retribution, and ignorance about legal support increase their miseries. Gradual increase of acid attacks suggests that legal provisions and their enforcement are not adequate and effective. Social awareness, economic and psychologic support, rehabilitation, and strict enforcement of laws are key to combat acid violence in Bangladesh.     

Psychiatric aspects of sexual abuse

Sexual abuse of children and adolescents has become an increasingly publicized phenomenon. Psychiatrists and other mental health professionals are often called upon to evaluate and treat children and adolescents who may have been sexually abused, to provide counseling or treatment to the families of such children, and to provide reports and testimony for proceedings about such cases in the child protection system, the criminal justice system, and in custody disputes. Clarity regarding the medical, psychiatric, and legal aspects of sexual abuse is essential in carrying out such professional activities and in evaluating and formulating research on sexual abuse. In this paper current knowledge regarding these aspects of sexual abuse is summarized, and the role of psychiatrists in clinical and forensic work involving allegations of sexual abuse is discussed.     

Death during percutaneous transluminal coronary angioplasty (PTCA) and the medicolegal aspects

Coronary embolisation is a very rare complication of the clinically widespread method of percutaneous transluminal coronary angioplasty (PTCA). The well-documented case of a 64-year-old male patient is presented comparing angiographic and morphological findings. The occluded left anterior descending artery (LAD) was successfully dilated during PTCA. Simultaneously the circumflex artery showed acute occlusion. The patient fell into cardiac shock and died after attempted resuscitation and agonal installation of extracorporeal circulation. The autopsy revealed severe residual stenosis of the proximal LAD by parietal thrombosis and occlusion of the proximal circumflex artery by an unattached intraluminal thrombus (0.8 x 0.3 x 0.2 cm) which had been dislocated during PTCA. Autopsy thus confirmed the clinical presumption of coronary embolism and, in addition, disclosed a previously unknown perforation of the femoral artery which had occurred during agonal installation of extracorporeal circulation and contributed to death via severe retroperitoneal hemorrhage. The case is discussed under the aspects of clinical quality control by forensic pathological investigations.     

An unusual penetrating head wound by a yard broom and its medicolegal aspects

A fatal case of a homicidal penetrating head injury by a blunt object (yard broom) is described. A piece of wood penetrated the skull and remained in the intracranial cavity resulting in infection. The need of careful examination of the head injury is emphasized.     

Forensic medical aspects of bone tissue injuries and pathology

This paper reports the results of a number of investigations into forensic medical aspects of bone tissue injuries and pathology that may be of value, both theoretical and practical, for the further studies in this field. The data obtained shed light on the influence of bone porosity on the mechanism of fractures and processes of reparation in the bone tissue. Moreover, they can be used for the purpose of forensic medical expertise.     

Reconstruction of sexual offences--forensic aspects of sperm traces

The investigation of sexual offences is a real challenge, as the injuries are often unspecific or faint and may sometimes be missing completely. Evidence recovery and analysis as well as the statements of the victims and suspects are therefore of vital importance. In both presented cases, the results of trace evidence analysis were basically consistent with a sexual assault, but the victims' statements regarding the course of events and the pattern of traces showed severe discrepancies.     

Medicosocial aspects of sexual abuse crimes in Arkhangel'sk

The criminological and victim sides of sexual abuse crimes in Archangelsk are analyzed and the data are compared with the data for Russia and for St. Petersburg. Seasonal patterns of rapes and violations and the most vulnerable age of victims have been determined. Flaws in the resolutions on expert evaluations in cases with social abuse are analyzed.     

The response of relatives to medicolegal investigations and forensic autopsy

Relatives of deceased persons, on whose body a forensic autopsy had been performed at the Institute of Forensic Science, Bern, Switzerland, were interrogated by a questionnaire. The aim was to investigate the attitude of relatives toward medicolegal investigation procedures in general and toward forensic autopsy in particular. A great majority of the relatives showed a positive or indifferent attitude toward a forensic autopsy. They showed a great interest in autopsy results and wished to be informed. It was concluded that information given before the autopsy is important for better understanding and can, if properly given, improve the relatives' acceptance and collaboration regarding forensic investigations. By contrast, a lack of information before the autopsy and about the autopsy results can cause further suffering on behalf of the bereaved. A forensic autopsy can be of great benefit for relatives and can help them to cope with a tragic loss.     

How some medicolegal aspects of the Zeebrugge Ferry disaster apply to the investigation of mass disasters.

The capsizing of a British Channel ferry as it left Zeebrugge, Belgium's harbor, on the 6th of March, 1987, resulted in an all-out effort by Belgian and British authorities to identify the victims as well as to determine the medicolegal ramifications. This report describes the investigation and the lessons learned from it.     

视神经损伤与再生的研究进展及其法医学意义

视神经损伤后,以视网膜神经节细胞(RGCs)及其轴索的溃变死亡为主的病理变化导致了视功能障碍,随着一定数量存活的RGCs及其轴突在合适环境下的修复再生,视功能可有一定的恢复。综述相关研究文献,旨在了解视神经损伤及修复再生可能存在的规律,以及研究这种规律对客观评价视功能和损伤或死亡时间推断的法医学意义。     

法医学鉴定质量评价与控制研究

目的探讨法医学鉴定质量评价与控制的有效途径。方法根据法医学鉴定的要求，选择评价指标、评价等级以及确定权重指数，应用模糊数学综合评判的方法，对法医学鉴定质量进行评价与控制，并结合实例分析如何应用模糊数学综合评判的方法对法医学鉴定质量进行评价与控制。结果该方法对法医学鉴定质量具有有效的评价与控制。结论模糊数学综合评判可作为法医学鉴定质量评价与控制的有效手段。     

法医学鉴定质量评价与控制研究

目的探讨法医学鉴定质量评价与控制的有效途径。方法根据法医学鉴定的要求,选择评价指标、评价等级以及确定权重指数,应用模糊数学综合评判的方法,对法医学鉴定质量进行评价与控制,并结合实例分析如何应用模糊数学综合评判的方法对法医学鉴定质量进行评价与控制。结果该方法对法医学鉴定质量具有有效的评价与控制。结论模糊数学综合评判可作为法医学鉴定质量评价与控制的有效手段。     

医疗诊治过错与鉴定

在伤害案件鉴定中，我们发现一些医疗卫生单位，不注重对医务人员的医德医风教育，对医务人员制定不合理的经济指标或以不同形式将科室个人承包，片面追求经济效益，致使少数医务人员不结合临床实际草率处置病人，在诊治过程中出现人为的错误，致使一些伤者小病大养，轻伤久治，费用过高，出院难等，造成案件久拖不决，甚至上访，给鉴定及处理带来困难，严重干扰了正常的司法诉讼。现将笔者遇到两例报告如下，供同仁讨论。案1，张某，男，47岁，农民。因纠纷被人扭伤左手腕，速到当地卫生院进行X光片检查，报告为左尺骨远端骨折，医生根据X…     

The significance of medicolegal autopsy in determining mode and cause of death

A comparative examination has been made to evaluate decisions as to causes and modes of death among 436 consecutive medicolegal deaths before and after coming to autopsy. All available information was used, including police reports, in evaluating mode and cause of death prior to the autopsy. Among the women, the mode of death evaluation differed in 23.4% of the cases and the cause of death evaluation differed in 77.5% of the cases. Among the men, the mode of death evaluation differed in 23.4% of the cases and the cause of death evaluation differed in 46.9% of the cases. These figures were achieved, however, on the basis of the fact that in most cases the mode of death and cause of death were reported as unknown. After autopsy, the cause of death remained unknown in 3.3% of the females over the age of 2 years and in 4.2% of the males over the age of 2 years. No characteristics relationship was established between the differences found and the age groups. The investigation shows the importance of the medicolegal autopsy for correctly recording cases where the death is obscure.     

医疗诊治过错与鉴定

在伤害案件鉴定中,我们发现一些医疗卫生单位,不注重对医务人员的医德医风教育,对医务人员制定不合理的经济指标或以不同形式将科室个人承包,片面追求经济效益,致使少数医务人员不结合临床实际草率处置病人,在诊治过程中出现人为的错误,致使一些伤者小病大养,轻伤久治,费用过高,出院难等,造成案件久拖不决,甚至上访,给鉴定及处理带来困难,严重干扰了正常的司法诉讼.现将笔者遇到两例报告如下,供同仁讨论.     

Fatal amphetamine-associated cardiotoxicity and its medicolegal implications

Amphetamines are popular drugs of abuse, particularly among youngsters and at dance scenes. Cardiotoxicity (manifested as cardiomyopathy, acute myocardial infarction/necrosis, heart failure, or arrhythmia) after the recreational (mis)use of amphetamine and its synthetic derivatives has been documented but is rather rare. Amphetamine-related cardiac fatalities are even more rare. We present 6 cases of young persons who died unexpected after the chronic abuse of amphetamines. Death was not attributed to a lethal intoxication but to an acute myocardial necrosis, a right ventricle rupture, a cardiomyopathy, or an arrhythmia. Two of the deceased persons presented prior to their death to the emergency department, but their complaints were not considered (probably due to their young age) to be of cardiac origin. One case was a sport-related fatality where medical screening failed to identify the underlying cardiac pathology or the amphetamine abuse, and 1 case was a so-called idiopathic dilated cardiomyopathy where substance abuse was not considered by the treating physician. We think that amphetamine-associated cardiotoxicity is a rare but probably genuine entity that should be considered both in forensic and clinical/emergency medicine because of its potential medicolegal implications.     

人体骨盆有限元模型的建立及其在法医学鉴定中的应用价值

目的建立骨盆三维有限元模型,并应用有限元法对骨盆进行损伤生物力学分析,探讨有限元法在法医鉴定中的应用价值。方法基于骨盆CT扫描图像,利用Mimics 13.1软件建立骨盆有限元模型,包括髂骨、骶骨、双侧股骨头、关节软骨及韧带,模型以CT值设定材料属性。于骶骨上终板表面沿垂直轴向下施加600N静压力,以验证骨盆有限元模型的有效性。模拟侧面撞击作用,于右侧股骨大转子表面分别加载1、2、3、4、5 kN的侧向作用力,计算骨盆模型的von Mises应力云图、位移云图及应力分布曲线。结果建立了完整的骨盆有限元模型,包括关节软骨及韧带,模型几何外形与CT数据高度吻合。站立位骨盆应力主要分布于骶髂关节及坐骨大切迹处。侧面撞击下骨盆应力集中于双侧耻骨上下支、髋关节及骶髂关节。结论本研究建立的骨盆模型具有真实、有效的骨盆力学特性,可用于进行损伤模拟,为法医学鉴定提供直观、准确的依据。