Use of Autopsy to Determine Live or Stillbirth: New Approaches in Decision‐support Systems

Fetal deaths are important cases for forensic medicine, as well as for criminal and civil law. From a legal perspective, the determination of whether a deceased infant was stillborn is a difficult process. Such a determination is generally made during autopsy; however, no standardized procedures for this determination exist. Therefore, new facilitative approaches are needed. In this study, three new support systems based on 10 autopsy parameters were tested for their ability to correctly determine whether deceased infants were alive or stillborn. Performances were analyzed and compared with one another. The artificial neural networks and radial basis function network models had 90% accuracy (the highest among the models tested), 100% sensitivity, and 83.3% specificity. Thus, the models presented here provide additional insights for future studies concerning infant autopsies.     

Multiple Giant Coronary Artery Aneurysms: A Rare Cause of Sudden Cardiac Death

Multiple giant aneurysms involving the coronary arteries are uncommon and rarely reported. In the presented case, a 63‐year‐old man with poorly controlled hypertension died suddenly. Gross autopsy examination showed multiple giant thrombus‐filled coronary artery aneurysms, atherosclerotic coronary artery disease, and cardiomegaly. Histological sections of the coronary aneurysms showed atherosclerotic changes with both organized and fresh thrombus. Giant coronary aneurysm is defined as a segmental enlargement of a coronary artery with a diameter exceeding 20 mm or more. The main etiology of this nebulous entity is attributed to atherosclerosis and inflammatory or inherited connective tissue disorders with the remainder being congenital, infectious, or idiopathic. Before its cataclysmic presentation, when ruptured or thrombosed, giant coronary aneurysm usually has a silent clinical course. Sudden death owing to giant multiple coronary aneurysms is rare and mandates careful classification of the aneurysms and prudent search for autoimmune‐mediated or genetically based factors for subsequent ancillary autopsy studies.     

Previous judicial detection and paedophilic sexual interest partially predict psychological distress in a non-forensic sample of help-seeking men feeling inclined to sexually offend against children

Little is known about overall psychological distress in paedophiles who are not formally involved with the criminal justice system. Since knowledge in this context could help to optimise intervention efforts, this study aimed to examine the association between distress as measured with the Brief Symptom Inventory (BSI) and preference- and offence-related variables in a sample of N?=?455 men self-reporting sexual interest in children, of whom 402 were diagnosed as paedophiles. Results showed that 59% reported clinically relevant levels of distress, with paedophiles being significantly more distressed than teleiophiles. A regression analysis revealed that a paedophilic preference and prior detection were relevant predictors for distress. However, past offending behaviour had no impact and the major part of variance could not be explained. The results suggest that paedophilia is associated with distress, but other factors influence whether a paedophilic man is distressed on a clinically significant level.     

侦查理论与实务几个问题的探讨

我国《刑事诉讼法》的修改必须考虑到中国的实际情况,应避免立法主张上浓厚的理想主义色彩;我国正酝酿着侦查理念的一次变革和飞跃,但相应的制度和经费保障能不能到位,对此有着直接的影响;“命案必破”的提法虽有积极作用,但其负面作用日益凸显,因此应停止使用;处置劫持人质案件的培训工作应有计划性和整体规范;对心理画像结论的准确性、具体性和可靠性程度应该有客观的认识,不能对其怀有过高的期望。     

Intravascular bullet embolism to the right atrium

Bullet embolism is a relatively unusual complication of gunshot wounds. Embolism to the right atrium comprises <5% of all reported intravascular bullet emboli. We report an additional case of bullet embolus to the right atrium of a 0.38-caliber bullet following a gunshot wound to the chest. The intracardiac bullet was recognized radiologically on presentation, but the patient was hemodynamically stable and managed conservatively, with the bullet left in place. The missile remained within the heart without clinical significance for several years and was recovered from the right atrium only at the time of autopsy. To the best of our knowledge, this is the first documented case of a 0.38-caliber bullet which embolized to the right atrium and remained inconsequential for an extended period of time.     

Case series of completed suicides by burning over a 13-year period

Suicide by burning is an extreme act that is uncommon in the United States and throughout the Western world. The characteristics of people who complete such acts are not well understood. To address this issue, we examined the death records of the King County Medical Examiner's Office in Washington State over the 13 years from 1996 to 2009. Twenty-five cases of suicide by burning were identified and used to characterize decedent demographics, circumstances of death, and motivating factors. Compared to other methods of suicide, burning demonstrated a significant overrepresentation of decedents who were women, 40-59 years of age, and Asian/Pacific Islander. They also tended to have previous psychiatric illness and/or substance abuse issues. Self-burning predominantly occurred at the decedent's residence with the intent of suicide given. There was no unifying theme in motivating factors. Together, these data represent the characteristics of people whose death is because of suicide by burning in King County, Washington.     

A case of suicidal suffocation simulating homicide

This case concerns an unusual suicidal plastic bag suffocation. An elderly white man was found dead and partially disrobed in his apartment lying supine on a sofa with a plastic bag closed by a rope over the head and the upper and lower extremities tightly tied with two other ropes, the end of both arranged into slipknots (self-rescue mechanism). Police investigations found no pornography in the apartment, and circumstantial data alleged no psychiatric disorders or suicidal intentions. The autopsy excluded signs of struggle and sexual intercourse as well as any type of injury or physical illness. Chemical analyses on the peripheral blood excluded acute drugs and/or alcohol intoxication. A differential diagnosis of the manner of death was performed, including scenarios of accidental autoerotic asphyxiation, homicide during either sexual activity or ritualistic, elderly suicide. The collected data most strongly supported the hypothesis of a suicidal asphyxiation simulating homicide to devolve a life insurance to the victim's sons because of economic difficulties.     

So-called Spontaneous Human Combustion

A well-documented case of so-called Spontaneous Human Combustion is reported. Review of the literature shows that these strange observations have been reported since the 17th century, even in famous novels. There are several main features that may lead to help the diagnosis: the vicinity of the body is intact or nearly intact, some parts of the body are turned into ashes (usually the middle third of the body), whereas other parts are intact or nearly intact, burning of the body usually occurs postmortem, the cause of death is usually natural, there is often (but not always) high concentrations of blood alcohol, there is a source of heat near the body. It is indispensable to rule out a homicide by the examination of the body in situ, the autopsy, the toxicological and histopathological samples, the arson assessment, and a thorough police inquiry.