Spleen and portal lymphnode pathology in fatal drug addiction

Spleen and portal lymphnode sections from 86 drug addicts submitted for medico-legal autopsy at the Institute of Forensic Medicine in Copenhagen in the year 1979 were studied together with tissue sections from 24 "normal" persons. In 70% of the drug addicts the spleen weight was more than 200 g, and in 71% portal lymphnode hyperplasia was found. Birefringent foreign material was found in spleen tissue of drug addicts in 72% and in portal lymphnode tissue in 44%. Signs of antigen stimulation in both spleen and portal lymphnode tissue evaluated by the number of germinal centre and plasma cells were found in more than 80% of the drug addicts compared with about 20% of the "normal" persons. The results were related to anamnestic information of duration of drug abuse, to the spleen weight, to the occurrence of birefringent material and to the liver changes. Examination of lysozyme and immunoglobulin containing cells using the indirect preoxidase technique was performed in a total of 72 cases of spleen tissue, 59 cases of portal lymphnode tissue from drug addicts, 24 cases of spleen tissue and 18 of portal lymphnode tissue from "normal" persons. Lysozyme, IgM and IgG containing cells were found significantly more often among drug addicts than "normal" persons. The results indicate that the splenomegalia and the portal lymphnode hyperplasia often found in drug addicts are caused by continuous antigen stimulation due to repeated injections of various antigens.     

Blind validation of postmortem interval estimates using developmental rates of blow flies

This study evaluated the use of different degree day (DD) models, developmental thresholds and developmental data sources for estimating postmortem interval (PMI) based on developmental rates of blow flies (Diptera: Calliphoridae). Blow fly evidence was collected from three mock crime scenes and sent for blind analysis of PMI. PMI estimates were calculated using averaging, single sine, double sine, single triangle, and double triangle models of DD calculation with minimum developmental thresholds of 0, 6 and 10 °C and Anderson's, Byrd and Allen's, Greenberg's, Nishida's and Kamal's developmental data sets. These estimates were compared with the actual PMI to determine which combination of DD model, developmental threshold and developmental data provided the most accurate estimate. For all three cases, at least one method gave a PMI estimation that was within 1 day of the actual date of death. There was no variability between PMI estimated using the five models of DD calculation. Overall, as lower developmental threshold increased, the PMI interval estimates increased. Depending on the developmental data set used, increasing the lower developmental threshold caused some overestimations of the date of oviposition, with estimates given that were prior to the actual death. Future PMI estimates should include error ranges, so that overestimation of PMI is avoided.     

保外就医法医学鉴定研究(附54例分析)

目的为探索当前我国保外就医的特点，揭示保外就医中存在的问题，为制定有关政策法规提供参考依据，同时探讨保外就医的审查过程中法医学鉴定的必要性。方法两名研究人员从1992—1997年6年期间的司法鉴定资料中筛选出与保外就医有关的法医学鉴定案例，三名研究人员根据既定条件确定研究对象，并进行统计学分析。结果符合条件者共54例，主要年龄范围为20—50岁，罪名分类发现经济性犯罪明显多于非经济性犯罪，前者51例（94．4％），后者3例（5．55％）。提出保外就医申请的理由以单纯病名和主要症状者居多，少有提出辅助症状者，法医学鉴定表明检查结果与申请理由一致者为14例（25．92％），不一致者为40例（74．04％）；进一步鉴定揭示患有疾病确需保外就医者仅为3例（5．55％），而无需保外就医者高达51例（94．4％），其中无病者32例（59．25％），夸大病情者19例（35．18％）。结论本研究提示当前保外就医中犯罪装病、夸大病情等现象明显严重，这与保外就医所经历的中间环节缺乏有效的监督体制有关。因此，单纯以医疗系统进行保外就医鉴定是难以保证法律的公正执行。     

论医源性不合理医疗费鉴定与赔偿

目的　探讨医源性不合理医疗费产生原因、表现形式 ,以及法医学鉴定与赔偿的可行性。方法随机抽取人身损害赔偿案件 480例 (自 1996到 2 0 0 2年 ,每年 80件 ,不包括 1999年 ) ,对其医疗费进行全面的调查研究 ,并作统计分析。结果存在医源性不合理性医疗费的案件数逐年上升 ,有关费用数额也逐年增加。结论开展对医源性不合理医疗费的审查和鉴定 ,并追究侵权行为主体的法律责任具有必要性和可行性     

Courts' misplaced confidence in psychiatric diagnoses

In considering psychiatric evidence, criminal justice systems make considerable use of labels from official psychiatric classificatory systems. There are legislated requirements for psychological and/or behavioural phenomena to be addressed in legal tests, however medico-legal use of the current categorical diagnostic frameworks which are increasingly complex is difficult to justify. The lack of validity in large domains of the present classificatory systems is now more openly acknowledged, prompting a critical rethink. Illustrative examples include post-traumatic stress disorder, various personality disorders, and dissociative identity disorder. It follows that the Courts' faith in the present categorical classifications (e.g., DSMIV and ICD10) is misplaced and may be ultimately unhelpful to the administration of justice.     

The value of the medico-legal examination in sexual offences

A review is presented of medico-legal examinations performed on two series of rape and attempted rape in 1975 and 1980 with a total of 74 victims. Judicial outcome was known in 93% of the cases and is compared with the results of the medico-legal examinations. Between the two series, public discussions and pressure from feminist movements concerning the procedure in rape cases together with modifications of civil penal code resulted in alterations of police practice. Eighteen percent of known offenders in 1975 and 42% in 1980 were charged, 50% and 90%, respectively, of these were convicted. A correlation between the judicial outcome and the results of the medico-legal examination was not found in all cases. The importance of psychological guidance to the victim at the medico-legal examination is stressed.     

Estimating the degree of ethanol intoxication from analysis of cerebro-cranial hematomas

314 cases of combined cerebro-cranial trauma and posttraumatic intracranial hematomas were identified of which ethanol was detected in 114 hematomas. The other investigative group was 103 hospitalized patients who had hematomas evacuated during neurosurgical procedures. In 62 of these cases ethanol was detected. Blood and urine samples were also collected and the alcohol concentration was determined in all specimens by GC and ADH. The ethanol elimination rate for autopsy and operative intracranial hematomas was approximately 0.07–0.08‰/h(±0.034‰/h). The elimination rate of ethanol from blood (β₆₀) was about two or three times greater as that from hematomas. Because of the different water content of intracranial hematomas from blood, it was necessary to adjust the ethanol concentration for water content. On the basis of the corrected ethanol concentrations and the elimination rates for both tissues it was possible to estimate the ethanol concentration at the time of injury. Intracranial hematomas are tissues of possible value in the determination of alcohol intoxication especially in alcoholism. Ethanol can be found in hematomas even after 72 h from head injury.     

Mental health and fitness to plead proposals in England and Wales

Proposals to reform fitness to plead legislation have been published by the Law Commission in England and Wales; they include a new test of decision making capacity and a new psychiatric test that has yet to be fully developed. Although proposals have met with some support, there have also been detractors. The history of fitness to plead is reviewed and current case law (including the 1836 Pritchard criteria) is examined. Although existing arrangements have been criticised, this may be attributable to inconsistent practical application, rather than inherent conceptual flaws. The Pritchard test has largely stood the test of time and has emerged relatively unscathed. Fitness to plead is not a medical construct, but rather a legal entity and any new test would be likely to introduce its own difficulties. A capacity based assessment could enhance debate and disagreement and increase court time in many cases, presenting new resource implications with questionable benefit. As the existing Pritchard criteria, amended by case law, already include a five limb test that closely resembles a capacity assessment (ability to plead to the indictment, to understand the course of the proceedings, to instruct a lawyer, to challenge a juror and to understand the evidence) and given the difficulties in introducing a functional test format in other jurisdictions, the Law Commission's proposals should now be set aside, perhaps for another day: reconsideration may be possible some decades hence, pending enhanced scientific developments within psychiatry and better understanding of the mind.     

Non-linear kinetics of ethanol elimination in man: Medico-legal applications of the terminal concentration-time data analysis

Research regarding parameters suitable for reporting on the activity of enzymatic systems responsible for ethanol metabolism is of obvious interest in medico-legal practice. Blood ethanol concentration-time curves, following oral administration of ethanol, have been developed for ethylic and non-ethylic subjects. This study has confirmed the non-linear kinetics of ethanol elimination; however, existing non-linear models appear to be inadequate for usual medico-legal practice, because of their complexity. We observed three phases during the elimination of ethanol. The first order terminal phase is characterized by its half-life. This parameter seems adequate as a basis for determining the activity of enzyme systems responsible for the metabolism of ethanol.     

Staphylococcal scalded skin syndrome mimicking child abuse by burning

Child abuse by burning comprises 6–20% of all child abuse cases, but misdiagnosis may arise in cases of some medical conditions. We present two cases of suspected inflicted burns, later diagnosed as staphylococcal scalded skin syndrome (SSSS).