Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland--monitoring early changes in HIV-seropositivity among risk groups and average population.

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.     

Identification based on medical findings

1. The indications such as the place of finding, the identification of clothes or other personal items, represent only the first step towards the identification of a corpse. 2. An identification based on medical data, other than dental, is often possible, more often than it is believed. 3. The forensic pathologist plays a double role in the case of such an identification: a) in the phase of the inquiry, he must contact the investigators and the families to explain his wishes and the different possibilities of identification. b) he must use the gathered information in the appropriate way. 4. It would be desirable to compose some statistical tables of the various medical elements useful for the identification (mutilations, surgical operations, etc...). We present six cases of identification in our practice.     

The incidence of alleged sexual abuse in 603 family court cases

The conflict and animosity that sometimes accompanies child custody disputes can give rise to the propagation of allegations of child sexual abuse. To characterize the magnitude of the problem, the present study attempted to determine whether and to what extent child sexual abuse allegations predominate in family court litigation. The entire one-year caseload of a county family court docket was systematically reviewed and coded. Methodical evaluation of 603 family court files yielded base rates of pertinent allegations and other information profiling the cases. The findings did not support the contention that sexual abuse allegations are commonplace in child custody disputes. Sexual abuse allegations were made in 2% of cases in which custody or access was contested and in only 0.8% of the cases overal. Implications of the findings for future research were discussed.The authors gratefully acknowledge the assistance of the Honorable William R. Campbell and Barbara Scott, Clerk of Court for the South Carolina Fifth Judicial Circuit, as well as the contributions of Angie Newton, Frank Robinson, and Kimberly Ellis in the data collection process.     

Thyreoglobulin and violent asphyxia

The concentration of thyreoglobulin (tg) was determined for death caused by hanging, strangulation by ligature, and throttling. Cases of sudden death (traumatic aortic rupture, penetrating wounds of the heart) were used for comparison. The mean values in cases of hanging (149.9±202.3 ng/ml), strangulation by ligature (193.1±173.3), manual strangulation (561.6±173.9) are distinguishable from violent acute deaths (23.3±27.6) and living healthy individuals (17.3±16.1). By means of statistical comparisons, significant differences were found between throttling and strangulation by ligature and between throttling and hanging (adjusted P<0.001). In connection with examination of the bodies high tg values can be regarded as a vital reaction in obstructive asphyxia.