Forensic medical differential diagnosis of craniocerebral trauma in children

It is emphasized that history, complaints, a comprehensive neurological examination, craniography are not often sufficient for differentiation between brain concussion and mild brain contusion in children because of specific characteristics of craniocerebral trauma (CCT) in such patients. To make an adequate forensic medical diagnosis of CCT in children, it is necessary to take into consideration anatomophysiological peculiarities of a child, biomechanical conditions of the brain injury, to apply modern methods of neurovisualization (ultrasonography, computed and MR imaging), to follow up brain function with quantitative electroencephalography. Improvement of differential forensic-medical assessment of CCT severity in childhood should be made according to the principles of evidence-based medicine.     

Spontaneous cerebellar hemorrhage in children

Spontaneous cerebellar hemorrhages are a rare but often fatal occurrence in children. Although there are several predisposing factors such as blood dyscrasias or astrocytomas, the most common cause of cerebellar hemorrhage in an otherwise healthy child is the rupture of a vascular malformation. We reviewed the files of the Office of Chief Medical Examiner of the City of New York and found four such instances over a period of less than two years. We present these here and outline the approach the forensic pathologist should take in evaluating such deaths.     

Bilateral fractures of the coronoid processes: differential diagnosis of intra-oral gunshot trauma and scavenging using a sheep crania model

Approximately half of the skeleton of an adult male (minus the cranium) was found in a forested part of Greater Vancouver, Canada, in August 2000 by the Royal Canadian Mounted Police (RCMP). Authorities ruled the death as suicide. The only compelling signs of perimortem trauma were symmetrically fractured coronoid processes of the mandible, which can be attributed to a gunshot in the mouth. However, the remains had also been scavenged by canids, raising a problem in differential diagnosis. Could canid scavenging produce bilateral fracturing of the mandible indistinguishable from gunshot wounds to the mouth? We found that canid scavengers could not mimic the type of damage to the mandible caused by intra-oral gunshot wounding using a sheep model (n = 20). Bilateral fracturing of the coronoid processes was found to be characteristic of intra-oral gunshot wounding, while canid scavengers typically ignore this region of the mandible.     

Spontaneous Clostridium infection--often a post-mortem diagnosis

Infections with Clostridium species occur very seldom but then often as a lethal disease. They are mainly associated with trauma, surgery and malignancies, but can also occur with dermal and intestinal infections, burns and septic abortion. The development of gas gangrene is insidious and progression is very rapid. So it may stay unrealized until death and is often diagnosed only at autopsy.     

The differential diagnosis of injuries to the occipital area of the head

The problem of differential diagnosis of head occipital lesions in different mechanisms of trauma is discussed. Statistical method of data processing is suggested. This method combined with common methods increase the scientific level of expert conclusions.     

Use of liver morphometry in the differential diagnosis of chronic alcohol and narcotic poisoning

Data on the quantitative histomorphological involvement of the liver in chronic narcotic and ethanol poisoning and their combination are presented. Alcohol use by narcomaniacs augments hepatocyte damage, which manifests by increased fatty degeneration, increased activity of lobular hepatitis, appearance of the neutrophil admixture in inflammatory infiltration, and stimulation of sclerotic processes leading to an increase in the perimeter of portal tract section at the expense of connective tissue growth. Quantitative analysis of these processes is recommended for forensic medical histological differential diagnosis of chronic narcotic and ethanol poisoning.     

A soft-tissue calcification: differential diagnosis and pathogenesis

An autopsy of a 72-year-old white male revealed a 30.5 x 5.1 cm vertically aligned heterotopic ossification just deep to a 30.5 cm midline abdominal scar. The ossified mass was determined to be a heterotopic ossification or myostitis ossificans (MO) traumatica resulting from an abdominal surgical incision during life. While, MO traumatica is relatively common accounting for roughly 60-75% of patients with soft-tissue ossification, heterotopic ossification of abdominal incisions are relatively rare and thus infrequently reported. This article details the manifestation of this relatively large heterotopic bone and provides a comprehensive review of the literature and pathogenesis of this unusual ossification. A review of the English literature from 1920 to the present produced only a handful of articles for a total of 185 reported cases. All had bone formed within vertical incisions, usually within 1 year of surgery, and 89% were males. Knowledge of this phenomenon and the variable size at presentation is useful to both the autopsy pathologist and the anthropologist in generating a diagnosis for abnormal calcifications.     

The differential diagnosis and the identification importance of the track of the heel of stabbing-cutting weapons in skin wounds

Data on 123 cut-stab wounds and 52 knives were examined in the course of medicolegal expert evaluation. It was found that 30 knives possessed heels which could have two forms: symmetric and asymmetric. Heel traces were seen in 16 expert evaluations (34%) in 31 wounds (25.2%) and in some of them particular features of knife blade heel were represented. Differences between butt end and heel trace according to series of signs were noted.     

Virological analysis in the diagnosis of sudden children death: a medico-legal approach

Infections are considered to be an important cause of unexpected death in children. It has also been assumed that respiratory viruses are involved in the genesis of sudden infant death syndrome (SIDS). The Spanish National Institute of Toxicology and Forensic Sciences act as the forensic reference centre for Spain. We analyse the experience of this centre in the virological study of 64 cases of sudden children death where viral serology, virological cultures, herpesviruses polymerase chain reaction (PCR) and electron microscopy were performed. According to pathological findings, death could only be attributed to an adenovirus infection in one amygdalitis with upper airways stenosis and asphyxia. Human herpes virus 6 (HHV-6) was detected by PCR in one case with pathological findings characteristic of SIDS. Recent infection by respiratory syncytial virus (RSV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were also detected. Meanwhile, 85.9% of the cases yielded negative viral results. Twenty-eight infants were finally categorised as SIDS. Pathological findings of infection were detected in 12 patients despite the negativity of viral analyses. Although viral infection is an uncommon cause of sudden children death, a complete microbiological investigation will help to solve the puzzle of SIDS. Definitive guidelines for microbiological analyses need to be updated whilst new pathogens are discovered or new techniques are implemented in order to clarify unsolved cases.     

Spontaneous hypnosis in the forensic context

"Hypnosis" denotes either specific phenomena (altered volition, perception, cognition, and recall) or interpersonal transactions that often elicit them. Basic research leads to paradox: hypnosis is validated, and shown to be dissociative in essence, at the same time that neither its phenomena nor transactions can be separated from those of everyday living without logical absurdity. This paradox can be resolved by assuming that consciousness and volition are complex, occurring simultaneously at many levels in the same waking individual. Hypnotic-like phenomena and transactions occur spontaneously, in either covert or overt forms. The former are pervasive, whereas the latter are often associated with psychological trauma. Forensic implications are twofold: for criminal responsibility, and the reliability of eyewitness testimony. Hypnotic-like states and transactions are rarely affirmed as an insanity defense because at some level these subjects are aware of what they are doing and why. Diminished capacity and mitigation of sentence are more appropriate defense strategies. Several conflicted traditions of case law have evolved to protect eyewitness testimony from hypnotic-like distortions in cognition, perception, and memory that can occur either during or outside of formal hypnotic procedures. These include the admissibility of posthypnotic testimony, due process safeguards at eyewitness identification procedures, and the admissibility of expert testimony on the findings of eyewitness research. These areas are inseparable from one another and demand a systematic coordinated approach.     

Spontaneous rupture of the oesophagus

A case of death due to spontaneous rupture of the oesophagus is reported. Few similar cases have been previously reported. In some the oesophageal wall had been weakened by previous ulceration or scarring. In this case there was no history or postmortem evidence of such damage. Under certain circumstances postmortem rupture of the oesophagus could occur and should be distinguished from antemortem rupture.     

Morphology of fractures of long tubular bones in children upon trauma due to solid blunt objects

Morphologic features of diaphyseal fractures of lond tubular bones in different age groups in childhood were studied experimentally on biodummy using direct stereomicroscopy (MBC-9). Blow effect was induced by solid blunt objects at the middle diaphyseal parts at a right angle. A series of specific morphologic features which help to diagnose the specific bone tissue lesions in different fracture zones as well as in different age periods was obtained. Experimental data were confirmed by expert observations which proves the possibility of using these specific morphologic features of diaphyseal fractures of long tubular bones in childhood for medicolegal purposes.     

Spontaneous bacterial peritonitis in the non-cirrhotic individual

A case of spontaneous bacterial peritonitis is reported. A methodical postmortem examination failed to disclose cirrhosis or other liver pathology; nor, was any anatomic alteration of the immune system noted. Acquired immunodeficiency syndrome was likewise discounted. A discussion ensues concerning recognition of this entity.