Forensic medical assessment of the skull bone fractures owing to blow impacts depending on anatomical characteristics and a nature of a trauma-causing objects

Fractures in bones of the skull base (BSB) are preconditioned by the contact zone of interaction between the two below surfaces, i.e. the trace-forming one (object) and the trace-receiving one (bone). On the basis of their independent research, the authors suggest a set of criteria for the expert evaluation of fractures in BSB for the purpose of specifying the properties of the trauma-causing object, which is made with due regard for the anatomic specific features of the trauma zone.     

The ordinal localization of multiple mono-type carpal bones

The case study was based on the osteologic collection of the chair for anthropology, State Moscow University, including the male carpal bones (67) and female carpal bones (13), aged above 18 to 20. Four measurements were made according to Martin's scheme for metacarpal bones and finger phalanxes. A diagnostic method was worked out on the bases of the discriminative analysis, with such method enabling the remodeling of the ordinal localization of metacarpal bones as well as of main, medium and distal phalanxes. The maximally accurate classification was ensured for metacarpal bones, ranging from 81.5% to 100%; and the minimally accurate one was achieved for distal phalanxes, ranging from 20% to 95%. The discriminative analysis results were checked for distal phalanxes by Neklyudov's series (male--100, female--85); they were described according to 7 sizes. However, an attempt to enhance the accuracy of the classification of these phalanxes failed. The offered method should be applied in combination with the traditional anatomic-and-morphological method; besides, if possible, it is necessary to check the congruence of joint surfaces in the metacarpal interphalangeal joints.     

Changes in adrenergic and cholinergic innervation of the external genitalia in alcohol and drug intoxication

Eighteen cadavers of persons, who died of acute and chronic alcohol and drug intoxication (ephedron-addiction), were used to study the changes in the spinal nerve plexuses and external genitals. The activity of acetylcholinesterase and of NADPH-diaphorase was determined histochemically; the adrenergic nerve fibers were detected by a glyoxyl-acid technique. Rectified changes in the relative density of adrenal-cholinergic- and nitroxydergic structures and in the activity of mediators in different intoxications were found. The chronic intoxication by alcohol and ephedron was accompanied by a reduced activity of enzymes involved in the metabolism of acetylcholine, nitric oxide and catecholamines. A lower density was observed in the nerve fibers that contained the examined substances. The results can be used as an additional criterion in evaluating the male sexual-function status.     

The emperor has no clothes: examining the employee exception to the anti-referral laws

The Anti-Referral laws are omnipresent in the practice of health law. Perhaps as a result of their wide scope in application, those laws have had a number of unintended consequences. This Article closely examines one aspect of those laws: the exception applicable to otherwise forbidden conduct that takes place between employer and employee. The author concludes that this exception does nothing to advance the policy of the laws, has led to much confusion, and has had the unintended consequence of accelerating the business consolidation of physicians with each other and with clinics and hospitals. Consequently, she asserts that this exception should be repealed.     

Immunostaining by complement C9: a tool for early diagnosis of myocardial infarction and application in forensic medicine

Before the first 12 hours, diagnosis of early myocardial infarctions is always difficult for forensic pathologists. We tested complement C9 expression in 121 formalin-fixed and paraffin-embedded heart samples by an immunohistochemical procedure. The heart specimens were separated into four groups: 33 cases in group 1 with typical ischemic damages histologically located, 20 cases in group 2 with death related to myocardial infarction on the basis of ischemic presentation on electrocardiogram but no obvious histological ischemic damage, 35 cases in group 3 with severe coronary disease without cause of death found at the autopsy, and 33 cases in group 4 without sign of myocardial infarction and without coronary disease. In the first group, all 33 heart samples showed a well-defined C9 expression in the necrotic areas. The second group in 17 of 20 cases showed positive areas for C9 expression. In the other three heart specimens, only few stained cells were observed whereas the painful symptoms had begun less than 1 h before death. The third group showed C9 immunopositive areas in six of 35 cases, few stained cells in 8 cases, and no C9 deposition in the 21 other cases. The last group showed no staining area. To avoid nonspecific C9 staining due to tissue autolysis, we studied C9 expression during a controlled putrefactive process in four cases included in group 1; staining was found only in infarcted myocardial areas, and was observed up to ten days. Specificity of C9 expression was evaluated to be 100% [89.4 to 100%] and sensitivity to be 85% [62.11 to 96.79%]. In conclusion, evaluation of immunohistochemical expression of C9 appears to be a highly sensitive and specific marker of early myocardial infarction, useful in forensic medicine if survival is more than 1 h after the beginning of myocyte damage.     

Profenofos metabolites in human poisoning

Profenofos and its metabolites were determined in a case of fatal poisoning. Little profenofos and large amounts of metabolites were detected by gas chromatography/flame photometric detection in the acid extracts of blood and urine after methylation with diazomethane. Four major metabolites containing phosphorus were identified with the synthesized metabolites, namely, despropylated profenofos, desethylated profenofos and des-S-propylated profenofos, respectively. 4-Bromo-2-chlorophenol (BCP), an aryl moiety of profenofos, was also determined in blood and urine with high performance liquid chromatograph (HPLC) as free or conjugated metabolites.