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.     

眼球钝挫伤后视网膜脱离的司法鉴定

目的分析眼球钝挫伤后视网膜脱离在法医临床学眼损伤及伤残鉴定中的致伤原因及因果关系。方法研究112例眼球钝挫伤后视网膜脱离案例,对其中视网膜裂孔类型、外伤至视网膜脱离时间、合并其他损伤或疾病进行分析。结果本组案例锯齿缘离断4.28%,黄斑裂孔12.50%,其他部位的裂孔(<90°)56.25%,巨大裂孔(>90°)5.00%,未发现裂孔的增殖性玻璃体视网膜病变(PVR)性视网膜脱离11.6%,其中45眼有不同程度的PVR。外伤至视网膜脱离的时间以1周～2个月为常见(61.60%)。合并中高度近视者83.93%,合并玻璃体混浊者52.68%。外伤与视网膜脱离存在直接因果关系者41.07%,存在间接因果关系者52.68%,外伤与视网膜脱离难以联系者6.25%。结论视网膜脱离与多种危险因素有关,外伤与视网膜脱离之间因果关系的分析是法医学眼损伤及伤残鉴定的重要内容。     

The forensic medical assessment of the micromorphology of brain stem hemorrhages in craniocerebral trauma

Microscopic features of primary and secondary hemorrhages in the stem portion of the brain in craniocerebral injuries are described. Criteria of differential diagnosis between primary and secondary hemorrhages in the stem in subjects dead during 24 h after isolated and combined craniocerebral injuries are defined. The forensic medical significance of differential diagnosis of hemorrhages in the stem for the solution of many expert problems is evaluated.     

Forensic medical assessment of subendocardial hemorrhage in acute blood loss

A retrospective analysis of forensic autopsy protocols for 240 victims who died of acute blood loss aged 17-55 years (186 male and 56 female corpses--76.8 and 23.2%, respectively) has shown that appearance of Minakov's spots (MS) depends on duration of the terminal period. Subendocardial hemorrhages occurred most frequently (61.5%) in the terminal period up to one hour. The terminal period for several minutes was associated with MS appearance in 27.5% cases, for several hours--in 6.6%, for 24 hours and more--in 4.4%. MS incidence rate did not correlate with the group of the study, blood loss volume, severity of alcohol intoxication.     

非法行医的法医学鉴定1例

我国刑法三百三十六条规定的非法行医罪是指未取得医生执业资格的达到刑事责任年龄 ,具备刑事责任能力的自然人明知自己的行为可能造成危害社会的后果而放任该后果的发生心态而行医且情节严重的行为。边疆侵犯了国家对医疗卫生行业的管理秩序和广大人民生命健康权。现将笔者近期所遇的非法案例报导于后 (犯罪嫌疑人已逮捕 ) ,借此探索和解决当前的医疗卫生秩序。案　例 :2 0 0 1年 10月 3日晚 ,圈龙乡灯塔村 3级村民杨某某 (女 ,2 2岁 )第一胎足月孕临产 ,村“接生员”左某某 (未经培训也无合格证 )用“丰谷酒”搓手后并未消毒产妇会阴部就…     

非法行医的法医学鉴定1例

我国刑法三百三十六条规定的非法行医罪是指未取得医生执业资格的达到刑事责任年龄，具备刑事责任能力的自然人明知自己的行为可能造成危害社会的后果而放任该后果的发生心态而行医且情节严重的行为。边疆侵犯了国家对医疗卫生行业的管理秩序和广大人民生命健康权。现将笔者近期所遇的非法案例报导于后（犯罪嫌疑人已逮捕），借此探索和解决当前的医疗卫生秩序。     

Forensic medical assessment of late cadaveric changes in examination of dismembered corpses

The investigation was made of dismembered corpses parts in time aspect. Various conventional features of the late postmortem period were under consideration: corpse potherb, emphysema, maceration of the skin. The time of manifestation of rotten transformation of a corpse was specified for each dismembered part: the head, the upper and lower parts of the body, the extremities. The results allow the investigator to define time of death by each fragment of a dismembered corpse.     

Forensic medical assessment of acute blood loss in combination with craniocerebral trauma and alcohol intoxication

Forensic medical findings have been analysed retrospectively for 242 deceased of acute blood loss: 186 (76.8%) corpses were male and 56 (23.2%) corpses were female. It was found that in acute blood loss (ABL) duration of the terminal period (TP) depended on its combination with craniocerebral trauma (CCT) or alcohol intoxication (AI). A short TP (several minutes) was observed in ABL patients with CCT (39.6%), a long-term TP--in ABL associated with AI (20-60 min, 40.4% cases; several hours, 56.3%; over 24 hours, 54.5%). Slow TP occurred primarily in mild AI (TP for several hours 55.6%, over 24 hours--83.3% cases). In severe AI the number of cases with a short TP exceeded the number of cases with a long TP (over 24 hours) by 53.7%.     

Forensic medical assessment of the mechanisms of development of gunshot lesions caused by elastic destructive agents

This paper reports the results of analysis of the data obtained in experimental studies and practical expert assessments of body injuries inflicted by rubber balls for traumatic weapons. The causes accounting for the polymorphism of such injuries and the mechanisms of their development were elucidated by means of damage simulation taking into consideration the physical and dynamic properties of elastic ball-type destructive agents and the morphological structure of different anatomical regions of the human body. The results of the study may be of interest for differential diagnostics of gunshot lesions caused by elastic destructive agents.     

医疗纠纷的法医临床学鉴定

目的：剖析医疗纠纷产生的原因;介绍法医介入鉴定的法律依据,法医学鉴定的特点,赔偿的方法,存在的问题等;在最终减少案件发生的前提下,妥善地处理此类诉讼案件。方法：对46例医疗纠纷案件进行回顾性研究,将其按案件的性质、涉及的器官、引起的后果等归类。分析。结果：80％的案例其医疗行为与最终的不良后果之间存在着因果关系,原因包括手术医师对手术区域局部解剖结构分辨不清等技术性因素以及医护人员粗心大意、责任心不强等责任性因素;20％无因果关系。结论：临床医师应与其他行业一样为其所实施的医疗行为承担一定的法律责任。医疗纠纷作为一种特殊的民事侵权行为,在进行民事诉讼赔偿时,法医有必要对其中的因果关系进行评定,以保护双方当事人的合法权益。     

Forensic medical assessment of injuries to the human body and clothes caused by a crossbow arrow

Analysis of the data published in the special literature revealed the lack of information for the objective comprehensive forensic medical evaluation of injuries to the human body and clothes caused by the arrows from different models of crossbows. Morphological characteristics of injuries were shown to strongly depend on the design features of the arrows. This fact can be used to differentiate between injuries inflicted by crossbow arrows and other types of missile weapons.     

Forensic assessment of survived strangulation

By a retrospective analysis of all survived strangulation cases examined at the Institute of Forensic Medicine of Berne, Switzerland between 1987 and 2002, the authors tried to find out, if findings and symptoms of victims could be related to the fierceness of the assault and the mode of strangulation and if general evaluation criteria could be established on the basis of objective findings. One hundred and thirty-four survived strangulation cases were analysed on the basis of written reports, photographies and schematical sketches. Findings and symptoms reflected the fierceness of the assault in 71% of all cases by displaying a continuum of findings from minor injuries to severe traumatisation. This applied especially for cases of manual strangulation while other modes of strangulation resulted in different constellations of findings. As a result of this study, the authors deem the following classification of three degrees of severity as practical on condition that a complete forensic medical examination was performed upon the surviving victim shortly after the incident of strangulation: Light strangulation, confined to skin abrasions and/or reddening of the skin of the neck. Moderate strangulation, defined as bruising to, and/or bleeding from the neck, and/or damage to deeper soft tissues or the larynx, as exhibited by the symptoms of sore throat, difficulty in swallowing, and hoarseness. Severe, life-threatening strangulation if the victim presents petechial bleedings as a result of venous congestion with or without accompanying loss of consciousness.