Social Support, Risk-Level and Safety Actions Following Acute Assessment of Suicidal Youth

The purpose of the pilot study was to examine the interrelationship between social support, risk-level, and safety actions for 2 groups of suicidal adolescents (50 attempters and 50 ideators), who had presented for an acute assessment at an outpatient mental health service. A social support model was proposed in which it was thought that information related to patients' social support would impact upon the types of risk-level and safety actions made by clinicians. Data was collected from a total of 100 patient files, utilizing the acute assessment reports (e.g., reports assessing risk of self-harm). Findings show that groups differed significantly on indices of negative support severity, positive support, and risk-level. Limited support was found for the proposed social support model. Limitations and implications for future research are discussed.     

Arterial-esophageal fistulae in patients requiring nasogastric esophageal intubation

A rare and potentially fatal cause of hematemesis is fistula formation between the esophagus and the vascular system. A case report of a 39-year-old woman with congenital aortic arch anomalies hospitalized for treatment of head injuries demonstrates the potential for iatrogenic esophageal trauma to initiate fistula formation between the esophagus and an anomalous arterial system. A literature review revealed 6 other cases of vascular-esophageal fistulae caused by nasogastric esophageal intubation. It is concluded that aortic arch anomalies increase the risk of esophageal injury and subsequent fistula formation from nasogastric esophageal intubation. In addition, the clinical features and pathologic findings of vascular-esophageal fistulae are reviewed.     

Unexpected childhood death due to hemolytic uremic syndrome

Two cases of unexpected childhood death due to hemolytic uremic syndrome are reported. A 21-month-old girl who was discovered dead in bed following a short illness was found at autopsy to have overwhelming sepsis resulting from transmural colitis. Escherichia coli serotype 0157A was isolated from the intestine, and renal changes of hemolytic uremic syndrome were found. A 4-year-old girl died suddenly in hospital from intracranial hemorrhage while being treated for hemolytic uremic syndrome-related renal failure. Culture of urine and feces grew verocytotoxin producing E. coli. These cases demonstrate that hemolytic uremic syndrome may be a rare cause of unexpected childhood death and that the diagnosis may not be established prior to autopsy. Postmortem culture of tissues and fluids in cases of suspected sepsis in children may be essential in establishing this diagnosis, because histologic evaluation may be compromised by profound sepsis and tissue putrefaction. Accuracy in diagnosis may have significant public health and medicolegal consequences.     

Truth,Lies, and Videotape: An Investigation of the Ability of Federal Parole Officers to Detect Deception

The ability of a group of Canadian federal parole officers to detect deception was investigated over the course of 2 days of lie detection training. On the first day of training, 32 officers judged the honesty of 12 (6 true, 6 fabricated) videotaped speakers describing personal experiences, half of which were judged before and half judged after training. On the second day, 5 weeks later, 20 of the original participants judged the honesty of another 12 videotapes (again, 6 pre- and 6 posttraining). To isolate factors relating to detection accuracy, three groups of undergraduate participants made judgments on the same 24 videotapes: (1) a feedback group, which received feedback on accuracy following each judgment, (2) a feedback + cue information group, which was given feedback and information on empirically based cues to deception, and (3) a control group, which did not receive feedback or cue information. Results indicated that at baseline all groups performed at or below chance levels. However, overall, all experimental groups (including the parole officers) became significantly better at detecting deception than the control group. By the final set of judgments, the parole officers were significantly more accurate (M = 76.7%) than their baseline performance (M = 40.4%) as well as significantly more accurate than the control group (M = 62.5%). The results indicate that detecting deceit is difficult, but training and feedback can enhance detection skills.     

Stereolithography: a potential new tool in forensic medicine

Stereolithography is a computer-mediated method that can be used to quickly create anatomically correct three-dimensional epoxy and acrylic resin models from various types of medical data. Multiple imaging modalities can be exploited, including computed tomography and magnetic resonance imaging. The technology was first developed and used in 1986 to overcome limitations in previous computer-aided manufacturing/milling techniques. Stereolithography is presently used to accurately reproduce both the external and internal anatomy of body structures. Current medical uses of stereolithography include preoperative planning of orthopedic and maxillofacial surgeries, the fabrication of custom prosthetic devices; and the assessment of the degree of bony and soft-tissue injury caused by trauma. We propose that there is a useful, as yet untapped, potential for this technology in forensic medicine.