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.     

Organization and procedure of forensic medical expert evaluation of professional working capacity loss

Sixty-one forensic medical expert conclusions on the loss of professional working capacity are analyzed and typical errors are characterized. The procedure of forensic medical expert evaluation of the degree of loss of professional working capacity in accordance with the Civil Code and Civil Judicial Procedure Code of the Russian Federation and the actual norm-setting documents is described.     

Organization and methodological activities of Russian Center for Forensic Medical Expert Evaluations Ministry of Health of the Russian Federation

Analyzes the organization and methodological activities of Russian Center for Forensic Medical Expert Evaluations in 1996-1998. Informs about the federal law on forensic medical expert evaluations and norm-setting acts aimed at improvement of forensic medical service in the Russian Federation, which have been developed at the Center. Offers recommendations on improving the quality control of expert evaluations at territorial centers and continuous education of experts. Formulates the main tasks of the Center fort the nearest future.     

Discrimination between functions of an expert bureau and a burial firm (topic for discussion)

The authors suggest measures aimed at discrimination of the functions performed by forensic medical experts and the services rendered by burial firms. The responsibilities of pathology departments of hospitals and bureaus of forensic medical expert evaluations, which should be reflected in official documents, should be confined to manipulations needed to solve the professional problems and removal of sections. Cases when utilization of certain chemicals or manipulations aimed at restoration of the body are prohibited should be listed in detail. The order of transfer of the body from pathology department or forensic medical bureau to the burial firm and to relatives should be regulated with consideration for the results of autopsy. The moment of the end of autopsy studies is to be determined.     

The use of emission spectrum analysis in the forensic medical expertise of gunshot wounds (experimental research)

Presents the methodology of experimental shots from various guns (n = 11) by common cartridges and of emission spectral analysis (ESA) which was used to study the regularities in deposition of "gunshot metals" at the site of gunshot injuries and to detect the characteristic differences in shooting with and without obstacles. Effects of some factors on deposition of metal components of gunshot products at the site of gunshot injuries are studied: type of gun, shell (with/without coating or semicoated), presence of obstacles, distance, and order of the shot. Results of studies are presented for some guns, which may be useful in forensic medical expert evaluations by means of ESA.     

A new surgical method from the viewpoint of personal identification: a case of identification based on the presence of a metallic Z-stent

To the best of our knowledge, the first case of successful personal identification based on the characteristic finding of a metallic Z-stent, unexpectedly discovered in the common bile duct, is reported. An unknown human male cadaver was found at the seaside. The age was estimated to be ~50–70 years and the postmortem interval was considered to be ~2 weeks. There was a small surgical scar of 1.5 cm in diameter in the epigastrium. The cadaver was group A in the ABO blood group system. Internally, the following severe injuries were observed: the dislocation of the occipito-atlantal joint, fractures of the cervical and thoracic portions of the spinal column, multiple fractures of the bilateral ribs, and ruptures of the spleen, left kidney and liver. Furthermore, a 4.5 cm long metallic stent was found in the common bile duct, and the gallbladder was not thoroughly identified because of the severely tight adhesion of the surrounding tissues. In every cut surface of the liver, multiple bile plaques, signifying the presence of long-standing cholestasis, were conspicuous. A microscopic examination revealed the invasion of cancer cells into the liver, which was diagnosed as well or moderately differentiated adenocarcinoma, although the primary origin of the adenocarcinoma could not be determined. The cause of his death was diagnosed as traumatic shock. According to the police investigation after the autopsy, it was revealed that a 60-year-old male, suffering from gallbladder carcinoma, had disappeared. His medical chart disclosed that his blood group was A and that a metallic Z-stent had been inserted in the common bile duct in order to dilate the stenotic duct because of the invasion of the gallbladder carcinoma, and that he had never received cholecystectomy. The male's X-ray films revealed that the metallic Z-stent found at autopsy was identical with the one placed in the common bile duct by percutaneous transhepatic cholangial drainage (PTCD) procedures. The cadaver, therefore, could be identified as this missing 60-year-old male. Finally, it is recognized that forensic pathologists should have as much knowledge as possible of advanced modern iatrotechniques (surgical procedures, appliances, etc.) in order properly to perform a personal identification of unknown cadavers or people in whom the evidences of such modern iatrotechniques are found.     

Sequential monitoring of burials containing small pig cadavers using ground penetrating radar

Ground-penetrating radar (GPR) was used to monitor 12 pig burials in Florida, each of which contained a small pig cadaver. Six of the cadavers were buried in sand at a depth of 0.50-0.60 m, and the other six were buried in sand at a depth of 1.00-1.10 m to represent deep and shallow burials that are generally encountered in forensic scenarios. Four control excavations with no pig interment were also constructed as blank graves and monitored with GPR. The burials were monitored for durations of either 13 or 21 months, and were then excavated to correlate the decomposition state of the cadaver with the GPR imagery. Overall, this study demonstrated that it may be difficult to detect small cadavers buried in sand soon after they are skeletonized because the area surrounding the body, or the grave, may not provide a strong enough contrasting area to be detected by GPR when compared to that of the surrounding undisturbed soil. Also, depth of burial appears to influence grave detection because bodies that are buried at deeper depths may be detected for a longer period of time due to reduced decomposition rates.     

Cadaver dog and handler team capabilities in the recovery of buried human remains in the southeastern United States

The detection of human remains that have been deliberately buried to escape detection is a problem for law enforcement. Sometimes the cadaver dog and handler teams are successful, while other times law enforcement and cadaver dog teams are frustrated in their search. Five field trials tested the ability of four cadaver dog and handler teams to detect buried human remains. Human and animal remains were buried in various forested areas during the summer months near Tuscaloosa, Alabama. The remains ranged in decomposition from fresh to skeletonized. Cadaver dogs detected with varying success: buried human remains at different stages of decomposition, buried human remains at different depths, and buried decomposed human and animal remains. The results from these trials showed that some cadaver dogs were able to locate skeletonized remains buried at a significant depth. Fresh and skeletonized remains were found equally by the cadaver dogs along with some caveats. Dog handlers affected the reliability of the cadaver dog results. Observations and videotape of the cadaver dogs during field trials showed that they were reliable in finding buried human remains.     

Collembola of the grave: a cold case history involving arthropods 28 years after death

This report describes a cold case in which a cadaver of a 28-year-old female was exhumed in February 2005 from a cemetery in Battle Creek, Michigan. She had sustained a gunshot wound to the head and was found dead in her home on November 15, 1977. The body of the victim was subsequently embalmed and then buried at a depth of 1.8 m in an unsealed casket that was placed inside an unsealed cement vault. The exhumation yielded thousands of live specimens of a single species of the order Collembola or spring tails, Sinella (Coecobrya) tenebricosa (Entomobryidae). This species is considered to be a "tramp" species, cosmopolitan in the United States and Canada. Due to the ideal environmental conditions at the site, the population of this species underwent growth and development inside the casket for a number of years. Collected with the Collembola were large numbers of Acarina (mites) of the Family Glycyphagidae, and fly puparia, Conicera tibialis Schmitz (Order: Diptera, Family: Phoridae), also known as coffin flies. These invertebrates are sometimes mentioned by forensic investigators as occurring on corpses in graves, but aspects of their life history are rarely described. The species of Collembola that was found surviving and reproducing on this corpse in a casket exhumed after 28 years was the oldest reported grave site occurrence for any collembolan species based on a survey of the literature back to 1898.     

Decomposition of buried bodies and methods that may aid in their location

This is the second report on an ongoing study conducted to collect data on the decompositional rates of human cadavers and the first on buried cadavers. Six unembalmed human cadavers were buried separately in unlined trenches of various depths and allowed to naturally decompose for a time period ranging from a month to a year. During the period of burial, data were collected daily on the air, soil, and cadaver temperature at each burial site. At the end of each specified burial period the cadavers were exhumed and examined for the degree of decomposition which had taken place as well as changes in the soil pH, surface vegetation, and carrion insect activity. Analysis of the data shows that the decomposition rate of buried cadavers is highly dependent on the depth of burial and environmental temperatures. The depth at which the cadaver was buried also directly affected the degree of soil and vegetational changes as well as access by carrion insects. Application of this information can contribute to a more accurate estimation of time since death of a buried corpse and may aid in the location of such corpses.     

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.     

Effect of different post-feeding intervals on the total time of development of the blowfly Lucilia sericata (Diptera: Calliphoridae)

By estimating the age of the immature stages of flies developing on a corpse, forensic entomologists are able to establish the minimum post-mortem interval. Blowflies, which are the first and most important colonizers, usually leave the cadaver at the end of the last larval stage searching for a pupation site. This period of development is referred as the post-feeding or wandering stage. The characteristics of the ground where the corpse was placed might be of notable importance for the post-feeding dispersal time: For pupariation the larvae prefer an environment protected from light and predators and may have a longer dispersal time in order to reach an appropriate pupation site. Hence, the dispersal time can vary and may influence the total time of development which may lead to an erroneous calculation of the post-mortem interval. This study investigates the effect of various post-feeding time intervals on the development of the blowfly Lucilia sericata at a temperature of 25°C. As larvae reached the post-feeding stage a pupariation substrate was offered at 0 and after 12, 24 and 48h. Only the larvae with a dispersal time of 24h (total time of development 325.2h; median) and 48h (total time of development 347.7h; median) showed a significantly longer total development time compared to the control group (total time of development 318.4h; median). The mortality rate did not differ between groups; however the flies that emerged from the group with a dispersal of 48h were significantly smaller indicating increased energy consumption during dispersal. The results of this study indicate that a prolonged post-feeding stage could increase the total developmental time of L. sericata which should be taken into consideration when interpreting entomological findings. The need for a serious examination of current rearing practices in forensic entomology laboratories is indicated because reference data sets for the time of development are usually produced by offering the post-feeding stage a substrate for pupariation immediately.     

Expert systems for medical diagnosis: A study in technology transfer

Expert systems continue to evolve for specific applications in medical diagnosis. This is necessary because the influx of new information is so massive that the expert systems must be specialized. The research methodology for this study was based on the usage patterns of expert systems in clinical pathology with data obtained at 94 US medical schools from 202 medical-school-based clinical pathologists. The study showed the link between the use of expert systems in medical schools and within the professional medical community. Initial education in medical schools and ongoing communications through residency programs, post-doctoral fellowships and clinical usage at university hospitals with the goal of technology transfer between medical schools and physicians, seem to represent the future for this valuable diagnostic technique.     

Sequential monitoring of burials containing large pig cadavers using ground-penetrating radar

Ground-penetrating radar (GPR) was used to monitor 12 pig burials in Florida, each of which contained a large pig cadaver. Six of the cadavers were buried in sand at a depth of 0.50-0.60 m, and the other six were buried at a depth of 1.00-1.10 m and were in contact with the upper surface of a clay horizon. Control excavations with no pig internment were also constructed as blank graves and monitored with GPR. The burials were monitored with GPR for durations of either 12-13 or 21-21.5 months when they were then excavated to correlate the decomposition state of the cadaver with the GPR imagery. Overall, cadavers in sand were easily detected for the duration of this study at 21.5 months, even when completely skeletonized. Conversely, in clay it became increasingly difficult to image the pig cadavers over the first year of burial, even when they still retained extensive soft tissue structures.     

Munchausen syndrome by proxy (MSBP): an extreme form of child abuse with a special forensic challenge

Munchausen syndrome by proxy (MSBP) is a special form of child abuse in which an adult repeatedly produces symptoms of illness in a person under his/her care. In most cases the perpetrators are mothers who repeatedly and in different ways produce or feign symptoms of illness in their children in order to obtain medical treatment for them. MSBP is thus a special form of child abuse that is also of importance in the field of forensic medicine and a particular challenge to the medicolegal expert. We report two cases of poisoning with different substances (clozapine and clonidine) detected by toxicological investigations at our Department of Legal Medicine. The relevance of the problem for the medicolegal expert and the importance of an interdisciplinary co-operation are pointed out.     

新冠肺炎疫情期间公安法医应当加强尸体甄别和个体防护

因鉴定体制特点,公安法医除参与尸体有关的现场勘查工作外,还需进行尸体检验工作。在此过程中,可能面对很多风险,受伤和中毒等事件时有发生。然而,国内公安法医对新冠肺炎等传染病流行期间死亡的尸体如何甄别进行尸体检验鉴定,对现场勘查及尸体检验工作的防护只有少量规定,且内容不够详尽。本文对法医在现场勘查中遇到的尸体及尸体检验中实验室建设、职业现状、风险评估及防范措施等进行了论述。最后,建议出台相关的制度规定等具体约束规范措施,以保障公安法医现场勘查及尸体检验工作的顺利进行,以解除基层鉴定机构和鉴定人的后顾之忧。     

The QR code in society, economy and medicine--fields of application, options and chances

2D codes like the QR Code ("Quick Response") are becoming more and more common in society and medicine. The application spectrum and benefits in medicine and other fields are described. 2D codes can be created free of charge on any computer with internet access without any previous knowledge. The codes can be easily used in publications, presentations, on business cards and posters. Editors choose between contact details, text or a hyperlink as information behind the code. At expert conferences, linkage by QR Code allows the audience to download presentations and posters quickly. The documents obtained can then be saved, printed, processed etc. Fast access to stored data in the internet makes it possible to integrate additional and explanatory multilingual videos into medical posters. In this context, a combination of different technologies (printed handout, QR Code and screen) may be reasonable.     

Medical negligence in drug associated deaths

According to epidemiological studies adverse drug events are one of the most frequently encountered complications during medical treatment, a leading cause of hospitalisation and frequent cause of death. However, medical malpractice claims due to medication errors seem to be relatively rare. Based on a retrospective multicentre study on medical malpractice cases with lethal outcome (n = 4450), drug related cases (n = 575) were further evaluated. In 50% of cases a causal connection between drug therapy and death could be ruled out already after autopsy. In 232 cases a causal connection between drug therapy and death could be approved (drug allergies, relative overdose, wrong application, mix-up of drugs and sepsis after injection abscess). However, within the legal context only in 70 cases a medication error was approved which was in 42 cases causal for death, in 28 not. Administration of contraindicated drugs, incorrect application and relative overdose in renal insufficiency are the prevalent mistakes. Concerning the frequency of ADE in epidemiological studies medication errors are underreported in all data sources on medical malpractice; this seems to be due to the fact that even doctors and attending physicians rarely recognize an ADE; furthermore approving the connection between drug effect and death is extremely difficult for the expert witness.