The current potential of forensic medical expertise of a local radiation injury

The present review concerns radiation injury, a most challenging problem facing modern forensic medical expertise. It is shown that its successful solution requires the combined application of all currently available relevant methods including radio- and biodosimetry, forensic histological examination, etc.     

25例医疗纠纷的法医临床学鉴定回顾性分析

目的探讨医疗纠纷的法医临床学鉴定及其相关问题。方法对25例医疗纠纷案例资料进行了回顾性整理分析。结果医疗失误16例,其中有不良后果的10例,均发生于手术科室;无医疗失误9例。结论医疗纠纷法医学鉴定过程中认定医疗失误是基础,认定医疗失误与不良后果的关系是关键。     

医疗纠纷的法医学鉴定

目的研究医疗纠纷法医学鉴定的特点,并讨论医疗纠纷法医学鉴定的重点及难点。方法将医疗缺陷分为责任性缺陷、技术性缺陷、管理性缺陷、学科性缺陷和其他缺陷,对36件案例分别进行分类并进行统计。其中把18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较分析,其他18例另行统计。结果36例案件中存在医疗缺陷的占86.11%,其中技术性缺陷66.67%,责任性缺陷和管理性缺陷均占25%。18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较,医疗缺陷的认定两者有明显差异(P<0.05),对于医疗缺陷已对患者造成不良影响的认定,两者具有显著性差异(P<0.01)。结论法医进行医疗纠纷的鉴定,对医疗纠纷诉讼案件的处理起着积极的作用。目前,医疗纠纷的法医学鉴定仍存在许多问题需要进一步讨论。     

The forensic medical expertise of the victims of large-scale fires]

The difficulties of present-day forensic medical expert evaluation of poisonings in fires are explained by exposure of man to highly toxic compounds that form during burning of polymers. Analyzing forensic medical expert evaluations of a large number of victims dead in a large-scale fire, the authors emphasize the necessity of measuring not only dead people's blood levels of HbCO, but of some other toxic combustion products that may exert combined effects on human body. The authors think it desirable that criteria of forensic medical evaluation of combined poisoning in fire be defined.     

Iatrogenic conditions as an object of forensic medical studies

The author proposes an original definition of iatrogenic states and their forensic medical model based on the analysis of the causes underlying the development of these conditions. A rationale for the application of this model in the forensic medical practice is formulated.     

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.     

Teaching forensic psychiatry to medical students

Are separate courses on forensic psychiatry available for medical students? During the 1985 to 1986 academic year, the authors surveyed all U.S. medical schools to identify courses on forensic/legal psychiatry. A minority of schools included separate courses or practicums on forensic psychiatry or mental health law. In a follow-up telephone survey, instructors of each of these courses were interviewed. Information was obtained on format of course, duration, discipline of instructor or instructors, topics covered, reading materials, institutional settings, and the number of students who took the course. The results are discussed and compared with earlier surveys.     

Forensic medical assessment of the validity of medical risk

The notions of an unfavorable outcome as accepted in medical practice as well as those of defected medical care and of iatrogeny are presented in the paper alongside with examples from forensic medical practice. An algorithm is suggested for the thanatogenetic analysis applicable to detection and evaluation of the cause-and-effect relations between the therapeutic-and-diagnostic measures, on the one hand, and the above outcome, on the other hand. Risk criteria are substantiated with reference to medical practice. Finally, a objective assessment scheme is suggested to confirm that the diagnostic and treatment tools, related with a higher risk, were justifiable.     

Basic approaches to medical,forensic, and biomechanical studies in expert evaluation of a car injury

Modern approaches to forensic medical expert evaluation of car injuries are discussed. Many problems remain unsolved after examination of injuries in victims inside the car, which negatively tells on the versions suggested during criminal investigation of car accidents. The experts often neglect the most sensitive methods for evaluation of these injuries and many fundamental approaches to the problem: differential diagnosis of primary and secondary injuries; basic medical and biomechanical methods and studies of the clues; fundamentals of total systems evaluation of the results of forensic medical expert evaluation.     

Sexual assault examinations and forensic medical samples

Recent studies and a review in the United States have identified that tens of thousands of used but untested sexual assault examination kits containing medical examination specimens are to be found in police station evidence rooms, forensic science laboratories, hospitals and rape crisis centres. A 2007 survey undertaken by the National Institute of Justice in the United States explored some of the reasons why forensic specimens are not tested by forensic science laboratories. Many of these relate to lack of knowledge on the part of investigators as to how scientific information can assist the investigation process, even if not used subsequently at trial. Cost factors and laboratory casework overload were also identified as significant. For the medical practitioner, the lack of testing poses issues that include quality management of the forensic medical examination and informed consent in a setting requiring the balancing of public and private benefits for the examinee. Limiting scientific testing, even with intelligence-led triaging of sample testing, could have an adverse effect on both prosecution and defence decision-making and ultimately could adversely affect trial outcomes.     

Forensic medical expertise of injuries in the anorectal region and rectum related to the sexual assault

Injuries to the anorectal region and rectum associated with sexual crimes require forensic medical assessment even though this issue remains to be poorly developed. The results of 84 forensic medical expertises are presented based on the materials obtained by examining both women and men who applied with complains of sexual abuse (anogenital penetration) to the Primorskoye territorial Bureau of forensic medical expertise during 5 years, from 2005 to 2009. The study has demonstrated correlation between dynamics of applications of the victims of either sex and the lack of a tendency toward a decrease in their frequency. The signs characteristic of acute injuries and chronic conditions are described. The causes of diagnostic errors during forensic medical expertise of sexual abuse are discussed.     

Forensic medical aspects of bone tissue injuries and pathology

This paper reports the results of a number of investigations into forensic medical aspects of bone tissue injuries and pathology that may be of value, both theoretical and practical, for the further studies in this field. The data obtained shed light on the influence of bone porosity on the mechanism of fractures and processes of reparation in the bone tissue. Moreover, they can be used for the purpose of forensic medical expertise.     

Criteria for forensic medical evaluation of professional working capacity loss

The main and additional criteria used in evaluation (in percent) of loss of professional working capacity are characterized. Criteria common for forensic medical and medical social expert evaluations and differences between them are discussed. These differences are due to the fact that forensic medical expert evaluations are based on the Civil and Civil Processual Codes of the Russian Federation but not on the departamental norm-setting documents.     

Development of forensic medical expertise of sexual conditions in men

The necessity of new methodological approaches in forensic medical examination of sexual male conditions are discussed basing on the analysis of questionnaire surveys of isolated groups of men and forensic medical examinations of male victims accused of sexual crimes. How to update expertise of sexual male conditions including investigations of anorectal and erectile dysfunctions in shown.     

Unfavorable outcome of medical service: study of the problem in forensic medicine

The main tendencies in the development and study of the problem of unfavorable outcome and expert assessment of quality of medical aid were examined. Russian and foreign forensic medicine and juristic practice were compared. A combined approach to improve of forensic medical expertise and to prevent delinquencies of medical stuff was proposed.     

Forensic medical expert evaluation in connection with civil actions of patients complaining of improper dental care

The authors discuss questions facing forensic medical experts in connection with civil "medical" actions. The questions are classified as common and private. Expert evaluations of correspondence of the scope and quality of dental care are offered as the base for analysis of these problems within the framework of civil legislation. The data evidence efficiency of forensic medical expert evaluations in civil legal procedure and the significance of forensic medical service in the solution of problems of quality and efficiency of medical (including dental) care of the population.     

Peculiarities of forensic medical expertise in a situation of massive salmonellosis morbidity in a military unit

The authors propose to consider infectious diseases as mass clinical conditions in both normative-legal and medical contexts. Peculiarities of commission and comprehensive inspections carried out in situations of massive infectious morbidity among servicemen are illustrated by examples of the work of state forensic medical organizations and investigative authorities of the Russian Defense Ministry.     

The epidemiological characteristics of fatal subdural hematomas in forensic medical practice

A retrospective analysis of subdural hematomas is carried out: 493 in subjects dead from mechanical injuries (from files of forensic medical morgues in Tver', 1992-1994), and 37 cases with chronic subdural hematomas (from files of forensic medical morgues No. 2 and 6 in Moscow, 1995-1997). Age and sex of victims, time and circumstances of injuries, topographic and morphological features of subdural hemorrhages and their relation to concomitant injuries, and presence of ethyl alcohol in the organism are studied. The data on chronic subdural hematomas are presented. The authors emphasize the need in forensic medical studies of this condition.     

Forensic medical evaluation of harm severity inflicted to one's health by slight craniocerebral injuries in the remote period

A pressing problem is discussed: forensic medical evaluation of harm inflicted to health by slight craniocerebral injuries. Analysis of 2150 expert forensic medical and medico-social conclusions revealed serious organization and methodological errors in evaluation of harm inflicted to health by slight craniocerebral injuries. Approaches to improving the quality of such forensic medical expert evaluations are outlined.     

Forensic medical identification of death due to poisoning of tetrodotoxin in puffer fish

One case died of poisoning of tetrodotoxin in dry fugu fillet was reported. Through the detailed forensic examination for this lethal case, many questions about forensic medical identification of death due to poisoning of tetrodotoxin was discussed and its medico-legal significance was also discussed. In particular, emphasis was placed on the details of a case, extraction of TTX in specimen, quantitative detection of TTX, purplish mouth and nails, dilatation of stomach and intestines, excluding other causes and combining animal experiment in order to get definite forensic medical identification.