Laceration of the stomach by blunt trauma in a child: a case of child abuse

A case of perforation of the stomach following blunt abdominal trauma is described in a two-year-old boy. The abdominal trauma was the result of a blow to the abdomen by the stepfather. The child had ingested a large meal in the hour preceding the injury. The child died from peritonitis and shock 12 h following the injury. The literature on gastric perforation by blunt trauma is reviewed. Injuries to the stomach from nonpenetrating trauma are quite rare and are most often related to vehicular accidents. Gastric injury in a child presenting with a history of a minor home or play injury should arouse suspicion of more significant and perhaps intentional trauma.     

Burn injuries caused by a hair-dryer--an unusual case of child abuse

About 1.4-26% burn injuries in children appear to be abusive in origin. A 2.5-year-old girl was referred to our institute because of suspected child abuse. Clinical examination and later interrogation of the mother revealed non-recent deep second degree burn injuries on both gluteal regions, caused by the partner of the mother by pressing a hand-held hair-dryer against the skin. The authors present the findings of this unusual method of child abuse.     

虐待儿童致死1例报告

虐待损伤具有病变的多样性、广泛性及新旧不一性等特点,与其它损伤有较大区别,现报告一例.     

Caffeine fatality: a case report

A case of fatal caffeine toxicity due to suicidal ingestion of a "look-alike" illicit drug is reported. Caffeine concentrations were determined by high pressure liquid chromatography (HPLC) with the brain having the highest level reported in the literature to date. Also, the blood concentration of caffeine was one of the highest among the cases reported. A literature review of caffeine fatalities is presented.     

Nonfracture-associated fatal fat embolism in a case of child abuse

Fatal fat embolism is usually thought of as a sequel to long-bone fracture, although cases secondary to soft tissue injury and atraumatic conditions have been infrequently reported. In this case of a two-year-old child-abuse victim who sustained multiple blunt traumatic injuries without skeletal fractures, pulmonary and systemic (brain and kidney) fat emboli were identified. At autopsy, all thoracic and abdominal viscera were intact; cranial contents exhibited only diffuse symmetrical petechial hemorrhages of the white matter. Because of the severe and widespread nature of soft tissue hemorrhage, and the absence of a grossly discernible cause of death, fat embolism was suspected. Using a combination of frozen section with oil red O staining and formalin-fixed osmium stained tissues, the immediate cause of death was determined to be diffuse fat embolism. Review of the literature reveals a pathophysiologic basis for fat embolism in the absence of fracture, both as a consequence of an acute increase in local pressure at the site of trauma and an alteration of the emulsification of blood lipids during shock. In light of these findings, we present this case to remind the forensic science community to consider fat embolism as the cause of death in cases of blunt-force injury without fracture.     

Biomechanical and morphologic reconstruction of a questionable case of child abuse

A 3-month-old baby died 8 days after admission to the hospital as a result of injuries received under unknown circumstances. The forensic autopsy revealed a fracture of the scull and a severe blunt injury to the head and brain. Histological investigation of the reactive changes at and around the edges of the fracture showed that the trauma could not possibly have been congenital. According to the defendant, the baby boy had been lying on the table used for changing his nappy and almost fell off it. The defendant moved "instinctively" to catch him, and this "reflex movement" caused the injuries observed. The event was then reconstructed by the criminal investigators and this reconstruction, coupled with the authors' biomechanical experiments using stroboscopic recording, revealed that the defendant's statement could not be true, as the force necessary to inflict the injuries was much greater than could be explained by an attempt to catch the baby.     

A case of traumatic osteomyelitis in a victim of child abuse

A premature black female infant born at 31 weeks gestation with history of 4 weeks in the newborn intensive care unit was discharged healthy to the care of her mother and was lost to follow-up. At age 4 months the infant was found dead in bed. There was no history of trauma and no external injuries were noted. There was no attempt at resuscitation. Coroner's autopsy showed acute bronchopneumonia, 3 partially healed skull fractures, a chronic subdural hematoma, chronic intracerebral hemorrhage, retinal hemorrhages, multiple healing rib fractures, a fractured fibula, and a partially healed fracture of the distal right radius. The fracture of the right radius showed a medullary abscess of the bone surrounded by scar tissue and containing pus and granulation tissue. We believe this inflicted fracture became secondarily infected by a hematogenous route. The final diagnosis of the cause of death was pneumonia secondary to multiple blunt force trauma, and the manner of death was diagnosed as homicidal. This is believed to be the first reported case of osteomyelitis in a context of child abuse.     

Characteristics of child abuse by anteroposterior manual compression versus cardiopulmonary resuscitation: case reports

Lethal and sublethal injuries to infants caused by anteroposterior manual compression can be accompanied by lateral rib fractures, hemorrhage into the viscera, and when severe, rupture of large vessels and solid organs. Abusers may claim that these injuries were sustained in an attempt to perform cardiopulmonary resuscitation (CPR). The difference between injuries caused by CPR and injuries caused by inflicted anteroposterior compression is examined in one sublethal and two lethal cases.     

A case of panhypogammaglobulinemia masquerading as child abuse

A case of panhypogammaglobulinemia in a 15-month old boy is presented. The child was followed at a local university teaching hospital for pneumonia, failure to thrive, and possible child abuse/neglect. Following minor trauma to the face, massive sepsis developed in the child. The mother was afraid to seek medical care because she was fearful of legal action against her. Upon the child's demise at home, police and medical examiner involvement ensued. The correct diagnosis was established at autopsy.     

An unusual case of child abuse homicide/suicide

This case report examines a child abuse homicide in which the perpetrator committed suicide a few hours after the infant's death. At the time of the perpetrator's suicide he was not under investigation, nor was he a suspect in the death of the child. Although the literature does not contain reports of similar cases, we are sure they exist. This report raises the question of the degree of social stigma attached to the accusation of child abuse. It also serves as a warning to those who must deal with the potentially suicidal child abuser.     

Childhood panhypopituitarism presenting as child abuse: a case report and review of the literature

Childhood panhypopituitarism may be acquired or congenital. Children with panhypopituitarism can present clinically with diabetes, growth failure, decreased bone density, and morbid obesity. In the forensic setting without the proper history, it can be misdiagnosed as child abuse or neglect. We report a case of a 3-year-old black girl who was admitted to the emergency room with apnea and subsequently died. While at the emergency department, it was discovered that the child had a fractured left hip and was severely growth retarded for age. The coroner wanted to rule out child abuse and/or neglect and requested an autopsy based on the physical findings identified by hospital staff. Significant findings at autopsy included small for age (15th percentile for age), hypoplastic brain/pituitary gland/adrenal gland/thyroid gland, abnormally formed skull with an occipital protuberance, a fractured left hip with decreased bone density, and central adiposity. Subsequent to the autopsy, it was discovered that at 6 weeks of age the child suffered from group B streptococci meningitis that resulted in panhypopituitarism. The panhypopituitarism then resulted in seizure activity, diabetes insipidus, and growth retardation. The authors hope this case report and review of the literature will assist investigators, pathologists, and clinicians in making a distinction between neglect or inflicted injury of child abuse and panhypopituitarism that can present with similar signs and symptoms.     

Prosecuting child sexual abuse in rural Kentucky: Factors influencing case acceptance by prosecuting attorneys

This study examined the relationship between felony prosecutors’ discretion and the legal and social factors present in cases of child sexual abuse. Prosecuting attorneys from 20 rural circuits in Kentucky were targeted for semistructured interviews in order to determine what influences them to accept or not accept a case for prosecution. Findings show a relationship between rural Kentucky prosecutors’ decision to accept a case and the availability of physical evidence, victims’ age and competence, potential trauma inflicted upon the victim, and the situation in which the allegation of sexual abuse originated. The relationship between prosecutors’ discretion and various factors is discussed regarding the impact on other criminal justice officials in their pursuit to combat child sexual abuse in Kentucky and in other rural communities as well. Winner of 1997 Outstanding Graduate Paper Award, Southern Criminal Justice Association     

Case report: Forensic anthropological assessment in a suspected case of child abuse from South Africa

Not many case reports of suspected child abuse as assessed solely on skeletal remains are available. Forensic anthropologists have intimate knowledge of normal skeletal anatomy, bone trauma and processes of healing of bone and may therefore be of help in suspected cases of child abuse. Patterns of trauma in juvenile skeletal remains which are suggestive of abuse include fractures in different phases of healing, multiple fractures, typical fractures on ribs and long bones and severe, complicated cranial fractures. The aim of this paper is to report on the findings of the analysis of the skeletal remains of a 3.5 years old boy. Forensic pathological examination indicated that the boy had died from a massive cranial fracture, with multiple injuries present to the rest of the body. After the body had been buried for some time, it was exhumed and we were requested to look for signs of chronic, long-term abuse. Findings included a massive cranial fracture, another fracture in the roof of the orbit, two areas of non-specific subperiosteal bone growth and several untreated carious teeth. No clear healed fracture could be found, except for a possible healed cranial base fracture which stretched transversely across the petrosal bone. This area showed signs of recent bone activity. The court decided that this was not enough evidence of chronic abuse and found the accused guilty of murder but not of chronic child abuse. This case illustrates the difficulty to obtain clear signs of chronic injury on juvenile remains.     

Scald burns complicated by isopropyl alcohol intoxication. A case of fatal child abuse

Scald burns are the most common type of thermal injury in child abuse. Death associated with nonaccidental burns, however, is uncommon. We recently investigated the case of a 4-year-old child who died from extensive body burns due to scalding. A contributory cause of death was isopropyl alcohol intoxication resulting from application of this chemical to the burns.     

Perceptions of victims and perpetrators in a depicted child sexual abuse case: gender and age factors

This study investigated the roles of respondent, perpetrator, and victim gender on attributions toward a 10- or 15-year-old victim and an adult perpetrator in a hypothetical sexual abuse case. It was predicted (a) that female respondents would be more provictim and antiperpetrator than men, (b) that 10-year-old victims would be deemed more credible than 15-year-olds, and (c) that men would deem a 15-year-old male victim more culpable when child sexual abuse is perpetrated by a female abuser. Three hundred thirty-seven respondents read a 350-word sexual abuse depiction in which victim age, victim gender, and perpetrator gender were varied between respondents. Respondents then completed a 14-item attribution scale, relating to victim blame, perpetrator blame, assault severity, and victim credibility. A series of ANOVAs revealed support for all predictions. Results are discussed in relation to gender role attitudes. Suggestions for future work also considered.     

吸毒案件中的尿吗啡检测

目的　研究吸毒人员停止使用毒品海洛因后 ,尿吗啡含量自然递减的一般规律。方法　对确证的 1 82名吸毒 (海洛因 )人员在停止使用毒品后连续 9天采集尿样 ,用放射免疫分析法检测尿吗啡含量。结果　 1 82名吸毒 (海洛因 )人员在停止吸毒后第 8天 ,尿吗啡平均含量降至 30ng/ml。 结论　在办案中 ,吸毒 (海洛因 )人员的尿样检测 ,建议最好在末次使用海洛因 8天之内     

Malnutrition, a rare form of child abuse: diagnostic criteria

Infantile malnutrition is often difficult to diagnose as it is rarely observed in industrialized countries. It may be associated with physical violence or occur in isolation. The essential clinical sign is height and weight retardation, but malnutrition also causes a variety of internal and bone lesions, which lead to neuropsychological sequelae and death. We report a rare case of death by malnutrition in a female child aged 6 1/2 months. The infant presented height and weight growth retardation and internal lesions related to prolonged protein-energy malnutrition (fat and muscle wasting, thymic atrophy, liver steatosis) resulting in a picture of marasmus or kwashiorkor. We detail the positive and negative criteria that established the diagnosis of abuse, whereas the parents had claimed a simple dietary error.     

Cyclizine as a drug of abuse?

Two British people going from Amsterdam to Berlin was examined at the borderline near Aix la Chapelle. Customsinspectors found besides a lot of hashish a letter hidden in a pocket lamp concerning drugs received in Amsterdam as remarks to LSD trips. Therefore a white powder found in a little paper in the purse of one person was tested for drugs. Previous examinations at the border failed and after further investigations at the Department of Forensic Medicine including mass spectrophotometry the powder was identified as Cyclizine. The analytical data like mass spectrum are described. This compound used many years for the prevention and treatment of motion sickness is off the market because of suggested teratogen effects. Previous reports about LSD-like symptoms after ingestion of large amounts of Cyclizine as the environment the powder was found let us suppose that some people will know about psychotic effects at high doses of this drug not being an inhibited narcotic.