Fatal penetrating abdominal injury by a metallic projectile

Penetrating abdominal injury is often a life-threatening condition, which is mainly associated with inflicted injuries. Fatal self-inflicted sharp force abdominal injuries too have been reported in the literature. Inadvertent penetrating abdominal injuries are a rarity and are caused by sharp objects of low-velocity and often nonmissile-type. A 27-year-old male factory worker was brought dead to the emergency department with an alleged history of sustaining abdominal injury by a sharp metal projectile while working on a metal cutting grinder. Autopsy observations were consistent with the history of inadvertent penetrating injury. Our case reports a fatal missile-type inadvertent sharp force trauma over the abdomen with intestinal perforation, a relatively uncommon scenario in occupational/workplace settings. The present case report describes the significance of the death scene visit and corroborating the medical findings with investigating agencies. This case further emphasizes on the need for adopting proper safety measures at the workplace.     

Lethal small bowel obstruction due to pica

Up to 25% of institutionalized patients with cognitive deficiencies display pica-like behavior, with an estimated annual incidence of small bowel obstruction of 2%. We present a case based on the forensic autopsy of a 41-year-old woman who died as a result of a missed diagnosis of small bowel obstruction after ingesting a foreign body. The case underlines the importance of precaution when treating patients with cognitive deficiency and/or language deficits and gastrointestinal symptoms. In such cases, it is important to employ a liberal threshold for radiological investigations and, if possible, obtain a medical history from a person close to the patient.     

论医疗事故罪的主体

医疗事故罪是新刑法增加的一种犯罪,自规定后争议一直颇大,特别是医疗事故罪的主体范围问题。医疗事故罪主体除了医务人员外,实习人员、医疗单位中从事行政管理、后勤服务等非医疗工作的人员在特定情况下也能成为本罪主体,但是单位不能成为本罪的主体。     

医疗事故罪客观要件探析

认定医疗事故罪,在客观上首先必须存在合法的医疗行为。其次必须在合法的医疗过程中出现严重不负责任的行为。认定严重不负责任,应当主要结合医务人员的注意义务,把违反常规性、常识性的注意义务,以及常发性的过失行为认定为严重不负责任。再次,严重损害就诊人身体健康应当根据《刑法》所规定的重伤标准去判断。最后,严重不负责任是就诊人死亡或严重损害就诊人身体健康的后果的主要原因力。     

大胆尝试,谨慎操作——论医疗公证中的若干问题

本文从真实性、合法性、可行性三个角度论证了医疗公证可以成为公证业务的新领域 ,医疗公证可以大胆尝试。但同时指出 ,由于相关法律不健全 ,配套条件不完善 ,尤其是监督机制的缺失 ,医疗公证存在被滥用的可能 ,因此 ,医疗公证在实践中必须谨慎操作。最后作者对如何遏制滥用医疗公证提出了自己的建议。     

法医文证审查100例分析

通过100例法医文证审查案件的分析,发现在目前检察机关文证审查工作中,存在委托数量不足、委托程序不规范、送检材料不全面等问题;在送审鉴定文书中,也存在标准条文掌握不当、鉴定人基础知识欠缺和粗心大意等问题。同时发现,鉴定文书的规范化程度和采信率已经得到有效的提高;且规范化越高的鉴定机构,则其鉴定文书的准确率越高,被采信率也越高。目前有必要加强检察技术部门文证审查的技术水平,进一步积累办案经验,切实增强检察机关的法律监督能力。     

医疗责任保险的思考

大力发展医疗责任保险,对医疗执业过失给患者造成的损害进行充分赔偿,在保障患者和医疗机构及其医务人员的合法权益,优化医疗环境和医疗公共秩序方面有重要的促进作用。由于我国医院主体是公立医院,侵权法人身损害赔偿相对于综合医院尚未到重大程度,并且综合性医院每年发生的医疗过失案件基本确定,选择满足面临危险的医院财务安全需要的医疗责任保险模式,如医疗责任保险信托等,才能促进医疗责任保险的发展。实践表明,商业性医疗责任保险不宜成为我国医疗责任保险的主体。建立独立的医疗过失纠纷调解鉴定机构,才能保证医疗责任保险顺利开展。     

SPECIAL NEEDS CHILDREN IN FAMILY COURT CASES

This article presents a conceptual framework for describing cases involving children with special needs that are increasingly being seen in family court. Three categories that represent the most common of such cases include (1) acute, life-threatening medical conditions; (2) chronic developmental disorders; and (3) psychological and behavioral syndromes. After detailing the nature of the disabilities in each category, perspectives from the bench are offered with specific recommendations and general strategies for effective case management. This is followed by a proposal of an innovative conceptual model—the Individualized Parenting Plan (IPP)—that organizes and integrates nine domains essential for a comprehensive parenting plan for special needs children. The article concludes with a list of sixteen strategic guidelines for servicing the families of these special needs children, in their best interests.     

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.     

人道功利主义——当今医学道德的价值取向

医学道德规范体系的核心是医学道德的价值取向。在当代的医疗实践中 ,传统的医学道德价值取向不能够适应实践的需要。根据新的实践要求 ,重构医学道德的价值取向———人道功利主义 ,这是当今医疗卫生事业的性质及发展所决定的。因此 ,人道功利主义应是构建当今医德规范体系的基石。