Esophagoaortic perforation by foreign body (coin) causing sudden death in a 3-year-old child.

We report an extremely unusual consequence to foreign body ingestion in a case of a 3-year-old boy who died suddenly and at autopsy was found to have an esophagoaortic fistula. This fistula was caused by a coin which lodged posteriorly and eroded through the esophagus into the aorta. Serious complications following foreign body ingestion are rare and include stricture formation, intramural abscess, and the formation of fistula tracts. This case illustrates the potentially unpredictable behavior of impacted foreign bodies. The child's parents were initially suspected of child abuse based on the terminal hemoptysis.     

Aortoesophageal fistula and sudden death. A report of two cases and review of the literature

Two cases of aortoesophageal fistula are presented. The etiology, symptoms, and diagnosis of aortoesophageal fistula are reviewed. Signs and symptoms of gastrointestinal hemorrhage followed by sudden collapse hours to days later should prompt consideration of an aortoesophageal fistula. Accidental ingestion of foreign bodies, particularly by children, is a frequent etiology.     

Radiographic demonstration of esophageal and tracheal fistulas at autopsy using a contrasting medium that vulcanizes at room temperature

Esophageal and tracheal fistulas, which occur in 0.05% of medicolegal autopsies, were demonstrated in three cases by a postmortem radiographic technique using silicone rubber/lead oxide as a contrasting medium that vulcanizes at room temperature. In one 83-year-old male, a tracheoesophageal fistula was detected, which had developed after surgical repair of an esophageal rupture caused by a flexible fiberoptic endoscope. In a second case, carcinoma of the esophagus in a 78-year-old male had eroded the trachea and arcus of the aorta creating a fatal tracheoesophagoaortic fistula. In a third case, 55-year-old female developed a tracheobrachicephalic artery fistula as a result of an infiltrating cystic adenocarcinoma of the trachea, resulting in a fatal hemorrhage into the trachea. The results of this study indicate that diagnostic radiologic methods using a vulcanized contrasting medium are useful in supplementing normal dissection in autopsy cases with suspected fistulas of the esophagus or trachea.     

Traumatic false aneurysm of descending aorta with aortoesophageal fistula

We report a case of traumatically induced false aneurysm with secondary bacterial aortitis of the descending aorta and fistula formation between the aorta and esophagus. This lesion was diagnosed at autopsy and caused death in a 68-year-old female 19 years after an automobile accident. Aortoesophageal fistula (AEF) formation as a result of any cause is rare. To our knowledge, this is the second reported case of traumatic aortic aneurysm as a result of an automobile accident with subsequent AEF formation.     

Iatrogenic biliovenous fistula

A 44-year-old man had suffered from cholecystolithiasis with recurrent jaundice for many years, and a cholecystectomy was carried out. Because of a radiomanometric obstruction of the common bile duct, the intra- and extrahepatic bile ducts were also scanned. One day after the operation the jaundice increased (serum bilirubin max. 742 mumol/l). The cause of the icterus was found in a small biliovenous fistula, and diverse surgical and angiological attempts to resect or close the fistula failed. In the third postoperative week renal failure developed, followed by a disturbance of coagulation and insufficient respiration and circulation. The man died 33 days after the operation. Autopsy showed massive jaundice, gastrointestinal bleeding, and cholemic nephrosis. Extensive preparation of liver resulted in a 20 X 8 X 15 mm fistula in the right lobe 9 cm proximal to the choledochotomy and anastomosing a thin branch of the right hepatic duct and a small hepatic vein. Long-time bilhemia resulted from this fistula and entailed renal failure and finally death. The fistula obviously resulted from scanning the bile ducts when the catheter was accidentally deviated into a biliary duct that was too small.     

Arterial-esophageal fistulae in patients requiring nasogastric esophageal intubation

A rare and potentially fatal cause of hematemesis is fistula formation between the esophagus and the vascular system. A case report of a 39-year-old woman with congenital aortic arch anomalies hospitalized for treatment of head injuries demonstrates the potential for iatrogenic esophageal trauma to initiate fistula formation between the esophagus and an anomalous arterial system. A literature review revealed 6 other cases of vascular-esophageal fistulae caused by nasogastric esophageal intubation. It is concluded that aortic arch anomalies increase the risk of esophageal injury and subsequent fistula formation from nasogastric esophageal intubation. In addition, the clinical features and pathologic findings of vascular-esophageal fistulae are reviewed.     

Barrett esophagus and unexpected death

Barrett esophagus is characterized by the presence of columnar mucosa in the lower esophagus in continuity with gastric mucosa. Complications include ulceration and adenocarcinoma. Although sudden and unexpected death is not a usual outcome, the case of a 63-year-old man is presented who died unexpectedly following perforation of an ulcerated Barrett esophagus, with development of an esophagopleural fistula. Sudden and/or unexpected death in individuals with Barrett esophagus may result from hemorrhage due to erosion into mural vessels, the aorta or heart, or from penetration into the pleural space, trachea, bronchi, and pericardial sac, with the development of tension pyopneumothorax, bronchial fistula, and mediastinitis. Ulceration of the lower esophagus at autopsy should prompt consideration of the possibility of a Barrett esophagus and initiate careful dissection/examination of the surrounding mediastinal tissues and vessels.     

Exsanguination by subclavian-esophageal fistula associated with a left subclavian aneurysm

Aortic aneurysms are a common autopsy finding, but aneurysms confined exclusively to the subclavian arteries are rare. When found, they are typically associated with trauma, surgery, or aberrant vessel distribution. Subclavian-esophageal fistula formation is also rare, with the vast majority being related to aberrant vessel distribution or esophageal foreign bodies. Dicle et al. first reported a subclavian-esophageal fistula associated with a non-aberrant subclavian artery aneurysm in 1999 (1). The following case would mark the second report of that phenomenon, and the first in the setting of a forensic autopsy.     

Explosive "Roman find"

A case of a 40-year-old hobby archeologist is presented who searched for remains from Roman times. After finding an oblong, cylindrical object, he opened it with a saw to examine it, which triggered an explosion killing the man. The technical investigation of the remains showed that the find was actually a grenade from the 2nd World War. The autopsy findings and the results of the criminological investigation are presented.     

"Homicide by heart attack" revisited

The sudden death of a person caused by an arrhythmia that is induced by physical and/or emotional stress provoked by the criminal activity of another person is sometimes referred to as "homicide by heart attack." Published criteria for such an event relate to situations where no physical contact occurs between the perpetrator and the victim. Situations involving physical contact, but with absence of lethal injuries, are frequently treated is a similar fashion by forensic pathologists. Herein, we propose a set of modified criteria, which include cases where physical contact has occurred. Five examples of so-called "homicide by heart attack" are presented, including a 40-year-old man who was struck in the head with a wooden statue, a 74-year-old man who was punched in the jaw by a robber, a 66-year-old woman who was started awake by a home-intruder, a 67-year-old woman who struggled with a would-be purse-snatcher in a parking lot, and a 52-year-old man who was in a physical altercation with a younger man. In each instance, autopsy revealed the presence of severe, underlying heart disease, as well as absence of lethal injuries. In each case, investigative information was such that the emotional and/or physical stress associated with the criminal activity of another individual was deemed contributory to the death. The presumed mechanism of death in each case was a cardiac dysrhythmia related to underlying heart disease, but initiated by the emotional and/or physical stress.     

Suicidal incised wound of a fistula for hemodialysis access in an elderly woman: case report

A very rare case of suicide by stab wound of a fistula for hemodialysis access in an elderly woman is reported. The incidence of suicide attempts in people undergoing hemodialysis is well known. Nevertheless, suicide means do not usually include stab wounds of the arteriovenous access. Various pattern differences between homicidal and suicidal stab wounds, characteristics of suicide in the elderly, and approaches to the investigation of such cases are briefly discussed.     

Examination of a "velasco" signature on an oil painting

In September 2003, an investor bought an oil painting at auction in Denmark. The painting was signed "José Maria Velasco." The investor attempted to sell the painting in the United States, but found that he needed confirmation that this was an authentic Velasco painting. The provenance of the painting was questionable because it came to Europe from Cuba without appropriate documentation including the date of its entry into the European market. If the signature was determined to be authentic, the painting would have an approximate value of 1 million dollars. Initial research on the life and works of the artist and a literature review resulted in the preparation of an "Art Worksheet." Known signature specimens were obtained from reputable sources. A comparison of the known signatures with the questioned signature concluded the questioned signature was very probably not executed by José Maria Velasco.     

信息公开与法治政府--从"非典"到"禽流感"的启示

20 0 3年“非典”引发了社会普遍的对政府信息公开问题的关注 ,尽快建立健全在公民知情权基础上的政府信息公开制度成为人们的共识。在一年以后 ,“禽流感”又在亚洲蔓延 ,所不同的是 ,由于政府及时将有关疫情向社会公开 ,我国并未出现“非典”时的恐慌和混乱 ,民众对政府充满信心。可见 ,信息公开对于建设公正、透明和信赖保护的法治政府有着重要意义。我国政府信息公开制度还处于初级阶段 ,还存在一定的缺漏 ,急需在法律层面上进一步完善。     

"Insanity" in civil law

The issue of "insanity" is rarely alluded to in the area of civil law. As a consequence, the legal standard for insanity is not clearly understood by many psychiatrists. The standard derives from case law and is based upon statutory law in the criminal sector. A civil case will be presented where the question of "insanity" was raised. In this case an individual committed suicide and his insurance company refused to pay the beneficiaries of his life insurance policy based upon a provision in his policy that excluded payment in situations of suicide. His beneficiaries sued, claiming that the deceased was insane at the time of his suicide and therefore not responsible for his actions. The standard for insanity in New Jersey and the reasoning of the psychiatrists will be presented.     

回归“马锡五”的思考

马锡五审判方式是特定历史时期的产物。现今,重提马锡五审判方式也有其特定的原因,本文对其原因进行较为全面的分析。笔者坚持认为,作为一种审判方式,囿于自身的特点和理念,马锡五审判方式已不具有普遍的现实意义,已经疏离了中国社会的发展趋势。重提这种方式虽然对我们建构和完善多元化、替代性纠纷解决方式具有警示性,但在中国法治建设的初级阶段,民事诉讼建构的基本方向依然应当是强调诉讼裁判的主导性、强调裁判程序的正当性,以顺应和推动中国社会的转型。     

The "last vestiges of life"

On 4 June 2010, Deputy State Coroner Schapel of the Coroner's Court of South Australia ruled that he had jurisdiction to conduct an inquest into the death of Tate Spencer-Koch, who was declared deceased following complications during her home-birth. Coroner Schapel considered he had jurisdiction on the basis that Tate was a "person in the eyes of the law" under the born alive rule, as she had completely left her mother's body and she could be shown to have been alive after birth, evident from the PEA detected in her heart 10 minutes following her delivery. Close consideration of this ruling, however, reveals issues with the application of the born alive rule in the case.     

Fatal suicidal injury of a radiocephalic arteriovenous fistula

A 59-year-old man was found dead in his living room. His body was covered with blood, but the only injury found was a 31-mm-long, transverse incision on the radial surface of the left forearm. Autopsy revealed that the injured vessel was an enlarged cephalic vein from a radiocephalic arteriovenous fistula (RC-AVF) that had been created 23 years before for hemodialysis. Cephalic vein injury is usually not fatal, but circumstantial evidence, autopsy, and histological findings suggested that hemorrhagic shock and death occurred within a short time after the self-inflicted incised wound. This may be explained by the blood flow rate in the RC-AVF, which can reach 12 ml/s; this is 25 times higher than the normal cephalic vein blood flow.     

Contribution of Antemortem Computed Tomography Findings to Cause of Death Determination: An Unusual Fatal Stroke

In the case reported here, the antemortem computed tomography scan (CT scan) was essential in the forensic investigation. A 32‐year‐old man was found fully awake with a facial abrasion, after what seemed to be a car accident. He lost consciousness suddenly one hour after initial management. Successive CT scan showed a facial fracture and a metallic foreign body in the carotid canal associated with an occlusion/dissection of the left internal carotid, a pseudoaneurysm, and a carotid‐cavernous fistula. The victim died from a stroke. Autopsy confirmed that the facial abrasion was a gunshot entrance wound, the metallic foreign body being a projectile. Intracranial vascular injuries linked with gunshot wounds are most of the time isolated and due to pelet embolism. The observed vascular injury association has never been described in the existing literature. The CT scan provided a better understanding of the chronology of events that led to death.     

On "Coherence" and "Law": An Analysis of Different Models

The aim of this paper is to compare different conceptions of the role of (normative) coherence in the legal field. More precisely, it aims to deepen Neil MacCormick's theory of legal reasoning, in which coherence is essentially considered an interpretative tool, and Ronald Dworkin's legal theory, in which coherence occupies a more crucial place. The main results of this paper can be summarized in two points. A) For Dworkin, coherence is not just an interpretative standard but constitutes the hard core of his theory of law. B) As a consequence of A, Dworkin's reflections on coherence (as an interpretative standard) cannot be separated from his theory of law grounded on the concept of integrity.     

U.S. Industries v. Director: "claim" versus "condition" in the analysis of workers' compensation cases

Under most workers' compensation statutes, an injury must "arise out of " and "in the course of" employment in order to qualify as a compensable disability. In U.S. Industries v. Director, the Supreme Court held that the Longshoremen's and Harbor Workers' Compensation Act must be strictly construed to avoid transforming the compensation system into a form of social insurance. In U.S. Industries, the Court denied a disability claim based on an arthritic condition which was manifested while the worker was at home in bed. This Note contends that the Supreme Court neglected to consider pertinent medical realities when analyzing the causation question. Thus, the decision undermines the overall rationale behind workers' compensation legislation. Nonetheless, the Note argues that the case does not relax the requirement of adequately scrutinizing the causative elements underlying any reasonable claim for disability benefits. An analysis adequately accommodating both medical and legal facts, instead of relying upon the vagaries of statutory interpretation, is necessary to improve the efficiency and fairness of workers' compensation disability determinations.