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PubMed2000

[Acute psychiatric symptoms as the initial manifestation of HIV-infection: differential diagnosis, therapy and medico-legal issues].

The prevalence of psychiatric symptoms and disorders in HIV-infected patients is high. The differential diagnosis includes psychoreactive disorders, acute psychiatric symptoms of an HIV-associated encephalopathy, and symptomatic psychotic illnesses due to secondary neurologic manifestations such as opportunistic central nervous infections and intracerebral lymphoma. Clinical aspects and psychopathological findings are not sufficient for differential diagnosis and identification of primarily psychiatric disorders. Secondary neurologic manifestations causing a symptomatic psychosis must be excluded as soon as possible by brain imaging (CT, MRI) and analysis of the cerebrospinal fluid. In emergency situations, however, German law imposes strict regulations, especially in the case of sectioned patients. These medical and medicolegal questions are illustrated by case reports and propositions for an effective strategy are made.

AIDS Dementia Complex↗

PubMedDate not supplied

[Viewing the criminal site in unusual cadaver evidence: concealment, identification, determining time of death and reconstruction].

The three cases presented here (Place of finding: bath tub.: [a] 19 year old, female, stabbed to death, detection six months pm, nearly airtight room--silicon rubber; [b] 56 year old, male, drowning, detection 1.5 months pm. [c] Place of finding: slope, 49 year old, female, polytrauma, detection 3 months pm) are characterized by incomplete mummification, skeletization and colliquation of soft-tissue. According to our experience medicolegal examiner's presence is necessary on the scene in order to secure in-situ-findings, to recover the human remains and to arrange a proper transport. The autopsy should be performed in the institute's autopsy-room because of access to better equipment e.g. light, air condition, x-ray, instruments. Under these conditions a high quality of forensic examination, improved training of students and police-officers and the dignity of the deceased can be maintained.

Adult↗

PubMed1984

Skull film radiography in the management of head trauma.

The contribution of plain skull radiography to the management of head trauma has been a subject of debate for more than 20 years. In an effort to reduce overutilization, criteria have been developed to identify those patients likely to have positive diagnostic results; these were called "high-yield criteria." Such high-yield criteria have been shown to reduce significantly the ordering of skull radiographs without any apparent adverse effect on patients. Several issues must be addressed before high-yield criteria or referral criteria can be promulgated on a nationwide basis. First, it must be determined whether the criteria applicable to a pediatric population differ from the criteria applicable to an adult population. Second, studies must be conducted to determine the outcome of patients who are not radiographed when high-yield criteria are used. A more fundamental issue, perhaps, is whether the identification of a fracture has any impact on patient management. It may, in fact, be more relevant (as Masters suggests) to develop a set of criteria to identify those patients in whom significant sequelae would be expected. Physician acceptance of referral criteria for ordering skull radiographs may depend ultimately on the direction taken on the medicolegal issue in this country, and on patient and physician attitudes regarding the necessity of knowing whether the patient has sustained a simple skull fracture.

Craniocerebral Trauma↗

PubMed1981

Postmortem wound dehiscence: a medicolegal masquerade.

Postmortem artifactual changes associated with decomposition have been well reported throughout the forensic literature. The recognition and correct interpretation of these artifactual changes are of paramount importance in determining if injuries were sustained before or after death. Presented is a case of surgical wound dehiscence associated with bloating in the postmortem decomposition state. Previously undescribed in the current forensic science literature, this entity can present difficulties in interpretation. The artifact is described and the methods used in its identification are discussed.

Adult↗

PubMed1985

Sudden and unexpected natural death in childhood and adolescence.

The descriptive epidemiology of sudden nontraumatic death from persons aged 1 to 21 years was studied in a defined population. In nine years, the 207 deaths in this group (4.6/100,000 population/per year) comprised 22% of nontraumatic mortality. Age-specific rates were highest between 1 and 4 years (mainly infections and undetermined causes) and 14 and 21 years (mainly cardiovascular, epilepsy, intracranial hemorrhage, and asthma). Nonwhite rates were higher than whites, and white males had higher rates than white females. Referral for medicolegal evaluation was inconsistent. Only 18% died at university hospitals. Infections included lower respiratory tract and septic shock. The main cardiac diagnosis was myocarditis. Most epilepsy deaths were unwitnessed and had absent or low anticonvulsant levels. Eighty-five cases had a known associated chronic illness and 111 reported prodromal symptoms. Prevention of these events requires improved identification and management of antecedent conditions.

Adolescent↗

PubMedDate not supplied

[The significance of the structural characteristics of the sphenoid sinuses in the development of sphenoiditis].

Medicolegal autopsies show a great incidence of sphenoiditides (63.3%) with a prevalent chronic atrophy (48%). Frontal and asymmetric presentation of the posterior cribrate cells about the sphenoid sinuses proved an unfavorable regional anatomic factor underlying dysfunction of the shunt drainage. Sphenoiditides are also promoted by digestions of the Vidian nerve canal producing harbours at the base of the sphenoid pterygoid process. Identification of anatomical factors of risk and characterization of the mucosal defects can be conducted at additional x-ray examination.

Adult↗

PubMedDate not supplied

Applications of cytology to forensic pathology.

In the practice of forensic pathology, all of the disciplines of anatomic and clinical pathology, as well as other forensic sciences, are employed for the solution of medicolegal questions and cases. This is a brief review of the current applications of cytology to forensic pathology, presented for the benefit of both cytologists and other pathologists who may be involved in forensic work. Cytologic studies employing established methods of specimen collection and preparation are used for the determination of sex in both living and dead persons, for the determination of sex and for tissue identification in trace evidence and in the documentation of some disease processes occurring in the forensic setting. Correlation of the cytologic evidence with the investigative and clinical findings is mandatory. The application of cytology to forensic pathology is both proven and practical

Crime↗

PubMed1997

In defense of routine antimicrobial susceptibility testing of operative site flora in patients with peritonitis.

The species and number of bacteria present at a surgical site correlate with postoperative wound infection. When organisms cultured from intraabdominal infections are resistant to the presumptive antimicrobial therapy, the incidence of postoperative wound and intraabdominal infections is significantly increased. Knowledge of operative site culture data allows identification of resistant organisms, leads to an early change in therapy, and guides selection of antimicrobials for treatment of postoperative complications. Anaerobic susceptibility data vary geographically, even differing within hospitals in the same city. Surveillance of resistance patterns of bacteria causing intraabdominal infections facilitates accurate initial therapy. Failure of treatment in the absence of bacteriologic results confirming appropriate antimicrobial therapy may be difficult to rationalize on a medicolegal basis. In summary, it is advisable for surgeons to perform cultures and susceptibility tests for both aerobic and anaerobic organisms present in intraabdominal infections.

Bacteria, Anaerobic↗

PubMed1981

The medicolegal and forensic aspects of fires.

Fires, their consequences and their investigations, continue to provide forensic scientists, especially those involved in medicolegal investigation (the medical examiner or forensic pathologist), with constant work and variations in problems. The recent history of mass disasters involving high-rise buildings, transport accidents, and arson-related accidents in nightclubs and prisons has emphasized the necessity for corrective and preventive means to ensure safety to the occupants of any of these areas. Problems presented by fires include the determination of the cause of the fire, the identification of the victims, and the cause and manner of their deaths. The motivation of the fire setter and the settlement by the insurance company or legal means are also aspects to be considered. The imperceptible effects of the fires include many other aspects, among which loss of loved ones and family providers and loss of industrial revenue and job potential are all felt. The most frightening development of all, however, is the insidious surfacing of arson as a possible factor in many major fires. The most recent tragedies involving the Stouffer Inn fire and the Hilton International Hotel fire were both related to arsonous acts. The scope of this article is to review the subject as it affects the forensic medical practitioner directly or indirectly so that his or her investigation may be brought to completion in conjunction with other authorities involved in the case.

Accidents, Occupational↗

PubMed1980

gamma-Glutamyltransferase test as a new tool for identification of seminal stains.

A simple qualitative method for identification of seminal stains based on a high activity of gamma-glutamyltransferase (gamma-GTP) in human semen is described. It employs the release of alpha-naphthylamine from N-gamma-glutamyl-alpha-naphthylamide by the gamma-GTP action: alpha-naphthylamine couples with Fast Garnet GBC salt to produce a strong brownish-red color. The data on its simplicity, specificity, and stability show that the present method is suitable for medicolegal examination of seminal stains as a preliminary test.

Adolescent↗

PubMed1998

Medicolegal aspects of the Thai Airbus crash near Kathmandu, Nepal: findings of the investigating pathologists.

A Thai Airbus, carrying 99 passengers and 14 crew members, traveling from Bangkok to Kathmandu, hit a mountain and crashed several minutes before landing. There were no survivors. Recovered human remains, none of which was easily identifiable, varied in size from a small piece of muscle to mutilated bodies. Of the 97 fragments, only 15 were sufficiently intact (albeit, only partially) to be designated as "bodies." Of the fragments and "bodies," only 11 were positively identified. Causes of death, although all traumatic, could not be stated accurately due to the degree of disintegration. Identification of human remains in these circumstances is a major problem for the pathologist.

Accidents, Aviation↗

PubMedDate not supplied

The damage to a person caused by venous thromboembolism in the civil responsibility.

The venous thromboembolism can clinically show itself as deep venous thrombosis or as pulmonary embolism. Both serious and potentially fatal, for this high incidence, they assume importance in social economic sphere. The authors take into account the medicolegal diagnostics methodology of the deep venous thrombosis and of the pulmonary embolism, the traumatic and post traumatic etiology, to determine the connection of causality and the estimating parameters of the damage to a person in the sphere of civil responsibility. To attain to a certain diagnosis of thromboembolism, since its difficult cause of paucisymtomaticity or asymtomaticity of the pathology after an attentive evaluation of symptoms, clinic manifestations and factors of risk, it can't be disregarded to utilize scientific diagnostic criteria, and instrumental ascertainments, serial too, helped by conventional means of standardization, such as the new American system of classification CEAP. The following phases of medicolegal ascertainment consist in identifying the causal connection between disease and event and in estimating of the damage to a person, with rigorous and objective methodology and using tabular orientation guides, that have to indicate the percentage incidence of the undergone disablement on the person's validity for indemnity. It is showed the particular delicacy of the medical examiner's evaluation in thromboembolic disease, in the sphere of civil responsibility, both for the difficulties of the diagnostic identification of the deep venous thrombosis, and of the pulmonary embolism, and for the determination of the connection of causality with traumatic events and with following operation of orthopedics-traumatology and neurosurgery (sector on which the most difficult problems of professional responsibility can connect) and finally for the real evaluation of the consequent damage to a persons, in order to its indemnity.

Diagnostic Errors↗

PubMed1988

Identification of male bloodstains by dot hybridization of human Y chromosome-specific deoxyribonucleic acid (DNA) probe.

The sex determination of bloodstains was performed using a human Y chromosome-specific (DNA) fragment of 1.9-kb length as a hybridization probe. The DNA samples were taken from 1- and 4-week-old bloodstains of males and females, respectively. Strong signals with male DNA were observed by Y-probe, while faint signals with female DNA were detected. In addition, clear signals were observed in the extract samples from male bloodstains (16-week-old) on paper. Dot hybridization of the Y-probe would be widely applicable to studies on sex determination of medicolegal materials such as blood, bloodstains, teeth, and cadaverous parts.

Blood Stains↗

PubMed1965

FORENSIC MEDICINE: AN AID TO CRIMINAL INVESTIGATION.

Forensic medicine is medicine as applied to the problems of the law. The origins of both are hidden in the mists of antiquity, dating from the beginnings of family and tribal life. Recorded human history goes back for 6000 years. Sumeria, Babylon and Egypt all contributed to the development of forensic medicine. Imhotep was probably the first real medicolegal expert. Hippocrates, the Greek physician, and Galen, the Roman, made considerable contributions. Little advance was made during the millenium of the Dark Ages. But Renaissance medicine gave this branch of medicine an impetus in the seventeenth, eighteenth and nineteenth centuries, and in the twentieth, interest in forensic medicine is worldwide. The physician, the coroner, the pathologist, the medical specialist and the forensic laboratory contribute to the investigation of crimes against the person, and to the solution of such problems as identification, untoward deaths, apparent drowning and many others.

Abortion, Illegal↗

PubMed1999

Identification of feigned grip effort using isokinetic dynamometry.

OBJECTIVE: To investigate the feasibility of applying isokinetic dynamometry for identifying submaximal grip strength. DESIGN: Measurement of maximal and feigned concentric and eccentric strength at high and low contraction velocities. BACKGROUND: Identification of feigned grip strength is a highly problematic issue which has been challenged using various techniques, invariably related to isometric efforts. This study is based on recent research which has indicated that isokinetic dynamometry was highly efficient in identifying feigned efforts in other major muscle groups. METHODS: Seventeen healthy women aged 20-25 took part in the study. Prior to executing the feigned effort, subjects were told to exert lower than the maximal grip strength in an attempt to obtain financial compensation for a simulated injury to hand musculature which in fact did not result in weakness of grip. RESULTS: Findings indicated that based on a parameter termed DEC which was defined as the difference between the ratios of the eccentric to concentric strength at the high and low velocities, feigned efforts could very effectively be identified (P<0.0001). Furthermore, a multivariate model enabled this identification to be described in terms of the level of confidence by which a claim concerning weakness of grip may be proclaimed as genuine or insincere. CONCLUSIONS: Though the neuromotor mechanisms responsible for grip strength may differ from those acting with respect to other muscle groups, the inability to adjust the eccentric and concentric force components during submaximal efforts is probably a general feature. RELEVANCE: Isokinetic dynamometry is a powerful method for quantifying various aspects of muscle performance. However, its application in the medicolegal area of muscle weakness has only recently been explored. Combined with previous research, this study strongly indicates that if certain trauma or pathology-related weakness does not result in variations in the force-velocity characteristics of the affected muscles, than this technique has the potential to validly differentiate between patients who have a genuine reason for compensation and those ('symptom magnifiers') who do not.

Adult↗

PubMed1996

Medicolegal death investigator preemployment test development.

The medicolegal death investigator (MDI) represents an essential component in the multidisciplinary investigation of sudden and unexpected deaths. Presently there exists no specific program for the job training evaluation procedure for new (MDI) employees. We discuss the development of a medicolegal death investigator preemployment training tool, which consists of a training and evaluation program containing a list of tasks and task steps. After the investigator demonstrates the ability to perform individual tasks independently, the trainee will be objectively evaluated by the completion of a written test specifically designed to cover the task items. The preemployment test has been developed by those professionals best able to determine the job requirements, the death investigators. The specific outcomes of the process also include further definition of the profession, preemployment testing, policy and procedure development, posttraining evaluation, identification of training needs, curriculum design and further professional development, and identification of the profession of death investigator.

Aptitude Tests↗

PubMed1997

[Proposed medical record to be used in rape cases. New diagnostic and medicolegal aspects].

The latest report of 1996 on human development in the UN development programme (UNDP) states that 130,000 women are raped every year in the industrialized countries. Illegal "violation" is defined as the sexual penetration of any orifice of the body without the victim's consent. The doctor's contribution is essential in order to ascertain this offence. It can be divided into two stages: precise and complete (... missing? ...) information regarding the sexual aggression which might have taken the form of rape. Management of a rape case represents an extremely complex undertaking for the doctor since it involves medical and legal aspects and requires a number of interventions that lead to a rational evaluation and appropriate treatment. In this context, the doctor's role is not only to protect the psychophysical integrity of the victim, but also to contribute, following an early diagnosis of sexual aggression, to the identification of the particulars of an offence which still risks remaining unpunished, owing to the difficulty of diagnosis and in spite of the recent enactment of Law no. 66 on 15 February 1996. The medical record proposed by the authors consists of a descriptive anamnestic part and a graphic part, thus making the evaluation of the victim more rapid and precise. The proposed medical record is subdivided into anamnesis, objective examination, psychological examination, laboratory tests, any consultancy requested and therapy.

Female↗

PubMed1990

Meeting the challenge of the rising cesarean birth rate.

The rising cesarean birth rate is a matter of national concern, and the goal of clinical obstetricians is to contain this trend while maintaining good maternal and perinatal outcome. Despite published reports suggesting that excellent perinatal outcome can be achieved with modest cesarean birth rates, the general increase of abdominal delivery in the United States appears to continue unabated. An educational approach to modify the community cesarean rate was directed at physicians, nurses, and interested lay groups via presentations in the Denver metropolitan community over a 5-year period. The content of these presentations included management of patients with previous cesarean births, diagnosis and management of fetal distress, the approach to patients with apparent failed progress in labor, indications and strategies for the indicated induction of labor, alternatives in the management of breech presentations and twin deliveries, and identification of patients at risk for genital herpes. The total cesarean birth rate increased to a level of 19.3% in this community in 1986, largely accounted for by the increase in the primary rate to 13.7%. Repeat cesarean birth rates remained relatively stable at 5.6% over the 2-year survey. Hospitals in which resident house officers either managed the entire service or participated in patient care achieved some of the lowest rates of both primary and repeat cesarean birth. Although intellectual arguments for decreasing cesarean births are acknowledged by physicians and nurses alike, translating them into practice on a daily basis is tempered by the constraints of time and the burden of medicolegal concerns. Educational efforts alone, therefore, are likely to produce change only slowly.

Cesarean Section↗