Diagnosis of Alzheimer's disease in an exhumed decomposed brain after twenty months of burial in a deep grave

After 20 months of interment in a deep grave, the decomposed body of the 81-year old testator of a will was exhumed to sustain the burden of proof that he lacked testamentary capacity when the will was rewritten two days prior to his death. The brain was mushy and pulverized with complete disappearance of the brainstem, cerebellum and subcortical ganglia. Small foci of relatively intact dorsal frontal neocortex were identified. Sections from these foci were stained with hematoxylin and eosin, bielchowsky silver stain and immunostains for beta amyloid peptide (betaA4), tau and alpha-synuclein. Despite severe autolysis and decomposition, the bielchowsky stain and the betaA4 immunostains showed preserved frequent neuritic amyloid plaques with very few residual neurofibrillary tangles. Cerebral Amyloid Angiopathy was present. At the present time this case represents the first documented and reported case of direct tissue diagnosis of Alzheimer's Disease pathology in a decomposed brain following long term burial in a deep grave.     

Origin of blood ethanol in decomposed bodies

Problems related to blood contamination by other postmortem fluids in decomposed bodies (DB) make the interpretation of medicolegal blood alcohol levels (B EtOH) a very difficult task. So the aim of this paper is to show the utilization of vitreous humor (VH) as the biological fluid for an unequivocal determination of ethanol origin in DB for forensic purposes. Alcohol was determined in VH, blood (chest fluid-CF) and urine (Ur) collected from 27 DB in different states of putrefaction. A simple head-space gas-chromatographic method was used. In fifteen cases alcohol was found to be of endogenous production due to its absence in VH. In the twelve remainders, alcohol was detected in VH and CF in an atypical distribution. Examining the reliable scene and historical information together with the analytical data, ethanol origin in these cases was classified: endogenous production (3 cases), ingested (2 cases), both (2 cases), contaminated plus endogenous production (3 cases) and unable to determine (2 cases). According to the results obtained it was possible to conclude that alcohol analysis in VH is fundamental for determining the origin of ethanol detected in CF of DB.     

Approaches to setting up the Center for identification of exhumed bodies in Chechen Republic

The authors participated in the activity of a group of European experts who visited Moscow, Rostov-on-Don and Grozny in September 2005 to clarify situation with identification of exhumed unknown dead bodies of the civil population. The European experts recommend to set up Center for Identification in Chechen Republic (in Grozny). The authors propose to make DNA identification tests in the Russian Federation Center for Forensic Medical Evaluation in Moscow which has much experience and staff skilled in identification of unknown exhumed bodies and can solve the problem of genetic identification of unidentified bodies of people missed in the Chechen Republic more effectively.     

Domestic violence: a medicolegal review

This paper reviews the recent medical and legal literature in the field of spouse abuse. Domestic violence is a national phenomenon that directly affects victims of spouse abuse and indirectly conditions the children of the victims to accept violent behavior as normative. This paper characterizes the cycle of violence battered women encounter, describes their injury patterns, explores the dynamics of the abusive relationship, and discusses the factors that compel women to remain in such violent relationships. The second section describes many of the recent legislation designed to prevent spouse abuse. Next, this paper addresses the case law utilizing the "battered woman syndrome" as a defense for spousal homicide. The third section of the paper explores the often neglected topic of the battered husband.     

The forensic radiographer: a new member in the medicolegal team

Multidetector computed tomography is becoming more widespread in forensic medicine. In most services, autopsy assistants perform the radiological examination. We introduced professional radiographers into the legal medicine service and hypothesized they would also be able to take over duties currently reserved for other specialists. The aims of this study were to evaluate if radiographers could be trained as "forensic radiographers" by (1) integrating graduated medical radiographers into the legal medicine service, (2) investigating the advantages of this collaboration, and (3) defining the duties of the forensic radiographers.The study was performed prospectively on a group of 8 recruited radiographers who underwent a testing period with special training. They learned the basics of medicolegal case treatment, the autonomous execution of postmortem computed tomography angiography, and postprocessing of data. Seven of 8 radiographers finished the training and were integrated into our service. Although all radiographers were able to fulfill the duties demanded after the training period, some radiographers could not enter or complete the program because they were unable to work with dead bodies.Our study presents the advantages of integrating radiographers into the medicolegal team and proposes how to train the forensic radiographers. In addition, the duties and responsibilities of these new specialists are defined.     

Acid violence: a burning issue of Bangladesh--its medicolegal aspects

Throwing acid on others' face and body to cause grievous injuries is a barbaric act of vengeance. For the last few years, it has been on the rise in both urban and rural areas of Bangladesh. The perpetrators are mostly men and adolescent boys. The victims are girls and young females. The reasons for attacks are sexual advances from man, refusal of marriage proposal, and vengeance. Cheap and easy availability of acids makes it the most effective weapon for man to use against girls' or young women's faces to prove that they have no right to deny a man's proposal and is one of the extreme forms of repression and violation of women's right. The consequence of acid attacks on survivors brings dramatic change in their lifestyle. Most of them have to give up their education or work. Social isolation, fear of further attacks, and insecurity damage their self-esteem and confidence. Illiteracy, poverty, threats to further retribution, and ignorance about legal support increase their miseries. Gradual increase of acid attacks suggests that legal provisions and their enforcement are not adequate and effective. Social awareness, economic and psychologic support, rehabilitation, and strict enforcement of laws are key to combat acid violence in Bangladesh.     

Withholding and withdrawing of life support: a medicolegal dilemma

The developments in medicine in general and the technology of life support in particular have provided the means of maintaining organ function for prolonged periods of time. However, there are many situations where life-sustaining treatment in an intensive care unit (ICU) may lead to a death with lingering and suffering of the patient, as well as burdening their family. Although often equated, withholding and/or withdrawing life-prolonging treatments that allow the patient to die needs to be differentiated from the physician-assisted suicides and euthanasia that involve the active ending of life. There is a difference between an unintended but accepted consequence of forgoing therapy and an intended result of death from suicide or euthanasia. The present-day physicians view most patient deaths as an inevitable process secondary to disorders unresponsive to treatment and/or multiple organ dysfunction syndromes. The large majority of patients dying in ICUs today succumb not after cardiopulmonary resuscitation, but rather, after the forgoing of life-sustaining treatment. Such approach has frequently caused families, institutions, and conservators of patients to resort to judicial fiat for resolution.     

Transsexualism in medicolegal limine: an examination and a proposal for change

This article investigates transsexualism and our creation of a state of medicolegal limine for transsexuals. The article addresses transsexuality as it is currently defined and explores our dichotomization of sex and gender. The author discusses both the social construction and the praxis of transsexuality, highlighting the medicolegal implications resulting from our current approach to transsexuality. The author argues that the creation of a medicolegal limine essentially prevents transsexuals from ever integrating fully as a member of one sex or gender, while simultaneously preventing the larger society from reconsidering its definitions of sex and gender. The article concludes with a summary of current challenges to our model of transsexualism and with suggestions for the resolution of this liminal medicolegal phase.     

Sudden infant death syndrome: a subject of medicolegal research

During the last decade, much attention has been paid to the risk factors of sudden infant death syndrome (SIDS). Many researchers have demonstrated that infant-care practices are linked to the risk of SIDS. Prone sleeping, bed sharing, maternal substance abuse, and cigarette smoking have been reported to be significant potentially modifiable risk factors for SIDS. Despite the reports that the incidence of SIDS has decreased by 38% in the United States, it remains the leading cause of death in the first year of life. Deaths resulting from child abuse or neglect inflicted or permitted by their caretakers being second only to SIDS in infant mortalities and some recommendations regarding the differentiation of SIDS and child abuse have generated speculation that some cases of infanticide were misdiagnosed as SIDS. To reach a proper conclusion as to the cause and manner of death of an infant who died suddenly and unexpectedly, investigation must be thorough and professional.     

Patent ductus arteriosus as a natural cause of pulmonary hemorrhage in infants: a medicolegal dilemma

Patent ductus arteriosus (PDA) is a recognized risk factor for massive pulmonary hemorrhage (MPH) in the newborn and is generally seen in association with other MPH risk factors such as prematurity. We report 6 cases of sudden and unexpected death of infants older than 4 days with MPH and PDA at autopsy. The cases were reviewed for other factors that could contribute to MPH to ascertain whether PDA is directly linked to MPH. Histology samples were examined for distribution of hemorrhage in the lungs and iron stained for hemosiderin evaluation. All of the cases had clinical histories and scene examinations which raised the differential diagnosis of mechanical asphyxia in the form of so-called overlayings. The diagnostic dilemma of attributing the MPH to the PDA as the sole cause, dual cause, or incidental finding is discussed. These cases illustrate the medicolegal dilemma faced by the pathologist, as well as the need for further research into the potential association of PDA with MPH.     

Cocaine in decomposed human remains.

From March 1988 through March 1990, at the Philadelphia Medical Examiner's Office toxicology laboratory, samples from 77 decomposed human bodies were tested for the presence of cocaine, employing gas chromatography/mass spectrometry (GC-MS). The material analyzed included decomposed soft tissue, bloody decomposition fluid, mummified tissue, maggots, and beetle feces. Twenty-two cases (28.6%) were positive for cocaine, many of these cases in states of advanced decomposition. These findings indicate the usefulness of testing decomposed tissue for cocaine in all cases where its presence is suspected. This is contrary to what might be expected, since cocaine is generally labile and rapidly broken down by both enzymatic and nonenzymatic mechanisms.     

A serious medicolegal problem after surgery: gossypiboma

After surgery, the most common foreign bodies retained in the abdominal cavity are the surgical sponges. The aim of the present study was to emphasize the importance of gossypiboma, which is a serious and medicolegal problem. The records of 12 patients with a confirmed diagnosis of gossypiboma after abdominal surgery at Dicle University Hospital were retrospectively reviewed between January 1994 and December 2009. Eight of the 12 patients were females, and 4 were males. Previously, 7 patients had been operated on electively, and 5 had undergone operations on an emergency basis. Abdominal ultrasonography clearly demonstrated gossypibomas in 5 patients, and computed tomography demonstrated a more precise image of retained surgical sponges in 3 patients. One patient died because of ventricular fibrillation; the other 11 patients were discharged in good health. To eliminate the risk of gossypibomas, all sponges should be counted at least twice (once preoperatively and once postoperatively); use of small sponges should be avoided during laparotomy, and only sponges with radiopaque markers should be used. The surgeon should explore the abdomen before closure. In cases in which the sponge count is uncertain, an abdominal x-ray should be performed before closure.     

医疗诊治过错与鉴定

在伤害案件鉴定中，我们发现一些医疗卫生单位，不注重对医务人员的医德医风教育，对医务人员制定不合理的经济指标或以不同形式将科室个人承包，片面追求经济效益，致使少数医务人员不结合临床实际草率处置病人，在诊治过程中出现人为的错误，致使一些伤者小病大养，轻伤久治，费用过高，出院难等，造成案件久拖不决，甚至上访，给鉴定及处理带来困难，严重干扰了正常的司法诉讼。现将笔者遇到两例报告如下，供同仁讨论。案1，张某，男，47岁，农民。因纠纷被人扭伤左手腕，速到当地卫生院进行X光片检查，报告为左尺骨远端骨折，医生根据X…     

医疗诊治过错与鉴定

在伤害案件鉴定中,我们发现一些医疗卫生单位,不注重对医务人员的医德医风教育,对医务人员制定不合理的经济指标或以不同形式将科室个人承包,片面追求经济效益,致使少数医务人员不结合临床实际草率处置病人,在诊治过程中出现人为的错误,致使一些伤者小病大养,轻伤久治,费用过高,出院难等,造成案件久拖不决,甚至上访,给鉴定及处理带来困难,严重干扰了正常的司法诉讼.现将笔者遇到两例报告如下,供同仁讨论.     

Sudden infant death syndrome (SIDS): a burgeoning medicolegal problem.

This Article presents a summary analysis of the administrative and statutory bases for the documented, prevalent mismanagement of Suddern Infant Death Syndrome (SIDS) cases by a majority of local death investigation agencies in the United States. Herein, Alan P. Cleveland, J.D. advances the theory that the unsatisfactory handling of cases of SIDS by the medicolegal community is the inevitable outgrowth of state laws that expressly require investigative agencies to approach a sudden, unexplained death from the direction of determining first whether or not a criminal act has occurred. In so doing, most statutorily mandated autopsy procedures are socially counterproductive since, in ignoring an acute medical need for supportive family counselling, they often constitute an insuperable obstacle to the effective management of SIDS as a public health problem. The author recommends that a requisite first step in implementing an SIDS management program at the state level is to insulate surviving family members form criminal investigative procedures by appropriate amendment of state laws governing local death investigation systems.     

Asbestos body burden in decomposed human lungs

The authors discuss the influence of postmortem tissue decomposition on the lung asbestos body (AB) burden, with the aim of evaluating the reliability of data obtained from autopsies performed for medicolegal purposes several months after deaths in possible connection with asbestos-related pathology. Eight autopsy cases were selected, each one with occupational exposure considered very probable on the basis of the history or pathologic findings. In each case the AB concentrations were assessed soon after death in one lung and after periods of 1 to 18 months in the others, which had been stored in sealed containers without fixation. AB concentrations consistently decreased with time in rotten lungs. The counts in some cases became negative a few months after death, even in cases with very high AB counts at first examination. It may be reasonably inferred that, in putrefied lungs from corpses exhumed after months of internment, the counts in digested tissues and the screening of histologic sections for AB may give false-negative results.