Non-vehicular accidents among teenagers--the 5-year Metro Dade County experience from 1979 to 1983

A study of non-vehicular accidents among the teenage population of Metropolitan Dade County, Miami, Florida, U.S.A., was performed. The case files of the Office of the Medical Examiner were reviewed and all teenage non-vehicular accidents during the 5-year period from 1979 to 1983 were collected. These 102 cases were then analyzed as to the age, race, sex, cause of death, blood alcohol content at autopsy, and drugs detected of the victim. The geographic location, scene circumstances, and presence of human error were also noted. Predominantly, a white male population between 16 and 19 years is involved. Usually they die from drowning at home or in a natural body of water, commonly drugs or alcohol are involved; human error or poor judgment is noted two-thirds of the time.     

道路交通事故损伤中的损伤部位与伤残关系

研究道路交通事故中活体损伤案例 ,损伤部位、伤残率、伤残程度之间关系。收集 1997年～ 1999年间武汉地区道路交通事故中活体损伤案例 35 47例 ,对其进行统计和分析。 1792例损伤被评残 ( 5 0 5 2 % ) ,伤残评定率最高的部位为周围神经损伤和耳外伤 ,分别为 90 0 0 % ,83 30 %。最低为躯干及四肢软组织损伤 ( 17 5 2 % )。伤残程度评定中Ⅸ～Ⅹ级和Ⅰ～Ⅴ级伤残评定率分别为 78 74%和 4 41%。伤残评定率与损伤部位的发生并不一致 ,伤后治疗效果直接影响伤残评定。伤残程度以Ⅸ～Ⅹ级最多 ,各部位损伤均可见 ,Ⅰ～Ⅴ级伤残较少 ,Ⅰ级伤残仅见于颅脑和脊髓损伤     

Homicide with special reference to alcoholic intoxication and relation to time of day

112 cases of homicide (around 4%) are presented from material of approximately 3000 psychiatric expert-opinions for criminal proceedings. The data of 107 committers were usable and could be evaluated statistically. 63% of the homicides were executed, 37% were attempted. 14% of the committers were considered to be psychopaths. The circumstances surrounding the crimes were further subdivided in imitation of Rasch and especially tested for daytime linkage. 53% of the males but only a very small percentage of the female committers were alcoholized. Neither alcoholization nor personality had influence upon the success of the crime. For most of the psychotic committers the attempt failed to succeed. There was a tendency that some of the assaults were performed during night-time. This was more pronounced in alcoholized than in sober committers. No linkage to the night hours could be found neither for criminal actions of psychotics or child murder, nor for murder or robbery. In conclusion we assume that certain forms of human aggression underlie a diurnal rhythm.     

Examples for use of the STR systems in stain assessment with special reference to Y chromosome systems

The authors describe 3 cases where Y-chromosomal systems were used for typing the biological traces. In the first case, a murder, for the major amount of cell material found on a dish towel (and analysed two years after the crime) female persons were excluded for the system amelogenin and Y-chromosomal systems. A brother of the victim could not be excluded for autosomal STR-systems. Upon confrontation with the results of the DNA-analysis (among other things), this brother confessed the murder of his sister some days later. He was found guilty by the court. In the second case described, a rape of two girls, many traces were analysed parallely with Y-chromosomal and autosomal PCR-systems. The objects where male DNA matching the suspect were found (a paper tissue, a sweat shirt and the knickers of the girls), also showed small amounts of alleles matching with the suspect for autosomal systems, while the major part in these systems was from the girls. The suspect was sentenced to many years imprisonment. In the third case, a possible rape of a young woman, a stained microscope slide of a vaginal swab had to be examined. Microscopically a few sperm heads could be seen in a surplus of leucocytes. The male proportion could be analysed only in the Y-chromosomal systems, not in the autosomal ones. For the frequency calculation of the Y-chromosomal allele combination the haplotype data bank of the Institute for Legal Medicine of the Humboldt university in Berlin was indispensable.     

Fatal intoxications in the Nordic countries. A forensic toxicological study with special reference to young drug addicts

Fatal intoxications in the 15-34 age group in the five Nordic countries during the years 1984 and 1985 (Sweden only in 1984) were investigated. The known drug addicts were studied separately. The highest incidence of intoxications, calculated per 10(5) population, was found in Finland (11.3), followed by Denmark (10.3), Sweden (8.5), Iceland (7.2) and Norway (6.6). The percentage of intoxications caused by drugs was 92 in Denmark, 71 in Norway, 66 in Sweden, 50 in Finland and 17 in Iceland. Ethanol intoxications were seen 5-7 and 2-3 times as frequently in Finland and in Iceland, respectively, than in the other three countries. Carbon monoxide intoxications accounted for two-thirds of all fatal intoxications in Iceland. Drug addicts accounted for 62% of all fatal intoxications in the Danish material. The corresponding figures were 33% in the Norwegian, 16% in the Swedish and 5% in the Finnish material. No deaths in drug addicts were found in Iceland. Most drug addicts in Denmark, Norway and Sweden died of hard drugs and most in Norway and Sweden, from heroin or morphine, whereas in Denmark other strong analgesics, such as methadone, dextropropoxyphene and ketobemidone, accounted for 40% of all hard-drug-related fatal intoxications. To a certain extent the results reflect differences in the legal autopsy routines in the various Nordic countries. However, the ascertainment of drug addicts is assumed to be near-complete in each country.     

Offender characteristics in lethal violence with special reference to antisocial and autistic personality traits

The objective of the study is to assess the relationships between personality traits, lifetime psychosocial functioning, and crime scene behavior. Thirty-five male offenders referred for forensic psychiatric assessment in Sweden (1996-2001) and assigned a main diagnosis of either antisocial personality disorder (APD) or autism spectrum disorder (AUT) were retrospectively studied. APD were subcategorized into impulsive (APDi) and controlled (APDc). Those in the AUT group were less intoxicated at the time of the crime and did not often use knives or guns compared to the APD group. Males in the APDi group were older and had a higher proportion of abuse of alcohol and drugs in biological parents, physical abuse during childhood, psychiatric contacts, and suicide attempts compared to the APDc group. In the APDi group, knives were used in the homicide compared to the use of guns in the APDc group. The results suggest differences in psychosocial functioning and crime scene characteristics related to personality traits.     

Racial identification from the midfacial skeleton with special reference to American Indians and whites

Successful approaches to race determination of unidentified human remains have been developed by anatomists and physical anthropologists, but few quantitative methods are available for distinguishing American Indian crania from those of whites. The leading method in use today is particularly ineffective in its placement of American Indian skulls from the western regions of the United States. Recent development and testing of a new metric method suggests a much more effective technique. The method involves six breadth and projection measurements of the midfacial skeleton, the calculation of three indices, and a simple direct reading of results. The method has the additional advantage of use in the autopsy room with minimal dissection of soft tissue required. Based upon a less extensive test of East Asian and Arctic Mongoloid crania, the method appears to be even more effective in separating them from the sharp featured whites. Larger samples of American blacks and Polynesians are presently under study and these also appear to separate quite readily from whites using the same or similar sectioning values.     

Human-type blood group activities on chimpanzee erythrocytes with special reference to M and N

Human-type blood group activities on the red blood cells (RBCs) of three chimpanzees were individually examined with commercial mouse monoclonal antibodies (anti-A, -B, -H, -M, -N, -Lea, and -Leb) as well as lectins (UEA-I and VGA) and conventional polyclonal antisera for the systems ABO, MN, Lewis, Rh-Hr, P, Kell, Kidd, Duffy, and Lutheran. For further analysis of the MN antigens, treatment of the RBCs with sialidase, trypsin, and chymotrypsin were employed. The activities recognized among the three chimpanzees were A, H, M, N, Leb, c, S, k, and Jka. The RBCs of the three individuals possessed the A antigen which showed the same serologic activity as the human A1. Those chimpanzee RBCs showed higher H-activity than the human A1 RBCs. The Lewis b activity was revealed by the absorption-elution method. The RBCs of the three individuals showed a reactivity to the polyclonal anti-M reagents, which was affected by both the sialidase and trypsin treatment. The RBCs of two individuals were agglutinated with the monoclonal anti-N. The receptor was sensitive to sialidase and chymotrypsin. The RBCs of the three individuals, however, did not react with the monoclonal anti-M or with one of the polyclonal anti-N. These results indicate structural differences in the glycophorins and MN antigens between the human and chimpanzee.     

Significance and testimonial value of hemo-genetic legal identification with special reference to DNA analysis

175 hemogenetic expertises on the identity of ostensibly jumbled blood samples were analysed. In 4.5% of the cases a genetically qualified non-identity was found, although an erronous mixing-up of samples could be excluded. A major problem may arise when the expert witness has to find out whether a non-identity is due to either genetic or to artificial reasons. A battery of conventional blood group systems as well as highly informative DNA polymorphisms is a powerful tool in discriminating between both reasons and enables the expert to reach a decision.     

Determination of total hemoglobin in forensic blood samples with special reference to carboxyhemoglobin analysis

For the determination of total hemoglobin (Hb) in blood containing elevated carboxyhemoglobin (COHb), a newly developed reagent containing a 100-fold concentration of ferricyanide (20 g/l) and a 2-fold concentration of Sterox SE was compared with a standard reagent (0.2 g/l ferricyanide), the reagent of van Kampen and Zijlstra, using forensic blood samples and experimentally heated blood samples. There were no significant differences between the spectra of hemiglobincyanide (HiCN) solution produced with our reagent and the van Kampen and Zijlstra reagent using experimentally heated blood samples. Although the spectra of HiCN changed gradually with increased heating time and with the passage of time after mixing, the absorbance at 540 nm (A540) did not change until at least 120 min for both the reagents. When forensic blood samples containing elevated COHb were mixed with the van Kampen and Zijlstra reagent, total-Hb concentrations determined 5 min after mixing were 10-20% higher than those determined after 180 min. The overestimates of total Hb determined after 5 min resulted in comparable underestimates of percentage saturation of COHb (COHb%) when COHb% was obtained from the ratio of COHb content, determined by gas chromatogrpahy, to total-Hb concentration in blood. However, there was an extremely good correlation between the values of total Hb in forensic blood samples determined with the van Kampen and Zijlstra reagent after 180 min and those determined with our reagent after 5 min. From the results obtained, our reagent proved to be suitable for the determination of total Hb in forensic science practice.     

Strategy for the estimation of chronological age using the aspartic acid racemization method with special reference to coefficient of correlation between D/L ratios and ages

The estimation of chronological age has been performed by various methods in forensic science. Among these, racemization methods, which are based on the age-dependent non-enzymatic changes of L-form amino acids to D-form mainly using aspartic acid, are one of the most reliable and accurate methods to date. Separation of enantiomers is generally performed by gas chromatography or high performance liquid chromatography. Various tissues with low metabolic rates have been applied for this purpose. In addition, single proteins purified from these target tissues are also applicable. In this brief review we describe this method in detail, noting points of caution, as well as the advantages and disadvantages of the different target tissues. In addition, special attention is given to the correlation rates obtained between chronological age and enantiomer ratios. Currently, based on accuracy of estimated age, simplicity of the method, time required, and reproducibility, tooth dentin is considered one of the best target tissues. Alternatively, analysis of osteocalcin and elastin have also provided accurate and reproducible results.     

Evaluation of sudden death in psychiatric patients with special reference to phenothiazine therapy: forensic pathology

The investigation of sudden unexpected death in psychiatric patients and the ensuing litigation has brought to our attention many unusual features important in the evaluation of such deaths. Certain pathophysiologic mechanisms of death, rarely encountered in routine forensic science practice, may be important in determining the cause of death in psychiatric patients, especially in cases where the autopsy is unrevealing. Of particular concern is a tendency in the current literature to implicate phenothiazines as a cause of death when the death investigation and the autopsies are incomplete. Thus, based on our experience and on a review of the current literature, we have set forth factors that the forensic pathologist should consider when faced with a sudden psychiatric death. A case report illustrates these unique aspects of scene investigation and analysis of terminal events and autopsy findings.     

关于完善我国医疗事故责任等级的建议简

我国现行的《医疗事故技术鉴定暂行办法》规定了医疗事故中医疗过失行为的责任程度分为：完全责任、主要责任、次要责任、轻微责任。该办法用这四种责任程度来判定医疗过失行为的责任程度存在明显的缺陷,缺少了一个同等责任程度的规定。为了今后便于司法实践的操作,公平合理地维护医患双方的权益,应该增加同等责任程度的规定,来完善我国医疗事故技术鉴定相关立法。     

Histomorphologic lung findings in long-term artificial respiration with special reference to extreme continuous artificial respiration using pure oxygen

The respirator lung is characterized histologically in the first exudative phase by capillary congestion, intra-alveolary edema, hyaline membranes and in most cases by concomitant inflammatory alterations. In the following irreversible phase, fibrous organization processes dominate and show a variable tendency towards pulmonary fibrosis. In 27 cases with long-term artificial respiration from 4 days to 12 weeks, mainly the proliferative alterations were investigated. In 18 cases, the histopathological findings indicated fibrosis of the alveolar septa with disseminated distribution. In 9 cases, focal fibrosis with obliterations of alveoli prevailed. The extent of pathological results in the lungs does not correlate with the duration of artificial respiration. In cases of artificial respiration with pure oxygen, there is a special toxic component, which is illustrated by a young woman with polytraumatism who was administered artificial respiration for 5 weeks with pure oxygen. She died from respiratory insufficiency with severe pulmonary fibrosis. As different pathogenetic factors may cause irreversible pulmonary fibrosis, histomorphological classification is difficult later and, moreover, forensic problems result.     

Histologic thyroid gland findings in the newborn infant and infant, with special reference to sudden infant death

The morphological picture of the thyroid gland, the only endocrine organ with a follicle structure, allows a limited conclusion to be drawn with respect to the functional state in spite of any physiological variability. The thyroid of the newborn shows total colloid release and collapse of the follicles. The regular structure of the thyroid will be rebuilt within several weeks after birth. Total colloid absorption can be found in cases of stress-activated thyroids as well as in cases of death due to freezing. A histological examination was done on 88 thyroids of fetuses, newborns and infants. About 70% of the results on 27 cases of sudden infant death syndrome (SIDS) may be interpreted as a morphological correlate of a premortal chronic or recurrent stress reaction. The value of these results is discussed.     

Serum C-reactive protein levels in postmortem blood--an analysis with special reference to the cause of death and survival time

We have investigated postmortem serum CRP levels in 408 forensic autopsy cases consisting of 216 acute and 192 non-acute death cases having postmortem interval of less than 48 h. CRP ranged from 0.03 to 66.13 mg/dl with the median of 0.28 mg/dl. In 362 traumatic death, survival time and the presence of severe infection were the major factors contributing to CRP elevation, while postmortem interval, age, gender, hepatic injury and liver cirrhosis was not. In almost all the immediate deaths (15/16) CRP remained at a low level (<0.5 mg/dl). Acute deaths and subacute deaths within 6 h showed lower CRP levels compared to longer survivors, consistent with the clinical and experimental studies. As for natural diseases, the CRP level reflected the pathological findings. The results suggest a possibility of CRP as a forensic diagnostic marker.