Stories about sexual activity abound and are often the source of considerable interest and speculation. These anecdotal accounts are rarely subjected to any serious scrutiny and yet may develop folklore proportions. It is concerning that many forensic practitioners are prepared to perpetuate similar myths behind a veneer of scientific practice. Practices such as impotence or virginity testing and the interpretation of penile measurements are lucrative endeavors that remain alive and well. Similarly, court evidence on topics such as the circumstances by which genital injuries were sustained, the relationship between pubertal staging and age or the interpretation of anal findings are often less than objective. These practices are unprofessional. Further, they have the potential to cause significant harm to many individuals and to undermine the standing of the criminal justice system.
This paper reviews the literature in respect to the photo-colposcopic examination of anogenital injury in the sexually assaulted child, considered to be the 'gold standard' of examination, and how this compares with gross visualisation, still the standard procedure in adult examinations. It then examines the claim that, because the presence of injury does not provide a distinction between consensual and non-consensual intercourse in adults, photo-documentation is unnecessary medically and constitutes an invasive procedure which is ethically unacceptable. The paper questions whether the unwillingness of forensic physicians to extend photo-colposcopy to the examination of adult victims is related more to political and gender issues than to claims made on ethical and medical grounds, and concludes that any move to ban anogenital photography in adult forensic examinations (currently under consideration in the author's own jurisdiction) would possibly constitute an interference with independent clinical judgment and an incursion into the patient's right to evidence-based medicine.
A 28-year-old woman delivered twin girls. The first twin was delivered without any difficulty. The head of the second twin failed to descend with pushing. A special kind of obstetrical forceps, Thierry's spatulas, were used to extract the second twin in the occipito-posterior vertex position. She was declared dead after recording Apgar scores of 0 and 0 and after 35 min of resuscitation. An autopsy was performed for medico-legal reasons. Macroscopic examination of the brain showed a small area of leptomeningeal haemorrhage in the left sylvian fossa and the base of the brain. Histopathological studies demonstrated cerebellar tissue emboli in meningeal and pulmonary arteries. Excessive pressure on the suboccipital region during delivery can cause traumatic separation of the occipital chondral junctions, which may lead to separation of the occipital squama from lateral parts of the occipital bones. The inferior part of the occipital squama is displaced forward and upward into the posterior fossa. This produces tearing of the duramater and occipital sinuses leading to leptomeningeal haemorrhage in the posterior cranial fossa, often associated with cerebellar lesions. Major stretching and tearing of the posterior aspect of tentorium cerebelli in contact with the sinuses and the cerebellar cortex may also occur, inducing slight movement of the occipital bones and subsequent emboli. This case study is that of a newborn death due to pulmonary cerebellar tissue embolism occurring during delivery with Thierry's forceps, which are considered less traumatic to the foetal cranium. A review of the literature identified 17 other published cases. In difficult deliveries this pathology should sought carefully. Brain, lung and placenta tissue sections must be studied.
We investigated the effect of carnitine supplementation during vitamin C (ASC) deficiency by measuring the levels of ASC and carnitine in plasma and cardiac muscle cells (CMC), and histological analysis with electron microscopy. The levels of carnitine were significantly decreased in ASC-deficient rats in plasma and the heart than those in the control. In carnitine supplemented ASC-deficient rats, a significant increase of carnitine levels were observed in both plasma and heart. The number of lipid droplets significantly increased in the ASC-deficient rats compared to the control rats, but did not increase in carnitine supplemented rats. These results indicate that ASC deficiency causes a generalized mitochondrial abnormality and accumulation of lipid droplets in CMC as observed in carnitine deficiency, and supplementation of carnitine prevented these changes even in the presence of ASC deficiency.
A retrospective case note review of 212 individuals (190 women) attending a city-centre Genitourinary Medicine clinic between 1/4/2002 and 31/3/2004 following an acute sexual assault. Direct referral by the Forensic Medical Examiner to the dedicated weekly clinic for victims of sexual assault facilitated the attendance of 55/113 attending the dedicated clinic. The 99 individuals who did not disclose a recent assault as the reason for attendance were seen at routine clinics. One third of individuals attending the dedicated clinic were less than 16 years old, reflecting the facilitated referral pathway. Those attending the dedicated clinic were more likely to be offered the extended service outlined in the departmental protocol. Twenty four sexually transmitted infections were detected in 23 (11%) individuals but 23/24 could have been acquired during other recent consensual sexual activity. Overall, the assailant was known to the victim in 53% cases, there was an allegation of violence associated with the assault in 20%, suspicion of a drug facilitated ('spiked drink') assault in 24% and admission of alcohol intoxication in 11% cases. The 22/212 (10%) who were male were more likely to present to a routine clinic.
Clinical forensic medicine is a relatively new discipline in Belgium although (sexual) violence has been around for centuries. A brief overview of the Belgian legal system and the way it interacts with forensic medicine is presented, with special emphasis on the investigation of complainants of sexual violence. The epidemiology of sexual violence in Belgium is discussed together with the procedures that were developed by the government to standardise the medical examination of sexual assault victims.
This force-wide study in the Northumbria Police area provides an audit of the quality and quantity of work carried out by Forensic Medical Examiners (FMEs) over a three month period. Approximately 25% of all arrests during the period of the audit resulted in a request for FME assessment of the detainee. About 79% of consultations were performed to establish fitness to detain, in which over 30% of detainees were intoxicated and over 40% addicted to drugs and/or alcohol. Over 30% of those queried for fitness to detain also required advice and occasionally prescription for medication, both for the management of addiction and the treatment of chronic illness. In comparison to prior work this study found lower rates of mental illness in alcohol and drug dependent populations (13% and 6%, respectively). It is hoped this study will provide information in respect of the specific competencies not only required by future FMEs but also nurses working with detainees within the custody suites.
Brown Séquard syndrome is an uncommon incomplete spinal cord injury with ipsilateral motor and proprioception loss and contralateral pain and temperature loss. A 14-year-old student with classic Brown Séquard syndrome after pen assault injury by his classmate in posterior neck area presented here; with medical and supportive care, the patient was discharged with good outcome. Brown Séquard syndrome is mostly due to penetrating trauma. Several types of penetrating objects have been reported but this appears to be the first report of a pen or pencil injury.
Little information is presenting in Greek literature regarding forensic and criminological aspects of homicide in North-West Greece. Autopsy reports and the prosecution authorities' files were respectively analyzed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment in order to comprehensively characterize relevant forensic and criminologic aspects. In the 8-year period from January 1998 to May 2005, 26 homicide cases were autopsied in the Department of Forensic Medicine and Toxicology, University of Ioannina, Greece. Twenty-nine homicide victims (18 males, 11 females; mean age 47 years) and 26 offenders were involved--20 single, 4 multiple-offenders and 2 were not known (24 males, 2 females; mean age 35 years). The most common method used for homicide was gunshot trauma (41.4%). Head injuries and multiple trauma were the most common cause of fatal injuries. Most homicides took place outside in a deserted area or close to agricultural side (n=12). Fifty percent (n=13) of all cases the offender and the victim were known to each other (acquaintances). Twenty-three cases were categorized as "single" homicides and 3 as "multiple" and the victims were classified; 20 as murder-physical injury with fatal outcome, 2 homicide-suicide, 1 infanticide, 4 matricide, and 2 as patricide.
A 26-year-old man suffered acute arsenic poisoning after a poisoning attempt. He developed multiple organ failure including encephalopathy, bleeding disorders, pancreatitis, renal and hepatocellular impairment. Generalized erythroderma also developed within one week after admission. The developed acute respiratory distress syndrome and Aspergillus fumigatus was isolated from the endotracheal aspirate. Despite intensive care support, antidote administration and various epuration techniques, the patient died on day 26 from subarachnoid bleeding. An autopsy was obtained and the concentration of arsenic was determined in different tissues. Multiple abscesses due to Aspergillus fumigatus were seen in the lungs, myocardium and kidneys. This uncommon complication in a previously immunocompetent patient could be related to impaired immunity directly caused by arsenic poisoning.
OBJECTIVE:To investigate the causes of death and characteristics of sudden death in children and to offer scientific bases for prevention and cure, and medicolegal expertise of sudden death in children.MATERIAL:A retrospective study was carried out on the 265 cases of sudden death in children under 14 years old from 1960 to 2003 in three key hospitals of Haikou city, Hainan Province, China.RESULT:Of the 265 cases, 164 were male and 101 were female (1.6:1). Most of them were babies aged 1 month-1 year (37.0%). The three most common causes of sudden death in children were diseases such as lobular pneumonia, aspiration pneumonia and viral pneumonia.CONCLUSION:Most of the reported cases of sudden death in children were babies aged 1 month approximately <1 year and males were much more than females in the ratio of 1.6:1. The main diseases causing sudden death were the diseases of the respiratory system, especially pneumonia.
Attacks on humans by wild animals causing fatal injuries are not uncommon in rural and forest areas of India. But death occurring due to attack by a wild boar is rare. As the victims of boar attack are usually recovered from dense forest areas, the investigating officers could be misled as to the nature of infliction of these multiple, fatal penetrating injuries to a possible homicide. Unlike the injuries inflicted by wild cats, canines and bulls, the hallmark of boar attack is the infliction of multiple penetrating injuries to the lower part of the body. This case is reported for its rarity, for the awareness of the possible injuries in such unnatural deaths, and for the factors predisposing to a boar attack.
An electronic weapon, the Taser M26, has recently entered the use-of-force continuum for police officers in England and Wales and is currently licensed for use by authorised firearms officers only. The aim of this report was to assess the relative risk of injury to officers and subjects of police use-of-force options and to evaluate whether the current positioning of the M26 in the use-of-force hierarchy is appropriate. We analysed use-of-force data from Northamptonshire Police Force and M26 field use data from TASER International®. We found officer injury rates associated with M26 deployment were lower than those for CS spray and baton use. Subject injury rates were lower in M26 deployment than in deployment of CS spray, batons or police dogs. We suggest that the M26 should be made more widely available to police officers in the UK.
