A case of self-inflicted wounding by the introduction of needles through the abdominal wall to induce abortion

The self-inflicted wounding of a 23-year-old woman who introduced needles through the abdominal wall to induce abortion is reported. The woman first came to hospital with metrorrhagia and pain in the right iliac fossa. Initially she refused treatment and went home. Twenty-two hours later she was admitted to hospital after giving birth at home to a male fetus of 610 g. The placenta was expelled in the hospital and a sewing needle was found. Lateral and anteroposterior radiographs revealed 15 such needles in the hypogastric region, most of them at subcutaneous level. The newborn was admitted to the intensive care unit in a generally poor condition, with hypothermia, cyanosis and bradycardia. An X-ray showed a metallic object in the abdominal region which, again, corresponded to a sewing needle. The newborn did not respond to treatment and died 2h after admission.     

Species differentiation by placental morphology with human and animal tissue. A contribution to species determination in relation to embryo findings

On the occasion of an embryo being found with attached placenta, species differentiation of the fetus was to be carried out within the framework of a preliminary proceeding. Consulted gynecologists diagnosed a human embryo. From the macroscopic and histologic structure of the placenta, our investigations resulted a species diagnosis of an embryo belonging to the order Carnivora (cat). The diversity of external placental shapes as well as of different histologic structures permit species differentiation. The delimitation of the human embryo from nonhuman tissue should always be possible, even on formalin-fixed material.     

眼球钝挫伤后视网膜脱离的司法鉴定

目的分析眼球钝挫伤后视网膜脱离在法医临床学眼损伤及伤残鉴定中的致伤原因及因果关系。方法研究112例眼球钝挫伤后视网膜脱离案例,对其中视网膜裂孔类型、外伤至视网膜脱离时间、合并其他损伤或疾病进行分析。结果本组案例锯齿缘离断4.28%,黄斑裂孔12.50%,其他部位的裂孔(<90°)56.25%,巨大裂孔(>90°)5.00%,未发现裂孔的增殖性玻璃体视网膜病变(PVR)性视网膜脱离11.6%,其中45眼有不同程度的PVR。外伤至视网膜脱离的时间以1周～2个月为常见(61.60%)。合并中高度近视者83.93%,合并玻璃体混浊者52.68%。外伤与视网膜脱离存在直接因果关系者41.07%,存在间接因果关系者52.68%,外伤与视网膜脱离难以联系者6.25%。结论视网膜脱离与多种危险因素有关,外伤与视网膜脱离之间因果关系的分析是法医学眼损伤及伤残鉴定的重要内容。     

On the Logic of Deontic Conditionals*

Abstract. The paper outlines the approach to the analysis of deontic conditionals taken in earlier work by Jones and Pörn, compares it very briefly with two main trends within dyadic deontic logic, and then discusses problems associated with the augmentation principle and the factual detachment principle. The author then modifies Jones and Pörn's previous system, using a classical but not normal (in the sense of Chellas) deontic modality to provide the basis for an alternative analysis of deontic conditionals. This new analysis validates neither the factual detachment nor the augmentation principles. However, influenced by the approach of James Delgrande to default reasoning, the author tries to show how a restricted form of factual detachment may be accommodated within the revised system.     

Old pulmonary embolus of the distal part of a Pudenz low-pressure ventriculoatrial shunt

At the autopsy of a man, aged 21 years, who had suffered from spastic tetraplegia for 10 years, the distal 25 cm of the Pudenz low-pressure ventriculoatrial shunt was found in the pulmonary artery, partly adherent to and partly covered with intima. The site of the detachment was the connection at the entrance to the facial vein. It is mentioned in the literature that the entrance of the venous system is, indeed, the most common site of detachment. An x-ray film of the chest, taken 3 1/2 years previously, retrospectively disclosed the catheter at the same location as demonstrated at the autopsy, but it had been overlooked at the time. On the non-intima-coated parts of the catheter, fresh thrombotic material was found, and there was cor pulmonale. The cause of detachment may have been the long-standing spastic tension in the neck muscles.     

Grenada: the Path to Revolution

At dawn on 13 March 1979, people living near the army barracks in the valley of True Blue near St. George's, capital of the young state of Grenada, were awakened by gunfire. A detachment of 47 rebels was attacking the barracks where approximately 300 soldiers were housed, and, taking advantage of the panic, seized the guns and ammunition stored there. The soldiers fled. It was 4 a.m., and an hour later the rebels took over the radio station. They appealed over the radio to the populace to take up arms and support the revolution that was beginning. The police were advised to surrender without resistance. In the hours that followed, the detachments of rebels, now joined by workers and student youth, seized the prime minister's residence, telegraph installations, and other strategic objectives. In the course of the day, all police stations hung out white flags. The sagging regime collapsed. Fidel Castro called the anti-imperialist democratic revolution that had been victorious in Grenada "a big revolution in a small country."¹     

Posttraumatic thrombosis of the middle cerebral artery

Posttraumatic cerebral infarction resulting from carotid or cerebral artery occlusion is rare. Traumatic dissection of the carotid artery is the most frequent cause of infarction, whereas posttraumatic thrombosis of the cerebral artery is very rare. The authors describe a case of posttraumatic thrombosis of the left middle cerebral artery. Early in the morning, a 16-year-old boy was found unconscious in the parking lot of a supermarket. He had received fist blows and kicks to the head, face, body, back, and hip during the night. Computed tomography 10 hours after the violence revealed a gross cerebral infarction in the area of the left middle cerebral artery. He died 9 days after the violence. The autopsy revealed a thrombosis in the left middle cerebral artery. Microscopically, granulation tissue in the intima and a rupture of the internal elastic lamina were observed near the beginning of the artery. It was concluded that the blows to the head and face caused a partial rupture in the arterial wall, leading to thrombosis and cerebral infarction.     

32例妊娠期死亡法医病理学研究

目的　探讨妊娠死亡的特点。　方法　对 1990～ 2 0 0 0年间华西医科大学法医学院所做 3 2例妊娠死亡尸检病例进行分析。　结果　妊娠产妇死亡年龄以 2 5～ 3 0岁为多见 ,职业以农民常见 ,且绝大多数无产前检查记录 ,死亡多发生于分娩过程中 ,区、乡一级卫生院多发。前四位的死因依次为 :胎盘残留、输卵管妊娠破裂、产后感染和子宫血管结扎出血 ,绝大多数妊娠产妇死亡前产下活婴。　结论　有必要加强基层与农村医疗保健工作和制订有关的预防措施 ,以降低妊娠产妇的死亡率。     

Statistical analysis of DNA mixtures using peak area information and allelic drop out

A case of a woman killed in Perugia is reported. The woman was beaten to death and the body showed evidence of bites, kicks and punches. The request of the Court was to verify the presence of bites and if they belonged to humans. Morphological examination and genetic analysis with human Y-specific markers were performed in order to verify the origin of the bites. The DNA profile from the surrounded area of the traces was compared with the profile of the victim's husband (the suspect).The results showed a match between the profile of the suspect and that of the traces for all loci examined. Due to the fact that also other relatives of the husband's male lineage lived in the same house, it was not possible to identify the man who really contributed to the traces. Therefore, the analysis was implemented with autosomal STR markers, which showed a mixed genetic profile. In order to verify the number and the identity of the contributors, statistical analysis based upon peak area information was performed with Probabilistic Expert Systems.     

论医疗机构对患者的安全保障义务

患者在医院走失 (丢失 )、财产被盗、受到第三人侵害的事情时有发生 ,因此而发生的损害赔偿纠纷成为医患诉讼新的焦点。本文对与此相关的理论进行探析 ,旨在探讨法院在评判双方过错时所应适用的标准。笔者认为 ,附随义务是医疗机构对患者及其财产进行安全保障的依据 ,法院在认定医疗机构是否有过错应当以具体情事和诚信原则作为标准。     

Legal Positivism and Deontic Detachment

I consider a puzzle that arises when the logical principle known as “deontic detachment” is applied to the law. It is not possible to accept the principle of deontic detachment in a legal setting while also accepting that the so‐called “social facts thesis” applies to all legal propositions. According to the social facts thesis, the existence and content of law is determined by the attitudes or practices of legal officials. Abandoning deontic detachment is not an appropriate solution to the problem—the puzzle can be recreated with other plausible closure principles. The problem can be solved by restricting the social facts thesis to legal rules, rather than applying it to all legal propositions. Properly construed the social facts thesis does not apply to facts about what legally ought to be the case.     

Mechanism responsible for the formation of focal swellings on injured neuronal processes using a novel in vitro model of axonal injury

A novel in vitro model of axonal injury using PC12 cells was designed to introduce traumatic alterations on neuronal processes and to identify mechanisms responsible for the formation of focal swellings by observation with phase-contrast and transmission electron microscopes. The injury on the processes was developed by one-dimensional, horizontal oscillation. Phase-contrast microscopic observation on the injured processes showed their terminal increase in diameter. Long term observation of cellular responses to the mechanical insult disclosed that the terminal swelling coincided with the detachment of growth cones from the culture plate. The finding suggests that the detachment of the growth cone would destroy a cytoskeletal network, which determines and maintains the cell shapes, and then cause the spherical deformation of the processes. Ultramicroscopically, the processes with terminal swellings regenerated the growth cones by the cytoskeletal reconstruction.     

可行与可及：论医院内部调解的正当性及功能

医院内部调解是在医疗纠纷解决过程中发挥重要作用但往往被人们忽略的一种有效调解形式。以调解的正当性要求审视,医院内部调解可以在符号、语言、程序和关系网络等方面实现调解的中立要求,也可以在治疗型调解和教化型调解中满足调解的合意要求,这证明了医院内部调解的可行性。实践证明,医院内部调解可以较大提高纠纷的终结力,提高医患双方对解纷的满意度,还能有效维护医疗秩序和提高医疗质量,这证明了医院内部调解的可及性。     

Suffocation death by occlusion of the airways with sand

Eleven cases are reported in which death occurred because of suffocation as a result of occlusion of the respiratory tract by sand (without thoracic compression: 3 cases) or being buried alive (8 cases). Two tables demonstrate the findings and circumstances in the events. Three cases are described in detail. A 22-year-old woman was manhandled by blows and kicks to the head and neck. She became unconscious and her head and neck were covered by a layer of sand so that she suffocated. A 42-year-old man was smothered, while unconscious, in a prone position with his face in the sand, after hard blows to the head by two culprits. A 17-year-old girl finally died by chocking. Previously the culprit had pressed her face into the ground, so that she aspirated particles of soil. The question of vital reactions during aspiration of sand was investigated by microscopic examination of the content of the air passage and by destroying parts of the lungs by sulphuric acid. Minimal aspiration of sand occurred in all cases. Although the postmortal remains were left in the ground, there was no postmortem penetration of sand into the air passage. Histological examinations were carried out to support the diagnosis of violent suffocation. In some cases, there were remarkable findings (mobilization of alveolar cells, hepatocelullar hydropic degeneration), but there were no typical or unanimous findings that pertained to all cases.     

An unusual fatality in a child due to oxycodone

An unusual fatality secondary to oxycodone in a child is reported. A 2-year-old female child was conveyed to a local hospital after exhibiting signs of rubbing of the mouth and staggering. A hospital toxicological immunoassay screen for drugs of abuse and tricyclic antidepressants was performed on a urine sample and reported as negative. She was discharged and found unresponsive the next morning. She was conveyed to a second hospital in full cardiopulmonary arrest and despite resuscitative efforts, was pronounced dead upon arrival. An autopsy was performed and postmortem specimens were submitted and screened for drugs using mainly chromatographic techniques. Quantitation was achieved by gas chromatography with nitrogen phosphorus detection. Confirmation was performed by gas chromatography/mass spectrometry. Oxycodone was the only drug detected in the following concentrations: heart blood, 1.36 mg/L; gastric contents, 7.33 mg in 33 mL (222.34 mg/L); liver, 0.2 mg/kg; and urine, 47.23 mg/L (47,230 ng/mL). In addition, immunoassay testing of the urine was positive for the opiate class of drugs. This case report demonstrates an unusual cause of death in a young child with emphasis on potential limitation in hospital urine screening tests and the importance of complete forensic toxicological testing in all child deaths.     

Problems associated with the diagnosis of vitality in burned bodies

The most important signs of vitality in burned bodies are soot deposits in the respiratory tract, the esophagus and the stomach as well as elevated CO-Hb values in the blood. But these findings show only that a person was exposed to fire fumes while alive; they are no indicator for vital heat exposure. As the external findings in burned bodies are often not very conclusive due to postmortem consumption by the fire, the internal findings are all the more important. Macroscopic signs that hot fumes were inhaled may be edematous swelling and vesicular detachment of the mucosa in the pharynx, the larynx and/or the upper section of the esophagus. As histological changes in the respiratory tract soot deposits, vesicular detachment of the epithelium, hyperemia and edema of the tracheal and bronchial mucosa as well as increased secretion of mucus have been described. These findings may partly be absent although the victim was alive during the fire, which can make diagnosis more difficult. Especially in peracute deaths vitality findings are usually sparse. The significance of the macroscopic and histological parameters of vitality was systematically investigated on the basis of our own autopsy material from the years 1996-2002 (88 cases) and compared with the statements found in the literature. In our study material, the vitality parameters were incomplete in 23% of the burned corpses. In 3% of the cases the question whether there was an antemortem heat exposure could not be answered.     

Diagnostic value of the placenta in medico-legal practice

In three suspected cases of infanticide, histological examinations of the placentas were effective in clarifying the circumstances. We have estimated the 5th month of pregnancy from pieces of the placenta in one case and diagnosed the causes of perinatal abnormalities in two cases, those being acute chorioamnionitis and possible premature separation of normally implanted placenta.     

Severe necrosis of oesophageal and gastric mucosa in fatal methanol poisoning

Methanol is a potent neurotoxic substance that causes severe metabolic acidosis and serious neurological disorders. Most of the cases are accidental exposures to drinking beverages contaminated with methanol. There are few articles reporting pure methanol intoxication; however, it is well known that small quantities of pure methanol causes blindness and death, the minimum lethal dose being 50-100 ml.A case report is presented of a 67-year-old woman, who committed suicide by ingestion of 500 ml of absolute methanol. Despite symptomatic and supportive intensive care, the woman died 23 h after hospital admission due to metabolic acidosis and multiple organ dysfunction syndrome. A complete medico-legal autopsy was performed. Grossly, there was complete detachment of the oesophagus mucosa and brownish discolouration of the gastric mucosa. Histological findings showed diffuse haemorrhagic necrosis of the stomach mucosa and intense acute inflammatory infiltration of the lamina propria. To our knowledge, this is the first autopsy report of such severe digestive injuries. A discussion and review of the recent literature on the subject are given.     

Perforating gunshot to the head with a power-actuated tool

The article describes a shortly survived suicide with a powder-actuated tool. A 51-year-old man shot all through his head from the right to the left temple. The pin produced an extensive area of destruction in the brain tissue, but neither in the hospital nor during the autopsy was any projectile found. Finally the pin was detected in a metal fitting of the bed in which the man had killed himself. The suicide instrument was a powder-actuated tool firing a metal pin after igniting a cartridge. Unlike a nail gun using compressed air, pins fired by means of a propellant reach a velocity of up to 150 m/s thus developing a higher destructive potential.     

Transmesenteric hernia due to double-loop formation in the small intestine: a fatal case involving a toddler

We report a unique case of transmesenteric hernia resulting in death, which went undiagnosed during a recent hospital visit. The victim was a 2.5-year-old girl who - with the exception of chronic constipation - had no medical history. One night she complained of abdominal pains and was taken to a pediatric hospital where doctors performed an abdominal X-ray and echography. No significant findings suggesting bowel obstruction (e.g. air-fluid levels or dilation of the bowel) were obtained on examinations and bloody feces were not observed in this particular episode. As her abdominal pain gradually attenuated, the doctor allowed her to return home. A few hours later, she lost consciousness and expired despite resuscitation efforts attempted at an emergency hospital. A subsequent autopsy revealed that the small bowel had herniated through a defect in the mesentery resulting in two consecutive and inversely forming loops, in which each loop protruded on either side of the mesentery. This rare morphological anatomy seems to have progressed in a two-step process. The girl's mild abdominal pain was likely induced by herniation and formation of the first intestinal loop, followed by severe shock occurring when the subsequent intestinal segment invaginated into the same defect forming the second loop on the opposite side of the mesentery. This case illustrates the difficulty of diagnosing transmesenteric hernia due to the presentation of unspecific symptoms; especially in infants and toddlers. Furthermore, this report demonstrates the value of a complete autopsy in cases of sudden and unexpected deaths involving children.