Unusual neck lesion in a pedestrian caused by a road accident

The authors describe a road accident that occurred in the Trieste region of Italy in 1998, wherein a pedestrian experienced a mortal injury. During the on-site examination, the forensic officer in charge noticed, in addition to dispersed abrasions, bruises, and fractures, an unusual position of the head with a highly unusual motility of the cervical rachis and, above all, an apparent whitish fibrous elastic cord, 7-8 cm long, which came out of the mouth. The cord was found to be a segment of the spinal cord, expelled and driven into the mouth cavity by the impact. This represents an interesting case because of the specific dynamics of the accident and the type of lesion involved. This kind of spinal cord injury, in particular, is infrequent among pedestrians involved in road accidents in comparison with other road casualties.     

Fatal accident with a special automobile

The authors report on a traffic accident in which the passenger of a Light Four-wheeled Vehicle (Microcar) approved for use by a disabled person was killed after a rear collision with a compact car. The severity of the accident trauma was critically determined by the vehicle's light construction. Consideration is also given to the legal situation regarding registration and driver's license issues.     

医疗事故赔偿责任中美立法比较

笔者认为医疗事故的处理中存在4大关键性问题:范围限定、科学鉴定、赔偿依据、责任承担方式。大量的事实说明,在对医疗事故处理的立法上,不仅在中国,而且在世界上许多发达国也没有合理解决这些。为了更科学的处理医疗事故、协调医患双方的利益,本文对这4个方面进行了分析,比较了中美立法上的异同,指出中美立法中各自存在的优缺点,在一些敏感、难点问题上提出了自己的一些建议,对今后中国医疗事故处理的立法、兼顾医患双方利益、妥善处理民事纠纷做出了有益的探索。     

A novel hunting accident. Discharge of a firearm by a hunting dog

The authors report the case of a 21-year-old man who was killed while duck hunting when a shotgun accidentally discharged, shooting him in the head. The loaded weapon, which had been lying on the ground with the safety off and the muzzle pointed toward a river a few feet away, discharged when a hunting dog stepped on the trigger. Scene investigation confirmed that the victim had been standing in the river, planting decoys, with his head approximately level with the adjacent bank. Autopsy examination and ballistic testing confirmed a range of fire consistent with the witness' statements. Examination of the weapon in question documented a light trigger pull but no mechanical defects. The authors review the epidemiology and causality of hunting accidents and discuss the various safety rules that were violated in this highly unusual case. The importance of a complete death investigation, including autopsy, when dealing with a firearm death is emphasized.     

Satellite dish as source of electric current. Case report of a fatal and nearly fatal accident at the work site

The authors report on an initially unrecognized fatal accident caused by electric current at the place of work. The source of the current was a satellite dish which had been improperly connected to an old music box with subsequent connection to the household electrocution system (220 V, 50 Hz). Only when a second nearly fatal accident occurred, proper diagnosis and detection of the uncommon source of the electric current was made.     

Methods for identification of 28 burn victims following a 1996 bus accident in Spain

A car collided head-on with a bus containing 56 passengers plus the driver. A few seconds after the crash, the bus caught fire and 28 persons (15 male and 13 female) lost their lives. All the deceased were almost completely incinerated. To establish the identity of the victims, the judge in charge of the case designated a multidisciplinary Identification Commission. Postmortem procedures included a general external examination, routine photographs, dental examination, dental (intraoral and extraoral) and general radiographs (chest, ankle, etc.), and complementary biological methods for identification (e.g., DNA analysis). The antemortem information, including dental and medical records available, were transcribed onto the INTERPOL disaster victim identification forms. The detailed ante- and postmortem information were compared manually. In this disaster dental identity could be established in 57% of the victims, whereas dental evidence did not allow by itself the identification of 12 burned victims. Odontological examination and complementary radiographic procedures were found to be accurate, economic and rapid methods of identifying badly burned victims in this bus accident.     

Hyperpigmentation in the long bones of the lower limbs as a basis for vehicle identification and traffic accident reconstruction

Following the earlier studies on the identification of injuries in unbroken cranial bones, the described method was adapted for the examination of the long bones in fatal casualties of traffic accidents.Two types of bumper injuries might occur: the bumper was found to cause fracturing of limbs [1], and femoral muscle contusions and microtraumas within compact and spongiose parts in the femoral with subsequent maculate hyperpigmentation [2].The authors show that the correlation of above mentioned traces of the trauma, facilitates the reconstruction of the accident and also the identification of the vehicle.     

Fatal impalement with transfixion of the neck in a road traffic accident

The authors describe a singular case of fatal impalement due to penetration of a metal tube at the level of the neck in a victim of a road traffic accident. The man was traveling in the passenger seat ("death seat") of a car that hit the parapet of a bridge head on; death was attributed to hemorrhagic shock, which was brought on virtually instantly at the moment of impact.     

Pedestrian accident analysis with a silicone dummy block

When a car is parked in an inclined plane in a parking lot, the car can roll down the slope and cause a pedestrian accident, even when the angle of inclination is small. A rolling car on a gentle slope seems to be easily halted by human power to prevent damage to the car or a possible accident. However, even if the car rolls down very slowly, it can cause severe injuries to a pedestrian, especially when the pedestrian cannot avoid the rolling car. In an accident case that happened in our province, a pedestrian was injured by a rolling car, which had been parked on a slope the night before. The accident occurred in the parking lot of an apartment complex. The parking lot seemed almost flat with the naked eye. We conducted a rolling test with the accident vehicle at the site. The car was made to roll down the slope by purely gravitational pull and was made to collide with the silicone block leaning against the retaining wall. Silicone has characteristics similar to those of a human body, especially with respect to stiffness. In the experiment, we measured the shock power quantitatively. The results showed that a rolling car could severely damage the chest of a pedestrian, even if it moved very slowly.     

Assessment of the cause and mode of death of victims of a mass industrial accident in the Halemba coal mine

On 21 November 2006 in the Halemba coal mine, Ruda ?l?ska, a mass industrial accident occurred. The underground catastrophe was probably due to combustion of methane followed by explosion of pulverised coal and resulted in death of twenty-three miners. The occurrence has been acknowledged to be one of the most serious accidents in Polish mining industry. Post-mortem examinations of the deceased were carried out in Department of Forensic Medicine, Medical University of Silesia, and in some cases additional dissecting techniques were employed. Photographs were taken as well as numerous specimens for various laboratory tests were collected. Toxicological analyses of blood samples revealed high levels of carboxyhaemoglobin saturation in seventeen cases, and detected presence of methane in the lungs of seven individuals, whereas microscopic specimens mainly showed lesions characteristic of putrefaction. The post-mortem procedures eventually allowed to establish the cause of death of all victims. The authors attempt to determine a range of requisite medico-legal proceedings and examinations that should be carried out in case of a mass industrial accident, and emphasise the need for development of appropriate guidelines.     

Fatal workplace accident involving ethyl acetate: a distribution study

The tissue distribution of ethyl acetate and ethanol in a case of acute intoxication by ethyl acetate is presented. The victim was a 39-year-old man who was found dead lying on his abdomen in the interior of a tank containing ethyl acetate. Confirmation of ethyl acetate was obtained with static headspace gas chromatography with mass spectrometry. In blood, rapid biotransformation of ethyl acetate occurs by plasma esterases resulting in acetic acid and ethanol. Quantitation of ethyl acetate and ethanol in the postmortem samples was performed using static headspace gas chromatography with flame ionization detector. N-butanol was used as internal standard. Separation of the compounds was obtained on a Supelcowaxtrade mark-10 Fused Silica capillary column. The method was linear over the specific ranges investigated and showed a within-run accuracy of 99.8 and 101.0% and a precision of 0.5 and 2.0% for ethanol and ethyl acetate, respectively. The postmortem samples were analyzed in duplicate or triplicate. Coefficients of variation were < or =4.51% for ethyl acetate and < or =0.52% for ethanol. The low ratios of the ethyl acetate concentration to the ethanol concentration found in the postmortem tissue samples confirmed the rapid in vivo biotransformation of ethyl acetate. The highest concentration of ethyl acetate was found in the testis indicating that postmortem percutane absorption may have occurred. To our knowledge, this is the first reported tissue distribution study of ethyl acetate and ethanol in a case of acute intoxication by ethyl acetate.     

Diffuse vascular injury in fatal road traffic accident victims: its relationship to diffuse axonal injury

The authors have reported a macro- and microscopic study of brain lesions in 120 victims of fatal road traffic accidents, independent of the survival time. Diffuse vascular injury (DVI) was found in 14 patients (11.7%). All patients with DVI died within 24 h after the accident. The 14 patients with DVI also showed severe (Grade 2 or 3) diffuse axonal injury (DAI). Since DVI is restricted to road traffic accidents and incompatible with life, the high frequency observed in our series could be explained by the fact that all 120 patients were victims of road traffic accidents, and 69.2% had died within 24 h after the accident. The association between DVI and severe DAI (Grades 2 and 3) suggests that both lesions depend on the same mechanism, with the degree of axonal and vascular damage being determined by the intensity of the head acceleration. Our results show a relationship between DVI and DAI that suggest there may be a spectrum or at least a continuum between these entities as distinct from DVI being a separate entity.     

Analysis of mutation of the plasma cholinesterase gene in a man who had died following a traffic accident

We analyzed mutation of the butyrylcholinesterase (BCHE) gene in a 69-year-old man on whom a forensic autopsy had been performed after he had died following a traffic accident. Extremely low plasma cholinesterase activity had been pointed out by the emergency doctor at the hospital prior to his death and based on this, organophosphorus poisoning had been suspected. However, no pesticides, which could have reduced the plasma cholinesterase activity, were detected by toxicological analysis using GC/MS. Subsequently, one base insertion was found in exon 2. The frame shift mutation had occurred because a homozygous extra T had been inserted between nucleotides 1343 and 1344, resulting in the appearance of a stop codon in codon 454 (AGA454TAA, Arg454stop). This heterozygous frame shift mutation at this point was identified in the man's son. It is likely that there may be many such latent patients with abnormal plasma cholinesterase activity, and accordingly we should always bear this fact in mind and should carry out molecular genetic testing for an accurate diagnosis of this deficiency.     

Scene investigation, identification, and victim examination following the accident of Galaxy 203: disaster preplanning does work

Galaxy Airlines Flight 203 crashed following takeoff from Reno-Cannon International Airport on 21 Jan. 1985. Sixty-eight persons on board the aircraft perished in the initial crash and resultant fire which followed. Two victims expired as a result of crash injuries within subsequent days and one passenger survived. A community disaster response plan was in place and had been practiced by local government agencies before this incident. The successes of this preplanned response, as well as methods of actual recovery, identification, and examination of the victims is presented.     

An attempt to objectify the condition of cervical spine distortion injury in traffic accident victims for court purposes

Introduction

According to morphological criteria, cervical spine injuries include, among others, contusion, distortion, luxation and fracture. Distortion of the intervertebral articulations occurs when the force of movement exceeds the physiological range, and the articular/joint capsule, cartilage and ligaments are damaged. While within the articulation a haematoma is formed, which produces clinical manifestations such as localised idiopathic pain, tenderness to palpation and analgesic limitation on both the passive and active joint mobility (i.e., a syndrome of subjective painfulness), as reported by the patient, the diagnostic imaging techniques (i.e., regular radiograph pictures) typically applied in such cases do not show any post-traumatic changes. Distortion of the cervical spine, resulting in a post-traumatic feeling of pain, usually occurs indirectly as a result of transmission of the force of injury onto the spine, as in the case of a traffic accident. Frequently, in cases of abuse, arriving at a hasty clinical diagnosis of post-traumatic cervical spine distortion apparently presents a serious problem in giving medical opinions for court purposes; thus encouraging the authors to attempt objectifying the condition of cervical spine distortion.

Methods

In a retrospective investigation, the authors analysed the medical opinions given by the Department of Forensic Medicine, Medical University of Silesia, for court purposes.

Results

Among nearly 5500 opinions in the past 5-year period, we analysed 167 cases related to cervical spine injury.

Conclusions

An attempt is made to either substantiate or negate the clinical diagnosis issued for court purposes by assessing the following: the findings of the physical examination of the person involved, the condition of the person involved in the accident from the period prior to accident (radiograph findings confirming the level of the already existing degenerative changes; age and sex of the person involved; positive or negative history of injuries sustained prior to accident), the course of treatment after the accident (character of symptoms reported and their evolution with time; co-existence of other bodily injuries; outpatient treatment instituted, including the application of Schantze collar, rehabilitation) and also the circumstances in which the accident occurred.     

Gasoline exposure in motor vehicle accident fatalities

Three cases are described in which deaths after motor vehicle accidents occurred as a result of positional asphyxia associated with exposure to gasoline. The deceased individuals were aged 16, 34, and 35 years, respectively (M:F = 1:2) and had all been in the back seat of motor vehicles involved in rollover accidents that had resulted in spilling of gasoline with contamination of the cabins. Major components of gasoline were detected in blood and tissues by headspace gas chromatography. Postmortem toxicologic investigations of such cases, which include analyses for volatile hydrocarbons, may therefore produce additional significant information.     

The fourth in a series of reports by David Davies analysing the experiences of those involved in a computer disaster

One of the most fascinating of human traits is their blase approach to possible disaster. Serious road accidents are something that happens to someone else, so drivers carry on taking appalling risks at high speed. In corporate terms management takes a similar approach to disaster, and computer disasters are no exception. “It won't happen to us” or “we'll muddle through somehow” are common excuses for the absence of a disaster recovery plan. Psychologists tell us that this is because we cannot come to terms with something we have not previously experienced: we simply cannot imagine the experience, therefore it has no reality as something that could affect us.In this series I am relaying the experiences of those people who have been involved in computer disasters, the lessons they have learned and the effects of the disaster on their company and on their own lives. If you are one of the great majority without a workable recovery plan, remember as you read: tomorrow this could be you!     

"A brilliant ball of fire." The sabotage of United Airlines Flight 629

Among the known causes of aircraft disasters, sabotage is perhaps the most terrifying and difficult to comprehend. Bombs have been exploded in at least 34 commercial aircraft, with the resultant loss of more than 300 lives. Motives for these acts include profit, the deaths of certain persons, and politics. On November 1, 1955, United Airlines Flight 629, bound to Denver-Portland, exploded and burned in flight near Longmont, Colorado, a few minutes after takeoff, with the loss of all 44 on board. Investigation revealed that the plane had been destroyed by the explosion of a bomb that had been placed in the rear luggage hold in Denver. Twelve days after the disaster, John Gilbert Graham, the son of one of the female passengers, was arrested and charged with murder. He reportedly admitted placing a time bomb on board the aircraft, apparently in order to collect $37,500.00 in life insurance that he had taken on his mother's life. Though he soon recanted, he was convicted of murder and was executed. The potential for additional such crimes remains.     

Dental participants in mass disasters--a retrospective study with future implications

Mass casualty incidents continue to require the services of forensic dentists to determine the identity of victims. Across North America and Europe. teams of forensic dentists train, using mock disaster exercises, to prepare for such duties. It is vital that these mock exercises simulate the features of real disaster situations as far as possible. In order to inform those responsible for the design and implementation of mock exercises, a study was undertaken to determine the features of actual disasters that dental personnel had attended. Using a questionnaire, data were solicited from 38 odontologists. The average number of disasters attended by the respondents was eight, with an average casualty number of 94. Aircraft crashes were the most frequent cause of disasters that were attended by the odontologists. The authors conclude that future mock disaster exercises should replicate features of aircraft crashes as closely as possible by using commingled, fragmented, and burned remains. In addition, mock disasters should require the identification of a realistic number of individuals to ensure authenticity and the maximum logistical preparedness of participants.     

论中国赦免制度的法典化

河北省政法委颁布“大赦民企原罪”的《决定》引起了社会各界的广泛关注,社会各界对其合理性作出了褒贬不一的评论。本文认为赦免应当依法而行,我国赦免实践的无序,源于赦免制度的缺失。作者从现代赦免制度的特征谈起,评析我国赦免制度之不足,提出赦免制度法典化的建议,并对中国赦免制度的适用范围、原则、程序、效力进行了初步的构想。