Pitfalls in the Interpretation of Traumatic Socioethnic Practices

The purpose of this case study was to raise awareness among forensic pathologists and medicolegal death investigators regarding two unique socioethnic practices and regional customs that have significant forensic implications. We present two cases involving coining (gua sha) and bloodletting (sapi) that represent two forms of traditional customs that involve the use of blunt force and sharp force trauma, respectively. In coining, the skin lesions are produced as a result of dermabrasion with oils and oval objects such as coin. In sapi, multiple superficial linear scrapes are made in the skin as part of a bloodletting ceremony. The identification of these lesions will prevent the interpretation of them as non‐voluntary‐inflicted trauma.     

Hesitation Wounds and Sharp Force Injuries in Forensic Pathology and Psychiatry: Multidisciplinary Review of the Literature and Study of Two Cases

The aim of this paper was to showcase the significant diagnostic value of hesitation wounds in terms of forensic, psychiatric, and medicolegal interest. A number of studies were reviewed to update and summarize the relevant literature on the incidence, distribution, character, and function of hesitation wounds as well as the sociodemographic variables and psychopathology of the inducers. This study also investigates their importance as a forensic criterion in the distinction between suicide and homicide as well as a psychiatric diagnostic tool in suicide prevention. In addition, the paper reports two new cases. Results conclude that there is equal incidence, but different distribution of hesitation wounds between genders. Furthermore, the low dispersion of hesitation wounds contrasts with the high dispersion of defense wounds. The inducers' psychopathology lies principally in Axis I disorders. Finally, there is a comprehensive analysis of non‐suicidal self‐injury and the role of self‐wounding in suicide prevention.     

Lethal Epistaxis

Epistaxis or nosebleed refers to bleeding from the nostrils, nasal cavity, or nasopharynx. Occasional cases may present with torrential lethal hemorrhage. Three cases are reported to demonstrate particular features: Case 1: A 51‐year‐old woman with lethal epistaxis with no obvious bleeding source; Case 2: A 77‐year‐old man with treated nasopharyngeal carcinoma who died from epistaxis arising from a markedly neovascularized tumor bed; Case 3: A 2‐year‐old boy with hemophilia B who died from epistaxis with airway obstruction in addition to gastrointestinal bleeding. Epistaxis may be associated with trauma, tumors, vascular malformations, bleeding diatheses, infections, pregnancy, endometriosis, and a variety of different drugs. Careful dissection of the nasal cavity is required to locate the site of hemorrhage and to identify any predisposing conditions. This may be guided by postmortem computerized tomographic angiography (PCTA). Despite careful dissection, however, a source of bleeding may never be identified.     

Persistent Retinal Iron in Abusive Head Trauma

Retinal hemosiderin deposition is a histologic indicator of sustained hemorrhage but cannot be used to precisely estimate the elapsed time since an episode of trauma. A 5‐month‐old male infant was admitted to hospital after acute deterioration. Examination revealed encephalopathy, subdural hematomas, and retinal hemorrhages consistent with abusive head trauma (AHT). At the age of 3, he was readmitted to hospital with spontaneous osteopenic fracture of the right femur. The patient deteriorated and died after unsuccessful resuscitation. Ophthalmopathological investigation showed atrophy of the retina and optic nerve and hemosiderin deposition in both eyes. Retinal hemosiderin deposition is currently generally assumed to disappear within 6–8 weeks after the occurrence of hemorrhage in AHT. This case report describes an infant with bilateral retinal hemosiderin depositions due to hemorrhages sustained from AHT occurring 32 months prior to death. Implications of this finding for the interpretation of retinal hemosiderin depositions in AHT are discussed.     

脑外伤所致精神障碍司法鉴定400例分析

目的探讨精神疾病司法鉴定中颅脑损伤所致精神障碍的临床特征及相关因素。方法收集脑外伤后司法鉴定案例资料,按照神经外科GCS评分把脑损伤所致精神障碍鉴定案例分为重型(A组)、中型(B组)及轻型(C组)颅脑损伤;对案例的临床症状进行分析,根据中国精神障碍分类与诊断标准(第三版)(CCMD-3)进行精神障碍诊断,并探索临床症状与脑外伤程度之间的关系。结果轻、中度颅脑损伤所致精神障碍以器质性神经症样综合征最多见。重度颅脑损伤所致精神障碍中以智能损害综合征为多。三组间有显著性差异(P≤0.01)。结论在精神疾病司法鉴定中,不同严重程度的颅脑损伤所致的精神障碍有不同的临床特征。     

人体器官移植中生命权法律保护的探讨

生命权是一切权利之根本,属于基本人权之范畴。作为挽救病人生命的重要方式,人体器官移植应恪守尊重生命权的原则。因此,对人体器官捐献、摘取和器官捐献者生命状态的判定应遵循严格程序,器官摘取和移植中的相关法律责任要明确规定。我国人体器官移植方面的法律法规,也要根据上述要求,加以完善。     

NEGLECTED INFANTS IN FAMILY COURT

This paper applies the science of early childhood development to the question of neglect in infancy to offer best practice guidance to family law and child protection professionals charged with acting in their best interest. The paper discusses the challenges of presenting cases of infant neglect, particularly emotional neglect, to the court. Current science on the implications of neglect for brain development, and long term mental health are discussed. Recommendations for assessment, intervention and questions that should be addressed in court deliberations are outlined.     

Cultural Trauma as a Potential Symbolic Boundary

Using the case of the Holocaust as a cultural trauma in the Jewish-Israeli context, some insights are suggested as to the ways younger members of collectives view cultural trauma as a symbolic boundary. The findings obtained from three groups of students, each expressing their views on a different facet of the Holocaust as a symbolic boundary, suggest that the major contributing factor that turns cultural trauma into a symbolic boundary is the way in which members of the collective categorize the modes through which others, within and outside the collective, relate to that cultural trauma.

Provider Perspectives on Sex Trafficking: Victim Pathways,Service Needs, & Blurred Boundaries

This study examines service providers’ perspectives on survivors of trafficking using a purposeful sample of professionals specializing in intimate partner violence, sexual assault, and child maltreatment. Entry points into trafficking included recruitment by Romeo pimps, survival sex, kidnapping, and deceptive offers of employment. Service needs of survivors were described as more extreme and enduring than those of other types of victims served, with particular needs in long-term housing, health and mental health, substance use treatment, legal aid, and employment assistance. An overarching issue involved survivors’ dual identities as both victims and offenders, including self-identification and understanding/treatment by human service providers and law enforcement officers.