Vaginal "fisting" as a cause of death

We describe the death of a young girl that resulted from the insertion of a clenched hand and forearm into her vagina during heterosexual activity. (The male homosexual practice of rectal fist insertion has been described previously.) We believe this death to be the first reported case of a "fisting" death due to vaginal fist insertion during heterosexual activity. This death is reported to alert forensic pathologists, medicolegal death investigators, and coroners aware of the role of aberrant sexual activity and its potential to cause death.     

构建学习型政府的价值取向及其路径选择

学习型政府是“以人为本”、“以学习为基础”、“以强化公共服务”为特征的民主政府,而构建学习型政府则正是对学习型政府中的“人本价值”、“学习价值”、“服务价值”和民主价值的追求和索取。因此,要实现学习型政府的公共价值,就必须提出科学合理的对策和建议,以加快构建学习型政府的实践进程。     

Glycogenated squamous epithelial cells as a marker of foreign body penetration in sexual assault

Nonconsensual insertion of a foreign object into the vagina, anus, or mouth in some judicial jurisdictions is synonymous with rape, and elsewhere may constitute some degree of sexual assault or battery. Few techniques, however, are available to assist the criminalist in determining whether an object has been criminally inserted. Glycogenated epithelial cells have been used as a marker for vaginal epithelium, and as such, may indicate vaginal insertion if recovered from an object. This hypothesis was tested by studying orally and vaginally inserted objects from 42 volunteers and 20 rectally inserted objects recovered from cadavers. Glycogen positivity was assayed from smears of object swabbings stained with the periodic acid-Schiff (PAS) technique. More than 75 glycogen positive cells were recovered from 39 of 42 vaginally inserted objects. Glycogenated cells were recovered from 8 of 20 rectally inserted objects (5 with more than 100 positive cells). Of 42 orally inserted objects, 32 also contained glycogen positive cells, but none with more than 28 positive cells. No glycogen positive cells were seen in skin exposed but not inserted objects. Large numbers of glycogen cells were seen in dried saliva drops. Amylase activity was not seen on 5 of 20 orally inserted shields, and thus the possibility of noninsertional saliva contamination could not be ruled out with shields yielding only small numbers of positive cells. Recovery of large numbers of glycogenated cells from foreign objects is strongly suggestive of either vaginal or anal insertion assuming amylase negativity. Glycogen positive cells are not seen secondary to glabrous skin exposure.     

Sexual abuse and death of an elderly lady by "fisting"

We describe the death of an elderly lady which resulted from the insertion of the hand and forearm into the rectum. The practice of "fisting" is a form of sexual activity confined primarily to the homosexual community. We report this death to alert forensic pathologists to this unusual practice, which can be fatal.     

Punched with a fist: the etiology of a fatal depressed cranial fracture

We report a case in which a 33-year-old man was discovered unconscious following a fistfight with another man. Emergency neurosurgical efforts to repair a depressed temporoparietal skull fracture and associated brain injuries were unsuccessful. The forensic anthropologist and pathologist worked in tandem to sort out a complex combination of cranial evidence, including healed antemortem trauma, perimortem blunt force trauma, remote and recent neurosurgical intervention, and the craniotomy cut performed at autopsy. The victim had suffered head injuries and a right temporoparietal craniotomy ten years prior to death. The perimortem cranial fractures were centrally located within a surgically repaired roundel of bone involving portions of the right temporal and parietal bones. Reportedly, the victim was punched on the right side of his head as he was lying on the ground with the left side of his head against an asphalt surface. A primary question in the case was whether a blow with a fist could have produced the observed cranial injuries. To adequately answer that question, known data on the minimum amount of force required to fracture the temporoparietal region were compared to data on the amount of force generated by a blow with a fist. A biomechanics expert demonstrated that a single blow with a fist to the rigidly supported head of the victim could generate the required force to produce the observed fractures. The previous medical condition possibly predisposed the victim to the cranial fractures and contributed to the depressed nature of the fractures. Although depressed cranial fractures do not typically result from a blow with a fist, it was determined in this case that the fracture pattern was consistent with a punch to the head.     

From Boundary Drawing to Transitions: the Creation of Normativity under the EU Directive on Integrated Pollution Prevention and Control

This article aims to make a contribution to debates about how to conceptualise normativity. It argues that normativity can not be just understood through defining it and in particular through identifying conceptual boundaries around the normative and the non-normative. Instead the article suggests that it is important to explore how transitions between the non-normative and the normative occur in practice. This argument is developed through a critical examination of literature on legal pluralism and an analysis of qualitative empirical data on the drafting of technical guidance documents under the European Union Directive on Integrated Pollution Prevention and Control (96/61/EC).     

Reliability of paper brightness in authenticating documents

Evaluation of paper brightness in multipage documents is a practice of forensic document examiners when there is a question of a page insertion or substitution. This article demonstrates that occasional errors occur in the manufacturing process that affects the consistency of paper brightness. The inconsistency of paper brightness may therefore influence conclusions reached in authenticating documents. Reams of multipurpose paper, from 21 manufacturers, were examined. When assessing the individual pages of each package with an ultraviolet light, approximately 30% of the reams revealed differences in paper brightness. A study of the paper-manufacturing process was conducted to determine where variations originate. It is concluded that brightness differences occur when one incompatible roll of paper is mistakenly placed with others used for one production run. It was also determined that brightness variations (when present) are patterned throughout individual reams. When the authenticity of a document is in question, consideration of these findings is essential to assure an accurate assessment.     

Insulin- or morphine-injection?: Immunohistochemical contribution to the elucidation of a case

Two autopsy cases of an elderly couple who died on the same day will be used to underline the importance of immunohistochemistry in forensic practice. At first unexplainable injection marks on the upper arms of the corpses and the possibility of a closely related physician injecting insulin and certifying a natural death made it important, considering suspect insulin concentrations in the blood, to exclude insulin injections in these marks. Further, the statement that morphine had been injected for the analgesia of tumour pains, was reinforced by immunohistochemistry.     

Investigation of a death caused by rectal insertion of cocaine

A 29-year-old homosexual man died as a result of cocaine inserted into his rectum by his sexual partner. The apparent purpose of this form of drug abuse is to relax the anal sphincter muscles. However, as in this case, cocaine administered in this fashion has a high potential for toxicity. The possible legal and medical ramifications of death resulting from this practice are discussed.     

Hypervariable locus of the 3'-flanking region of the neurotensin receptor gene: an effective region for personal identification in forensic practice

We examined the complex short tandem repeat (STR) locus at the 3'-flanking region of the neurotensin receptor (NTR) gene. The polymorphism of this locus was first reported as a simple tetranucleotide repeat variation by Le et al., but it also offers a surprisingly informative variation, that permits reliable individual identification by two complementary strategies: fluorescent-labelled polymerase chain reaction (PCR)/electrophoresis and direct sequencing of the PCR products. We determined the alleles in 203 Japanese by fluorescent-labelled PCR/electrophoresis. Determination was based on their length with a reliability of +/-1 bp, and the frequency of each allele was very low. Sequencing analysis further grouped these alleles in detail. Sequencing demonstrated that the locus varied by six repetitive units and three insertion/deletion positions of nucleotide fragments. We detected multiple alleles having different structures even in the same allele length. We found structural differences in homozygous alleles having the same base pair size. We also determined that apparently homozygous alleles were heterozygous from sequencing electropherograms showing an overlap of nucleotides or +/-1 bp difference. These results indicate that this locus is structurally hypervariable in addition to having allelic length variations, promising a great advance in individual identification in forensic practice.     

Forensic medical examination in cases of sexual abuse

The article presents the analysis of forensic medical expert practice in the field of sexual abuse. Drawbacks in expert examinations, official decisions on such examinations, low expertise of forensic medical personnel in sexual crime, lack of tools for genital and anal examination are analysed and methods of correction of this situation are proposed.     

Morphology of preimaginal stages of Calliphora vicina Robineau-Desvoidy, 1830 (Diptera, Calliphoridae): a comparative study

A comparative morphological study of preimaginal stages (larvae and pupae) of Calliphora vicina Robineau-Desvoidy, 1830 is presented. The entomological samples came from laboratory colonies bred under controlled environmental conditions (25°C and 60% relative humidity). In this study, a recently published technique to clear Diptera larvae for light microscopy and a standard protocol for scanning electron microscopy were used. For the morphological comparison of larval instars I, II and III, and pupae of C. vicina, different larval regions (cephalic, thoracic and abdominal, including anal division), as well the internal chitinised cephalopharyngeal skeleton, were considered separately. Our results focus on showing the changes observed throughout development for the most important structures in the cephalic region (sensilla of maxillary palpus, antennae and oral ridges), the thoracic region (the first segment and its anterior spinose band) and in the anal division of the abdominal region (posterior spiracles and shape of the papillae). In addition, some morphological structures are described or pictured for the first time, such as the ventral organ and the anterior spiracle of larva I and the antenna sensilla, Keilin's organ and wrinkled area of the anal division of all instars. The cephalopharyngeal skeleton is an important structure for the taxonomy of Diptera larvae in all instars, including Calliphoridae. Our observations in C. vicina indicate that an in-depth review of the sclerite composition is needed. Pupae and larvae stages can only be compared by following the segmentary spinose bands and the anal segment, where the morphology of the posterior spiracles and papillae can be observed, in some cases despite the reduced condition of the latter.     

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2001. Health Care Financing Administration (HCFA), HHS. Final rule with comment period

This final rule with comment period makes several changes affecting Medicare Part B payment. The changes include: refinement of resource-based practice expense relative value units (RVUs); the geographic practice cost indices; resource-based malpractice RVUs; critical care RVUs; care plan oversight and physician certification and recertification for home health services; observation care codes; ocular photodynamic therapy and other ophthalmological treatments; electrical bioimpedance; antigen supply; and the implantation of ventricular assist devices. This rule also addresses the comments received on the May 3, 2000 interim final rule on the supplemental survey criteria and makes modifications to the criteria for data submitted in 2001. Based on public comments we are withdrawing our proposals related to the global period for insertion, removal, and replacement of pacemakers and cardioverter defibrillators and low intensity ultrasound. This final rule also discusses or clarifies the payment policy for incomplete medical direction, pulse oximetry services, outpatient therapy supervision, outpatient therapy caps, HCPCS "G" Codes, and the second 5-year refinement of work RVUs for services furnished beginning January 1, 2002. In addition, we are finalizing the calendar year (CY) 2000 interim physician work RVUs and are issuing interim RVUs for new and revised codes for CY 2001. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule also announces the CY 2001 Medicare physician fee schedule conversion factor under the Medicare Supplementary Medical Insurance (Part B) program as required by section 1848(d) of the Social Security Act. The 2001 Medicare physician fee schedule conversion factor is $38.2581.     

Fatal traumatic rupture of an aortic aneurysm of the sinus of Valsalva: an autopsy case

This report describes an autopsy case of a rare type of aortic sinus of Valsalva aneurysm, which caused fatal rupture from a blunt chest impact. A 51-year-old male was hit in the chest with a fist, lost consciousness after about 15min and died after approximately 7h. The postmortem examination revealed a large saccular aneurysm of the right coronary sinus bulging on the right atrium, which had a full laceration causing pericardial hematoma (cardiac tamponade). A related chest wall injury was observed in the right outer mammary region. A rare type of bulging onto the right atrium and subsequent sclerosis of the right coronary artery appeared to have greatly contributed to the fatal rupture.     

Anal findings in sexual abuse of children (a descriptive study)

The aim of this study was to assess anal physical findings in children whose abuse was admitted by the perpetrator. Fifty children were studied in whom medical assessment took place remote in time from anal abuse which was admitted by the perpetrator. Medical assessment included examination to detect the presence of anal physical signs. Most frequent signs were anal scars and tags (either single or multiple) present, respectively, in 84 and 32% of cases. In some cases scars extended to the perianal region. Other signs included reflex anal dilatation (RAD) and venous congestion (VC) found, separately or associated with other signs, in over 33% of the cases. In 6% of the cases there were no abnormal anal findings. The results confirm earlier reports that physical signs, including scars, tags, RAD, funneled anus and extensive venous congestion, are often present in abused children, singly or in combination, and that anal examination should be undertaken even months after a known or suspected sexual assault. In the legal setting these physical signs are seen in association with anal abuse and support the child's statement. They do not per se provide proof of abuse.     

An Exceptional Case of Acute Respiratory Failure Caused by Intra‐Thoracic Gastric Perforation Secondary to Overeating

An 18‐year‐old female patient arrived at the emergency department complaining of abdominal pain and fullness after a heavy meal. Physical examination revealed she was filthy and cover in feces, and she experienced severe abdominal distension. She died in ED and a diagnostic autopsy examination was requested. At external examination, the pathologist observed a significant dilation of the anal sphincter and suspected sexual assault, thus alerting the Judicial Authority who assigned the case to our department for a forensic autopsy. During the autopsy, we observed anal orifice expansion without signs of violence; food was found in the pleural cavity. The stomach was hyper‐distended and perforated at three different points as well as the diaphragm. The patient was suffering from anorexia nervosa with episodes of overeating followed by manual voiding of her feces from the anal cavity (thus explaining the anal dilatation). The forensic pathologists closed the case as an accidental death.     

商业贿赂罪之刑法本体界定

商业贿赂首先是一个经济法上的概念,然后才是一个刑法上的概念,必须区分经济法上的商业贿赂和刑法上的商业贿赂。商业贿赂犯罪是市场经济发展到一定阶段的必然产物。商业贿赂犯罪是对发生在经济领域中的贿赂犯罪的集合称呼,它包括一系列具体罪名,而不是仅仅指公司、企业人员贿赂犯罪。     

Vaginorectal impalement injury in a 2-year-old child--caused by sexual abuse or an accident?

Anogenital impalement injuries are rarely encountered in clinical or forensic practice. If seen in children and if incurred under suspect circumstances, sexual abuse must be considered in the differential diagnosis. Here we describe the case of a 2-year-old girl admitted to hospital with a vaginorectal impalement injury. According to the girl's parents, she had slipped in the bathroom and fallen onto the handle of an upright toilet bowl brush. Since a second slight anal injury was present, the parents' account appeared inconsistent. Therefore, physicians from the Institute of Legal Medicine were consulted to investigate the possibility of underlying sexual abuse. Because they could not rule out that the injuries could have been caused by sexual abuse, they recommended having the police immediately examine the site of the purported accident for evidence. The police and forensic investigations, however, verified the parents' account of an accidental injury. Thus, in this case, the initiation of a police inquiry, which is not compulsory in Germany even when sexual abuse is strongly suspected, led to the exoneration of the father.     

Medical Evidence and Expert Testimony in Child Sexual Abuse

Expert medical testimony in child sexual abuse cases can be critical to the outcome of a legal case. This article will review the development of the medical knowledge and clinical expertise in child sexual abuse. Since the passage of mandatory child abuse reporting laws, the forensic medical examination of a child for evidence of sexual abuse has become standard. Until recently, many myths regarding female genital anatomy existed but were based primarily on dogma and lack of empirical research. Over the past 25 years, many research studies and accumulating clinical evidence have expanded medical knowledge and debunked old myths. Physical evidence, even in cases of alleged genital or anal penetration is rare. Sexually transmitted infections are also uncommon and often require medical interpretation as to their significance in a prepubertal child. Specialized medical knowledge, training, and clinical expertise have developed in order to evaluate children presenting with allegations of sexual abuse. Such medical expertise provides invaluable service to courts. We review criteria for evaluating such expertise in light of current medical practice.     

Fatal bilateral pneumothoraces after electroacupuncture treatment: A case report and literature review

Acupuncture is practiced as a complementary medicine worldwide. Although it is considered a safe practice, pneumothorax is one of its most common serious complications. However, there have been few reports of deaths due to pneumothorax after acupuncture treatment, especially focused on electroacupuncture. We report an autopsy case of a man in his 60s who went into cardiopulmonary arrest and died immediately after receiving electroacupuncture. Postmortem computed tomography (PMCT) showed bilateral pneumothoraces, as well as the presence of numerous gold threads embedded subcutaneously. An autopsy revealed two ecchymoses in the right thoracic cavity and a pinhole injury on the lower lobe of the right lung, suggesting that the needles had penetrated the lung. There were marked emphysematous changes in the lung, suggesting that rupture of bullae might also have contributed to bilateral pneumothoraces and fatal outcome. The acupuncture needles may have been drawn deeper into the body than at the time of insertion due to electrical pulses and muscle contraction, indicating the need for careful determination of treatment indications and technical safety measures, such as fail-safe mechanisms. This is the first case report of fatal bilateral pneumothoraces after electroacupuncture reported in the English literature. This case sheds light on the safety of electroacupuncture and the need for special care when administering it to patients with pulmonary disease who may be at a higher risk of pneumothorax. This is also the first report of three-dimensional reconstructed PMCT images showing the whole-body distribution of embedded gold acupuncture threads, which is unusual.