Morphometrical analysis of retinal hemorrhages in the shaken baby syndrome

A morphometrical analysis of retinal hemorrhages was performed in cases of physical child abuse including the shaken baby syndrome and in controls (severe head injury, intravital brain death, non-traumatic intracranial hemorrhage, SIDS including cardiopulmonary resuscitation). The extent of the retinal hemorrhages was significantly different between both groups. In all cases of physical child abuse, massive retinal hemorrhages in at least one eye could be found ranging between a maximum value of 19.2 and 73.2% of the entire retinal area. In contrast, only two cases of the control group (severe head injury with skull fractures and intracranial bleeding following traffic accident or fall) showed slight hemorrhages of 3.33 or 1.18% of the retinal area but only in one eye. Therefore, the results provide evidence that massive intraretinal hemorrhages indicate violent shaking — in particular in association with other signs of physical child abuse.     

摇晃婴儿综合征争议及研究进展

摇晃婴儿综合征是常见的虐待性颅脑损伤,其病理表现为三联征:脑实质病变、硬脑膜下出血、视网膜出血。虽然摇晃婴儿综合征被广泛运用于医学及法律领域,但是由于目前尚无直接证据证实成人摇晃儿童能造成严重脑损伤甚至死亡的后果,因此摇晃婴儿综合征存在学术争议。争议内容包括摇晃婴儿综合征的生物力学机制、病理生理机制等方面。由于某些疾病也能导致病理三联征,因此在诊断摇晃婴儿综合征过程中,应当注意外伤史、案情调查等。     

Cerebral traumatism with a playground rocking toy mimicking shaken baby syndrome

Shaken baby syndrome (SBS), one of the most deadly and devastating forms of child abuse, is caused by violent shaking. The combination of subdural hematoma, retinal hemorrhage, brain swelling, and diffuse axonal injury is highly typical of this syndrome and faced with these autopsy findings, induced traumatic lesions are strongly considered. However, it is known that motor-vehicle accidents and falls from great height can also produce this pattern of injury. Nevertheless, stories of arms fall, couch fall, or bumped head while the baby is being carried are generally considered incompatible with SBS. We here report a case of a 2-year-old boy presenting with all the classic autopsy findings of SBS from a playground rocking toy shaken by an older child.     

Periadventitial extracranial vertebral artery hemorrhage in a case of shaken baby syndrome

We report a case of a two-month-old boy who became unresponsive in the sole custody of his father. Resuscitation efforts on route to the hospital were able to restore the infant's heart beat. However, neurologic function never recovered. Autopsy revealed massive cerebral edema, recent subdural, and subarachnoid hemorrhages, bilateral retinal hemorrhages, and cervical spine ligament hemorrhages. Separation of individual cervical vertebrae showed extensive, bilateral, periadventitial vertebral artery hemorrhages between C1 and C4, with corresponding luminal compression of the vertebral arteries. The importance of this previously unreported phenomena of periadventitial vertebral artery hemorrhage in the setting of shaken baby syndrome is discussed.     

Shaken baby syndrome and the death of Matthew Eappen: a forensic pathologist's response

Subdural hemorrhage, retinal hemorrhage, and cerebral edema have been considered diagnostic for a "shaken infant" since the syndrome was described almost 30 years ago. However, the specificity of these findings has been disputed by defense witnesses in recent U.S. criminal prosecutions. This review examines the scientific basis for the shaken baby syndrome.     

Case analysis of brain-injured admittedly shaken infants: 54 cases, 1969-2001

The English-language medical case literature was searched for cases of apparent or alleged child abuse between the years 1969 and 2001. Three-hundred and twenty-four cases that contained detailed individual case information were analyzed yielding 54 cases in which someone was recorded as having admitted, in some fashion, to have shaken the injured baby. Individual case findings were tabulated and analyzed with respect to shaking as being the cause for the injuries reported. For all 54 admittedly-shaken-infant cases, the provided details regarding the shaking incidents and other events are reported. Data in the case reports varied widely with respect to important details. Only 11 cases of admittedly shaken babies showed no sign of cranial impact (apparently free-shaken). This small number of cases does not permit valid statistical analysis or support for many of the commonly stated aspects of the so-called shaken baby syndrome.     

Crossbow suicide: mechanisms of injury and neuropathologic findings

Crossbow injuries are rarely reported events in modern times. Two cases of death due to self-inflicted crossbow injuries to the head are reported in 2 men aged 18 and 27 years, respectively. Despite relatively low velocity and concussive force, the sharpness and propulsion force of crossbow bolts may be sufficient to enable penetration of the skull at short range. Due to the relatively low concussive force of the crossbow bolt, however, death may not be instantaneous but may occur from intraparenchymal cerebral damage sometime thereafter. Detailed neuropathologic evaluation of such cases may therefore demonstrate "red cell" hypoxic injury, as well as axonal injury, not limited to the region of the missile tract, but widely distributed, even to the point of extensive brain stem involvement. These changes may result from primary mechanical deformation at the time of injury, from secondary hypoxic damage, or from a combination of both factors. Immunohistochemical staining of brains for amyloid precursor protein to delineate more clearly the pattern of axonal damage may assist in determining the extent of injury in such cases.     

股骨有限元模型的建立及损伤生物力学验证

目的 探讨利用Mimics软件将CT医学影像数据转化为有效的股骨有限元模型的可行性,为股骨骨折的生物力学研究提供模型基础.方法 利用16排螺旋CT扫描股骨,将扫描结果以DICOM格式导入Mimics软件中,生成股骨三维模型,并对模型网格划分、材料赋值.在LS-DYNA软件中分别施加1000N的垂直载荷、进行三点弯曲试验...     

Challenging Australia's "closed" model of neonatal care: the need for reform following Re baby D (No 2)

The withdrawal or withholding of life-sustaining treatment to compromised newborns is a subject of controversy in countries where there is now highly advanced neonatal care to keep such newborns alive. The topic has generated comparatively less debate in Australia, where case law is sparse and parents and clinicians themselves make decisions regarding the cessation of care, largely free from extemal oversight. The recent case of Re Baby D (No 2) [2011] FamCA 176 endorses this "closed" approach to neonatal decision-making. This article critically discusses some of its implications and makes suggestions for reform to ensure meaningful oversight of decisions to withdraw or withhold treatment. The authors argue that the judgment fails to address some fundamental issues, such as ensuring that those with the responsibility to make decisions are doing so on a "best interests" basis. This is important because, in a society where disability remains stigmatised and poorly understood, there is no opportunity under the approach adopted in Baby D to guarantee adequate protection of the rights of individuals born with physical or intellectual impairments.     

Toward a social geography of baby farming

This paper uses a range of archival sources to undertake a case study of the people and practices encompassed by the term “baby farming” in Melbourne, Victoria, Australia. It argues that baby farming needs to be located in space and time in order to reach some accommodation between its materiality and the discursive construction that continues to distort historical debate. Neither a criminal nor a compassionate practice, baby farming emerges as an economic exchange predicated on the vulnerability of single mothers, the disposability of their children, and in many cases, the desperation of poor women who see taking infants to nurse as a way of earning an income.     

Compensation of personal injury resulting from road traffic accidents in Cameroon: a critical analysis

Road traffic accident compensation which is meant to address the financial rights and needs of those injured is faced with a lot of challenges and hurdles in Cameroon. The system is based on automatic compensation linked to a direct insurance of risks created by road accidents. This however, still does not guarantee a befitting and timely compensation. The fact that such actions still have to go through lengthy administrative and legal procedures, alongside costly legal fee for the assessment of damages, has made most claimants disappointed. Such concern over the system of compensation calls for a thorough address and redress of the issue. Most jurisdictions the world over have moved away from the court system of calculation of damages to a social security system where all persons injured in road accidents have a right to compensation while still maintaining their right to litigation. These schemes are based on the philosophy of social justice and community responsibility. The focus of this paper is to bring out the limitations of the current system of compensation of road traffic accidents in Cameroon. It undertakes a comparative analysis to evaluate the arguments in support of the introduction of a collective insurance scheme of compensation in Cameroon.